Causes of severe visual loss in the early treatment diabetic retinopathy study: ETDRS report no. 24

Published on Feb 1, 1999in American Journal of Ophthalmology5.258
路 DOI :10.1016/S0002-9394(98)00309-2
Donald S. Fong24
Estimated H-index: 24
(UCLA: University of California, Los Angeles),
Frederick L. Ferris95
Estimated H-index: 95
(NIH: National Institutes of Health)
+ 1 AuthorsEmily Y. Chew102
Estimated H-index: 102
(NIH: National Institutes of Health)
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Abstract
Abstract PURPOSE: To describe the causes of and risk factors for persistent severe visual loss occurring in the Early Treatment Diabetic Retinopathy Study (ETDRS). METHODS: The ETDRS was a randomized clinical trial investigating photocoagulation and aspirin in 3,711 persons with mild to severe nonproliferative or early proliferative diabetic retinopathy. Severe visual loss, defined as best-corrected visual acuity of less than 5/200 on at least two consecutive 4-month follow-up visits, developed in 257 eyes (219 persons). Of these 257 eyes, 149 (127 persons) did not recover to 5/200 or better at any visit (persistent severe visual loss). Ocular characteristics of these eyes were compared with those of eyes with severe visual loss that improved to 5/200 or better at any subsequent visit. Characteristics of patients with severe visual loss that did and did not improve and those without severe visual loss were also compared. RESULTS: Severe visual loss that persisted developed in 149 eyes of 127 persons. In order of decreasing frequency, reasons recorded for persistent visual loss included vitreous or preretinal hemorrhage, macular edema or macular pigmentary changes related to macular edema, macular or retinal detachment, and neovascular glaucoma. Compared with all patients without persistent severe visual loss, patients with persistent severe visual loss had higher mean levels of hemoglobin A 1c (10.4% vs 9.7%; P = .001) and higher levels of cholesterol (244.1 vs 228.5 mg/dl; P = .0081) at baseline. Otherwise, patients with persistent severe visual loss were similar to patients with severe visual loss that improved and to those without severe visual loss. CONCLUSIONS: Persistent severe visual loss was an infrequent occurrence in the ETDRS. Its leading cause was vitreous or preretinal hemorrhage, followed by macular edema or macular pigmentary changes related to macular edema and retinal detachment. The low frequency of persistent severe visual loss in the ETDRS is most likely related to the nearly universal intervention with scatter photocoagulation (either before or soon after high-risk proliferative diabetic retinopathy developed) and the intervention with vitreous surgery when clinically indicated.
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#1Frederick L. Ferris (NIH: National Institutes of Health)H-Index: 95
ANALYSIS of data from four decades of clinical research demonstrates that currently recommended treatments are considerably more effective in preventing blindness from proliferative diabetic retinopathy (PDR) than has been previously appreciated. In fact, careful follow-up, timely photocoagulation, and vitrectomy when necessary strikingly reduce the risk of blindness for patients with PDR. This remarkable finding lends even greater urgency to current efforts to ensure that virtually all persons ...
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#2Kanemitsu Muraoka (Gunma University)H-Index: 10
Last. Koichi Shimizu (Gunma University)H-Index: 18
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Abstract Using composite super-wide fluorescein angiography, 152 eyes with nonproliferative diabetic retinopathy were evaluated for capillary nonper-fusion. Four basic types of eyes were distinguished according to the location of capillary nonperfusion: peripheral type 4 eyes, midperipheral type 93 eyes, central type 40 eyes and generalized type 15 eyes. The rate of enlargement of nonperfused area was more rapid in peripheral type, midperipheral type, central type and the generalized type in the...
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Abstract We evaluated the topologic distribution of vaso-occlusive and vasoformative lesions in 119 eyes with diabetic retinopathy using our newly developed super-wide (130掳) fluorescein angiographic montage technique. A numeric coding system was applied to assess the vaso-occlusive lesions by dividing each fundus maximally into 418 blocks. We demonstrated that the midperipheral retina was far more prone to undergo capillary nonperfusion than the posterior retina. The extent of capillary nonperf...
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#1Uriel Ticho (Johns Hopkins University)H-Index: 3
#2Arnall Patz (Johns Hopkins University)H-Index: 45
The presence of nonperfusing capillaries in diabetic retinopathy was first described by Ashton using the india ink injection techni颅 que. Cogan and associates路 subsequently demonstrated acellular capillary zones in trypsin digestion flat retinal preparations. The latter authors interpreted these acellular capillaries as nonperfusing, based on the ab颅 sence of red blood cells in the lumen, and suggested that the capillary closure was sec颅 ondary to shunting of blood into surround颅 ing vessels. On...
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