Navigated panretinal photocoagulation vs conventional pattern laser for PDR
An interventional trial recently compared standard and navigated pattern PRP techniques. In this article, Dr Kozak explains how continuous prepositioning and stabilisation of the aiming beam with navigated PRP, enables pattern application of the more effective longer pulse durations while reducing treatment times and broadens therapeutic options in proliferative diabetic retinopathy.
Take-home message: An interventional trial recently compared standard and navigated pattern PRP techniques. In this article, Dr Kozak explains how continuous prepositioning and stabilisation of the aiming beam with navigated PRP, enables pattern application of the more effective longer pulse durations while reducing treatment times and broadens therapeutic options in proliferative diabetic retinopathy.
By Dr Igor Kozak, MD, PhD
Laser panretinal photocoagulation (PRP) is the standard of care of ischemic retinopathies such as proliferative diabetic retinopathy (PDR). The landmark Diabetic Retinopathy Study (DRS)1 and the Early Treatment Diabetic Retinopathy Study (ETDRS)2 established standardised treatment with parameters of 200 to 500 µm spot size, pulse duration of 100-200 milliseconds (ms) and power adjusted to produce moderate-intensity burns.
In 2006, pattern scanning laser photocoagulation technique was introduced with a reduction in pulse duration of each laser spot.3 This minimised the time needed to apply multiple laser treatment spots in a pre-selected, fixed pattern during which the eye can move. The introduction of pattern scanning laser systems, where the treating ophthalmologist only positions a regular pattern of laser spots, significantly reduced the treatment time as well as the patient’s pain perception.4 However, this improvement required the reduction of the pulse duration to 20-30 milliseconds, representing a change from the ETDRS protocol.
Navigated laser photocoagulation technique was introduced in 2009 initially for focal laser treatment, with an ability to perform color, infrared and fluorescence angiography imaging, digital treatment planning of desired treatment location based on fundus images and subsequent focal laser treatment to compensate eye movements.5 The navigation functions offered by this laser for focal treatment such as laser pre-positioning by computer assistance has been studied extensively. Retinal navigation has shown significant increase in treatment accuracy compared to all currently existing laser systems6 and a significant reduction in need of laser retreatments.7 Also, two studies demonstrate a significant reduction in anti-VEGF injections after navigated laser treatment.8,9
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