1. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 1 Case 3 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 & 2?

2. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 2 Case 3 1994 Background retinopathy AND Blot haemorrhages… what is the significance? New vessel growth imminent!

3. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 3 dob 1969 IDDM type 1 dm 1977 this photo 1995 What is happening? What is the treatment? Does not smoke or drink, HbA1c 9%, bd insulin What is the prognosis with good control? Poor control? He lives alone…does this matter?

4. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 4 Photo shows a number of blot haemorrhages, a significant increase from the year before. Almost certainly will have new vesels (he did), requiring lots of laser, reasonably gentle burns, over many sessions With good control?..will get worse before stabilising Poor control? …will get slowly worse, with very poor prognosis He lives alone…does this matter?..good control…more hypos

5. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 5 1994 1995

6. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 6 1997 Has had lots of laser. HbA1c still 9% bd insulin What is going on here? What do you tell the patient? What is the treatment? Area of severe ischaemia (blot haems etc); Will get a vitreous haemorrhage (warn patient), needs lots of laser

7. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 7 1999 …what is happening here? …what is the treatment? Vitreous haemorrhage and very active neovascular process When this active needs indirect laser, at least x2 per eye

8. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 8 2000 Still could not control diabetes…multiple insulin dose, but had a very severe hypo Meanwhile, what does the FFA show and indicate (6/9 vision)? Damaged FAZ (foveal avascular zone), with CSME (clinically significant macular oedema) Indicating may lose a lot of central vision.

9. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 9 2002 (and current) what do you notice about the retinopathy? No haemorrhages or exudates or CSME…stable! 6/9, drives, cannot play squash…plays raquet ball, works, well

10. Diabeticretinopathyafternoon case 3, Good Hope Hosp, 2005 10 Patients with diabetic retinopathy May have autonomic neuropathy Leads to severe feet and other problems (beware of feet infections) 87% have renal problems..need a BP <115 systolic to prevent these Retinopathy can be lasered, renal failure needs a transplant This patient went on an insulin pump in ~2001 and controlled his diabetes well, HbA1c ~7.5%..this probably explains why the retinopathy stabilised.