Ultra-Widefield Fluorescein Angiography-Based Targeted Retinal Photocoagulation versus Panretinal Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Controlled Trial

TL;DR

This study compares two laser treatments for diabetic eye disease and finds both are equally effective, but one causes more vision loss.

Contribution

Demonstrates that targeted retinal photocoagulation is as effective as traditional PRP without worsening visual field metrics.

Findings

TRP and PRP showed similar improvements in visual acuity and macular thickness.

PRP led to significant worsening of mean deviation and visual field index.

TRP improved central macular thickness significantly from baseline.

Abstract

To compare the safety and efficacy of ultra-widefield fluorescein angiography-based targeted retinal photocoagulation with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy.

This randomized controlled trial was conducted from September 1, 2022, to February 28, 2024. Patients with proliferative diabetic retinopathy were randomly allocated to targeted retinal photocoagulation (TRP) and panretinal photocoagulation (PRP). In TRP group, the laser was applied only to the ischemic area demarcated by ultra-widefield fluorescein angiography, whereas in PRP group, the conventional PRP laser photocoagulation protocol was followed. Data was gathered for the treatment effects on best corrected visual acuity (BCVA), central macular thickness (CMT), mean deviation (MD) and visual field index (VFI).

A total of 120 participants were recruited during the study period, with 60 in each group. The mean age was 65.66 ± 9.33 years with 64 (53.3%) males. There was no statistically significant difference between the two groups at baseline and after the treatment for BCVA, CMT, MD and VFI. When compared within the groups, CMT improved from baseline which was statistically significant (p=0.002) in TRP group. The PRP group also showed significant improvement in CMT from baseline (p=0.01), but MD and VFI worsened significantly from the baseline (p<0.001).

Targeted retinal and panretinal photocoagulation are equally effective in reversing proliferative diabetic retinopathy, but panretinal photocoagulation negatively affects mean deviation and visual field index.

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