Pascal panretinal laser ablation and regression analysis in proliferative diabetic retinopathy: Manchester Pascal Study Report 4

Muqit, Mahiul M. K.; Marcellino, George; Henson, David B.; Young, Lorna B.; Turner, G. S.; Stanga, Paulo E

doi:10.1038/eye.2011.188

Cited by 52 publications

(44 citation statements)

References 20 publications

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“…8,9 However FFA has been used in subsequent publications to indicate persistent leakage from new vessels in eyes with previous laser therapy. 11,12 In this study we have also used it as a marker for sites of new or persistent NV. We recognise that although not all new vessels that leak fluorescein will require further laser, treated new vessels that do not leak fluorescein are probably stable and have not been identified in our study as NV.…”

Section: Discussionmentioning

confidence: 99%

Is it safe to discharge treated proliferative diabetic retinopathy patients from the hospital eye service to a community screening programme?

Negretti

Vafidis

2014

Eye

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Purpose To investigate the distribution of new vessels (NV) in patients treated with pan-retinal photocoagulation for proliferative diabetic retinopathy (PDR). To assess whether it is safe to discharge treated PDR patients to the NHS Diabetic Eye Screening Programme (DESP) which uses two mydriatic 451 fields of each eye. Methods Consecutive treated PDR patients undergoing fundus fluorescein angiography between July 2010 and October 2011 for the purpose of looking for NV were included. The distribution of NV was mapped. In particular it was noted whether NV occurred in the area covered by the DESP standard screening images. Results A total of 76 patients (108 eyes) met the inclusion criteria for the study. Leaking NV were found inside the DESP fields in 89% of study patients. In 108 eyes with leaking NV, there were a total of 35 NVD and 336 NVE. NV were found within DESP fields in 83% of eyes. Of the 336 NVE, 54% occurred within and 46% outside DESP standard fields. There was no statistically significant difference in the retinal quadrant distribution of NVE. Conclusions If these findings apply to the whole treated PDR population, NVE would be identified in 89% of patients undergoing DESP screening. This would support stable treated PDR patients being monitored within the DESP. We found no preferential clustering of NV within quadrants or between posterior and less posterior retina suggesting that there would be no benefit to the DESP of taking an additional field or graders concentrating on one particular quadrant more than another.

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Section: Discussionmentioning

confidence: 99%

Is it safe to discharge treated proliferative diabetic retinopathy patients from the hospital eye service to a community screening programme?

Negretti

Vafidis

2014

Eye

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“…One study (Muraly 2011 78 ) reported that the authors had no conflict of interest. In Muqit 2010/11, [74][75][76] one author was an employee of OptiMedica Corporation and one author had received financial support from the same company. In the remaining studies, this information was not available.…”

Section: Funder/conflict Of Interestmentioning

confidence: 99%

“…Patients were followed up for 18 months in Muqit 2011. 76 The follow-up period ranged from 6 to 45 months in Al-Hussainy 2008. 79 In one study (Japanese study of Ophthalmology 2012 17 ) the follow-up period ranged between 6 and 60 months.…”

Section: Follow-upmentioning

confidence: 99%

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Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

Royle

Mistry

Auguste

et al. 2015

Health Technol Assess

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BackgroundDiabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).ObjectivesThe primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?Eligibility criteriaRandomised controlled trials (RCTs) for efficacy but other designs also used.Data sourcesMEDLINE and EMBASE to February 2014, Web of Science.Review methodsSystematic review and economic modelling.ResultsThe Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.LimitationThe current evidence is insufficient to recommend PRP for severe NPDR.ConclusionsThere is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.Study registrationThis study is registered as PROSPERO CRD42013005408.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Decreased duration of exposure and increased laser power result in better localization of the laser to the external retina and a reduction in thermal diffusion, which reduces the amount of epithelial scarring, scotoma, and inflammation associated with laser. (4)(5)(6) But as the type of damage mechanism to retinal pigment epithelium (RPE), other retinal layers and choroid depends on the duration of the applied laser pulse. At continuous wave (CW) to 10-ms exposure time, a pure thermal denaturation of tissue has been shown to be the primary retinal damage mechanism.…”

mentioning

confidence: 99%

Comparison between multi-spot laser and conventional laser in treatment of diabetic clinically signifcant macular edema

Elsawah¹,

El-lkwa²,

Elabedin³

et al. 2017

Revista Brasileira De Oftalmologia

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Objectives: The purpose of this work is to assess the safety and the efficacy of multi-spot laser in comparison with the conventional laser in the treatment of non-proliferative diabetic retinopathy with CSME in relation to the visual outcome, central macular thickness by (OCT)and ResumoObjetivos: O objetivo deste trabalho é avaliar a segurança e a eficácia do laser multi-spot em comparação com o laser convencional no tratamento da retinopatia diabética não proliferativa com CSME em relação ao resultado visual, à espessura macular central por (OCT) e à presença de eventos adversos. Métodos: estudo prospectivo randomizado sobre o número total de 50 olhos divididos em dois grupos, cada um de 25 pacientes. Os pacientes do grupo A foram submetidos a fotocoagulação focal, a laser de grade, ou de laser macular de grade modificada com a utilização do laser verde de 532nm GYC-1000. O grupo B foi submetido a fotocoagulação fotocoagulação focal, a laser de grade, ou de laser macular de grade modificada (os critérios de inclusão VALON TT foram pacientes com diabetes mellitus tipo II, edema macular clinicamente significativo). Os pacientes foram monitoradoss para BCVA, OCT, IOP, eventos adversos pré e uma semana, um mês, e três meses de pós-operatório. Resultados: O BCVA preoperatório médio no grupo A com laser convencional foi 0,294 ± 0,1715 decimal, e no grupo B com laser multispot (valon) foi 0,3040 ± 0,2140. O BCVA médio 3 meses após o laser no grupo A foi 0.4820 ± 0.244 decimal, e no grupo B foi 0.5080 ± 0.1977. A espessura macular central dos pacientes foi medida antes do laser e nos períodos de acompanhamento de 1 semana, um mês e três meses. O CMT médio pré-operatório no grupo A foi 375,92 ± 65,69 um, e no grupo B foi 361,0 ± 50,400 um. O CMT médio 3 meses após o laser no grupo A foi 314,44 ±85,938 um, e no grupo B foi 0322,668 ± 57,500 um. Os parâmetros do sistema multisport utilizaram uma potência media 155 mW ± 90,1 superior a do laser convencional de 100 mW ± 19,4 para produzir o mesmo efeito terapêutico visível. Conclusão: Descobrimos que o sistema multisport é seguro, rápido e eficaz no tratamento de edema macular clinicamente significativo em períodos de acompanhamento de curto prazo, e ele teve um curto tempo de exposição. Embora uma duração de pulso mais curta do sistema multisport necessite utilizar uma potência maior, ela não está associada aos efeitos adversos.

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Pascal panretinal laser ablation and regression analysis in proliferative diabetic retinopathy: Manchester Pascal Study Report 4

Cited by 52 publications

References 20 publications

Is it safe to discharge treated proliferative diabetic retinopathy patients from the hospital eye service to a community screening programme?

Is it safe to discharge treated proliferative diabetic retinopathy patients from the hospital eye service to a community screening programme?

Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

Comparison between multi-spot laser and conventional laser in treatment of diabetic clinically signifcant macular edema

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