Short wavelength automated perimetry and peripapillary retinal nerve fiber layer in early diabetes

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To investigate the significance of short wavelength automated perimetry (SWAP) in detecting retinal functional impairment in early diabetic patients without retinopathy and with mild non-proliferative diabetic retinopathy (NPDR). <br /><br /> <strong>METHODS:</strong> This is a prospective, cross-sectional study of 37 eyes of early diabetics which were divided into 2 groups: no DR with 18 subjects and mild NPDR with 19. All subjects underwent HBA1C, SWAP, peripapillary RNFL thickness measurement and fundus photo. Visual field indices: MD and PSD as well as average RNFL thickness were compared among the 2 groups. Correlation of MD with RNFL thickness and HBA1C were also analyzed. <br /><br /> <strong>RESULTS:</strong> There was no statistically significant difference in the MD (-4.46 ± 3.03 vs -2.94 ± 2.21; p=0.09), PSD (3.08 ± 1.28 vs 2.69 ± 0.47; p=0.23) and average peripapillary RNFL thickness (98.47 ± 6.89 vs 98.72 ± 11.01; p=0.93) among early diabetics with mild NPDR and no signs of DR. There is no correlation between MD and RNFL thickness in the no DR group (R2=0.017) and the mild DR group (R2=0.000). There was a weak correlation between MD and HBA1C in the no DR group (R2=0.137), while no correlation was seen in the mild NPDR group (R2=0.000). <br /><br /> <strong>CONCLUSION:</strong> SWAP does not appear to be a sensitive measure of worsening retinopathy in older individuals with early diabetes. The usefulness of SWAP and peripapillary RNFL thickness in the early stages of retinopathy are inconclusive.</p>

Causes of failure of pneumatic retinopexy

Methods: A retrospective review of pneumatic retinopexy procedures performed at the UP-PGH from January 1996 to December 2002 was undertaken. Seventeen cases were analyzed as to preoperative and intraoperative variables: age; sex; preoperative visual acuity; presence of proliferative vitreoretinopathy(PVR); extent of retinal detachment; presence of macular detachment; presence, number, and type of lattice degeneration; previous cataract surgery; surgeon factor; and intraoperative use of cryotherapy. Two-tailed Fishers exact test and Chi square test were used in the analysis of statistical significance. Results: The following variables were shown to be significantly correlated with failure: eyes with breaks outside the 11-1 oclock meridians (p=0.02), eyes with less than or equal to 3 quadrants of retinal detachment (p=0.05), and preoperative visual acuity worse than 5/60 (p0.100). Conclusion: Failure in eyes with retinal breaks outside the 11-1 oclock meridians suggested poor patient compliance with regard to postoperative posture. In eyes with less than or equal to three quadrants of detachment, failure may ensue as a result of spillover of subretinal fluid to uninvolved quadrants. Future success with pneumatic retinopexy will rely ultimately on careful patient selection, surgeon familiarity with the technique, and patient cooperation.