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Selective, targeted laser treatment effective in patients with diabetes
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VIENNA — Initial experience with the 577 nm subthreshold yellow Pascal laser in patients with diabetes shows that the technology may provide selective, targeted treatment with minimal damage to surrounding areas and reduced side effects.
“Diabetics need treatment for life, usually from a young age, and we need minimal laser to stabilize the condition at every recurrence,” Paulo Stanga, MD, said at the Advanced Retinal Therapy meeting.
The novel Endpoint Management feature of the 577 nm yellow Pascal laser (Topcon) allows accurate titration of energy within the subthreshold range.
“Laser damage is very confined and localized, with significant reduction of side effects,” Stanga said.
Stanga has used previous Pascal models since 2006, and a first series was published 2 years later. A fundus autofluorescence technique was also developed to image the burns and confirmed that they were confined and localized to the outer retina.
The following studies compared single session vs. multiple sessions and pain response with Pascal vs. conventional laser photocoagulation, and evaluated laser-tissue interaction and healing responses.
“We found better results with single-session Pascal. The macula remains thin, with diminished central retinal thickness because of the lesser inflammatory response,” Stanga said.
There were lower levels of anxiety, headache, pain and photophobia with multi-spot 20 ms Pascal compared with single-spot 10 ms panretinal photocoagulation.
“Possible reasons include lower fluence, shorter pulse duration and less spatial summation of laser nociception with multi-spot Pascal technique,” Stanga said.
The latest PETER PAN study evaluated the advantages of Optos wide-angle imaging-guided Pascal laser treatment for targeted retinal photocoagulation.
“The advent of wide-field imaging and hence improved means of identifying retinal non-perfusion and penumbra have made [targeted retinal photocoagulation] a reality,” Stanga said.
Disclosure: Stanga is consultant to Topcon and Optos.