Top PDF Clinical study of panretinal photocoagulation in the treatment of diabetic retinopathy using laser indirect ophthalmoscopy

Clinical study of panretinal photocoagulation in the treatment of diabetic retinopathy using laser indirect ophthalmoscopy

Clinical study of panretinal photocoagulation in the treatment of diabetic retinopathy using laser indirect ophthalmoscopy

Shimura, et al 5 , compared the panretinal scatter photocoagulation efficacy at weekly/biweekly intervals prospectively. They observed that 36 diabetic patients had SNPDR and early PDR with good vision before laser therapy. Treatments after the follow-up for 12 weeks were analysed. The BCVA were maintained in 89% and 92% following PRP treatment at weekly and biweekly intervals respectively.

10 Read more

<p>Visual evoked potentials after panretinal photocoagulation in patients with proliferative diabetic retinopathy</p>

<p>Visual evoked potentials after panretinal photocoagulation in patients with proliferative diabetic retinopathy</p>

visual acuity in 6 m with a Snellen E chart (LED visual chart projector, LC-13, MEDIZ Inc., City, Korea), slit- lamp biomicroscopy (BM 900, Haag-Streit, Bern, Switzerland) using a Volk 90D lens (Volk Optical, Mentor, Ohio, USA), fundus photography with high-reso- lution spectral-domain optical coherence tomography (SD- OCT, Spectralis, Heidelberg Engineering, Heidelberg, Germany) and fl uorescein angiography (HRA II Heidelberg, Heidelberg, Germany) for evaluating the DR. Subjects with any history of previous treatments for diabetic retinopathy including surgery and laser therapy, BCVA of 20/200 and worse, any type of signi fi cant opa- city, any ocular disease other than diabetic retinopathy that may change the visual evoked potential responses, pre- and post-PRP signi fi cant macular edema (all sessions of treatment) and any history of systemic diseases other than diabetes were excluded. It is necessary to note that in this study, the screening process for evaluation of diabetic macular edema in 1 week after each laser therapy session with high-resolution SD-OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany) and fl uorescein angio- graphy (HRA II Heidelberg, Heidelberg, Germany) was performed and patients with macular edema were excluded to avoid a possible change in visual evoked potential components.
Show more

6 Read more

Diabetic retinopathy and the use of laser photocoagulation: is it cost-effective to treat early?

Diabetic retinopathy and the use of laser photocoagulation: is it cost-effective to treat early?

A literature search was undertaken for cost-effective- ness studies of the use of PRP and/or anti-VEGF medication for patients with moderate or severe NPDR. However, we could not identify any appropriate studies. 5 Therefore, we developed a de novo Markov model in Microsoft Excel to assess the cost-effectiveness of early versus delayed PRP. The different clinical pathways for patients were obtained from information from the Early Treatment Diabetic Retinopathy Study (ETDRS) 6 and from expert opinion. 5 The model starts with a hypothetical cohort of 1000 patients with diabetes with a starting age of 50 years presenting with moderate NPDR at an ophthalmology clinic. Fifty years was chosen for the starting age, as this was the mean age of patients with DR. 5 As DR is a bilateral disease, we have assumed that the model is a two-eye model and that the severity level is the same in each eye. The model assumes that people can progress through all
Show more

8 Read more

Effect of panretinal photocoagulation on macular morphology and thickness in eyes with proliferative diabetic retinopathy without clinically significant macular edema

Effect of panretinal photocoagulation on macular morphology and thickness in eyes with proliferative diabetic retinopathy without clinically significant macular edema

