Diabetic retinopathy.

The only methods of treatment for severe diabetic retinopathy that have been proved effective by controlled clinical trials are photocoagulation and pituitary ablation. It must be noted that photocoagulation and pituitary ablation impede but do not cure diabetic retinopathy. Pars plana vitrectomy can be highly effective for removing blood from the vitreous of the eye, allowing better vision, particularly if the retina has been shown to be functional by electrophysiologic testing and ultrasonography. In addition, vitrectomy allows the ophthalmologist to visualize, evaluate, and treat the diabetic retina by photocoagulation or other methods. Attempts at better regulation of blood sugar have reduced the development of microangiopathy in experimental animals and recently in man. The benefits of rigorous regulation of the blood sugar has been noted in a policy statement by the American Diabetes Association. The development of a practical, beneficial pancreas has been undertaken, and may be required in order to reap the full benefits of rigorous blood sugar control. It has been recommended that all patients be evaluated by an ophthalmologist as soon as they have been found to have diabetes, that all diabetics be examined ophthalmologically on an annual basis, and that patients with significant retinopathy be seen at 6 month or shorter intervals by their ophthalmologist. The evaluation and treatment of diabetic retinopathy has progressed enormously during the past decade. It is hoped that the cause of diabetic microangiopathy and retinopathy will be discovered in the near future so that treatment will ultimately cure rather than control the process of diabetic retinopathy.