Abstract
Currently available data from multicenter randomized trials on laser treatment of diabetic macular edema refer only to eyes with pretreatment visual acuities of 20/160 or better. After observing reduction of more severe macular edema and visual improvement following panretinal photocoagulation (PRP) alone in some patients, we reviewed our experience with this problem. In 18 eyes of 14 patients with proliferative diabetic retinopathy and visual acuity of 20/200 or worse, secondary to severe macular edema were identified. At 6 months after PRP without focal macular laser treatment, macular edema was reduced in 13 eyes, 8 of which improved by ≥ 2 lines of vision. Among the latter 8 eyes, the visual acuity of 4 recovered to 20/80 or better; the remaining 10 eyes, which had chronic retinal pigment epithelial atrophy or extensive macular ischemia, did not improve. Based on these observations, we suggest that peripheral PRP performed in multiple sessions over several months may have a beneficial effect on severe macular edema in some eyes with adequate macular perfusion.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aiello LM, Rand LI, Briones JC (1981) Diabetic retinopathy in Joslin Clinic patients with adult-onset diabetes. Ophthalmology 88:619–623
Blankenship GW (1988) A clinical comparison of central and peripheral argon laser panr etinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 95:170–177
Bresnick G (1983) Diabetic maculopathy. A critical review highlighting diffuse macular edema. Ophthalmology 90:1301–1317
Diabetic Retinopathy Study Research Group (1978) Photocoagulation treatment of proliferative diabetic retinopathy: the second report of Diabetic Retinopathy Study findings. Ophthalmology 85:82–106
Diabetic Retinopathy Study Group (1979) Preliminary report on effects of photocoagulation therapy. Am J Ophthalmol 81:383–396
Diabetic Retinopathy Study Research Group (1981) Photocoagulation treatment of proliferative diabetic retinopathy: relationship of adverse treatment effects to retinopathy severity; Diabetic Retinopathy Study report 5. Dev Ophthalmol 2:248–261
Deft BH, Blankenship GW (1982) Single versus multiple treatment sessions of argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 89:772–779
Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report 1. Arch Ophthalmol 103:1796–1806
Early Treatment Diabetic Retinopathy Study Research Group (1987) Treatment techniques guidelines for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study report 3. Int Ophthalmol Clin 27:254–264
Feke GT, Green GJ, Goger DG, McMeel JW (1982) Laser Doppler measurements of the effect of panretinal photocoagulation on retinal blood flow. Ophthalmology 89:757–762
Ferris FL, Podgor MJ, Davis MD, The Diabetic Retinopathy Study Research Group (1987) Macular edema in Diabetic Retinopathy Study patients: Diabetic Retinopathy Study report 12. Ophthalmology 94:754–760
Grunwald JE, Brucker AJ, Petrig BL, Riva CE (1989) Retinal blood flow regulation and the clinical response to PRP in proliferative diabetic retinopathy. Ophthalmology 96:1518–1522
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin Epidemiologic Study of Diabetic Retinopathy: II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102:520–526
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin Epidemiologic Study of Diabetic Retinopathy: III. Prevalence and risk when age at diagnosis is 30 or more years. Arch Ophthalmol 102:527–532
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin Epidemiologic Study of Diabetic Retinopathy: IV. Diabetic macular edema. Ophthalmology 91:1464–1474
Klemen UM, Freyler H (1982) Courses of diabetic retinopathy. Graefe's Arch Clin Exp Ophthalmol 213:135–142
Landers MB, Stefansson E, Wolbarsht ML (1982) Panretinal photocoagulation and retinal oxygenation. Retina 2:167–175
McDonald HR, Schatz H (1985) Visual loss following panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 92:388–393
McDonald HR, Schatz H (1985) Macular edema following panretinal photocoagulation. Retina 5:5–10
Meyers SM (1980) Macular edema after scatter laser photocoagulation for proliferative diabetic retinopathy. Am J Ophthalmol 90:210–216
Parving H-H, Viberti GC, Keen H, Christiansen JS, Lassen NA (1983) Hemodynamic factors in the genesis of diabetic microangiopathy. Metabolism 32:943–949
Puklin JE, Tamborlane WV, Felig P, Genel M, Sherwin RS (1982) Influence of long-term insulin infusion-pump treatment of type I diabetes on diabetic retinopathy. Ophthalmology 89:735–747
Shimizu K, Muraoka K, Kitagawa M (1983) Midperipheral vascular lesions in diabetic retinopathy. In: Little HL, Jack RL, Patz A, Forsham PH (eds) Diabetic retinopathy. Thieme-Stratton, New York, pp 242–256
Sinclair SH, Grunwald JE, Riva CE, Braunstein SN, Nichols CW, Schwartz SS (1982) Retinal vascular autoregulation in diabetes mellitus. Ophthalmology 89:748–750
Varley MP, Frank E, Purnell EW (1988) Subretinal neovascularization after focal argon laser for diabetic macular edema. Ophthalmology 95:567–573
Wise GN, Wangvivat Y (1966) The exaggerated macular response to retinal disease. Am J Ophthalmol 61:1359–1363
Wolbarsht ML, Landers MB, Stefansson E (1981) Vasodilation and the etiology of diabetic retinopathy: a new model. Ophthalmic Surg 12:104–107
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gardner, T.W., Eller, A.W. & Friberg, T.R. Reduction of severe macular edema in eyes with poor vision after panretinal photocoagulation for proliferative diabetic retinopathy. Graefe's Arch Clin Exp Ophthalmol 229, 323–328 (1991). https://doi.org/10.1007/BF00170689
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00170689