Sponsored by ZEISS
Clínica de Olhos Leitão Guerra, Salvador, Brazil
Patients with non-proliferative diabetic retinopathy (NPDR) face a troubling future if their disease is left untreated. The risk of developing proliferative diabetic retinopathy (PDR) within 1 year is more than 50% for patients with severe NPDR, and for those with very severe NPDR, the risk of PDR development within 1 year is 75%.1 Further, patients with diabetes have a significant risk of developing diabetic macular edema (DME): approximately 27% of patients develop some form of DME within 9 years of their diabetes diagnosis.2 Early detection and intervention are key to reducing the risk of vision loss due to diabetic eye disease. ZEISS Retina Workflow solutions can assist to identify and track NPDR, PDR, and DME at any stage of the disease.
Want to see how you can apply ZEISS Retina Workflow solutions to real-world DR and DME cases?
Choose a patient journey below.
Long-term Diabetic Patient
DR and DME
treatment-naïve proliferative DR
A 75-year-old diabetic patient with proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) had been undergoing treatment for many years. How can ZEISS Retina Workflow solutions ensure good long-term care?
No time for a video? Scroll down to see a series of animated GIFs featuring explanations from Dr. Guerra.
A 73-year-old woman with DR and refractory DME is in the chair. How will ZEISS Retina Workflow solutions guide you toward a solution via multimodal imaging?
No time for a video? Scroll down to see a series of animated GIFs featuring explanations from Dr. Guerra.
A 49-year-old diabetic man with no history of retinal examination has vision issues. How can ZEISS Retina Workflow solutions ensure this patient receives a thorough examination?
No time for a video? Scroll down to see a series of animated GIFs featuring explanations from Dr. Guerra.
On CLARUS 700 True Color image evaluation, silicon oil droplets in the vitreous cavity were observed. These originated from the multiple anti-VEGF injections that had already been performed.
Sparse laser photocoagulation marks in the mid periphery were better visualized in the FAF green images. This allowed us to identify numerous areas that had not been adequately treated with laser.
This patient had DME refractory to anti-VEGF treatment. For this reason, we decided to administer panretinal photocoagulation using the VISULAS green laser, using autofluorescence to guide placement. A few months after the treatment, autofluorescence helped to understand the areas that were correctly treated and those that might need further treatment despite the laser treatment.
The macular thickness map timeline in Retina Workplace is a powerful tool to monitor long-term cases. The patient had undergone more than 49 anti-VEGF applications over 5 years. The ability to identify each anti-VEGF medication with different colors offers a quick glance at treatment history, and the macular thickness graph offers a comprehensive understanding of the case over many years of follow-up.
The en face minimum intensity map is a useful tool for tracking fluid disposition over time, and the drag-and-drop functionality in the analysis makes the assessment of these cases even faster.
This patient’s extensive anti-VEGF history led to opacities that reduced the quality of the CLARUS True Color images.
CIRRUS SD-OCT analysis revealed increased macular thickness as shown in the quantitative assessment, along with intraretinal fluid and exudates involving the fovea.
En face OCT Imaging was crucial in identifying the source of the refractory edema: telangiectatic capillaries located in the superior nasal peri-macular region.
Focal laser treatment was applied to the lesion using the VISULAS green VITE system, resulting in resolution of the macular edema. Notice the obvious reduction in retinal thickness represented by warm colors when comparing this patient over time in ZEISS Retina Workplace.
I start by analyzing the CLARUS 700 color fundus images to classify the severity of diabetic retinopathy. The separation of color channels is particularly useful in this evaluation.
CLARUS fluorescein angiography revealed multiple abnormalities including microaneurysms, intraretinal microvascular abnormalities, areas of capillary non-perfusion, and (in the late phase) neovascularization and increased vascular permeability in both eyes.
Given the diagnosis of PDR, panretinal photocoagulation was performed using the multi-spot VISULAS green laser system, allowing comprehensive treatment in a single session. The treatment for the fellow eye was performed 1 week later.
To monitor the laser-induced scars over time, I compared multiple sequential images in ZEISS Retina Workplace. In this case, improvement in the appearance of exudates in the macula is observed 7 months post-treatment. This highlights the effectiveness of laser treatment in modulating macular permeability.
Long-term Diabetic Patient
DR and DME
treatment-naïve proliferative DR
Ricardo Leitão Guerra, MD, MSc
Clínica de Olhos Leitão Guerra, Salvador, Brazil
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Contact Us →1. American Optometric Association. Evidence-based Clinical Practice Guideline: Eye Care of the Patient With Diabetes Mellitus. https://bit.ly/40nBizr. Accessed September 12, 2024.
2. Duphare C, Desai K, Gupta P, et al. Diabetic Macular Edema. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554384/
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