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Impressum
Development after "Gentle-Grid- Coagulation" in diabetic cystoid macular edema
Herfurt S., Knuth I., Clemens S.
Eye Clinic of Ernst-Moritz-Arndt University, Greifswald
Background: The cystoid macular edema represents an autonomous
form of the diabetic maculopathy. Regarding the mechanism of development
there are two theses discussed. Among other things both theses proceed
from a lesser nutrition of the complex consisting of photoreceptors and
retinal pigment epithelium. Therefore one should strive for a mild photocoagulation
( "gentle grid") in order to stimulate the retinal pigment epithelium.
Method: We performed a " Gentle -Grid-Coagulation"with
an Argon- Laser(514 nm) in 82 eyes of 52 patients. 12 patients suffered
from an insulin dependent diabetes mellitus ( IDDM) type 1 and 40 patients
from IDDM type 2. All patients underwent a complete ocular examination
with visual acuity, slit-lamp biomicroscopy, fundus photography, fundus
fluoreszein angiography and control of the current HbA1clevel. The mean
follow up examination was scheduled 12 months later.
Results: The visual acuity improved in 28 eyes ( 34%), of those
18 eyes improved by one line in the visual acuity scale and 10 eyes by
two or more lines.The majority of treated eyes 39 eyes (48%)showed a stable
situation with constant visual acuity in far distance.Comparing the results
of the both groups in diabetic types, type1 diabetics showed in general
better visual acuity results. On average the HbA1clevel in type 1 diabetics
were 7,4%, compared to the far more pathological values around 8,5% of
type 2 diabetics.
Conclusion: Our results point out that the majority of the patients
profit of a "Gentle-Grid Coagulation", despite the severity
and complexity of the disorder . Particulary in the group of type 1 diabetics,
with a demonstrably better metabolism situation, an improvement of the
visual acuity could be achieved. Our results clarifies the strong necessity
of an intensive cooperation between the ophthalmologist and the general
practioner respectively the diabetes specialist.