Diabetic papillopathy with macular edema treated with intravitreal ranibizumab

Abstract

We report a case of diabetic papillopathy that demonstrated a resolution of optic disk swelling and rapid visual recovery when intravitreal ranibizumab was administered. A 51-year-old male presented with acute painless visual loss in his right eye. His vision was 20/320 in the right eye and 20/50 in the left eye. Fundus examination of the right eye showed nonproliferative diabetic retinopathy with macular edema and a swollen optic disk. Fluorescein angiography showed dye leakage from the right optic disk. Optical coherent tomography revealed a significant increase in retinal nerve fiber-layer thickness. Magnetic resonance imaging of the brain was normal. The patient received a single intravitreal ranibizumab (0.5 mg) injection. Two weeks following injection, there was marked regression of the disk swelling and improvement of macular edema, with vision improving to 20/100. Three months following injection, there was complete resolution of the optic disk swelling. No further treatment was required.

Diabetic papillopathy treated with intravitreal ranibizumab

“…Unlike AION; DP has a benign course without significant sequela 1. Although there is no accepted treatment paradigm; in some recent case reports, treatment with intravitreal injection of different agents was effective in reducing disc swelling 4–6. In this study we report a case of DP treated with intravitreal ranibizumab injection and demonstrate resolution of optic disc swelling.…”

“…Anti-VEGF agents have recently been used for some reported DP cases with visual improvement and reduced optic disc swelling 4,5. Periocular and intravitreal corticosteroid injection was also found to be effective in patients with DP 6.…”

Optometric Care of the Patient with Diabetes

“…196 While there is no generally accepted treatment for diabetic papillopathy and most cases resolve without sequelae over a few months, anti-VEGF injections or periocular steroids have been used for treatment. 197,198,199,200 Patients with diabetes are at higher risk for developing non-arteritic anterior ischemic optic neuropathy (NAION), 132,201 one of the more common causes of acute optic nerve injury in individuals 50 years of age or older.…”