This 59YO female was referred for proliferative diabetic retinopathy (PDR). She noted floaters in her right eye for several months. There was a 20-year history of type 2 diabetes, which was currently insulin-dependent. Vision was 20/25 bilaterally.
Color photography dated 4/6/23 shows florid bilateral disc neovascularization (NVD) secondary to previously undiagnosed PDR. Bilateral Avastin injections were given that day. She returned two weeks later with several days of blurred vision OS. Vision was 20/60 in this eye due to a new moderate vitreous hemorrhage.
She returned on 5/11/23, subjectively better, with 20/25 OD and 20/30 OS. The vitreous hemorrhage in her left eye was much improved, and the NVD had dramatically resolved in each eye. Panretinal photocoagulation (PRP) will be started bilaterally.
Learning Points:
PRP has been around since the 1960s and still remains the mainstay for treating proliferative disease. Although the majority of treatment-naive retinal neovascularizations will respond to PRP, in our experience, this type of succulent NVD rarely regresses significantly with laser alone.
As in this case, we prefer to first stabilize the neovascularization with anti-VEGF therapy, and then add PRP as a more permanent solution to prevent reproliferation.
