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Diabetic Macular Edema - Hypertensive Retinopathy - Circinate Exudate 55-year-old woman was seen in the office on 9/25/2009. She has been diabetic for fifteen years. She has always had some trouble getting her diabetes lined up. She also has Crohn’s disease and fibromyalgia. She has had a problem with high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60. IOP: OD 18, OS 17. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. On the inferotemporal portion of the optic nerve there are lacy fine vessels which look to be neovascular. There are patchy retinal hemorrhages. There are microaneurysms around the fovea. There are exudates and there is macular edema, including cystoid macular edema. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There are multiple cotton-wool spots, retinal hemorrhages, exudates, as well as edema. OCT SCAN: There is foveal edema in both eyes. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows multiple staining microaneurysms in both eyes with areas of nonperfusion. There is neovascularization on the inferotemporal margin of the optic nerve of the left eye. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – RIGHT EYE 2. PROLIFERATIVE DIABETIC RETINOPATHY – LEFT EYE 3. DIABETIC MACULAR EDEMA – BOTH EYES 4. HYPERTENSIVE RETINOPATHY – BOTH EYES 5. CATARACTS 6. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that she does have worsening vision from a combination of diabetic retinopathy and hypertensive retinopathy. I believe with time her vision may improve but because of the severity of the macular swelling and retinal vascular damage, I suggest we do laser treatment to the right eye today, which has an excellent chance of reducing the risk of further vision loss and will probably help improve the vision. I treated the right eye with focal laser without any difficulty. The patient will return for evaluation and probable treatment in the fellow eye this coming Tuesday. Subsequent to that, if her vision does not start to improve within a few weeks, I will probably inject each eye with steroids.
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1667 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1390 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1631 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1047 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1088 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 1177 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 2111 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 826 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 740 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 699 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 559 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 716 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 619 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 620 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 580 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 578 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 614 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 595 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 524 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 570 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 596 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 548 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 726 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 628 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) vista 734 veces55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60 (0 votos)
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55-year-old woman was seen in the office on 9/25/2009. She has been diabetic for fifteen years. She has always had some trouble getting her diabetes lined up. She also has Crohn’s disease and fibromyalgia. She has had a problem with high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60. IOP: OD 18, OS 17. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. On the inferotemporal portion of the optic nerve there are lacy fine vessels which look to be neovascular. There are patchy retinal hemorrhages. There are microaneurysms around the fovea. There are exudates and there is macular edema, including cystoid macular edema. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There are multiple cotton-wool spots, retinal hemorrhages, exudates, as well as edema. OCT SCAN: There is foveal edema in both eyes. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows multiple staining microaneurysms in both eyes with areas of nonperfusion. There is neovascularization on the inferotemporal margin of the optic nerve of the left eye. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – RIGHT EYE 2. PROLIFERATIVE DIABETIC RETINOPATHY – LEFT EYE 3. DIABETIC MACULAR EDEMA – BOTH EYES 4. HYPERTENSIVE RETINOPATHY – BOTH EYES 5. CATARACTS 6. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that she does have worsening vision from a combination of diabetic retinopathy and hypertensive retinopathy. I believe with time her vision may improve but because of the severity of the macular swelling and retinal vascular damage, I suggest we do laser treatment to the right eye today, which has an excellent chance of reducing the risk of further vision loss and will probably help improve the vision. I treated the right eye with focal laser without any difficulty. The patient will return for evaluation and probable treatment in the fellow eye this coming Tuesday. Subsequent to that, if her vision does not start to improve within a few weeks, I will probably inject each eye with steroids.