Case 50 severe retinopathy
- 1981 Male, born
- 1983 Type 1 dm
- 1999-2008 Hba1c 8.5%, 2009 Hba1c 8.0%
- 2003 retinopathy screening: background/mild non-proliferative retinopathy
- 2006 similar; 2007 did not attend clinic
- 2008 aggressive proliferative retinopathy, lots of laser needed
- 2009 laser continued; Intravitreal triamcinolone x1 each eye;
- 2010 several avastin injections both eyes, for diabetic maculopathy (macular oedema) more arranged; vision right 6/15; left 6/9
- Severe retinopathy has developed despite reasonable control and blood pressure. Unfortunately 95% of type 1 patients will develop retinopathy eventually, and really good control is the only way to prevent this (HbA1c <7.5%).
- In 2003 retinopathy was evident (microaneurysms). Diabetic control should really have been improved then as it was clear that severe retinopathy would otherwise develop.
- The patient re-presented with very severe retinopathy in 2008...really laser should have been carried out a year or two before to prevent such changes.
- Avastin was needed on repeated occasions, as there was so much macular oedema.
- Patient remained positive throughout with a wonderfully supportive family.
2003: tiny haemorrhages and microaneurysms are visible. Seen more easily with a red-free illumination
2008: many blot haemorrhages visible...very severe retinopathy (ischaemic haemorrhages)
2008, later in the year after some laser. Still many blot haemorrhages visible.
2009: just a few blot haemorrhages visible, much less ischaemia
2010 much less ischaemia...should stop getting worse
OCT 2009 june, showing exudates in foveal area, indicating uncertain prognosis
2009 December, OCT showing an increase in macular oedema
2010 OCT showing chronic macular oedema, hazy view probably due to early cataract
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