Diabetic patient with retina problem, what treatment would be suggested?

Question

Hello doctor,

I am 54 years old. I am a diabetic patient since 24 years. I have a retina problem in both the eyes. I had a laser surgery in both my eyes two years ago. It was repeated last year with three injections of Avastin and this year, the laser surgery was done only in the right eye. But, I cannot see very well. I see something like a black point. So, I got checked for ischemic eye stroke. I checked with two doctors in my city. The first said that there is a cataract in the right eye and that three injections Eylea, Ozurdex, and Accentrix had to be given, while the left eye is well. The second said that the cataract was in the beginning stage and no removal is required. Only an injection of Accentrix and two laser treatments would suffice. So, now I am confused. Please help me. I have attached few pictures.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and seen the pictures (attachment removed to protect patient identity).

You have diabetic edema and diabetic retinopathy in the eye. From what I have seen, the left eye is fine but, the right eye is still swollen. The laser treatment was done because of the presence of ischemic areas. Did you undergofluorescein angiography of the eye? If not, then get it done soon. That would tell us if further injections will help. Secondly, if the cataract is very dense, then an angiography will also be difficult. So, I would request you to please let me know what is the grading of the cataract. Thirdly, one can go for a cataract surgery with an injection of a combination of Ozurdex (Dexamethasone) and Accentrix (Ranibizumab) 15 days prior to the surgery. Ultimately, you will need to go for injections as the swelling is still present.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Definitely, there are very severe diabetic changes. I can see abnormal new vessels also to be growing. Sometimes, they can bleed and may lead to vitreous hemorrhage. I do not suggest giving the three injections at one go because two of them are the same.

Rather, I would ask you to go for only Accentrix (Ranibizumab), maybe two at an interval of one month, and then repeat the OCT (optical coherence tomography) scan and angiography. A cataract surgery may trigger some changes and will not be of much benefit now. There are no complications otherwise. Eyelea (Aflibercept) is generally not recommended in diabetic patients. It is more effective in patients with macular degeneration. I do not feel that Ozurdex (Dexamethasone) will help you.

Thank you.