Vitreous Hemorrhage - Mild - Neovascularization
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58-year-old woman has diabetic retinopathy in both eyes with neovascularization of the optic nerve, worse in the right eye than the left eye. She has had panretinal laser in both eyes and vitreous hemorrhage in the left eye. Her vision, since I saw her last in June, is about the same.
VISUAL ACUITY: Vision OD is 20/25, OS is 20/20. IOP: OD 16, OS 17. There is trace nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is a large tuft of neovascularization on the superior pole of the optic nerve, extending about 2-3 disc diameters off the nerve. There is tractional retinal detachment superotemporal to the periphery. There is moderate panretinal laser.
OS: Vertical C/D ratio is 0.0. There is an area of neovascularization on the inferior pole of the optic nerve, as well as in the inferotemporal periphery.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows excellent perfusion of each eye with areas of hypofluorescence corresponding to the hemorrhage and hyperfluorescence corresponding to the microaneurysms. There is also leakage from neovascularization on the nerve in each eye in the late frames, more in the right eye than the left eye.
IMPRESSION: 1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. HIGH-RISK DIABETIC RETINOPATHY – BOTH EYES
3. VITREOUS HEMORRHAGE – LEFT EYE
4. PREVIOUS LASER
DISCUSSION: I explained to the patient with further panretinal laser there is an excellent chance of inducing regression of the neovascularization and controlling her diabetic retinopathy. I gave the right eye retrobulbar anesthetic injection today and I added the laser to the periphery. I asked her to return for check in about three to four weeks for similar treatment in the left eye.
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58-year-old woman has diabetic retinopathy in both eyes with neovascularization of the optic nerve, worse in the right eye than the left eye. She has had panretinal laser in both eyes and vitreous hemorrhage in the left eye. Her vision, since I saw her last in June, is about the same.
VISUAL ACUITY: Vision OD is 20/25, OS is 20/20. IOP: OD 16, OS 17. There is trace nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is a large tuft of neovascularization on the superior pole of the optic nerve, extending about 2-3 disc diameters off the nerve. There is tractional retinal detachment superotemporal to the periphery. There is moderate panretinal laser.
OS: Vertical C/D ratio is 0.0. There is an area of neovascularization on the inferior pole of the optic nerve, as well as in the inferotemporal periphery.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows excellent perfusion of each eye with areas of hypofluorescence corresponding to the hemorrhage and hyperfluorescence corresponding to the microaneurysms. There is also leakage from neovascularization on the nerve in each eye in the late frames, more in the right eye than the left eye.
IMPRESSION: 1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. HIGH-RISK DIABETIC RETINOPATHY – BOTH EYES
3. VITREOUS HEMORRHAGE – LEFT EYE
4. PREVIOUS LASER
DISCUSSION: I explained to the patient with further panretinal laser there is an excellent chance of inducing regression of the neovascularization and controlling her diabetic retinopathy. I gave the right eye retrobulbar anesthetic injection today and I added the laser to the periphery. I asked her to return for check in about three to four weeks for similar treatment in the left eye.
