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Clinical Examples in Managing Diabetic Retinopathy

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Diabetic Retinopathy

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Abstract

In previous chapters, the emphasis has been on a detailed understanding of a particular aspect of diabetic retinopathy. In this chapter the approach will be more topical and practical and the principles presented previously will be exemplified in characteristic situations. Actual cases will be presented with discussions regarding management. These cases were circulated among the co-authors and comments on management independently solicited and then compiled. The discussants for the cases used the comments as a springboard to review the literature and provide a synthesis that reflects both the diverse clinical judgments of the reviewers and the published evidence pertinent to the case.

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Notes

  1. 1.

    Discussed by David J. Browning MD, PhD

  2. 2.

    Discussed by David J. Browning MD, PhD

  3. 3.

    Discussed by David J. Browning MD, PhD

  4. 4.

    Discussed by David J. Browning MD, PhD

  5. 5.

    Discussed by Keye Wong MD

  6. 6.

    Discussed by David G. Telander MD, PhD

  7. 7.

    Discussed by David J. Browning MD, PhD

  8. 8.

    Discussed by David J. Browning MD, PhD

  9. 9.

    Discussed by Keye Wong MD

  10. 10.

    Discussed by David G. Telander MD, PhD

  11. 11.

    Discussant: David G. Telander MD, PhD

  12. 12.

    Discussed by Scott E. Pautler, M.D.

  13. 13.

    Discussed by Scott E. Pautler, M.D.

  14. 14.

    Discussed by Scott E. Pautler, M.D.

References

  1. O'Hanley GP, Canny CLB. Diabetic dense premacular hemorrhage. A possible indication for prompt vitrectomy. Ophthalmology. 1985;92:507–511.

    PubMed  Google Scholar 

  2. Raymond LA. Neodymium. YAG laser treatment for hemorrhages under the internal limiting membrane and posterior hyaloid face of the macula. Ophthalmology. 1995;102:406–411.

    CAS  PubMed  Google Scholar 

  3. Yang CM, Chen MS. Tissue plasminogen activator and gas for diabetic premacular hemorrhage. Am J Ophthalmol. 2000;129:393–394.

    CAS  PubMed  Google Scholar 

  4. Shih CW, Yang CM, Chen MS, Wang TJ. Intravitreal injection of bevacizumab and gas for diabetic premacular hemorrhage and active fibrovascular proliferation. Graefe's Arch Clin Exp Ophthalmol. 2008;246:1547–1551.

    CAS  Google Scholar 

  5. Dayani PN, Grand MG. Maintenance of warfarin anticoagulation for patients undergoing vitreoretinal surgery. Arch Ophthalmol. 2006;124:1558–1565.

    CAS  PubMed  Google Scholar 

  6. Fu AD, McDonald HR, Williams DF, et al. Anticoagulation with warfarin in vitreoretinal surgery. Retina. 2007;27:290–295.

    PubMed  Google Scholar 

  7. Charles S, Rosenfeld PJ, Gayer S. Medical consequences of stopping anticoagulant therapy before intraocular surgery or intravitreal injections. Retina. 2007;27:813–815.

    PubMed  Google Scholar 

  8. Mason JO III, Nixon PA, White MF. Intravitreal injection of bevacizumab (avastin) as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol. 2006;142:685–688.

    CAS  PubMed  Google Scholar 

  9. Arevalo JF, Maia M, Flynn HW Jr, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) inpatients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2007;92:213–216.

    PubMed  Google Scholar 

  10. Joussen AM, Joeres S. Benefits and limitations in vitreoretinal surgery for proliferative diabetic retinopathy and macular edema. Dev Ophthalmol. 2007;39:69–87.

    PubMed  Google Scholar 

  11. Kroll P, Gerding H, Busse H. Retinale proliferationen als komplikation retinaler chirurgie mit silikonoltamponade. Klin Monatsbl Augenheilkd. 1989;195:145–149.

    CAS  PubMed  Google Scholar 

  12. Lucke KH, Foerster MH, Laqua H. Long -term results of vitrectomy and silicone oil in 500 cases of complicated retinal detachments. Am J Ophthalmol. 1987;104:624–633.

    CAS  PubMed  Google Scholar 

  13. La Heij EC, Tecim S, Kessels AGH, Liem ATA, Japing WJ, Hendrikse F. Clinical variables and their relation to visual outcome after vitrectomy in eyes with retinal traction detachment. Graefe's Arch Clin Exp Ophthalmol. 2004;242:210–217.

