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Anales de la Sociedad Mexicana de Oftalmología y Archivos de la Asociación Para Evitar la Ceguera en México

2006, Number 3

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Rev Mex Oftalmol 2006; 80 (3)

Retinopatía diabética proliferativa de alto riesgo y su manejo con mayor fotocoagulación inicial

Rivera-Robles V, Flores-Aguilar M, Celis de la RA

Language: Spanish
References: 22
Page: 126-131
PDF size: 81.63 Kb.


ABSTRACT

Purpose: To evaluate the efficacy of stronger than standard laser panretinal photocoagulation spots as suggested by the Early Treatment Diabetic Retinopathy Study (ETDRS), for regression of high risk PDR, when applied as initial therapy.
Design: Control clinical trial (paired).
Material and methods: Forty eyes of twenty patients, with bilateral PDR, and 3 to 4 high risk factors for visual loss were included. One eye randomized to receive experimental treatment of 3,000 laser spots and the other with 1,500 spots. Two mask independent observers, with clinical photographs and fluorescein angiography, measured regression of high risk factors.
Laboratory test was performed to established metabolic and renal status, and atherogenic risk.
Results: Difference between study groups was statistically significant (p= 0.022). Patients, treated with 3000 spots, had eleven times more chance of regression of high-risk characteristics than other group (odds ratio of 11.0, confidence interval of 1.42 to 85.2).
Conclusions: Characteristics of population studied were long-term diabetes, hypertension, poor metabolic control, clinical albuminuria, and high-risk atherogenesis. These were homogeneous and did not influence results. A larger number of panretinal photocoagulation spots in patients with high risk PDR may be effective in a better control of the disease.


REFERENCES

  1. Dirección General de Epidemiología e Instituto Nacional de la Nutrición. Encuesta Nacional de Enfermedades Crónicas, México 1993.

  2. Aiello LIP, Gardner TW, King GL y col. Diabetic retinopathy. Diabetes Care 1998; 21:143-156.

  3. Salazar SB, Garduño EJ y col. Características de los pacientes con diagnóstico de invalidez por diabetes mellitus: Un análisis en trabajadores del área de la salud. Rev Med IMSS (Méx.) 1991; 29:225-259.

  4. Okun E, Cibis P. The role of photocoagulation in the therapy of proliferative diabetic retinopathy. Arch Ophthalmol 1966; 75:337-352.

  5. Diabetic Retinopathy Study Research Group. Report 6: Design, methods, and baseline results. Invest Ophthalmol Vis Sci 1981; 21:149-209.

  6. Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of diabetic retinopathy study (DRS) findings. DRS report no. 8. Ophthalmology 1981; 88:583-600.

  7. Early Treatment Diabetic Retinopathy Study Research Group. Early treatment diabetic retinopathy study design and baseline patient characteristics. ETDRS report no.7. Ophthalmology 1991; 98:741-5.

  8. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report no. 9. Ophthalmology 1991; 98:766-85.

  9. Doft B, Metz D, Kelsey S. Augmentation laser for proliferative diabetic retinopathy that fails to respond to initial panretinal photocoagulation. Ophthalmology 1992; 99:1728-35.

  10. Aylward GW, Pearson RV, Jagger JD, Hamilton AM. Extensive argon laser photocoagulation in the treatment of proliferative diabetic retinopathy. Br J Ophthalmol 1989; 73:197-201.

  11. Vine AK. The efficacy of additional argon laser photocoagulation for persistent, severe proliferative diabetic retinopathy. Ophthalmology 1985; 92:1532-7.

  12. Cordeiro MF, Stanford MR, Phillips PM, Shilling JS. Relationship diabetic microvascular complications to outcome in panretinal photocoagulation treatment of proliferative diabetic retinopathy. Eye 1997; 11,531-36.

  13. Verdaguer TJ. Asociación Panamericana de Oftalmología. Retinopatía Diabética. Clasificación, normas para pesquisa y tratamiento. Imprenta NOCIÓN Cia. Ltda. Quito. 1988.

  14. Reddy VM, Zamora RL, Olk RJ. Quantitation of retinal ablation in proliferative diabetic retinopathy. Am J Ophthalmol 1995; 119:760-6.

  15. González VME, González VC, Arredondo PB, Stern MP. Diabetic retinopathy in México. Prevalence and clinical characteristics. Arch Med Res 1994; 25(3):355-360.

  16. Rodríguez VE, Cervantes AF, Avalos MME y cols. Incidencia y progresión de la retinopatía diabética en pacientes con diabetes mellitus no insulinodependientes. CaliMed 1997; 3(1):3.

  17. Klein BEK, Moss SE, Klein R, Surawicz TS. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology 1991; 98:1261-5.

  18. United Kindom Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-53.

  19. Sorbinil Retinopathy Trial Research Group. A randomized trial of sorbinil, an aldose reductase inhibitor, in diabetic retinopathy. Arch Ophthalmol 1990; 108:1234-44.

  20. Aiello LP, Pierce EA, Foley ED y col. Suppression of retinal neovascularization in vivo by inhibition of vascular endothelial growth factor (VEGF) using soluble VEGF-receptor chimeric proteins. Proc Natl Acad Sci USA 1995; 92:10457-61.

  21. Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. N Engl J Med 1988; 318:1315-21.

  22. Charles CB. Estimation of the maximum number of argon laser burns posible in panretinal photocoagulation. Am J Ophthalmol 1984; 97:697-703.




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