Abstract
Purpose: :
To evaluate the efficacy of focal/grid photocoagulation for the treatment of diabetic macular edema (DME) in Afro-Caribbeans.
Methods: :
The visual outcome of one hundred Afro-Caribbean subjects with DME involving the fovea that had photocoagulation at least 5 years ago was retrospectively analyzed. In bilateral cases, the eye with the worse visual acuity was included. Systemic and local factors that influenced outcome were also assessed.
Results: :
The mean gain in visual acuity at the end of 5 years is 4.05±17 ETDRS letters. There was no statistical difference between Africans and Caribbeans (P = 0.15). Eleven percent lost more than 15 letters and 23% gained more than 15 letters. The mean time lag between onset of Diabetes and first laser treatment is 12 years. At presentation 73% had mild non proliferative diabetic retinopathy, 11% had moderate to severe and 11% had proliferative retinopathy. The mean number of laser sessions in the five years was 2.69 macular lasers. Four percent had previous pan retinal photocoagulation (PRP) and 34% had PRP in the 5 year follow up with an average time lag between focal and PRP of 30 months. Four percent had vitreo-retinal procedures, 16% had cataract surgery and 4% had intra vitreal triamcinolone for non-resolving macular thickness during the follow up. Twenty three subjects were concomitantly being treated for glaucoma. The systemic associations included hypertension in 73% of subjects, with 31% being on 3 or more drugs, 23% had macro-vascular complications. Nearly 50% were on both Insulin and oral anti diabetic drugs as standard treatment. Mean time to laser from the initiation of insulin to the regime was 10±27 months. Having macular laser in the other eye did not influence the visual outcome (P = 0.4). Each patient attended an average of 17 retina clinic appointments, and at 5 yr follow up 4 patients were deceased.
Conclusions: :
The 5 year visual outcome following macular photocoagulation for DME in Afro-Caribbeans does not differ significantly from the published literature on predominantly Caucasian cohorts.
Keywords: diabetic retinopathy • laser • visual acuity