title: The impact of pulse duration and burn grade on size of retinal photocoagulation lesion: implications for pattern density.
abstract: OBJECTIVE
  Shorter pulses used in pattern scanning photocoagulation (10-20 milliseconds [ms]) tend to produce lighter and smaller lesions than the Early Treatment Diabetic Retinopathy Study standard 100-ms exposures. Smaller lesions result in fewer complications but may potentially reduce clinical efficacy. It is worthwhile to reevaluate existing standards for the number and size of lesions needed.
  
  
  METHODS
  The width of the coagulated zone in patients undergoing retinal photocoagulation was measured using optical coherence tomography. Lesions of "moderate," "light," and "barely visible" clinical grades were compared for 100, 200, and 400 μm spot sizes and pulse durations of 20 ms and 100 ms.
  
  
  RESULTS
  To maintain the same total area as in 1,000 standard burns (100 ms, moderate) with a 400-μm beam, a larger number of 20-ms lesions are required: 1,464, 1,979, and 3,520 for moderate, light, and barely visible grades, respectively. Because of stronger relative effect of heat diffusion with a smaller beam, with 200 μm this ratio increases: 1,932, 2,783, and 5,017 lesions of 20 ms with moderate, light, and barely visible grades correspond to the area of 1,000 standard burns.
  
  
  CONCLUSIONS
  A simple formula is derived for calculation of the required spot spacing in the laser pattern for panretinal photocoagulation with various laser parameters to maintain the same total coagulated area.
authors.affiliation: Department of Ophthalmology, Stanford University, Stanford, California 94305-4085, USA. palanker@stanford.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Palanker
authors.forename: Daniel
authors.initials: D
authors.lastname: Lavinsky
authors.forename: Mark Scott
authors.initials: MS
authors.lastname: Blumenkranz
authors.forename: George
authors.initials: G
authors.lastname: Marcellino
mesh_terms: D003930:Diabetic Retinopathy / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008433:Mathematics; D012160:Retina / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D041623:Tomography, Optical Coherence