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49-year-old woman was seen in the office on 10/17/08. She has been diabetic for the last six years. She has had decreasing vision over the last year. She checks her blood pressure at home. She is a nurse and her blood pressure has been running reasonably good. Her blood sugars though have been fluctuating. She comes in for evaluation. She does have shortness of breath and has a history of heart attack. VISUAL ACUITY: Vision OD is 20/80, OS 20/80. IOP: 10 OU. SLIT LAMP EXAM: The lenses are clear. There is no rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is 3+ cystoid macular edema, multiple cotton-wool spots and patchy retinal hemorrhages. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There is 3+ cystoid macular edema and multiple cotton-wool spots. I checked her blood pressure which was 200/95. OCT SCAN: The OCT scan shows severe cystoid macular edema in both eyes. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows multiple microaneurysms in the fovea in both eyes. There is also severe nonperfusion, both inside the macula and in the mid periphery. IMPRESSION: 1. HYPERTENSIVE RETINOPATHY 2. DIABETIC RETINOPATHY 3. CYSTOID MACULAR EDEMA DISCUSSION: I explained to the patient the pattern of leakage in her eyes is more diffuse than focal and, therefore, I could probably reduce her macular edema with intravitreal Kenalog. However, given her youth, there is the concern about inducing cataract and also glaucoma. If her blood pressure comes under better control, it is probable the macular edema will subside and the retinal perfusion may even improve. I suggested we try that over the next few months. I would appreciate you aggressively lowering her blood pressure. If she could get down into the 120/60 range, I suspect her vision would improve over the next three months.

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Diabetic Patient with Macular Edema and Blood Pressure 200/95264 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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Diabetic Patient with Macular Edema and Blood Pressure 200/95245 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(1 votes)
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Diabetic Patient with Macular Edema and Blood Pressure 200/95180 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28329.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/95139 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28429.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/95115 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28529.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/95115 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28629.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9598 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28729.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9592 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28829.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9588 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_28929.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9591 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_281529.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9581 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_281029.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9593 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_281129.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/9585 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_281229.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/95129 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_281329.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/95132 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
dmhypertensiveretin_61852sufr_281429.jpg
Diabetic Patient with Macular Edema and Blood Pressure 200/95157 views49-year-old decreasing vision over the last year. OD is 20/80, OS 20/80. blood pressure which was 200/95.
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(0 votes)
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49-year-old woman was seen in the office on 10/17/08. She has been diabetic for the last six years. She has had decreasing vision over the last year. She checks her blood pressure at home. She is a nurse and her blood pressure has been running reasonably good. Her blood sugars though have been fluctuating. She comes in for evaluation. She does have shortness of breath and has a history of heart attack. VISUAL ACUITY: Vision OD is 20/80, OS 20/80. IOP: 10 OU. SLIT LAMP EXAM: The lenses are clear. There is no rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is 3+ cystoid macular edema, multiple cotton-wool spots and patchy retinal hemorrhages. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There is 3+ cystoid macular edema and multiple cotton-wool spots. I checked her blood pressure which was 200/95. OCT SCAN: The OCT scan shows severe cystoid macular edema in both eyes. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows multiple microaneurysms in the fovea in both eyes. There is also severe nonperfusion, both inside the macula and in the mid periphery. IMPRESSION: 1. HYPERTENSIVE RETINOPATHY 2. DIABETIC RETINOPATHY 3. CYSTOID MACULAR EDEMA DISCUSSION: I explained to the patient the pattern of leakage in her eyes is more diffuse than focal and, therefore, I could probably reduce her macular edema with intravitreal Kenalog. However, given her youth, there is the concern about inducing cataract and also glaucoma. If her blood pressure comes under better control, it is probable the macular edema will subside and the retinal perfusion may even improve. I suggested we try that over the next few months. I would appreciate you aggressively lowering her blood pressure. If she could get down into the 120/60 range, I suspect her vision would improve over the next three months.