A review of retinal photocoagulation at the Department of Ophthalmology, University of Nairobi and Eye Department, Kenyatta National Hospital

Abstract

Objectives: To determine the indications for retinal laser therapy done at UoNI KNH Eye Departments between January 2001 and January 2008, the treatment techniques, outcomes, complications and parameters. Design: Retrospective case series. Setting: UoN/ KNH Eye Departments in Nairobi, Kenya. Materials and Methods: Medical records of patients who received retinal photocoagulation therapy within the review period were retrieved and data was entered in a structured questionnaire and analysed using SPSS version 13.0. Results: Diabetic retinopathy was the main indication in this set up (74.7%), with CSME (43.7%) being the commonest indication, followed by PDR (31.0%). Central laser was the predominant treatment technique (41.7%) followed by PRP (36.3%) and a combination of the two (15.0%). 76% of all eyes treated had a favourable outcome (improved or maintained VA post retinal photocoagulation). Seventy nine eyes (24%) had deterioration of VA despite retinal photocoagulation. For central laser, 63% had a favourable outcome whereas (37%) deteriorated. Eighty two percent of eyes that had PRP done had a favourable outcome. Of eyes that had central laser done, there was regression of macul.ar oedema in 74%. In 26% there was no regression. These eyes needed repeat central laser. Sixty five eyes (61%) which had PDR showed regression of new vessels post photocoagulation whereas 40 eyes (39%) had no regression hence needed fill in PRP. There was a low complications rate of 5.1% (17 eyes). Majority of those had a mild decrease in visual acuity by 1-2 Snellen's lines following retinal photocoagulation. One eye was noted to have constricted visual fields, attributable to intense retinal photocoagulation. Laser parameters used in this study were comparable to those used in related studies. Conclusion: Central laser and PRP are the main treatment techniques in the UoNI KNH eye clinic and the main indication is Diabetic Retinopathy of which most eyes with CSME or PDR had a favourable outcome. Complications rate was low at 5.1%. Parameters used are in keeping with preferred practice pattern. There was a high loss to follow up (33%). Recommendations: There is need to improve recording in laser register and patients files (laser chart proposed), as well as need to improve follow up (follow up form proposed)