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 Eye549 views67-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 Eye450 views67-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 Eye428 views67-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 Eye456 views67-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 Eye466 views67-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 Eye399 views67-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 Eye406 views67-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 Eye456 views67-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 Eye401 views67-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 Eye419 views67-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 Eye398 views67-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 Eye443 views67-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-Perfusion418 views67-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-Perfusion444 views67-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 Eye392 views67-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 Eye429 views67-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 Eye452 views67-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 Eye473 views67-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 Fluorescein593 views67-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 Eye509 views67-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 Hemorrhage576 views67-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
