Panretinal versus targeted retinal photocoagulation with and without intra-vitreal ranibizumab in proliferative diabetic retinopathy
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Keywords
Targeted retinal photocoagulation, Proliferative diabetic retinopathy, Panretinal retinal photocoagulation, Anti-VEGF
Abstract
Purpose: To investigate the effectiveness of targeted retinal photocoagulation (TRP) with and without inrtavitreal injection of Ranibizumab and compare it to pan retinal photocoagulation (PRP) treatment.
Methods: This study depends upon a randomized prospective comparative study that included 60 eyes with PDR randomized to three treatment groups; PRP group, TRP group and TRP plus intravitreal injection of Ranibizumab group. Follow up every 3 months along one year to detect neovessel regression by FFA and measurement of BCVA, measurement of IOP, and OCT for evaluation of central subfield thickness (CSMT) and vitreo-macular interface (VMI).
Results: No statistical significant differences were observed between the three groups concerning the new vessels regression at all follow ups (76.5%, 61.1% and 72.2% in PRP, TRP and TRP plus groups respectively at 1 year). There was a statistically significant mild increase in CSMT (22.64 (SD ± 17.52), 27.46 (SD ± 14.98), and 12.64 (SD ± 14.79) in PRP, TRP and TRP plus groups respectively, P-Value =0.023). There was a non-significant slight increase in the percentage of cases that acquired ERM, that was 20 %, 15% and 5% in TRP plus, PRP and TRP groups respectively (P-Value =0.505). There was a non-significant slight decrease BCVA (Log MAR BCVA was 0.05 ± 0.26, 0.13 ± 0.15 and 0.13 ± 0.19 in PRP, TRP and TRP plus groups respectively, P-Value 0. 362).
Conclusions: both TRP and TRP plus were effective, safe and comparable to the standard PRP. But further studies with large-sized samples and ultra wide FFA are required.
References
2. Vander JF, Duker JS, Benson WE, et al. Long-term stability and visual outcome after initial positive response in proliferative diabetic retinopathy to panretinal photocoagulation. Ophthalmology 1991; 98: 1575-1579.
3. Gentile RC, Stegman Z, Liebmann JM, et al. Risk factors for ciliary choroidal exudate after panretinal photocoagulation. Ophthalmology 1996; 103:827-832.
4. McDonald HR. Schatz H. Macular edema after panretinal photocoagulation. Retina 1985; 5:5-10.
5. Jardeleza MS, Miller JW. A review of anti-VEGF therapy in proliferative diabetic retinopathy. Semin Ophthalmol. 2009; 24:87-92.
6. Shimizu K, Kobayashi Y, Muraoka K. Involvement of the mid-peripheral fundus in diabetic retinopathy. Ophthalmology 1981; 88:601-612.
7. Blackening GW. Clinical comparison of central and peripheral argon laser panretinal photocoagulation in proliferative diabetic retinopathy. Ophthalmology, 1988; 95:170-7.
8. Muqit MM, Marcellino GR, Henson DB, et al. Optos-guided pattern scanning laser (Pascal)-targeted retinal photocoagulation in proliferative diabetic retinopathy. Acta Ophthalmol. 2013; 91(3):251-8. doi: 10.1111/j.1755-3768.2011.02307.x.
9. Gross JG, Grassman AR. New treatments for proliferative diabetic retinopathy: Antivascular endothelial growth factor therapy. JAMA Ophthalmol. 2016; 134(1):13-14.
10. Gross JG, Grassman AR, Jean-Paul LM. Writing committee of the Diabetic Retinopathy Clinical Research Network. Panretinal photocoagulation versus intravitreal ranibizumab in proliferative diabetic retinopathy: Randomized clinical trial (Vol. 314, p. 2137, 2015). J Am Med Assoc. 2016; 315(9):944-.
11. Filho JA, Messias A, Almeida FP, et al. Panretinal photocoagulation (PRP) versus PRP and intravitreal ranibizumab in high-risk proliferative diabetic retinopathy. Acta Ophthalmol. 2011;89(7):e567-72.
12. Nicholson B, Schachat A. A review of clinical trials of anti-VEGF agents for diabetic retinopathy. Graefe's Arch Clin Exp Ophthalmol. 2010; 248:915-930.
13. Liu TYA, Arevalo JF. Wide-field imaging in proliferative diabetic retinopathy. Int J Retin Vitr 2019, 5 (Supplement 1):20.
14. Muqit MM, Young LB, McKenzie R, A randomized pilot clinical trial of Pascal Targeted Retinal and PAN retinal 20 ms variable fluence lasers in diabetic retinopathy: Peter Pan research. Br J Ophthalmol. 2013;97(2):220-7.
15. Nikkhah H, Ghazi H, Razzaghi MR, et al. Extended targeted retinal photocoagulation compared with conventional panretinal photocoagulation in proliferative diabetic retinopathy in a randomized clinical trial. Int Ophthalmolo. 2018;38(1):313-21.
16. Lang GE, Stahl A, Voegeler J, et al. Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy - the PRIDE study. Acta Ophthalmol. 2020;98(5):e530-e539. doi: 10.1111/aos.14312.
17. Sun JK, Glassman AR, Beaulieu WT, et al. Diabetic Retinopathy Clinical Research Network. Rationale and Application of the Protocol S Anti-Vascular Endothelial Growth Factor Algorithm for Proliferative Diabetic Retinopathy. Ophthalmology. 2019; 126(1):87-95. doi: 10.1016/j.ophtha.2018.08.001. .
18. Obeid A, Su D, Patel SN. et al. Follow-up of proliferative diabetic retinopathy with panretinal photocoagulation. Intravitreal Anti-Vascular Endothelial Growth Factor vs Consequences of Lost Eye Blindness. Ophthalmology. 2019;126(3): 407-13.
19. Gao S, Lin Z, Shen X. Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials. Front Pharmacol. 2020;11:849. doi: 10.3389/fphar.2020.00849.
20. Tonello M, Costa RA, Almeida FP, et al. Panretinal photocoagulation versus PRP and intravitreal bevacizumab in high-risk proliferative diabetic retinopathy (IBeHi study). Acta Ophthalmol. 2008;86(4):385-9.
21. Zhou AY, Zhou CJ, Yao J, et al. Panretinal photocoagulation versus panretinal photocoagulation plus intravitreal bevacizumab in high-risk proliferative diabetic retinopathy. Int J Ophthalmol. 2016;9(12):1772.
22. Ali W, Abbasi KZ, Raza A. Panretinal photocoagulation and intravitreal bevacizumab versus panretinal photocoagulation alone in proliferative diabetic retinopathy. J Coll physicians Surg Pak., 2018 (12):923-7.
23. Chang CK, Cheng CK, Peng CH. Incidence and risk factors for developing vitreomacular interface abnormalities in diabetic macular edema treated with intravitreal injection of anti-VEGF. Eye. 2017 (5):762-70.
24. Agarwal S, Patel AK, Yadav RS, et al. Changes in IOP after laser photocoagulation in the treatment of diabetic retinopathy. Int J Surg. 2017; 4(10):3433-40.
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