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28-year-old woman was seen on 4/15/08. She has been diabetic since age nine, and she also has had multiple strokes. She was diagnosed with moyamoya disease, which is an extremely rare disorder causing progressive intracranial vascular stenosis. She had a re-vascularization operation of the brain in March of 2008, and since then she has had a little bit more of the floaters in the right eye. She is concerned about that. She was also suspected of having thyroid disease. At one point, she had half of her thyroid removed because of nodules, but the nodules were found to be benign. She had laser treatment by Dr. Mallis in December of 2007. VISUAL ACUITY: Vision OD is 20/30, OS is 20/30. IOP: OD 14, OS 13. AMSLER GRID: Normal in both eyes. SLIT LAMP EXAM: Normal with clear lenses. There is no rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. There is neovascularization of the optic nerve. There are patchy retinal hemorrhages and multiple microaneurysms and light macular laser. OS: Vertical C/D ratio is 0.0. There is no posterior vitreous separation. There is no neovascularization of the optic nerve. There are macular laser. There are retinal hemorrhages and there is some neovascularization in the inferonasal periphery. OCT SCAN: There is parafoveal edema and foveal edema in both eyes, which is clinically significant. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. The fluorescein angiogram shows moderately severe nonperfusion in the periphery of both eyes with extensive microaneurysms in the macula and periphery of both eyes and neovascularization of the nerve in the right eye and the periphery of the left eye. IMPRESSION: 1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES 2. DIABETIC MACULAR EDEMA – BOTH EYES 3. HISTORY OF MACULAR LASER – BOTH EYES DISCUSSION: I explained to the patient that I am concerned about her neovascularization in the eye, especially in light of her other significant systemic diseases. My main concern with her would be that she might have other problems which would prevent her from maintaining regular appointments here. I, therefore, suggested we do as much laser as we can while she is feeling up to it. I gave her a retrobulbar injection behind the right eye, and I did both focal and panretinal laser, doing over 1500 laser spots in the periphery of the right eye. I asked her to return for check in three weeks, at which point I will probably finish the panretinal laser of the right eye and then subsequent to that start panretinal laser in the left eye.

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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease121 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease168 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease151 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease139 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease83 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease89 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.33333
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease106 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease52 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease66 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease131 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease64 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease42 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease105 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease79 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease106 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease50 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease61 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease55 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease63 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease37 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease64 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease61 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease58 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease60 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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Proliferative Diabetic Retinopathy in patient with Moyamoya Disease102 views28-year-old womandiabetic since age nine, and she also has had multiple strokes. OD is 20/30, OS is 20/30.00000
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28-year-old woman was seen on 4/15/08. She has been diabetic since age nine, and she also has had multiple strokes. She was diagnosed with moyamoya disease, which is an extremely rare disorder causing progressive intracranial vascular stenosis. She had a re-vascularization operation of the brain in March of 2008, and since then she has had a little bit more of the floaters in the right eye. She is concerned about that. She was also suspected of having thyroid disease. At one point, she had half of her thyroid removed because of nodules, but the nodules were found to be benign. She had laser treatment by Dr. Mallis in December of 2007. VISUAL ACUITY: Vision OD is 20/30, OS is 20/30. IOP: OD 14, OS 13. AMSLER GRID: Normal in both eyes. SLIT LAMP EXAM: Normal with clear lenses. There is no rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. There is neovascularization of the optic nerve. There are patchy retinal hemorrhages and multiple microaneurysms and light macular laser. OS: Vertical C/D ratio is 0.0. There is no posterior vitreous separation. There is no neovascularization of the optic nerve. There are macular laser. There are retinal hemorrhages and there is some neovascularization in the inferonasal periphery. OCT SCAN: There is parafoveal edema and foveal edema in both eyes, which is clinically significant. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. The fluorescein angiogram shows moderately severe nonperfusion in the periphery of both eyes with extensive microaneurysms in the macula and periphery of both eyes and neovascularization of the nerve in the right eye and the periphery of the left eye. IMPRESSION: 1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES 2. DIABETIC MACULAR EDEMA – BOTH EYES 3. HISTORY OF MACULAR LASER – BOTH EYES DISCUSSION: I explained to the patient that I am concerned about her neovascularization in the eye, especially in light of her other significant systemic diseases. My main concern with her would be that she might have other problems which would prevent her from maintaining regular appointments here. I, therefore, suggested we do as much laser as we can while she is feeling up to it. I gave her a retrobulbar injection behind the right eye, and I did both focal and panretinal laser, doing over 1500 laser spots in the periphery of the right eye. I asked her to return for check in three weeks, at which point I will probably finish the panretinal laser of the right eye and then subsequent to that start panretinal laser in the left eye.