Atypical manifestations of diabetic retinopathy

Abstract

We review here the clinical features and treatment implications associated with the atypical manifestations of diabetic retinopathy.

Wnt Signaling in Angiogenesis

“…It is commonly reported that first-degree family members who are asymptomatic often do have retinal defects that are apparent with flourescein angiography [35]. Manifestations unrelated to the eye are also reported, for instance defects in digit formation, or in the case of LRP-5 mutations, bone density abnormalities.…”

Featureless retina in diabetic retinopathy: Clinical and fluorescein angiographic profile

“…DR per se rarely presents with significant bilateral asymmetry. [ 6 11 ] Though several ocular and systemic conditions and pathologies can potentially accelerate or slow down the progression of DR and cause asymmetric presentation, they can generally be ruled out with meticulous examination (supra vide). [ 6 ] FLR should be added to the list of such atypical presentations and proactively looked for.…”

“…1a and b ]. [ 6 7 ] FLR was proactively suspected when DR was clinically observed to be asymmetric between the two eyes of a diabetic subject: PDR in one eye and mild-moderate NPDR in the other eye with/without the aforementioned characteristics of FLR. [ 6 ] Fluorescein angiography (FA) was performed to look for the macular perfusion and midperipheral capillary closure in all the enrolled cases [ Fig.…”

“…The exclusion criteria included clinically apparent high-risk features (HR-PDR) such as large, elevated new vessels, preretinal hemorrhage; features of severe NPDR such as extensive dot-blot hemorrhages, venous beading, or intraretinal microvascular abnormalities (IRMA); involutional or quiescent PDR with white fibrovascular proliferation at the optic disc (FPD) or elsewhere (FPE) with/without spontaneously settled tractional retinal detachments and epiretinal membrane[ 2 7 8 ]; post-scatter photocoagulation regression of PDR; complete posterior vitreous detachment, or degenerative conditions such as high myopia, open-angle glaucoma, and retinitis pigmentosa, which slow down the progression of DR;[ 6 ] and absence of good-quality fluorescein angiography (FA) records for the patient or an increased arteriovenous transit time (suggestive of ocular ischemic syndrome) on FA. Finally, the presence of any coexisting disease such as retinal vein occlusion, uveitis, retinal vasculitis, or recent intraocular surgery (which could accelerate/complicate/mimic DR or FLR) was carefully excluded.…”

“…While the initial comprehensive grading by ETDRS has been substantially simplified for the practicing physician,[ 4 5 ] the increasing prevalence of diabetic retinopathy keeps unveiling an ever wider variety of uncommon presentations that flummox and mislead us. [ 6 ] One such presentation is featureless retina , only briefly touched upon in Ryan's textbook of Retina; the description has practically remained unchanged over several editions,[ 7 ] and has never been specifically described in the peer-reviewed literature. We present our clinical experience with diagnosis, investigation, and management of this poorly known and probably underdiagnosed clinical presentation of the advanced stages of DR.…”