SUMMARY The course of proliferative diabetic retinopathy involving the optic disc was followed, and the response to peripheral retinal photocoagulation monitored by argon laser in 11 patients during and after 13 pregnancies. Traditional obstetric practice assumes that pregnancy is a stimulus to irreversible progression of proliferative diabetic retinopathy, and that timely abortion and sterilisation are essential in order to achieve control of the neovascular process. Extensive photocoagulation will cause significant regression of neovascular complexes in 63 % of cases, and it confers sufficient benefits to make ophthalmic indications for therapeutic abortion and sterilisation no longer tenable.Taylor and Dobree' stated that between 68 and 73-25% of patients presenting with proliferative diabetic retinopathy have neovascularisation involving the optic disc. In a 3-year study Beetham et al.2 showed that 85% (28 patients) of untreated eyes with vitreous haemorrhage bled from new vessels at the optic disc. This group of patients, exhibiting neovascularisation of the optic disc, inevitably have the poorest prognosis. Consequent on haemorrhage one-third of involved eyes are blind and one-third have permanent impairment of vision within 1 year.3 This is the most serious potential hazard for visual prognosis;4 50% of these diabetic patients are blind within 2 to 3 years. If one eye becomes blind, Patz and Berkow6 have shown that the second (good) eye follows rapidly (50% within 1 year).New vessels in proliferative diabetic retinopathy tend to progress during 9 months of activity in many cases, and it is therefore difficult to assess the effect of pregnancy on the course of this process.

SUMMARY A randomised controlled trial is reported of 94 patients with a symmetrical proliferative diabetic retinopathy involving the optic disc, who were treated by a peripheral retinal ablation technique using the argon laser. A highly significant difference in mean cumulative deterioration of visual acuity and blindness was shown in all but the late stages of the disease process between treated and untreated eyes. The untreated eyes exhibited far worse results. The earlier photocoagulation is initiated in the course of the proliferative process in this disease to control or preferably eliminate optic disc neovascularisation, the better the visual prognosis.In England and Wales diabetic retinopathy is responsible for 7% of all new blind registrations and up to 20% in the middle-aged (Sorsby, 1972 (1970) noted that their patients with proliferative retinopathy had an incidence of optic disc neovascularisation of 68 to 73-25 %.Visual prognosis is far worse if the proliferative retinopathy involves the optic disc region (Deckert et al., 1967); 50% of patients in this category are blind within two to three years. Neovascularisation of the optic disc frequently leads to vitreous haemorrhage and blindness (Patz and Berkow, 1968). In their three-year study Beetham et al. (1970) showed that 85% (29 patients) of untreated eyes with vitreous haemorrhage bled from new vessels at the optic disc. Caird et al. (1968) showed that after a vitreous haemorrhage one-third of involved eyes were blind within one year and one-third had vision which was permanently impaired. Patz and Berkow (1968) found that the second (good) eye in patients blind in the other eye frequently became blind through extension of the proliferative process in a short period of time (50 % within one year). Meyer- (1971a, b); and Taylor and Dobree (1970) noted regression of disc neovascularisation occasionally when extensive xenon-arc photocoagulation of the diabetic retina had been undertaken.A circumferential ablation technique using the ruby laser was described first by Aiello et al. (1969). In a subsequent series (Beetham et al., 1970) 30% of patients with optic disc neovascularisation showed significant reduction of new vessels after treatment. James and L'Esperance (1974) treated 52 eyes with proliferation at the optic disc by a retinal ablation technique with the argon laser. After treatment 42% of eyes showed obliteration of disc neovascularisation, and 33% showed a significant response.Interim reports from a multicentre study in the United States using both xenon arc and argon laser (Diabetic Retinopathy Study Research Group, 1976) and England (British Multicentre Photocoagulation Trial, 1977)

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