J Retin.  2021 Nov;6(2):162-170. 10.21561/jor.2021.6.2.162.

Clinical Presentation of Diabetic Papillopathy in Patients with Type 2 Diabetes

• Heo JS
• Lee IG
• Kim JT

• KMID: 2552185
• DOI: http://doi.org/10.21561/jor.2021.6.2.162

Abstract

Purpose
To describe the clinical findings and prognosis in four eyes with diabetic papillopathy (DP) in three patients with type 2 diabetes.
Case summary
Case 1. A 51-year-old female with poor glycemic control presented with macular edema (ME) and optic nerve swelling (ONS) in both eyes at 3 months after insulin treatment. Intravitreal bevacizumab injection with panretinal photocoagulation did not resolve ONS. Following several sub-Tenon injections or intravitreal injections of triamcinolone, the patient’s ONS improved at 6 months after presentation. Best corrected visual acuity (BCVA) of the both eyes was 0.06/0.125 (right/left) due to optic disc pallor and macular atrophy at 48 months after initial diagnosis. Case 2. A 64-year-old male with poor glycemic control presented with a 3-month history of decreased visual acuity in his right eye. Retinal examination showed ONS and ME. Although the ME improved after intravitreal bevacizumab injection, the ONS did not. The ONS did improve 1 month after second bevacizumab injection. BCVA was finger counting at 50 cm due to development of ischemic central retinal vein occlusion at 8 months after initial presentation. Case 3. A 71-year-old male who had not taken his diabetes medication for 4-5 weeks due to gastric discomfort presented with a 1-week history of decreased visual acuity in his right eye. DP was diagnosed. Although ONS had not improved at 1 month after sub-Tenon triamcinolone injection, it had improved at 2 months after the injection. BCVA was 0.25 in the right eye at 48 months after initial diagnosis.
Conclusions
Ophthalmologists should be aware that optic disc pallor with long-term poor prognosis can develop in eyes with long-standing refractory DP.

Keyword

Diabetic papillopathy; Diabetic retinopathy; Optic nerve swelling