Randomized Clinical Trial to Evaluate the Effects of Pascal Panretinal Photocoagulation on Macular Nerve Fiber Layer

Muqit, Mahiul M. K.; Marcellino, George; Henson, David B.; Fenerty, Cecilia; Stanga, Paulo E

doi:10.1097/iae.0b013e318207d188

Cited by 29 publications

(25 citation statements)

References 25 publications

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“…In addition, it uses a shorter pulse duration of 10-30 ms for either PRP or macular grid photocoagulation. This might result in less destruction within the retina [12,13,14,15,16,17], less thermal diffusion to the choroid, less pain, and better preservation of retinal sensitivity than the conventional laser treatment [18]. …”

Section: Introductionmentioning

confidence: 99%

Short Pulse Laser Induces Less Inflammatory Cytokines in the Murine Retina after Laser Photocoagulation

et al. 2015

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Aims: The purpose of this study was to evaluate the effect of pulse duration on the expression of inflammatory cytokines in the murine retina after laser photocoagulation treatment with a PASCAL® pattern scan laser photocoagulator and conventional laser treatment. Methods: Retinal scatter laser photocoagulation was performed on C57BL/6J mice using a short pulse (10 ms) with a PASCAL laser or conventional settings (100 ms) with a multicolor laser. Eyes were enucleated before treatment (control) and 1 day, 3 days and 7 days after treatment. The levels of inflammatory cytokines (i.e., VEGF, MCP-1, RANTES and IL-6) in the retina/choroid were quantified by an ELISA. The expression patterns of VEGF and macrophages (i.e., F4/80) in the retina/choroid were evaluated by immunohistochemistry. Results: The levels of RANTES, IL-6 and MCP-1 after PASCAL and conventional laser treatments were significantly elevated compared with controls (p < 0.05). Conventional laser treatment, but not PASCAL treatment, resulted in the up-regulation of VEGF. RANTES and IL-6 levels on day 1 and MCP-1 levels on day 3 in the sensory retina were also significantly up-regulated with conventional laser treatment compared with PASCAL treatment (p < 0.05). Immunohistochemical analysis showed that PASCAL treatment was associated with lower VEGF and F4/80 expression levels compared with conventional laser treatment. Conclusions: Our data suggested that the short pulse duration induced fewer inflammatory cytokines in the sensory retina compared with the conventional pulse duration. Short pulse laser photocoagulation with the PASCAL may prevent macular edema after panretinal photocoagulation.

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Section: Introductionmentioning

confidence: 99%

Short Pulse Laser Induces Less Inflammatory Cytokines in the Murine Retina after Laser Photocoagulation

et al. 2015

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“…After primary laser injury, the laser scar lesions may coalesce, leading to functional damage such as visual field defects and if involving the macula, visual disturbance [2][3][4]. There may be discernible changes to the optic nerve head [1,[4][5][6][7][8][9]. Consequently, it is difficult to ascertain whether an increasing CDR in post PRP treated eyes is due to glaucoma, diabetes related ischemia or simply a non-progressive injury secondary to the PRP itself.…”

Section: Introductionmentioning

confidence: 95%

“…Whilst it is purported that this PRP is less destructive to the retinal layers, Muqit et al reported thinning of the macular nerve fiber layer [6]. Although, one may assume that this may, with time, translate into peripapillary RNFL loss, they did not examine for this [4,6]. Cankaya et al also suggested that PRP-treated eyes were found to have a significantly thinner mean peripapillary retinal nerve fibre layer compared with the eyes in the control group [12].…”

Section: Introductionmentioning

confidence: 99%

“…Pulse durations are reduced by nearly a log unit to around 20-30 ms [4]. Whilst it is purported that this PRP is less destructive to the retinal layers, Muqit et al reported thinning of the macular nerve fiber layer [6]. Although, one may assume that this may, with time, translate into peripapillary RNFL loss, they did not examine for this [4,6].…”

Section: Introductionmentioning

confidence: 99%

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The Effects of PASCAL Panretinal Photocoagulation on the Peripapillary Retinal Nerve Fiber Layer

