Comparison of Pain Scores Among Patients Undergoing Conventional and Novel Panretinal Photocoagulation for Diabetic Retinopathy: A Systematic Review

Investigation of the reasons for delayed presentation in proliferative diabetic retinopathy patients

AIM

To investigate reasons for delayed presentation in patients with proliferative diabetic retinopathy (PDR).

METHODS

A questionnaire was designed to investigate consecutive PDR patients with delayed presentation who visited our center between January 2021 and December 2021. The questionnaire was divided into four sections: knowledge regarding diabetic retinopathy (DR), attitude toward DR treatment, difficulties adhering to follow-up plans, and medical care. The systemic disease status and severity of DR were recorded. Logistic analysis was undertaken to investigate DR treatment refusal and delay factors.

RESULTS

A total of 157 patients were included in this study, with an average age of 50.0 ± 11.6 years. The median glycated hemoglobin level (HbA1c) was 7.8% (IQR 2.5%). Among the 157 eyes, most required vitrectomy intervention (144, 91.7%); 17 developed neovascular glaucoma (NVG), while only 13 required additional photocoagulation. Among the 36 patients with undiagnosed DM, the reason for delayed DR presentation was a lack of awareness of DM status among these patients (36 cases, 100.0%). Most of the patients with a known history of DM exhibited inadequate DR knowledge (29, 24.0%), believed their good visual acuity did not require DR screening (98, 81.0%), and had poorly controlled diabetes (113, 93.3%). Factors related to refusing DR treatment were patients with an inability to receive regular diabetes treatment in internal medicine clinics (OR 6.78, 95% CI 1.73-26.59, p = 0.006), patients who could not tolerate discomfort during ophthalmic examination and treatment (OR 15.15, 95% CI 2.70-83.33, p<0.001), and patients who did not have any retinal abnormalities detected and were not informed about the need for regular screening (OR 2.05, 95% CI 1.36-3.09, p<0.001).

CONCLUSIONS

This study investigated the factors contributing to delayed presentation among patients with PDR. Many individuals in the delayed population were found to have undiagnosed DM. Among patients already aware of their DM status, reasons for delay included insufficient knowledge about DR, negative attitudes toward screening and treatment, and difficulties seeking medical care in real-life situations. Furthermore, there needed to be more improvements in the detection, treatment, and follow-up of DR by internal medicine practitioners and ophthalmologists.

Multimodal imaging of unusual macular macroaneurysm rupture after navigated retinal laser in a patient with adult onset Coats disease

Purpose

To report the uncommon rupture of a macular macroaneurysm (MAR) during navigated retinal laser (Navilas®) focal treatment in a patient with adult onset Coats disease.

Observation

A 30-year-old man consulted for progressive decrease of vision in his right eye from one week. Fundoscopy examination showed macular hard exudates, aneurysms, vascular telangiectasias in the temporal inferior quadrant consistent with an adult onset Coats disease (CD). Spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) revealed macular edema, vessels abnormalities associate to non-perfused areas. Ultra-widefield optical coherence tomography angiography (UWF-OCTA) clearly showed the blood flow abnormalities in both superficial and deep capillary plexus. Focal laser photocoagulation of abnormal vessels by navigated retinal laser and intravitreal injections (IVT) of aflibercept, successfully resolved macular edema. During supplemental navigated focal laser treatment, a macular macroaneurysm rupture occurred, causing intravitreal hemorrhage with a self-limiting resolution in three months. Indeed, visual acuity progressively improved during follow-up and absence of macular edema was observed at 18 months.

Conclusion

Adult onset CD is a rare condition. Our patient presented an unusual intravitreal hemorrhagic complication due to a MAR rupture after focal navigated laser treatment. Despite this complication, early laser photocoagulation and IVT injections of anti-VEGF, successfully resolved macular edema. UWF-OCTA follow-up clearly showed abnormal vessels in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) and successfully guided additional navigated focal laser treatment.