Intraocular pressure and diabetic retinopathy

Between intraocular pressure (I.O.P.) and the metabolic carbohydrate disturbance is a relationship: 1. diabetics frequently show primary open angle-galucoma; 2. as the diabetic retinopathy progresses towards stage III (Pr.), IOP decreases; 3. as diabetics exhibit dilatation of veins, increased blood viscosity, arteriolar narrowing and increased I.O.P. central retinal vessel disease with hemorrhages occurs redily; 4. capillary hemorrhages, periapaillary and macular oedema may be caused by increased oncotic pressure with acidosis of the blood; hyperglycemia with ketosis goes together with decreased I.O.P.; 5. only mild I.O.P.-rise may be considered as usefull to prevent hemorrhages by reducing retinal blood flow resulting subsequently from reduced uveal blood flow; 6. local application of glucocorticoids with permanent control of visual fields and I.O.P. should be a good additional treatment for diabetic retinopathy; unfortunately only very few cases are responsive to increase of I.O.P. by glucocorticoids; 7. it is important that prolactine levels in the blood are higher in the morning before the patient wakes up: this goes together with the morning I.O.P.-rise in glaucoma patients. Decreased activity of the hypophysis improves the diabetic retinopathy; this is contradictory to the beneficial effect of mild I.O.P.-rise.