Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
Case 1
What is going on here?
Discuss the possible diabetic history etc…age/type/control/duration
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
1995 ..background retinopathy & laser burns, for maculopathy…point out features
Dob 14.10.66, dm age 9, type 1 diabetes
What is going to happen next? What would you like to know to be able to predict what is going to happen next?
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
Developed new vessels, requiring lots of laser, not really visible on photos
…but see para-foveal haem..sign of proliferation
..very important for interpreting screening photos
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
1998 …what is happening here?Does the patient have new vessels?What has happened in between?Is the diabetes controlled? Is the retinopathy controlled?What will happen next?
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
1998 …what is happening here?Does the patient have new vessels?What has happened in between?Is the diabetes controlled? Is the retinopathy controlled?What will happen next?
Blot haems, maculopathyProbably/will do soon
laser for PRPNo! No!
More new vessels etc
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
There are new vessels…what is the treatment?
Grid/focal for maculopathy, and PRP for NVE
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
1999 • Still has retinal haemorrhages, no new
vessels remaining• HbA1c 5.5%, insulatard & actrapid• Still smoking 10/cigarettes/day, unable
to stop• 3 pints beer a night (6 units)• started an ACE inhibitor at request of
ophthalmologist (3rd request)
Diabeticretinopathyafternoon case 1, Good Hope Hosp, 2005
2000• Really excellent diabetic control continues• Reasonable BP, smokes• Cuts down alcohol to 3 units/night