Pan Retinal Photocoagulation

WHAT IS PAN-RETINAL PHOTOCOAGULATION OR PRP?

Laser photocoagulation uses the heat from a laser to seal or destroy abnormal, leaking blood vessels in the retina. One of two approaches may be used when treating diabetic retinopathy:

• Focal photocoagulation: Focal treatment is used to seal specific leaking blood vessels in a small area of the retina, usually near the macula. Your retina specialist identifies individual blood vessels for treatment and makes a limited number of laser burns to seal them off.
• Scatter (pan-retinal) photocoagulation: Scatter treatment is used to slow the growth of new abnormal blood vessels that have developed over a wider area of the retina. Your retina specialist may make hundreds of laser burns on the retina to stop the blood vessels from growing. Patients may need two or more treatment sessions.

Laser photocoagulation is usually not painful. The injection of anesthetic may be uncomfortable. And then you may feel a slight stinging sensation or see brief flashes of light when the laser is applied to your eye.

WHAT CONDITIONS DOES PRP TREAT?

Laser photocoagulation is done to reduce the risk of vision loss caused by diabetic retinopathy. It is most often used to stabilize vision and prevent future vision loss rather than to improve vision loss that has already occurred. (Sometimes focal photocoagulation for macular edema caused by nonproliferative retinopathy can help restore lost vision.)

Laser photocoagulation may be used to treat and prevent further progression of:

• Macular edema: Focal photocoagulation is usually used in these cases.
• Proliferative retinopathy: Scatter (pan-retinal) photocoagulation is used to treat proliferative retinopathy.

WHAT TO EXPECT ON PROCEDURE DAY

Your treatment will be performed in the clinic in a specially equipped laser room. It does not require the surgery center. It is usually performed without anesthesia, although some will want a local anesthetic.

Before your procedure begins, an eyelid holder will be placed between your eyelids to keep you from blinking. Next, your retina specialist will begin laser treatment with an argon or diode laser. The laser treats the peripheral (outside) and middle portions of your retina. It does not treat the central or macular region because this would likely cause serious loss of vision.

The initial treatment usually consists of approximately 1,500-2,000 spots of laser per eye. This will be done in two or more sessions.

Your vision will be poor immediately after the treatment, but will recover to the pre-treatment level over time. You should plan to have someone drive you home, and you should relax for the rest of the day. Most patients resume activities within a few days. Regular follow-up visits are required.

WHAT TO EXPECT AFTER TREATMENT

The goal of pan-retinal photocoagulation is to prevent the development of new vessels over the retina and elsewhere, not to regain lost vision. There is no improvement in vision after the laser treatment. Vision may decrease due to edema/swelling of the retina, after the laser treatment. It may improve to its previous level in two to three weeks or may remain permanently deteriorated. Recurrences of proliferative retinopathy may occur even after an initial satisfactory response to treatment.

This procedure sacrifices peripheral vision in order to save as much of the central vision as possible and to save the eye itself. Night vision will be diminished. After pan-retinal photocoagulation, blurred vision is very common. Usually, this blur goes away, but in a small number of patients some blur will continue forever.

Serious complications with pan-retinal photocoagulation are extremely rare, but like any surgical procedure, it does have risks. These risks can be minimized by going to a specialist experienced in pan-retinal photocoagulation.

You will need someone to drive you home from the doctor's office or clinic after the procedure. Eyedrops are used to widen (dilate) your pupils before the procedure. And your eyes will remain dilated for several hours afterward. Wear sunglasses to keep bright light out of your eyes while they are still dilated.

Your vision may be blurry and your eye may hurt a little for a day or two after the treatment. Be sure to keep all follow-up appointments with your doctor and report any changes in vision that you notice. Follow-up treatment can make a big difference in keeping your vision for the long term.

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If you and your doctor decide that pan-retinal photocoagulation (PRP) is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

If you would like more information about this procedure you can make an appointment or contact the office for additional information.

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