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

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

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

The percentage change in a- and b-wave amplitudes at each post-PRP visit when compared to baseline pre- treatment ERG is outlined in Table 3. When the total mean changes in percentage were compared, a-wave amplitude reduction was found to be higher than the b-wave amplitude reduction. The amplitude changes in Table 3 represent cumu- lative measurements since retinal tissue changes after each session sums with preceding treatments. It should be noted that the difference between sessions involves the summation of prior retinal tissue loss (resulting in reduced amplitude) with the possible post-treatment recovery in amplitudes which may be beginning by the second post-treatment week. Figure 2 provides a graphical breakdown of ERG changes in a sample patient from this study.
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<p>Vitreous and Serum Concentrations of Vascular Endothelial Growth Factor and Platelet-Derived Growth Factor in Proliferative Diabetic Retinopathy</p>

<p>Vitreous and Serum Concentrations of Vascular Endothelial Growth Factor and Platelet-Derived Growth Factor in Proliferative Diabetic Retinopathy</p>

Purpose: This study aimed to investigate the concentrations of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) in vitreous and serum samples, analyze the ratio, and compare among proliferative diabetic retinopathy (PDR) subgroups. Patients and Methods: This study included 17 eyes of patients with PDR, identi fi ed as the PDR group which was divided into three subgroups (vitreous hemorrhage [VH], VH with fi brotic tissues, and tractional retinal detachment), and fi ve control eyes (nucleus and intraocular lens drop). Vitreous and serum samples were obtained on the same day. The VEGF-A and PDGF-AB concentrations were calculated by enzyme-linked immunosorbent assay.
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Intravitreal bevacizumab improves the clearance of vitreous haemorrhage and visual outcomes in patients with proliferative diabetic retinopathy

Intravitreal bevacizumab improves the clearance of vitreous haemorrhage and visual outcomes in patients with proliferative diabetic retinopathy

Objective To evaluate the occurrence of vitreous haemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR) and the efficacy of intravitreal bevacizumab (IVB) for VH in 5- year real- life data. Methods and analysis 850 adult patients with type 1 (T1D) or type 2 diabetes (T2D) with PDR were screened for VH. The effect of IVB was evaluated by the clearage of VH and the change in best corrected visual acuity (BCVA). The rates of VHs, reinjections, macular oedema, complications, additional treatments and outcomes of spontaneous resorption, panretinal photocoagulation or pars plana vitrectomy (PPV) for VH were also investigated. results VH occurred in 16% of patients with T1D and 9% of patients with T2D with PDR. 336 VHs in 140 eyes of 103 patients were documented. VH was cleared in 92% of cases in less than 3 months by the initial IVB. IVB was superior to other treatment methods in shortening the time for clearance of VH (Kaplan- Meier, p<0.0001). The average rate of IVB reinjections was 1.7±1.1 and the reinjection interval was 7.2±3.9 weeks. BCVA increased 0.73±0.04 logarithm of the minimum angle of resolution units after IVB (generalised estimating equations, p=0.0004). In 5 years, the patients had 2.2±2.7 recurrence of VHs. A simultaneous 72% decrease in the rate of PPVs was documented (p<0.0001).
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A case of proliferative diabetic retinopathy in which scintillating particles appeared in the intravitreal cavity after laser photocoagulation

A case of proliferative diabetic retinopathy in which scintillating particles appeared in the intravitreal cavity after laser photocoagulation

Crystallin was initially reported as a constituent protein of the lens, with later reports indicating its expression not only in the lens but also in the ciliary body, the neural retina, and retinal pigment epithe- lium [1, 2]. It has previously been reported that the retinas of diabetes patients have higher-than-normal expressions of αA-crystallin, and that its production is induced by glycated proteins, i.e., the accumulation of advanced glycation end-products (AGE) in the eye [3]. Here, we report a case of proliferative diabetic retinopathy (PDR) in which a scintillating substance that appeared to be crystallin developed in the intra- vitreal cavity after laser photocoagulation.
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<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>

