www.diabeticretinopathy.org.uk

retinopathy details

Case 50 severe retinopathy

David Kinshuck

Background

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Some issues

  1. Severe retinopathy has developed despite reasonable control and blood pressure. Unfortunately 95% of type 1 patients will develop retinopathy eventually, and really good control is the only way to prevent this (HbA1c <7.5%).
  2. In 2003 retinopathy was evident (microaneurysms). Diabetic control should really have been improved then as it was clear that severe retinopathy would otherwise develop.
  3. The patient re-presented with very severe retinopathy in 2008...really laser should have been carried out a year or two before to prevent such changes.
  4. Avastin was needed on repeated occasions, as there was so much macular oedema.
  5. Patient remained positive throughout with a wonderfully supportive family.

 

Photos, right

early retinopathy (background/none-proliferative),case 50

2003: tiny haemorrhages and microaneurysms are visible. Seen more easily with a red-free illumination

early but severe proliferative retinopathy with lots of ischaemia. case 50

2008: many blot haemorrhages visible...very severe retinopathy (ischaemic haemorrhages)

many blot haemorrhages visible...very severe retinopathy, case 50

2008, later in the year after some laser. Still many blot haemorrhages visible.

retinopathy after laser, with much ischaemia, case 50

2009: just a few blot haemorrhages visible, much less ischaemia

mush less ischaemia..stable now, case 50

2010 much less ischaemia...should stop getting worse

Scans

 showing exudates in foveal area, indicating uncertain prognosis, OCT 2009 june

OCT 2009 june, showing exudates in foveal area, indicating uncertain prognosis

 

OCT showing an increase in macular oedema

2009 December, OCT showing an increase in macular oedema

 

OCT showing chronic macular oedema, hazy view probably due to early cataract

2010 OCT showing chronic macular oedema, hazy view probably due to early cataract