Acute macular edema and peripapillary soft exudate after pancreas transplantation with accelerated progression of diabetic retinopathy.
BACKGROUND
The effect of pancreas transplantation on diabetic retinopathy remains inconclusive. Herein, we report six patients with type 1 diabetes mellitus (DM) who underwent pancreas transplantation and developed acute macular edema and peripapillary soft exudate with rapid progression to proliferative diabetic retinopathy.


METHODS
In this retrospective observational study, diabetic patients who underwent pancreas transplantation in a single medical center and developed symptomatic acute macular edema and peripapillary soft exudate within 3 months after the operation were enrolled. The complete ophthalmic course and medical records of the patients were retrospectively reviewed. Diabetic retinopathy and progression following treatment after pancreas transplantation were measured.


RESULTS
Six Chinese women with type 1 DM were enrolled in this study. Mean hemoglobin (Hb) A1c was 13.4% prior to transplantation and decreased rapidly to 6.5% within 2 months postsurgery. The patients had no or mild pretransplant diabetic retinopathy and developed acute symptomatic macular edema and peripapillary soft exudate in both eyes after pancreas transplantation. All macular edema resolved either with or without treatment. Five cases progressed to proliferative diabetic retinopathy and received panretinal photocoagulation. Diabetic retinopathy remained stable in all eyes after treatment, and the visual prognosis was good, except in one eye that had macular branch retinal artery occlusion with foveal involvement.


CONCLUSIONS
Acute macular edema after pancreas transplantation has a favorable treatment outcome despite rapid progression to proliferative diabetic retinopathy. High pretransplant HbA1c and abrupt blood sugar normalization may be related to the disease course.
Department of Ophthalmology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan, ROC.
Fang-Yi
FY
Tsai
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: leliew@vghtpe.gov.tw.
Ling-Ing
LI
Lau
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
An-Fei
AF
Li
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Shih-Jen
SJ
Chen
Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Shin-E
SE
Wang
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Fenq-Lih
FL
Lee
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Catherine Jiu-Lin
CJ
Liu
Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Yi-Ming
YM
Shyr
D000208:Acute Disease; D000328:Adult; D003930:Diabetic Retinopathy / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008269:Macular Edema / Q000209:etiology*; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
diabetic retinopathy; hemoglobin A1c; macular edema; pancreas transplantation; soft exudate