Non-perfusion in Far Periphery and Vitreous Hemorrhage
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67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40. IOP: OD 12, OS 11. The right eye has a posterior chamber intraocular lens in good position, as does the left eye.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.8. There is neovascularization on the inferior and superior pole of the optic nerve.
The macula is dry. There are ischemic changes in the periphery including ghost vessels.
OS: Vertical C/D ratio is 0.8. There is a 2+ vitreous hemorrhage. There is partial pan retinal laser.
OCT SCAN: The OCT scan of the right eye shows the macula to be flat. The left eye shows a stable macular pucker. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows leakage from the neovascularization on the nerve in the right eye and in the inferotemporal of the macula in the left eye and also the peripherals sweeps in the right eye show significant non perfusion, especially inferonasally.
IMPRESSION:
1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. NON CLEARING MILD VITREOUS HEMORRHAGE – LEFT EYE
3. GLAUCOMA
DISCUSSION: I explained to the patient with the proliferative retinopathy in the right eye, he has a high risk of vision loss, especially given that he has blood already in his left eye. I would like to protect the right eye from a similar fate. I started pan retinal laser in the right eye today
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye586 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye481 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye466 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye493 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye493 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye428 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye440 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye496 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye430 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye445 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye437 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye465 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Dark Area is Non-Perfusion458 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Dark Area is Non-Perfusion477 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye427 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye468 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye499 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye506 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Vessel Leaking Fluorescein615 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye545 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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Proliferative Diabetic Retinopathy Both Eyes - Vitreous Hemorrahge Left Eye - Dark Area is Vitreous Hemorrhage614 views67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40
(0 votes)
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67-year-old man has proliferative diabetic retinopathy in both eyes with vitreous hemorrhage in the left eye. He has had pan retinal laser in the left eye. The vitreous hemorrhage has been there for greater than two years and his vision is still hazy. He takes Lumigan in both eyes for his glaucoma.
VISUAL ACUITY: OD 20/40, OS 20/40. IOP: OD 12, OS 11. The right eye has a posterior chamber intraocular lens in good position, as does the left eye.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.8. There is neovascularization on the inferior and superior pole of the optic nerve.
The macula is dry. There are ischemic changes in the periphery including ghost vessels.
OS: Vertical C/D ratio is 0.8. There is a 2+ vitreous hemorrhage. There is partial pan retinal laser.
OCT SCAN: The OCT scan of the right eye shows the macula to be flat. The left eye shows a stable macular pucker. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows leakage from the neovascularization on the nerve in the right eye and in the inferotemporal of the macula in the left eye and also the peripherals sweeps in the right eye show significant non perfusion, especially inferonasally.
IMPRESSION:
1. PROLIFERATIVE DIABETIC RETINOPATHY – BOTH EYES
2. NON CLEARING MILD VITREOUS HEMORRHAGE – LEFT EYE
3. GLAUCOMA
DISCUSSION: I explained to the patient with the proliferative retinopathy in the right eye, he has a high risk of vision loss, especially given that he has blood already in his left eye. I would like to protect the right eye from a similar fate. I started pan retinal laser in the right eye today
