Abstract
Purpose: :
To characterize diabetic patients with foveal neovascularization (NVF) and to study its influence on vision. Until now, 24 eyes with NVF have been described in literature.
Methods: :
An observational case series. Optical coherence tomography (OCT), fluorescein angiography (FA) and visual acuity assessment.
Results: :
Eight diabetic patients (9 eyes) were diagnozed to have NVF (5 by E.L., 2 by P.S. and one by P.T.) at Helsinki University Eye Hospital in 2002 to 2004. They were 5 males and 3 females, all but one with type 1 diabetes mellitus (DM), with a mean age of 32 years and a mean duration of DM of 25 years. Their HbA1c was >9% and 5 were on antihypertensive medication. NVF was unilateral in all but one patient. In one eye, NVF was the first sign of proliferative diabetic retinopathy detected after midperipheral photocoagulation for severe non–proliferative retinopathy. In a patient with bilateral, extensive NVE, NVF was seen in one eye before any treatment was given. In 2 and 4 patients, NVF was found during panphotocoagulation for new vessels elsewhere in the retina (NVE) and high risk proliferative retinopathy with new vessels on the disk (NVD), respectively. NVF appeared as a nodular, fibrotic tissue or a reddish clump. OCT revealed a tuft–like configuration of NVF, and FA confirmed leakage. No macular edema or haemorrhage have occurred and vision has remained unaffected in 3 and impoved in 6 eyes during 6–month to 2–year–long follow–up, in spite of some growth of NVF.
Conclusions: :
NVF in this series seems to be associated with poorly controlled DM and with widespread retinal capillary closure. Panretinal photocoagulation, which has effectively caused regression of NVD/NVE, had no effect of NVF. The long–term impact of NVF on vision is not yet known. NVF may be more common that previously thought. OCT and FA help to confirm their presence.
Keywords: diabetic retinopathy • macula/fovea • neovascularization