Red krypton and blue-green argon panretinal laser photocoagulation for proliferative diabetic retinopathy: a laboratory and clinical comparison

Abstract

The effects of PRP with red krypton laser are essentially identical to those produced with blue-green argon laser. Burns of the rabbit retina produced with these two different lasers are almost the same. In a prospective and randomized clinical trial of proliferative diabetic retinopathy treatment there was no significant difference between PRP using these two different lasers. The characteristic changes of rabbit fundi 3, 7, and 30 days after PRP with red krypton laser were almost the same as those following blue-green argon laser. Both types of treatment frequently produced small vitreous hemorrhages and exudative retinal detachments, but choroidal thickening occurred more frequently with argon treatment. These changes were transient and had resolved within 30 days of treatment. The microscopic changes consisted of pigment epithelial disruption with pigment migration into the retina, heat coagulation of the photoreceptors, disruption of the outer and inner nuclear layers with atrophy of the nuclei, and temporary swelling of the nerve fiber layer. The untreated retina and choroid between burns was not involved and appeared normal at each period. Thirty days after treatment, the scarring produced by these two types of burns was identical. Seventy-one eyes with proliferative diabetic retinopathy having three or four retinopathy risk factors were treated with panretinal laser photocoagulation, and followed in a prospective study for 6 months. Thirty-six eyes were randomly selected for blue-green argon treatment, and 35 were randomly selected for red krypton treatment. The incidence of undesired side effects during the first 2 weeks following treatment was almost identical between the two groups. However, by 1 month the majority of eyes in both groups had visual acuities equal to or better than the pretreatment acuities and complete regression of NVD. Six months after treatment, the majority of eyes in both groups continued to have visual acuities equal to or better than the pretreatment acuities with fewer cases having larger losses of vision in the krypton treated group. Loss of peripheral visual field was equal with the two types of treatment having a minimal decrease with the IV-4e isopter, but substantial loss with the I-4e isopter. Additional vitreous hemorrhage rarely occurred in either group, but was slightly more frequent in those treated with krypton. Complete regression was accomplished in most eyes with pretreatment disc and/or NVE in both groups, but persistence of neovascularization was more frequent in those treated with krypton. Overall, the wavelength used seemingly had little effect on the result.(ABSTRACT TRUNCATED AT 400 WORDS)