Examination included assessment of visual acuity using a Snellen chart, anterior segment examination by slit-lamp biomicroscopy, intraocular pressure measurement with applanation tonometry, and fundus examination by slit- lamp biomicroscopy and indirect ophthalmoscopy. Vision was recorded using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR) for data analysis. Fundus photography was done for documenta- tion and follow-up whenever necessary. Fundus fluorescein angiography and OCT were carried out for all patients before PRP. Fluorescein angiography was done to rule out macular ischemia and to confirm early PDR. Patients with macular ischemia were excluded from the study at baseline because this could have had a bearing on the visual outcome and be a confounding variable during analysis. OCT was done before and one week, one month, and 3 months after PRP. Line scan and fast macular scans were done to study the macula on the Stratus OCT (Carl Zeiss Meditec, Dublin, CA, USA), and a 5-line raster scan and cube 512 × 200 scan was done on the Cirrus OCT (Carl Zeiss Meditec, Dublin, CA, USA). The line scan/5-line raster protocol were used to study the morphological features of macular edema, ie, spongy edema/ spongy retinal thickening, epiretinal membrane, vitreomacu- lar traction, subretinal fluid, and cystoid macular edema. Spongy edema/retinal thickening was defined as increased retinal thickness with reduced intraretinal reflectivity and expanded areas of lower reflectivity on OCT. Fast macular protocol/cube data were used to study central foveal thick- ness. PRP was done with standard parameters using green laser in 3–4 sittings, with a one-week interval between each sitting. After completion of PRP, patients were followed up at one week, one month, and 3 months. At each visit, visual acuity was assessed by Snellen chart, and a qualitative and quantitative study of the macula was done with OCT and clinical examination. Comparison of visual acuity and macular changes with regard to morphological and macular thickness was made at each post treatment visit. The Chi- square test, paired t-test, and Pearson’s correlation were used in the statistical analysis, which was performed using the Statistical Package for the Social Sciences version 19.0 (SPSS Inc, Chicago, IL).
Show more

5 Read more

<p>Electroretinogram Changes Following Sequential Panretinal Photocoagulation for Proliferative Diabetic Retinopathy</p>

<p>Electroretinogram Changes Following Sequential Panretinal Photocoagulation for Proliferative Diabetic Retinopathy</p>

PDR, either as monotherapy or, more commonly, as an adjunct to PRP. PRP remains popular because the treatment effect is longer than anti-VEGF and because anti-VEGF therapy requires a high degree of patience compliance for frequent injections. 21 Combination treatment with PRP and anti-VEGF is a popular treatment option that allows for more rapid regression of neovascularization via anti-VEGF with more long-term protection against recurrent neovasculariza- tion via PRP. Combination PRP and intravitreal ranibizumab treatment showed less adverse effects on retinal functions than PRP alone, possibly because less intense PRP treatment was required. 22 PRP is typically titrated to ensure regression or stabilization of neovascularization, and the ideal amount of treatment is unknown. In this study, alternations in retinal function after PRP were demonstrated. These fi ndings help quantify the degree of ERG loss after each session of 350 – 400 spots of PRP treatment. A better understanding of the degree of retinal damage following PRP may be helpful in determining the ideal amount of laser treatment that bal- ances regression of retinal neovascularization while mini- mizing reductions in retinal function.
Show more

9 Read more

The potential neuroprotective effects of weekly treatment with glatiramer acetate in diabetic patients after panretinal photocoagulation

The potential neuroprotective effects of weekly treatment with glatiramer acetate in diabetic patients after panretinal photocoagulation

In this randomized, controlled clinical trial, we enroled dia- betic insulin-dependent and noninsulin-dependent patients with very severe nonproliferative or early proliferative retinopathy from the Retina Sector of the Federal University of São Paulo (UNIFESP) between July 2006 and July 2007. The protocol was approved by the Research Ethics Com- mittee of the Federal University of São Paulo. Informed consent was obtained from all participants in accordance with the tenets of the 1989 Declaration of Helsinki. Patients, ophthalmologists, technical staff and statisticians participated in a masked fashion. The study was conducted using scientific methodology based on the Revised CONSORT 16 statement
Show more

7 Read more

The relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema : an indirect comparison in a systematic review

The relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema : an indirect comparison in a systematic review

Main outcome measures The primary outcome was the proportion of patients with an improvement in best corrected visual acuity of more than two lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Secondary outcomes included mean changes in best corrected visual acuity and in central macular thickness, and adverse events. Best corrected visual acuity was converted to logMAR units, a linear scale of visual acuity with positive values representing increasing visual loss. Indirect comparisons were done using Bayesian methods to estimate relative treatment effects of bevacizumab and ranibizumab. Results Five randomised controlled trials with follow-up of 6–12 months and a common comparator (multiple laser treatment) were sufficiently similar to be included in the indirect comparison. Generally studies were small, resulting in wide credible intervals. The proportions of patients with an improvement in best corrected visual acuity of >2 lines were 21/77 participants (27%) for bevacizumab and 60/152 participants (39%) for ranibizumab (odds ratio 0.95 (95% credible interval 0.23 to 4.32)). The wide credible intervals cannot exclude a greater improvement, or worse outcome, for either drug. The mean change in best corrected
Show more

