Painless indirect argon laser in high risk proliferative diabetic retinopathy

Proliferative retinopathy is an important cause of vision loss in diabetic patients. Incomplete panretinal photocoagulation (PRP) can lead to recurrent proliferation of new vessels.

We retrospectively analysed the outcome of patients with high risk proliferative diabetic retinopathy (PDR) previously treated with slit lamp PRP who underwent indirect fill in argon laser treatment with scleral indentation under anesthesia for persistent neovascular proliferation.

Seventeen eyes of ten patients were included. The mean age at diabetes onset was 17.3 years SD 16.2 (range 2-44). All patients reported long standing poor glycemic control (mean HbA1c: 8.5% SD 1.3 range 5.9-10.2). The area of retinal ischemia decreased significantly from 15±7.5 disk areas (DA) before fill-in laser to 3.2±4.2 DA after fill-in laser (p=0.001). The new vessels also regressed significantly after laser treatment 8.6±6.1 DA before treatment versus 6.5±6.4 DA after laser treatment, (p=0.044). Quiescent PDR was reached in 10 eyes (58.8%) at the last visit.

Fill-in indirect argon laser under general anesthesia should be considered to achieve further new vessels regression in high risk PDR patients. Scleral indentation and absence of pain may allow for more extensive laser application.