    Google Scholar 

  14. Flynn HW, Chew EY, Simons BD, Barton FB, Remaley NA. Pars plana vitrectomy in the early treatment diabetic retinopathy study. ETDRS report number 17. The early treatment diabetic retinopathy study research group. Ophthalmology. 1992;99:1351–1357.

    Google Scholar 

  15. The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Arch Ophthalmol. 1985;103:1644–1652.

    Google Scholar 

  16. Ho T, Smiddy WE, Flynn HW Jr. Vitrectomy in the management of diabetic eye disease. Surv Ophthalmol. 1992;37:190–202.

    CAS  PubMed  Google Scholar 

  17. Azen SP, Scott IU, Flynn HW, et al. Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study. Ophthalmology. 1998;105:1587–1597.

    CAS  PubMed  Google Scholar 

  18. Castellarin A, Grigorian R, Bhagat N, et al. Vitrectomy with silicone oil infusion in severe diabetic retinopathy. Br J Ophthalmol. 2003;87:318–321.

    CAS  PubMed  Google Scholar 

  19. Michels RG, Wilkinson CP, Rice TA. Vitreous surgery. In: Klein EA ed. Retinal Detachment. 1st ed. St. Louis, Mo: CV Mosby Co; 1990:Chap. 13.

    Google Scholar 

  20. Imamura Y, Minami M, Ueki M, et al. Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy. Br J Ophthalmol. 2003;87:563–566.

    CAS  PubMed  Google Scholar 

  21. Oshima Y, Sima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology. 2009;116:927–938.

    PubMed  Google Scholar 

  22. Avery RL. Regression of retinal and iris neovascularization after intravitreal bevacizumab (Avastin) treatment. Retina. 2006;26:352–356.

    PubMed  Google Scholar 

  23. Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006;113:1695–1705.

    PubMed  Google Scholar 

  24. Murakami Y, Kusaka S, Oshima Y, et al. Diagnostic and therapeutic challenges. Retina. 2008;28:1357–1360.

    PubMed  Google Scholar 

  25. Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the diabetes control and complications trial. Ophthalmology. 1995;102:647–661.

    Google Scholar 

  26. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–853.

    Google Scholar 

  27. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications of type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–713.

    Google Scholar 

  28. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema-early treatment diabetic retinopathy study report number 1. Arch Ophthalmol. 1985;103(12):1796–1806.

    Google Scholar 

  29. The Diabetic Retinopathy Study Research Group. Four risk factors for severe visual loss in diabetic retinopathy. Arch Ophthalmol. 1979;97, 654–655.

    Google Scholar 

  30. McDonald HR, Schatz H. Macular edema following panretinal photocoagulation. Retina. 1985;5:5–10.

    CAS  PubMed  Google Scholar 

  31. Bandello F, Polito A, Pognuz DR, Monaco P, Dimastrogiovanni A, Paissios J. Triamcinolone as adjunctive treatment to laser photocoagulation to laser panretinal photocoagulation for proliferative diabetic retinopathy. Arch Ophthalmol. 2006;124:643–650.

    CAS  PubMed  Google Scholar 

  32. Hudson HL, Chong LP, Frambach DA, et al. Encircling panretinal laser photocoagulation may prevent macular detachment after vitrectomy for proliferative diabetic retinopathy. Int Ophthalmol. 1994;18:101–104.

    CAS  PubMed  Google Scholar 

  33. DRS Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings. DRS Report #8. Invest Ophthalmol Vis Sci. 1981;88:583–600.

    Google Scholar 

  34. ETDRS Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report #9. Ophthalmology. 1991;98:766–785.

    Google Scholar 

  35. DCCT Study Group. The relationship of glycemic exposure (Hgb A1c) to the risk of development and progression of diabetic retinopathy in the DCCT. Diabetes. 1995;44:968–983.

    Google Scholar 

  36. ETDRS Research Group. Early treatment diabetic retinopathy study design and baseline patient characteristics. ETDRS report #7. Ophthalmology. 1991;98:741–756.

    Google Scholar 

  37. Diabetic Retinopathy Clinical Research Network. Comparison of modified-ETDRS and mild macular grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol. 2007;125:469–480.

    Google Scholar 

  38. Massin P, Allouch C, Haouchine B, et al. Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery. Am J Ophthalmol. 2000;130:732–739.

    CAS  PubMed  Google Scholar 

  39. Massin P, Haouchine B, Gaudric A. Macular traction detachment and diabetic edema associated with posterior hyaloidal traction. Am J Ophthalmol. 2001;132:599.

