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The effect of different sequence of panretinal photocoagulation on severe non-proliferation diabetic retinopathy

Objective To compare the long-time effect of traditional PRP and modified PRP on the treatment of diabetic retinopathy.Design Evaluation of a new treatmental technique.Participants 100 cases(200 eyes) with severe non-proliferation diabetic retinopathy and macular microaneurysms diagnosed by fundus fluorescein angiography(FFA) and without clinical significant diabetic macular edema diagnosed by optical coherence tomography(OCT).Methods The left eye was performed with traditional PRP.Goldmann three-mirror lens was used to treat temporal-inferior,nasal-inferior,nasal-superior,and temporal-superior areas sequentially.About 500 laser spots were given in each session.The right eye was performed with modified PRP.Retinoscope was used to give direct laser coagulation on the microaneurysm and macular photocoagulation in a C pattern.Then laser coagulation was placed over the equator retina,the superior and inferior peripheral retina.Follow-ups lasted for 60 months were designed at 2 weeks,1 month,3 months,6 months,1 year and every year after PRP.Main Outcome Measures Visual acuity,macular thickness,vitreous hemorrhage,tractional retinal detachment,retinal neovascularization and neovascular glaucoma were observed.Results There were 82 cases(164 eyes) completed 5-year follow-up.The mean visual acuity was 0.45±0.02 in the left eye and was 0.62±0.04 in the right eye(P0.05).The mean macular thickness was 182.32±32.31 μm in the left eye and 158.49±42.06 μm in the right eye(P0.05).Macular edema occurred in 70 left eyes and 28 right eyes.Vitreous hemorrhage occurred in 15 left eyes and 3 right eyes.Tractional retinal detachment occurred in 10 left eyes and 1 right eye.Retinal neovascularization was observed in 12 left eyes and 3 right eyes.In 1 left eye,neovascular glaucoma developed.Conclusions The modified PRP may be a recommended photocoagulation method that may significantly alleviate macular edema,maintain better visual acuity,and reduce the rate of complications including vitreous hemorrhage,tractional retinal detachment and retinal neovascularization.