Case 3

1
Case 3
1995 What is going on here? Discuss the possible
diabetic history etc age/type/control/duration Wh
at is this prognosis? Does this case differ from
case 1 2?
2
Case 3
1994 Background retinopathy AND Blot
haemorrhages what is the significance? New
vessel growth imminent!
3

• 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 alonedoes this matter?
4
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 alonedoes this
matter? ..good controlmore hypos
5
1994
1995
6
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
7

• 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
8

• 2000
• Still could not control diabetesmultiple insulin
  dose, but had a very severe hypo
• Meanwhile, 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.
9

• 2002 (and current) what do you notice about the
  retinopathy?
• No haemorrhages or exudates or CSMEstable!
• 6/9, drives, cannot play squashplays raquet
  ball, works, well

10

• 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 lt115 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.