ABSTRACT
PURPOSE: This work deals with the photocoagulation treatment of severe NPDR, suggesting a new therapeutic practice. It is proposed to adopt treatment intensity to each clinical form, to preserve healthy territories through biomicroscopy and to evaluate the risk of complications inherent in this technique, and to be at least as efficient as comparative studies. MATERIAL AND METHOD: We treated 52 eyes and kept under observation 2 eyes which revealed severe NPDR. The patients were followed between 1991 and 1996. The approach was essentially biomicroscopic. Photocoagulation treatment utilized green, yellow or orange wavelengths through panoramic contact lenses. RESULTS: After an average follow-up of 30 months, there was a decrease of visual acuity of 0.72 to 0.64 (Monoyer scale); a severe visual loss in 1.8% of the cases; and an early decrease in visual acuity at 6 weeks in 7.4% of the cases. A "High Risk" PDR occurred in 3.7% of the cases and we had to perform a vitrectomy (1.85% of the cases). We treated with less than 1600 I in 68.5% of the cases and with more than 1600 I in 31.5% of the cases. Patients had 5.5 photocoagulation sessions and were examined every 3.5 months on average. CONCLUSION: We believe our therapeutic approach is interesting, by comparison with other studies, but that it can be improved. All patients show a primary condition in the nasal field which, if treated too massively, becomes unable to see and disturbs daily life. We also note the severe potential for progression in insulin-dependent patients.
