Cryoablation of the Pituitary in the Treatment of Progressive Diabetic Retinopathy

Abstract

Sixteen diabetic patients with sight-threatening progressive diabetic retinopathy who were carefully screened ophthalmologically, endocrinologically and medically, underwent stereotaxic transphenoidal pituitary cryoablation and were followed for an average of 26.2 months postoperatively. Hypophysectomy was complete or borderline in fifteen of the sixteen patients with no serious complications except chronic diabetes insipidus in one patient. Two patients died of nonsurgically-related conditions four and one-half and twentyfive months respectively after operation. Endocrine management was uncomplicated except for reversible cholestatic jaundice due to oral methyltestosterone in one patient. Insulin requirements were reduced in most instances following pituitary cryoablation. Ocular improvement occurred in ten of the sixteen patients with two patients stable, indicating a 75 per cent success rate. It is concluded that cryoablation offers a safe, reproducible, simple and effective method of pituitary ablation in well-selected patients with progressive diabetic retinopathy and threatening blindness.