Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Mar 15;3(3):CD012314.
doi: 10.1002/14651858.CD012314.pub2.

Different lasers and techniques for proliferative diabetic retinopathy

Tanya Moutray  1 , Jennifer R Evans, Noemi Lois, David J Armstrong, Tunde Peto, Augusto Azuara-Blanco
Affiliations
Meta-Analysis

Different lasers and techniques for proliferative diabetic retinopathy

Tanya Moutray et al. Cochrane Database Syst Rev. .

Abstract

Background: Diabetic retinopathy (DR) is a chronic progressive disease of the retinal microvasculature associated with prolonged hyperglycaemia. Proliferative DR (PDR) is a sight-threatening complication of DR and is characterised by the development of abnormal new vessels in the retina, optic nerve head or anterior segment of the eye. Argon laser photocoagulation has been the gold standard for the treatment of PDR for many years, using regimens evaluated by the Early Treatment of Diabetic Retinopathy Study (ETDRS). Over the years, there have been modifications of the technique and introduction of new laser technologies.

Objectives: To assess the effects of different types of laser, other than argon laser, and different laser protocols, other than those established by the ETDRS, for the treatment of PDR. We compared different wavelengths; power and pulse duration; pattern, number and location of burns versus standard argon laser undertaken as specified by the ETDRS.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 8 June 2017.

Selection criteria: We included randomised controlled trials (RCTs) of pan-retinal photocoagulation (PRP) using standard argon laser for treatment of PDR compared with any other laser modality. We excluded studies of lasers that are not in common use, such as the xenon arc, ruby or Krypton laser.

Data collection and analysis: We followed Cochrane guidelines and graded the certainty of evidence using the GRADE approach.

Main results: We identified 11 studies from Europe (6), the USA (2), the Middle East (1) and Asia (2). Five studies compared different types of laser to argon: Nd:YAG (2 studies) or diode (3 studies). Other studies compared modifications to the standard argon laser PRP technique. The studies were poorly reported and we judged all to be at high risk of bias in at least one domain. The sample size varied from 20 to 270 eyes but the majority included 50 participants or fewer.Nd:YAG versus argon laser (2 studies): very low-certainty evidence on vision loss, vision gain, progression and regression of PDR, pain during laser treatment and adverse effects.Diode versus argon laser (3 studies): very-low certainty evidence on vision loss, vision gain, progression and regression of PDR and adverse effects; moderate-certainty evidence that diode laser was more painful (risk ratio (RR) troublesome pain during laser treatment (RR 3.12, 95% CI 2.16 to 4.51; eyes = 202; studies = 3; I2 = 0%).0.5 second versus 0.1 second exposure (1 study): low-certainty evidence of lower chance of vision loss with 0.5 second compared with 0.1 second exposure but estimates were imprecise and compatible with no difference or an increased chance of vision loss (RR 0.42, 95% CI 0.08 to 2.04, 44 eyes, 1 RCT); low-certainty evidence that people treated with 0.5 second exposure were more likely to gain vision (RR 2.22, 95% CI 0.68 to 7.28, 44 eyes, 1 RCT) but again the estimates were imprecise . People given 0.5 second exposure were more likely to have regression of PDR compared with 0.1 second laser PRP again with imprecise estimate (RR 1.17, 95% CI 0.92 to 1.48, 32 eyes, 1 RCT). There was very low-certainty evidence on progression of PDR and adverse effects.'Light intensity' PRP versus classic PRP (1 study): vision loss or gain was not reported but the mean difference in logMAR acuity at 1 year was -0.09 logMAR (95% CI -0.22 to 0.04, 65 eyes, 1 RCT); and low-certainty evidence that fewer patients had pain during light PRP compared with classic PRP with an imprecise estimate compatible with increased or decreased pain (RR 0.23, 95% CI 0.03 to 1.93, 65 eyes, 1 RCT).'Mild scatter' (laser pattern limited to 400 to 600 laser burns in one sitting) PRP versus standard 'full' scatter PRP (1 study): very low-certainty evidence on vision and visual field loss. No information on adverse effects.'Central' (a more central PRP in addition to mid-peripheral PRP) versus 'peripheral' standard PRP (1 study): low-certainty evidence that people treated with central PRP were more likely to lose 15 or more letters of BCVA compared with peripheral laser PRP (RR 3.00, 95% CI 0.67 to 13.46, 50 eyes, 1 RCT); and less likely to gain 15 or more letters (RR 0.25, 95% CI 0.03 to 2.08) with imprecise estimates compatible with increased or decreased risk.'Centre sparing' PRP (argon laser distribution limited to 3 disc diameters from the upper temporal and lower margin of the fovea) versus standard 'full scatter' PRP (1 study): low-certainty evidence that people treated with 'centre sparing' PRP were less likely to lose 15 or more ETDRS letters of BCVA compared with 'full scatter' PRP (RR 0.67, 95% CI 0.30 to 1.50, 53 eyes). Low-certainty evidence of similar risk of regression of PDR between groups (RR 0.96, 95% CI 0.73 to 1.27, 53 eyes). Adverse events were not reported.'Extended targeted' PRP (to include the equator and any capillary non-perfusion areas between the vascular arcades) versus standard PRP (1 study): low-certainty evidence that people in the extended group had similar or slightly reduced chance of loss of 15 or more letters of BCVA compared with the standard PRP group (RR 0.94, 95% CI 0.70 to 1.28, 270 eyes). Low-certainty evidence that people in the extended group had a similar or slightly increased chance of regression of PDR compared with the standard PRP group (RR 1.11, 95% CI 0.95 to 1.31, 270 eyes). Very low-certainty information on adverse effects.

