Twenty patients with insulin dependent diabetes mellitus were selected on the basis of morphological signs of blood-retinal barrier leakage--namely, hard exudates seen on fundus photographs and/or localised leakage of fluorescein seen on fluorescein angiograms. Computerised perimetry was carried out in visual field areas that corresponded to the morphological lesions, and the visual field data were accurately correlated with the morphology as seen on fundus photographs and fluorescein angiograms. In addition, in seven of the patients who represented the range of leakage among the patients studied, the blood-retinal barrier leakage was quantitated by vitreous fluorophotometry. In 16 cases normal light sensitivity was found in retinal areas showing localised leakage as studied on fluorescein angiograms. In four cases with pronounced maculopathy, where scotomata occurred, there was no topographical correlation between the scotomata and barrier leakage. Furthermore hard exudates often, but not consistently, caused localised scotomata when arranged in dense conglomerates. The permeability values correlated with angiographically observed hyperfluorescence in the macular area. On the basis of the techniques employed in the present study it seems that breakdown of the blood-retinal barrier is an earlier event than disturbance of neurosensory function in the development of diabetic retinopathy. However, the findings give no evidence of a causal relationship between barrier leakage and damage to sensory cell function.
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