17 Read more

<p>The Evolving Treatment of Diabetic Retinopathy</p>

<p>The Evolving Treatment of Diabetic Retinopathy</p>

and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of interven- tion in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a fi rst-line option when cost and treatment burden are more constrained. Results with subthreshold laser appear promising but will require more rigorous study to establish its role as adjunctive therapy. Evidence to support an optimal integration of the various treatment options is lacking. Central to the widespread adoption of any therapeutic regimen for DR and DME is substantiation of safety, ef fi cacy, and cost-effectiveness by a body of sound clinical trials. Keywords: diabetes, retina, diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor, vitrectomy pars plana vitreous surgery, antiangiogenic therapy
Show more

26 Read more

A study on clinical outcomes of laser photocoagulation for premature retinopathy.

A study on clinical outcomes of laser photocoagulation for premature retinopathy.

In an effort to reduce the time and stress accompanying cryotherapy, refinements of ablative therapeutic technique were studied- in particular, laser therapy using the binocular indirect ophthalmoscope delivery system (LIO). During the early 1990s laser ablation gained acceptance as an alternative to cryotherapy. In general, ophthalmologists have found that the LIO delivery system is technically easier than cryotherapy and creates fewer postoperative sequelae related to the treatment (inflammation and swelling) than cryotherapy. Furthermore it seemed apparent that the outcomes of treatment of threshold disease in zone 1 and posterior zone 2 were superior to cryotherapy and at least equivalent to cryotherapy results for zone 2 disease.
Show more

98 Read more

Changes in Peripapillar Retinal Nerve Fiber Layer Analized by Td-Oct in Patients with Diabetic Retinopathy That Receive Panretinal Photocoagulation

Changes in Peripapillar Retinal Nerve Fiber Layer Analized by Td-Oct in Patients with Diabetic Retinopathy That Receive Panretinal Photocoagulation

References particularize that anatomical results are variable. Most cases the nerve fiber layer get thicker at 10 weeks, and thinner at 6 months after laser photocoagulation. Must be considered that some articles (just a few) explain that there is not difference between retinal thickness pre and post treatment, this evidences that results may vary. In this study, the results are alike references taking in count adverse anatomy effects in retina in the PFC30 and the PFC180 group. Also, must be considered geography condition and patient attitude in the geographical region to get subsequent revisions, because of their irregularity.
Show more

6 Read more

<p>Evaluation Of The Timing Of Intravitreal Bevacizumab Injection As Adjuvant Therapy To Panretinal Photocoagulation In Patients With Diabetic Macular Edema Secondary To Diabetic Retinopathy</p>

<p>Evaluation Of The Timing Of Intravitreal Bevacizumab Injection As Adjuvant Therapy To Panretinal Photocoagulation In Patients With Diabetic Macular Edema Secondary To Diabetic Retinopathy</p>

This study is a nonrandomized retrospective study and was conducted in 2017. The study adhered to the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) at the University of Padjajaran. Patient informed consent was not required by the IRB because the data were collected retrospectively, and patient data were deidenti fi ed to protect patient priv- acy. Data were collected retrospectively from the electro- nic medical records at the Netra Eye Hospital in Bandung, Indonesia of patients that underwent IVB injection before laser treatment and patients treated with PRP before IVB injection. Inclusion criteria included patients >18 years of age with PDR or severe non-proliferative diabetic retino- pathy (NPDR) who were treated with the above therapies and complied with testing and follow-up. The diagnostic criteria of NPDR are diabetic retinopathy with one or more of the following: hemorrhage in four quadrants, venous beading in two quadrants, and/or intraretinal microvascu- lar abnormalities in one quadrant. 5 PDR is de fi ned as diabetic retinopathy with neovascularization. 5 Exclusion criteria included patients with signi fi cant media opacities, neovascular glaucoma, and history of intraocular laser treatment or surgery within 3 months of treatment.
Show more

