Pathogenesis and treatment of diabetic maculopathy

Abstract

It is submitted that a retinal hypoxic focus, if located in the vicinity of the macula, presents the basic pathogenic lesion underlying the development of diabetic maculopathy and determining its pattern. Conversion of these foci into anoxic scars by light coagulation would be expected to improve macular function or to arrest its further impairment. Based on this working hypothesis, 121 eyes (in 112 patients) affected by diabetic maculopathy were treated by light coagulation aimed at converting hypoxic retinal foci into inert scars. Routinely the better eye of the two was not treated and was used as a control. The operations were performed under sedation and local anesthesia and as out patient procedures. Follow up time extended from a minimum of 6 months to 4 years. Of the treated eyes 53% showed improvement of visual acuity against only 4% which deteriorated (apart from four cases of preoperative progressive cataract). Of the control eyes, 6.8% improved and 38.9% deteriorated. Of the treated eyes, 38.8% including nine eyes with preoperative visual acuity below 6/60 remained unchanged; of the untreated eyes 54.3% remained unchanged. For the 103 paired eyes, chi2 statistical analysis demonstrated p<0.001, a highly significant figure.