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Diabetic Retinopathy

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Step 1: View clinicals

A 58 year old man presents with blurred vision in his left eye for 1 month. He was diagnosed with type 2 diabetes mellitus 8 years ago, and is currently on oral Metformin and Glimepiride. His medical history is otherwise unremarkable. His last ophthalmological evaluation was 2 years ago, at which time mild non-proliferative diabetic retinopathy without clinically significant macular edema was noted.

Step 2: Order all relevant investigations


The HbA1c level is 7.9%

Fluorescein angiography

Both eyes show multiple severe leakages from neovascularization of the disc and retina; in addition, there is capillary nonperfusion of two quadrants in the right eye and three in the left eye.

Urine Albumin:Creatinine ratio

12 mg/mmol (normal: < 3.4; microalbuminuria: 3.4 - 34; macroalbuminuria > 34)

Fasting Plasma Glucose

180 mg/dl (normal: 70-99; prediabetes: 100-126; diabetic: >126)

Step 3: Select appropriate management

Photocoagulation L/eye
Photocoagulation R/eye
Aspirin 150 mg/day
ACE Inhibitors

Score: ★★☆