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Abstract: The patient was a 23-year-old man who came to our hospital with “blurred vision in both eyes for 3 months and no improvement in visual acuity with glasses”. After visual acuity, fundus examination, optical coherence tomography and fundus fluorescence angiography, the diagnosis of bilateral diabetic retinopathy was established. The disease is one of the common complications of diabetes mellitus. After giving the patient total retinal laser photocoagulation treatment, the disease was controlled stably and the treatment effect was good.
Basic information】Male, 23 years old
Disease Type】Diabetes mellitus, bilateral diabetic retinopathy (proliferative phase)
Hospital】The First Hospital of Harbin Medical University
Date of consultation】September 2021
Treatment plan】Total retinal laser photocoagulation therapy
Treatment period】retinal laser photocoagulation once a week (4 times in total), review after 1 month
Effectiveness】The condition was controlled and the treatment effect was good
I. Initial consultation
In September 2021, the patient came to our hospital, complaining of “blurred vision in both eyes for 3 months and no improvement in vision with glasses”. The patient said that he had blurred vision in both eyes about 3 months ago and thought it was due to myopia, so he did not pay attention to it. 1 day ago, he found that his vision did not improve after wearing glasses, so he came to our hospital. The course of the disease was not accompanied by symptoms such as eye redness, eye pain, dizziness, nausea and vomiting. The patient denied systemic systemic diseases such as hypertension and diabetes mellitus, but no recent physical examination was performed.
On examination: corrected visual acuity was 0.4 in the right eye and 0.3 in the left eye. No significant abnormalities were seen in the anterior segment of both eyes, microangiomas, hemorrhages and exudates were seen on fundus examination of both eyes, and the central macular sulcus was diffuse in response to light. Fundus fluorescence angiography (FFA) examination suggested that microangiomas with strong fluorescence, sheet hemorrhage, obscured fluorescence, sheet non-perfused areas, and neovascular fluorescence leakage were seen in the retina of both eyes.
All the above findings supported the diagnosis of diabetic retinopathy (proliferative phase) in both eyes, so the patient was advised to consult with the endocrinology department, and the results confirmed that the patient had diabetes and already had complications of retinopathy.
(FFA examination)
II. Treatment history
Considering that the patient was already in the proliferative stage of diabetic retinopathy and had neovascularization in the retina, the patient was given a treatment plan of total retinal laser photocoagulation, which had the following therapeutic effects: to destroy the retina in the ischemic area, to reduce the oxygen demand, to prevent the formation of neovascularization, and to degenerate the formed neovascularization to stop the continued deterioration of the lesion. After detailed communication about the condition and treatment plan, the patient and his family expressed their understanding and willingness to cooperate with the treatment. The patient underwent retinal laser photocoagulation once a week, and each laser treatment was performed about 400 laser spots for a total of 4 times. Before the end of the treatment, the patient was asked to have a review in 1 month, and to consult the patient at any time if there was any change in his condition.
III. Treatment results
The patient underwent 4 retinal laser photocoagulation treatments and was reviewed 1 month later. The results of the review showed that the retina was visible with microangiomas, small patchy hemorrhages, a large number of laser spots, no obvious non-perfused areas, no neovascular fluorescence leakage, the patient’s macular edema was reduced and the condition was under control, and the patient and family expressed great satisfaction with the treatment. At the same time, the patient was educated about diabetes and advised to strictly control blood glucose and to have regular physical examination, focusing on blood pressure and blood lipids and regular fundus examination.
IV. Notes
We are glad that the patient’s condition is under control after the treatment. Diabetic retinopathy is a retinal lesion and dysfunction caused by high blood sugar in diabetic patients that leads to retinal microvascular lesions. In daily life, patients should maintain a healthy lifestyle, including moderate exercise according to individual conditions, eating more foods rich in dietary fiber, such as bitter melon, and also consuming more nutritious ingredients, such as soybeans. A well-controlled diet, weight, and blood sugar will help slow the progression of the disease. At the same time, patients should have regular eye examinations and seek medical advice whenever there is a change in their condition to avoid delaying treatment.
V. Personal insight
Diabetic retinopathy is a common complication of diabetes, and with the increased incidence of diabetes, as well as the increasing number of young people suffering from this disease. As health checkups in China are not yet completely popular, many people suffer from diabetes without being aware of it, and wait until complications of diabetes appear and they go to the hospital to find out diabetes, but at this time, they often miss the early treatment time, and organic lesions have already occurred, at which time treatment can only control the progress of the disease, and cannot change the occurrence of these irreversible symptoms. Therefore, it is recommended to have regular medical checkups to achieve early detection and early treatment.