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K. E. Waite, M. Bennett, C. Otto, E. Ng; PHOTON: Pegaptanib and Reduced-Fluence PASCAL Laser Photocoagulation for Proliferative Diabetic Retinopathy as Evidenced by Ultra-Widefield Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4242.
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To evaluate the effectiveness of Pegaptanib therapy timed with reduced-fluence PASCAL laser photocoagulation for the treatment of proliferative diabetic retinopathy (PDR) with active neovascularization.
In this prospective, FDA and IRB approved study, patients with PDR, active neovascularization, and retinal ischemia were identified using OPTOS ultra wide field angiography. Treatment with 0.3mg Pegaptanib was followed 1 week later by reduced-fluence PASCAL laser photocoagulation. Laser energy, fluence, was titrated down to produce a barely visible laser spot, using a 200um spot size at 20ms duration. Patients were evaluated at weeks 1, 6, 12, and 24. Complete ophthalmic examinations, ETDRS vision, ultra widefield angiography, and SD-OCT were obtained. Primary endpoint was angiographic regression of neovascularization. Secondary endpoints were changes in visual acuity, SD-OCT center thickness.
32 eyes were identified and treated. All eyes demonstrated significant angiographic regression of neovascularization. 30/32 (94%) eyes had complete neovascular regression at week 12. 2/32 (6%) required supplemental laser treatment between weeks 12 and 24. 31/32 (97%) of eyes had stable or improved visual acuity. 28/32 (88%) eyes had stable or improved OCT center thickness (+25um).
Anti-VEGF treatment with Pegaptanib given in combination with reduced-fluence PASCAL laser photocoagulation appears to be effective for the treatment of PDR with active neovascularization and retinal ischemia. DRS protocol panretinal photocoagulation, while effective, is associated with visual field loss, decreased color vision, and decreased contrast sensitivity. This gold standard treatment typically delivers a total energy load of 64J. By combining pegaptanib with reduced-fluence laser treatment, the total energy load required for neovascular regression ranged from 1.78 to 8.20J, which represents a reduction of energy delivered by over 70%. Combination pegaptanib and reduced-fluence laser could minimize direct and collateral damage to the neurosensory retina and underlying retinal pigment epithelium; potentially minimizing the visual morbidity associated with standard DRS laser parameters.
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