Subthreshold Pan-Retinal Photocoagulation Using Endpoint Management Algorithm for Severe Nonproliferative Diabetic...

Area of Science:

• Ophthalmology
• Diabetic Retinopathy Treatment
• Retinal Laser Therapy

Background:

• Diabetic retinopathy (DR) is a leading cause of vision loss in diabetic patients.
• Severe nonproliferative diabetic retinopathy (NPDR) requires timely intervention to prevent progression to proliferative diabetic retinopathy (PDR).
• Conventional threshold pan-retinal photocoagulation (PRP) is a standard treatment but can cause visual field deficits.

Purpose of the Study:

• To compare the efficacy and safety of subthreshold PRP using an endpoint management (EPM) algorithm versus conventional threshold PASCAL PRP for severe NPDR.
• To evaluate the risk of progression to PDR and changes in visual acuity (VA), central foveal thickness (CFT), and visual field (VF) parameters.

Main Methods:

• A prospective, single-center, paired randomized controlled trial involving 28 participants with bilateral severe NPDR.
• One eye received subthreshold EPM PRP, while the fellow eye received threshold PASCAL PRP.
• Outcomes assessed included 1-year risk of PDR progression, changes in logMAR VA, CFT, and VF parameters.

Main Results:

• Both subthreshold EPM PRP and threshold PASCAL PRP showed similar 1-year risks of PDR progression (17.86% vs. 14.29%).
• No statistically significant differences were observed in VA or CFT between the two groups.
• Threshold PASCAL PRP led to significant visual field loss, whereas subthreshold EPM PRP showed no obvious visual field damage.

Conclusions:

• Subthreshold EPM PRP is noninferior to conventional threshold PASCAL PRP for treating severe NPDR over 12 months.
• Subthreshold EPM PRP demonstrates a potentially better safety profile regarding visual field preservation.
• Subthreshold EPM PRP represents a viable alternative treatment for patients with severe NPDR.