Long-Term Visual Outcome in Proliferative Diabetic Retinopathy Patients After Panretinal Photocoagulation

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Abstract

Background: There is the need for a long-term study on the visual outcome of panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients.

Cases: We retrospectively reviewed the clinical course and visual results in 66 eyes of 59 patients with PDR who were followed-up for at least 10 years after argon or krypton laser PRP.

Observations: Thirty-nine eyes had stage B-II, whereas 8 eyes had stage B-III retinopathy. Stage B-IV and B-V retinopathy were seen in 15 and 4 eyes, respectively. Although active stages of diabetic retinopathy were encountered after 5 years, complete regression could be successfully attained after 10 years. Long-term visual prospects were promising for eyes with stage B-II DR; 28.2% still enjoyed 20/40 or better visual acuity by 5 years. Most cases had maintained the same visual acuity at 10 years. Eyes with stage B-III DR did not attain 20/40 vision by 10 years. Panretinal photocoagulation in cases with neovascularization of the optic nerve head was seen to be beneficial but limited, suggesting that such cases might benefit from maximal initial and supplemental PRP followed by vitrectomy and intraoperative endophotocoagulation when necessary. Although 20% of the eyes with stage B-IV and 25% of the eyes with stage B-V DR had 20/40 or better visual acuity, analyses of the visual change revealed that about half the eyes with stage B-IV and all eyes with stage B-V DR experienced a visual loss of two lines or more.

Conclusions: Progression of lens opacities, chronic macular edema, vitreous hemorrhage, macular traction, and neovascular glaucoma were the main causes of visual loss in this series. Panretinal photocoagulation for PDR provides good anatomical and visual outcome for 10 years or longer.

Introduction

Photocoagulation is a well-established treatment for proliferative diabetic retinopathy (PDR) that has been shown to induce regression of neovascularization and arrest of progression of diabetic retinopathy.1 Randomized multicenter collaborative clinical trials have shown that not only is laser treatment preferable to no treatment, but a timely applied treatment is more effective as far as visual prognosis is concerned.2, 3 However, photocoagulation may not eliminate the possibility of visual loss in “high-risk” eyes, as described by the Diabetic Retinopathy Study.2, 4 Although many clinical trials have provided very valuable information about the visual prospects of PDR following panretinal photocoagulation (PRP), there have been only a few studies providing clinical and visual data for a period longer than 10 years.5, 6, 7 Moreover, there is no study showing the relationship between the long-term visual outcome of PDR following PRP and the stage of retinopathy. Therefore, we retrospectively reviewed the clinical course and visual results of patients with PDR who were followed-up for at least 10 years.

Section snippets

Materials and Methods

The records of 59 patients (66 eyes) treated with argon or krypton laser PRP for PDR at the Diabetes Outpatient Clinic of Kobe University Hospital, Department of Ophthalmology, were surveyed in this study. The presence of diabetes in all patients had been confirmed by the corresponding Internal Medicine Department; data on HbA1c and fasting blood-glucose levels were also available. Patients with a fasting blood-glucose level of less than 140 mg/dL and a HbA1c of less than 8% were accepted as

Diabetic Status

There were 20 female and 39 male patients whose ages ranged from 28–74 years (mean = 56 years). Three patients had insulin-dependent and 56 cases had non–insulin-dependent diabetes mellitus. The duration of diabetes varied from 14–40 years (mean = 12.4 ± 7.6 years) and the patients were followed up between 10 and 13 years (mean = 11.6 ± 1.4 years). Diabetes was under good control in 17 patients before the use of photocoagulation therapy.

Course of Diabetic Retinopathy

Thirty-nine eyes had stage B-II, whereas 8 eyes had stage

Discussion

Panretinal photocoagulation has already been shown by multicenter clinical trials to be effective in reducing the incidence of visual loss and preventing subsequent neovascularization in patients with PDR.1, 2, 3, 4, 9 Little5 reported that 60% of the 66 cases in his series treated with argon laser PRP had 20/50 or better and 75% had 20/100 or better acuity at the 5 to 12-year follow-up visits. Likewise, the visual results from the Bascom Palmer Diabetic Retinopathy Study at 15 years were

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This paper was presented at the 101st Japanese Ophthalmological Society Congress, May 15, 1997, Kyoto, Japan.

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