Last additions - Vitreous Hemorrhage - Mild 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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PDR - Preretinal Fibrosis955 views58-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. Oct 27, 2010
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PDR - NVE742 views58-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. Oct 27, 2010
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PDR - Macula Line Scan578 views58-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. Oct 27, 2010
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PDR562 views58-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. Oct 27, 2010
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PDR546 views58-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. Oct 27, 2010
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PDR562 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision561 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision563 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision564 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision505 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision539 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision519 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision548 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision522 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision515 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision530 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision528 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision538 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision555 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision588 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision736 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision631 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision639 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision681 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision780 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision575 views58-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. Oct 27, 2010
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PDR - Mild Vitreous Hemorrhage and Good Vision567 views58-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. Oct 27, 2010
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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.
