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P. Chiranand, M. Pekmezci, L. Akduman; Efficacy of PASCAL Photocoagulation in Treatment of Retinal Disorders. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2770.
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To analyze the benefits, efficacy, and complications of the PASCAL® photocoagulation laser system (OptiMedica, Santa Clara, CA) in patients treated at our institution.
We conducted a retrospective chart review of 19 patients (28 eyes) who underwent laser treatment using the PASCAL® photocoagulation system from November 2006 to November 2007. Treatment was performed for macular edema (Group 1; n=21 eyes) or for iris or retinal neovascularization (Group 2; n=7 eyes) secondary to diabetic retinopathy or other ischemic retinal vascular disorders. Outcomes measured included best corrected visual acuity (BCVA), efficacy of laser treatment, complications, duration of the procedure, and pain perception which were noted in the charts for panretinal treatments.
Follow-up was 5.9+/- 2.6 months for Group 1 and 5.9+/- 4.0 months for Group 2. In Group 1; 9/28 eyes required a second treatment for remaining edema. BCVA was stable or better in 66% and average central foveal thickness on OCT improved or was stable in 71%. Time to completion for a number of laser patterns for grid photocoagulation was felt to be too long for completing the total pattern safely, although we have not noted any related complications. There exists a moderate learning curve in determining the best software alternatives presented by the machine. In Group 2, the neovascularization regressed at least partially in 3/7 patients. All treatments were done after topical proparacaine. Patient-reported pain perception averaged 3-4 on a scale of 1-10 for Group 2. All panretinal photocoagulation sessions took less than 5 minutes of laser time for up to 1825 spots. Occasional hemorrhages occurred secondary to irregular laser uptake at different spots in the patterns. Inconsistencies of laser uptake were due to variation in pigmentation and the amount of edema at those specific spots for Groups 1 and 2. We observed no consequences on the visual outcome during the follow-up due to these hemorrhages.
Retinal Photocoagulation by the PASCAL® laser has comparable efficacy to historical results with conventional retinal photocoagulation in short term follow up. PASCAL® photocoagulation can be performed quicker with less discomfort for the patients. Some of the pattern and parameter alternatives readily presented in the software have to be modified for the safest laser application. Laser complications such as retinal hemorrhages and their consequences from inconsistent laser uptake should also be meticulously investigated with larger and longer follow-up studies.
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