Case 1: Type 1 Diabetes & Proliferative Retinopathy
Atypical partly successfully treated patient. Same case, a 7mb Powerpoint slide show, and in Flash. A Flash quiz is presented just below if you have Flash; otherwise scroll down below the movie to see a regular web page presentation (same patient) This patients case study was reviewed again in 2003 in complete with large photos.
Early new vessels are not easily seen, but the haemorrhages (pointer) suggest new vessel presence.
- 1995, age 26
- Early proliferation
- 8 years of insulin dependant diabetes. Well, normotensive, reasonable diabetic control, smokes.
- Early new vessels all over, that do not show readily in photos.
- New vessels are best seen with bright halogen ophthalmoscope using a green filter... the vessels show as tiny black wires or 'buds' (similar to a plant seedling) against the retinal background
- Continues to proliferate
- Several laser treatments. (6000 or more burns each eye, 1000 per session). Stopped smoking.
Some haemorrhages are still present. Laser has been applied
outside the area photographed.
Haemorrhages & tiny new vessel loops are present here. (New vessel
appearance exaggerated opposite for illustration.)
The same eye on the same day: dilate pupil. A halogen rechargeable ophthalmoscope with green filter can demonstrate both haemorrhages and new vessels best. Exaggerated here for illustration.
- the new vessels are more easily seen with a red free (green) filter.
- 1999 Starting to stabilise
- 6/6 vision right and left, restricted side vision
- Retinopathy nearly 'burnt out', that is the new vessels may have permanently stopped growing. Drives, works, plays sport.
Why was the treatment successful?
New vessels have stopped growing. Note very few haemorrhages present. Pointers show the extensive laser.
- caught early, before vessels enter vitreous and bleed and the vitreous shrinks
- but there have been may ups and downs. In 2008 this patient has noticed loss of peripheral visual field, presumably fue to enlarging laser burns, and has lost his driving licence. He maintains reasonable health, but is not happy with his sight.
- in ~2000, he experienced minor vitrous haemorrhages that slowly resolved.