Spontaneous regression of pre‐proliferative diabetic retinopathy

It has been suggested that the presence of two or more features of preproliferative diabetic retinopathy normally points to development of overt proliferative retinopathy within two years. In a retrospective review of 78 patients with two or more pre‐proliferative features, followed up for a mean period of 4.2 years, proliferative retinopathy developed in only 29.5%. In 24.3% the preyproliferative features persisted, and in 46.2% spontancous regression to background retinopathy occurred. Regression of pre‐proliferative retinopathy tended to occur in eyes with fewer preyproliferative features on fundoscopy and, in patients with Type I diabetes, in those who developed diabetes at an older age. In Type 2 diabetes, apart from fundus appearance, there was no significant difference between patients whose retinopathy regressed or progressed. Cottonywool spots were found more frequently in eyes which underwent regression of retinopathy, suggesting that this is the least sinister pre‐proliferative feature.

Pre‐proliferative retinopathy always requires careful follow up but its apperance does not necessarily lead to the development of sight‐threatcning retinopathy.