Abstract
Purpose: :
To compare the pain perceived by patients undergoing Argon laser pan retinal photocoagulation treatment for proliferative diabetic retinopathy using slit lamp delivery after topical anaesthesia and indirect laser delivery after Peribulbar anaesthesia.
Methods: :
Prospective, Multi–center non–randomized study. Forty–six eyes of 46 patients with proliferative diabetic retinopathy were treated either by slit lamp delivery using topical anaesthesia or indirect laser pan retinal photocoagulation after Peribulbar anaesthesia. Patients in both the categories were divided into two subgroups, one receiving pan retinal photocoagulation for the first time and the second group receiving scatter laser for the second or subsequent time.
Outcome measures; the primary outcome measure was eye pain perceived during the laser treatment and pain within 48 hours following laser treatment. Patients graded the pain from (0–10) on a visual analogue scale. Secondary outcome measure included the need for oral analgesia within 48 hours following the laser procedure.
Results: :
25 eyes received PRP treatment with indirect ophthalmoscope after Peribulbar anaesthesia, whereas 21 eyes received PRP under a slit lamp using a contact lens under topical anaesthesia .Peribulbar anesthesia does not completely abolish pain during pan retinal photocoagulation.PRP laser for the first time with, Peribulbar injection was more comfortable than topical anaesthesia (p=0.001), but both the groups perceived similar pain 48 hours following the laser procedure (p=0.571).Subsequent laser treatment sessions are again more comfortable under Peribulbar anaesthesia (P=0.000) and it also causes less pain 48 hours following laser treatment (p=0.004) when compared to topical anaesthesia.
Conclusions: :
Peribulbar anaesthesia does not abolish pain completely, but definitely made argon laser pan retinal photocoagulation treatment more comfortable for patients. PRP laser under topical anaesthesia is painful and this pain may persist for up to 48 hours. Peribulbar anaesthesia is not effective in controlling pain during the first 48 hours following laser treatment in those, patients undergoing laser application for the first time. Patients need to be counseled regarding pain and need for oral analgesia following laser Panretinal photocoagulation under both Peribulbar and topical anaesthesia.
Keywords: diabetic retinopathy • laser • retina