European Association for the Study of Diabetic Eye Complications

Annual Meeting Munich 21-23rd May 2004

Paper Abstracts

Varia

DIABETES AND LOW VISION

Stephan J. Froehlich

Low-Vision-Department of the Eye-Hospital, Ludwig-Maximilians University , Munich/Germany

Purpose: Diabetes mellitus is the second major contributing cause of visual impairment in industrial nations following Age-Related Macular Degeneration (ARM). When medical interventions can no longer restore or maintain a person`s functional vision, matching and prescription of Low Vision aids are the main goal of rehabilitation. In this context, the role of both optical and electronic devices to restore reading ability will be evaluated.

Methods: During 2003, a total of 1395 patients was seen in the Low Vision Department of the University Eye Hospital Munich. Among them were 167 visually impaired patients because of diabetic ocular involvement (12%), 641 patients with ARM (46%). Mean age of the diabetes patients was 64 years, 82 patients were female, 85 male. In every patient, best corrected distance and near visual acuity (VA) as well as the required magnification factor were measured. Finally, matching of magnifying aids and discussing aspects of professional and social rehabilitation were main parts of our interdisciplinary Low Vision service.

Results: From the 167 patients with diabetes, the average of best corrected distance VA at the better eye was 20/65 (20/100 in ARM), of best corrected near VA 20/100 (20/100 in ARM). The required mean magnification factor was 4x (related to the reading of newspaper text) compared to 6x in patients with ARM. In 153 patients (92%), optical magnifiers could be prescribed (e.g. magnifying eyeglasses, telescopes, monoculars, galelean and keplerian systems), whereas electronic devices were necessary in only 14 patients (8%). Comparatively, patients with ARM had to be provided in 19% with electronic systems.

Conclusions: Reading ability in the majority of visually impaired patients as cause of diabetes could be restored using optical Low Vision aids. To only 8% of the patients, electronic devices had to be prescribed because of the higher amount of required magnification (more than 8x related to the reading of newspaper text). Therefore, optical rehabilitation is often easier in diabetic Low Vision patients than in patients suffering from advanced ARM, even both groups having the same mean near VA. This fact can mainly be explained with the lack of absolute central scotomas and its negative effects on reading speed in diabetic patients compared to ARM patients.

TRANSSCLERAL CYCLOPHOTOCOAGULATION WITH THE DIODE LASER FOR NEOVASCULAR GLAUCOMA IN DIABETIC PATIENTS

G.F.Romeo, B.Majone, F.Di Mauro, M. Prantera

Department of Ophthalmology, C.da Grazia Hospital, Milazzo

PURPOSE: Neovascular glaucoma is a devastating ocular disease that occurs in diabetic patients and often results in loss of vision. The current standard of care includes retinal ablation and control of increased intraocular pressure (IOP) with medical and surgical therapy. Complete panretinal photocoagulation and medical therapy are sometimes unsuccessful to control IOP. In these cases, currently, trabeculectomy with antimetabolite therapy, aqueous shunt implants and diode laser cyclophotocoagulation are the preferred surgical treatment options. Purpose of the present study is to describe the effect of contact diode laser transscleral cyclophotocoagulation in a group of diabetic patients with neovascular glaucoma.

METHODS: A diode laser system (IRIS Medical IRIS OCULIGHT 810nm SL/SLK, contact G.Probe) was used to treat 24 eyes of 23 diabetic patients with neovascular glaucoma. In all the eyes despite the retinal ablation (panretinal photocoagulation in 21 eyes and retinal cryoablation in 3 eyes) the glaucoma was medically uncontrollable. After peribulbar anesthesia with 5cc of 2% mepivacine, all the eyes were treated with 18 laser spots placed over 270 degrees, 1mm posterior to the limbus. The power used ranged from 1500 to 2250 mW, with an exposure duration of 2000msec.. The mean follow-up was 30.12 months (range 6-42 months). Success was defined as an IOP less than or equal to 22 mm Hg or absence of pain for poorly sighted and blind eyes.

