Therapeutic Challenges in the Management of Proliferative Diabetic Retinopathy in Oculo–Cutaneous Albinism

Abstract

Abstract: : Purpose: To present a case of proliferative diabetic retinopathy in a patient with oculo–cutaneous albinism; we discuss the therapeutic challenges, solutions and potential complications involved. Methods: Interventional case report Results: A 44–year–old male presented with visual acuities of count fingers OD and 20/120 OS. His past medical history was notable for oculo–cutaneous albinism, type I diabetes and hypertension. Examination of the right eye revealed neovascularisation of the disc associated with a vitreous haemorrhage. The left eye had moderate non–proliferative retinopathy. He had typical features of oculo–cutaneous albinism including nystagmus and a hypopigmented fundus.Primary pars plana vitrectomy combined with endolaser was considered the most appropriate intervention. No laser burns were visible at follow up, and his retinopathy progressed. Subsequent operations were required to control his proliferative disease over the following 18–months including bilateral pan–retinal cryoablation and a left pars plana vitrectomy. He then developed a rhegmatogenous retinal detachment requiring silicone oil tamponade. Conclusions: This case illustrates the difficulties of using traditional methods of retinal ablation in patients with hypopigmented fundi. Whilst early vitrectomy and cryoablation controlled the diabetic retinopathy, the possible sight–threatening complications of surgery need to be discussed with the patient.

Keywords: diabetic retinopathy • retinal pigment epithelium • vitreoretinal surgery