How would you manage this case of recurrent PDR with DME?

PDR Pre and five days Post Rx with AntiVEGF

Sixty-eight years old male known to be diabetic for ten years had a myocardial infarction two years ago presented to me 18 months ago with HighRisk PDR with no DME and did him pan-retinal laser photocoagulation (PRP).
Five days ago, he presented to me again with neovascularization on the disc (NVD) covering more than 2/3 rds of the disc area with minimal cystic changes on the macula. His BCVA is 20/30, and I injected him with intravitreal Aflibercept, and within five days, the NVD regressed, leaving only fibrous tissue. What would you do??
I would proceed with an additional PRP laser, and I will reinject based on macular edema status

Check the clinical guidelines for diabetic retinopathy

#PDR #Diabetic #DME #PRP #LASER

Comments

Adult-onset vitelliform macular dystrophy

One of the most common pattern dystrophies similar to best occurs in adulthood, as it appears as oval or yellowish macular material, originated from the debris of photoreceptors, or the RPE phagocytosis failure. Fundus image showing Adult-onset vitelliform macular dystrophy On OCT, it appears as subretinal vitelliform material accumulation but above the RPE with intact ellipsoid zone and thus explains good visual acuity without an increase in retinal thickness. OCT cross-section showing Adult-onset vitelliform macular dystrophy Fluorescein angiography typically shows hypo-fluorescence at the area of vitelliform accumulation surrounded with hyper-fluorescence increases intensity in late phases; however, it may show liner, patchy, or ring-like, which is inconsistent with visual acuity. Adult-onset vitelliform macular dystrophy itself does not warrant any treatment; however, a regular follow up to monitor any progression to choroidal neovascularization. How would you approa...

Cellophane maculopathy

Caused by an epiretinal membrane, clinically, it appears as a sheen abnormal foveal reflex which features epiretinal membrane, due to inflammatory mediators and proliferation of glial cells secondary to a partial separation of posterior cortical vitreous. Fundus image shows cellophane maculopathy OCT features a hyperreflective band covering the inner retinal layers, causing minimal disturbance of inner retinal tissues. OCT cross-section shows epiretinal membrane Cellophane maculopathy itself in individuals with good visual acuity may not need any interventions, but it is warranted to do a detailed peripheral retinal exam to rule out retinal tear or hole However, an epiretinal membrane may proliferate further and cause additional tangential traction. Thus, it may induce macular pucker or lamellar/pseudo hole and increase disturbance of inner retinal tissues, macular thickness, and reduction of vision. These patients may require pars plana vitrectomy to remove the epiretinal membran...

Approaching serous PED

Serous PED is a result of fluids leak via Bruch’s membrane to space between Bruch’s and RPE, causing an increased in hydrostatic pressure separating RPE from Bruch’s membrane. Fundus image On clinical examination, a smooth, well-defined border of RPE elevation along with a slight pale appearance PED is associated with subretinal fluid or intraretinal hemorrhage. Fundus image showing serous PED with subretinal fluids and drusen Optical coherence tomography On OCT, PED features smooth or irregular RPE elevation, which contains clear fluids that looks like a homogeneous hyporeflective area. PED may feature sub / intraretinal fluids accompanied by ellipsoid zone disruption. OCT cross-section showing serous PED with subretinal and intraretinal fluids Fluorescein fundus angiography On FFA, serous PED shows a distinct area of early hyperfluorescence, which increases in the mid and late phase due to dye pooling. FFA is useful to detect the presence of neovascular membrane. Fundus im...

Retinal Assistant Module Blog

Search This Blog