This 59YO male with a history of type 2 diabetes presented with bilateral diabetic macular edema. Vision was counting fingers OD and 20/30 OS.
There was extensive bilateral macular lipid, particularly in his right eye. Venous beading and sausaging were noted OD, indicating severe retinal ischemia.
Fluorescein angiography confirmed severe ischemia with peripheral temporal retinal neovascularization.
Triton swept-source OCT scanning shows severe central-involved diabetic macular edema (CI-DME) with scattered hyperreflective lipid flecks OD, non-central-involved diabetic macular edema (NCI-DME), and milder lipid OS.
Macular laser for the NCI-DME was recommended for his left eye. Monthly anti-VEGF injections were recommended for the CI-DME in his right eye. Remarkably, vision improved to 20/80 so far after a single injection.
Learning Points:
Anti-VEGF injections are the mainstay of treatment for CI-DME. It is expected that these injections will also stabilize, or possibly reverse, this patient’s proliferative disease.
We also plan to begin panretinal photocoagulation once the central edema resolves. There are multiple ways we could have approached his treatment plan. What would you do and why?