6 Read more

A Study on Clinical Effects of Grid Laser Photocoagulation in Diabetic Maculopathy

A Study on Clinical Effects of Grid Laser Photocoagulation in Diabetic Maculopathy

Ophthalmological society reported that approximately 21.7% of patients with diabetes had DR 2 . Macular oedema increases 3% in moderate NPDR, 38% in severe NPDR and 71% in PDR. Epidemiological studies and clinical trials have shown that Diabetic macular edema results in irreversible loss of vision and is the major cause of visual morbidity in patients with Diabetes of adult onset. To date, the most effective means to reduce the risk of vision loss from DME includes focal/grid laser photocoagulation and intensive blood sugar control. In Early Treatment Diabetic Retinopathy study (ETDRS), Focal/Grid Laser photocoagulation of eyes with diabetic macular edema (DME) reduced the risk of moderate visual acuity loss (defined as a loss of 15 or more letters) by approximately 50%. One of the major findings
Show more

7 Read more

An Observational study to Analyse the Role of Visual Evoked Potential in Visual Prognosis Before and After Panretinal Photocoagulation for Diabetic Retinopathy in Type 2 Diabetic Mellitus

An Observational study to Analyse the Role of Visual Evoked Potential in Visual Prognosis Before and After Panretinal Photocoagulation for Diabetic Retinopathy in Type 2 Diabetic Mellitus

In conventional PRP, the appearance of grayish-white lesion that is formed due to denaturation and photocoagulation of the retina by thermal energy is the end point of laser treatment seen opthalmoscopically. Recent studies has showed, however, that retinal burnt lesions might not be permanent ,as in less intense and small burns the outer retina can fill the damaged areas in animal models. light PRP also named as minimum intensity photocoagulation (MIP) .Several reports have indicated that these approaches such as minimum intensity photocoagulation (MIP) and subvisible treatment using micropulse photocoagulation may have an equivalent efficacy over conventional PRP in regression of high-risk PDR. Small studies suggested that MIP is associated with only fewer complications and less treatment sessions.Therefore, these approaches could give the therapeutic benefit as much as of conventional therapy without its side effects
Show more

114 Read more

Diabetic retinopathy and the use of laser photocoagulation : is it cost effective to treat early?

Diabetic retinopathy and the use of laser photocoagulation : is it cost effective to treat early?

A literature search was undertaken for cost-effective- ness studies of the use of PRP and/or anti-VEGF medication for patients with moderate or severe NPDR. However, we could not identify any appropriate studies. 5 Therefore, we developed a de novo Markov model in Microsoft Excel to assess the cost-effectiveness of early versus delayed PRP. The different clinical pathways for patients were obtained from information from the Early Treatment Diabetic Retinopathy Study (ETDRS) 6 and from expert opinion. 5 The model starts with a hypothetical cohort of 1000 patients with diabetes with a starting age of 50 years presenting with moderate NPDR at an ophthalmology clinic. Fifty years was chosen for the starting age, as this was the mean age of patients with DR. 5 As DR is a bilateral disease, we have assumed that the model is a two-eye model and that the severity level is the same in each eye. The model assumes that people can progress through all
Show more

10 Read more

Diabetic Retinopathy Screening Update

Diabetic Retinopathy Screening Update

Although retinal imaging pro- grams are important in improving access to care and identifying patients who need further evalu- ation, they do not replace comprehensive eye exams by oph- thalmologists. A full evaluation is required when a screening retinal photograph is unreadable and for follow-up of abnormalities detected by the screening system. In addi- tion, non–diabetes-related ocular conditions such as cataract, hyper- tensive retinopathy, and glaucoma Figure 2. Nonmydriatic digital fundus camera (Zeiss Visucam Pro) with output

6 Read more

The outcomes and prognostic factors of vitrectomy in chronic diabetic traction macular detachment