    CAS  PubMed  Google Scholar 

  40. Gupta A, Gupta V. Diabetic maculopathy and cataract surgery. Ophthalmol Clin North Am. 2001;14:625–637.

    CAS  PubMed  Google Scholar 

  41. Browning DJ. Diabetic macular edema: a critical review of the Early Treatment Diabetic Retinopathy Study (ETDRS) series and subsequent studies. Comp Ophthalmol Update. 2000;1:69–83.

    Google Scholar 

  42. Dowler JGF, Sehmi KS, Hykin PG, Hamilton AMP. The natural history of macular edema after cataract surgery in diabetes. Ophthalmology. 1999;106:663–668.

    CAS  PubMed  Google Scholar 

  43. Escaravage GK, Cohen KL, Patel SB, et al. Quantification of macular and optic disc hyperfluorescence after phacoemulsification in diabetes mellitus. J Cataract Refract Surg. 2006;32:803–811.

    PubMed  Google Scholar 

  44. Otani T, Kishi S. Correlation between optical coherence tomography and fluorescein angiography findings in diabetic macular edema. Ophthalmology. 2007;114:104–107.

    PubMed  Google Scholar 

  45. Squirrell D, Bhola R, Bush J, Winder S, Talbot JF. A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes. Br J Ophthalmol. 2002;86:565–571.

    CAS  PubMed  Google Scholar 

  46. Gillies MC, Sutter FK, Simpson JM, et al. Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a double-masked, placebo-controlled, randomized clinical trial. Ophthalmology. 2006;113:1533–1538.

    PubMed  Google Scholar 

  47. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;115(9):1447–1449.

    Google Scholar 

  48. Arevalo JF, Garcia-Amaris RA, Roca JA, et al. Primary intravitreal bevacizumab for the management of pseudophakic cystoid macular edema: pilot study of the Pan-American collaborative retina study group. J Cataract Refract Surg. 2007;33:2098–2105.

    PubMed  Google Scholar 

  49. Mason JO III, Albert MA Jr, Vail R. Intravitreal bevacizumab (Avastin) for refractory pseudophakic cystoid macular edema. Retina. 2006;26:356–358.

    PubMed  Google Scholar 

  50. Johnson MW. Etiology and treatment of macular edema. Am J Ophthalmol. 2009;147:11–21.

    PubMed  Google Scholar 

  51. Cervera E, Diaz-Llopis M, Udaondo P, Garcia-Delpech S. Intravitreal pegaptanib sodium for refractory pseudophakic macular edema. Eye. 2008;22:1180–1182.

    CAS  PubMed  Google Scholar 

  52. Cheema RA, Al-Mubarak MM, Amin YM, Cheema MA. Role of combined cataract surgery and intravitreal bevacizumab injection in preventing progression of diabetic retinopathy. A prospective randomized study. J Cataract Refract Surg. 2009;35:18–25.

    PubMed  Google Scholar 

  53. Paccola L, Costa RA, Folgosa MS, et al. Intravitreal triamcinolone versus bevacizumab for treatment of refractory diabetic macular oedema (IBEME study). Br J Ophthalmol. 2008;92:76–80.

    CAS  PubMed  Google Scholar 

  54. Wade EC, Blankenship GW. The effect of short versus long exposure times of argon laser panretinal photocoagulation on proliferative diabetic retinopathy. Graefe's Arch Clin Exp Ophthalmol. 1990; 228:226–231.

    CAS  Google Scholar 

  55. Ryan SJ. Traction retinal detachment. XLIX Edward Jackson Memorial Lecture. Am J Ophthalmol. 1993;115:1–20.

    CAS  PubMed  Google Scholar 

  56. Larsson LI, Nuija E. Increased permeability of the blood-aqueous barrier after panretinal photocoagulation for proliferative diabetic retinopathy. Acta Ophthalmol Scand. 2001;79:414–416.

    CAS  PubMed  Google Scholar 

  57. Foos RY, Kreiger AE, Nofsinger K. Pathologic study following vitrectomy for proliferative diabetic retinopathy. Retina. 1985;5:101–106.

    CAS  PubMed  Google Scholar 

  58. El-Batarny AM. Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy. Clin Ophthalmol. 2008;2:709–716.

    CAS  PubMed  Google Scholar 

  59. Kim JE, Pollack JS, Miller DG, Mittra RA, Spaide RF, ISIS Study Group. ISIS-DME. A prospective, randomized, dose-escalation intravitreal steroid injection study for refractory diabetic macular edema. Retina. 2008;28:735–740.

