J Korean Ophthalmol Soc.  2017 Oct;58(10):1211-1214. 10.3341/jkos.2017.58.10.1211.

A Case of Rapid Progression to Proliferative Diabetic Retinopathy Associated with Generalized Edema

• Lim JH
• Lee SU
• Lee SJ
• Nam KY

• KMID: 2393176
• DOI: http://doi.org/10.3341/jkos.2017.58.10.1211

Abstract

PURPOSE
We report a case of rapid progression to proliferative diabetic after generalized edema occurrence in a non proliferative diabetic retinopathy patient.
CASE SUMMARY
A 48-year-old man visited our hospital with both eyes visual disturbance which occurred 1 week ago. He was diagnosed with moderate non proliferative diabetic retinopathy 5 months ago and there was no significant interval change 3 weeks ago. Date of visit, diffuse macular edema and neovascularization were observed in both eyes. Accompanying visual disturbance, he had generalized edema and 10 kg of weight gain. We thought it was not common diabetic macular edema, we held ophthalmic treatment such as an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection and requested medical treatment to the department of nephrology. Diagnosed with aggravation of left ventricle heart failure and diabetic nephropathy, he took diuretics and low salt diet for 10 days. After 10 days, his visual acuity improved and macular edema disappeared. Since then, he received intravitreal anti-VEGF injection and panretinal photocoagulation for proliferative diabetic retinopathy treatment. Nevertheless, he underwent pars plana vitrectomy due to vitreous hemorrhage in right eye.
CONCLUSIONS
We experienced a case of sudden diffuse macular edema and progression to proliferative diabetic retinopathy associated with generalized edema. We suggest that it is necessary to consider systemic changes in diabetic retinopathy.

Keyword

Macular edema; Non proliferative diabetic retinopathy; Proliferative diabetic retinopathy; Rapid progression; Systemicedema

MeSH Terms

Diabetic Nephropathies
Diabetic Retinopathy*
Diet
Diuretics
Edema*
Endothelial Growth Factors
Heart Failure
Heart Ventricles
Humans
Light Coagulation
Macular Edema
Middle Aged
Nephrology
Visual Acuity
Vitrectomy
Vitreous Hemorrhage
Weight Gain
Diuretics
Endothelial Growth Factors

Figure

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  Figure 1 Several ophthalmic examinations at visiting with visual disturbance for 1 week. (A, B) Fundus photography shows diffuse macular edema and retinal hemorrhage. (C, D) Optical coherence tomography shows diffuse macular edema. (E, F) Fluorescein angiography shows fluorescein leakage at the disc in right eye and elsewhere in left eye.

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  Figure 2 Optical coherence tomography after diuretics and low salt diet treatment for 10 days. Optical coherence tomography shows absence of diffuse macular edema. OD = oculus dexter; OS = oculus sinister.

Reference

1. Schachat AP, Wilkinson CP, Hinton DR, et al. Ryan's Retina. 6th ed. Vol. 2. St. Louis: Elsevier;2017. p. 1038.

2. Klein R, Klein BE, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984; 102:527–532.

3. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991; 98:5 Suppl. 823–833.

4. Knol JA, van Kooij B, de Valk HW, Rothova A. Rapid progression of diabetic retinopathy in eyes with posterior uveitis. Am J Ophthalmol. 2006; 141:409–412.

5. Dev S, Pulido JS, Tessler HH, et al. Progression of diabetic retinopathy after endophthalmitis. Ophthalmology. 1999; 106:774–781.

6. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol. 1998; 116:874–886.

7. Dahl-Jørgensen K, Brinchmann-Hansen O, Hanssen KF, et al. Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study. Br Med J (Clin Res Ed). 1985; 290:811–815.

8. Tsai FY, Lau LI, Li AF, et al. Acute macular edema and peripapillary soft exudate after pancreas transplantation with accelerated progression of diabetic retinopathy. J Chin Med Assoc. 2017; 80:319–325.

9. Grunwald JE, Riva CE, Martin DB, et al. Effect of an insulin-induced decrease in blood glucose on the human diabetic retinal circulation. Ophthalmology. 1987; 94:1614–1620.

10. Koo NK, Kim YC. Resolution of macular edema after systemic treatment with furosemide. Korean J Ophthalmol. 2012; 26:312–315.

11. Bhalla V, Isakson S, Bhalla MA, et al. Diagnostic ability of B-type natriuretic peptide and impedance cardiography: testing to identify left ventricular dysfunction in hypertensive patients. Am J Hypertens. 2005; 18(2 Pt 2):73S–81S.