Case 55, retinopathy worse with good control
- 1963 date of birth, male, obese, -
- 1997, diabetic, type 2, basal bolus insulin
- 2011 background none-proliferative retinopathy right vision 6/9; left 6/6 HbA1c 9.7, 140/90
- advised to seek good control
- 2011 November right 6/18; left 6/12
- HbA1c 7.1: much better diabetic control, but worse retinopathy!
- The retinopathy will settle, and the patients will be better off in the long term, but in the short term laser and Avastin are needed.
Late 2011..macular oedema, more haemorrhages, much worse retinopathy, laser needed as below enlarge
Early 2011...a few haemorrhages, none proliferative. But diabetes was out of control (HbA1c 9.7).
- Tightening control can increase retinopathy rapidly.
- But good control with help the retinopathy in the long term, with much better visual results.
- These is disagreement as to how quickly good control should be achieved Most recommend gradual improvement over 12 months, others say longer.
- The only real solution is to never let control get bad!-
- If the control is poor and needs to improve (in order to help other prevent diabetic complications) expect problems and laser early.
- -Laser PRP α haemorrhages, do not wait for new vessels. Lots of haemorrhages need lots of PRP laser.
- Warn patient-they retinopathy may progress significantly.
- Anti-VEGFs can be very helpful ....needed for CME & severe proliferation. It is probably needed in this case (in addition to laser). Repeated injections are needed.
- New wide angle photography shows peripheral ischaemia....should we be lasering the peripheral retina more heavily and earlier? Few if us have this! PRP if ischaemic periphery.-
- Laser burns: 0.01-0.02 seconds all laser, lighter, more shots for PR; - grids for macula; then Avatin
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