56 year old lady presented with a sudden fall in vision in the
left eye of 1 day duration. She had history of Diabetes Mellitus
for the last 12 years and was under treatment (oral hypoglycemic
agents). But her sugar was not under control and fasting blood sugar was
180 mg/dl. On examination her vision in the right eye was 6/9 and left
eye was counting fingers 2 meters. Lens showed early cataract in both
eyes. Fundus right eye showed many scattered retinal hemorrhages while
the left eye fundus could not be seen due to vitreous hemorrhage.
Ultrasonography (B scan)
left eye showed vitreous echoes
corresponding to the hemorrhage and an intact retina.
She was diagnosed to have moderate Non Proliferative Diabetic
right eye and Proliferative Diabetic Retinopathy
with vitreous hemorrhage in the left eye. For the right eye she was
advised regular follow up at 3- 4 months to see for any proliferative
changes while for the left eye it was decided to wait for the
spontaneous clearing of the hemorrhage.
She was kept at a regular follow up of 2-3 weeks and the hemorrhage was
found to be resolving. As the hemorrhage cleared a new vessel tuft was
seen at the disc. The visible areas of the retina were treated with
Laser in 4 sittings (Pan Retinal Photocoagulation)
. Four months
later the vision left eye was 6/12, vitreous hemorrhage had completely
resolved and the new vessels had almost regressed.
43 - year old gentleman with history of Diabetes Mellitus
years duration complained of sudden loss of vision in the left eye since
5 days. His sugar was moderately controlled on drugs, with fasting blood
sugar being 140 mg/dl. He also had blurred vision in the right since 5-6
months. He had no history of previous retinal examination. Visual acuity
in the right eye was 6/24 while left eye had just perception of light.
Fundus examination right eye showed thickening of the macula with
exudates and new blood vessels at 2 places in the retina. Left eye had
no view due to dense vitreous hemorrhage. Ultrasonography left eye
showed no retinal traction or detachment.
Patient was diagnosed to have Proliferative Diabetic Retinopathy
both eyes with maculopathy
in the right eye and vitreous
hemorrhage in the left eye. He was advised focal Laser
in the right eye and observation in the
left eye to look for resolution of vitreous hemorrhage. He underwent
laser in the right eye but his left eye vitreous hemorrhage did not
clear till 3 months. It was then decided to do surgery (Vitrectomy)
in the left eye. During the operation the hemorrhage was removed from
the vitreous cavity, few membranes seen on the retina were removed and
endolaser done. Post operatively retinal diabetic changes stabilized and
patient regained vision of 6/9.
51-year old gentleman presented with loss of vision in the right eye of
15 days duration. He was a known diabetic for 15 years and was currently
on Insulin therapy for uncontrolled diabetes. He had already undergone 3
sittings in the left eye 10 months back. Six months ago he
had a similar episode of sudden fall in vision in the right eye, which
had slowly improved over the months but he had not gone back for a
retinal examination. Now with the loss of vision of again he had come
for an eye check up. On examination his vision in the right eye was
perception of light and in the left eye was 6/12. Intraocular pressures
were normal. Fundus examination right eye revealed vitreous
while left eye showed Laser scars in the retinal
midperiphery and no new blood vessels.
of the right eye showed few vitreous echoes and
retina pulled up by a few membranes. He was diagnosed to have Proliferative
with vitreous hemorrhage and Tractional
right eye with Proliferative Diabetic Retinopathy
status post Pan Retinal Photocoagulation
left eye. The patient
was advised urgent surgery in the right eye to repair the retinal
detachment. He underwent Pars Plana Vitrectomy
in the right eye
during which the vitreous hemorrhage and the membranes on the retina
were removed. The retina was flattened, endolaser done and silicon oil
injected to stabilize the retina. Postoperatively retina remained stable
and subsequently silicon oil was removed 3 months later by a small
surgery. The patient had a vision of 6/18 in the right eye after the
surgery and was able to carry out his normal routine satisfactorily.