A 58-year-old man with Type 2 diabetes is found on fundoscopy to have new vessels at the optic disc covering about one third of the disc area, with a small preretinal haemorrhage over the posterior pole. Visual acuity is 6/9. What is the most appropriate management?

• A Focal laser photocoagulation to leaking microaneurysms
• B Observation with review every three months
• C Intravitreal triamcinolone injection
• D Panretinal photocoagulation ✓

Explanation

Neovascularisation at the disc exceeding one third of the disc area, or any disc new vessels accompanied by preretinal or vitreous haemorrhage, constitutes high-risk proliferative diabetic retinopathy by the Diabetic Retinopathy Study criteria. Panretinal photocoagulation induces regression of neovascular tissue and reduces severe visual loss by about 50 percent. Focal laser treats clinically significant macular oedema, not disc neovascularisation, and observation risks devastating vitreous haemorrhage.

Reference: Khurana, Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.