First Author: S.Mahapatra INDIA
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To demonstrate and discuss a rare situation where two different clinical entity like diabetic macular edema and central serous choridoretinopathy were seen simultaneously to give rise to a rare clinical manifestation like psedohypopion over macula.
A 45 year old diabetic female presenting to a tertiary eye care center in eastern India with a peculiar finding of psedohypopion over macula.
Routine ophthalmological examination including visual acuity, slitlamp examination, indirect ophthalmoscopy, FFA, OCT was done on initial examination and followups.blood examination including fasting blood sugar, post prandial blood sugar, comlpet blood count, blood urea, serum creatinine, lipid profile and glycasilated hemogliobin was done on as and when required basis.
A 45 year old diabetic female presented with gross diminution of vision in her right eye for 2 weeks. Her visual acuity was 1/60 and 6/12 in right eye and left eye respectively. She has moderate NPDR with CSME in both eyes and sub macular fluid in right eye. FFA showed a ink blot leak near the superior arcade in right eye and leaking microaneurysms over the macular area in bot the eyes. OCT showed serous elevation of neurosensory retinal suggestive of CSCR with high reflective echoes in the neurosensory retina and below suggestive of hard exudates. Hence the patient was advised for focal laser for both eyes. When the patient came for focal laser 2 days later there was neurosensory macular elevation with a psedohypopyon in right eye. Direct laser was applied to the ink blot leak but the leaking micro anurysims were not amniable to grid laser in right eye. Hence intravitreal Avastin was given. left eye received Grid laser. She was maintaining a good vision and clear fundus till one year of follow-up with no leaks on FFA and no abnormality of OCT in both eyes.
Both dibetic macular edema and Central serous choroidoretinopathy are common as clinical entities individually. But a diabetic female presenting with sudden gross diminution of vision with a pseudohypopyon over macula is rare. FFA showed a specific ink blot leak along with leaking microanurysms and OCT showed subretinsl fluid (SRF) with few hyperreflective spots suggestive of hard exudates. This has led to gravitation of exudates in SRF of CSCR forming a pseudohypopyon. Direct focal laser was done to CSCR leak and intravitral Avastin injection was given for DME which was not amniable to focal laser, causing a visual improvement and disappearance of Pseudohypopyon, a clinical situation which is not only interesting but also very rare.