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A. Yandra, S. Jyothi, F. Mubashar, T. Adewoyin, S. Sivaprasad; Longitudional Study on the Systemic Factors in Patients With Diabetic Macular Oedema. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4416.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the association of systemic factors on long term visual outcome in patients who had undergone focal/grid photocoagulation for the treatment of diabetic macular edema (DME).
Retrospective analysis of visual outcome of two hundred subjects with type 2 diabetes, and DME involving the fovea that had photocoagulation at least 5 years ago. In bilateral cases, the eye with the worse vision was included. Relevant systemic and local factors were analyzed.
At 5years, mean gain in visual acuity was 0 ± 17.4 ETDRS letters. Subjects who lost more than 15 letters were 16% and 20% gained more than 15 letters. The mean time lag between onset of diabetes and macular laser treatment is 12 years. Previous pan retinal photocoagulation (PRP) was done in 2%. DME with associated NPDR (78%) had better visual outcome than with PDR (14%) (P=0.0015). Patients with tablet controlled diabetes 28%) had statistically significant better vision than patients on insulin (26%), or both Insulin and oral (28%) (P=0.04). The mean number of macular laser sessions in the five years was 2.6. In the 5 years, 36% had PRP and the mean time lag between focal and PRP was 25 months. Six percent had vitreo-retinal procedures, 12% had cataract surgery and 4% had intra vitreal triamcinolone for non-resolving macular thickness, and in the other eye macular and pan retinal laser was done in 70% and 38% respectively. The systemic associations included hypertension in 78% of subjects, with 54% being on 3 or more drugs, 30% had macro-vascular complications, 30% had foot related complications. Mean time to laser from the initiation of insulin to the regime was 30 months. The average blood pressure and HbA1c had improved at the end of 5 year follow up. Each patient attended an average of 16 retina clinic appointments, and the mortality rate was 7.5% at 5 year follow-up.
One third of subjects with type 2 diabetes treated for diabetic macular oedema have macro vascular complications. Approximately half of the cohort were insulin dependent and on 3 or more anti-hypertensive drugs. The visual outcomes at 5 years were similar to the laser outcomes of the DRCRN trial at 2 years. Better control of systemic factors have improved long-term visual outcome of laser photocoagulation of diabetic retinopathy.
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