Efficacy and side effects of individualized versus standard panretinal photocoagulation for treatment-naive proliferative diabetic retinopathy: results from a randomized clinical trial

Purpose : Proliferative diabetic retinopathy (PDR) is as a standard treated with panretinal photocoagulation (PRP). However, this treatment is known to cause side effects such as loss of visual fields (VF) and affection of night vision. To address this, we conducted a 6-month prospective, single-blinded randomized clinical trial (RCT) of patients with treatment-naïve PDR, where we investigated efficacy, side effects and retinal quality of life (RQOL) of patients treated with individualized navigated PRP (targeting only affected retinal quadrants) as compared to standard (all quadrants) navigated PRP.

Methods : We included 53 eyes of 42 patients with treatment-naïve PDR. Patients were randomized to individualized (targeting only affected retinal quadrants) or standard (targeting all retinal quadrants) PRP. Navilas ® laser was used for treatment. VF and dark adaptation (DA) were measured and a validated Danish version of Visual Function Questionnarie-25 was filled out by the patients at baseline prior to PRP and at 6 months follow up (M6). Main outcome measure were efficacy and safety of individualized and standard PRP.

Results : There was no difference in the number of patients with disease progression at M6 (individualized: 48.0% vs. standard: 59.3%, p=0.27). Furthermore VF (VFI (individualized: 92.5±7 vs. standard: 95.5±8, p=0.13); MD (individualized: -4.70±4.23 vs. standard: -3.47±4.22, p=0.25)), DA (individualized: 0.41666±0.051 vs. standard: 0.41340±.0.059, p=0.76), best corrected visual acuity (individualized: 85±10 vs. standard: 88±7, p=0.19), and RQOL (individualized: 90.9±2.4 vs. standard: 89.6±10.4, p=0.41) did not differ between the groups at M6.

Conclusions : In this RCT of patients with treatment-naïve PDR, individualized PRP targeting only affected retinal quadrants had the same efficacy and safety as standard PRP; furthermore side-effects (VF and DA) and RQOL did not differ. In future studies it would be interesting to test individualized PRP on a larger cohort with a longer follow-up period to confirm the long-term effects of a less intensive PRP.

This is a 2020 ARVO Annual Meeting abstract.