Abstract
Abstract: :
Purpose: To analyze the influence of hypertensive control on the outcome of focal laser treatment for diabetic retinopathy in a high risk population. Methods: In this retrospective study 256 eyes of 189 diabetic patients aged between 27 and 76 years of age (57.76 ± 8.86 years) were included. Laser treatment for clinically significant macular edema was performed by one surgeon between 1998 and 2001 at South Auckland Superclinic that caters to Auckland's large Polynesian population. Prevalence and incidence of diabetes is three to fourfold higher in Maori and Polynesian than in Caucasians, with the onset of type 2 being observed much earlier. At the time of laser treatment and at each following visit visual acuity (VA) was tested, biomicroscopy and ophthalmoscopy were performed, medical history was taken, intraocular pressure and blood pressure were measured. The mean follow-up was 28.57 months. Results: Forty-seven patients had no history of hypertension. In 88 patients with known hypertension or borderline blood pressure, hypertension was well controlled with anti-hypertensive therapy. Compared to normotensive patients, fifty-four patients with poorly controlled or uncontrolled hypertension had a statistically significant higher rate of incomplete resolution of the edema and higher loss in VA (p<0.0001). These patients also needed more laser sessions for complete resolution. No difference was observed between patients without hypertension and those well controlled under therapy. Conclusions: In this study, control of hypertension was an independent predictor for the outcome of focal laser treatment for diabetic macular edema. Hypertensive patients with diabetes should have a strict anti-hypertensive treatment. Especially in high risk populations with early onset and longer lifetime exposure to hyperglycemia early anti-hypertensive treatment may be essential to maintain long-term vision.
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: ris • laser