Answer: Image B, show again below, is correct. In this image, there are scattered dot-bot hemorrhages in the macula. Note: in the previous multiple choice question, image A shows macular degeneration, Image C shows a normal fundus, and image D shows papilledema.
These areas of hemorrhage are highlighted in the red-free version of the photo below:
Ophtho visit: In reviewing the note from the ophthalmologist, you find the following information:
Intraocular pressures: OD 15 mmHg, OS 14 mmHg (normal range 10-21 mmHg)
An attached copy of the patient’s optical coherence tomography (OCT) of the macula shows the following:
This OCT of the macular portion of the retina shows cystic swelling (edema) which can cause decreased vision.
The ophtho note reads as follows:
“DMII with mild NPDR and ME OU. Plan: IVA today”
This indicates the patient has non-proliferative diabetic retinopathy (NPDR) with macular edema (ME). In addition to improving BS control, diabetic macular edema can be treated with intravitreal injection (IV) of anti-VEGF medications such as bevacizumab and ranibizumab.
The patient receives an IV anti-VEGF injection in his right eye, and then 2 weeks later in his left eye. One month later his vision improves to 20/30 OU and his OCT macula looks like this:
The patient is advised to follow up again with ophthalmology in 1 month. However, he is unfortunately lost to follow up for 2 years. He now comes to you with a painful, red eye and sudden loss of vision.
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Case 6 Index