Authors' conclusions: Modern laser techniques and modalities have been developed to treat PDR. However there is limited evidence available with respect to the efficacy and safety of alternative laser systems or strategies compared with the standard argon laser as described in ETDRS.

PubMed Disclaimer

Conflict of interest statement

Tanya Moutray has received educational travel grants from Novartis Pharmaceuticals and Bayer HealthCare Pharmaceuticals. Jennifer Evans has no conflicts of interest. David Armstrong has no conflicts of interest. Tunde Peto has no conflicts of interest. Noemi Lois has no conflicts of interest. Augusto Azuara‐Blanco has no conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bandello 1993 {published data only}
    1. Bandello F, Brancato R, Trabucchi G, Lattanzio R, Malegori A. Diode versus argon‐green laser panretinal photocoagulation in proliferative diabetic retinopathy: a randomized study in 44 eyes with a long follow‐up time. Graefe's Archive for Clinical and Experimental Ophthalmology 1993;231(9):491‐4. - PubMed
    1. Brancato R, Bandello F, Trabucchi G, Leoni G, Lattanzio R. Argon and diode laser photocoagulation in proliferative diabetic retinopathy: A preliminary report. Lasers and Light in Ophthalmology 1990;3(3):233‐7.
Bandello 1996 {published data only}
    1. Bandello F, Brancato R, Lattanzio R, Trabucchi G, Azzolini C, Malegori A. Double‐frequency Nd:YAG laser vs. argon‐green laser in the treatment of proliferative diabetic retinopathy: randomized study with long‐term follow‐up. Lasers in Surgery and Medicine 1996;19(2):173‐6. - PubMed
Bandello 2001 {published data only}
    1. Bandello F, Brancato R, Menchini U, Virgili G, Lanzetta P, Ferrari E, et al. Light panretinal photocoagulation (LPRP) versus classic panretinal photocoagulation (CPRP) in proliferative diabetic retinopathy. Seminars in Ophthalmology 2001;16(1):12‐8. - PubMed
    1. Bandello FM, Brancato R, Menchini U, Lanzetta P. Light panretinal photocoagulation (LPRP) versus classic panretinal photocoagulation (CPRP) in proliferative diabetic retinopathy (PDR). American Academy of Ophthalmology. 1999:240. - PubMed
Blankenship 1988 {published data only}
    1. Blankenship GW. A clinical comparison of central and peripheral argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 1988;95(2):170‐7. - PubMed
Brancato 1991 {published data only}
    1. Brancato R, Bandello F, Trabucchi G, Lattanzio R. Frequency‐doubled Nd:YAG laser versus argon‐green laser photocoagulation in proliferative diabetic retinopathy: A preliminary report. Lasers and Light in Ophthalmology 1991;4(2):97‐102.
Han 1995 {published data only}
    1. Han HJ, Oum BS. Diode laser panretinal photocoagulation in diabetic retinopathy. Journal of the Korean Ophthalmological Society 1995;36(11):1972‐9.
Nikkhah 2017 {published data only}
    1. Nikkhah H, Ghazi H, Razzaghi M R, Karimi S, Ramezani A, Soheilian M. Extended targeted retinal photocoagulation versus conventional pan‐retinal photocoagulation for proliferative diabetic retinopathy in a randomized clinical trial. International Ophthalmology 2017 Feb 6 [Epub ahead of print]. [DOI: 10.1007/s10792-017-0469-7] - DOI - PubMed
Pahor 1998 {published data only}
    1. Pahor D. Visual field loss after argon laser panretinal photocoagulation in diabetic retinopathy: Full‐ versus mild‐scatter coagulation. International Ophthalmology 1998;22(5):313‐9. - PubMed
Tewari 2000 {published data only}
    1. Tewari HK, Ravindranath HM, Kumar A, Verma L. Diode laser scatter photocoagulation in diabetic retinopathy. Annals of Ophthalmology ‐ Glaucoma 2000;32(2):110‐2.
Theodossiadis 1990 {published data only}
    1. Theodossiadis GP, Boudouri A, Georgopoulos G, Koutsandrea C. Central visual field changes after panretinal photocoagulation in proliferative diabetic retinopathy. Ophthalmologica 1990;201(2):71‐8. - PubMed
Wade 1990 {published data only}
    1. Wade EC, Blankenship GW. The effect of short versus long exposure times of argon laser panretinal photocoagulation on proliferative diabetic retinopathy. Graefe's Archive for Clinical and Experimental Ophthalmology 1990;228(3):226‐31. - PubMed

