Type 1 Diabetic and Hypertensive Retinopathy: Case Presentation and Review of Literature
Type 1 Diabetes (T1D) Mellitus is a complex, chronic illness that affects half a million children
under the age of 15 years. Complications associated with diabetic retinopathy
can be prevented with continued self-management of Blood Glucose (BG) and Blood Pressure
(BP) into adulthood.
In this case, we present a 20-year-old man with a 15 year history of T1D who loses control
of his BG and BP for 2 years. Blood pressure, visual acuity and intraocular pressures were
measured at the time of visit.
Non-mydriatic retinal imaging was performed using a Canon CR-2 Plus AF with
a resolution of 18 megapixel. A Spectral Domain (SD)-OCT provided a 5 micron resolution of
the posterior pole including the macula/fovea.
Optical Coherence Tomography Angiography (OCTA) (Optovue, Inc., Fremont,
CA, USA) captured 6*6 mm angiograms centered on macula. TeamViewerTM was used
to perform remote tele-presence tele-ophthalmology.
Color Fundus Photo (CFP) of the subject in 2013 showed few hemorrhages with virtually
no signs of retinopathy although his BP, last Glycated hemoglobin (HbA1c) and BG
were uncontrolled (130/91 mm Hg, 13+, 421 mg/dL, respectively).
Two years later, after 15 years of diabetes, his BP, last HbA1c, and BG are still uncontrolled
(142/62 mm Hg, 13.5%, and 319 mg/dL, respectively). CFP and tele-consultation confirms
severe Non-proliferative diabetic retinopathy (NPDR), after 131 days since last annual eye examination,
with 259 retinal hemorrhages and 12 Intraretinal microvascular abnormalities (IRMAs) in his left eye.
OCT was normal, but OCTA identified areas of retinal telangiectasia and micro-aneurysm formation.
days following NPDR diagnosis, he reduced BP to 122/78 mm Hg, HbA1c to 10%, and BG
to 115 mg/dL. CFP showed 80 fewer hemorrhages and 10 IRMAs. 57 days following NPDR
diagnosis.
Diabetes Res Open J. 2015; 1(4): 113-122. doi: 10.17140/DROJ-1-118