Serous Retinal Detachment Following Panretinal Photocoagulation (PRP) Using Pattern Scan Laser (PASCAL) Photocoagulator

OPEN ACCESS Case Report
Serous retinal detachment following panretinal

photocoagulation (PRP) using Pattern Scan Laser
(PASCAL) photocoagulator
Abstract
Objective: To report a case of serous retinal detachment after Pattern Georges Azar1
Scan Laser (PASCAL) treatment in a diabetic woman.
Benjamin Wolff1
Methods: A 34-year-old diabetic woman presented with florid diabetic
retinopathy after a miscarriage during the 20th week of pregnancy. Her Pierre-Loïc Cornut2
Best Corrected Visual Acuity (BCVA) was 20/40 right eye (OD) and 20/30 Martine
left eye (OS). Fundus exam showed multiple microaneurysms, large blot Mauget-Faÿsse3
hemorrhages and venous dilation both eyes (OU). Fundus fluorescein
angiography (FFA) revealed large areas of capillary nonperfusion and
panretinal neovascularisation in all quadrants OU. Macular Spectral- 1 Retinal Department,
Domain Optical Coherence Tomography scan (SD-OCT) did not show Rothschild Ophthalmologic
Foundation, Paris, France
any foveal thickening. Panretinal photocoagulation (PRP) was immedi-
ately performed OU during the same day. 2 Edouard Herriot Hospital,
Results: Two days after PASCAL treatment, her BCVA decreased to Lyon, France
20/80 OU and worsened to Count Fingers (CF) during the following 3 Centre Rabelais, Lyon,
days. Fundus exam revealed an extensive serous retinal detachment France
confirmed on SD-OCT. 2 sub-conjunctival injections of 0.1 ml Beta-
methasone were done OU. One month later, BCVA improved to 20/30
and SD-OCT confirmed regression of retinal detachment.
Conclusions: PASCAL is considered to be a safe treatment, but one has
to be aware of its potential side effects. It has to be used with caution
in pregnant women.
Keywords: serous retinal detachment, florid diabetic retinopathy, PASCAL
treatment
Introduction her biological and clinical exam. According to her obstet-

rician, the miscarriage was due to poor control of her
The Pattern Scan Laser (PASCAL) photocoagulator (Opti- diabetes.
Media, Santa Clara, California) was first introduced in On presentation, Best Corrected Visual Acuity (BCVA) was
2005 for the treatment of various retinal vascular dis- 20/40 right eye (OD) and 20/30 left eye (OS). Slit lamp
eases [1]. It automates retinal photocoagulation using a examination was normal in both eyes (OU). Fundus abnor-
brief pulse with rapid raster application of multiple spots, malities included multiple microaneurysms in the posteri-
which allows shorter treatment delivery time [2]. It offers or pole, large blot hemorrhages and venous dilation OU.
greater speed and comfort than traditional argon laser Fundus fluorescein angiogram (FFA) showed large areas
for patients receiving panretinal photocoagulation (PRP), of capillary nonperfusion and dye leakage from preretinal
and is widely considered as a safe treatment [3]. How- neovascularisation in all quadrants OU. There was no
ever, we now report the first case of a patient who de- angiographic evidence of macular ischemia or leakage.
veloped large serous retinal detachment after PASCAL Macular spectral-domain optical coherence tomography
treatment. scan (SD-OCT) showed one small intraretinal microcyst
without significant macular thickening or foveal involve-
ment OU (Figure 1).
Case description PRP with PASCAL photocoagulator was immediately
started and completed OU the same day, using classic
A 34-year-old woman with long-standing insulin-dependent parameters as previously described [4]. 2000 laser spots
diabetes mellitus (IDDM), presented with florid diabetic of 200 microns and moderate intensity producing retinal
retinopathy after a miscarriage during the 20th week of blanching, using the Mainster PRP 165 laser lens were
pregnancy. Her blood pressure was always within normal applied. Two days later, our patient presented with a
limits, and there was no history of pre-eclampsia, rapid decrease in her vision. Her BCVA was 20/80 OU.
eclampsia or any other vascular diseases as noted with
GMS Ophthalmology Cases 2012, Vol. 2, ISSN 2193-1496 1/3

