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Incidence of macular oedema following pan‐retinal photocoagulation using a multi‐spot semi‐automated pattern‐scanning laser in one sit versus 4 monthly sits in mild proliferative diabetic retinopathy or pre‐proliferative diabetic retinopathy
Author(s) -
Gabrielle P.H.,
Massin P.,
Kodjikian L.,
Bron A.,
Creuzot C.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0353
Subject(s) - medicine , diabetic retinopathy , ophthalmology , retinal , visual acuity , retinopathy , diabetes mellitus , endocrinology
Purpose To compare the central retinal thickness (CRT) 9 months after a pan retinal photocoagulation (PRP) with a multi‐spot semi‐automated pattern‐scanning laser (PASCAL) in one sitting (1S‐PRP) vs. four monthly sitting (4S‐PRP) for diabetic retinopathy. Methods Prospective multicenter randomized study carried out between October 2011 and November 2015, including patients with a mild proliferative diabetic retinopathy or a pre‐proliferative diabetic retinopathy (DR). Patients with best‐corrected visual acuity (BCVA) under 54 letters ETDRS (Early Treatment Diabetic Retinopathy Study) and CRT ≥ 350 mm were excluded. DR was treated by PRP with at least 3,000 burns given with a PASCAL laser either in one session or in four monthly sessions. Each patient underwent a complete ophthalmologic exam including an assessment of BCVA, a 9 fields retinophotography and a Spectral‐Domain Optical Coherence Tomography (SD‐OCT) macular imaging at baseline and at one, two, three, six and nine months after inclusion. Results Eighty one eyes of 81 patients were included with a median age of 56 years [IQR : 47.0; 66.0]. The mean CRT and median BCVA did not significantly differ between both groups during all the follow‐up and especially at 9 months (285 mm [273.5; 304.0] in 1S‐PRP vs. 291 mm [275.5; 313.0] in 4S‐PRP, p = 0.27/82 letters [76.8; 87.3] vs. 82 letters [75.3; 87.0], p = 0.76). A positive effect on DR at 9 months was observed in 32 (84.2%) of eyes in the 1S‐PRP group vs. 27 (75.0%) of eyes in the 4S‐PRP group (p = 0.39). The 1S‐PRP strategy was nearly 2 times shorter and less expensive (22 min [17.5; 30.5], 471€/patient) compared with the 4S‐PRP strategy (43 min [37.0; 59.5], p < 0.001, 775€/patient). Conclusions Our study showed the non‐inferiority of the PRP in 1 sitting versus 4 monthly sittings in term of CRT and the medico‐economic interest of a single session PRP.