Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

Diabetic Retinopathy 481

Pt w/ history of noncompliance or poor follow-up

PDR that develops during pregnancy

Moderate to severe NPDR in 1 eye & severe PDR w/ visual loss

in other eye

Juvenile-onset diabetes

Rapid progression of retinopathy

➣Most eyes w/ early PDR & severe NPDR require treatment w/in

3–5 y; early treatment, even if light, often prevents disease pro-

gression

specific therapy

Treatment Options

■Laser techniques: various laser wavelengths – green, red, yellow —

all can be effective

■Vitrectomy:

➣Clears media of opacities & vitreous hemorrhage

➣Allows repair of traction and rhegmatogenous retinal detach-

ment

➣Removes fibrous proliferation

➣Removes scaffold for growth of fibrovascular proliferation; after

successful vitrectomy, neovascularization usually does not recur

follow-up

■Monitor eyes w/ high-risk PDR & treated by PRP closely at 6–8 wk

intervals until NV has regressed

complications and prognosis

■Burns of excessive intensity can result in pt discomfort & increase

risk of adverse effects (rupturing Bruch’s membrane, choroidal hem-

orrhage, choroidal effusions, visual field loss)

■Decreased central visual acuity & visual field loss most common &

significant complications after PRP; decreased visual acuity after PRP

may be due to development or exacerbation of macular edema

■Inadvertent foveal burns may occur

Clinical Trials – Potential New Treatments

■Macugen (pegaptanib sodium; OIS/Eyetech) – anti-VEGF (vascular

endothelial growth factor) aptamer, injected intravitreally

➣0.3 mg -> stable or improved vision (73% vs. 51%, p=.023),

decreased mean retinal thickness≥100 microns (42% vs. 16%,

p <.05), reduced need for additional laser therapy (25% vs. 48%,

p <.05)