Oman Journal of Ophthalmology

CLINICAL IMAGE
Year
: 2017  |  Volume : 10  |  Issue : 3  |  Page : 255--256

Foveal neovascularization in a patient with Type 2 diabetes mellitus


Anisha Seth, Basudeb Ghosh, Vishaal Bhambhwani, Anika Gupta, Usha K Raina 
 Guru Nanak Eye Centre, New Delhi, India

Correspondence Address:
Anisha Seth
BN-56, East Shalimar Bagh, New Delhi - 110 088
India

Abstract

Retinal neovascularization in Diabetes mellitus (DM) is commonly seen at the optic disc and mid-periphery. It is rare at the fovea as the fovea is an avascular zone and there are very few case reports of foveal neovascularization in Type 1 DM. We report a case of unilateral foveal neovascularization in Type 2 DM.



How to cite this article:
Seth A, Ghosh B, Bhambhwani V, Gupta A, Raina UK. Foveal neovascularization in a patient with Type 2 diabetes mellitus.Oman J Ophthalmol 2017;10:255-256


How to cite this URL:
Seth A, Ghosh B, Bhambhwani V, Gupta A, Raina UK. Foveal neovascularization in a patient with Type 2 diabetes mellitus. Oman J Ophthalmol [serial online] 2017 [cited 2019 Sep 17 ];10:255-256
Available from: http://www.ojoonline.org/text.asp?2017/10/3/255/216012


Full Text

 Introduction



Retinal neovascularization in Diabetes mellitus(DM) is rare at the fovea as fovea is an avascular zone. Few cases of neovascularization at fovea (NVF) are reported but all in younger patients with type 1 DM.[1],[2],[3],[4] We describe the first case of unilateral NVF in type 2 DM.

 Case Report



A 52-year-old male patient, a known case of Type 2 DM for 5 years, presented with decrease in vision in both eyes for 1 month. He had received 2 sittings of laser treatment to both eyes in the last month. His best-corrected visual acuity was 20/80 in the right eye and 20/200 in the left eye. The anterior segment was unremarkable in both eyes. The fundus examination revealed high-risk proliferative diabetic retinopathy (PDR) with clinically significant macular edema, with scattered laser photocoagulation scars in both eyes and neovascularization at the fovea (NVF) in the left eye [Figure 1]. Fluorescein angiography confirmed PDR with mild leakage at macula in the right eye and PDR with NVF and enlarged foveal avascular zone in the left eye [Figure 2]. Optical coherence tomography of macula showed spongy macular edema with hard exudates in both eyes and NVF projecting into the vitreous cavity in the left eye [Figure 3]. We completed pan-retinal photocoagulation in both eyes, following which all neovascularization regressed.{Figure 1}{Figure 2}{Figure 3}

 Discussion



Retinal neovascularization in DM is commonly seen at optic disc and mid-periphery. It is rare at the fovea as fovea is an avascular zone and receives its nutrition from underlying choriocapillaris. The choriocapillaris is densely vascular, and oxygen supply to the fovea is maintained even in the presence of severe capillary nonperfusion areas in the retina. However, it has been seen that choroidal blood flow in the foveal region is significantly decreased in DM, especially in patients with macular edema.[5] Hence, there are rare case reports of neovascularization at the fovea. Finkelstein et al. reported three patients with bilateral white foveal lesions that they called abortive neovascularization.[1] Joondeph et al. described NVF in seven cases, but all had macular ischemia.[2] Kurz et al. and Rajagopal et al. also reported cases with bilateral and unilateral NVF respectively and perfused macula.[3],[4] All the described cases are younger patients with Type 1 DM. We describe the first case of unilateral NVF in Type 2 DM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Joondeph BC, Joondeph HC, Flood TP. Foveal neovascularization in diabetic retinopathy. Arch Ophthalmol 1987;105:1672-5.
3Kurz PA, Nguyan H, Cooney MJ. Bilateral foveal neovascularization in a patient with insulin-dependent diabetes mellitus. Arch Ophthalmol 2003;121:1656-7.
4Rajagopal J, Kamath AG, Kamath GG, Solanki N. Foveal neovascularisation in diabetic retinopathy: Case report and review of literature. Int Ophthalmol 2010;30:311-4.
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