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52-year-old man has been diabetic for nineteen years. He has problems with high blood pressure, high cholesterol, and heart disease. He has moderate kidney failure. He has recently developed substantial vision loss over the last month or two. He saw someone in the emergency room with a vitreous hemorrhage in the left eye. The blood is clearing and his vision is improving. He has had laser, but unfortunately because of the vitreoretinal traction in the left eye he was told he may need surgery in the left eye, also the right eye is not seeing very well in the last few weeks. VISUAL ACUITY: OD 20/70, OS 20/200. IOP: OD 15, OS 10. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. There are no reveals. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is lace and neovascularization in the nerve. There is no posterior vitreous separation. There is 3+ cystoid macular edema. OS: Vertical C/D ratio is 0.0. There is a large patch of neovascularization and that is superior and inferior to the macula. There is preretinal fibrosis with tractional retinal detachments involving the macula. OCT SCAN: The OCT scan shows macular edema in both eyes. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: The fluorescein angiogram shows neovascularization in both eyes as well as macular edema. IMPRESSION: 1. DIABETIC MACULAR EDEMA – BOTH EYES 2. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES 3. TRACTIONAL RETINAL DETACHMENT – LEFT EYE DISCUSSION: I explained to the patient that unfortunately, he does have significant problems with his eyes, but the tractional retinal detachment in the left eye being the worse. I suggested protect that eye and have more laser today. I gave him a subconjunctival anesthetic shot, so I could add more laser. Anticipating surgery in the next few weeks and then the right eye I will treat with intravitreal Kenalog the next visit to try and dry up the macula. I think that will help the vision in the right eye substantially, but the left eye is probably going to take at least a month or two to rehabilitate.

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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye218 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye301 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye252 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.11111
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye173 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye220 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye167 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye126 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye81 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye59 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye48 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye101 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.55555
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye89 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye80 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye142 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye122 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye142 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.00000
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52-year-old man has been diabetic for nineteen years. He has problems with high blood pressure, high cholesterol, and heart disease. He has moderate kidney failure. He has recently developed substantial vision loss over the last month or two. He saw someone in the emergency room with a vitreous hemorrhage in the left eye. The blood is clearing and his vision is improving. He has had laser, but unfortunately because of the vitreoretinal traction in the left eye he was told he may need surgery in the left eye, also the right eye is not seeing very well in the last few weeks. VISUAL ACUITY: OD 20/70, OS 20/200. IOP: OD 15, OS 10. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. There are no reveals. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is lace and neovascularization in the nerve. There is no posterior vitreous separation. There is 3+ cystoid macular edema. OS: Vertical C/D ratio is 0.0. There is a large patch of neovascularization and that is superior and inferior to the macula. There is preretinal fibrosis with tractional retinal detachments involving the macula. OCT SCAN: The OCT scan shows macular edema in both eyes. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: The fluorescein angiogram shows neovascularization in both eyes as well as macular edema. IMPRESSION: 1. DIABETIC MACULAR EDEMA – BOTH EYES 2. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES 3. TRACTIONAL RETINAL DETACHMENT – LEFT EYE DISCUSSION: I explained to the patient that unfortunately, he does have significant problems with his eyes, but the tractional retinal detachment in the left eye being the worse. I suggested protect that eye and have more laser today. I gave him a subconjunctival anesthetic shot, so I could add more laser. Anticipating surgery in the next few weeks and then the right eye I will treat with intravitreal Kenalog the next visit to try and dry up the macula. I think that will help the vision in the right eye substantially, but the left eye is probably going to take at least a month or two to rehabilitate.