management of proliferative diabetic retinopathy
Last reviewed 01/2018
Principal goal is prevention with
- systemic and local measures (1)
- good glycaemic control
- control of hypertension
Treatment is directed at regressing neovascularisation using Argon laser pan-retinal photocoagulation
- the new vessels themselves are not targeted but photocoagulation is spread over a wide area in order to destroy ischaemic retina and remove the vasoproliferative stimulus
- there is variable visual loss and night blindness.
Vitrectomy is indicated if a vitreous haemorrhage has not resolved spontaneously within 6 months or retinal detachment is suspected.
- vitrectomy (2)
- a surgical technique
- approached from the pars plana,
- vitreous excised
- suctioning the gel done
- replaced with aqueous fluid.
- fibrous tissue removed
- areas of retinal detachment flattened
- a surgical technique
Patients with neovascular glaucoma or high-risk proliferative diabetic retinopathy should receive prompt scatter photocoagulation (3)
Gene therapy for ocular neovascularization is still under study (4)
Future treatment prospects under trial include (5)
- protein kinase C inhibitors,
- intravitreal steroid,
- anti-vascular endothelial growth factor agents,
- angiotensin converting enzyme inhibitors,
- growth hormone
Pan-retinal photocoagulation may prevent thrombotic glaucoma but once developed, this may be difficult to treat.
Untreated eyes with severe disease have about 40% risk of severe visual loss within two years.
Reference:
- American Academy of Ophthalmology, basic and clinical science course,2005-2006, retina and vitreous, section12, 99-119
- Ferris FL et al. Treatment of Diabetic Retinopathy.N Engl J Med 1999;341:667.
- Campochiaro PA.Gene therapy for ocular neovascularization. Curr Gene Ther. 2007 Feb;7(1):25-33.
- American Academy of Ophthalmology Retina Panel (2003). Diabetic Retinopathy,Preferred Practice Pattern® Guideline
- Yam JC et al. Update on the treatment of diabetic retinopathy.Hong Kong Med J. 2007 Feb;13(1):46-60.