Mohla¹,

Mathur²

2016

J Clin Exp Ophthalmol

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Purpose: To investigate the effects of Pascal (Topcon Medical Laser Systems, Inc. Oakland, NJ) pan-retinal photocoagulation (PRP) on the optic nerve head (ONH).Method: This was a prospective case control study comparing 3 groups of patients seen in the diabetic retinopathy (DR) clinics, without any coexistent optic nerve pathology.Group A patients had proliferative or severe non proliferative DR necessitating PRP during the study period. Group B patients had mild or moderate DR and did not require PRP throughout the study period. Group C patients had standard retinal laser (green argon or frequency doubled YAG) PRP at least 2 years ago. All the 3 Groups had retinal oxygenation measurements and retinal vessel caliber readings by Oxymap T1(Oxymap, Reykjavik, Iceland), optic disc stereophotographs, high definition optical coherence tomography (HD-OCT) scans of the ONH by both Cirrus (Carl Zeiss Meditec Inc, Dublin, CA) and Spectralis (Heidelberg Engineering, Heidelberg Germany). These were performed prior to PRP at baseline, then at 3, 6, and 12 months post PRP for group A and at baseline, 3, 6, and 12 months for groups B and C. Paired t-test was used to assess the mean changes in parameters from baseline for each group.Results: A total of 90 patients were recruited including 27 in Group A, 31 in Group B and 32 in Group C. At baseline, the average retinal nerve fibre layer (RNFL) was significantly thicker in group A compared to group B (102.0 ± 16.8 vs. 89.5 ± 11.6 μm, p=0.001) and group C (88.6 ± 11.2 μm, p=0.001) respectively. At 3 months, Group A exhibited a significant increase in the Cirrus average RNFL thickness (5.60 ± 8.54 µ, p=0.003) when compared to baseline. At 6 months, the average RNFL reverted to baseline values (p=0.89), and remained stable at 12 months (p=0.85). There was no significant change noted in the average Cirrus RNFL thickness at 3 and 6 months in Group B. At 12 months, the average RNFL was significantly thinner compared to baseline (-6.68 ± 8.10; p=0.005). In Group C, the average RNFL remained stable from baseline through to month 12 (p>0.05 at the three timepoints). No significant changes were noted in the average Spectralis RNFL thickness at any timepoints in each of the three groups.Oxygen saturation dropped in all 3 groups at 3 months, being significant only in group B (-2.05 ± 4.20%, p=0.03). Conclusion:In eyes treated with Pascal PRP, there was an initial increase in the retinal nerve fibre layer at the optic nerve head at 3 months followed by a thinning back to baseline values at 6 months which then remained stable up to 12 months. Hence the Pascal PRP did not have a significant effect on the nerve fibre layer at 12 months.Keywords: Pascal panretinal photocoagulation; Optic nerve head; Retinal nerve fibre layer thickness; Retinal oximetry; Diabetic retinopathy SummaryIn this study, we investigated the effects of Pascal (Topcon Medical Laser Systems, Inc. Oakland, NJ) pan-retinal photocoagulation (PRP) on the optic nerve head (ONH). This was a prospective case control study c...

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“…Conventional judgement of photocoagulation lesions evaluates retinal whitening in three or four categories, [29][30][31] which is observer-dependent and requires evaluation by several investigators in clinical trials. 32 The judgement depends on the latency from application to evaluation as well.…”

Section: Discussionmentioning

confidence: 99%

Temperature-Controlled Retinal Photocoagulation Reliably Generates Uniform Subvisible, Mild, or Moderate Lesions

Koinzer

Baade

Schlott

et al. 2015

Trans. Vis. Sci. Tech.

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Purpose: Conventional retinal photocoagulation produces irregular lesions and does not allow reliable control of ophthalmoscopically invisible lesions. We applied automatically controlled retinal photocoagulation, which allows to apply uniform lesions without titration, and aimed at five different predictable lesion intensities in a study on rabbit eyes.Methods: A conventional 532-nm photocoagulation laser was used in combination with a pulsed probe laser. They facilitated real-time fundus temperature measurements and automatic exposure time control for different predefined time/ temperature dependent characteristics (TTC). We applied 225 control lesions (exposure time 200 ms) and 794 TTC lesions (5 intensities, exposure times 7-800 ms) in six rabbit eyes with variable laser power (20-66.4 mW). Starting after 2 hours, we examined fundus color and optical coherence tomographic (OCT) images over 3 months and classified lesion morphologies according to a seven-stage OCT classifier.Results: Visibility rates in funduscopy (OCT) after 2 hours were 17% (68%) for TTC intensity group 1, 38% (90%) for TTC group 2 and greater than 94% (.98%) for all consecutive groups. TTC groups 1 through 4 correlated to increasing morphological lesion intensities and increasing median funduscopic and OCT diameters. Group 5 lesions were as large as, but more intense than group 4 lesions.Conclusions: Automatic, temperature controlled photocoagulation allows to apply predictable subvisible, mild, or moderate lesions without manual power titration.Translational Relevance: The technique will facilitate standardized, automatically controlled low and early treatment of diabetic retinopathy study (ETDRS) intensity photocoagulation independently of the treating physician, the treated eye and lesion location.

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Randomized Clinical Trial to Evaluate the Effects of Pascal Panretinal Photocoagulation on Macular Nerve Fiber Layer

Abstract: Compared with 20-millisecond SS-PRP, eyes treated with conventional 100-millisecond single-spot delivered over multiple sessions showed increased total macular thickness at 4 weeks, with a thinning of macular nerve fiber layer at 12 weeks.

Cited by 29 publications

References 25 publications

Short Pulse Laser Induces Less Inflammatory Cytokines in the Murine Retina after Laser Photocoagulation

Short Pulse Laser Induces Less Inflammatory Cytokines in the Murine Retina after Laser Photocoagulation

The Effects of PASCAL Panretinal Photocoagulation on the Peripapillary Retinal Nerve Fiber Layer

Temperature-Controlled Retinal Photocoagulation Reliably Generates Uniform Subvisible, Mild, or Moderate Lesions

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