Complications
Patients with diabetes have a significant increase in the risk of developing cataracts and requiring cataract surgery.[133]
Cataracts may obstruct the surveillance or treatment of retinopathy, and cataract surgery may worsen macular oedema or PDR. Postoperative macular oedema may be suppressed by intravitreal corticosteroid injection.[134]
In patients with PDR, forward diffusion of retina-derived growth factors may induce neovascularisation of the iris, which in turn may occlude the outflow tracts for aqueous humour and cause glaucoma.
If visual prognosis is good, treatment is directed at controlling neovascularisation with pan-retinal photocoagulation or anti-vascular endothelial growth factor agents, and controlling intraocular pressure with tube drainage surgery. If visual prognosis is poor, treatment is directed at ameliorating discomfort and cosmesis.
Following vitrectomy, intracavitary haemorrhage is common but frequently clears rapidly without treatment.
Pan-retinal photocoagulation is associated with the development or exacerbation of macular oedema.[136] In most instances this is self-limiting and does not require treatment.
Visual field in patients with PDR may be compromised by areas of capillary non-perfusion and the effects of pan-retinal laser burns.[137]
Patients undergoing macular laser therapy experience a measurable reduction in central visual function.
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