We present a 46-year-old man who showed acutely progressive diabetic retinopathy and who was diagnosed as “severe retinopathy at an adjacent papilla”.
This nonobese patient with NIDDM, noticed thirstiness in 1982. He was indicated as having glucosuria and visited our clinic in March 1984.
His blood glucose level was 487 mg/dl, HbA₁ was 15.3%, and urinalysis revealed proteinuria. Fundus examination revealed Scott IIIb, and simple retinopathy was diagnosed. He was treated by diet and small-dosage insulin injections.
Three months later, in July 1984, fundus examination showed preproliferative retinopathy, and panretinal photocoagulation (PRP) was performed. Recognizing the presence of retinopathy, we controlled the patient's blood glucose level carefully to prevent a rapid lowering of the fasting blood glucose level.
However, soon after the PRP was completed, the patient's sight acuity diminished rapidly. Massive hemorrhages, exudates and lipid deposition on the posterior pole appeared. In September 1984, fluorescein angiography revealed neovascularization of the optic disc and the patient was diagnosed as proliferative retinopathy. In April 1985, vitreous hemorrhage occurred bilaterally. The fundus showed massive hemorrhages, exudates and lipid deposition throughout the posterior pole, and PRP was not effective. Hence, the condition was diagnosed as “severe retinopathy at an adjacent papilla”.
The onset was two years previously, so the duration was not long. The patient was not hypertensive or obese, Blood glucose was controlled carefully. The cause of deterioration in this case is uncertain, and no clear risk factor except for mild proteinuria can be found. There might be a relationship between the progress of retinopathy and nephropathy.