Complications
Patients with diabetes have a significant increase in the risk of developing cataracts and requiring cataract surgery.[137]
Cataracts may obstruct the surveillance or treatment of retinopathy, and cataract surgery may worsen macular edema or PDR. Postoperative macular edema may be suppressed by intravitreal corticosteroid injection.[138]
In patients with PDR, forward diffusion of retina-derived growth factors may induce neovascularization of the iris, which in turn may occlude the outflow tracts for aqueous humor and cause glaucoma.
If visual prognosis is good, treatment is directed at controlling neovascularization with panretinal 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 hemorrhage is common but frequently clears rapidly without treatment.
Panretinal photocoagulation is associated with the development or exacerbation of macular edema.[140] In most instances this is self-limited and does not require treatment.
Visual field in patients with PDR may be compromised by areas of capillary nonperfusion and the effects of panretinal laser burns.[141]
Patients undergoing macular laser therapy experience a measurable reduction in central visual function.
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