Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy.
Between 1960 and 1976 117 patients underwent pituitary implantation with yttrium-90 (90Y) for treatment of proliferative retinopathy at the Hammersmith Hospital, London. Mean age at operation was 35 +/- 11 years (mean +/- SD), and mean duration of diabetes 18.6 +/- 10.0 years. Mean insulin dosage prior to implant was 67.2 +/- 24 units, falling to 30.4 +/- 14.9 units post-implant. Thirty-two per cent of patients are still living, 60% are deceased and 8% are lost to follow-up. The 5-year survival rate was 82%. Of the causes of death, 21% died of infection, adrenal insufficiency or hypoglycaemia, 12% of renal failure, and 47% of myocardial or cerebral vascular disease. Ophthalmological follow-up was carried out on the 100 patients operated on between 1965 and 1976. The mean age of this group at implant was 35 +/- 10.5 years, and mean duration of diabetes 17.2 +/- 8.7 years. Visual acuity in the better eye at operation was 6/12 or better in 84% of patients, and this percentage remained similar at the time of the 5 and 10 year follow-up. Blindness (6/60 or worse) in both eyes was present in 12% of patients at the time of 5 and 10 year assessments. By 5 years new vessels on the disc had improved from a mean grading of 2.7 +/- 1.6 to 0.8 +/- 1.2 (p less than 0.001), and by 10 years there was no disc neovascularisation in any eye. There was a similar improvement in the grading of hard exudates, microaneurysms and haemorrhages, but there was an increase in fibrous retinitis proliferans.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001918:Brachytherapy / Q000009:adverse effects; D003930:Diabetic Retinopathy / Q000628:therapy*; D005123:Eye / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D009389:Neovascularization, Pathologic / Q000473:pathology; D010902:Pituitary Gland / Q000528:radiation effects*; D014792:Visual Acuity; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
D001786:Blood Glucose; D006728:Hormones; D015021:Yttrium Radioisotopes