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Comparison of laser photocoagulation for diabetic retinopathy using 532-nm standard laser versus multispot pattern
Manish Nagpal1, Sangita Marlecha, Kamal Nagpal
1Retina Foundation, Near Shahibag Underbridge, Shahibag, Ahmedabad, Gujarat, India 380004. drmanishnagpal@yahoo.com
Purpose:
The purpose of this study was to compare the efficacy, collateral damage, and convenience of panretinal photocoagulation for proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy using a 532-nm solid-state green laser (GLX) versus a multispot 532-nm pattern scan laser (PASCAL).
Methods:
This study was a prospective randomized clinical trial. Sixty patients with bilaterally symmetrical proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy participated. Each patient underwent panretinal photocoagulation: one eye with GLX and the other with PASCAL, two sittings per eye. Grade 3 burns with a 200-mum spot size were placed with both modalities. The fluence, pain using the visual analog scale, time, laser spot spread with infrared images, and retinal sensitivity were compared.
Results:
Pattern scan laser and GLX required an average fluence of 40.33 vs 191 J/cm(2), respectively. Average time required per sitting was 1.43 minutes with PASCAL and 4.53 minutes with GLX. Average visual analog scale reading for GLX was 4.6, whereas that for PASCAL was 0.33. Heidelberg retinal angiography images showed the spot spread as being 430 versus 310 microm at 3 months with GLX and PASCAL. The eyes treated with PASCAL showed higher average retinal sensitivity in the central 15 degrees and 15 degrees to 30 degrees zones (25.08 and 22.08 dB, respectively) than the eyes treated with GLX (23.16 and 17.14 dB), respectively.
Conclusion:
Pattern scan laser showed lesser collateral damage and similar regression of retinopathy compared with GLX. Pattern scan laser treatment was less time consuming and less painful for the patient compared with GLX.
