Purpose: To compare pain related to intravitreal injection and panretinal photocoagulationin the management of patients with higha-risk proliferative diabeticretinopathy. Methods: Prospective study including patients with high-risk proliferative diabeticretinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group) or panretinal photocoagulation plus intravitrealranibizumab (PRPplus group). In all patients, panretinal photocoagulation wasadministered in two sessions (weeks 0 and 2), and intravitreal ranibizumab wasadministered at the end of the first laser session in the PRPplus group. Retreatmentwas performed at weeks 16 and 32 if active new vessels were detected at fluoresceinangiography. Patients in the PRPplus group received intravitreal ranibizumaband patients in the PRP group received 500-μm additional spots per quadrant ofactive new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity ofpain during the whole procedure (retinal photocoagulation session or intravitrealranibizumab injection). Statistics for pain score comparison were performed usinga nona-parametric test (Wilcoxon rank sums).Results: Seventeen patients from PRPplus and 14 from PRP group were evaluatedfor pain scores. There were no significant differences between both groups regardinggender, glycosylated hemoglobin and disease duration. Mean intravitrealinjection pain (±SEM) was 4.7 ± 2.1 and was significantly lower (p <0.0001) than mean panretinal photocoagulation pain (60.8 ± 7.8). Twelve out of 17 patientsfrom the PRPplus group referred intensity pain score of zero, while the minimalscore found in PRP group was found in one patient with 10.5.Conclusion: In patients with higha-risk proliferative diabetic retinopathy who neededretreatment for persistent new vessels, there was more comfort for the patientwhen retreatment was performed with an intravitreal injection in comparisonwith retinal photocoagulation. Further larger studies are necessary to confirmour preliminary findings.
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