Diabetes Mellitus Type II, Dyslipidemia, Diabetic Retinopathy
Short Summary

69-year-old male suffers of diabetes complicated by neuropathy and retinopathy. He had uveitis and choroiditis which were fungal in origin, and underwent cataract surgery.  Medical reports describe myopic maculopathy and neovascular age related macular degeneration in the right eye, and non-prolific diabetic retinopathy in the left eye.

Patient's Questions

The patient requests expert's opinion on the prognosis and on a possible treatment for Diabetic retinopathy increases chances of maintaining sight.

Medical Background

Expert's Opinion

See Expert's Answer

Patient's History
 
Medical diagnosis: Diabetes mellitus, type II. Dyslipedemy. Diabetic retinopathy.
 
Medical history:
A 69 year old male, no significant family history, with the exception of maternal diabetes. Smokes 20 cigarettes a day. Medical records report good appetite and drinking of about ¾ of a litre of wine a day. 
The patient was admitted into the hospital for cephalalgia accompanied by temporal absence in a diabetic patient with an abnormal ECG showing irritation signs. All neurological tests gave negative results except for a right carotidography showing a stenosis of the initial tract of the internal carotid artery (no subsequent medical control was documented).
In a second hospitalization, the patient was diagnosed with right uveitis, decompensated diabetes mellitus type II, and slight peripheral neuropathy. Another hospitalization was due to an acute anterior uveitis of the right eye and fungal choroiditis. An ultrasound exam of the right eye showed posterior detachment and inflammation of the vitreous body. The patient underwent a phacoemulsification procedure for a complex cataract of the right eye. A month after surgery, a retinal fluorangiography gave the following results: numerous capillary, epicapillary and macular micro aneurysms and dilations in the right eye with some retinal ischemia. In the left eye, a widespread vascular tortuousness and a dilation of the perimacular capillary net with macular edema was found and treated with photocoagulation. Hard exudates at the posterior pole with hemorrages of the retina around the macular area were observed.
Digital angiography revealed a high myopic maculopathy in the right eye and a laser-treated, non-proliferative diabetic retinopathy in the left eye (cf images).  Medicaldiagnosis describes an advanced senile maculopathy in the right eye with extensive neovascularisation and sub-retinal hemorrages at the posterior pole; a laser-treated pre-proliferative diabetic retinopathy, micro aneurysms, retinal hemorrages and hard essudates at the posterior pole of the left eye . No areas of hypo-afflux are reported (cf images).
 
Diabetic condition showed an improvement of the glycate values (8.4) and the treatment with Glibomet and Glucophage was recommended. Several reports indicate that the patient is having difficulty in maintaining an appropriate diet. In the last check-up, Cholesterol and TGL values were in the normal range. Glycaemia was 182 mg/dl and glycate is 8.7%. Cardiologic and other blood tests within the normal range. More recent reports are not available.
 
Expert's Answer
 
Doctor's Assessment: The patient suffers from diabetic retinopathy and maculopathy in both eyes, as well as maculopathy of another origin in the right eye. The neovascular lesion described in the right eye is not recent, and might be secondary to uveitis, myopia, or age related macular degeneration.
 
No details were provided regarding the visual acuity, recent ophthalmic exam, or recent imaging studies. In the absence of these details, it is difficult to determine the prognosis for the preservation or improvement of visual acuity in either eye. The chronic nature of the lesion in the right eye and the fluoresceine angiography results suggest that chances of improvement of acuity in either eye are probably low.
 
Recommendations:
1.    To enable determination of prognosis and treatment it is recommended to perform an OCT test and a new high quality fluoresceine angiography.
2.    Perform a complete ophthalmic exam including measurement of visual acuity, intraocular pressure, and opthalmoscopy. I'll be happy to evaluate this patient in my clinic or alternatively, review a report of recent exams.
3.  Tight control of blood glucose, blood pressure, and lipid levels to decrease the risk of progression of diabetic retinopathy. 

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