References to studies excluded from this review

Al Hussainy 2008 {published data only}
    1. Al‐Husainy SS, Dodson PM, Gibson JM. Pain response and follow‐up of patients undergoing panretinal laser photocoagulation with reduced exposure times. Eye 2008;22(1):96‐9. - PubMed
    1. Al‐Husainy SS, Dodson PM, Gibson JM. Pain response in patients undergoing panretinal photocoagulation by continuous Wave Nd‐YAG laser. Investigative Ophthalmology and Visual Science 2002; Vol. 43:ARVO E‐abstract 3459.
Alvarez Verduzco 2010 {published data only}
    1. Alvarez‐Verduzco O, Garcia‐Aguirre G, Lopez‐Ramos Mde L, Vera‐Rodriguez S, Guerrero‐Naranjo JL, Morales‐Canton V. Reduction of fluence to decrease pain during panretinal photocoagulation in diabetic patients. Ophthalmic Surgery Lasers and Imaging 2010;41(4):432‐6. - PubMed
Beetham 1969 {published data only}
    1. Beetham WP, Aiello LM, Balodimos MC, Koncz L. Ruby‐laser photocoagulation of early diabetic neovascular retinopathy: preliminary report of a long‐term controlled study. Transactions of the American Ophthalmological Society 1969;67:39‐67. - PMC - PubMed
Belucio‐Neto 2015 {published data only}
    1. Belucio‐Neto J, Oliveira Xavier C, Oliveira Dias JR, Passos RM, Maia M, Maia A. Functional and anatomical outcomes in patients submitted to panretinal photocoagulation using 577nm multispot vs 532nm single‐spot laser: A clinical trial. Investigative Ophthalmology and Visual Science 2016;57:ARVO E‐abstract 5856.
    1. Belucio‐Neto J, Passos RM, Oliveira Xavier C, Oliveira Dias JR, Moraes N, Maia AM. Evaluation of 577nm multispot vs 532nm single‐spot panretinal photocoagulation for diabetic retinopathy: A clinical trial. Investigative Ophthalmology and Visual Science 2015; Vol. 56:ARVO E‐abstract 5686.
Blankenship 1986 {published data only}
    1. Blankenship GW. Red krypton and blue‐green argon panretinal laser photocoagulation for proliferative diabetic retinopathy: a laboratory and clinical comparison. Transactions of the American Ophthalmological Society 1986;84:967‐1003. - PMC - PubMed
    1. Blankenship GW, Gerke E, Batlle JF. Red krypton and blue‐green argon laser diabetic panretinal photocoagulation. Graefe's Archive for Clinical and Experimental Ophthalmology 1989;227(4):364‐8. - PubMed
Blankenship 1991 {published data only}
    1. Blankenship GW. Fifteen‐year argon laser and xenon photocoagulation results of Bascom Palmer Eye Institute's patients participating in the diabetic retinopathy study. Ophthalmology 1991;98(2):125‐8. - PubMed
Canning 1991 {published data only}
    1. Canning C, Polkinghorne P, Ariffin A, Gregor Z. Panretinal laser photocoagulation for proliferative diabetic retinopathy: the effect of laser wavelength on macular function. British Journal of Ophthalmology 1991;75(10):608‐10. - PMC - PubMed
Capoferri 1990 {published data only}
    1. Capoferri C, Bagini M, Chizzoli A, Pece A, Brancato R. Electroretinographic findings in panretinal photocoagulation for diabetic retinography. A randomized study with blue‐green argon and red krypton lasers. Graefe's Archive for Clinical and Experimental Ophthalmology 1990;228(3):232‐6. - PubMed
Chen 2004 {published data only}
    1. Chen Y, Dong Y, Guo X. Clinical research in the treatment of diabetic retinopathy using different wavelength Krypton lasers photocoagulation. Chinese Ophthalmic Research 2004;22(1):89‐91.
Chen 2013 {published data only}
    1. Chen Z, Song Y. Functional and structural changes after pattern scanning laser photocoagulation in diabetic retinopathy. Documenta Ophthalmologica 2013;127(1 Suppl. 1):37‐8.
Chew 1991 {published data only}
    1. Chew E, Ferris F, Singerman LJ, Brucker A, Murphy R, Mowery R. Clinical results of the Krypton‐Argon regression of Neovascularization Study (KARNS). The Macula Society 1991:40.
Chhablani 2014 {published data only}
    1. Chhablani J, Mathai A, Rani P, Gupta V, Arevalo JF, Kozak I. Comparison of conventional pattern and novel navigated panretinal photocoagulation in proliferative diabetic retinopathy. Investigative Ophthalmology and Visual Science 2014;55(6):3432‐8. - PubMed
    1. Chhablani J, Sambhana S, Mathai A, Gupta V, Arevalo JF, Kozak I. Clinical efficacy of navigated panretinal photocoagulation in proliferative diabetic retinopathy. American Journal of Ophthalmology 2015;159(5):884‐9. - PubMed
Crick 1978 {published data only}
    1. Crick MD, Chignell AH, Shilling JS. Argon laser v. xenon arc photocoagulation in proliferative diabetic retinopathy. Transactions of the Ophthalmological Societies of the United Kingdom 1978;98(1):170‐1. - PubMed
