Florid diabetic retinopathy (FDR): a long-term follow-up study

Purpose: To evaluate efficacy of laser photocoagulation and pars-plana vitrectomy in patients with FDR. Methods: Eighty-eight patients (155 eyes) with FDR were retrospectively evaluated (mean age 27 +/-6.0 years; proportion of females 66%; insulin-dependent diabetes 100%; mean duration of diabetes 16.5 +/-5.8 years; poor metabolic control 83%). The eyes were divided in two groups: group I: 136 eyes amenable to laser photocoagulation and, when necessary, to vitrectomy afterwards (45/136); group II: 19 eyes subjected directly to vitrectomy. Results: In group I (mean follow-up 51.2 +/- 38.7 months) the initial visual acuity (TVA) was 0.61 +/-0.30 and the final visual acuity (FVA) was 0.47 +/-0.34; in the 45 vitrectomized eyes IVA was 0.15 +/-0.24 and FVA was 0.19 +/-0.25. FDR regressed in 75% and worsened in 25% of the cases. In group II (mean follow-up 46.4 +/- 36.3 months) IVA was 0.1 +/-0.14 and FVA 0.14 +/-0.22. FDR regressed in 32% and worsened in 68% of cases. Conclusions: FDR remains a cause of severe visual impairment in diabetics. Patients at risk of FDR are young females with long-standing, poorly controlled insulin-dependent diabetes. Panretinal laser photocoagulation prior to vitrectomy is beneficial; information on this severe form of retinopathy is essential to ensure prompt diagnosis and improve its unfavorable clinical course.