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Pegaptanib And Reduced Fluence PASCAL Laser Treatment For Proliferative Diabetic Retinopathy 1. Clifton Otto¹ 1. Retina Institute of Hawaii, Honolulu, Hawaii, USA. Purpose: To evaluate the effectiveness of Pegaptanib combined with reduced fluence PASCAL laser photocoagulation for the treatment of proliferative diabetic retinopathy (PDR). Methods: In this prospective, FDA/IRB approved, Eyetech sponsored study, patients with PDR and active neovascularization were identified using ultra widefield angiography. Treatment with 0.3mg of Pegaptanib was followed one week later by reduced fluence PASCAL laser photocoagulation. Laser energy was titrated to produce a barely visible laser burn, using a 200um spot of 20ms duration. Patients were evaluated at weeks 1, 6, 12, and 24. Complete ophthalmic examinations, ETDRS vision, angiograms, and SD-OCT were obtained. Primary endpoint was angiographic regression of neovascularization. Secondary endpoints were changes in visual acuity and OCT center thickness. Results: 32 eyes were included. All demonstrated angiographic regression of neovascularization. 94% showed complete neovascular regression at week 12. 6% required additional laser between weeks 12 and 24. 97% had stable or improved visual acuity and 88% showed stable or improved OCT measurements. Conclusions: Pegaptanib combined with reduced fluence PASCAL laser photocoagulation appears to effectively treat PDR with active neovascularization. DRS protocol pan-retinal photocoagulation, while effective, typically delivers total energy in the range of 64J and can be associated with significant side effects. By combining pegaptanib with reduced fluence laser treatment, the total energy required for neovascular regression ranged from 1.78 to 8.20J, a reduction of over 70%. This significant reduction could minimize damage to the neurosensory retina and underlying retinal pigment epithelium, and potentially minimizing the visual morbidity associated with standard DRS laser parameters. |
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