Treatment of Foveal Neovascularization in a Patient With Type 1 Diabetes

Abstract

A man in his 30s with type 1 diabetes presented with bilateral, highrisk,proliferativediabeticretinopathyandpreviouslyhadreceivedpanretinal photocoagulation. Visual acuity was 20/25 OD and 20/30 OS. Fluorescein angiography demonstrated extensive, multifocal areas of retinal capillary nonperfusion extending into the macular region and multipleareasofneovascularizationelsewhereintheposteriorpoleand midperiphery.Inthelefteye,fovealretinalneovascularizationwasidentified arising from the margins of an enlarged, irregular foveal avascu-lar zone (Figure). He received additional panretinal photocoagulation in both eyes and received 3 intravitreal injections of bevacizumab, 1.25 mg/0.05 mL, before regression of neovascularization was achieved. Visual acuity was 20/20 OD and 20/25 OS 8 months after the most recent intravitreal injection. Previous case reports described foveal retinal neovascularization and its association with macular capillary nonperfusion, 1,2 decreased choroidal perfusion, 3,4 and regression with panretinal photocoagulation. 1,3,5,6

Contributory factors for developing foveal neovascularization in proliferative diabetic retinopathy

“…A study by Schocket et al showed the choroidal volume and choroidal flow were significantly reduced in patients with PDR 7 Hence, foveal NV in PDR is possible and there are a few case reports published in literature. [8][9][10][11][12][13][14][15][16][17][18] Previous case reports depicting foveal NV in PDR have shown involvement of both unilateral and bilateral cases in both type 1 and type 2 diabetics. 10,13 One of the important indications for treating PDR with anti-VEGF therapy according to the Protocol S DRCR.net trial is a posterior location of NV.…”