Quantitation of Retinal Ablation in Proliferative Diabetic Retinopathy

Reddy, Venkat M.; Zamora, Rene L.; Olk, R. Joseph

doi:10.1016/s0002-9394(14)72782-5

Cited by 32 publications

(20 citation statements)

References 20 publications

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“…This is broadly similar to rates of 6 and 17% reported in other studies. 14,15 The rates of new VH, new TRD, and new rubeosis in this study were lower than the national audit, but the vitrectomy rate was significantly higher (7.5 vs 1.5%, P ¼ 0.02 w 2 ). This is partly due to our policy of performing early vitrectomy, and also of performing initial PRP in high-risk cases at presentation, prior to a planned vitrectomy.…”

Section: Discussioncontrasting

confidence: 54%

“…14 The timing of vitrectomy continues to be controversial, and the respective roles of continued observation vs augmentation laser therapy or early vitrectomy have not yet been clearly defined. 15 The limitations of this study include all those associated with a retrospective study. Lack of a randomised control group makes direct comparison of data difficult, and occasionally, essential case note data are missing.…”

Section: Discussionmentioning

confidence: 98%

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Routine, single session, indirect laser for proliferative diabetic retinopathy

Tinley

Gray

2009

Eye

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Aims To evaluate the visual and morphological outcomes of routine, single session, indirect panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, and to examine adverse events related to indirect laser within the first 8 weeks of treatment. Methods The case notes of 107 diabetics with proliferative retinopathy undergoing indirect PRP were reviewed retrospectively, and compared with the UK National Diabetic Retinopathy Laser Treatment Audit. Patients who had received PRP previously were excluded. Follow-up data were collected as close as possible to 9 months following the initial laser treatment. Results Fifteen patients (14.0%) returned with adverse events within the first 8 weeks of indirect PRP. There were two tractional retinal detachments and two new vitreous haemorrhages. One patient with underlying neurotrophic keratopathy developed a persistent epithelial defect. One developed non-progressive macular drag with a one-line drop in Snellen acuity. Three experienced new or exacerbations of preexisting clinically significant macular oedema, which resolved spontaneously. There were two transient choroidal effusions, two transient anterior uveitis, and two transient visual deteriorations without macular oedema clinically. There were no significant differences in the rates of new tractional retinal detachment, vitreous haemorrhage or rubeosis, but our vitrectomy rate was higher (7.5 vs 1.5%, P ¼ 0.02, v 2 ), largely due to our policy of performing vitrectomy early. Conclusions Visual and morphological outcomes of routine, single session, indirect PRP for proliferative diabetic retinopathy were not inferior to the outpatient-based national audit, and the incidence of significant PRP-induced adverse events was low.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 98%

Routine, single session, indirect laser for proliferative diabetic retinopathy

Tinley

Gray

2009

Eye

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“…Complete PDR regression was present in 14/21 eyes (67%), and the mean time to regression was 11 months (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Factors related to persistent active disease included worsening HbA1C control from 7.2 to 9.1 mg/dl over a 22-month period (n ¼ 1); pregnancy-related worsening of PDR (n ¼ 1); and, most commonly, failure to comply with follow-up appointments at MREH since completion of MAPASS resulted in worsening disease to PDR grade 3 NVD (n ¼ 5).…”

Section: Proliferative Disease Regressionmentioning

confidence: 99%

“…1,2 Longer-term reports including a DRS cohort study showed that the effectiveness of PRP treatment is dose related, and supplemental 'top-up' PRP is often required following primary treatment in order to achieve complete disease regression. [3][4][5] In the United Kingdom, a Department of Health-funded National Diabetic Retinopathy Laser Treatment Audit evaluated PRP laser delivery in 1995, and reported that the clinical and visual outcomes is dependent on the surface area ablated with PRP laser. 6,7 In current clinical practice, the parameters for PRP are evolving, with shorter pulse duration laser settings being used.…”