Azar et al.: Serous retinal detachment following panretinal photocoagulation ...
Figure 1: SD-OCT at presentation OU showing a small intraretinal microcyst with no significant macular thickness. No foveal
involvment is shown.
Figure 2: SD-OCT showing a large serous retinal detachment (SRD) at the level of the temporal superior arcade (arrow) OD 2
days following PRP with the PASCAL photocoagulator (A). A similar image was seen in the fellow eye (B).
Fundus examination showed extensive pan-retinal laser Discussion

burns with large perimacular serous retinal detachment
at the level of the temporal superior arcade as confirmed PASCAL is widely considered to be a safe and effective
on SD-OCT (Figure 2). FFA revealed a marked reversal of treatment in various retinal diseases. However, one has
microvascular lesions and leakage. During the following to be aware of its potential side effects. In this particular
days, her vision further dropped to Count Fingers (CF) patient with very poor controlled diabetes, an extensive
due to worsening of her retinal detachment. 2 sub-con- PASCAL treatment was done in order to prevent any
junctival injections of 0.1 ml Betamethasone were done hemorrhage, tractional retinal detachment and neovas-
24 hours apart on each eye. One month later, her BCVA cular glaucoma, rendering future laser difficult or unre-
improved to 20/30. SD-OCT confirmed regression of ret- sponsive. However, this may have exaggerated the effect
inal detachment. of intra-vitreal growth factors already abundantly present
in this 34-year-old woman who just had her miscarriage.
Even if the pulse duration is shorter, this technique still
delivers energy and heat to the retinal pigment epithelium

Azar et al.: Serous retinal detachment following panretinal photocoagulation ...
and may be responsible for transient rupture of the blood- 3. Sanghvi C, McLauchlan R, Delgado C, Young L, Charles SJ,
Marcellino G, Stanga PE. Initial experience with the Pascal
retinal barrier.
photocoagulator: a pilot study of 75 procedures. Br J Ophthalmol.
2008 Aug;92(8):1061-4. DOI: 10.1136/bjo.2008.139568
Conclusion 4. Muqit MM, Sanghvi C, McLauchlan R, Delgado C, Young LB,

Charles SJ, Marcellino GR, Stanga PE. Study of clinical
applications and safety for Pascal((R)) laser photocoagulation in
Long terms complications and eventual recurrences have retinal vascular disorders. Acta Ophthalmol. 2010 Feb 16;88:1-
to be carefully observed when using the PASCAL photoco- 7. DOI: 10.1111/j.1755-3768.2009.01854.x
agulator. It has to be used with caution in pregnant wo-
men. The maximal tolerated spot count per session as
well as other laser parameters used to control proliferative
diabetic retinopathy are yet to be determined, and should Corresponding author:
always be weighted to potential side effects encountered. Georges Azar, M.D.
Fondation ophtalmologique Adolphe de Rothschild,
Service du Pr Sahel, 25 Rue Manin, 75019 Paris, France,
Notes Phone: +33.7.87.90.58.57, Fax: +33.1.48.03.65.23 20
georgesazar@hotmail.com
Competing interests
Please cite as
Azar G, Wolff B, Cornut PL, Mauget-Faÿsse M. Serous retinal detachment
The authors declare that they have no competing in- following panretinal photocoagulation (PRP) using Pattern Scan Laser
terests. (PASCAL) photocoagulator. GMS Ophthalmol Cases. 2012;2:Doc01.
DOI: 10.3205/oc000008, URN: urn:nbn:de:0183-oc0000086
References This article is freely available from

http://www.egms.de/en/journals/oc/2012-2/oc000008.shtml
1. Blumenkranz MS, Yellachich D, Andersen DE, Wiltberger MW,
Mordaunt D, Marcellino GR, Palanker D. Semiautomated Published: 2012-06-14
patterned scanning laser for retinal photocoagulation. Retina.
2006 Mar;26(3):370-6. DOI: 10.1097/00006982-200603000-
00024 Copyright
©2012 Azar et al. This is an Open Access article distributed under the
2. Muqit MM, Marcellino GR, Henson DB, Young LB, Patton N, terms of the Creative Commons Attribution License
Charles SJ, Turner GS, Stanga PE. Single-session vs multiple- (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You
session pattern scanning laser panretinal photocoagulation in are free: to Share — to copy, distribute and transmit the work, provided
proliferative diabetic retinopathy: The Manchester Pascal Study. the original author and source are credited.
Arch Ophthalmol. 2010 May;128(5):525-33. DOI:
10.1001/archophthalmol.2010.60

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OPEN ACCESS Case Report

Serous retinal detachment following panretinal

Introduction her biological and clinical exam. According to her obstet-

GMS Ophthalmology Cases 2012, Vol. 2, ISSN 2193-1496 1/3

Fundus examination showed extensive pan-retinal laser Discussion

GMS Ophthalmology Cases 2012, Vol. 2, ISSN 2193-1496 2/3

Conclusion 4. Muqit MM, Sanghvi C, McLauchlan R, Delgado C, Young LB,

References This article is freely available from

GMS Ophthalmology Cases 2012, Vol. 2, ISSN 2193-1496 3/3

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