Argon Laser Treatment for Diabetic Maculopathy

You have a disease in which leaking blood vessels and small dilatations of the arteries at the back of the eye result in swelling of the central retina or macula.
This is the part of the eye that is responsible for seeing detailed images and if left alone, may result in loss of vision.

Argon laser is applied to areas of swelling and leaking blood vessels in order to reduce the chances of this occurring. The procedure is usually quite painless and can usually be performed within a few minutes. You will be free to go home immediately after the operation.
Drops are applied to the eye and no freezing is required.
Possible side effects occurring with this treatment include seeing small black spots around the central vision, but occasionally patients have reported loss of central vision. This is extremely rare.
Statistically it has been shown that applying laser therapy appropriately can reduce the chances of you losing vision from your disease. However, it should be noted that this only reduces the chances, it does not eliminate them. The treatment is really designed to slow the progress of the disease. Once you have lost vision from severe macular edema vision cannot usually be fully restored, but treatment is still indicated in an attempt to halt the progress of the disease.

Treatment for Diabetic Macular Edema:

Recently a new treatment has become available for patients with diabetic macular edema. This involves injecting a long-acting corticosteroid agent, called Kenalog, into the vitreous cavity. The results of this are promising and many diabetic patients have demonstrated an improvement in vision after injection of this agent. There is a low risk of infection initially reported, but certainly the incidence of this has decreased and so far, after injecting about 50 patients none have developed an infection and recently the rate of infection has been reported at about 1% in the worlwide literature . Other possible side effects include development of glaucoma which is usually controlled with drops but patients with pre-existing glaucoma should undergo this treatment with caution.
The injection of Kenalog is performed at the Royal Inland Hospital, using drops as anesthetic agent, and after the operation, patients often experience floaters which disappear in a few days but the patients will have to be checked 48 hours after the injection, either by myself or by the patient’s local eye care provider.

Intravitreal Kenelog

Kenelog is a relatively new treatment that is used for a number of ocular conditions including:
1) Diabetic retinopathy; occasionally patients with this condition develop thickening of the retina which results in a decrease in vision.
2) Swelling of the retina following cataract surgery.
3) Chronic ocular inflammation.
4) As an adjunctive treatment of wet macular degeneration.
5) Following vascular occlusions within the retina.
Kenelog is a type of steroid that is injected into the ocular cavity, in other words, directly into the eyeball to alleviate and hence improve vision in the above mentioned conditions

Procedure: (what to expect)
A small volume of kenelog usually around 1/10 cc is injected into the eye using drops to freeze the surface of the eye. Usually the injection is quite painless and is over in a matter of seconds. The injection is performed at the hospital as a short day surgery procedure. You may experience significant floaters in the form of small black spots for a few days or even weeks after the injection, however, these will disappear spontaneously. Patients may experience an improvement in vision within a few days to weeks after the injection but certainly not all patients will respond in the same way to this treatment.
This treatment is merely one tool that has been used successfully in the above groups of patients where other therapies such as eye drops or laser treatments have failed or only given partial improvement in vision.
Possible complications:
Significant side effects/complications have been encountered with this procedure in some patients. These include ocular infection, which is a rare occurrence. It occurs in far less than 1% of patients and a rising intraocular pressure. For this reason patients are seen one-week following the injection to check for signs are infection and measure the intraocular pressure. If you're from out-of-town, it may be inconvenient for you to come back to my office. You can get your referring ophthalmologist or optometrist to do this for you and if any problems are encountered they'll contact me immediately, particularly if there are signs of infection. Usually a rise in pressure can be managed with eye drops. The rise in pressure is usually only temporary but on rare occasions may necessitate glaucoma surgery.
The most common complication however, is failure to respond to the medication. As mentioned, not all patients will experienced an improvement in vision. It is common that a patient will respond initially to treatment with an improvement in vision and after a few months vision may begin to deteriorate slowly once again. This may necessitate further injections.

Peter Hopp M.D.