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Derniers ajouts - Diabetic Macular Edema and non-perfusion

68-year-old woman has severe diabetic retinopathy in both eyes. She has had vitrectomies and lasers. Her vision is better since her cataract surgery and YAG capsulotomy, but it is still not perfect. VISUAL ACUITY: OD 20/70, OS 20/200. IOP: OD 17, OS 16. The posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.9. There is 3+ cystoid macular edema. There is light macular laser and moderate panretinal laser. OS: Vertical C/D ratio is 0.6. There is panretinal laser. The OCT in the right eye shows cystoid macular edema centrally. The left eye shows macular edema with cysts predominately nasal to the fovea. Her photos confirm clinical findings. Fluorescein angiogram in the right eye shows delayed retinal re-circulation time with reasonably good capillary profusion and macular edema. The left eye shows severe non-profusion and the peripheral macula with multiple microaneurysms. IMPRESSION: 1. CYSTOID MACULAR EDEMA IN BOTH EYES. 2. POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE. 3. SEVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE. DISCUSSION: I explained to the patient that at this point both eyes have macular swelling, more in the right eye than the left eye. The angiogram does not show many capillary microaneurysms in the left eye. In the right eye I suggest we try posterior subTenon’s Kenalog injection there to dry up the macula. I treated her with that today without any difficulty. She will return for a check in 6 weeks, sooner should she notice any problem and see you regularly.

PDRnonperfusionpago-08007_281629.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 616 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_281529.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 566 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_281429.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 572 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_281329.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 631 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_281229.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 625 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_281129.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 722 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_281029.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 595 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28929.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 543 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28829.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 618 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28729.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 637 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28629.jpg
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 592 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28529.jpg
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 550 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28429.jpg
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 779 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28329.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 683 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28229.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 1003 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007_28129.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 755 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
PDRnonperfusionpago-08007.png
 Diabetic Retinopathy - Non-Perfusion - Possible Central Retinal Vein Occlusionvu 758 fois68-year-old woman OD 20/70, OS 20/200 CYSTOID MACULAR EDEMA, POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE,S EVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE.14 Novembre 2010
     
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68-year-old woman has severe diabetic retinopathy in both eyes. She has had vitrectomies and lasers. Her vision is better since her cataract surgery and YAG capsulotomy, but it is still not perfect. VISUAL ACUITY: OD 20/70, OS 20/200. IOP: OD 17, OS 16. The posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.9. There is 3+ cystoid macular edema. There is light macular laser and moderate panretinal laser. OS: Vertical C/D ratio is 0.6. There is panretinal laser. The OCT in the right eye shows cystoid macular edema centrally. The left eye shows macular edema with cysts predominately nasal to the fovea. Her photos confirm clinical findings. Fluorescein angiogram in the right eye shows delayed retinal re-circulation time with reasonably good capillary profusion and macular edema. The left eye shows severe non-profusion and the peripheral macula with multiple microaneurysms. IMPRESSION: 1. CYSTOID MACULAR EDEMA IN BOTH EYES. 2. POSSIBLE EITHER OCULAR ISCHEMIC SYNDROME IN THE RIGHT EYE OR OCCULT CENTRAL RETINAL VEIN OCCLUSION IN THE RIGHT EYE. 3. SEVERE NON-PerfUSION WITH DIABETIC RETINOPATHY IN THE LEFT EYE. DISCUSSION: I explained to the patient that at this point both eyes have macular swelling, more in the right eye than the left eye. The angiogram does not show many capillary microaneurysms in the left eye. In the right eye I suggest we try posterior subTenon’s Kenalog injection there to dry up the macula. I treated her with that today without any difficulty. She will return for a check in 6 weeks, sooner should she notice any problem and see you regularly.