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Severe macular ischemia in a poorly controlled diabetic patient

Joao Pereira Figueira, Jose Cunha Vaz

The DRS study showed that panretinal laser photocoagulation in eyes with high risk proliferative diabetic retinopathy (HR-PDR) significantly reduces the risk of severe loss of vision. However, some eyes do not respond to this treatment and surgery with vitrectomy and endophotocoagulation may be useful in those cases. The authors report a case of a young diabetic patient with poor metabolic control and poor compliance to the treatment. She presented kidney impairment and HR-PDR associated with severe macular ischemia, macular edema and vitreo-macular traction syndrome, which did not respond to scatter laser treatments. She was submitted to surgery, which resulted in regressed neovascularization in both eyes, although functional recovery was limited. More recently she was submitted to combined kidney and pancreas transplantation, which solved the renal failure and allowed a much better metabolic control, without the need for insulin or other antiglycemic drugs.