This 57YO female presented with 2 weeks of blurred vision. There was a 10-year history of type 2 diabetes and prior use of intravenous crack cocaine, though she claimed to have been clean for 18 years. Vision was 20/30 OD and 20/60 OS. The intraocular pressures were normal, but diffuse rubeosis was seen in her left eye.
Optos color imaging is fairly unremarkable, except for a few scattered bilateral dot-blot retinal hemorrhages.
Fluorescein angiography, however, shows diffuse vascular staining and ischemia, especially temporarily in her left eye. Cystoid leakage is also seen in her right macula.
Intravitreal Avastin was injected into her left eye. One week later, vision decreased to counting fingers OS, and the rubeosis had completely resolved. However, there was a marked increase in retinal ischemia. Unfortunately, she was then lost to follow-up.
Learning Points:
The rapid progression of the retinal ischemia in her left eye would be quite unusual for diabetes, especially immediately following intravitreal Avastin.
Although we are not certain of the underlying etiology, possible concurrent cocaine use in combination with diabetic endothelial damage may have been a contributing factor.
