11/16/2023 0 Comments Dot blot hemorrhage eye![]() Past medical history withheld for the purpose of discussion was that our patient had a known diagnosis of Waldenstrom’s macroglobulinemia with increased production of IgM. FA of the left eye was unremarkable (Figure 2D).Īdditional Case History and Clinical Course: Fluorescein angiography (FA) of the right eye was significant for spots of hypofluorescence in the macula and temporal and inferior retinal periphery corresponding to blockage from the scattered retinal hemorrhages and peripheral nonperfusion along with several small microaneurysms temporally (Figures 2A – 2C). The posterior segment of the left eye showed mild venous dilation (Figures 1C and 1D). There was also very mild dilation but no increased tortuosity of the retinal veins and several larger retinal hemorrhages in the temporal and inferior mid-periphery (Figure 1B). On posterior segment examination of the right eye, there was optic nerve hyperemia and a few small dot-blot hemorrhages in the macula (Figure 1A). Intraocular pressure and anterior segment examination were normal in both eyes. On examination, best-corrected visual acuity was 20/20 bilaterally. His only medications were alendronate, glucosamine, calcium, vitamin D, and low-dose aspirin. His past ocular, family, and social history were all noncontributory. The patient denied any decreased vision, pain, or other ocular symptoms. Laser treatments to the peripheral retina called panretinalphotocoagulation (PRP), treat the oxygen-deprived areas of the retina to prevent them from releasing VEGF, which prevents growth of new, harmful blood vessels.A 57 year-old Asian man was referred for evaluation of retinal hemorrhages in the mid-periphery of the right eye. Once proliferative retinopathy occurs, the ischemic areas of the retina need to be treated. Swelling in the back of the eye is called macular edema and can sometimes be treated with medications called VEGF inhibitors or low-intensity laser called Focal Laser. Once diabetes becomes established in the eye, treatment centers around two problems – swelling in the macula and bad blood vessel growth (Proliferative Retinopathy). The best way to prevent diabetes in the eye is to control blood sugars and blood pressure. What is the treatment for diabetes in the eye? An A1c of 7 or more puts you at significantly increased risk for diabetes development in the eye. Studies have shown that an A1c of around 6 to 6.5 is ideal to prevent diabetes from developing in the eye. However, it also gives you a good target! It gives your primary care doctor an idea of what your control has looked like (even with daily fluctuations). ![]() The best way to stop diabetes from affecting your eyes is to maintain good blood glucose control! Do you know your Hemoglobin A1c? This number is an average of the last 3 months of blood sugars. Can I stop diabetes from affecting my eyes? With bleeding (vitreous hemorrhage) you may notice sudden increases in floaters, often times patients describe this event as suddenly seeing “ink in water”, “snow globe” or “swarm of bees.” Advanced cases can develop retinal detachments which can significantly limit vision and often requires surgery. This can cause blurring that doesn’t improve, even with new glasses. Macular edema is fluid accumulation in the part of the eye responsible for central vision. However, if you develop diabetic retinopathy, visual changes may occur. Not all patients develop diabetic changes in their eyes, and often times, diabetes will have no effect on your vision. However, if your blood sugars are too high for too long, you may notice some of the signs of diabetes in the eye. Your primary care doctor will likely instruct you to see your eye doctor as part of your overall diabetes care. In the early stages, you may not know you have diabetes. How will I know if I have diabetes in my eye? If you have diabetes, it is extremely important to get routine follow up with your eye doctor to detect these changes at an early stage. If these changes are detected early, they are much more treatable than if they are advanced at the time of diagnosis. These affects can be profound, leading to vision loss. They tend to leak fluid, form scar tissue and can pull on the retina, causing retinal detachments. However, these vessels are not normal vessels. Eventually, the oxygen-deprived retina releases a chemical (VEGF) that causes more blood vessels to grow. These damaged vessels are unable to adequately transport oxygen to retina, which can damage the nerve tissue – a process called retinal ischemia.
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