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Study: PRP with reduced laser exposure similarly effective to conventional procedures

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Panretinal photocoagulation performed using a shortened laser exposure time appears similarly effective to procedures performed using conventional parameters, according to a study by researchers in England. The reduced laser exposure is also significantly less painful for patients, the study authors noted.

Jonathan M. Gibson, MD, and colleagues at Birmingham Heartlands and Solihull NHS Trust performed panretinal photocoagulation (PRP) on the superior and inferior hemi-retina of 20 patients with proliferative retinopathy. Specifically, 17 patients had proliferative diabetic retinopathy, two had ischemic central retinal vein occlusion and one had ocular ischemic syndrome, the authors reported.

Investigators randomly assigned each hemi-retina to undergo one of two photocoagulation procedures, either conventional lasering or a modified technique involving short exposure and high energy.

Conventional laser procedures were performed using a 0.1 second exposure time, a 300 µm spot size and adequate energy to produce visible gray-white burns.

The modified technique involved a 0.02 second exposure, also with a 300 µm spot size and adequate energy to produce visible burns, according to the study.

In all cases, surgeons used a 532-nm wavelength Nd:YAG laser.

Pain was assessed using a 10-point, self-reported visual analog scale; efficacy was assessed using fundus photography.

Follow-up ranged from 6 to 45 months.

The researchers found that patients reported significantly more pain from the conventional procedures, with an average pain score of 5.11 points. In comparison, the modified procedure was associated with a mean pain score of 1.4 points (P = .001), according to the study.

All patients preferred treatment with shorter exposure times, the authors noted.

"Further treatments, if required, were performed with [short exposure] and long-term follow-up has shown no evidence of undertreatment," they said.

The study is published in the January issue of Eye.