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Comparison of Pain Scores Among Patients Undergoing Conventional and Novel Panretinal Photocoagulation for Diabetic Retinopathy: A Systematic Review

Authors Azarcon CP, Artiaga JCM

Received 30 November 2020

Accepted for publication 11 January 2021

Published 2 March 2021 Volume 2021:15 Pages 953—971


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Corrina P Azarcon,1 Jose Carlo M Artiaga2,3

1Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines – Manila, Manila, Philippines; 2International Eye Institute, St. Luke’s Medical Center Global City, Taguig City, Philippines; 3Department of Ophthalmology, Ospital ng Muntinlupa, Muntinlupa City, Philippines

Correspondence: Corrina P Azarcon
Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines – Manila, Manila, Philippines
Email [email protected]

Purpose: To summarize key findings from a systematic review focusing on pain as an adverse outcome of panretinal photocoagulation (PRP) among patients with diabetic retinopathy.
Design: Systematic review.
Methods: We systematically searched articles in major databases from July to September 2020. Studies that compared pain outcomes of PRP among diabetic patients who underwent conventional single-spot laser (SSL), conventional multi-spot laser (MSL), and/or novel navigated laser (NNL) were included. The Cochrane RoB 2 tool and ROBINS-I tool were used to evaluate the risk of bias of the included randomized controlled trials (RCTs) and controlled clinical trials (CCTs), respectively.
Results: We included 13 RCTs and 4 CCTs. Thirteen studies were included for Comparison 1 (Conventional SSL versus Conventional MSL), 3 studies were included for Comparison 2 (NNL versus Conventional MSL), and 3 studies were included for Comparison 3 (NNL versus Conventional SSL). A total of 783 patients and 1961 eyes were included in this review. The review showed that NNL yielded the lowest pain scores, followed by conventional MSL, then by conventional SSL.
Conclusion: This review summarizes findings of multiple studies that reported pain as an adverse outcome of PRP among patients with advanced diabetic retinopathy. Data from RCTs with mostly some concerns for bias (RoB 2 tool) and CCTs with mostly moderate risk of bias (ROBINS-I tool) show benefit of using MSL over SSL, and NNL over conventional systems for PRP in diabetic retinopathy, considering pain as the primary outcome.

Keywords: pain, panretinal photocoagulation, diabetic retinopathy, PASCAL®, NAVILAS®

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