Diagnostic challenges in diabetic retinopathy: IJO Case Report
A 67-year-old male of Middle-Eastern ethnicity presented with complaints of defective vision in both eyes for the past 1 year. Examination revealed a best‑corrected visual acuity of 20/100 in the right eye (OD) and 20/70 in the left eye (OS). The patient was diagnosed with type 2 diabetes mellitus more than 10 years ago and had high glycated hemoglobin (HB1AC: 10.2%). The patient was seen elsewhere and diagnosed with moderate nonproliferative diabetic retinopathy (NPDR) with perifoveal exudation in both eyes. The patient had renal failure and is on dialysis three times a week, making him an unsuitable candidate for fluorescein angiography. Fundus examination revealed a hypopigmented area in the macula of OD.
What is the next step?
Additional imaging, including optical coherence tomography (OCT) and OCT angiography (OCTA).
Findings:
(a). There was significant intraretinal fluid and a temporal parafoveal hyperreflective lesion in the outer retina. There was mild atrophy of the outer retinal layers in this region. The OCT angiography (OCTA) superficial capillary plexus (SCP) showed a right‑angled venule (yellow arrow) and flow void areas in the perifoveal region
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