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Background DR

A 56 year old male with diabetes mellitus for 12 years. His best corrected visual acuity is 20/20= in the right eye and 20/30 in the left. Intraocular pressure and anterior segment examination were within normal limits. Fundus examination of the right eye revealed small retinal hemorrhage and mild thickening superior to the macula.

RTA color fundus image of the right eye showing small retinal hemorrhages and microaneurysms. RTA color fundus image of the right eye showing small retinal hemorrhages and microaneurysms.


Fluorescein angiography of the right eye displayed several pin-point hyperfluorescent lesions consistent with microaneurysms and leakage in an area of 1/2 to 1/3 disc diameter superior to the fovea.

RTA color fundus image of the right eye showing small retinal hemorrhages and microaneurysms.

RTA color fundus image of the right eye showing small retinal hemorrhages and microaneurysms.

Early frame of fluorescein angiography image showing pin-point hyperfluorescent lesions consistent with retinal microaneurysms.

Late frame of fluorescein angiography image showing a triangular hyperfluorescent lesion in the superior aspect of the macula.

Retinal thickness map of the right eye shows normal thickness pattern of the retina.

Retinal thickness map showing borderline thickening of the perifoveal retina and more significant thickening superior to the fovea corresponding to the leakage demonstrated on fluorescein aniography.

The thickening at the temporal aspect of the fovea is caused by leaky microaneurysms seen on the fluorescein aniography (yellow arrow). 

The upper right window of the screen shows the color fundus view. The small retinal hemorrhage is seen superior aspect of the macula.

A yellow square in the color fundus image illustrates the retinal area being scanned.

Within the yellow square a green line crossing the hemorrhage shows the location of the specific slit that is displayed in the green square in the lower window of the RTA screen.

The blue cross marker in the color fundus image window is placed just inferior to the hemorrhage. The corresponding location on the slit (lower window) is displayed by a horizontal yellow line crossing the slit and the thickness measurement appears in the upper left window.

Compared to the normal upper part of the slit, the slit above and below the hemorrhage is thickened displaying localized retinal edema. The reflection from the surface of the RPE is blocked by the hemorrhage.

Fundus examination of the left eye revealed scattered retinal hemorrhages and microaneurysms. In the supero-nasal area a few flame shaped hemorrhages and a cotton wool spot were noted.

Fluorescein angiography of the left eye displayed scattered pin-point hyperfluorescent lesions consistent with microaneurysms around the fovea with late leakage

     
Early frame of fluorescein angiography image showing pin-point hyperfluorescent lesions consistent with retinal microaneurysms and blockage caused by small retinal hemorrhages.

Late frame of fluorescein angiography image showing leakage from microaneurysms that surround the fovea.

Retina thickness map of the left eye showing some mild thickening around the fovea (red arrows) preserving the foveal contour.  Thickened supero temporal extension and less significant infero temporal extension (blue arrows) correspond to leaking microaneurysms on fluorescein angiography

RTA screen view of the left eye: The blue cross is placed superior to the small retinal hemorrhage. The corresponding horizontal yellow line in the slit window is located above the small retinal hemorrhage expressed as a small indentation in the slit. The hemorrhage blocks the reflection from the RPE surface.