Non-perfusion in Far Periphery and Vitreous Hemorrhage
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67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40. IOP: OD 12, OS 11. The right eye has a posterior chamber intraocular lens in good position, as does the left eye.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.8. There is neovascularization on the inferior and superior pole of the optic nerve.
The macula is dry. There are ischemic changes in the periphery including ghost vessels.
OS: Vertical C/D ratio is 0.8. There is a 2+ vitreous hemorrhage. There is partial pan retinal laser.
OCT SCAN: The OCT scan of the right eye shows the macula to be flat. The left eye shows a stable macular pucker. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows leakage from the neovascularization on the nerve in the right eye and in the inferotemporal of the macula in the left eye and also the peripherals sweeps in the right eye show significant non perfusion, especially inferonasally.
IMPRESSION:
1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. NON CLEARING MILD VITREOUS HEMORRHAGE – LEFT EYE
3. GLAUCOMA
DISCUSSION: I explained to the patient with the proliferative retinopathy in the right eye, he has a high risk of vision loss, especially given that he has blood already in his left eye. I would like to protect the right eye from a similar fate. I started pan retinal laser in the right eye today
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 545 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 444 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 422 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 453 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 459 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 394 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 401 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 453 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 398 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 415 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 389 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 439 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Dark Area is Non-Perfusionvu 413 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Dark Area is Non-Perfusionvu 439 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 390 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 424 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 445 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 466 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Vessel Leaking Fluoresceinvu 589 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eyevu 506 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Dark Area is Vitreous Hemorrhagevu 571 fois67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40. IOP: OD 12, OS 11. The right eye has a posterior chamber intraocular lens in good position, as does the left eye.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.8. There is neovascularization on the inferior and superior pole of the optic nerve.
The macula is dry. There are ischemic changes in the periphery including ghost vessels.
OS: Vertical C/D ratio is 0.8. There is a 2+ vitreous hemorrhage. There is partial pan retinal laser.
OCT SCAN: The OCT scan of the right eye shows the macula to be flat. The left eye shows a stable macular pucker. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows leakage from the neovascularization on the nerve in the right eye and in the inferotemporal of the macula in the left eye and also the peripherals sweeps in the right eye show significant non perfusion, especially inferonasally.
IMPRESSION:
1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. NON CLEARING MILD VITREOUS HEMORRHAGE – LEFT EYE
3. GLAUCOMA
DISCUSSION: I explained to the patient with the proliferative retinopathy in the right eye, he has a high risk of vision loss, especially given that he has blood already in his left eye. I would like to protect the right eye from a similar fate. I started pan retinal laser in the right eye today
