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Pallavi Singh, Atul Kumar, Parijat Chandra, Vinod Kumar; Ultra-wide Field Fluorescein Angiography Guided Targeted Retinal Photocoagulation in Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1900.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic retinopathy is a leading cause of avoidable blindness in the world. Conventional scatter laser in diabetic retinopathy is associated with adverse effects like worsening of macular edema, loss of contrast sensitivity and other visual functions. Lesser invasive laser techniques are needed to overcome the problems associated with conventional laser. We performed a prospective interventional study to assess the effects of ultra-wide field fluorescein angiography (UWFFA) guided targeted retinal photocoagulation (TRP) in diabetic retinopathy.
Thirty eyes with severe non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) without high risk characteristics (HRC) were subjected to TRP of only capillary non-perfusion (CNP) areas as seen on UWFFA. The patients were followed up for a minimum of six months. Visual acuity, contrast sensitivity, central macular thickness, visual fields`and disease regression were assessed at baseline, 6 weeks, 3 months and 6 months after laser photocoagulation.
There was a significant change in visual acuity from baseline to 6 weeks, amounting to a 10-letter improvement. The contrast sensitivity also increased from 1.05 to 1.2 (p<0.01), and mean deviation on visual fields also showed improvement (p <0.01). These changes remained stable at 3 and 6 months. There was no statistically significant difference in the central macular thickness over the course of observation. Eight eyes required additional laser and two eyes required injection of anti-VEGF at 3 months. Disease regression was seen in 93.3% eyes at 6 months.
UWFFA guided TRP is an effective treatment modality in eyes with severe NPDR and PDR without HRC. It results in disease regression in a good percentage of cases without any detrimental effects of laser induced worsening of macular edema and function.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Ultra widefield guided targeted retinal photocoagulation in a treatment naive eye with PDR without HRC. A) Pre-laser FA showing multiple microaneurysms, mid-peripheral areas of neovascularization with leaks and peripheral capillary non-perfusion areas B) Post-laser FA at 3 months showing PASCAL laser of CNP areas with a single persistent neovascular leak requiring additional laser.
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