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Felipe P. Almeida, Célia R. Lucena, José A. Ramos, Andre Messias, José A. Silva, Ingrid U. Scott, Rodrigo Jorge; Panretinal Photocoagulation Versus Intravitreal Injection Retreatment Pain in High-Risk Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):356.
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Compare pain score between panretinal photocoagulation (PRP) or intravitreal injection of ranibizumab (IVR) in patients with proliferative diabetic retinopahty (PDR) already treated with PRP.
PRP patients (n = 16) received full scatter PRP in two sessions (Weeks 0 and 2) while the PRP plus group (n = 17) received the same LASER treatment and an additional IVR at week 0 (immediately after the 1st PRP session). After week 16, the patients of both groups underwent a fluorescein angiography (FA). If leakage were shown, PRP group patients would receive an additional PRP session (500 additional spots per quadrant of active new vessels) and PRP plus patients received an additional IVR. Fifteen minutes after the end of, a masked examiner used a 100-degree Visual Analog Scale (VAS) for pain score estimation.
Sixteen and 17 patients from the PRP and PRP plus groups respectively completed the 16-week visit, and 14 patients from PRP and 17 from PRP plus were evaluated for pain scores. At week 16, all patients from both groups showed leakage confirmed by FA, and were retreated according to study protocol. Mean IVR pain (±SEM) was 4.7 ± 2.1, significantly lower (p<0.0001) than mean PRP pain (60.8 ± 7.8). Twelve out of 17 patients from the PRP plus group referred no pain (score zero) with the intravitreal injection treatment while the minimal score found in one patient of PRP group was 10.5 while all others scored above 30.
PRP plus ranibizumab is superior to PRP alone for high-risk PDR treatment of BCVA and new vessels regression. In addition, the patient comfort is higher when treatment is performed with an additional intravitreal injection. Further larger studies are necessary to confirm the findings here reported.
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