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 Occlusionvu 724 fois68-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 Occlusionvu 707 fois68-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 Occlusionvu 961 fois68-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 Occlusionvu 648 fois68-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 Occlusionvu 749 fois68-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 Occlusionvu 501 fois68-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 Occlusionvu 552 fois68-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 Occlusionvu 581 fois68-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 Occlusionvu 584 fois68-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 Occlusionvu 508 fois68-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 Occlusionvu 534 fois68-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 Occlusionvu 674 fois68-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 Occlusionvu 576 fois68-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 Occlusionvu 582 fois68-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 Occlusionvu 531 fois68-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 Occlusionvu 536 fois68-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 Occlusionvu 580 fois68-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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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.
