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What may be gained from standard photocoagulation during early worsening of diabetic retinopathy? An observational study in type-1 diabetic patients after tightening of glycaemic control.
Diabetes Metab. 2001 Jun; 27(3):366-71.DM

Abstract

OBJECTIVE

To assess the outcome of laser photocoagulation treatment for rapidly progressing diabetic retinopathy, socalled early worsening, subsequent to a rapid improvement of glycemic control. For the purpose of this study, early worsening was defined as any incidence or progression of retinopathy that followed a reduction in HbA1c by > 2% within 6 months.

MATERIAL AND METHODS

Retrospective observational study in type-1 diabetic patients in a university diabetes center.

PATIENTS

23 patients with early worsening were identfied during a 16-year period, with a mean age of 25 years, duration of diabetes of 12 years, and glycated hemoglobin HbA1c of 12.4%; retinopathy was absent or mild nonproliferative at baseline. Focal, and/or panretinal laser coagulation was performed according to standard ETDRS criteria. Retinal pathology and visual acuity was followed-up for 12-120 months.

RESULTS

Improving metabolic control induced mild non-proliferative retinopathy without macular edema in 4 patients, which regressed without treatment. In 19 patients, symptomatic diabetic maculopathy developed with macular edema, resolving by focal coagulation in 3 patients. Of the remaining 16 patients, 14 developed proliferative retinopathy (7 of whom despite focal, grid or scatter coagulation pretreatment), and were treated by full panretinal coagulation. In 7 of the 14 patients with proliferative retinopathy, vitreous hemorrhages occurred requiring pars plana vitrectomy. Proteinuria, polyneuropathy, and impaired vision prior to laser treatment were indicative of poor prognosis. Visual acuity > 0.3 in at least one eye was preserved in 22 of the 23 patients.

CONCLUSIONS

In patients with type-1 diabetes mellitus and early worsening of diabetic retinopathy, the benefit of standard laser photocoagulation was limited, and particularly in the presence of symptomatic macular edema.

Authors+Show Affiliations

Diabetes outpatient clinic, Department of Metabolic Diseases and Nutrition, Heinrich-Heine-University of Düsseldorf.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11431602

Citation

Chantelau, E. "What May Be Gained From Standard Photocoagulation During Early Worsening of Diabetic Retinopathy? an Observational Study in Type-1 Diabetic Patients After Tightening of Glycaemic Control." Diabetes & Metabolism, vol. 27, no. 3, 2001, pp. 366-71.
Chantelau E. What may be gained from standard photocoagulation during early worsening of diabetic retinopathy? An observational study in type-1 diabetic patients after tightening of glycaemic control. Diabetes Metab. 2001;27(3):366-71.
Chantelau, E. (2001). What may be gained from standard photocoagulation during early worsening of diabetic retinopathy? An observational study in type-1 diabetic patients after tightening of glycaemic control. Diabetes & Metabolism, 27(3), 366-71.
Chantelau E. What May Be Gained From Standard Photocoagulation During Early Worsening of Diabetic Retinopathy? an Observational Study in Type-1 Diabetic Patients After Tightening of Glycaemic Control. Diabetes Metab. 2001;27(3):366-71. PubMed PMID: 11431602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What may be gained from standard photocoagulation during early worsening of diabetic retinopathy? An observational study in type-1 diabetic patients after tightening of glycaemic control. A1 - Chantelau,E, PY - 2001/6/30/pubmed PY - 2001/9/21/medline PY - 2001/6/30/entrez SP - 366 EP - 71 JF - Diabetes & metabolism JO - Diabetes Metab VL - 27 IS - 3 N2 - OBJECTIVE: To assess the outcome of laser photocoagulation treatment for rapidly progressing diabetic retinopathy, socalled early worsening, subsequent to a rapid improvement of glycemic control. For the purpose of this study, early worsening was defined as any incidence or progression of retinopathy that followed a reduction in HbA1c by > 2% within 6 months. MATERIAL AND METHODS: Retrospective observational study in type-1 diabetic patients in a university diabetes center. PATIENTS: 23 patients with early worsening were identfied during a 16-year period, with a mean age of 25 years, duration of diabetes of 12 years, and glycated hemoglobin HbA1c of 12.4%; retinopathy was absent or mild nonproliferative at baseline. Focal, and/or panretinal laser coagulation was performed according to standard ETDRS criteria. Retinal pathology and visual acuity was followed-up for 12-120 months. RESULTS: Improving metabolic control induced mild non-proliferative retinopathy without macular edema in 4 patients, which regressed without treatment. In 19 patients, symptomatic diabetic maculopathy developed with macular edema, resolving by focal coagulation in 3 patients. Of the remaining 16 patients, 14 developed proliferative retinopathy (7 of whom despite focal, grid or scatter coagulation pretreatment), and were treated by full panretinal coagulation. In 7 of the 14 patients with proliferative retinopathy, vitreous hemorrhages occurred requiring pars plana vitrectomy. Proteinuria, polyneuropathy, and impaired vision prior to laser treatment were indicative of poor prognosis. Visual acuity > 0.3 in at least one eye was preserved in 22 of the 23 patients. CONCLUSIONS: In patients with type-1 diabetes mellitus and early worsening of diabetic retinopathy, the benefit of standard laser photocoagulation was limited, and particularly in the presence of symptomatic macular edema. SN - 1262-3636 UR - https://www.unboundmedicine.com/medline/citation/11431602/What_may_be_gained_from_standard_photocoagulation_during_early_worsening_of_diabetic_retinopathy_An_observational_study_in_type_1_diabetic_patients_after_tightening_of_glycaemic_control_ L2 - https://medlineplus.gov/diabeticeyeproblems.html DB - PRIME DP - Unbound Medicine ER -