    PubMed  Google Scholar 

  60. Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema-Early treatment diabetic retinopathy study report number 2. Ophthalmology. 1987;94:761–774.

    Google Scholar 

  61. Diabetic Retinopathy Clinical Research Network, Scott IU, Edwards AR, Beck RW, Bressler NM, Chan CK et al. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema. Ophthalmology. 2007;114:1860–1867.

    Google Scholar 

  62. Bailey CC, Sparrow JM, Grey RHB, Cheng H. The national diabetic retinopathy laser treatment audit. I. maculopathy. Eye. 1998;12:69–76.

    PubMed  Google Scholar 

  63. Akduman L, Olk RJ. Subthreshold (invisible) modified grid diode laser photocoagulation in diffuse diabetic macular edema (DDME). Ophthalmic Surg Lasers Imaging. 1999;30:706–714.

    CAS  Google Scholar 

  64. Schatz H, Madeira D, McDonald R, Johnson R. Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol. 1991;109:1549–1551.

    CAS  PubMed  Google Scholar 

  65. Finkelstein D. Ischemic macular edema recognition and favorable natural history in branch vein occlusion. Arch Ophthalmol. 1992;110(10):1427–1434.

    CAS  PubMed  Google Scholar 

  66. Early Treatment Diabetic Retinopathy Study Group. Classification of diabetic retinopathy from fluorescein angiograms. ETDRS Report Number 11. Ophthalmology. 1991;98:807–822.

    Google Scholar 

  67. Chew EY, Benson WE, Blodi BA, et al. Diabetic Retinopathy Preferred Practice Pattern. American Academy of Ophthalmology; 2008.

    Google Scholar 

  68. Patz A, Smith RE. The ETDRS and diabetes 2000. Ophthalmology. 1991;98:739–740.

    CAS  PubMed  Google Scholar 

  69. Browning DJ, Glassman AR, Aiello LP, et al. Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology. 2007;114:525–536.

    PubMed  Google Scholar 

  70. ETDRS Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. ETDRS Report # 2. Ophthalmology. 1987;94:761–774.

    Google Scholar 

  71. Early Treatment Diabetic Retinopathy Study Research Group. Focal photocoagulation treatment of diabetic macular edema-relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report number 19. Arch Ophthalmol. 1995;113:1144–1155.

    Google Scholar 

  72. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002;109:920–927.

    PubMed  Google Scholar 

  73. Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Collaborative Retina Study Group at 6-month follow-up. Ophthalmology. 2007;114:743–750.

    PubMed  Google Scholar 

  74. McDonald HR, Schatz H. Visual loss following panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1985;92:388–393.

    CAS  PubMed  Google Scholar 

  75. Higgins KE, Meyers SM, Jaffe MJ, Roy MS, de Monasterio FM. Temporary loss of foveal contrast sensitivity associated with panretinal photocoagulation. Arch Ophthalmol. 1986;104:997–1003.

    CAS  PubMed  Google Scholar 

  76. Browning DJ, McOwen MD, Bowen RM Jr, O'Marah TL. Comparison of the clinical diagnosis of diabetic macular edema with diagnosis by optical coherence tomography. Ophthalmology. 2004;111:712–715.

    PubMed  Google Scholar 

  77. Diabetic Retinopathy Clinical Research Network. Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema. A pilot study. Ophthalmology. 2007;114:1190–1196.

    Google Scholar 

  78. Jonas JB, Degenring R, Kreissig I, Akkoyun I. Safety of intravitreal high-dose reinjections of triamcinolone acetonide. Am J Ophthalmol. 2004;138:1054–1055.

    CAS  PubMed  Google Scholar 

  79. Gillies MC, Kuzniarz M, Craig J, Ball M, Luo W, Simpson JM. Intravitreal triamcinolone-induced elevated intraocular pressure is associated with the development of posterior subcapsular cataract. Ophthalmology. 2005;112:139–143.

    PubMed  Google Scholar 

  80. Gillies MC, Simpson JM, Billson FA, et al. Safety of an intravitreal injection of triamcinolone: results from a randomized clinical trial. Arch Ophthalmol. 2004;122:336–340.

    CAS  PubMed  Google Scholar 

  81. Moshfeghi DM, Kaiser PK, Scott IU, et al. Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2003;136:791–796.

    CAS  PubMed  Google Scholar 

  82. Shimura M, Nakazawa T, Yasuda K, et al. Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema. Am J Ophthalmol. 2008 May;145(5):854–861. Epub 2008 Mar 6.

