Clinical observation on panretinal photocoagulation with compound anisodine in the treatment of diabetic retinopathy
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Panretinal photocoagulation
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Panretinal photocoagulation
Diabetic macular edema
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Background: Diabetic retinopathy is leading cause of blindness, is preventable, in whole of the world. Panretinal photocoagulation is a well-established treatment to induce regression of new blood vessels in diabetic retinopathy. This study to assess effectiveness of panretinal photocoagulation in treatment of diabetic retinopathy.Methods: We enrolled in retrospective study, using data from medical records of patients with proliferative diabetic retinopathy and severe non proliferative diabetic retinopathy between 2009 and 2011, and were assessed for visual acuity and fundus stability minimal 6 weeks after panretinal photocoagulation complete.Results: Panretinal photocoagulation was perfomed in 435 eyes (295 patients), with proliferative diabetic retinopathy was recognized in 245 eyes, and severe non proliferative diabetic retinopathy in 190 eyes. In cases of patients with proliferative diabetic retinopathy stabilization of visual acuity was observed in 137 (55,92%) of eyes and stabilization of the eye fundus in 119 (48,57%) of eyes. In patients with severe non proliferative diabetic retinopathy stabilization of visual acuity was found in 141 (74,21%) of eyes and stabilization of state of the eye fundus in 147 (77,37%) of eyes.Conclusion: Panretinal photocoagulation as gold standart therapy effectiveness to treatment proliferative diabetic retinopathy and severe non proliferative diabetic retinopathy to adhered visual acuity stability dan fundus stability.
Panretinal photocoagulation
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The Early Treatment Diabetic Retinopathy Study (ETDRS) was a randomized clinical trial involving nearly four thousand diabetic patients with early proliferative retinopathy, moderate to severe nonproliferative retinopathy, and/or diabetic macular edema in each eye. This paper (ETDRS report number 9) examined the question of when in the course of diabetic retinopathy it is most effective to initiate photocoagulation therapy. Based on the study findings, the authors recommended that panretinal scatter photocoagulation not be carried out in eyes with mild or moderate nonproliferative diabetic retinopathy; when retinopathy is more severe, however, panretinal scatter photocoagulation usually should not be delayed if the eye has reached the high-risk proliferative stage. Focal treatment should be considered for eyes with macular edema that involves or threatens the center of the macula, preferably before scatter photocoagulation for high-risk proliferative retinopathy becomes urgent.
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Panretinal photocoagulation in diabetic retinopathy improves oxygen saturation in the retina which results in regression of neovascularisation. This study is aimed at evaluating the plasma levels of angiogenic and angiostatic factors after panretinal photocoagulation for retinopathy. Thirty controls and 29 proliferative diabetic retinopathy subjects who were advised panretinal photocoagulation were recruited for the study. Plasma was collected both before and four weeks after the last dose of the therapy and analysed for angiogenic and angiostatic factors using ELISA technique. The plasma concentration of HIF-1α and VEGF were significantly decreased after laser therapy compared to baseline levels. The plasma concentration of MMP-9 and PEDF was increased significantly after photocoagulation. A significant improvement in the visual acuity was also observed following laser therapy. Panretinal photocoagulation significantly reduced plasma angiogenic and angiostatic factors. These factors may be used to assess therapeutic outcomes in proliferative retinopathy.
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Background: Proliferative diabetic retinopathy (PDR) is the most advanced stage of DR.It significantly increases the risk for progressive vision loss, and without intervention, approximately one half of eyes ultimately experience severe vision loss.Although PRP is the gold standard treatment of PDR by reducing moderate visual loss by 50% in treatment groups, it also caused significant macular edema, which is recognized as the most common cause of decreased visual acuity in diabetic eyes.Optical Coherent Tomography (OCT) helps us studying these macular edema and its characteristics.Objective: To investigate the changes in macular thickness and morphology after panretinal photocoagulation (PRP) in eyes with proliferative diabetic retinopathy (PDR) and without clinically significant macular edema. Patients and Methods:This study enrolled 20 eyes of 15 patients with early proliferative diabetic retinopathy (PDR) without any clinically significant macular edema.Panretinal photocoagulation was applied 3 sessions, one week apart.Fundus fluorescein angiography and OCT were carried out for all patients before PRP.Baseline and post PRP visual acuity and central foveal thickness were evaluated after 3 months. Results:The mean patient age was 59.00±9.93 years (range, 33-72 years).Fifteen of the 20 eyes (75%) had stable or improved vision, while 5 eyes (25%) had worsened by 3 months following PRP.Mean preoperative vision was 0.50±0.1 decimal fraction, and although worsened at 3 months 0.48±0.15decimal fraction, this was statistically insignificant (P = 0.453).Mean pre-PRP central foveal thickness was 253.05 ± 18.53 μm (ranging from 227 -281μ), increased significantly to 281.45 ± 28.71 μm (ranging from 240 -344μ) at 3 months' follow-up (P˂ 0.001).Three months after PRP, 15 eyes developed complications.The most common abnormality was cystoid edema seen in 6 eyes (30%), followed by diffuse macular edema in 4 eyes (20%), posterior vitreous detachment (PVD) in 2 eyes (10%), neuro sensory detachment in two eyes (10%), and epiretinal membrane (ERM) in one eye (5%). Conclusion:Panretinal photocoagulation is safe, effective in treating and preserving vision in proliferative diabetic retinopathy (PDR), although causing temporary drop in vision and changes in macular morphology/thickness.
