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Question:

From Cleveland, Ohio, USA:

I have been a type 1 diabetic over 20 years. I have proliferative retinopathy in both eyes. I have had three laser treatments, two on the right eye and one on the left eye.

After almost a year and a half of my eyes being stable, the left eye, which had only one treatment, now has a small leak. My retinologist said it needs one small laser treatment to seal the leak. He also said this is pretty common. Is it common? Once the laser treatment has been performed for PDR and the vessels shrink and the eye is stable, will the vessels grow back? I understand that as long as I have diabetes I can expect some new leakage now and then, but my main concern is the neovascularization. Does the laser destroy all this new growth and will it come back? I am terrified!

Answer:

It sounds as though you have developed "diabetic macular edema" (DME) in the left eye, a form of diabetic retinopathy that causes fluid (serum, lipid and protein) leakage into the center of the retina. In fact, macular edema is the leading cause of vision loss from diabetes. DME and proliferative diabetic retinopathy (PDR) often go hand in hand. In my experience, it is more common for type 2 patients to get DME after pan-retinal laser treatment for PDR. No matter, the key is to get the leaking vessels sealed as soon as possible, as research shows this lowers the risk of significant vision loss by 50 percent; the other key is to make sure your blood sugars, blood pressure and blood lipids are optimal. Reducing stress as much as possible may also help, as cortisol levels, which increase under stress, make macular blood vessels more leaky.

PDR can return, even after laser treatment. Laser itself does not destroy retinal neovascularization; neovascularization regresses (shrivels up) because laser destroys retinal tissue that is receiving inadequate blood supply. This turns off the biochemical signals that cause neovascularization in the first place. It is believed, though it has not been scientifically proven by large studies, that tight blood sugar and blood pressure control are important to preventing return of PDR after laser therapy.

Do not be terrified. Get educated and ask questions of your retinal specialist. You might want to search the internet for information about a special form of Vitamin B1 called "benfotiamine, " which was shown to totally prevent diabetic retinopathy in rats, Vitamin B1 blocks damage caused by hyperglycemia. It has not been thoroughly tested in humans for retinopathy, but it has been used extensively in Europe for diabetic neuropathy with good results and safety. I would also encourage you to read my book Diabetic Eye Disease: Lessons From A Diabetic Eye Doctor on diabetic eye disease. Remember, knowledge is power.

PC

DTQ-20040315033943
Original posting 16 Mar 2004
Posted to Complications

  
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Last Updated: Tuesday April 06, 2010 15:09:56
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