Diabetic papillopathy with macular edema treated with intravitreal ranibizumab
A 51-year-old male with a 10-year history of poorly controlled type 2 DM presented with acute painless visual loss in his right eye. His best-corrected visual acuity was 20/320 in the right eye and 20/50 in the left eye. Intraocular pressure was 12 mmHg in both eyes. An anterior-segment examination showed moderate nuclear sclerosis of both lenses. There was no afferent pupillary defect. Fundus examination of the right eye showed nonproliferative diabetic retinopathy with serous retinal detachment and a swollen optic disk with telangiectatic vessels (). Fluorescein angiography of the right eye showed optic disk leakage with the presence of microaneurysm (). Optical coherent tomography imaging of the right eye revealed serous macular detachment and a significant increase in retinal nerve fiber-layer thickness ( and ). Visual field examination showed diffuse depression on the right eye. Pattern visual evoked potential showed normal findings. The patient underwent clinical neurologic examination (including brain magnetic resonance imaging), blood pressure measurement, and complete blood count and electrolyte testing, all of which were within normal limits. Glycosylated hemoglobin was 10.9%. A diagnosis of DP and diabetic macular edema in the right eye was made. DP is a diagnosis of exclusion, made after other causes of disk swelling have been ruled out. Through full explanation of the expected effects and possible complications of intravitreal ranibizumab injection, informed consent was obtained from the patient before injection, and intravitreal ranibizumab (0.5 mg/0.05 mL) injection was performed using the standard technique.\nTwo weeks following injection, there was marked regression of disk swelling and improvement of macular edema, with visual acuity improving to 20/100 ( and ). Three months following injection, there was complete resolution of optic disk swelling, and visual acuity was 20/50 in his right eye ( and ). No further treatment was required.