Absence Of Diabetic Retinopathy In A Patient Who Has Had Diabetes Mellitus For 69 Years, And Inadequate Glycemic Control: Case Presentation
Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation Esteves et al; licensee BioMed Central Ltd.2009 The main risk factors for the development and progression of diabetic retinopathy (DR) are chronic hyperglycemia, disease duration and systemic blood pressure. So far chronic hyperglycemia is the strongest evidence concerning the risk of developing DR. However there are some patients with poor metabolic control who never develop this diabetic complication. We present a case of a 73-year-old woman with type 1 diabetes mellitus, diagnosed 69 years ago. The patient is 73 years old, with no evidence of DR, despite poor glycemic control and several risk factors for DR. This case suggests the presence of a possible protection factor, which could be genetic. Diabetic RetinopathyProliferative Diabetic RetinopathyChronic HyperglycemiaPoor Metabolic ControlHbA1c Test Diabetic retinopathy (DR) is the main cause of blindness in individuals aged 20-64 years, and accounts for 7.5% of the causes of adult work disability in Brazil. The risk of blindness is approximately 30-fold higher in people with diabetes mellitus (DM), compared to the population in general [ 1 , 2 ]. The most important risk factors for the development and progression of DR are chronic hyperglycemia, duration of the DM and systemic blood pressure levels [ 3 9 ]. Other possible risk factors are dyslipidemia, pregnancy, puberty and local ocular factors such as prior cataract surgery (facectomy) [ 10 ]. So far the most solid evidence for the risk of developing DR is chronic hyperglycemia [ 10 13 ]. After 20 years duration, there is some degree of DR in almost all patients with type 1 DM, 20% of them severe [ 14 ]. In insulin users wi Continue reading >>
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Case 1: Type 1 Diabetes & Proliferative Retinopathy
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. Content on this page requires a newer version of Adobe Flash Player. Early new vessels are not easily seen, but the haemorrhages (pointer) suggest new vessel presence. 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 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 demonstrateboth haemorrhages and new vessels best. Exaggerated here for illustration. the new vessels are more easily seen with a red free (green) filter. 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. New vessels have stopped growing. Note very few haemorrhages present. Pointers show the extensive laser. caught early, before vessels enter vitreous and blee Continue reading >>
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Optometric Management - Case Study: Rapid Progression Of Diabetic Retinopathy
Case Study: Rapid Progression of Diabetic Retinopathy This case illustrates the importance of careful monitoring and diabetic control. CASE STUDY:Rapid Progression of Diabetic Retinopathy This case illustrates the importance of careful monitoring and diabetic control. REED T. GIBB, O.D.; HARALD E. OLAFSSON, O.D., F.A.A.O. 1. Hard exudates within 500 microns on the fovea. On Nov. 11, 2001, a 54-year-old male of Pacific Island descent presented for an annual diabetic visual evaluation. The patient had no visual complaints and stated that his blood sugar normally reads about 155mg/dl, with an occasional reading of 200mg/dl. His last eye exam was about two years ago. Records from that visit noted a diagnosis of mild non-proliferative diabetic retinopathy (NPDR) without clinically significant macular edema (CSME). We noted hard exudates (HE) in the posterior pole, but away from foveal tissue. All other ocular history was unremarkable. No related social history was noted. This patient's medical history included renal insufficiency, depression, hyperlipidemia, hypertension, cellulitis of the leg and type II diabetes with renal and ophthalmic manifestations. Medications include insulin injections b.i.d., dressings to treat cellulitis of the leg, Zestril (Lisin-opril, AstraZeneca) and Zocor (Simvastatin, Merck). 2. Scattered edema from microaneurysm formation. Upon examination, all entrance testing was normal, other than entering acuities of 20/40-2 O.U. Best-corrected visual acuity (BCVA) was 20/25 O.U. Tonometry revealed intraocular pressure (IOP) of 12mm Hg O.D. and 15mm Hg O.S. Pertinent biomicroscopy findings included no rubeosis; mild cataract development O.U.; and, most importantly, exudates and hemorrhages within 500 microns of the fovea O.D. with retinal thickening (se Continue reading >>
A Case Of Proliferative Diabetic Retinopathy With Hiv Infection In Which Haart Possibly Influenced The Prognosis Of Visual Function