diabetic retinopathy, so neovascularization occurs in dia- betic retinopathy in response to retinal ischemia and new vessels may grow on optical discs or elsewhere. Since the blood vessels are abnormal, they can fl ow into the retina and affect the patient ’ s vision. To prevent the growth of abnormal new vessels, bleeding in the retina and other parts of the eye and severe vision loss, a standard treatment method called panretinal photocoagulation (PRP) is used. 6 In a 2014 survey, 98% of the retina specialists reported using PRP for initial proliferative diabetic retinopathy man- agement in the absence of diabetic macular edema. 7 Also, the usage of intravitreal pharmacologic agents in diabetic macular edema treatment reduces the risk of diabetic retino- pathy worsening and increases the chance of improvement. 8 Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy in these patients remains unknown. 9 The visual evoked potential is an objective and non-invasive method that expresses a mass bioelectrical response from the visual cortex to a speci fi c visual stimulus, so abnormal visual evoked potential responses observed in diabetic retinopathy indicate a general involvement of the visual system or of one of its composing structures and this test is used to evaluate ocular health from macula to cortex. 10,11 Because the visual evoked potential response is mainly due to the macular region, so the changes that occur due to retinopathy and post-PRP in this region will affect the visual evoked potential components. Therefore, the visual evoked poten- tial is a suitable technique for evaluating these changes.
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Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy: a case report

Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy: a case report

Serous retinal detachment (RD) is a rare complication after panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) in patients with diabetes melli- tus (DM). It is believed to be caused by excessive photo- coagulation, exceeding the energy-absorbing capacity of the retinal pigment epithelium, leading to a disruption of the blood–retinal barrier. Persistently elevated glucose levels leading to glycation and other covalent modification of macromolecules, leading to increased oncotic pressure, osmotic gradient, and fluid accumulation in the interstitial tissues, may contribute to this complication. Intensified
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<p>Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy</p>

<p>Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy</p>

The advent of anti-vascular endothelial growth factor (VEGF) therapy has greatly improved outcomes in the treatment of diabetic retinopathy. 4,5 From 2001 to 2012, while the general overall rate of vitrectomy among a large managed-care cohort rose by 31%, the rate of pars plana vitrectomy (PPV) among diabetics decreased by 43%. 6 However, despite these improvements, many patients still undergo surgical intervention for complications of disease – primarily non- clearing vitreous hemorrhage (NCVH) and tractional retinal detachment (TRD). 7,8 Since the advent of vitrectomy in the 1970s, surgical techniques and instrumen- tation have improved substantially, perhaps in part due to the use of smaller gauge
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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

and its characteristics. Although fluorescein angiography is typically used to assess vascular leakage qualitatively in patients with macular edema, assessment of actual macular thickening correlates better with loss of visual acuity. Traditional methods of evaluating macular thick- ening, including slit-lamp examination and stereo fundus photography, are relatively insensitive to small changes in retinal thickness. OCT has proved to be a sensitive tool for detecting subtle cystoid macular edema and subretinal fluid, which may be early and severe manifestations of macular edema and not visualized on clinical 11 or angiographic 12,13
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Insight into 144 patients with ocular vascular events during VEGF antagonist injections

Insight into 144 patients with ocular vascular events during VEGF antagonist injections

Abbreviations: AMD, wet age-related macular degeneration; DR, diabetic retinopathy; PDR, proliferative diabetic retinopathy; DM, diabetic maculopathy (in column of eye disease); NA, not assessed; Nl, normal; DM, diabetes mellitus (in column of systemic disease); HTN, systemic hypertension; CAD, coronary artery disease; CRAO, central retinal artery occlusion; BRAO, branch retinal artery occlusion; CRVO, central retinal vein occlusion; BRVO, branch retinal vein occlusion; AION, anterior ischemic optic neuropathy; CME, cystoid macular edema; NVG, neovascular glaucoma; IOP, intraocular pressure; OD, right eye; OS, left eye; OU, bilateral; HM, hand motion; LP, light perception; NLP, no light perception.
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Approach for Diabetic Retinopathy Analysis using Artificial Neural Networks

