1. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
1995
What is going on here?
Discuss the possible diabetic history etc …age/type/control/duration
What is this prognosis?
Does this case differ from case 1?
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

2. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
(Need to compare to case 1 later)
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

3. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
dob 1956
1985 niddm/type 2 UKPDS study patient
Obese 18 stone, BMI 36
smoked
father blind from diabetic retinopathy
6/9 6/6
How does this history influence the prognosis?
Genetic influences critical
Obesity and smoking also
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

4. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
1998
stopped smoking, still overweight, HbA1c ~10%
What is influencing the prognosis?
What is happening now?
Weight/control critical
Pre-prolif..widepread
Nv any any time; later maculopathy
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

5. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
1999 …what is happening here?
Does the patient have new vessels?
What has happened in between?
What will happen next?
Diffuse maculopathy & proliferative
Yes
(still not well controlled)
CSME will affect sight, but retinopathy will stabilise
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

6. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
2003
what has happened?
What is the VA?
Will it get worse?
Why has the retinopathy disappeared?
haemorrhages and microaneurysms have disappeared
(6/60)
Will keep current VA
Finally achieved good control …but too late, and had lots and lots of laser
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

7. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
What have you learnt from case 1 and 2?
What is puzzling you at this stage?
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

8. Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005
a similar scenario, new patient, same retinopathy, its now 2005
You got a bad result with a similar patient…would you treat this patient differently
Were you ..no different, wait for new vessels
Were you …more aggressive with your laser……if so, what would you do (this patient still finds it very difficult to control his diabetes)
Discuss the 2 options…many people now laser pre-proliferative
Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005