A big problem disguised as a flower: optical coherence tomography angiography in diabetes

Abstract

We present a 40-year-old female patient with type 1 diabetes since childhood and associated microvascular complication of proliferative diabetic retinopathy and diabetic macular edema. She had undergone multiple applications of aflibercept in both eyes and bilateral argon laser panphotocoagulation, achieving partial control of vasoproliferation secondary to her underlying pathology.

We proceeded to test her with ultra-widefield optical coherence angiotomography (WF-OCTA) with TowardPi BMizar 400KHz equipment (TowardPi Medical Technology, Beijing, China).

In segmented slices (from the internal limiting membrane to the posterior vitreous) we can see a clear example of neovascularization arising from the inferior temporal arcade of the right eye, which underlies the inner retinal vasculature and proliferates into the vitreous. Using a linear slice and the pseudo-color tool provided by the OCTA equipment, the blood flow and neovascularization attached to the posterior hyaloid are highlighted¹. Retinal microvascular proliferation can lead to complications such as hemovitreous with a drop in visual acuity and deterioration in the quality of life of this type of patient. These technological advances in posterior pole imaging methods have the potential to help us make the diagnosis, make better therapeutic decisions and follow patients with posterior pole microvascular pathologies^1-2.