IOTM: Diabetic Traction, Macular Hole, Retinal Detachment

Image of the Month (IOTM) is a collection of interesting clinical cases with high quality images for all relevant imaging modalities (ex: color fundus, OCT, OCTA, FAF, FA, En Face, Red-free, choroidal vasculography (CVG), anterior imaging) and other clinical results if relevant (ex: visual field plots). Each case is submitted by an eye care professional using one of Topcon’s industry-leading OCT devices.

Case background

48 y.o. female with poorly controlled diabetes presented for blurred vision. BCVA 20/50 OD, 20/70 OS. Patient assessed to have Proliferative Diabetic Retinopathy OU.

Fundus imaging (color/red-free), Fluorescein Angiography (IVFA), Swept Source OCT and Optical Coherence Tomography Angiography (OCTA) were performed. Color fundus image (A) shows peripapillary fibrovascular proliferation with membranes over posterior pole and arcuate vasculature. Dot, blot and flame hemorrhages seen over the macula with a distinct circular reddish lesion in center. Red-free image (B) clearly shows the hemorrhages and vessels undergoing antero-posterior traction and the macular hole over the central macula. Swept Source OCT B-scan (C) confirmed a full-thickness hole with underlying macular retinal detachment. Early FA (D) shows transmission defect hyperfluorescence corresponding to location of macular hole with sub-neurosensory pooling corresponding to the area of the macular detachment. Swept Source OCTA B-scan flow (E) shows wellvascularized tractional membranes attached all the way to the tip of the nasal edge of the hole adding valuable information in planning future surgical intervention. In light of the patient’s relatively good vision, panretinal laser photocoagulation was chosen over outright retinal surgery as the initial treatment.

— Leon Paolo Lara, MD

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The opinions, ideas, views and assumptions expressed are the author’s own and do not necessarily represent the views of Topcon, nor do they constitute advice from Topcon.

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