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Comparison of functional changes of retina after subthreshold and threshold pan-retinal photocoagulation in severe non-proliferative diabetic retinopathy

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Abstract

Purpose

To find a new approach of pan-retinal photocoagulation (PRP) with less damage to the retina in the treatment of severe non-proliferative diabetic retinopathy (NPDR), this study compared functional changes in the retina after subthreshold and threshold PRP treatment in severe NPDR eyes.

Methods

Post hoc analysis of a randomized clinical trial was conducted in this study. Seventy eyes of 35 patients with bilateral, symmetric, severe NPDR were enrolled. Two eyes from the same patient were randomized into two groups, one eye received subthreshold PRP (S-PRP) and the other eye received threshold PRP (T-PRP). Comprehensive ophthalmological evaluations were performed on the baseline and every 3 months for 1 year. Visual field (VF) and full-field electroretinography (ERG) were performed on the baseline and repeated at month 12.

Results

During the 12-month follow-up, 4 eyes (11.4%) in the S-PRP group and 3 eyes (8.6%) in the T-PRP group progressed to proliferative diabetic retinopathy (PDR) stage, and there was no statistical difference in PDR progression rate between the two groups (P = 0.69). In addition, the changes in best-corrected visual acuity (BCVA) from baseline to month 12 between the two groups had no statistical difference (P = 0.30). From baseline to month 12, changes in central VF between the two groups had no statistical difference (P = 0.25), but changes in total score points of peripheral VF in the S-PRP group (− 242.1 ± 210.8 dB) and the T-PRP group (− 308.9 ± 209.7 dB) were statistically significant (P = 0.03). At month 12, ERG records showed that the amplitude of dark-adapted 0.01 ERG, dark-adapted 3.0 ERG, oscillatory potentials, light-adapted 3.0 ERG, and 30 Hz flicker ERG of both groups were significantly decreased from the baseline (P < 0.05). In addition, the amplitude of each ERG record in the S-PRP group decreased significantly less than those in the T-PRP group (P < 0.05).

Conclusions

Subthreshold PRP is as effective as threshold PRP for preventing severe NPDR progress to PDR within 1 year with less damage to periphery VF and retinal function.

Trial registration.

ClinicalTrials.gov Identifier: NCT01759121.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Code availability

Not applicable.

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Acknowledgements

The authors are grateful to Li Ma, Guandi Chen, and Jinger He.

Funding

This study was funded by the Natural Science Foundation of Guangdong Province (2021A515011106).

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Authors and Affiliations

  1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, Guangdong, China

    Hongkun Zhao, Lijun Zhou, Kunbei Lai, Chuangxin Huang, Fabao Xu, Cong Li, Lin Lu & Chenjin Jin

  2. Electrophysiology Laboratory, Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA

    Minzhong Yu

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  1. Hongkun Zhao
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  7. Cong Li
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  8. Lin Lu
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Contributions

Conception and design: Chenjin Jin.

Data collection: Kunbei Lai, Chuangxin Huang, Fabao Xu, Cong Li

Analysis and interpretation: Hongkun Zhao and Lijun Zhou

Revise: Chenjin Jin, Lin Lu and Minzhong Yu

Obtained funding and overall responsibility: Chenjin Jin

Corresponding author

Correspondence to Chenjin Jin.

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Ethic approval

This study was performed in line with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Zhongshan Ophthalmic Center.

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Written consent was obtained from all individual participants included in the study.

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Not applicable.

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The authors declare no competing interests.

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Zhao, H., Zhou, L., Lai, K. et al. Comparison of functional changes of retina after subthreshold and threshold pan-retinal photocoagulation in severe non-proliferative diabetic retinopathy. Lasers Med Sci 37, 3561–3569 (2022). https://doi.org/10.1007/s10103-022-03635-8

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  • DOI: https://doi.org/10.1007/s10103-022-03635-8

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