Diabetic Neovascularization

Type 2 diabetes was recently diagnosed in a 59-year-old woman whose vision in both eyes had been impaired for about 1 month. She had experienced fatigue and malaise for 4 to 6 weeks but had delayed seeking medical care.

Funduscopic examination identified extensive optic nerve head neovascularization (A). Other changes included dot-blot and flame-shaped hemorrhages throughout the fundus. These hemorrhages were also within the macular area, which appeared to be swollen. Inferiorly, an extensive preretinal hemorrhage was found within the retrohyaloid space (B); this crescentic hemorrhage demarcated the level of posterior vitreous detachment. Occasionally, a preretinal hemorrhage may penetrate into the vitreal gel.

Because of the high risk of visual loss, all patients with diabetes who have neovascularization and preretinal or vitreous hemorrhages need to be treated with laser photocoagulation (see previous case, page 1845). The extent of photocoagulation depends on the severity of the proliferative diabetic retinopathy. Often more than one laser treatment is required to induce involution of new vessels and to prevent recurrent preretinal or vitreous hemorrhage.

This patient has undergone one laser treatment in each eye and is being monitored closely for her postoperative response. Because of the extensive retinopathy, it is likely that a second laser treatment will be needed.