Rajagopal Sangeetha, Madhivanan Nivean, Mayilvakanam Lakshmi, Nivean Pratheebadevi
MN Eye Hospitals Pvt Ltd, Chennai, India.
J Lasers Med Sci. 2020 Summer;11(3):345-347. doi: 10.34172/jlms.2020.55. Epub 2020 Jun 21.
Panretinal photocoagulation (PRP) remains the gold standard treatment for severe non-proliferative and proliferative diabetic retinopathy (PDR), as it reduces the risk of severe visual loss by more than 50%. In the conventional single-spot laser, the procedure involves the application of moderate-intensity burns of 200-500 microns, placed one spot-size apart to achieve a total of 1200-2000 applications in 2 or 3 sessions. The more advanced retina lasers like the Pattern Scan Laser (PASCAL) and the VITRA multi-spot laser are 532 nm frequency-doubled (Nd: YAG) solid-state lasers. These modern lasers enable the application of multiple laser burns in a rapid pre-determined sequence with reduced pulse duration (10-20 ms) to facilitate the PRP to be completed in a single sitting with lesser collateral tissue damage. Though multi-spot lasers have significantly reduced the adverse events when compared with the conventional single-spot lasers, we report a case of rare adverse events (serous choroidal detachment) following PRP with the VITRA multi-spot double frequency NdYAG (532 nm) laser. Most of the serious choroidal detachments following PRP are self-limiting. We recommend complete retinal evaluation post laser procedure even with modern multisport laser to look for such adverse events.
全视网膜光凝（PRP）仍然是重度非增殖性和增殖性糖尿病视网膜病变（PDR）的金标准治疗方法，因为它可将严重视力丧失的风险降低50%以上。在传统的单点激光治疗中，该过程包括应用200-500微米的中等强度烧灼，每点间隔一个光斑大小，分2或3次进行，总共进行1200-2000次照射。更先进的视网膜激光，如模式扫描激光（PASCAL）和VITRA多点激光，是532纳米倍频（Nd:YAG）固态激光。这些现代激光能够以快速预定的顺序进行多次激光烧灼，同时缩短脉冲持续时间（10-20毫秒），以便在单次治疗中完成PRP，减少对周围组织的损伤。尽管与传统的单点激光相比，多点激光显著减少了不良事件，但我们报告了1例使用VITRA多点倍频NdYAG（532纳米）激光进行PRP后发生罕见不良事件（浆液性脉络膜脱离）的病例。PRP后大多数严重的脉络膜脱离是自限性的。即使使用现代多点激光，我们也建议在激光治疗后进行全面的视网膜评估，以查找此类不良事件。
