Diabetic Macular Edema - Starry Sky Fluorescein Angiogram - Microaneurysms
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58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. I saw her for this last on December 21st. Her macula though looked worse. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25. IOP: OD 14, OS 18. There is trace nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is edema superior to the fovea with multiple microaneurysms.
OS: Vertical C/D ratio is 0.1. There is edema temporal to the fovea with multiple microaneurysms.
OCT SCAN: The OCT scan shows a little worsening macular edema. The average central foveal thickness in the right eye is 394 microns with a volume of 8.7 mm³. The left eye is 317 microns with a volume of 9.05 mm³. These numbers are slightly worse than last visit.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: There are multiple microaneurysms in each eye with exudates near the fovea in each eye.
IMPRESSION:
1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES
2. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES
3. MACULAR EXUDATES – BOTH EYES
4. DIABETIC MACULAR EDEMA – BOTH EYES
DISCUSSION: I explained to the patient the retinas both have edema associated with the diabetic retinopathy. With focal laser, we can reduce the risk of vision loss in both eyes. I suggested treating the right eye today. I treated the right eye with focal laser today without complication.
She will return for evaluation in one month for possible treatment of the fellow eye. If lasers do not work, we could always supplement the treatment with intravitreal injection.
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Mild Clinically Significant Diabetic Macular Edema970 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25. 
(0 votes)
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Mild Clinically Significant Diabetic Macular Edema879 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25.
(0 votes)
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Mild Clinically Significant Diabetic Macular Edema1089 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25.
(0 votes)
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Mild Clinically Significant Diabetic Macular Edema792 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25.
(0 votes)
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Mild Clinically Significant Diabetic Macular Edema903 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25.
(0 votes)
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Mild Clinically Significant Diabetic Macular Edema1146 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25.
(0 votes)
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Mild Clinically Significant Diabetic Macular Edema972 views58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25. 
(1 votes)
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58-year-old woman diabetic for 20 years who has diabetic macular edema in both eyes. I saw her for this last on December 21st. Her macula though looked worse. She has had waxing and waning edema in the past and I thought it might improve on its own but it did not. She notices her vision is still a little hazy.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/25. IOP: OD 14, OS 18. There is trace nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is edema superior to the fovea with multiple microaneurysms.
OS: Vertical C/D ratio is 0.1. There is edema temporal to the fovea with multiple microaneurysms.
OCT SCAN: The OCT scan shows a little worsening macular edema. The average central foveal thickness in the right eye is 394 microns with a volume of 8.7 mm³. The left eye is 317 microns with a volume of 9.05 mm³. These numbers are slightly worse than last visit.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: There are multiple microaneurysms in each eye with exudates near the fovea in each eye.
IMPRESSION:
1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES
2. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES
3. MACULAR EXUDATES – BOTH EYES
4. DIABETIC MACULAR EDEMA – BOTH EYES
DISCUSSION: I explained to the patient the retinas both have edema associated with the diabetic retinopathy. With focal laser, we can reduce the risk of vision loss in both eyes. I suggested treating the right eye today. I treated the right eye with focal laser today without complication.
She will return for evaluation in one month for possible treatment of the fellow eye. If lasers do not work, we could always supplement the treatment with intravitreal injection.