A Case of Proliferative Diabetic Retinopathy with HIV Infection in Which HAART Possibly Influenced the Prognosis of Visual Function Kitagaki T. Sato T. Hirai J. Kimura D. Kakurai K. Fukumoto M. Tajiri K. Kobayashi T. Kida T. Kojima S. Ikeda T. Department of Ophthalmology, Osaka Medical College Background: We report on a patient with proliferative diabetic retinopathy (PDR) and human immunodeficiency virus (HIV) infection who exhibited extremely active PDR followed by a rapid onset of blindness in the right eye. The progression of visual disturbance in the patients left eye was slowed after starting highly active anti-retroviral therapy (HAART), and vision in that eye was rescued after vitrectomy. Case Report: A 72-year-old male developed pneumocystis carinii pneumonia stemming from an HIV infection and began HAART at the Department of Hematology, Osaka Medical College, Takatsuki City, Japan. Prior to HAART, the patient had shown rapidly progressing retinopathy in the right eye accompanied by vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma, ultimately leading to early-onset blindness. After starting HAART, the progression of the retinopathy in the left eye became slower compared to the right eye, with corrected visual acuity improving to 0.6 after vitrectomy, despite being accompanied by vitreous hemorrhage. The patients overall condition has remained stable following the operation, and the condition of the ocular fundus in the left eye has also settled. Conclusion: Significant differences were found in the progression rate of PDR with HIV infection between before and after starting HAART. Our findings suggest that early administration of HAART to HIV patients with diabetic retinopathy is crucial for maintaining visual function. 2016 The Aut Continue reading >>
Diabetic Retinopathy
NATURAL HISTORY OF DIABETIC RETINOPATHY Diabetic retinopathy progresses from mild nonproliferative abnormalities, characterized by increased vascular permeability, to moderate and severe nonproliferative diabetic retinopathy (NPDR), characterized by vascular closure, to proliferative diabetic retinopathy (PDR), characterized by the growth of new blood vessels on the retina and posterior surface of the vitreous. Macular edema, characterized by retinal thickening from leaky blood vessels, can develop at all stages of retinopathy. Pregnancy, puberty, blood glucose control, hypertension, and cataract surgery can accelerate these changes. Vision-threatening retinopathy is rare in type 1 diabetic patients in the first 3–5 years of diabetes or before puberty. During the next two decades, nearly all type 1 diabetic patients develop retinopathy. Up to 21% of patients with type 2 diabetes have retinopathy at the time of first diagnosis of diabetes, and most develop some degree of retinopathy over time. Vision loss due to diabetic retinopathy results from several mechanisms. Central vision may be impaired by macular edema or capillary nonperfusion. New blood vessels of PDR and contraction of the accompanying fibrous tissue can distort the retina and lead to tractional retinal detachment, producing severe and often irreversible vision loss. In addition, the new blood vessels may bleed, adding the further complication of preretinal or vitreous hemorrhage. Finally, neovascular glaucoma associated with PDR can be a cause of visual loss. RISK FACTORS AND TREATMENTS Duration of disease The duration of diabetes is probably the strongest predictor for development and progression of retinopathy. Among younger-onset patients with diabetes in the WESDR, the prevalence of any retinopathy wa Continue reading >>
Mcw: Ophthalmic Case Study 14
A 35 year-old convenient store manager with history of non-insulin dependent DM x 5 years presents to the Eye Clinic for his annual visit. He admits to progressive blurring of vision since his last visit one year ago. Reading street signs while driving seems more difficult. He is unsure of which eye seems worse. He does not wear any glasses or contacts with the exception of over-the counter reading glasses. He denies any flashes or floaters, diplopia, eye discomfort or pain. The patient reports that he has been going through some tough times recently with a difficult divorce about 6 months ago. As a result of all the stress, his blood sugars have not been under good control and he feels he has been making this worse by eating a lot of junk food and not always taking his diabetic medications. His blood sugar has been as high as 400 and he was admitted to the hospital three months ago for diabetic ketoacidosis. No prior eye surgeries, no hx of eye trauma, amblyopia or strabismus. No prior diabetes findings in the eye. Clear view, CDR 0.35; neovascularization of the disc involving ~ 50% of disc; flat macula with multiple microaneurysms and hard exudates > 500 microns away from the fovea, no clinically significant macular edema; multiple dot-blot hemorrhages in the retina periphery in all 4 quadrants without retinal detachment Clear view, CDR 0.40 with sharp optic disc margins; flat macula with multiple microaneurysms and hard exudates > 500 microns away from the fovea, no clinically significant macular edema; peripheral retina with multiple dot-blot hemorrhages in the periphery in all 4 quadrants Fluorescein angiography with evidence of abnormal vasculature (microaneurysm with leakage in later frames) and areas of capillary dropout. In the R eye there is hyperfluorescence Continue reading >>
