Diabetic Macular Edema - Diffuse - also Pseudophakic CME
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56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. Her vision is hazy in both eyes. She sees more light but she cannot see clearly.
VISUAL ACUITY: OD 20/80, OS 20/200. IOP: OD 17, OS 14. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is 3+ cystoid macular edema. There is light laser. There are multiple microaneurysms near the fovea.
OS: Vertical C/D ratio is 0.5. There is 2+ clinically significant macular edema predominately nasal to the fovea with multiple microaneurysms and light laser.
OCT SCAN: The OCT scan shows severe macular thickening in the right eye with a central foveal thickness of 631 microns. The left eye has central foveal thickness of 251 microns.
FLUORESCEIN ANGIOGRAM: FA shows multiple microaneurysms around the fovea in both eyes with late leakage into the fovea in both eyes.
IMPRESSION:
1. CYSTOID MACULAR EDEMA – BOTH EYES
2. DIABETIC RETINOPATHY – BOTH EYES
3. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES
With the macular swelling and diabetic retinopathy and the microaneurysms, I think it is reasonable to first treat the macula with laser and then probably follow that up with intravitreal Kenalog. I treated the right eye with focal laser without any difficulty. She will return for a check in a week or two for probable treatment of the fellow eye.
6 month Follow -up
2 year Follow - up
59-year-old woman has background diabetic retinopathy in both eyes with macular edema. She has had Kenalog injections for the macular edema, but she also has glaucoma. She is currently taking Combigan in both eyes, Azopt in the left eye and Nevanac in the right eye. She had a YAG capsulotomy recently in the right eye and her vision in the right eye is great and vastly improved over previous visits. The left eye however, is beginning to decline and the last time I treated the left eye, it was August of 2009 with intravitreal Kenalog and prior to that I did focal laser.
VISUAL ACUITY: OD 20/50, OS 20/60. IOP: OD 22, OS 17. The posterior chamber intraocular lens is in good position in both eyes with open capsules. There is a dense vitreous film though behind the lens in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. The nerve is pale. There is an epiretinal membrane superior to the fovea. There is light macular laser.
OCT SCAN: The OCT scan shows the average central foveal thickness in the right eye of 259 microns, which is reasonable. The left eye has a average central foveal thickness of 297 microns, which is higher than it has been in the past. In the past it has been about 212 microns. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows microaneurysms clustered superior to the fovea in an area of macular edema and also there is significant capillary dropouts starting to develop. The right eye has a few microaneurysms. There is a moderately heavy laser pattern. Again, there is significant capillary non perfusion. There is no proliferation though.
IMPRESSION:
1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. DIABETIC MACULAR EDEMA – WORSE IN THE LEFT EYE THAN THE RIGHT EYE
3. MACULAR PUCKER – RIGHT EYE
4. VITREOUS OPACITIES – BOTH EYES
5. GLAUCOMA
6. RECENT YAG CAPSULOTOMY
DISCUSSION: I explained to the patient the macula in the left eye does look a little worse today. I suggested focal laser to try to dry up the macula, especially because of her problem with glaucoma. We talked about the risks, benefits, indications, and alternatives of focal laser photocoagulation and the patient agreed to this procedure after the questions were answered. Focal laser photocoagulation was performed today predominately to that area superior to the fovea, where the microaneurysms are clustered without any difficulty. I asked her to return here for a check in three months or sooner if she should notice a problem and see you periodically
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreatment Fundus Photo871 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200. 
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreatment Fundus Photo740 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pre Treatment659 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreament Line OD665 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pre treatment line OS638 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreatment early FA646 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreatment Early FA658 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreatment Mid FA642 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Pretreatment Mid FA626 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema FA Fellow Eye767 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Late FA - Leakage Macular and Nerve555 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Late FA fellow Eye641 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
(0 votes)
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Diabetic and Pseudophakic Cystoid Macular Edema Late FA569 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
(0 votes)
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Diabetic and Pseudophakic Cystoid Macular Edema Late FA534 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
(0 votes)
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Diabetic and Pseudophakic Cystoid Macular Edema Laser Photo - Focal Laser672 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema Laser Photo whole Macula631 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200.
