A 54-year-old woman with a 10-year history of insulin-dependent type 2 diabetes mellitus was referred by her optometrist because of the recent onset of blurriness in her right eye. Her optometrist told her that new blood vessel growth and leakage had developed.
The patient's best corrected visual acuity was 20/40 in the right eye and 20/25 in the left. Her pupils and intraocular pressures were normal in both eyes. A slit-lamp examination revealed mild nuclear sclerotic changes in the lenses of both eyes. No rubeosis of the iris was found on gonioscopic evaluation.
A funduscopic examination demonstrated neovascularization of the optic disc, with blood in the vitreous directly over the macular area of the right eye. Dot and blot retinal hemorrhages were scattered throughout the posterior pole. A few hard exudates were also seen (A). A large preretinal hemorrhage was detected in the infranasal quadrant of the left eye (B). Because the bleeding was not near the patient's line of sight, she had not experienced visual difficulties in this eye.
Proliferative diabetic retinopathy was diagnosed. The optic disc neovascular vessels had begun to leak, and the blood settling over the macula manifested as a cloud in the patient's vision. The patient's other retinal hemorrhages and hard exudates are common in moderate diabetic retinopathy. The preretinal hemorrhage in the left eye is another sign of proliferative diabetic retinopathy, which is treated with laser panretinal photocoagulation.