Pain Perception of Patients Undergoing Laser Panretinal Photocoagulation: Comparison of Single-Spot Versus Multispot Techniques

Abstract

BACKGROUND AND OBJECTIVE: To compare pain intensity with single-spot versus multispot technique in laser panretinal photocoagulation, using a 532-nm, solid-state laser system. MATERIALS AND METHODS: This was a prospective, interventional, randomized, single-masked comparison trial. Patients received two types of intervention: conventional single-spot technique, with an exposure time of 150 ms, and multispot technique, done with an exposure time of 20 ms, Both techniques used power sufficient to produce visible gray-white burns, and spot size of 20 μm. Participants received both treatments in the same eye, each one in one hemiretina, and were randomized to receive first single- or multispot technique and to the initial site of treatment. We assessed pain intensity using a numerical pain scale immediately after completion of each treatment. RESULTS: A significantly lower pain scale was observed with the multispot when compared with the single-spot technique (coefficient [Coef]: −1.61; 95% CI, −2.49 to −0.74; P < .001), which was not affected by treatment order, the hemiretina treated, or treatment duration ( P > .05). Among demographic characteristics, multiracial patients had a pain scale 1.25 greater than that of White patients (Coef: 1.25; 95% CI, 0.47 to 2.04; P = .002), but there is no effect of age or sex on the pain scale ( P > .05). Regarding treatment duration, a shorter procedure was also observed in the multispot technique (Coef: −1.13; 95% CI, −1.43 to −0.82; P < .001), and it was not affected by order of treatment ( P = .098), hemiretina ( P = .327), pain ( P = .141), or demographic data, such as age, sex, and race ( P > .05). CONCLUSION: The use of the multispot technique, with a short pulse duration (20 ms), is significantly less painful and less time-consuming for patients with proliferative retinopathy compared with the conventional single-spot technique using an exposure time of 150 ms. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53:40–45.]