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Diabetic Macular Edema - Good Vision 63-year-old man was seen in the office on May 10, 2012. He has been diabetic for twenty two years. You have been seeing him regularly lately. He did have a stroke in September. He lost his right peripheral vision. That is coming back some and you noticed problems with the macula and suggest he come here for an evaluation. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25. IOP: OD 11, OS 14. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered particularly inferior to the fovea. OS: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered superior to the fovea. In both eyes there does appear to be edema within 500 microns of the center of the fovea. SPECTRALIS-SD-OCT SCAN: The OCT scan in the right eye shows an average central foveal thickness of 270 microns, which is normal. The left eye shows an average central foveal thickness of 258 microns, which is normal. Both eyes though do have edema within less than a disc-diameter in the center. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows microaneurysms leaking inferior to the fovea in the right eye and superior to the fovea in the left eye. FUNDUS PHOTOGRAPHY - INFRA RED: The infra red and auto fluorescence images show a cluster of microaneurysms inferior to the fovea with some hemorrhage in that area. The infra red and auto fluorescence images in the left eye show microaneurysms clustered superior to the fovea with some hemorrhage in that area. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES 2. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES DISCUSSION: I explained to the patient he does have diabetic macular edema in both eyes. The ETDRS study shows that laser treatment is beneficial in this situation, however, the sub group analysis show that people with good vision there didn’t seem to be any difference between treated and non treated patients in two years. Therefore I think it is reasonable with today’s technology, to follow him closely and treat him should the edema worsen and not treat him should the edema stabilize or improve. To that I asked him to return for a check in three to four months or sooner should he notice a problem and see you back regularly.
Diabetic Macular Edema - Mildvista 636 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 546 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 493 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 496 veces70 year old man with mild edema did well without treatment (0 votos)
Diabetic Macular Edema - Mildvista 472 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 480 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 481 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 448 veces70 year old man with mild edema did well without treatment (0 votos)
Diabetic Macular Edema - Mildvista 442 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 456 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 432 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 476 veces70 year old man with mild edema did well without treatment (0 votos)
Diabetic Macular Edema - Mildvista 424 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 393 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 439 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 419 veces70 year old man with mild edema did well without treatment (0 votos)
Diabetic Macular Edema - Mildvista 407 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 399 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 432 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 453 veces70 year old man with mild edema did well without treatment (0 votos)
Diabetic Macular Edema - Mildvista 409 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 417 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 436 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 437 veces70 year old man with mild edema did well without treatment (0 votos)
Diabetic Macular Edema - Mildvista 490 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 484 veces70 year old man with mild edema did well without treatment (0 votos)	Diabetic Macular Edema - Mildvista 531 veces70 year old man with mild edema did well without treatment (0 votos)
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63-year-old man was seen in the office on May 10, 2012. He has been diabetic for twenty two years. You have been seeing him regularly lately. He did have a stroke in September. He lost his right peripheral vision. That is coming back some and you noticed problems with the macula and suggest he come here for an evaluation. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25. IOP: OD 11, OS 14. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered particularly inferior to the fovea. OS: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered superior to the fovea. In both eyes there does appear to be edema within 500 microns of the center of the fovea. SPECTRALIS-SD-OCT SCAN: The OCT scan in the right eye shows an average central foveal thickness of 270 microns, which is normal. The left eye shows an average central foveal thickness of 258 microns, which is normal. Both eyes though do have edema within less than a disc-diameter in the center. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows microaneurysms leaking inferior to the fovea in the right eye and superior to the fovea in the left eye. FUNDUS PHOTOGRAPHY - INFRA RED: The infra red and auto fluorescence images show a cluster of microaneurysms inferior to the fovea with some hemorrhage in that area. The infra red and auto fluorescence images in the left eye show microaneurysms clustered superior to the fovea with some hemorrhage in that area. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES 2. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES DISCUSSION: I explained to the patient he does have diabetic macular edema in both eyes. The ETDRS study shows that laser treatment is beneficial in this situation, however, the sub group analysis show that people with good vision there didn’t seem to be any difference between treated and non treated patients in two years. Therefore I think it is reasonable with today’s technology, to follow him closely and treat him should the edema worsen and not treat him should the edema stabilize or improve. To that I asked him to return for a check in three to four months or sooner should he notice a problem and see you back regularly.