The effect of pan retinal photocoagulation patterns for proliferative diabetic retinopathy on ocular surface parameters,and pain score

Abstract

Purpose

To evaluate the effect of sparing the horizontal meridian during Pan Retinal Photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) on corneal sensation, tear film parameters and to assess the pain in different retinal areas.

Design

Prospective comparative interventional study

Subjects

Patients were randomized to either Group (A): conventional PRP or Group (B): PRP with sparing of the horizontal meridian.

Main outcome

Comparing the change in central corneal sensation and the precorneal tear film parameters between the 2 groups

Methods

50 patients were divided into the two groups at random. The corneal sensation was evaluated by the Cochet Bonnet aesthesiometer & the tear film stability was evaluated by the Schirmer tests (1&2) & the Tear break up time (TBUT). The pain was recorded using a scale of 0–3 in different retinal areas.

Results

The corneal sensation decreased with a nonsignificant difference between the 2 groups through the follow up visits. Regarding the tear film stability, Schirmer test (1), (2) & TBUT decreased with a significant difference in the change from the baseline between the 2 groups (p-value for Schirmer test (1) <0.001, 0.001, 0.001, P-value of Schirmer test (2) 0.007, 0.001, 0.001, P-value of TBUT 0.03, 0.001, 0001 for 1 week, 1and 3 months respectively). Regarding the pain sensation during the PRP, the pain score was the highest in the horizontal meridian and was higher in the peripheral retina than in the central retina and in the lower retina than in the upper retina.

Conclusion

PRP performed with sparing of the horizontal meridian was found to maintain the tear film's stability with less pain increasing patient compliance with therapy.