[Improvement of retinopathy in the diabetic treated with an intraperitoneal insulin pump]

The recent development of continuous insulin infusion by pump as a treatment method of diabetics and the fact that several publications have shown some doubt as to the efficiency of this method of treatment on the development of diabetic retinopathy, have led us to study this problem. In our study we have followed 24 patients for an average of 22 months (13-41). These patients were diabetics type I, non-obese, normotensive and were divided into three groups based on the extent of their diabetic retinopathy. Group I: no retinopathy, 5 patients. Group 2: background retinopathy without ischaemia, 14 patients. Group 3: ischaemic retinopathy, 5 patients. Only patients from group 3 where subjected to photocoagulation. The above classification was based on angiographic findings and we compared angiograms before and after treatment. In group I, none of the patients developed diabetic retinopathy. In group 2, there was only one aggravation of the preexisting retinopathy, however without the development of proliferative changes. In group 3, the favourable outcome was mainly due to treatment by photocoagulation. The different classification of diabetic retinopathy that we have adopted into ischaemic and non-ischaemic forms based on angiographic findings might explain our favourable results. The classification into background and proliferative retinopathy does not indicate in the background type the relative importance of the oedema and the ischaemia. We suggest that the improved glycemic control obtained by continuous insulin infusion has a favourable outcome on non-ischaemic type of diabetic retinopathy, whereas photocoagulation remains the treatment of choice in ischaemic retinopathy.