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Purpose To describe the effect of coupling solutions used during laser photoco agulation on the ocular surface of patients with noninsulin dependent diabetes mellitus (NIDDM). Design A prospective case controlled study. Methods Ninety t wo eyes of 46 NIDDM patients with clinically significant macular edema, poor met abolic control of diabetes, and peripheral neuropathy and 100 eyes of 50 normal control subjects were studied. The patients’eyes were assigned to argon green f ocal/grid laser photocoagulation using an applanation contact lens and one of th e coupling fluids; 2%methocel, Thilo Tears Gel, 1.4%sodium hyaluronate, or 0. 9%simple saline. The control subjects received time matched three mirror cont act lens fundus examinations. All subjects underwent corneal sensitivity measure ments, Schirmer test, tear film breakup time, and corneal fluorescein staining b efore as well as 3 and 8 days after the laser procedures and contact lens examin ations. Patients with corneal problems persisting after 8 days were followed lon ger. Results Diabetic eyes assigned to 2%methocel and 1.4%sodium hyaluronate had significantly lower mean corneal sensitivities and break up time values a s well as significantly higher mean fluorescein staining scores at all examinati on points after laser photocoagulation. All diabetic eyes with aqueous deficienc y assigned to 2%methocel and 1.4%sodium hyaluronate developed delayed corneal epithelial healing. Conclusion The use of viscous coupling solutions during appl anation contact lens aided laser procedures may be detrimental for the corneal epithelium in poorly controlled NIDDM patients with peripheral neuropathy and co existing aqueous deficiency.
Purpose To describe the effect of coupling solution used during laser photocoagulation on the ocular surface of patients with noninsulin dependent diabetes mellitus (NIDDM). Design A prospective case controlled study. Methods Ninety t wo eyes of 46 NIDDM patients with clinically significant macular edema, poor met abolic control of diabetes, and peripheral neuropathy and 100 eyes of 50 normal control subjects were studied. The patients’eyes were assigned to argon green f ocal / grid laser photocoagulation using an applanation contact lens and one of th e coupling fluids; 2 % methocel, Thilo Tears Gel, 1.4% sodium hyaluronate, or 0.9% simple saline. The control subjects received time matched three mirror contact lens fundus examinations. All subjects underwent corneal sensitivity measure ments, Schirmer test, tear film breakup time, and corneal fluorescein staining b efore as well as 3 and 8 days after the laser procedures and contact lens examin ations. Patients with corneal problems p Results Diabetic eyes assigned to 2% methocel and 1.4% sodium hyaluronate had significantly lower mean corneal sensitivities and break up time values as well as significantly higher mean fluorescein staining scores at all examinati on points after laser photocoagulation . All diabetic eyes with aqueous deficienc y assigned to 2% methocel and 1.4% sodium hyaluronate developed delayed corneal epithelial healing. Conclusion The use of viscous coupling solutions during appl anation contact lens aided laser procedures may be detrimental for the corneal epithelium in poorly controlled NIDDM patients with peripheral neuropathy and co existing aqueous deficiency.