Pascal laser use in the treatment of retinal pathology

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; ALCARAZ, A.; LOPEZ, A.; BARDACH, A.; CIAPPONI, A; CESARONI, S

Documento de Evaluación de Tecnologías Sanitarias

IECS

Año: 2012 p. 1 - 30

1668-2793

The treatment of several retina conditions using laser is a non-invasive safe method widely used in ophthalmology.Intended to simplify laser application and to improve precision of shots, a new device called PASCAL (Pattern scanning laser) has been developed.Pascal Laser TechnologyIt is a semi-automatic system that reduces the duration of shots thus allowing laser burns to be evenly and equidistantly placed on the retina.PurposeTo evaluate the available evidence on the effectiveness and safety of the PASCAL device for the treatment of retina conditions.MethodsA bibliographic search was carried out on the main databases: DARE, NHS EED, on Internet general search engines, in health technology evaluation agencies and health sponsors. Priority was given to the inclusion of systematic reviews; controlled, randomized clinical trials (RCTs); health technology assessments and economic evaluations; clinical practice guidelines and coverage policies of other health systems.ResultsFour controlled, randomized, prospective studies were identified which included patients with diabetic retinopathy. Three compared conventional laser with Pascal laser and one compared the shots of different durations using the Pascal device; additionally, two retrospective studies were included.In the studies analyzed which compared Pascal laser versus the conventional laser, no statistically significant differences were observed regarding visual acuity post-treatment while statistically significant differences were observed favoring the PASCAL group as regards procedure duration and perception of pain. As regards treatment effectiveness both Napgal et al who evaluated patients with proliferative diabetic retinopathy (PDR) or non-proliferative diabetic retinopathy (NPDR) and Muraly et al, who studied patient with RDP, did not find statistically significant differences between the conventional laser group and the PASCAL group. Although Salman et al did not find significant changes in the regression rate of macular edema in NPDR patients, they did observe a significant greater difference in neovascularization regression rate in the NPDR patients who received PASCAL laser treatment.In the study conducted by Mugit et al, different shot durations were compared in one or along several sessions using PASCAL laser, but no statistically significant differences were reported in the percent of patients with RDP who responded to treatment nor modifications in visual field or visual acuity, although there were statistically significant differences in treatment duration, pain classification and photophobia duration, favoring the PASCAL group who used 20 msec in one session.As regards the retrospective studies included, one describes the visual acuity rate after using the PASCAL device in different conditions and the other the adverse effects observed.ConclusionsIn general, the studies did not find statistically significant differences in treatment effectiveness, visual acuity or visual field changes post-treatment when using conventional laser or PASCAL.The main reported advantages when compared against conventional laser were decreased treatment time and pain.More controlled randomized studies are required to obtain a better level of evidence of this technology results.