Painless Indirect Argon Laser in High Risk Proliferative Diabetic Retinopathy

 

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Abstract

Background: Proliferative retinopathy is an important cause of vision loss in diabetic patients. Incomplete panretinal photocoagulation (PRP) can lead to recurrent proliferation of new vessels. Patients and Methods: 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. Results: 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. Conclusions: 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.

Zusammenfassung

Hintergrund: Die proliferative Retinopathie ist die Hauptursache eines Visusverlusts bei diabetischen Patienten. Unvollständige panretinale Photocoagulation (PRP) kann zu wiederholter Gefäßproliferation führen. Patienten und Methoden: Wir untersuchten retrospektiv die Resultate aller Patienten mit Hochrisiko proliferativer diabetischer Retinopathie (PDR), die trotz vorgängiger Spaltlampen PRP eine ergänzende indirekte Argon-Laserbehandlung mit skleraler Eindellung unter Vollnarkose erhielten wegen persistierender neovaskulärer Proliferation. Ergebnisse: Siebzehn Augen von 10 Patienten wurden eingeschlossen. Die mittlere Dauer seit Diagnose des Diabetes lag bei 17.3 Jahren, SD 16,2 (zwischen 2 und 44 Jahren). Die Kontrolle des Blutzuckerspiegels war im Mittel nicht zufriedenstellend (mittlerer Wert des HbA1c 8,5 %, SD 1,3, zwischen 5,9–10,2). Die Netzhaut-Ischämie-Fläche wurde signifikant kleiner von 15 ± 7,5 Papillenoberflächen vor der ergänzenden Laserbehandlung auf 3,2 ± 4,2 nach der ergänzenden Laserbehandlung (p = 0,001). Die Gefäßneubildungen entwickelten sich auch signifikant zurück von 8,6 ± 6,1 auf 6,5 ± 6,4 (p = 0,044). Bei der Abschlussuntersuchung war die PDR bei 10 Augen (58,8 %) als ruhig eingestuft. Schlussfolgerungen: Die ergänzende indirekte Laserbehandlung unter Vollnarkose sollte in Betracht gezogen werden, um eine verbesserte Regression der retinalen Gefäßneubildungen bei refraktärer Hochrisiko-PDR zu erreichen. Die sklerale Eindellung und die Schmerzfreiheit können zu einer großflächigeren Applikation des Lasers verhelfen.

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