Vision-Related Quality of Life and Treatment Satisfaction Following Panretinal Photocoagulation in Diabetic Retinopathy-A Panel Study

Peripheral PRP in the Operating Room vs Standard Clinic PRP for the Initial Treatment of PDR

Purpose: To compare the long-term outcomes of standard panretinal photocoagulation (PRP) performed in the operating room (OR) with peripheral PRP performed in the clinic in treatment-naïve patients with proliferative diabetic retinopathy (PDR). Methods: Consecutive cases from 2017 to 2022 were retrospectively reviewed. Exclusion criteria included previous PRP, pars plana vitrectomy performed at the time of the initial PRP, PRP performed in another setting within 3 months of the initial treatment, a documented plan for future PRP at the time of the initial treatment, and less than 3 years of follow-up. Negative binomial regressions were used to compare the number of subsequent interventions between the 2 groups and t tests to compare the visual acuity (VA) outcomes. Results: Of the 961 eyes of 679 patients screened, 82 eyes of 53 patients met the inclusion criteria. The initial PRP was performed in the OR (OR cohort) in 57 eyes of 38 patients and in the clinic (clinic cohort) in 25 eyes of 15 patients. The OR cohort had a mean of 0.4 subsequent surgeries and 0.8 subsequent PRP treatments and the clinic cohort, 0.8 subsequent surgeries (P < .05) and 1.8 subsequent PRP treatments (P < .05). No significant between-group difference was found in the VA outcomes over the long-term follow-up (mean, 44.2 months). Conclusions: Peripheral PRP performed in the OR resulted in fewer subsequent interventions than standard PRP in the clinic and may afford better control of PDR.

Diabetic choriocapillaris flow deficits affect the outer retina and are related to hemoglobin A1c and systolic blood pressure levels

Patient systemic and ocular data based on optical coherence tomography (OCT) and OCT angiography images were analyzed (n = 45; control and diabetic eyes with or without diabetic retinopathy [DR]; mean age, 49.6 ± 8.1 years). All participants had best-corrected visual acuity < 0.05 in logMAR. The choriocapillaris flow area (CCFA) ratio was lower and the coefficient of variation (CV) of CCFA ratio was higher in diabetic eyes with or without DR than in control eyes. CCFA ratio of DR eyes was lower than that of diabetic eyes without DR. Superficial retinal vessel length density (VLD) was reduced only in DR eyes. CCFA ratio correlated with retinal VLD, photoreceptor outer segment (PROS) length, and retinal pigment epithelium (RPE) volume in the study population; mean PROS decreased in diabetic eyes with or without DR, and RPE volume increased in DR eyes. CCFA ratio < 65.9% and CV of CCFA ratio ≥ 0.140 were more frequently found in diabetic eyes (odds ratio [OR], 13.333; P = 0.001), and related to HbA1c ≥ 7.0% (OR, 4.992; 95% confidence interval [CI] 1.164-21.412; P = 0.030) or systolic blood pressure ≥ 135 mmHg (OR, 5.572; 95% CI 1.156-26.863; P = 0.032). These findings could help understand diabetic pathogenesis in the choriocapillaris and outer retina, and remind clinicians to manage both diabetes and hypertension.