RESULTS: The mean preoperative IOP was 40.62mmHg (range 26-54mm Hg). The mean IOP at the end of the follow-up was 21.00mmHg (range 10-42 mmHg). An IOP below 22mmHg was obtained in 17 out of the 24 eyes (70.83%). 10 of the 13 painful eyes had pain relief (76.92%). 1 eye required 1 retreatment. 15 eyes (62.5%) were able to discontinue one or more glaucoma medications. Postoperative anterior uveitis occurred in 2 eyes.

CONCLUSIONS: Diode laser transscleral cyclophotocoagulation appears to be simple, relatively safe and frequently successful in the control of IOP in neovascular glaucoma in diabetic patients. It also serves to reduce the number of antiglaucoma medications and it may be useful for those diabetic patients whose general medical condition precludes invasive surgery or who refuse more aggressive surgery (i.e., filter or tube).

PERCEPTION OF, AND ANXIETY LEVELS INDUCED BY, LASER TREATMENT IN PATIENTS WITH SIGHT-TREATENING DIABETIC RETINOPATHY. A MULTICENTRE STUDY.

M. Trento, M. Bajardi, E. Borgo, P. Passera, 2R. Benecchi, 2L. Scoccianti, 3C. Insacco, 3F. Bandello, M Montanaro, 4F. Cavallo, M. Porta

Diabetic Retinopathy Centre, Dept. of Internal Medicine, University of Turin,2Diabetic Centre and Laser Treatment, Inst of Ophthalmology, Parma, 3Dept. of Ophthalmology, University of Udine, 4 Dept.of Public Health and Microbiology, University of Turin.

Purpose: Retinopathy is a complication of diabetes that requires regular control visits and, sometimes, treatment by laser photocoagulation which is often delivered over multiple sessions. Aims: to investigate in 3 Diabetic Retinopathy Centres how diabetic patients perceive Laser Treatment (LT) in terms of awareness and anxiety.

Methods: Patients waiting for LT in 3 Diabetic Retinopathy Centres were administered 4 questionnaires: HADS (Hospital Anxiety e Depression Scale), FA-LTE (Family Apgar- List of Threatening Experiences), STAI1 and STAI2 (State-Trait Anxiety Inventory). After completion of the questionnaires, all pts. were asked open questions on whether: they had ever heard the word “laser”, they could describe LT and they knew why LT had been recommended for them. 145 patients consecutive were interviewed. 35.9% had only primary education and 47.6% were retired. 92 pts. had not had LT before, whereas 53 had one or more sessions within the past 12 months. Results are expressed as means ± SD.

Results: pts. about to receive LT displayed high levels of discomfort and anxiety, which increased among those who had to repeat treatment. Pts about to receive LT in Torino showed significant more anxiety than those in Torino Parma

Laser Treatment HADS FA-LTE STAI 1 STAI 2
Torino 14.80±6.8 6.46±2.7 48.8±13.0 48.6±11.3
Udine 11.30±8.1 7.56±2.9 39.3±10.4 38.3±10.1
Parma 8.12±6.0 8.53±2.0 36.3±8.5 36.8±9.2
p value p<0.001 p<0.01 p<0.001 p<0.001
Control Visit HADS FA-LTE STAI 1 STAI 2
Torino 10.31±6.3 8.00±2.2 42.26±13.0 41.00±13.5
Udine 11.3±7.9 7.44±2.1 37.35±12.1 39.31±11.0
p<value NS NS NS NS

Most of them could neither describe LT nor explain why they were about to receive it. LT was listed among the most stressing events occurred over the past year. Conclusions: these results suggest that LT induces fear and high levels of anxiety which increase, rather than decrease, with repeating LT sessions. More data should be collected to confirm this interpretation and to guide the development of more appropriate settings to improve approach and support to patients. Lowering anxiety and promoting coping mechanisms may help to reduce fear and prevent patients' avoidance of treatment.


 




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