Czech and Slovak Ophthalmology 30 Original article Results of treatment of diabetic retionopathy by the Pascal laser system Němčanský Jan https://orcid.org/0000-0003-1979-6419 Stěpanov Alexandr https://orcid.org/0000-0002-8462-8756 Němčanská Sabina Langrová Hana https://orcid.org/0000-0001-8488-7208 Studnička Jan https://orcid.org/0000-0002-9911-4379 30 1 2018 5+6 5

Purpose: To evaluate anatomical, functional and clinical efficacy of the pattern scanning laser (PASCAL®) photocoagulation in patients with diabetic retinopathy. Methods: The cohort included 91 eyes in 50 patients (average age 63 years, 24 men and 26 women) treated at the Clinic of Ophthalmology, Faculty Hospital Ostrava, from 2008 to 2013. All eyes showed the signs of diabetic retinopathy (20.9% of eyes – very severe non-proliferative diabetic retinopathy (NPDR), 79.1% of eyes - proliferative diabetic retinopathy (PDR)). All the eyes were „treatment naive“. The average duration of diabetes was 18 years, average baseline HbA1c value was 8.2 %. Panretinal photocoagulation was performed with by the means of PASCAL photocoagulator – with patterns and short duration pulses. Best corrected visual acuity (BCVA), central retinal thickness (CRT), fundus photography, biomicroscopy and complications were evaluated during the minimum of 12 months follow-up period. Statistical analysis using Shapiro-Wilk a Friedman tests with p value less than 0.05 was done. Results: Mean baseline BCVA was 0.13 logMAR. Values 0.12, 0.15 and 0.19 logMAR were observed in the follow-up intervals at the 4th, 6th and 12th month. At the 6th month visit all 91 eyes (100 %) were stabilized, and at the 12th month visit in 5 eyes (5.5 %) progression of the disease was observed. No complications were observed during the first 12 months follow up. Conclusion: Laser photocoagulation of the retina with the use of short pulse durations and patterns in patients with DR is an effective and safe method of treatment.

 diabetic retinopathy laser photocoagulation patterns low time of impulse Pascal References Blumenkranz, M. S., Yellachich, D., Andersen, D. E., et al.: Semiautomated patterned scanning laser for retinal photocoagulation. Retina, 26(3); 2006: 370–376. Bressler, SB., Qin, H., Melia, M., et al.: Diabetic Retinopathy Clinical Research Network. Exploratory analysis of the effect of intravitreal ranibizumab or triamcinolone on worsening of diabetic retinopathy in a randomized clinical trial. JAMA Ophthalmol. 131(8); 2013: 1033–40. Danielescu, C., Chiseliţă, D.: Panretinal photocoagulation with or without focal photocoagulation - the effect on central retinal thickness. Oftalmologia, 54(2); 2010: 99–103. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology, 98(5); 1991b: 766–85. Early Treatment Diabetic Retinopathy Study Research Group: Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report no. 3. Int Ophthalmol Clin, 27(4); 1987b: 54–264. neovascularization. Clin Ophthalmol, 3; 2009: 465–70. Early Treatment Diabetic Retinopathy Study Research Group: Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report Number 2. Ophthalmology, 94(7); 1987a: 761–774. Jain, A., Blumenkranz, MS., Paulus, Y., et al.: Effect of pulse duration on size and character of the lesion in retinal photocoagulation. Arch Ophthalmol, 126(1); 2008: 78-85. Kalvodová, B., Sosna, T., Ernest, J., et al: Doporučené postupy pro diagnostiku a léčbu diabetické retinopatie. Čes. a slov. Oftal. 72(6); 2016: 226–233. Kim, J.J., Im, J.C., Shin, J.P., et al.: One -year follow-up of macular ganglion cell layer and peripapillary retinal nerve fibre layer thickness changes after panretinal photocoagulation. Br J Ophthalmol, 98(2); 2014: 213–7. Little, H. L.: Treatment of proliferative diabetic retinopathy. Long-term results of argon laser photocoagulation. Ophthalmology, 92(2); 1985: 279–83. Modi, D., Chiranand, P., Akduman, L.: Efficacy of patterned scan laser in treatment of macular edema and retinal Muqit, M.M., Marcellino, G.R., Henson, D.B. et al.: Pascal panretinal laser ablation and regression analysis in proliferative diabetic retinopathy: Manchester Pascal Study Report 4. Eye (Lond), 25(11); 2011: 1447–56. Nagpal, M., Marlecha, S., Nagpal, K.: Comparison of laser photocoagulation for diabetic retinopathy using 532-nm standard laser versus multispot pattern scan laser. Retina, 30(3); 2010: 452–8. Nicholson, B.P., Schachat, A.P.: A review of clinical trials of anti-VEGF agents for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol, 248(7); 2010: 915–30. Oh, J.H., Kim, S.W., Kwon, S.S., et al.: The change of macular thickness following single-session pattern scan laser panretinal photocoagulation for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol, 253(1); 2015: 57–63. Palanker, D., Lavinsky, D., Blumenkranz, MS., et al.: The impact of pulse duration and burn grade on size of retinal photocoagulation lesion: implications for pattern density. Retina, 31(8); tického makulárního edému, Čes. a slov. Oftal. 71(5); 2015: 243–246. Sheth, S., Lanzetta, P., Veritti, D., et al.: Experience with the Pascal® photocoagulator: an analysis of over 1,200 laser procedures with regard to parameter refinement. Indian J Ophthalmol, 59(2); 2011: 87–91. Sosna, T. a kol: Diabetická retinopatie. Axonite, Praha, 2016, 280 p. Sosna, T., Švancarová, R., Netuková, M., Studnička, J.: Současný pohled na diabetický makulární edém. Čes. a slov. Oftal. 68(3); 2012: 91–97. Studnička, J.: Aflibercept v léčbě diabejo, J.L., Gonzalez-Mijares, C.C.: Pattern scan laser photocoagulation: safety and complications, experience after 1301 consecutive cases. Br J Ophthalmol, 94(6); 2010: 720–4. The Diabetic Retinopathy Study Research Group. Design, methods, and baseline results. Diabetic Retinopathy Study (DRS) Report Number 6. Invest Ophthalmol Vis Sci, 2; 1981a: 210–226. Tremolada, G., Del Turco, C., Lattanzio, R., et al.: The role of angiogenesis in the development of proliferative diabetic retinopathy: impact of intravitreal anti-VEGF treatment. Exp Diabetes Res, Epub 2012: 728325; doi: 10.1155/2012/728325.10.1155/2012/728325 Velez-Montoya, R., Guerrero-Naran- 2011: 1664–9. Yamakawa, M., Nozaki, M., Sato, R., et al.: Comparison of outcomes of conventional laser versus pascal laser for diabetic retinopathy. Nihon Ganka Gakkai Zasshi, 118(4); 2014: 362–7. Yang, H.S., Park, S.H.: Exacerbation of central serous chorioretinopathy following PASCAL photocoagulation. Can J Ophthalmol, 48(3); 2013: e42–3.