Panretinal photocoagulation
Diabetic macular edema
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Purpose To study the prognostic value of post-treatment retinopathy after panretinal laser photocoagulation for proliferative diabetic retinopathy in type 1 diabetes mellitus. Proliferative diabetic retinopathy is treated with panretinal photocoagulation, which significantly reduces the risk of visual loss from this complication. However, no parameters are presently known that can be used to define an optimal control interval after the initial panretinal photocoagulation treatment that ensures enhancement of the treatment in cases where this is needed. Methods In this retrospective cohort study, 85 eyes from 56 type 1 diabetic patients were identified who had been subjected to panretinal photocoagulation for proliferative diabetic retinopathy before 1990. The patients were divided into two groups: Group 1 had four or fewer microaneurysms only at the first post-treatment examination whereas Group 2 had more retinopathy. Results At the first photographic examination after treatment the eyes in Group 1 had a significantly lower visual acuity (VA) (mean=0.23, range: 0.01–1.00) than the patients in Group 2 (mean=0.48, range: 0.01–1.6). During the follow-up period the VA was further reduced in Group 2 but not in Group 1. Three eyes out of six in Group 1 had improvement of VA from below to above 0.1, whereas 6 eyes out of 12 in Group 2 experienced progression of retinopathy with a consequent worsening of VA to below 0.1 after a mean of 10.8 years (range: 6.8–15.9) after treatment. Conclusions The severity of post-treatment retinopathy can be used to assess the need for enhancing photocoagulation of proliferative diabetic retinopathy in type 1 diabetes. The interval between post-treatment examinations can be increased to several years when the initial treatment has reduced retinopathy to a minimal level.
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To evaluate the difference in intravitreal bevacizumab (IVB) injection timing as adjuvant therapy to panretinal photocoagulation in patients with diabetic retinopathy combined with diabetic macular edema.This was a retrospective nonrandomized study. Forty eyes with severe non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) were divided into two groups; the IVB injection prior to, or after, panretinal photocoagulation. Changes in central macular thickness between the two groups were measured.There was no significant difference in change in central macular thickness between two groups after treatment (p=0.66), neither in eyes with severe NPDR groups (p=0.48) nor eyes with PDR (p=0.82).IVB injection after panretinal photocoagulation gives insignificant difference in changes in central macular thickness with injection prior to laser treatment in patients with diabetic retinopathy combined with diabetic macular edema.
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Diabetic macular edema
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Objective Investigate and analyze the macular thickness in diabetic patients by optical coherence tomography(OCT) measurements.Methods There were 30 eyes(30 cases) in normal control group,and 90 eyes(30 cases) in diabetic group.The diabetic patients were divided into three groups: non-diabetic retinopathy(NDR),non-proliferative diabetic retinopathy(NPDR) and proliferative diabetic retinopathy(PDR).We observed the different tomographic features of diabetic macula and measured macular thickness.For each eye,nine different sectors were analyzed(central subfield,four parafoveal sectors,and four extrafoveal sectors).All the people had undergone examination of BCVA,slit lamp,ocular fundus,FFA and OCT.Results he average retinal thickness at central subfield(CSF) with 1 mm diameter respectively were NDR Group(225.8±18.0)μm,NPDR Group(246.8±34.2)μm,PDR Group(323.5±92.2)μm,Contral Group(224.8±15.9)μm.There were statistically significant differences in CSF among NPDR group,PDR group and the control eyes(P 0.05).But no significant difference between NDR group and the control eyes.Conclusion OCT can detect macular thickness and structural changes in eyes with DM.It is a useful tool to diagnose and monitor diabetic maculopathy.
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