A NEW TECHNIQUE OF PHOTOCOAGULATION IN SE VERE NONPROLIFERATIVE DIABETIC-RETINOPATHY - A PROSPECTIVE-STUDY IN 54 CASES

Purpose This work deals with the photocoagulation treatment of severe NPDR, suggesting a new therapeutic practice. It is proposed to adopt t reatment intensity to each clinical form, to preserve healthy territor ies through biomicroscopy and to evaluate the risk of complications in herent in this technique, and to be at least as efficient as comparati ve studies. Material and method We treated 52 eyes and kept under obse rvation 2 eyes which revealed severe NPDR. The patients were followed between 1991 and 1996. The approach was essentially biomicroscopic, Ph otocoagulation treatment utilized green, yellow or orange wavelengths through panoramic contact lenses. Results After an average follow-up o f 30 months, there was a decrease of visual acuity of 0.72 to 0.64 (Mo noyer scale), a severe visual loss in 1.8 % of the cases; and an early decrease in visual acuity at 6 weeks in 7.4 % of the cases. A ''High Risk'' PDR occurred in 3.7 % of the cases and we had to perform a vitr ectomy (1.85 % of the cases). We treated with less than 1600 I in 68.5 % of the cases and with more than 1600 I in 31.5 % of the cases. Pati ents had 5.5 photocoagulation sessions and were examined every 3.5 mon ths on average. Conclusion We believe our therapeutic approach is inte resting, by comparison with other studies, but that it can be improved . All patients show a primary condition in the nasal field which, if t reated too massively, becomes unable to see and disturbs daily life. W e also note the severe potential for progression in insulin-dependant patients.