14
Treatment
Î If laser surgery is elected, full panretinal photocoagulation is a proven
surgical technique. (I++, G, S)
Î Fluorescein angiography does not usually need to be performed in
order to apply the panretinal photocoagulation effectively. If clinically
significant macular edema (CSME) is present, however, a fluorescein
angiogram may be used to guide focal photocoagulation. (III, In, D)
Î Partial panretinal photocoagulation treatment is NOT recommended.
(III, G, S)
Î Laser photocoagulation may be indicated particularly when access to
health care is difficult. (III, In, D)
Î The recommendation to consider panretinal photocoagulation before
the development of high-risk proliferative diabetic retinopathy (PDR) is
particularly appropriate for patients with Type 2 diabetes and severe to
non-high-risk non-proliferative diabetic retinopathy (NPDR). (II+, M, S)
Î For patients with Type 1 diabetes, the timing of the panretinal
photocoagulation depends on the compliance with follow-up and the
status and response to treatment of the fellow eye. (III, In, D)
ÎThe risk of severe visual loss among patients with high-risk PDR is reduced
substantially by treatment using panretinal photocoagulation as described
in the Diabetic Retinopathy Study (DRS) and ETDRS. (I++, G, S)
Î Most patients with high-risk PDR should receive panretinal
photocoagulation surgery expeditiously. (II++, G, S)
Î Before laser surgery, the ophthalmologist should assess macular
edema, discuss side effects of treatment and risks of visual loss with
the patient, and obtain informed consent. (III, G, S)
Î When panretinal photocoagulation for severe NPDR or non-high-risk
PDR is to be performed on eyes with macular edema, many experts
think that it is preferable to perform focal photocoagulation and/or
anti-VEGF therapy prior to panretinal photocoagulation. (III, G, S)
Î Panretinal photocoagulation surgery should NOT be delayed when PDR
is at the high-risk stage. (III, G, S)
Î When PDR is at the high-risk stage, anti-VEGF therapy and panretinal
photocoagulation may be performed concomitantly. (III, G, S)
Î The treatment of CMSE has traditionally been laser surgery. However,
current data demonstrates that intravitreal anti-VEGF agents are
effective treatments for ci-CSME. (I++, G, S)
Î For patients who have CSME in addition to high-risk PDR, combined
anti-VEGF therapy and panretinal photocoagulation at the first
treatment session should be considered. (III, In, D)
