Fig. 4. Case 4 is a 59-year-old woman witha 25-year history of insulin-dependent diabetes who presented with diffuse retinal thickening involving the FAZ, hard exudates scatteres throughout the parafoveal region, and a central foveal cyst in the left eye (A; Color Fig. 4). Visual acuity was 20/60. Modified grid laser photocoagultion was recommended and fluorescein angiography performed (B). Modified grid photocoagultion was applied to all areas of the retinal thickening up to and including the edge of the FAZ (C). She returned for follow-up 4 months later with some reduction of her intraretinal lip and thickening; however, the central retinal thickening and central foveal cyst persisted (D). Supplemental photocoagulation was advised and a fluorescein angiogram was repeated (E). Supplemental modified grid laser photocoagultion was applied to all areas of residual retinal thickening (F). Four months later she returned with near-complete resorption of the intraretinal lipis and flattening of the central FAZ (G); visual acuity had improved to 20/30. Because no additional treatment was required, fluorescein angiography was not repeated. One year later visual acuity had improved to 20/20 without evidence of any recurrence (H). Comment: This case illustrates that fluorescein angiography is indicated once the decision to treat or to do supplemental treatment has been made based on clinical findings. Once the central thickening involving the FAZ has resolved and no further supplemental treatment is indicated, fluorescein angiography is no longer required. |