Doft 1982 {published data only}
    1. Doft BH, Blankenship GW. Single versus multiple treatment sessions of argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 1982;89(7):772‐9. - PubMed
Dong 2008 {published data only}
    1. Dong L, Mu H, Feng ZL, Zhang XM, Wang BJ. Influence of different sequence of laser photocoagulation position on curative effect. International Journal of Ophthalmology 2008;8(4):760‐2.
Fankhauser 1972 {published data only}
    1. Fankhauser F, Gloor BP, Lotmar W, Roulier A. Results of the treatment of diabetic retinopathy by photocoagulation using the argon gas laser and the xenon high pressure lamp. Modern Problems in Ophthalmology 1972;10:558‐63. - PubMed
    1. Fankhauser F, Lotmar W, Roulier A. Comparative management of diabetic retinopathy using photocoagulation with the Argon laser and Xenon high‐pressure lamp. I. Theoretical principles of phototherapy, side‐effects and apparatus design. Graefe's Archive for Clinical and Experimental Ophthalmology 1972;183(4):334‐7. - PubMed
Francois 1971 {published data only}
    1. Francois J, Cambie E. Retinal photocoagulation (xenon arc and lasers). Annals of Ophthalmology 1971;3(11):1201‐8. - PubMed
Francois 1977 {published data only}
    1. Francois J, Cambie E. Argon laser photocoagulation in diabetic retinopathy. A comparative study of three different methods of treatment. Metabolic Ophthalmology 1977;1(2):125‐30.
Geltzer 1972 {published data only}
    1. Geltzer AI. Laser photocoagulation and diabetic retinopathy. Rhode Island Medical Journal 1972;55(9):275‐81. - PubMed
Ghassemi 2013 {published data only}
    1. Ghassemi F, Ebrahimiadib N, Roohipoor R, Moghimi S, Alipour F. Nerve fiber layer thickness in eyes treated with red versus green laser in proliferative diabetic retinopathy: short‐term results. Ophthalmologica 2013;230(4):195‐200. - PubMed
Guo 2013 {published data only}
    1. Guo Y, Liu Y, Zhang SB. Proliferative diabetic retinopathy observed after laser photocoagulation. International Eye Science 2013;13(11):2333‐5.
Hamilton 1981 {published data only}
    1. Hamilton AM, Townsend C, Khoury D, Gould E, Blach RK. Xenon arc and argon laser photocoagulation in the treatment of diabetic disc neovascularization. Part 1. Effect on disc vessels, visual fields, and visual acuity. Transactions of the Ophthalmological Societies of the United Kingdom 1981;101(1):87‐92. - PubMed
Inan 2016 {published data only}
    1. Inan UU, Polat O, Inan S, Yigit S, Baysal Z. Comparison of pain scores between patients undergoing panretinal photocoagulation using navigated or pattern scan laser systems. Arquivos Brasileiros de Oftalmologia 2016;79(1):15‐8. - PubMed
KARNS 1994 {published data only}
    1. Anonymous. Randomized comparison of krypton versus argon scatter photocoagulation for diabetic disc neovascularization. The Krypton Argon Regression Neovascularization Study report number 1. Ophthalmology 1993;100(11):1655‐64. - PubMed
    1. Anonymous. Randomized comparison of krypton versus argon scatter photocoagulation for diabetic disc neovascularizion. Laser and Light in Ophthalmology 1994; Vol. 6:204.
    1. Singerman LJ, Ferris FL, Chew EY, Murphy RP, Brucker AJ. Krypton Argon Regression of Neovascularization Study: results of a randomized controlled clinical trial. American Academy of Ophthalmology 1992:92.
    1. Singerman LJ, Ferris FL, Mowery RP, Brucker AJ, Murphy RP, Lerner BC, et al. Krypton Argon Regression of Neovascularization Study (KARNS). The Macula Society 1987:72. - PubMed
    1. Singerman LJ, Ferris FL, Mowery RP, Brucker AJ, Murphy RP, Lerner BC, et al. Krypton laser for proliferative diabetic retinopathy: the Krypton Argon Regression of Neovascularization Study. Journal of Diabetic Complications 1988;2(4):189‐96. - PubMed
Khosla 1994 {published data only}
    1. Khosla PK, Rao V, Tewari HK, Kumar A. Contrast sensitivity in diabetic retinopathy after panretinal photocoagulation. Ophthalmic Surgery 1994;25(8):516‐20. - PubMed
Kovacic 2012 {published data only}
    1. Kovacic Z, Ivanisevic M, Bojic L, Hrgovic Z, Lesin M, Kurelovic D. Comparing two techniques of panretinal photocoagulation on visual acuity on patients with proliferative diabetic retinopathy. Medicinski Arhiv 2012;66(5):321‐3. - PubMed
Li 1986 {published data only}
