Beneficial Effect of Glycaemic Improvement in Non‐ischaemic Forms of Diabetic Retinopathy: A 3‐Year Follow‐up

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Abstract
Recent studies have suggested that optimal glucose control fails to arrest or even worsens background retinopathy possibly by aggravating retinal ischaemia. Fourteen insulin‐dependent diabetic patients, aged 34±11 years (mean ± SD) treated by long‐term intraperitoneal insulin infusion using portable pumps, were followed for 3 years. Preproliferative or proliferative lesions on ophthalmoscopy and large non‐perfused areas on fluorescein angiography were exclusion criteria. Six patients were found to have minimal and 8 mild background retinopathy. The patients were retrospectively assigned to two comparable groups except for their glycaemic equilibrium under insulin infusion: average control (n=6) and excellent control (n=8), although glycaemic control was significantly improved in all cases when compared to previous conventional therapy. Fluorescein changes were scored blindly and independently by 3 ophthalmologists according to modifications of fluorescein diffusion and capillary abnormalities. The two types of retinal lesions improved gradually in 10 patients and deteriorated in only 1 patient, although not progressing to proliferative retinopathy. Structural improvements were significantly more frequent in the excellently controlled group. We conclude that non‐ischaemic lesions may still be arrested and even improved by tight metabolic control.