Diabetic Retinopathy
Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes and is a leading cause of blindness.[1] It affects up to 80 percent of people who have had diabetes for 20 years or more.[2] At least 90% of new cases could be reduced if there were proper treatment and monitoring of the eyes.[3] The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.[4] Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years.[5] Signs and symptoms[edit] Normal vision The same view with diabetic retinopathy. Emptied retinal venules due to arterial branch occlusion in diabetic retinopathy (fluorescein angiography) Diabetic retinopathy often has no early warning signs. Even macular edema, which can cause rapid vision loss, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day. In the first stage which is called non-proliferative diabetic retinopathy (NPDR) there are no symptoms, the signs are not visible to the eye and patients will have 20/20 vision. The only way to detect NPDR is by fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can be done to see the back of the eye. Narrowing or blocked retinal blood vessels can be seen clearly and this is called retinal ischemia (lack of blood flow). Macular edema in which blood vessels leak their contents into the macular regi Continue reading >>
A Case Study Of A Patient With Diabetic Retinopathy | Mohammad Hossein Ebrahimi - Academia.edu
A case study of a patient with diabetic retinopathy G ModelDSX-559; No. of Pages 3 Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2016) xxxxxx Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsxCase ReportA case study of a patient with diabetic retinopathyMohammad Hossein Ebrahimi *, Hamed GharibiOccupational and Environmental Health Research Center, Shahroud University of Medical Sciences, Shahroud, IranA R T I C L E I N F O S U M M A R YKeywords: The patient, in this report, is a 52 years old male driver who had been diagnosed with type 2 diabetesProliferative diabetic retinopathy mellitus (T2DM) ve years ago without diabetic retinopathy at the baseline. The patient was beingType2 diabetes mellitus monitored for two intervals. It was at the second interval which he was diagnosed with proliferativeOccupational stress retinopathy; in fact, the progression rate of retinopathy from its rst sign, which occurred at the middle of the rst and second interval, to the point at which the patient lost his vision from the left eye occurred within a year. In this work, we introduce a new factor ignored through all the previously conducted studies, namely, type of profession. This factor which contributes to occupational stress plays an important role in the progression of proliferative retinopathy. We speculate that this factor can accelerate the progression of this disease dramatically, even when the other risk factors are not present. 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.1. Introduction years ago. As a driver, he had to be visited by in order to see whether he is qualied for work. The patient did not have diabetic Few patients with no ret Continue reading >>
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A Case Study Of A Patient With Diabetic Retinopathy - Sciencedirect
Volume 10, Issue 3 , JulySeptember 2016, Pages 166-168 A case study of a patient with diabetic retinopathy Author links open overlay panel Mohammad HosseinEbrahimi Get rights and content The patient, in this report, is a 52 years old male driver who had been diagnosed with type 2 diabetes mellitus (T2DM) five years ago without diabetic retinopathy at the baseline. The patient was being monitored for two intervals. It was at the second interval which he was diagnosed with proliferative retinopathy; in fact, the progression rate of retinopathy from its first sign, which occurred at the middle of the first and second interval, to the point at which the patient lost his vision from the left eye occurred within a year. In this work, we introduce a new factor ignored through all the previously conducted studies, namely, type of profession. This factor which contributes to occupational stress plays an important role in the progression of proliferative retinopathy. We speculate that this factor can accelerate the progression of this disease dramatically, even when the other risk factors are not present. Continue reading >>
- Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study
- EnteroMedics Announces Publication of Three-Year Data from vBloc Diabetic Patient Study in Journal of Diabetes and Obesity
- Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study
A Case Of Diabetic Retinopathy
My vision started getting blurry in right eye about five days ago. I see this red spot in my vision that is moving. Patient said he was diagnosed with insulin-dependent diabetes in 1992. He said that he didnt measure his blood sugar on regular basis but he remembers number 12. We assumed hemoglobin A1C was 12. The patient said his left eye had been blind for past six years, which he was told was due to cataracts at his last exam. Confrontation fields: FTFC OD, OS patient can see hand motion only Iris: OD NVI on the pupillary margin at 3, 7:30 and 9:30 oclock & OS No NVI This is not my patients eye. NVI was very subtle at the pupillary margin, not this obvious. Picture courtesy of Gonioscopy: No NVA (neovascularization of angle) OU OD NVD of inferior half of the optic nerve head This is not my patients eye. NVD stayed within the disc margin and it wasnt so significant. Picture courtesy of Severe, diffuse blot hemorrhaging, exudates and cotton wool spots in all quadrants and optic nerve head Picture courtesy of Two large pre-retinal hemorrhages in inferior retina Picture courtesy of Cloudy vitreous, which could be due to an old vitreous hemorrhage We could not see fundus of left eye clearly but it is possible that patient could have retinal hemorrhages and possible tractional detachment. We referred the patient to an ophthalmologist for further evaluation and possible pan retinal photocoagulation (PRP). One of the doctors had told me that almost all the diabetics get diabetic retinopathy, its just matter of time. Diabetic retinopathy can be nonproliferative or proliferative. Nonproliferative diabetic retinopathy (NPDBR) can be mild, moderate, severe and very severe. Mild NPDBR at least 1 microaneurysm , 5% risk of progression to PDR Moderate NPDBR at least 1 microaneurys Continue reading >>
Risk Factors For Late Presentation Of Diabetic Retinopathy. Pilot Case Control Study. | Iovs | Arvo Journals
ARVO Annual Meeting Abstract| May 2004 Risk factors for late presentation of diabetic retinopathy. Pilot case control study. Moorfields Eye Hospital, London, United Kingdom Moorfields Eye Hospital, London, United Kingdom Moorfields Eye Hospital, London, United Kingdom Moorfields Eye Hospital, London, United Kingdom Moorfields Eye Hospital, London, United Kingdom Commercial Relationships A.I. Marinescu, None; C. Bunce, None; B. Foot, None; R. Daniel, None; R. Wormald, None. Risk factors for late presentation of diabetic retinopathy. Pilot case control study. You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account A.I. Marinescu, C. Bunce, B. Foot, R. Daniel, R. Wormald; Risk factors for late presentation of diabetic retinopathy. Pilot case control study. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5249. ARVO (1962-2015); The Authors (2016-present) Abstract: : Purpose: Diabetic retinopathy is a leading cause of blindness in the world, predicted to reach epidemic proportions in developed countries. We intend to identify the common socioeconomic risk factors for first presentation of sight threatening diabetic retinopathy, in order to find those groups most at risk. Methods:This is a hospital based pilot case control study. Fifty two patients were newly diagnosed with diabetic retinopathy having their visual acuity checked and a complete eye examination. Twenty four patients with visual acuity < 6/12 were considered to be cases (late presenters) having sight threatening status (non proliferative retinopathy with maculopathy or proliferative with vitreous haemorrhage or/with neovascularization or with tractional retinal detachment). Twenty eight controls had early non prolifera Continue reading >>
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Case Studies: Bilateral Proliferative Diabetic Retinopathy
