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Safe and effective barely visible and subthreshold endpoint treatment parameters for 577NM (yellow) Pascal® laser with and without endpoint management® in proliferative diabetic retinopathy and diabetic macular edema

Session Details

Session Title: New Drug Treatment

Session Date/Time: Saturday 13/09/2014 | 14:30-16:30

Paper Time: 15:50

Venue: Boulevard F

First Author: : M.Gil SPAIN

Co Author(s): :    S. Pastor-Idoate   Y. D'Souza   S. Mahmood   C. Stephen   D. Henson   P. Stanga

Abstract Details

Purpose:

To report on safe and effective laser treatment parameters for 577nm Pascal laser (YW-PL) with and without Endpoint management (EpM®) in patients with Proliferative Diabetic Retinopathy (PDR) and/or Diabetic Macular Edema (DME) and which do not affect subfoveal choroidal thickness (SFCT).

Setting:

Manchester Royal Eye Hospital, Manchester Vision Regeneration (MVR) Lab at NIHR/ Wellcome Trust Manchester CRF, Academic Health Science Centre and Centre for Ophthalmology and Vision Research, Institute of Human Development, University of Manchester, UK

Methods:

Retrospective observational case series of 61 YW-PL procedures in 49 patients: 18 Females (36.73%) and 31 males (63.26%). Patients were categorised into three treatment groups: 1-Single-session Panretinal Photocoagulation (SS-PRP); 2-Focal or Modified Macular Grid (MG); 3- Single-session PRP with Macular Grid (MG+PRP). All patients underwent pre and post laser Fourier-Domain Optical Coherence Tomography (FD-OCT) (3D OCT-2000 FA plus®, Topcon Corp.), post laser macular (3D OCT-2000 FA plus®, Topcon Corp.) and Wide-Field Fundus Fluorescein Angiography (WF-FFA) and Autofluorescence (WF-FAF) (200Tx®, Optos plc). In a subgroup of 18 eyes (14 patients) diagnosed with proliferative diabetic retinopathy (PDR) or non-proliferative diabetic retinopathy (NPDR); 16 eyes with macular oedema underwent subthreshold YW-PL using EpM® in a grid pattern and 2 eyes underwent barely visible endpoint panretinal photocoagulation. SFCT was measured in these eyes using Swept Source Optical Coherence tomography (DRI-OCT1 Atlantis®, Topcon Corp, Japan) before and immediately after YW-PL treatment.

Results:

Group 1 (SS-PRP): a mean of 1,867± 802, 38 burns (20 ms, 367 ± 76.96 mW mean power, 200 microns spot size and one burn width spacing) were applied. Group 2(MG): a mean of 184.39±168.17 burns (10 ms, 148.18±48.61 mean power, 100 microns spot size and 0.75 burn width spacing) were applied. Group 3 (MG + PRP): macular laser was followed by PRP. MG: a mean of 341±303 burns (10 ms, 146.6 mW mean power, 100 microns spot size and 1 or 0.75 burn width spacing) were applied. PRP: a mean of 2695± 77,48 burns (20 ms, mean power of 275 mW, 200 microns spot size) were applied. Burns could be partially visualized on biomicroscopy and confirmed with WF-FAF. No increase in central retinal thickness (CRT) was found in Group 1 (p=0.941 t-Student). Diminished or unchanged CRT was found in Group 2 coincident with the reporting of these results (p=0.03 t-Student). Significantly reduced CRT was found in group 3 (p=0.014 t-Student). We did not find a statistically significant difference (p=0.08383, t-Student paired) between SFCT before and after treatment.

Conclusions:

Yellow 577nm wavelength Pascal® with and without EpM® was found to be safe and effective. FAF allows the identification and documentation of areas treated with barely visible or non-visible sub threshold laser. No changes on SFCT were observed following treatment with barely visible or subthreshold YW-PL.

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