Spontaneous Regression of Diabetic Macular Edema Combined With Florid Diabetic Retinopathy After Extensive Panretinal Photocoagulation

Abstract

Purpose: : to report the natural evolution of diabetic macular edema (DME) after extensive panretinal photocoagulation (PRP), in a type 1 diabetic patients' eyes series exhibiting florid proliferative diabetic retinopathy (FPDR).

Methods: : Retrospective observational case series. 16 eyes of 9 consecutive type 1 diabetic patients (7 women and 2 men) were studied. They all exhibited FPDR associated with a severe DME. All patients underwent panretinal laser photocoagulation. Evolution of visual acuity (VA) and progression of the FPDR were evaluated. The characteristics and the evolution of the DME during the follow up were assessed with fluorescein angiography and repeated optical coherence tomography examinations. Two eyes, which required immediate vitrectomy were excluded from the study.

Results: : At baseline, all the eyes had a diffuse cystoid DME. Mean decimal visual acuity was 0.26 +/- 0.3. Mean central macular thickness (CMT) was 464 +/- 125.24 microns. After PRP treatment, DME regressed spontaneously in all eyes after a mean follow up of 7.1 +/- 2.68 months. Mean CMT was significantly reduced to 270 .94 +/- 7.1 microns (t test, p=0.004). Mean decimal VA improved to 0.45 +/- 0.15. Mean HbA1C was 8.79 +/- 1.07% at baseline and was significantly reduced to 7.42+/-0.92 ( t test, p=0.015) at the end of the follow up. DME recurred during follow up in only three eyes.

Conclusions: : When DME is combined with FPDR in type 1 diabetic patients, extensive PRP and glycemic control seem to be efficient to reduce DME and improve visual acuity. In these cases, DME may be mainly due to excessive VEGF production by nonperfused retina.

Keywords: diabetic retinopathy • edema • macula/fovea