NEWS & EVENTS
Retinal Review, Issue 16
CASE NUMBER 16
A 52 year old woman was evaluated for diabetic retinopathy. She had been a noninsulin dependent diabetic for 22 years. Blood sugars have routinely been in the 200’s. She also has well controlled hypertension. Her initial retinal examination from a year ago showed moderate diabetic retinopathy. Tight control of her sugar was urged but she returned the following year with significant progression of her retinopathy. Vision on both occasions was 20/25 OU. The IOP’s and anterior segments were normal. The photos below demonstrate the progression from the first to second visit:
Although poor quality, the photos demonstrate significant progression of the diabetic retinopathy with ischemia, increased hemorrhaging and NVD in both eyes. She underwent panretinal photocoagulation in both eyes and returned several months later with improved retinal findings. Acuity remained 20/25 OU. OCT’s demonstrated intact macular structure as well.
The patient returned for her follow up three months later. She noted marked worsening of her vision in both eyes over the past week. Visual acuity measured 20/70 OU. There was a marked worsening of her retinal and OCT findings:
The examination demonstrated a marked increase in the retinal hemorrhaging and macular edema in both eyes. Differential diagnosis for this rapid change includes sudden extensive elevation of blood sugar or blood pressure, new onset kidney disease, severe anemia, or poor cardiac output. Treatment of the ocular findings will depend on the medical evaluation. Medical testing revealed a hematocrit of 21% (normal 37 to 43%). There was no sign of kidney disease or significant change in blood pressure or blood sugar. First course of treatment at this point is evaluation and treatment of her anemia. If the anemia is successfully treated, the retinal findings can spontaneously improve. If her retinopathy does not improve with improved blood counts, she might require additional laser and/or antiVEG-F injections. The patient was diagnosed with a gastrointestinal hemorrhage due to a bleeding ulcer. Her retinal vascular status returned to baseline once the ulcer was treated.