Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20051

Case 3

1995

What is going on here?

Discuss the possible diabetic history etc …age/type/control/duration

What is this prognosis?

Does this case differ from case 1 & 2?

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20052

Case 3

1994

Background retinopathy AND

Blot haemorrhages… what is the significance?

New vessel growth imminent!

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20053

•dob 1969

•IDDM type 1 dm 1977

•this photo 1995

•What is happening?

•What is the treatment?

•Does not smoke or drink, HbA1c 9%, bd insulin

What is the prognosis with good control?

Poor control?

He lives alone…does this matter?

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20054

Photo shows a number of blot haemorrhages, a significant increase from the year before.

Almost certainly will have new vesels (he did), requiring lots of laser, reasonably gentle burns, over many sessions

With good control? ..will get worse before stabilising

Poor control? …will get slowly worse, with very poor prognosis

He lives alone…does this matter? ..good control…more hypos

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20055

1994 1995

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20056

1997

Has had lots of laser.

HbA1c still 9%

bd insulin

What is going on here? What do you tell the patient? What is the treatment?

Area of severe ischaemia (blot haems etc);

Will get a vitreous haemorrhage (warn patient), needs lots of laser

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20057

1999…what is happening

here?…what is the treatment?

Vitreous haemorrhage and very active neovascular process

When this active needs indirect laser, at least x2 per eye

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20058

2000Still could not control diabetes…multiple insulin dose,

but had a very severe hypoMeanwhile, what does the FFA show and indicate (6/9

vision)?

Damaged FAZ (foveal avascular zone), with CSME (clinically significant macular oedema)

Indicating may lose a lot of central vision.

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 20059

2002 (and current) what do you notice about the retinopathy?

No haemorrhages or exudates or CSME…stable! 6/9, drives, cannot play squash…plays raquet ball, works, well

Diabeticretinopathyafternoon case 3, Good Hope Hosp, 200510

Patients with diabetic retinopathy• May have autonomic neuropathy• Leads to severe feet and other

problems• (beware of feet infections)• 87% have renal problems..need a BP

<115 systolic to prevent these• Retinopathy can be lasered, renal

failure needs a transplant• This patient went on an insulin pump in

~2001 and controlled his diabetes well, HbA1c ~7.5%..this probably explains why the retinopathy stabilised.