PDR in juvenile onset diabetics: high-risk proliferative diabetic retinopathy in juvenile onset diabetics.

We analyzed the subgroup of juvenile diabetics with proliferative diabetic retinopathy (PDR). One hundred consecutive Diabetic Retinopathy Study (DRS) defined high-risk eyes were treated with argon laser photocoagulation. Mean age of diabetes onset was 8.1 years and mean duration was 15.9 years. Average follow-up was 36 months. All treatment failures resulting in severe visual loss (less than 5/200 vision) occurred in the second eye treated, in spite of our routinely treating the worse eye first. We delayed treating fellow eyes prior to the 1976 DRS report. We now consider prompt treatment of the fellow high-risk eye mandatory. Five patients (5.6%) suffered severe visual loss in three years compared to 10.5% in two years in the DRS for high-risk treated eyes. We conclude that more extensive treatment, perhaps 2500 to over 3000 500 micron lesions, further reduces incidence of severe visual loss beyond the reduction shown by the DRS.