Section: Introductionmentioning

confidence: 99%

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

Muqit

Marcellino

Henson

et al. 2011

Eye

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Aims To quantify the 20-ms Pattern Scan Laser (Pascal) panretinal laser photocoagulation (PRP) ablation dosage required for regression of proliferative diabetic retinopathy (PDR), and to explore factors related to long-term regression. Methods We retrospectively studied a cohort of patients who participated in a randomised clinical trial, the Manchester Pascal Study. In all, 36 eyes of 22 patients were investigated over a follow-up period of 18 months. Primary outcome measures included visual acuity (VA) and complete PDR regression. Secondary outcomes included laser burn dosimetry, calculation of retinal PRP ablation areas, and effect of patient-related factors on disease regression. A PDR subgroup analysis was undertaken to assess all factors related to PDR regression according to disease severity. Results There were no significant changes in logMAR VA for any group over time. In total, 10 eyes (28%) regressed after a single PRP. Following top-up PRP treatment, regression rates varied according to severity: 75% for mild PDR (n ¼ 6), 67% for moderate PDR (n ¼ 14), and 43% in severe PDR (n ¼ 3). To achieve complete disease regression, mild PDR required a mean of 2187 PRP burns and 264 mm 2 ablation area, moderate PDR required 3998 PRP burns and area 456 mm 2 , and severe PDR needed 6924 PRP laser burns (836 mm 2 ; Po0.05). Conclusions Multiple 20-ms PRP treatments applied over time does not adversely affect visual outcomes, with favourable PDR regression rates and minimal laser burn expansion over 18 months. The average laser dosimetry and retinal ablation areas to achieve complete regression increased significantly with worsening PDR.

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“…The Diabetic Retinopathy Study (DRS) recommended that the amount of retina treated is equivalent to an area of 157-314 mm 2 , whereas the ETDRS recommended an area equivalent from 236 mm 2 to 314 mm 2 . Reddy 43 showed that the amount of initial treatment required for regression may be considerably more than that recommended by the Diabetic Retinopathy Study and that more extensive treatment was required with more retinopathy risk factors.…”

Section: Adequacy Of Laser Treatmentmentioning

confidence: 99%

Why do patients still require surgery for the late complications of Proliferative Diabetic Retinopathy?

Scanlon

2010

Eye

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Aim To briefly review and discuss the literature on why patients still require surgery for the late complications of proliferative diabetic retinopathy (PDR). Methods: Literature review. Results The reasons for incomplete coverage of screening and screening failures can be divided into non-modifiable and potentially modifiable risk factors. The non-modifiable group includes duration of diabetes, age, genetic predisposition, ethnic differences, and the various reasons for vitrectomy when optimum laser treatment has been applied at the appropriate stage of the disease process. The potentially modifiable group includes glycaemic control, blood pressure control, lipid control, and cessation of smoking in type 1 diabetes. Other potentially modifiable factors include adequacy of screening, including reaching the regular non-attender, and attempting to modify the psychological factors that lead to late presentations including depression and eating disorders. Other potentially modifiable risk factors are optimising laser treatments and the potential use of anti-VEGF therapy to prevent vitrectomy in iris neovascularisation and neovascular glaucoma. Conclusion Surgery for the late complications of PDR continues to be required even in some patients who have received optimal medical care and optimal laser treatment. There are certain modifiable risk factors that could be altered and further research is needed in specific fields, particularly with regard to the adequacy of laser treatments, the use of anti-VEGF agents in iris neovascularisation, and in the role of psychological support in reducing the type of late complications leading to surgery for PDR.

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Quantitation of Retinal Ablation in Proliferative Diabetic Retinopathy

Cited by 32 publications

References 20 publications

Routine, single session, indirect laser for proliferative diabetic retinopathy

Routine, single session, indirect laser for proliferative diabetic retinopathy

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

Why do patients still require surgery for the late complications of Proliferative Diabetic Retinopathy?

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