    1. Li XX, Lapp ER, Bornfeld N, Gerke E, Foerster MH. Electroretinography findings in proliferative diabetic retinopathy following argon laser coagulation of the middle and exterior peripheral retina. Fortschritte der Ophthalmologie 1986; Vol. 83, issue 4:459‐61. - PubMed
Liang 1983 {published data only}
    1. Liang JC, Fishman GA, Huamonte FU, Anderson RJ. Comparative electroretinograms in argon laser and xenon arc panretinal photocoagulation. British Journal of Ophthalmology 1983;67(8):520‐5. - PMC - PubMed
Lopez 2008 {published data only}
    1. Lopez MD, Velez‐Montoya R, Vera‐Rodriguez S, Martinez‐Castellanos M, Burgos‐Vejar O, Gonzalez‐Mijares CC, et al. Pattern‐scan laser system vs. conventional photocoagulation: changes in macular thickness after treatment. Investigative Ophthalmology and Visual Science 2008:ARVO E‐ abstract 2768.
    1. Perez Montesinos A, Velez‐Montoya R, Burgos O, Lopez‐Ramos L, Alvarez‐Verduzco O, Gonzalez‐Mijares C, et al. Pattern scan laser system vs. regular photocoagulation system: changes in contrast sensitivity post treatment in patients with diabetic retinopathy. Investigative Ophthalmology and Visual Science 2008:ARVO E‐ abstract 3507.
    1. Vera‐Rodriguez SE, Velez‐Montoya R, Lopez‐Ramos ML, Alvarez‐Verduzco O, Martinez‐Castellanos MA, Gonzalez‐Mijares CC, et al. Pattern scan laser system vs. conventional photocoagulation system: electroretinogram changes after treatment. Investigative Ophthalmology and Visual Science 2008:ARVO E‐ abstract 2766.
Ludwig 1994 {published data only}
    1. Ludwig K, Lasser T, Sakowski H, Abramowski H, Worz G. Continuous wave laser photocoagulation at different wavelengths: Equivalent power settings in edematous and non‐edematous retina. Lasers and Light in Ophthalmology 1994;6(3):159‐67. - PubMed
MAPASS 2010 {published data only}
    1. Muqit MM, Gray JC, Marcellino GR, Henson DB, Fenerty CH, Stanga PE. Randomized clinical trial to evaluate the effects of Pascal panretinal photocoagulation on macular nerve fiber layer: Manchester Pascal Study report 3. Retina 2011;31(8):1699‐707. - PubMed
    1. Muqit MM, Gray JC, Marcellino GR, Henson DB, Young LB, Patton N, et al. In vivo laser‐tissue interactions and healing responses from 20‐ vs 100‐millisecond pulse Pascal photocoagulation burns. Archives of Ophthalmology 2010;128(4):448‐55. - PubMed
    1. Muqit MM, Marcellino GR, Gray JC, McLauchlan R, Henson DB, Young LB, et al. Pain responses of Pascal 20 ms multi‐spot and 100 ms single‐spot panretinal photocoagulation: Manchester Pascal Study, MAPASS report 2. British Journal of Ophthalmology 2010;94(11):1493‐8. - PubMed
    1. Muqit MM, Marcellino GR, Henson DB, Young LB, Patton N, Charles SJ, et al. Single‐session vs multiple‐session pattern scanning laser panretinal photocoagulation in proliferative diabetic retinopathy: The Manchester Pascal Study. Archives of Ophthalmology 2010;128(5):525‐33. - PubMed
    1. Muqit MM, Marcellino GR, Henson DB, Young LB, Turner GS, Stanga PE. Pascal panretinal laser ablation and regression analysis in proliferative diabetic retinopathy: Manchester Pascal Study Report 4. Eye 2011;25(11):1447‐56. - PMC - PubMed
McLean 1976 {published data only}
    1. McLean EB. Argon and xenon photocoagulation in the treatment of diabetic retinopathy. Transactions of the Pacific Coast Oto‐Ophthalmological Society annual meeting 1976;57:183‐92. - PubMed
Menchini 1990 {published data only}
    1. Menchini U, Scialdone A, Pietroni C, Carones F, Brancato R. Argon versus krypton panretinal photocoagulation side effects on the anterior segment. Ophthalmologica 1990;201(2):66‐70. - PubMed
Menchini 1995 {published data only}
    1. Menchini U, Lanzetta P, Soldano F, Ferrari E, Virgili G. Continuous wave Nd:YAG laser photocoagulation in proliferative diabetic retinopathy. British Journal of Ophthalmology 1995;79(7):642‐5. - PMC - PubMed
Mirshahi 2013 {published data only}
    1. Mirshahi A, Lashay A, Roozbahani M, Fard MA, Molaie S, Mireshghi M, et al. Pain score of patients undergoing single spot, short pulse laser versus conventional laser for diabetic retinopathy. Graefe's Archive for Clinical and Experimental Ophthalmology 2013;251(4):1103‐7. - PubMed
Muraly 2011 {published data only}
    1. Muraly P, Limbad P, Srinivasan K, Ramasamy K. Single session of Pascal versus multiple sessions of conventional laser for panretinal photocoagulation in proliferative diabetic retinopathy: a comparitive study. Retina 2011;31(7):1359‐65. - PubMed
Nagpal 2008 {published data only}
