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Diabetic Macular Edema - Hypertensive Retinopathy - Circinate Exudate 55-year-old woman was seen in the office on 9/25/2009. She has been diabetic for fifteen years. She has always had some trouble getting her diabetes lined up. She also has Crohn’s disease and fibromyalgia. She has had a problem with high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60. IOP: OD 18, OS 17. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. On the inferotemporal portion of the optic nerve there are lacy fine vessels which look to be neovascular. There are patchy retinal hemorrhages. There are microaneurysms around the fovea. There are exudates and there is macular edema, including cystoid macular edema. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There are multiple cotton-wool spots, retinal hemorrhages, exudates, as well as edema. OCT SCAN: There is foveal edema in both eyes. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows multiple staining microaneurysms in both eyes with areas of nonperfusion. There is neovascularization on the inferotemporal margin of the optic nerve of the left eye. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – RIGHT EYE 2. PROLIFERATIVE DIABETIC RETINOPATHY – LEFT EYE 3. DIABETIC MACULAR EDEMA – BOTH EYES 4. HYPERTENSIVE RETINOPATHY – BOTH EYES 5. CATARACTS 6. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that she does have worsening vision from a combination of diabetic retinopathy and hypertensive retinopathy. I believe with time her vision may improve but because of the severity of the macular swelling and retinal vascular damage, I suggest we do laser treatment to the right eye today, which has an excellent chance of reducing the risk of further vision loss and will probably help improve the vision. I treated the right eye with focal laser without any difficulty. The patient will return for evaluation and probable treatment in the fellow eye this coming Tuesday. Subsequent to that, if her vision does not start to improve within a few weeks, I will probably inject each eye with steroids.
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1674 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1402 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1638 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1053 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1103 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1192 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 2124 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 835 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 742 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 701 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 574 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 722 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 625 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 631 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 584 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 588 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 620 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 617 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 527 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 579 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 602 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 554 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 735 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 637 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 741 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
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55-year-old woman was seen in the office on 9/25/2009. She has been diabetic for fifteen years. She has always had some trouble getting her diabetes lined up. She also has Crohn’s disease and fibromyalgia. She has had a problem with high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60. IOP: OD 18, OS 17. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. On the inferotemporal portion of the optic nerve there are lacy fine vessels which look to be neovascular. There are patchy retinal hemorrhages. There are microaneurysms around the fovea. There are exudates and there is macular edema, including cystoid macular edema. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There are multiple cotton-wool spots, retinal hemorrhages, exudates, as well as edema. OCT SCAN: There is foveal edema in both eyes. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows multiple staining microaneurysms in both eyes with areas of nonperfusion. There is neovascularization on the inferotemporal margin of the optic nerve of the left eye. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – RIGHT EYE 2. PROLIFERATIVE DIABETIC RETINOPATHY – LEFT EYE 3. DIABETIC MACULAR EDEMA – BOTH EYES 4. HYPERTENSIVE RETINOPATHY – BOTH EYES 5. CATARACTS 6. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that she does have worsening vision from a combination of diabetic retinopathy and hypertensive retinopathy. I believe with time her vision may improve but because of the severity of the macular swelling and retinal vascular damage, I suggest we do laser treatment to the right eye today, which has an excellent chance of reducing the risk of further vision loss and will probably help improve the vision. I treated the right eye with focal laser without any difficulty. The patient will return for evaluation and probable treatment in the fellow eye this coming Tuesday. Subsequent to that, if her vision does not start to improve within a few weeks, I will probably inject each eye with steroids.