This was a 66-year old female applied to ophthalmology clinic due to decreased and blurred vision in both eyes. She had type 2 diabetes mellitus and under the treatment of oral antidiabetic and insulin therapy. She underwent cataract surgery 4 years ago. The BCVAs were 20/32 in the right and 20/40 in the left eyes. The IOPs were within normal limits and anterior segment examination showed intraocular lenses in both eyes.
Fundus examination revealed widespread microaneurysms and small intraretinal hemorrhages in addition to a few cotton-wool spots wtihout any neovascularization.
Fundus fluorescein angiography exhibited widespread dot hyperfluorescence correspond with microaneurysms in addition to macular leakage in both eyes. No neovascularization was detected.
Optical coherence tomography of the right eye showed cystoid macular edema with a few hard exudates and hyperreflective spots. The OCT scan of the left eye showed a clump of intraretinal hyperreflective material within the retinal cyst with an adjacent oval-shaped large microaneurysm. Few hyperreflective spots were also noted. The integrity of the external limiting membrane and ellipsoid zone was preserved.
The patient was diagnosed with moderate severity of non-proliferative diabetic retinopathy accompaying diabetic macular edema in both eyes in addition to intracystic hyperreflective material in the left eye.
Intracystic retinal hyperreflective material is an additional finding on OCT in eyes with diabetic macular edema and anti-VEGF response tends to be poor in eyes with intracystic retinal hyperreflective material.
Credit: Kemal Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
Instagram accounts: @retina.academy and @dr.kemaltekin