    1. Nagpal M, Marlecha S, Nagpal, K. Comparative study of efficacy and of collateral damage of laser burns using single spot argon laser and pattern scan laser. American Academy of Ophthalmology 2008:263.
Nagpal 2010 {published data only}
    1. Nagpal M, Marlecha S, Nagpal, K. Comparison of laser photocoagulation for diabetic retinopathy using 532‐nm standard laser versus multispot pattern scan laser. Retina 2010;30(3):452‐8. - PubMed
Peng 2013 {published data only}
    1. Peng ZH, Cheng GM, Wu L. Observation of clinical efficacy of pattern scan laser photocoagulation on diabetic retinopathy. International Eye Science 2013;13(8):1639‐41.
PETER PAN 2011 {published data only}
    1. Muqit MM, Young LB, McKenzie R, John B, Marcellino GR, Henson DB, et al. Pilot randomised clinical trial of Pascal TargETEd Retinal versus variable fluence PANretinal 20 ms laser in diabetic retinopathy: PETER PAN study. British Journal of Ophthalmology 2013;97(2):220‐7. - PubMed
Plumb 1982 {published data only}
    1. Plumb AP, Swan AV, Chignell AH, Shilling JS. A comparative trial of xenon arc and argon laser photocoagulation in the treatment of proliferative diabetic retinopathy. British Journal of Ophthalmology 1982;66(4):213‐8. - PMC - PubMed
Roohipoor 2016 {published data only}
    1. Roohipoor R, Dantism S, Ahmadraji A, Karkhaneh R, Zarei M, Ghasemi F. Subfoveal choroidal thickness after panretinal photocoagulation with red and green laser in bilateral proliferative diabetic retinopathy patients: short term results. Journal of Ophthalmology 2016;2016:9364861. - PMC - PubMed
Sato 2012 {published data only}
    1. Sato Y, Kojimahara N, Kitano S, Kato S, Ando N, Yamaguchi N, et al. Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy. Japanese Journal of Ophthalmology 2012;56(1):52‐9. - PubMed
Schulenburg 1979 {published data only}
    1. Schulenburg WE, Hamilton AM, Blach RK. A comparative study of argon laser and krypton laser in the treatment of diabetic optic disc neovascularisation. British Journal of Ophthalmology 1979;63(6):412‐7. - PMC - PubMed
Seiberth 1987 {published data only}
    1. Seiberth V, Alexandridis E. Function of the diabetic retina after panretinal argon laser photocoagulation. Influence of the intensity of the coagulation spots. Ophthalmologica 1991;202(1):10‐7. - PubMed
    1. Seiberth V, Alexandridis E. Feng W. Function of the diabetic retina after panretinal argon laser coagulation. Graefe's Archive for Clinical and Experimental Ophthalmology 1987;225(6):385‐90. - PubMed
Seiberth 1993 {published data only}
    1. Seiberth V, Schatanek S, Alexandridis E. Panretinal photocoagulation in diabetic retinopathy: argon versus dye laser coagulation. Graefe's Archive for Clinical and Experimental Ophthalmology 1993;231(6):318‐22. - PubMed
Seymenoglu 2013 {published data only}
    1. Seymenoglu G, Kayikcioglu O, Baser E, SamiIlker S. Comparison of pain response of patients undergoing panretinal photocoagulation for proliferative diabetic retinopathy: 532 nm standard laser vs. multispot pattern scan laser. Turk Oftalmoloiji Dergisi 2013;43(4):221‐4.
Shiraya 2014 {published data only}
    1. Shiraya T, Kato S, Shigeeda T, Yamaguchi T, Kaiya T. Comparison of burn size after retinal photocoagulation by conventional and high‐power short‐duration methods. Acta Ophthalmologica 2014;92(7):e585‐6. - PubMed
Ulbig 1994 {published data only}
    1. Ulbig MR, Arden GB, Hamilton AM. Color contrast sensitivity and pattern electroretinographic findings after diode and argon laser photocoagulation in diabetic retinopathy. American Journal of Ophthalmology 1994;117(5):583‐8. - PubMed
    1. Ulbig MW, Hamilton AM. Comparative use of diode and argon laser for panretinal photocoagulation in diabetic retinopathy. Der Ophthalmologe 1993;90(5):457‐62. - PubMed
Yassur 1980 {published data only}
    1. Yassur Y, Pickle LW, Fine SL, Singerman L, Orth DH, Patz, A. Optic disc neovascularisation in diabetic retinopathy: II. Natural history and results of photocoagulation treatment. British Journal of Ophthalmology 1980;64(2):77‐86. - PMC - PubMed
Yilmaz 2016 {published data only}
    1. Yilmaz I, Perente I, Saracoglu B, Yazici AT, Taskapili M. Changes in pupil size following panretinal retinal photocoagulation: conventional laser vs pattern scan laser (PASCAL). Eye 2016;30(10):1359‐64. - PMC - PubMed
Zhang 2017 {published data only}
    1. Zhang S, Cao GF, Xu XZ, Wang CH. Pattern scan laser versus single spot laser in panretinal photocoagulation treatment for proliferative diabetic retinopathy. International Eye Science 2017; Vol. 17, issue 2:205‐8.

