[Evaluate the effectiveness of laser therapy in the treatment of diabetic maculopathy]. / Ocena skutecznosci laseroterapi w leczeniu makulopatii cukrzycowej.

UNLABELLED: Diabetes mellitus concerns a growing number of people in the world. Its complications are an important social problem. Diabetic macular edema (DME) is one of the leading causes of visual loss in the course of the disease. Deterioration of vision is typically the patients with long-standing, poorly controlled diabetes, both type 1 and 2. DME can occur at any stage of the disease. Because structural changes in the macula are reversible in the initial period, it is important to start treatment early. In the treatment of diabetic uses three techniques retinal laser--direct photocoagulation, photocoagulation a "grid" and the panphotocoagulation. The aim of this study was to evaluate the effectiveness of laser therapy in the treatment of diabetic macular edema. MATERIALS AND METHODS: The study included 90 patients (180 eyes) with DME, 50 women and 40 men aged from 18 to 80 years with a visual acuity of 0.08 to 0.7 with the best corrected on the Snellen chart. 9 people were with type 1 diabetes, 81 with type 2. 86 patients applied insulin, 4 people took drugs. Eye with poor visual acuity was qualified for the treatment. In all patients enrolled in the study visual acuity, anterior segment of the eye in the slit lamp and fundus by indirect ophthalmoscopy with Volk 78D lens were evaluated. DME was diagnosed on the basis of the results of fluorescein angiography and optical coherence tomography. In the patients laser therapy was performed twice: on day 1 after qualification and four months later. Performed two types of laser: the focal photocoagulation and the type of "grid" depending on the severity of DME. Retinal photocoagulation was performed using a diode laser 810 nm Diode Laser Systems OcuLight SL and SLx Iris Medical Models. Patients were monitored at 4 and 8 months after the laser therapy. The results were statistically analyzed. RESULTS: Duration of diabetes less than 10 years was in 67 patients, over 10 years in 23. In patients with diabetes under 10 years predominated limited type of macular edema (92.65%), in patients over 10--diffuse (72.73%). As a result of the treatment in 34 patients (37.8%) visual acuity was improved. 91.18% of them had limited macular edema. In 47 patients (52.2%) showed the stabilization of vision. These patients had also more limited type of edema (74.47%). In 9 patients (10%) visual impairment were observed and they were mostly patients with diffuse macular edema (66.67%). Average visual acuity in patients with limited macular edema before laser therapy was 0.37 +/- 0.18. In the four months after the laser treatment improved slightly (0.38 +/- .18). After 8 months of treatment the average visual acuity in this group remained at a level of 0.44 +/- 0.16. In patients with diffuse macular edema output type visual acuity was significantly lower and averaged only 0.16 +/- 0.1. In 4 months after the laser was found in this group decreased vision (Vo = 0.13 +/- 0.08). In 8 months after surgery visual acuity averaged 0.15 +/- 0.09. Average visual acuity before laser therapy in this group was 0.36 +/- 0.17, and 8 months after was at the level of 0.43 +/- 0.16. In patients with diabetes more than 10 years laser therapy has not brought the desired effect, and visual acuity were as follows: before treatment--0.18 +/- 0.16 and 8 months after--0.17 +/- 0.14 (p < 0.0001). Average macular thickness before laser therapy in patients with limited edema was 348.14 +/- 33.47 microns. In 4 months after the laser has been observed decreased to 340.29 +/- 31.2 microns, and after 8 months of further withdrawal of edema to an average of 337.88 +/- 32.95 microns. In patients with diffuse type average macular thickness was 394.38 +/- 38.18. After 4 months of laser treatment exacerbation of edema (mean 399 +/- 38.08). After 8 months, the thickness of macula in this group was average 388.95 +/- 32.85. CONCLUSIONS: Laser therapy is an effective type of treatment for DME. Better results after laser therapy are obtained in patients with a short-term macular edema and good visual acuity. In order to maintain useful visual acuity, patients with DME should undergo laser treatment in the early stages of the disease.

[Blood flow in vessels supplying the eye in persons with degenerative myopia. Part I. Blood flow in the ophthalmic artery]. / Przeplyw krwi w naczyniach zaopatrujacych galke oczna u osób z krótkowzrocznoscia degeneracyjna. Cz. I. Przeplyw krwi w tetnicy ocznej.

BACKGROUND: Mechanism of hemodynamic disturbances of blood circulation within the afferent vessels supplying the retina and the choroid, considered as one of main underlying causes of degenerative changes in myopic patients, is exceptionally likely, although not entirely proven. PURPOSE: To estimate the blood flow parameters in the ophthalmic artery of myopic subjects, depending on the extent and severity of progression of degenerative lesions observed in ocularfundi. METHODS: A prospective study included 70 myopic persons, aged from 18 to 79 years (44.9 +/- 18.3) with the mean axial ocular length of 27.9 +/- 5.37 mm. According to the extent and severity of degenerative lesion progression, patients were divided into 4 groups: I - no degenerative changes on the fundus (n = 32; K--23, M--9), II--myopic crescent (n = 20; K--14, M--6), III--retinal thinning accompanying the myopic crescent (n = 8; K - 6, M - 2), IV--extensive chorioretinal atrophy in the fundus (n = 10; K--7, M--3). Using colour Doppler ultrasonography (Aplio SSA Toshiba, frequency of the head of 12 MHz) the following parameters of the blood flow in the opthalmic artery were determined: the maximum (Vmax), minimal (Vmin) and mean (Vm) velocity, resistive index (RI) as well as pulsation index (PI). Differences were analysed statistically (the variance analysis and the Spearman's rank correlation coefficient). P < 0.05 was assumed as statistically significant. RESULTS: In groups I and II blood flow parameters were comparable. In group III Vmax, Vmin and Vm were lower than in groups I and II. However, an increase in these parameters was shown in group IV. The PI remained on the comparable level, and the RI across all the study groups. The observed differences were not statistically significant. CONCLUSIONS: The severity of degenerative retinal change progression at different stages of myopia is related to the blood flow in the ophthalmic artery, although these associations are not statistically significant. Blood flow discrepancies between the right and left artery, resulting from anatomical asymmetries, does not seem to be significant for the development of degenerative changes.