Approach for Diabetic Retinopathy Analysis using Artificial Neural Networks

Diabetic retinopathy (DR) is damage in the eye due to diabetes which may occur due to changes in blood glucose level that may lead to changes in retinal blood vessels. It is normally considered as the most common cause of vision loss for the past 50 years. Diabetic retinopathy is vision frightening that occurs in persons with long standing diabetes with progressive damage to the retina of the eye and a leading cause of blindness among working adults if it remains untreated. It can be perceived during dilated eye examination by an ophthalmologist or optometrist. Early detection and proper treatment of DR can help to avoid blindness [1]. DR is broadly classified into proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). In the event of PDR the blood vessels in the retina of the eye get blocked and avoid flow of blood in the eye. Whereby new, but weak vessels begin to form on the retina which supplies blood to the closed area. In the event of NPDR extra fluid will get leaked from the damaged blood vessels along with little amount of blood. This situation leads to the formation of exudates in the retina of the eye. As the disease advances, the quantities of the exudates also gain. Figure 1 and Figure 2 show the normal retinal image and DR affected image 2016.
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Epidemiological Features of Diabetic Retinopathy in Abidjan (Côte d’Ivoire):  A Study about 448 Patients

Epidemiological Features of Diabetic Retinopathy in Abidjan (Côte d’Ivoire): A Study about 448 Patients

Diabetic retinopathy is the main ophthalmological complication of the diabetic patient and is the leading cause of blindness in people under 60 in industrialized countries [1] [2]. Its prevalence can be estimated through population-based epi- demiological studies, ophthalmologist reporting studies, or screening campaigns. The corollary is the variability of the results according to the populations stu- died, the regions, and the methodology [4] [5]. The number of patients with di- abetic retinopathy worldwide was estimated at 93 million in 2012, including 17 million patients with a proliferative form and 21 million with macular edema [6]. A meta-analysis of 35 population-based studies reported a prevalence of di- abetic retinopathy, proliferative diabetic retinopathy, and diabetic Maculopathy of 34.6%, 7.0%, and 6.8%, respectively [7]. These prevalences are lower than those we observed, which were 45% for diabetic retinopathy and 14.6% for the proliferative form (Figure 1, Table 1), with however a prevalence less important of diabetic Maculopathy in our study 5.5%. The prevalence of diabetic retinopa- thy that we found, however, is close to that reported by Maroufizadeh [8] who noted in Iran a prevalence of 41.9% with 32.2% of non-proliferative retinopathy and 13.2% of proliferative retinopathy.
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Central subfield thickness and cube average thickness as bioimaging biomarkers for ellipsoid zone disruption in diabetic retinopathy

Central subfield thickness and cube average thickness as bioimaging biomarkers for ellipsoid zone disruption in diabetic retinopathy

Two hundred seventy-one consecutive patients of dia- betes mellitus in the age group of 40 to 65  years were included in the study. Sample size was calculated to be 271 using the formula for sample size calculation [9]. Power of the study was 80%. Diabetes was diagnosed according to American Diabetes Association criteria as a fasting plasma glucose level ≥ 126 mg/dL (7.0 mmol/L) or 2-h post prandial glucose level ≥ 200  mg/dL (11.1  mmol/L) during an oral glucose tolerance test [10]. Based on the fundus photography and fluorescein angiography, subjects were divided into three groups according to the early treatment of diabetic retinopa- thy study (ETDRS) classification [11]: diabetes mellitus patients without retinopathy (No DR, n = 97), with non- proliferative diabetic retinopathy (NPDR, n = 91), and with proliferative diabetic retinopathy (PDR, n = 83). Healthy controls (n = 82) with no diabetes mellitus were also included. The different OCT systems show discrep- ancies which can be explained by the differences in the retinal segmentation algorithms. Whereas the Spectralis HRA + OCT and Cirrus HD-OCT include the RPE layer in the retinal segmentation, the other instruments do not. The data imply that the different OCT systems cannot be used interchangeably for the measurement of macu- lar thickness [12]. Thus it is important to have a control group for baseline values.
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A NEW SOFT SET BASED PRUNING ALGORITHM FOR ENSEMBLE METHOD