The outcomes and prognostic factors of vitrectomy in chronic diabetic traction macular detachment

history and surgeries including previous retinal laser proce- dures, history of intravitreal bevacizumab injection directly preoperatively, the presence of vitreous hemorrhage or iris neovascularization, the appearance of the macula and macular vessels (ischemic macula with sclerotic macular vessels), the presence of thick fibrovascular tissue, and the approximate duration of macular detachment as represented by the documented time lapse between the diminution of vision from macular involvement and surgery. We attempted to collect data regarding anatomic details of the TMD, such as the shape and height, from preoperative ultrasound and optical coherence tomography images, as well as the perfusion status of the detached macula from fluorescein angiography, but such data were very limited and was not included. Preoperative bevacizumab was used only in eyes with signs of active membranes, vitreous hemorrhage, or iris neovascularization. It was not used in eyes with completely involuted retinopathy. Eyes were operated on within 4–7 days after preoperative injection.
Show more

9 Read more

The ChromaTest, a digital color contrast sensitivity analyzer, for diabetic maculopathy: a pilot study

The ChromaTest, a digital color contrast sensitivity analyzer, for diabetic maculopathy: a pilot study

Non-ophthalmic doctors can have a retinopathy detection rate of 49% compared to 96% for ophthalmologists [22]. Therefore, a cost effective method for screening is essential for diabetic retinopathy. Screening by digital photography proposed under the National Service Framework is offered to all patients with diabetes in the United King- dom. It is supplemented by biomicroscopy by the oph- thalmologists in monitoring and treating sight threatening disease. Furthermore, optical coherence tom- ography has become a powerful tool in screening and monitoring CSMO with sensitivity and specificity rates of near 80% and 90%, respectively [23]. Perhaps with fur- ther investigation, TCCT testing may become a supple- ment for detecting and monitoring sight threatening pathology without much equipment or trained techni- cians. However, with current data, all forms of TCCT test- ing including the Chromatest do not qualify for use in screening for CSMO.
Show more

6 Read more

The efficacy and safety of aflibercept and conbercept in diabetic macular edema

The efficacy and safety of aflibercept and conbercept in diabetic macular edema

Despite the fact that no study has reported on the efficacy of aflibercept combined with laser therapy in DME, several small-scaled clinical trials around the globe have examined the efficacy of combining ranibizumab with laser. However, the results are controversial. For example, in a single-arm, open-label, prospective clinical study conducted at four sites in Japan, DME patients were subjected to 2-monthly intra- vitreal injections of ranibizumab (IVRs) followed by PRN IVR in which IVR was performed when the CMT exceeded 300 µ m. One week after each IVR, short pulse focal/grid laser was delivered to treat residual leakage outside the fovea (.500 µ m). Six months later, both the BCVA and CMT
Show more

13 Read more

Fluocinolone acetonide intravitreal implant for the treatment of diabetic macular edema

Fluocinolone acetonide intravitreal implant for the treatment of diabetic macular edema

gery may be higher in the FAc-treated eyes, with more than 85% eyes needing cataract surgery after 3 years compared with the 37% of triamcinolone-injected eyes requiring this after 2 years; the follow-up period of the dexamethasone study is still not long enough to compare cataract progres- sion rates. Second, rates of IOP increase were highest in the FAc-implanted group and lowest in the dexamethasone implant study. However, each study reported separate mea- sures of increased IOP, making direct comparisons difficult. Of the patients with increased IOP, it appears that more patients treated with FAc device had progression leading to glaucoma surgery than did patients treated with triamci- nolone and dexamethasone. Lastly, there appears to be no difference in endophthalmitis incidence, with this occurring in ,1% of all eyes in all three types of steroid treatments, when reported. Although the FAc devices had higher rates of cataract progression and increased IOP, these differences may be artificially enhanced due to shorter follow-up times in the dexamethasone and triamcinolone studies.
Show more

10 Read more

Refractive outcome of prethreshold retinopathy of prematurity treated by diode laser: follow-up at 5&nbsp;years

Refractive outcome of prethreshold retinopathy of prematurity treated by diode laser: follow-up at 5&nbsp;years

At present, in Vietnam, advances in neonatology allow survival of children with extremely low gestational age and weight at birth, leading to an increase in the number of patients with ROP. Refractive error is a known complication of ROP and its treatment, and is a common cause of vision impairment in children. It is also treatable. Therefore, we initiated this study to evaluate the refraction of eyes treated with diode laser photocoagulation for prethreshold ROP at a mean of 5 years after treatment.

6 Read more

Show all 10000 documents...

Related subjects