Current management of established diabetic eye disease

Abstract

Diabetic patients with established diabetic eye disease are at risk of visual loss from vitreous haemorrhage, traction retinal detachment, macular oedema, cataract and eventually posterior capsule opacification. If there is an effective screening service, timely adequate photocoagulation should minimise visual loss from vitreous haemorrhage, traction retinal detachment and macular oedema. Vitreoretinal surgery should only be required in exceptional cases. Extracapsular cataract surgery and intraocular lens insertion can be followed by a dramatic worsening of pre-existing diabetic macular oedema. This can be prevented provided the severity of the retinopathy is recognised pre-operatively and treated appropriately by photocoagulation either before surgery or shortly afterwards. Neovascular glaucoma can follow YAG laser capsulotomy if the retina is very ischaemic. This likewise can be prevented provided the severity of the retinopathy is recognised and treated adequately by scatter photocoagulation.

References

  1. 1

    Blankenship GW . Fifteen year argon laser and xenon photocoagulation results of Bascom Palmer Eye Institute's patients participating in the diabetic retinopathy study. Ophthalmology 1991;98:125–8.

  2. 2

    Akiba J, Carlos WA, Trempe CL . Posterior vitreous detachment and neovascularisation in diabetic retinopathy. Ophthalmology 1990;97:889–91.

  3. 3

    Trick GL, Trick LR, Kilo C . Visual field defects in patients with insulin-dependent and non-insulin-dependent diabetes. Ophthalmology 1990;97:475–82.

  4. 4

    Bell JA, Feldon SE . Retinal microangiopathy: correlation of OCTOPUS perimetry with fluorescein angiography. Arch Ophthalmol 1984;102:1294–8.

  5. 5

    Hamilton AM, Townsend C, Khoury D, Gould E, Blach RK . Xenon arc and argon laser photocoagulation in the treatment of diabetic disc neovascularisation. I. Effect on disc vessels, visual field and visual acuity. Trans Ophthalmol Soc UK 1981;101:87–92.

  6. 6

    Blankenship GW . A clinical comparison of central and peripheral argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 1988;95:170–7.

  7. 7

    Chee CKL, Flanagan DW . Visual field loss in preproliferative and early proliferative diabetic retinopathy. Br J Ophthalmol (submitted).

  8. 8

    Williamson TH, George N, Flanagan DW, Norris V, Blamires T . Driving standard visual fields in diabetic patients after panretinal laser photocoagulation. In: Vision in Vehicles III. Amsterdam: North-Holland, 1991:265–72.

  9. 9

    Hulbert MFG, Vernon SA . Passing the DVLC field regulations following bilateral panretinal photocoagulation in diabetics. Eye 1992;6:456–60.

  10. 10

    Buckley SA, Jenkins L, Benjamin L . Fields, DVLC and panretinal photocoagulation. Eye 1992;6:623–5.

  11. 11

    Roth JA . Central visual field in diabetes. Br J Ophthalmol 1969;53:16–25.

  12. 12

    Caird FI, Pirie A, Ramsell IG . Diabetes and the eye. Oxford: Blackwell Scientific, 1969.

  13. 13

    Taylor E, Dobree JH . Proliferative diabetic retinopathy: site and size of initial lesions. Br J Ophthalmol 1970;54:11–8.

  14. 14

    Wiznia KI, Lieberman TW, Leopold IH . Visual fields in diabetic retinopathy. Br J Ophthalmol 1970;54:11–8.

  15. 15

    Greite JH, Zumbansen HP, Adamczyk R . Visual field in diabetic retinopathy (DR). In: Greve EL, Verriest G, editors. Fourth International Visual Field Symposium, Bristol, 13–16 April 1980. Documenta Ophthalmologica Proceedings Series 26. The Hague: Junk, 1981:25–32.

  16. 16

    Beck T . Coexistence of localised scotomata and neovascularisations in proliferative diabetic retinopathy. Acta Ophthalmol (Copenh) 1990;68:421–7.

  17. 17

    Beck T, Lund-Anderson H . Localised blood-retinal barrier leakage and retinal light sensitivity in diabetic retinopathy. Br J Ophthalmol 1990;74:388–92.

  18. 18

    Beck T, Lund-Anderson H . Cotton-wool spots and retinal light sensitivity in diabetic retinopathy. Br J Ophthalmol 1991;75:13–7.

  19. 19

    Blankenship GW . A clinical comparison of central and peripheral argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology 1988;95:170–7.

  20. 20

    ETDRS Report Number 9. Early photocoagulation for diabetic retinopathy. Ophthalmology 1991;98:766–85.

  21. 21

    Klein BEK, Klein R, Moss SE . Prevalence of cataracts in a population-based study of persons with diabetes mellitus. Ophthalmology 1985;92:1191–6.

  22. 22

    Straatsma BR, Pettit TH, Wheeler N, Miyamasu W . Diabetes mellitus and intraocular lens implantation. Ophthalmology 1983;90:336–43.

  23. 23

    Thompson SM, Kritzinger EE, Roper-Hall MJ . Should diabetes be a contraindication for an intraocular lens? Trans Ophthalmol Soc UK 1983;103:115–7.

  24. 24

    Patz A . Photocoagulation of retinal, vascular and macular diseases through intraocular lenses. Ophthalmology 1981;88:398–406.

  25. 25

    Jaffe NS . The way things were and are: changing indications for intraocular lens implantation. Ophthalmology 1983;90:318–20.

  26. 26

    Tasman W . Are there any retinal contraindications to cataract extraction and posterior chamber lens implants? Arch Ophthalmol 1986;104:1767–8.

  27. 27

    Jaffe GJ, Burton TC . Progression of nonproliferative diabetic retinopathy following cataract extraction. Arch Ophthalmol 1988;106:745–9.

  28. 28

    Cunliffe IA, Flanagan DW, George NDL, Aggarwaal RJ, Moore AT . Extracapsular cataract surgery with lens implantation in diabetics with and without proliferative retinopathy. Br J Ophthalmol 1991;75:9–12.

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Correspondence to D W Flanagan.

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Flanagan, D. Current management of established diabetic eye disease. Eye 7, 302–308 (1993). https://doi.org/10.1038/eye.1993.65

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