Northern Sydney Cataract | Retina | Vitreous | Oculoplastics Case studies: Bilateral Proliferative Diabetic Retinopathy Comments Off on Case studies: Bilateral Proliferative Diabetic Retinopathy Case studies: Bilateral Proliferative Diabetic Retinopathy I saw a patient, who presented to his optometrist initially due to a floater in his left eye. On examination today, his unaided acuities are right 6/12+ and left 6/6, the right improved to 6/9- with a pinhole. His intraocular pressures were right 16mmHg and left 14mmHg with Goldman applanation tonometry. Dilated fundus examination revealed bilateral proliferative diabetic retinopathy. He has pre-retinal haemorrhages on the right. See pictures. There were no signs of retinal tears This patient has bilateral proliferative diabetic retinopathy. Given he did not have a diagnosis of diabetes, we checked his sugar level, which was 20mmol/L. He has been sent to his GP for systemic assessment. Meanwhile a combination treatment of intravitreal injections and retinal laser has been advised for his eyes. Continue reading >>
Diabetic Retinopathy Clinical Presentation
In the initial stages of diabetic retinopathy, patients are generally asymptomatic; in the more advanced stages of the disease, however, patients may experience symptoms that include floaters, blurred vision, distortion, and progressive visual acuity loss. Continue reading >>
Case Study: A 37-year-old Man With Type 1 Diabetes, Vomiting, And Diarrhea
Case Study: A 37-Year-Old Man With Type 1 Diabetes, Vomiting, and Diarrhea R.C. is a 37-year-old man with a 32-year history of type 1 diabetes. His diabetes is complicated by hypoglycemia unawareness. His last episode of hypoglycemia with loss of consciousness was at age 20. He also has proliferative diabetic retinopathy treated with laser in 1992, gastroparesis treated with a low-fat diet and cisapride (Propulsid), and painful peripheral polyneuropathy. He has had two cranial nerve palsies: a right sixth cranial nerve palsy that required ocular muscle surgery and a left Bell's palsy. He has also had bilateral carpal tunnel releases. There is no history of nephropathy, hypertension, dyslipidemia, tobacco abuse, or cardiovascular disease. Past medical history is remarkable for reflux esophagitis and a seizure disorder. Since 1995, R.C. had been treated with an insulin infusion pump with buffered human insulin. More recently, he was switched to insulin lispro. Other medications include cisapride 10 mg four times daily and famotidine (Pepcid) 20 mg twice daily. The patient is allergic to sulfa and penicillin. He does not use ethanol. In November 1996, R.C. presented with nausea, vomiting, abdominal pain, and watery diarrhea. His wife and two young children had similar symptoms that had lasted 45 days and resolved. Two weeks earlier, he had been treated with azithromycin (Zithromax) for sinusitis. He denied fevers, chills, hematochezia, and melana. Bowel sounds were present. Abdominal exam revealed a soft, flat abdomen with mild diffuse tenderness but no rebound or guarding. Stools for fecal leukocytes, ova and parasites, and c-difficile were all negative. Because of dehydration, the patient required 2 liters of intravenous normal saline. He was treated symptomatically wit Continue reading >>
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Serous Retinal Detachment After Panretinal Photocoagulation For Proliferative Diabetic Retinopathy: A Case Report Tina Dietrich
@article{3f40be296f7f4d1f8f86da465da3a23c, title = "Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy: A case report Tina Dietrich", abstract = "Background: Proliferative diabetic retinopathy is a major cause of visual impairment in working-age adults worldwide. Panretinal photocoagulation is a cornerstone in its management; however, it may include a range of side effects and complications, one of these being serous retinal detachment. To the best of our knowledge, this is the first report of the use of intravitreal injection of bevacizumab for serous retinal detachment after panretinal photocoagulation. Case presentation: A 24-year-old Saudi man with poorly controlled type 1 diabetes presented with bilateral progressive proliferative retinopathy in spite of several sessions of panretinal photocoagulation. After one additional such session, he developed bilateral serous retinal detachment and vision loss, which was managed with a single bilateral intravitreal bevacizumab injection. The serous retinal detachment subsided with partial recovery of vision. Conclusions: Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy is a rare complication nowadays. In this case, it seems that excessive photocoagulation exceeded the energy-absorbing capacity of the retinal pigment epithelium, leading to a disruption of the blood-retinal barrier. A single injection of bilateral intravitreal bevacizumab was sufficient to control the serous retinal detachment. This effect may have been due to a reduction of vascular leakage resulting from the mechanism of action of this drug. No complications were noted from the injection. Caution should be exerted when attempting bilateral panretinal photocoagu Continue reading >>
