Diabetic retinopathy is a well recognised complication of diabetes, which tends to progress with poor metabolic control, ultimately requiring laser therapy. Diabetic retinopathy has been found to worsen in patients requiring chemotherapy for other coexistent conditions like Hodgkins lymphoma.
We describe a patient who was on treatment for type 2 diabetes for approximately six years from 1994 and had developed advanced non-proliferative diabetic retinopathy, (figure 1A) by the year 2000. These changes remained stable (February 2001, figure 1B). In August 2001 he was diagnosed to have a duodenal carcinoma and within a few months of commencing chemotherapy there were marked improvements to his retinopathy (March 2002, figure 1C).
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Changes in retinopathy
Improvement in diabetic retinopathy following immunosuppressive therapy is not well recognised and further work is required to evaluate the potential benefits of chemotherapeutic agents in the medical management of diabetic retinopathy.
Diabetic retinopathy is a well recognised microvascular complication of diabetes mellitus, and is mainly classified into a) background retinopathy b) pre-proliferative retinopathy c) proliferative retinopathy and d) diabetic maculopathy. The Early Treatment of Diabetic Retinopathy Study (ETDRS) suggested that certain features matter and commented on the '4-2-1' rule.
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If any one of these were present, there is a 15% chance of developing sight threatening retinopathy within the next year; if two are present the risk rises to 45%.