Florid Diabetic Retinopathy in a Young Patient

In May 2008, a 21-year-old single, non-obese, diabetic lady was referred to our clinic for routine eye examinations. The patient had been diagnosed with diabetes mellitus three months earlier and was receiving 100 milligrams of metformin daily and 80 milligrams of gliclazide twice daily orally, consistently maintaining her blood glucose levels between 72-90 mg/dl. She had a positive family history of diabetes mellitus. No related comorbidities were reported in her nephrology and rheumatology consultations and she had no visual complaints such as floaters, blurred vision, metamorphopsia or photophobia. Ocular examination revealed bilateral best corrected visual acuity (BCVA) of 6/18, and normal anterior segments without neovascularization on the iris or in the angles. However, fundus examination showed florid neovascularization of the disc (NVD) in both eyes (Fig.1). The vessels were profuse and extended all around the discs. The condition was termed “coralliform” NVD for its resemblance to sea corals. Other areas of neovascularization (NVE) were also seen in both eyes. The macular region was edematous bilaterally with a few hard exudates. Optical coherence tomography confirmed the presence of macular edema (Fig.2). The condition was explained to the patient and informed consent was obtained for bilateral panretinal laser photocoagulation (PRP) and grid laser photocoagulation. An initial grid laser treatment followed by multiple sessions of PRP was performed in both eyes (Fig.3). Despite two sessions of grid laser, the macular edema persisted. She refused receiving intraocular injections, therefore bilateral orbital floor injections of triamcinolone acetonide (20 milligrams) were administered twice within a one month interval. Subsequently, the macular edema resolved. The last examination in March 2011 revealed BCVA of 6/10 in both eyes and significant regression of NVD and NVE. There was no macular edema (Fig.4) and the patient was satisfied with her vision.