FULL PANRETINAL PHOTOCOAGULATION AND EARLY VITRECTOMY IMPROVE PROGNOSIS OF FLORID DIABETIC-RETINOPATHY

Background: Florid diabetic retinopathy (FDR) is a rare form of prolif erative diabetic retinopathy (PDR) that is characterized by a bilatera l rapidly progressive, very severe ischemic retinopathy. Florid diabet ic retinopathy was reported to carry a high risk of blindness. This st udy was conducted to determine whether visual prognosis of FDR can be improved by appropriate photocoagulation and surgical management. Meth ods: The authors retrospectively studied 20 patients (40 eyes) who wer e treated from October 1978 to February 1994. Systemic risk factors, v isual acuity, complete ocular examination, and fundus findings, as wel l as fluorescein angiography, were analyzed with respect to photocoagu lation and surgical management. Mean follow-up was 3.6 years. Results: All patients had poorly controlled type I diabetes (mean duration, 13 .5 years), which often was associated with systemic complications. Mea n initial visual acuity was equal to or better than 20/40 in 32 eyes ( 80%). During the course of the study, high-risk PDR was observed in 38 eyes (95%) and vitreous hemorrhage occurred in 26 eyes (65%). Extensi ve full subconfluent panretinal photocoagulation was performed complet ely in 37 eyes (92.5%). Vitrectomy was necessary in 15 eyes (37.5%). M acular edema was present in 30 eyes (75%). Major complications include d retinal detachment that required surgery (2 eyes, 5%) and neovascula r glaucoma (2 eyes, 5%). However, final visual acuity was equal to or better than 20/40 in 23 eyes (57.5%) and less than 5/200 in only 4 eye s (10%). Conclusion: These results suggest that aggressive treatment o f FDR with extensive panretinal photocoagulation and early vitrectomy, when necessary, may result in a much better prognosis than has been r eported previously.