Diabetes & Brain Surgery

I posted this article here because it is a striking reminder of how far we have come in the treatment of diabetes. Just a few decades ago, articles were being published that seriously suggested brain surgery as a treatment for diabetic retinal disease. In this 1968 issue alone of the Journal of the American Medical Association, three separate papers reported on the beneficial role of surgical removal or radioactive ablation of the pituitary gland (the part of our brain that controls hormone production) for severe cases of diabetic retinopathy. At the time, medical thinking held that certain hormones released by the pituitary gland may make the disease worse, and, in what now seems a less than brilliant leap of deduction, some reasoned the pituitary gland must go. So not more than three decades ago, you might not only have lost your vision from diabetes but your mind as well.

Fortunately, a generation of astute physicians recognized that patients who had diabetes and at the same time certain other retinal diseases that naturally damaged the peripheral retina, such as syphilitic retinitis, rarely developed the complications of diabetic retinopathy. This was because the concomitant retinal diseases had already wiped out the areas subject to severe ischemia in diabetic retinopathy. Like Einstein, physicians made their own quantum leap – without the ischemic stimulus, diabetic retinopathy did not seem to progress into its advanced stages. If only they could treat or cauterize the ischemic retina that develops in diabetes then they might be able to slow down the progression of disease. Meanwhile, they could also cauterize any leaking blood vessels present in order to decrease retinal swelling. All of this might prevent the severe loss of vision that was, up until then, part and parcel of diabetes. Well reasoned indeed but what was missing was a safe and effective tool by which these outcomes might be achieved – and we all now know that turned out to be the laser.