Question

A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management? 

• A. Focal laser photocoagulation
• B. Pan-retinal photocoagulation
• C. Grid laser photocoagulation
• D. Scleral buckling

Answer 1

The Correct Option is B

In diabetic retinopathy, preretinal hemorrhages and neovascularization at the optic disc suggest proliferative diabetic retinopathy (PDR). The management of PDR primarily involves laser treatment to reduce the risk of further vision loss. The correct treatment approach for this case is Pan-retinal Photocoagulation (PRP), which is designed to regress neovascularization and prevent complications such as vitreous hemorrhage or tractional retinal detachment.

The process of PRP involves using a laser to create multiple burns in the peripheral retina, which reduces the oxygen demand of the retina and decreases the release of vascular endothelial growth factor (VEGF), ultimately leading to regression of neovascularization.

Here are the steps for management:

• Confirm the presence of proliferative diabetic retinopathy through clinical examination and imaging, such as fundus photography or fluorescein angiography.
• Discuss the benefits and potential side effects of PRP with the patient, including possible peripheral vision loss or decreased night vision.
• Perform Pan-retinal Photocoagulation using a retinal laser, targeting the ischemic areas of the peripheral retina while avoiding the macula to preserve central vision.
• Schedule follow-up appointments to monitor response to treatment and adjust as necessary. Additional treatments may be required if neovascularization persists or recurs.