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    When diabetes goes from bad to worse

    Anti-VEGF therapy, glycemic control are keys to treatment

    A 30-year-old female with a 16-year history of insulin-dependent diabetes and no other ocular or systemic conditions developed proliferative retinopathy in March 2015. She had not been closely followed for the previous five years.

    Neovascularization of the disc and elsewhere was documented with multi-spectral

    imaging (MSI) in each eye (Figure 1). Best-corrected visual acuity at this visit was 20/25- in each eye. She was referred for evaluation that resulted in a recommendation for pan-retinal photocoagulation (PRP). She was then followed bi-monthly over the next six months when a second round of PRP was applied.

    PRP not the answer

    Best-corrected visual acuity remained stable over this interval. The patient complained that the procedure was uncomfortable, did not immediately result in improved vision, and negatively impacted her night vision.

    Previously from Dr. Semes: Diagnosing CHRPE lesions can be a challenge for ODs

    Over the next two months, the patient experienced mild subjective vision reduction.

    On evaluation in May 2015, she was diagnosed with center-involving, formerly designated as clinically significant macular edema (CSME) (Figure 2A). Visual acuity had declined to 20/400 in the right eye and 20/200 in the left eye.

    Anti-VEGF injections provide hope

    At the two-month follow-up visit, qualitative resolution of the edema in response to a single anti-vascular endothelial growth factor (VEGF) injection of ranibizumab 0.5 mg (Lucentis, Genentech) in each eye is seen in Figure 2B. The patient’s reaction to this treatment was more positive than to PRP. She reported some discomfort during the injection but experienced an almost immediate improvement in subjective visual performance.

    Cheryl N. Zimmer, OD
    Dr. Zimmer is a consultant for several ophthalmic organizations providing freelance research and technical writing services. She is a ...


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