    Google Scholar 

  83. Diabetic Retinopathy Clinical Research Network. Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol. 2009;127:132–140.

    Google Scholar 

  84. Takagi H, Otani A, Kiryu J, Ogura Y. New surgical approach for removing massive foveal hard exudates in diabetic macular edema. Ophthalmology. 1999;106(2):249–256; discussion 56-7.

    CAS  PubMed  Google Scholar 

  85. Beck RW, Edwards AR, Aiello LP, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009;127(3):245–251.

    PubMed  Google Scholar 

  86. Ozkiris A. Intravitreal bevacizumab (Avastin) for primary treatment of diabetic macular oedema. Eye. 2009;23(3):616–620.

    CAS  PubMed  Google Scholar 

  87. Soheilian M, Ramezani A, Bijanzadeh B, et al. Intravitreal bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment of diabetic macular edema. Retina. 2007;27(9):1187–1195.

    PubMed  Google Scholar 

  88. Kook D, Wolf A, Kreutzer T, et al. Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema. Retina. 2008;28(8):1053–1060.

    PubMed  Google Scholar 

  89. Kumar A, Sinha S. Intravitreal bevacizumab (Avastin) treatment of diffuse diabetic macular edema in an Indian population. Indian J Ophthalmol. 2007;55(6):451–455.

    PubMed  Google Scholar 

  90. Arevalo JF, Sanchez JG, Fromow-Guerra J, et al. Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up. Graefes Arch Clin Exp Ophthalmol. 2009;247(6):735–743.

    CAS  PubMed  Google Scholar 

  91. Schwartz SG, Flynn HW, Jr. Pharmacotherapies for diabetic retinopathy: present and future. Exp Diabetes Res. 2007;2007:52487.

    PubMed  Google Scholar 

  92. Xie XW, Xu L, Wang YX, Jonas JB. Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006. Graefes Arch Clin Exp Ophthalmol. 2008;246(11):1519–1526.

    PubMed  Google Scholar 

  93. Spandau UH, Derse M, Schmitz-Valckenberg P, Papoulis C, Jonas JB. Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular oedema. Br J Ophthalmol. 2005;89(8):999–1003.

    CAS  PubMed  Google Scholar 

  94. Chieh JJ, Roth DB, Liu M, et al. Intravitreal triamcinolone acetonide for diabetic macular edema. Retina. 2005;25(7):828–834.

    PubMed  Google Scholar 

  95. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002;109(5):920–927.

    PubMed  Google Scholar 

  96. Soheilian M, Ramezani A, Obudi A, et al. Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema. Ophthalmology. 2009;116(6):1142–1150.

    PubMed  Google Scholar 

  97. Kang SW, Sa HS, Cho HY, Kim JI. Macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol. 2006;124(5):653–658.

    CAS  PubMed  Google Scholar 

  98. Iida T. Combined triamcinolone acetonide injection and grid laser photocoagulation: a promising treatment for diffuse diabetic macular oedema? Br J Ophthalmol. 2007;91(4):407–408.

    PubMed  Google Scholar 

  99. Takaya K, Suzuki Y, Mizutani H, Sakuraba T, Nakazawa M. Long -term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy. Retina. 2004;24(1):23–29.

    PubMed  Google Scholar 

  100. Avci R, Inan UU, Kaderli B. Long -term results of excision of plaque-like foveal hard exudates in patients with chronic diabetic macular oedema. Eye. 2008;22(9):1099–1104.

    CAS  PubMed  Google Scholar 

  101. Larsson J, Kifley A, Zhu M, et al. Rapid reduction of hard exudates in eyes with diabetic retinopathy after intravitreal triamcinolone: data from a randomized, placebo-controlled, clinical trial. Acta Ophthalmol. 2009;87(3):275–280.

    CAS  PubMed  Google Scholar 

  102. Cunningham MA, Edelman JL, Kaushal S. Intravitreal steroids for macular edema: the past, the present, and the future. Surv Ophthalmol. 2008;53(2):139–149.

    PubMed  Google Scholar 

  103. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98(5 Suppl):766–785.

    Google Scholar 

  104. The Early Treatment Diabetic Retinopathy Study Research Group. Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report no. 3. The Early Treatment Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin. 1987;27(4):254–264.

    Google Scholar 

  105. Aylward GW, Pearson RV, Jagger JD, Hamilton AM. Extensive argon laser photocoagulation in the treatment of proliferative diabetic retinopathy. Br J Ophthalmol. 1989;73(3):197–201.