References to studies awaiting assessment

Chaine 1986 {published data only}
    1. Chaine G, Zerah I, Coscas G. Panretinal photocoagulation and proliferative diabetic retinopathy. Results of a long‐term prospective study [Photocoagulation pan‐retinienne et retinopathie diabetique proliferante. Resultats d'une etude prospective a long terme]. Bulletin des Sociétés d'Ophtalmologie de France 1986;86(11):1369‐72. - PubMed
Kianersi 2016 {published data only}
    1. Kianersi F, Jamshidimadad A, Dehghani A, Golabchi K, Ghanbari H, Akhlaghi M. Comparison of the effects of the pattern scan and conventional single spot panretinal photocoagulation in patients with proliferative diabetic retinopathy; a randomized clinical trial. Journal of Isfahan Medical School 2016;33(365):2288‐95.
Salman 2011 {published data only}
    1. Salman AG. Pascal laser versus conventional laser for treatment of diabetic retinopathy. Saudi Journal of Ophthalmology 2011; Vol. 25, issue 2:175‐9. - PMC - PubMed
Uehara 1993 {published data only}
    1. Uehara M, Tamura N, Kinjo M, Shinzato K, Fukuda M. A prospective study on necessary and sufficient retinal photocoagulation for diabetic retinopathy. Nippon Ganka Gakkai Zasshi 1993; Vol. 97, issue 1:83‐9. - PubMed
Wroblewski 1991 {published data only}
    1. Wroblewski JJ, Anand R. Macular effects of central versus peripheral scatter laser treatment in proliferative‐diabetic retinopathy. Investigative Ophthalmology and Visual Science 1991; Vol. 32:ARVO abstract 1762.
Yang 2010 {published data only}
    1. Yang JW, Lee YC. Comparison of the effects of patterned and conventional panretinal photocoagulation on diabetic retinopathy. Journal of the Korean Ophthalmological Society 2010; Vol. 51, issue 12:1590‐7.

