What is the term for panretinal laser photocoagulation performed during vitrectomy using an endolaser that does not penetrate the lens, with the lens (crystalline lens) still in the eye?

From the Guidelines

Endolaser panretinal photocoagulation (PRP) during vitrectomy is the term for the procedure being described, which involves applying laser treatment to the peripheral retina from within the eye during a vitrectomy surgery while the lens remains in place. This technique is particularly useful in treating patients with diabetic retinopathy or other retinal vascular diseases that require both vitrectomy and PRP. The endolaser method allows for more complete treatment of the peripheral retina compared to external laser delivery, especially in areas that might be difficult to visualize through conventional methods. Some key points to consider when performing endolaser PRP during vitrectomy include:

• The procedure is typically performed under local or general anesthesia
• The laser parameters are adjusted based on the specific pathology being treated
• The direct application of laser energy causes controlled burns in the peripheral retina, reducing the oxygen demand and decreasing the production of angiogenic factors that contribute to abnormal blood vessel growth Although the provided evidence 1 discusses the use of anti-vascular endothelial growth factor (anti-VEGF) injections as an alternative to traditional panretinal laser photocoagulation, it does not directly address the term for panretinal laser photocoagulation performed during vitrectomy. However, the description of endolaser PRP during vitrectomy is consistent with the goal of reducing the risk of vision loss in patients with high-risk proliferative diabetic retinopathy, as mentioned in the evidence 1. It's worth noting that the evidence 1 highlights the effectiveness of intravitreal injections of anti-VEGF agents in regressing proliferative disease and leading to noninferior or superior visual acuity outcomes compared with panretinal laser over 2 years of follow-up. Despite this, endolaser PRP during vitrectomy remains a valuable treatment option for patients with diabetic retinopathy or other retinal vascular diseases, particularly when combined with vitrectomy surgery.

From the Research

Panretinal Laser Photocoagulation

• The term for panretinal laser photocoagulation performed during vitrectomy using an endolaser that does not penetrate the lens, with the lens (crystalline lens) still in the eye, is endoscopic panretinal photocoagulation (EPRP) or endolaser photocoagulation 2.
• This procedure is often used to treat complications related to vasoproliferative diabetic retinopathy, such as vitreous hemorrhage and retinal detachment 2.
• The goal of EPRP is to destroy more than 35% and up to 50% of photoreceptors to prevent the growth of fibrovascular membranes and reduce the risk of complications 2.

Benefits and Complications

• EPRP has been shown to be effective in improving the anatomical state of the retina and stabilizing visual acuity in patients with proliferative diabetic retinopathy 2.
• However, panretinal photocoagulation (PRP) can also cause complications such as choroidal effusions, exudative retinal detachments, macular edema, visual field deficits, and night vision defects 3.
• The occurrence of these complications is closely tied to laser parameters such as increased duration and power and intensive treatment in a single sitting 3.

Alternative Treatments

• Other treatments for diabetic retinopathy include intravitreous ranibizumab, which has been shown to be noninferior to PRP for visual acuity outcomes in patients with proliferative diabetic retinopathy 4.
• Vitrectomy can also be used to restore useful vision to patients with severe diabetic retinopathy and vitreous hemorrhage with or without an accompanying traction retinal detachment 5.