A NEW SOFT SET BASED PRUNING ALGORITHM FOR ENSEMBLE METHOD

proven. We used the retinal fundus pix assembled on the "Aravind Eye recuperation workplace and Postgradute Institute of Opthalmology", Cuddalore avenue Thavalakuppam Junction, Pondicherry. The retinal photo is taken inside the RGB structure by way of fundus digital camera. A fundus camera or retinal digicam is a specific low electricity amplifying tool with a joined camera proposed to image within surface of the eye, which include the retina, optic circle, macula, and returned submit. The snap shots had been observed using a Canon TopCon TRC-50 EX with Nicon retinal digicam at a area-of-point of view (FOV) of fifty. The acquired photo willpower is 1280 ×1024 in 24bit JPEG outline. The appraisal of the proposed mechanized willpower course of action of diabetic retinopathy has been done by means of the use of a recreation plan of 250 fundus snap shots that's a mix of traditional, NPDR and PDR impacted photographs. the principle image is changed over to dim scale image. After that, bendy histogram conformity is related to improve the many-sided fine of the picture. via then, Discrete Wavelet remodel (DWT) is associated and the extent of the photo is reduced into half of as 640 × 512 [30]. with the aid of then Coordinated channel reaction (MFR) is associated with diminishing the noise in the image. At ultimate, Fuzzy C-implies bunching is hooked up to component the veins inside the image. in the wake of pre-processing of snap shots is finished, factors, for instance, Radius, Diameter, place, Arc duration, cognizance angle and 1/2 area are computed for each photograph. At that factor Demonstrating techniques like PNN, Bayes principle and SVM are applied and their exhibitions are checked out. At long final, the photographs are organized into 3 gatherings to be specific, traditional photograph, Non- Proliferative Diabetic Retinopathy (NPDR) and Proliferative Diabetic Retinopathy.
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The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

The progression to vision-threatening proliferative diabetic retinopathy (PDR) primarily depends on the stage of DR severity. The Early Treatment Diabetic Retinopathy Study (ETDRS) has revealed that the risk of progression from severe non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) is approximately 52% in one year. 4 Since the time of ETDRS, the management of diabetes has changed significantly. 5 Thus, more recent clinical trials or epidemiologic studies have revealed varying rates of PDR progression from baseline DR in 4 years ranging from 5.3 to 11.0%. 6-10 The key classification of DR was originally defined in the Airlie House Symposium in 1968 and modified in several landmark trials to date. 11,12 In
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<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>

Diabetic retinopathy is the most common microvascular complication of diabetes melli- tus and occurs secondary to metabolic aberrations and retinal ischemia characteristic of diabetes mellitus. 1 Proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) are the primary pathologies responsible for vision loss in diabetic eye disease. Panretinal photocoagulation (PRP) is the standard of care for prevention of vision loss in PDR. 2 This treatment ablates neurons in the peripheral retina to decrease metabolic demand in the peripheral retina and facilitate oxygen and nutrient supply to the inner retina, alleviating the ischemia that drives neovascularization in PDR. However, PRP may induce macular edema (ME) due to retinal in fl ammation and increased vascular permeability. 3 This PRP-induced ME may cause temporary or permanent vision loss. 2
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Retinal blood flow is increased in type 1 diabetes mellitus patients with advanced stages of retinopathy

Retinal blood flow is increased in type 1 diabetes mellitus patients with advanced stages of retinopathy