Additional references

Bressler 2017
    1. Bressler SB, Beaulieu WT, Glassman AR, Gross JG, Jampol LM, Melia M, et al. Factors associated with worsening proliferative diabetic retinopathy in eyes treated with panretinal photocoagulation or ranibizumab. Ophthalmology 2017;124(4):431‐9. - PMC - PubMed
Castillejos‐Rios 1992
    1. Castillejos‐Rios D, Devenyl R, Moffat K, Yu E. Dye yellow vs argon green laser in panretinal photocoagulation for proliferative diabetic retinopathy: a comparison of minimum power requirements. Canadian Journal Ophthalmology 1992;27(5):243‐4. - PubMed
CLARITY 2017
    1. Sivaprasad S, Prevost AT, Vasconcelos JC, Riddell A, Murphy C, Kelly J, et al. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single‐blinded, randomised, controlled, phase 2b, non‐inferiority trial. Lancet 2017;389(10085):2193‐2203. - PubMed
Covidence 2015 [Computer program]
    1. Veritas Health Innovation. Covidence. Version accessed after 3 October 2016. Melbourne, Australia: Veritas Health Innovation, 2015.
DCCT Research Group 1993
    1. DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long‐term complications in insulin‐dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. New England Journal of Medicine 1993;329(14):977‐86. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JP, Altman DG, editor(s). Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JP, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration 2011. Available from handbook.cochrane.org.
DRCR.net protocol S 2015
    1. Diabetic Retinopathy Clinical Research Network. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized trial. JAMA 2015;314(20):2137‐46. - PMC - PubMed
DRS Research Group 1978
    1. Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology 1978;85(1):82‐106. - PubMed
DRS Research Group 1981
    1. Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981;88(7):583‐600. - PubMed
ETDRS Research Group 1985
    1. ETDRS Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study Research Group. Archives of Ophthalmology 1985;103(12):1796‐1806. - PubMed
ETDRS Research Group 1987
    1. ETDRS Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1987;84(7):761‐74. - PubMed
ETDRS Research Group 1991
    1. ETDRS Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):766‐85. - PubMed
Evans 2014
    1. Evans JR, Michelessi M, Virgili G. Laser photocoagulation for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD011234.pub2] - DOI - PMC - PubMed
Feman 2004
    1. Feman SS. Diabetes and the eye. In: Tasman W, Jaeger EA editor(s). Duane's Clinical Ophthalmology. Vol. 5, Philadelphia, PA: Lippincott Williams & Wilkins, 2004.
Geiss 2011
    1. Geiss LS, Cowie C. Type 2 diabetes and persons at high risk of diabetes. In: Venkat Narayan KM, Williams D, Gregg EW, Cowie C editor(s). Diabetes Public Health: from Data to Policy. New York, NY: Oxford University Press, 2011:15–32.
Ghanchi 2013
    1. Ghanchi F, Diabetic Retinopathy Guidelines Working Group. The Royal College of Ophthalmologists’ clinical guidelines for diabetic retinopathy: a summary. Eye 2013;27(2):285–7. - PMC - PubMed
Ghosh 2005
    1. Ghosh F, Gjorloff K. Protein kinase C expression in the rabbit retina after laser photocoagulation. Graefe's Archive for Clinical and Experimental Ophthalmology 2005;243(8):803–10. - PubMed
Glanville 2006
    1. Glanville JM, Lefebvre C, Miles JN, Camosso‐Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130‐6. - PMC - PubMed
GRADEpro 2014 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 5 August 2017. Hamilton (ON): McMaster University (developed by Evidence Prime), 2014.
Gross 2015
    1. Writing Committee for the Diabetic Retinopathy Clinical Research Network, Gross JG, Glassman AR, Jampol LM, Inusah S, Aiello LP, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA 2015;314(20):2137–46. - PMC - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Altman DG, Sterne JAC, editor(s). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Klein 2007
    1. Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiology 2007;14(4):179–83. - PubMed
Martinez‐Zapata 2014
    1. Martinez‐Zapata MJ, Marti‐Carvajal AJ, Sola I, Pijoan JI, Buil‐Calvo JA, Cordero JA, et al. Anti‐vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD008721.pub2] - DOI - PMC - PubMed
Muqit 2010
    1. Muqit MM, Marcellino GR, Henson DB, Young LB, Patton N, Charles SJ, et al. Single‐session vs multiple‐session pattern scanning laser panretinal photocoagulation in proliferative diabetic retinopathy. Archives of Ophthalmology 2010;128(5):525‐33. - PubMed
RCOphth Diabetic Retinopathy Guidelines 2012
    1. DR Guidelines Expert Working Party. Diabetic Retinopathy Guidelines ‐ Royal College of Ophthalmologists. www.rcophth.ac.uk/.../2013‐SCI‐301‐FINAL‐DR‐GUIDELINES‐DEC‐2012 (accessed 25 July 2017).
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
RNIB 2009
    1. RNIB. Future Sight Loss UK 1: The economic impact of partial sight and blindness in the UK adult population. www.rnib.org.uk/sites/default/files/FSUK_Report.pdf (accessed prior to 31 October 2017).
Rowe 2014
    1. Rowe F, Wormald R, Cable R, Acton M, Bonstein K, Bowen M, et al. The Sight Loss and Vision Priority Setting Partnership (SLV‐PSP): overview and results of the research prioritisation survey process. BMJ Open 2014;4(7):e004905. - PMC - PubMed
Royle 2015
    1. Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, et al. Pan‐retinal photocoagulation and other forms of laser treatment and drug therapies for non‐proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technology Assessment 2015; Vol. 19, issue 51:1‐247. - PMC - PubMed
Stefánsson 2001
    1. Stefánsson E. The therapeutic effects of retinal laser treatment and vitrectomy: a theory based on oxygen and vascular physiology. Acta Ophthalmologica Scandinavica 2001;79(5):435‐40. - PubMed
Stratton 2006
    1. Stratton IM, Cull CA, Adler AI, Matthews DR, Neil HA, Holman RR. Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75). Diabetologia 2006;49(8):1761‐9. - PubMed
UKPDS Group 1998
    1. UK Prospective Diabetes Study Group. Intensive blood‐glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352(9131):837‐53. - PubMed
Yau 2012
    1. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35(3):556‐64. - PMC - PubMed

References to other published versions of this review

Moutray 2016
    1. Moutray T, Evans JR, Armstrong DJ, Azuara‐Blanco A. Different lasers and techniques for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews 2016, Issue 8. [DOI: 10.1002/14651858.CD012314] - DOI - PMC - PubMed

Publication types

MeSH terms