"Geyser" leakage on fluorescein angiography

Area of Science:

• Ophthalmology
• Diabetology
• Medical Imaging

Background:

• Diabetic retinopathy is a leading cause of vision loss in diabetic patients.
• Nonproliferative diabetic retinopathy with macular edema requires monitoring and treatment.
• Progression to proliferative diabetic retinopathy necessitates timely intervention.

Observation:

• An 82-year-old patient with diabetes presented with moderate nonproliferative diabetic retinopathy and macular edema.
• Initial focal macular laser treatment was performed.
• Three years later, the patient experienced blurred vision, with visual acuity declining to 3/60.

Findings:

• Vitreous hemorrhage and suspected neovascularization of the disc were observed.
• Fluorescein angiography confirmed neovascularization of the disc and revealed a distinctive vertical leakage pattern.
• Panretinal photocoagulation was initiated as treatment.

Implications:

• The observed "geyser" leakage may be attributed to partial posterior vitreous detachment or syneretic vitreous.
• Understanding these leakage mechanisms is crucial for managing proliferative diabetic retinopathy.
• Prompt diagnosis and treatment, including panretinal photocoagulation, are vital to prevent further vision loss.