Diabetic Macular Edema and non-perfusion
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68-year-old woman has severe diabetic retinopathy in both eyes. She has had vitrectomies and lasers. Her vision is better since her cataract surgery and YAG capsulotomy, but it is still not perfect.
VISUAL ACUITY: OD 20/70, OS 20/200. IOP: OD 17, OS 16. The posterior chamber intraocular lens is in good position in both eyes with open capsules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.9. There is 3+ cystoid macular edema. There is light macular laser and moderate panretinal laser.
OS: Vertical C/D ratio is 0.6. There is panretinal laser.
The OCT in the right eye shows cystoid macular edema centrally. The left eye shows macular edema with cysts predominately nasal to the fovea. Her photos confirm clinical findings.
Fluorescein angiogram in the right eye shows delayed retinal re-circulation time with reasonably good capillary profusion and macular edema. The left eye shows severe non-profusion and the peripheral macula with multiple microaneurysms.
IMPRESSION:
1. CYSTOID MACULAR EDEMA IN BOTH EYES.
2. POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE.
3. SEVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
DISCUSSION: I explained to the patient that at this point both eyes have macular swelling, more in the right eye than the left eye. The angiogram does not show many capillary microaneurysms in the left eye. In the right eye I suggest we try posterior subTenon’s Kenalog injection there to dry up the macula. I treated her with that today without any difficulty. She will return for a check in 6 weeks, sooner should she notice any problem and see you regularly.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion707 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion672 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion938 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion623 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion738 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion482 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion519 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion561 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion562 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
(0 votes)
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion483 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion519 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
(0 votes)
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion652 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
(1 votes)
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion545 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion554 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion507 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
(0 votes)
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion519 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
(0 votes)
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Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusion571 views68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
(0 votes)
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68-year-old woman has severe diabetic retinopathy in both eyes. She has had vitrectomies and lasers. Her vision is better since her cataract surgery and YAG capsulotomy, but it is still not perfect.
VISUAL ACUITY: OD 20/70, OS 20/200. IOP: OD 17, OS 16. The posterior chamber intraocular lens is in good position in both eyes with open capsules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.9. There is 3+ cystoid macular edema. There is light macular laser and moderate panretinal laser.
OS: Vertical C/D ratio is 0.6. There is panretinal laser.
The OCT in the right eye shows cystoid macular edema centrally. The left eye shows macular edema with cysts predominately nasal to the fovea. Her photos confirm clinical findings.
Fluorescein angiogram in the right eye shows delayed retinal re-circulation time with reasonably good capillary profusion and macular edema. The left eye shows severe non-profusion and the peripheral macula with multiple microaneurysms.
IMPRESSION:
1. CYSTOID MACULAR EDEMA IN BOTH EYES.
2. POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE.
3. SEVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.
DISCUSSION: I explained to the patient that at this point both eyes have macular swelling, more in the right eye than the left eye. The angiogram does not show many capillary microaneurysms in the left eye. In the right eye I suggest we try posterior subTenon’s Kenalog injection there to dry up the macula. I treated her with that today without any difficulty. She will return for a check in 6 weeks, sooner should she notice any problem and see you regularly.