    CAS  PubMed  Google Scholar 

  106. Vine AK. The efficacy of additional argon laser photocoagulation for persistent, severe proliferative diabetic retinopathy. Ophthalmology. 1985;92(11):1532–1537.

    CAS  PubMed  Google Scholar 

  107. Yeh PT, Yang CM, Yang CH, Huang JS. Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage: an ultrasound biomicroscopy study. Ophthalmology. 2005;112(12):2095–2102.

    PubMed  Google Scholar 

  108. Mosier MA, Del PE, Gheewala SM. Anterior retinal cryotherapy in diabetic vitreous hemorrhage. Am J Ophthalmol. 1985;100(3):440–444.

    CAS  PubMed  Google Scholar 

  109. Neely KA, Scroggs MW, McCuen BW. Peripheral retinal cryotherapy for postvitrectomy diabetic vitreous hemorrhage in phakic eyes. Am J Ophthalmol. 1998;126(1):82–90.

    CAS  PubMed  Google Scholar 

  110. McLeod D. A chronic grey matter penumbra, lateral microvascular intussusception and venous peduncular avulsion underlie diabetic vitreous haemorrhage. Br J Ophthalmol. 2007;91(5):677–689.

    PubMed  Google Scholar 

  111. Mason JO, III, Yunker JJ, Vail R, McGwin G, Jr. Intravitreal bevacizumab (Avastin) prevention of panretinal photocoagulation-induced complications in patients with severe proliferative diabetic retinopathy. Retina. 2008;28(9):1319–1324.

    PubMed  Google Scholar 

  112. Arevalo JF, Maia M, Flynn HW Jr, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92(2):213–216.

    CAS  PubMed  Google Scholar 

  113. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98(5 Suppl):766–785.

    Google Scholar 

  114. Yang CM, Su PY, Yeh PT, Chen MS. Combined rhegmatogenous and traction retinal detachment in proliferative diabetic retinopathy: clinical manifestations and surgical outcome. Can J Ophthalmol. 2008;43(2):192–198.

    PubMed  Google Scholar 

  115. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329(14):977–986.

    Google Scholar 

  116. Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol. 2004;122(11):1631–1640.

    PubMed  Google Scholar 

  117. Arend O, Wolf S, Harris A, Reim M. The relationship of macular microcirculation to visual acuity in diabetic patients. Arch Ophthalmol. 1995;113:610–614.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Charlotte Eye Ear Nose & Throat Associates, Charlotte, NC, 28210, USA

    David J. Browning

  2. Department of Ophthalmology, University of South Florida, University Community Hospital, Tampa, FL, 33607, USA

    Scott E. Pautler MD, FACS

  3. University of California Davis Medical Center, Sacramento, CA, 95817, USA

    David G. Telander MD, PhD

  4. University of South Florida, Sarasota, FL, 34242, USA

    Keye Wong MD

  5. Department of Ophthalmology, Mayo School of Medicine, Jacksonville, FL, 32082, USA

    Michael W. Stewart MD

  6. Clinical Research, Retina Center, Minneapolis, MN, 55404, USA

    Abdhish R. Bhavsar MD

  7. University of Minnesota, Minneapolis, MN, 55404, USA

    Abdhish R. Bhavsar MD

  8. Posterior Segment Research, Phillips Eye Institute, Minneapolis, MN, 55404, USA

    Abdhish R. Bhavsar MD

Authors
  1. David J. Browning
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  2. Scott E. Pautler MD, FACS
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  3. David G. Telander MD, PhD
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  4. Keye Wong MD
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  5. Michael W. Stewart MD
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  6. Abdhish R. Bhavsar MD
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Corresponding author

Correspondence to David J. Browning .

Editor information

Editors and Affiliations

  1. Throat Associates, Charlotte Eye Ear Nose &, Fairview Road 6035, Charlotte, 28210, USA

    David J. Browning

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© 2010 Springer Science+Business Media, LLC

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Browning, D.J., Pautler, S.E., Telander, D.G., Wong, K., Stewart, M.W., Bhavsar, A.R. (2010). Clinical Examples in Managing Diabetic Retinopathy. In: Browning, D. (eds) Diabetic Retinopathy. Springer, New York, NY. https://doi.org/10.1007/978-0-387-85900-2_16

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  • DOI: https://doi.org/10.1007/978-0-387-85900-2_16

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  • Online ISBN: 978-0-387-85900-2

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