Fast Progression to Proliferative Diabetic Retinopathy

Abstract

Purpose. This case report illustrates rapid progression of diabetic retinopathy in a patient with poor compliance to diabetic management. It additionally demonstrates the utility of panoramic/ultra-wide field retinal imaging in assessing diabetic retinopathy progression. Material and Methods. A 42-year-old female patient was examined seven times over a 25 month period at a private ophthalmology/optometry practice with dilated fundus examinations. Fundus images were obtained using a pano- ramic/ultra-widefield laser retinal imager. Fluorescein angio- graphy (FA) was performed to assess for diabetic macular edema (DME), retinal ischemia and neovascularization, and laser photocoagulation was conducted as indicated by the clinical picture. Ophthalmic ultrasonography was performed to confirm tractional retinal detachments (TRD) at the final visit. Results. Initially, visual acuity was adequate (20/30; 6/9; LogMAR 0.18 in each eye) and the patient was diagnosed with moderate non-proliferative diabetic retinopathy. Diffuse leakage resulting in DME, confirmed with FA at the second visit, was treated with focal laser photocoagulation. However, after being lost to follow-up for over a year, her vision had deteriorated severely to finger counting at 1ft (30.5 cm) in the right eye, and 20/400; 6/120; LogMAR 1.30 in the left: the result of high-risk proliferative diabetic retinopathy in each eye. The patient underwent three treatments of pan-retinal photocoagulation (PRP), but she nevertheless developed tractional retinal detachments (TRD) in both eyes. Conclusion. The combination of poorly controlled diabetes and poor compliance with follow-up care in diabetic retino- pathy can lead to rapid progression of retinopathy and blind- ness. Early detection of diabetic retinopathy with panoramic/ ultra-wide field retinal imaging allows for appropriate staging and management of the disease, and ultimately, better visual outcomes. Keywords Diabetic retinopathy, proliferative diabetic retinopathy, panoramic retinal imaging, ultra-wide field retinal imaging, pan-retinal photocoagulation, tractional retinal detachment