Interestingly, in the proliferative DRP group we found a statistically significant higher capillary blood flow as compared to the non-DRP group and controls. This group had previously been treated with panretinal photocoagulation. Studies investigating VEGF levels and blood flow in major retinal vessels suggest a decrease in blood flow after panretinal photocoagulation compared to pre-treatment [21–24]. Blood flow, measured in the larger retinal arteries, was found to decrease after retinal photocoagulation in these studies. To investigate whether panretinal photocoagulation changes retinal blood flow, we measured blood flow in a group of type 1 and type 2 diabetes patients with proliferative diabetic retinopathy before and after panretinal photocoagulation. In partial support of our findings, Cuypers et al. [17], using the same method, reported capillary blood flow to be increased in proliferative retinopathy as measured in the papillo- macular area and unchanged in other parts of the retina [17]. In pDRP two important hemodynamic changes are present. Firstly, this group has a more compromised vascular system with a more decreased autoregulatory function [25]. Secondly, panretinal photocoagulation destroys a significant part of the retinal microcirculation, but larger vessels are left intact. Blood from larger vessels then enters a damaged microcirculation with a diminished number of capillaries. This changed distribution of blood and decreased autoregulation function of the retinal vessels might lead to a higher flow in these capillaries. Capillary drop-out and peripheral areas of non-perfusion are present in proliferative diabetic retinopathy [26]. As we did not find extremely low blood flow values in the pDRP group, it can be assumed that capillary drop-out was modest in the measured areas. The peripheral retina could not be measured using our technique and therefore, and because our measurements were limited to the peri- papillary area, we are not able to extrapolate our findings to the entire retina. Hemodynamic changes are thought to parallel diabetic retinopathy progression and possibly even precede visible fundus changes. Studies have found differences in retinal and choroidal blood flow in relation to retinopathy severity [7, 8]. One study found changes in retinal blood flow in diabetic patients without retinopathy [6]. We found a significant positive linear trend for blood
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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

Comparing PFC30 group with PFC 180 group the mean of thickness was lower in this last group, all quadrants had a lower mean, but the significant difference was found in the inferior quadrant with a p=0.012. In reviewed references, 1 to 3 months after laser administration in patients with diabetic retinopathy the more relevant change is a thicker retina nerve fiber layer, but this result are found with PASCAL Laser unit, and as mentioned before, there are less secondary effects because of power and distribution of this automatized system; in the same way, may progress to thinner layer at long term, being more frequent in superior and inferior quadrant [15], [16], [17], [18]. There are many results in the following of the patients, either by the laser system, or by evolution time, even by specific patient conditions.
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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?

We suggest that a trial is needed that compares early versus deferred PRP with modern laser methods and devices, and also assesses the role of anti-VEGF or steroid drugs in combination with PRP in reducing new DMO or as adjuvant in those with pre-existing DMO. An economic evaluation alongside the trial would collect accurate cost estimates for the different regimens and also collect detailed health-related quality of life measures to enable calculation of QALYs. As generic-based measures such as EQ-5D are said to be insensitive to the changes in visual impairment due to DR progression, 24 the trial should also include a disease-specific measure such as NEI-VFQ-25 questionnaire. 25
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Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

retinopathy, and assess the outcomes of laser photocoagulation therapy in a diabetic population in Cameroon. Methods: We carried out a prospective cohort study during 24 months in the Department of Ophthalmology of the Douala General Hospital, Cameroon. We included all diabetic patients who were referred from diabetes clinics for ophthalmologic evaluation. Data included type and duration of diabetes, visual acuity, intra-ocular pressure, results of fundoscopy and fluorescein angiography, and outcomes two months after treatment with laser photocoagulation. Results: We included 407 patients; 88% had type 2 diabetes. Their mean duration of diabetes was 6.4 years (SD=6.6). Forty point three percent (164/407) of patients were found to have DR on fundoscopy. Of the 164 patients with DR, 63.4% (104/164) had non-proliferative and 36.6% (60/164) had proliferative DR. Diabetic maculopathy was found in 14.5% (59/407) of all participants, and 36% (59/164) of patients with DR. There was a strong correlation between the duration of diabetes and retinopathy status (p < 0.001, r = 0.9541). Overall, 17.4% (71/407) of patients were eligible for laser photocoagulation. Of these, 66.2% (47/71) were treated, and 78.7% (37/47) of treated patients came back for control two months later. Among these treated patients an improvement of the retinopathy was noted in 73% (27/37), no change in 16.2% (6/37) and a worsening in 10.8% (4/37). Severe proliferative DR was significantly associated with treatment failure (p < 0.001).
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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
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