A Case of Type 2 Diabetes Mellitus with Bilateral Optic Disc Swelling and Dural Arteriovenous Fistula

1. Hiroyuki Sasano
2. Kenichi Kohzaki
3. Takaaki Hayashi
4. Shunpei Ogawa
5. Akira Watanabe
6. Hiroshi Tsuneoka

Jikei University School of Medicine Department of Ophthalmology, Tokyo, Japan

Introduction: We present a case of type 2 diabetes mellitus (T2DM) with bilateral optic disc swelling.

Case: 29 years old man diagnosed T2DM in 2005. He was referred for visual acuity loss and bilateral optic disc swelling in 2009. Best-corrected visual acuity (BCVA) was 20/40 in right and 20/50 in left eye. Relative afferent pupillary defect was normal but critical flicker frequency decreased to 22 Hz in both eyes. Diabetes mellitus was poorly controlled, with hemoglobin A1c of 11.5%. We performed fundus examination which showed blurring of disc margins and chocked disc in both eyes. On fluorescein angiography, there was hyper-fluorescence around the disc. Humphrey perimetry showed an enlargement of Mariotte blind spot. Head CT and MRI showed no abnormalities. After three months, vitreoretinal traction with proliferative tissue on the bilateral disc and vitreous hemorrhage of left eye was observed. We performed vitrectomy for left eye and BCVA was improved to 24/20.
In April 2010, he had headache and transient blackouts. At this time MRI and selective cerebral angiography was performed. He underwent neurosurgery for thrombosis of superior sagittal sinus and bilateral transverse sinus, and dural arteriovenous fistula.

Conclusion: In this case, we considered the possibility that the chocked disc arose from intracranial hypertension with a venous perfusion problem, however we could not rule out the diabetic papillopathy. It is important to consult to neurosurgery for chocked disc in outpatient care.