Development of proliferative retinopathy in patients with long-standing insulin-dependent diabetes mellitus.

PURPOSE AND METHOD: Some patients with long-standing insulin-dependent diabetes mellitus (IDDM) develop little or no retinopathy. Using a clinic-based questionnaire and examination, we investigated a group of patients with over 40 years or more of IDDM who had been followed up at the King's Diabetes Centre for an average of 40 years. We compared those who had developed proliferative diabetic retinopathy during their disease with those with minimal or no retinopathy. RESULTS: The study did not find any statistically significant differences between the two groups to suggest why some long-term insulin-dependent diabetics develop little retinopathy. Those who developed sight-threatening retinal complications did so at an average of 35 years after diagnosis and it resulted in little visual disablement. Very few patients in either group had developed other significant complications. CONCLUSIONS: This study details an interesting group of patients with long-term IDDM mellitus with a mean follow-up period of 40 years. Some patients with long-standing IDDM develop little or no retinopathy. With the advent of community ophthalmic screening, these patients are now rarely seen in the eye clinic. Those who did develop retinal complications and required treatment have remarkably little visual disablement. However, these complications developed late in the history of their disease, emphasising the need for continued screening.

Diode laser contact transscleral retinal photocoagulation: a clinical study.

AIM: To examine the clinical efficacy of contact transscleral retinal photocoagulation with a diode laser. METHODS: Transscleral retinal photocoagulation was performed on 36 eyes. The conditions treated included peripheral retinal breaks associated with retinal detachments (30 eyes) and giant retinal tears (six eyes). Of the 30 eyes with retinal detachments, 28 underwent transscleral photocoagulation to the site of drainage of subretinal fluid in an attempt to reduce the risk of hemorrhage. RESULTS: Threshold lesions were obtained with irradiances of between 95.4 W/cm2 and 191 W/cm2. Satisfactory chorioretinal adhesion was achieved in all eyes with retinal breaks and giant retinal tears. The only significant complications of treatment encountered were punctate choroidal haemorrhages (three eyes). Drainage related choroidal haemorrhage following earlier photocoagulation occurred in two of 28 eyes. CONCLUSIONS: This study confirms the clinical potential of transscleral diode laser photocoagulation in the therapy of surgical retinal conditions.

Indomethacin retinopathy: case report and review.

The case of a 33-year-old man with probable indomethacin retinopathy is presented. The relevant literature is reviewed and the differences between our case and those previously reported are noted. Our patient appears to have suffered severe and irreversible ocular damage due to the very high dose of indomethacin ingested over a prolonged period.

Clinical trials versus intuition in evaluating the results of laser photocoagulation.

Clinical trials are often used to evaluate the efficacy of a given treatment. The results of clinical trials however do not always agree with a clinician's experience or intuition. The merits and demerits of Clinical Trials versus Intuition are discussed by using the laser photocoagulation trials of Proliferative Diabetic Retinopathy, Central serous retinopathy, Branch Vein Occlusion (treatment for macular oedema), Senile Macular Degeneration, and Pigment Epithelial Detachment. A model based on Intuition is used to explain the discrepancy between the results of the British and American trials of Branch Vein Occlusion and Senile Macular Degeneration. Proposals on the presentation of Clinical Trials and the place of Intuition are made.

Retinal detachment in patients with proliferative sickle cell retinopathy.

Results and complications of surgical treatment for retinal detachment in thirteen patients with proliferative sickle cell retinopathy are reported. Eleven had maintained or improved visual acuity after treatment. Methods and complications of exchange transfusion in eight patients are described. The pathogenesis and methods of treatment of these retinal detachments and the benefits of exchange transfusion are discussed.

Ocular disease in immunosuppressed patients.

New therapies and diseases causing immunosuppression have provoked new and devastating ocular diseases. The possible reasons for the vulnerability of the retina to opportunistic infections are discussed. The clinical patterns of disease caused by common opportunistic agents are described, and current treatment available is reviewed.

Place of panretinal photocoagulation and trabeculectomy in the management of neovascular glaucoma.

Established neovascular glaucoma in the presence of clear media can be treated by panphotocoagulation followed by drainage surgery. Three cases are described, and the advantages of this procedure as opposed to others available are discussed. Photocoagulation must be performed early before the development of opaque ocular media obscures the retina.

Retinal vein occlusion and the prevalence of lipoprotein abnormalities.

Ninety-nine patients with retinal vein occlusion (40 with central, 59 with branch vein occlusion) were investigated for the prevalence of associated diseases for comparison with an age-matched control group. There was a significantly increased prevalence of hyperlipidaemia (p less than 0.001) and hypercholesterolaemia (p less than 0.001) in the group with branch retinal vein occlusion and of hyperlipidaemia (p less than 0.001) and hypercholesterolaemia (p less than 0.02) in the group with central retinal vein occlusion compared with controls. An increased prevalence of hypertriglyceridaemia (p less than 0.001) was also found in patients with central vein occlusion. Other associations were noted (hypertension and oestrogen therapy). Increased serum cholesterol concentrations were found in patients with central vein occlusion (p less than 0.05) and branch vein occlusion (p less than 0.001) compared with controls, and similar tendencies were noted for levels of LDL and HDL cholesterol. Patients with central vein occlusion also had raised levels of serum triglyceride (p less than 0.001) and VLDL-triglyceride (p less than 0.05). The occurrence of both central and branch vein occlusions may be associated with an increased prevalence of hyperlipidaemia and hypertension. Increase of serum lipids may contribute to the aetiology of vein occlusion by altering plasma viscosity or affecting platelet function.

Photocoagulation for optic disc new vessels in diabetes mellitus.

The effects of treatment by argon laser and xenon arc photocoagulation in 165 diabetic patients with optic disc new vessel formation have been studied retrospectively. Visual acuity and degree of new vessel formation have been assessed over a period of between six months and seven years of follow-up (mean 23 months). Visual acuity improved in 36% of treated eyes and remained unchanged in 34%. Improvement was most marked in those with initially poor acuity (less than 6/36). There was no association between improvement in visual acuity and regression of disc vessels, the latter occurring in 79% of treated eyes. Only 6% of eyes became blind during the period of follow-up, principally as a result of vitreous haemorrhage and retinal detachment. There was no difference between the results produced by the use of separate or combined argon laser and xenon arc photocoagulation on the regression of disc new vessels. However, our results suggest that argon laser treatment was more effective than xenon arc photocoagulation in improving visual acuity. These findings suggest that either form of treatment or a combination offers considerable benefit in the management of proliferative diabetic retinopathy, even when very severe at presentation.

Xenon arc and argon laser photocoagulation in the treatment of diabetic disc neovascularization. Part 1. Effect on disc vessels, visual fields, and visual acuity.

Xenon arc and argon laser photocoagulation are equally effective in producing regression of disc neovascularization and maintaining visual acuity. Xenon has more destructive effects on the visual field and electroretinogram, but is more comfortable because retrobulbar anaesthesia is used and more convenient to the patient because fewer treatment sessions are needed.

Closed microsurgery in the management of intraocular foreign bodies.

The instrumentation and techniques of closed intraocular microsurgery offer a valuable approach to the management of selected intraocular foreign bodies. These methods facilitate the removal of retained material and the surgical repair of intraocular damage resulting from penetration. Although guidelines have been proposed, the precise indications and appropriate timing of surgery have not been established. We present the results of closed microsurgery in a consecutive series of patients with posterior segment intraocular foreign bodies or their sequelae. Factors which appear to limit visual recovery are discussed in relation to the timing of surgery.