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Diabetic and Pseudophakic Cystoid Macular Edema One year followup laser and intravitreal Kenalog with Good Vision690 views56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. OD 20/80, OS 20/200. 1 year ago NOW 20/50 OU
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56-year-old woman has diabetic retinopathy in both eyes and macular edema. She is recently pseudophakic. Her vision is hazy in both eyes. She sees more light but she cannot see clearly.
VISUAL ACUITY: OD 20/80, OS 20/200. IOP: OD 17, OS 14. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is 3+ cystoid macular edema. There is light laser. There are multiple microaneurysms near the fovea.
OS: Vertical C/D ratio is 0.5. There is 2+ clinically significant macular edema predominately nasal to the fovea with multiple microaneurysms and light laser.
OCT SCAN: The OCT scan shows severe macular thickening in the right eye with a central foveal thickness of 631 microns. The left eye has central foveal thickness of 251 microns.
FLUORESCEIN ANGIOGRAM: FA shows multiple microaneurysms around the fovea in both eyes with late leakage into the fovea in both eyes.
IMPRESSION:
1. CYSTOID MACULAR EDEMA – BOTH EYES
2. DIABETIC RETINOPATHY – BOTH EYES
3. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES
With the macular swelling and diabetic retinopathy and the microaneurysms, I think it is reasonable to first treat the macula with laser and then probably follow that up with intravitreal Kenalog. I treated the right eye with focal laser without any difficulty. She will return for a check in a week or two for probable treatment of the fellow eye.
6 month Follow -up
2 year Follow - up
59-year-old woman has background diabetic retinopathy in both eyes with macular edema. She has had Kenalog injections for the macular edema, but she also has glaucoma. She is currently taking Combigan in both eyes, Azopt in the left eye and Nevanac in the right eye. She had a YAG capsulotomy recently in the right eye and her vision in the right eye is great and vastly improved over previous visits. The left eye however, is beginning to decline and the last time I treated the left eye, it was August of 2009 with intravitreal Kenalog and prior to that I did focal laser.
VISUAL ACUITY: OD 20/50, OS 20/60. IOP: OD 22, OS 17. The posterior chamber intraocular lens is in good position in both eyes with open capsules. There is a dense vitreous film though behind the lens in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. The nerve is pale. There is an epiretinal membrane superior to the fovea. There is light macular laser.
OCT SCAN: The OCT scan shows the average central foveal thickness in the right eye of 259 microns, which is reasonable. The left eye has a average central foveal thickness of 297 microns, which is higher than it has been in the past. In the past it has been about 212 microns. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows microaneurysms clustered superior to the fovea in an area of macular edema and also there is significant capillary dropouts starting to develop. The right eye has a few microaneurysms. There is a moderately heavy laser pattern. Again, there is significant capillary non perfusion. There is no proliferation though.
IMPRESSION:
1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. DIABETIC MACULAR EDEMA – WORSE IN THE LEFT EYE THAN THE RIGHT EYE
3. MACULAR PUCKER – RIGHT EYE
4. VITREOUS OPACITIES – BOTH EYES
5. GLAUCOMA
6. RECENT YAG CAPSULOTOMY
DISCUSSION: I explained to the patient the macula in the left eye does look a little worse today. I suggested focal laser to try to dry up the macula, especially because of her problem with glaucoma. We talked about the risks, benefits, indications, and alternatives of focal laser photocoagulation and the patient agreed to this procedure after the questions were answered. Focal laser photocoagulation was performed today predominately to that area superior to the fovea, where the microaneurysms are clustered without any difficulty. I asked her to return here for a check in three months or sooner if she should notice a problem and see you periodically
