Choroidal microvascular proliferation secondary to diabetes mellitus

Abstract

Diabetes is a common endocrine disorder associated with peripheral microvascular diseases such as proliferative retinal microangiopathy (or diabetic retinopathy), which may lead to blindness. Unfortunately, diabetic microvascular abnormalities in the choroid are underestimated in clinical practice. Recent literature has revealed that the severity of diabetic retinopathy is aggravated by choroidopathy resulting from hyperglycemia. Here, we introduce a case of diabetic retinopathy with choroidal neovascularization membrane but without signs of retinal microvascular proliferation or drusen. We investigated the pathogenesis of choroidal microvascular proliferation secondary to diabetes. We postulate that choroidal neovascularization is an intraocular microvascular complication of diabetes mellitus. Intravitreal anti-vascular endothelial growth factor therapy may be a treatment option for microvascular proliferation in both retina and choroids.

Keywords: Pathology Section; choroidal neovasculation; fluorescein angiography; indocyanine green angiography; microangiopathy; proliferative diabetic choroidopathy.

Figure 1

Illustration of diabetic choroidal microvascular proliferation. A. Fundus photography demonstrating sporadic retinal microaneurysms and a submacular round dark reflection involving the fovea (yellow circle), without drusen. B. Late stage of fluorescein angiography showing macular leakage, multiple hyperfluorescent dots, and the normal background fluorescence originating from RPE except for leakage. C. Late stage of indocyanine green angiography indicating multiple hyperfluorescent dots and CNV. D. Foveal horizontal optic coherence tomography showing subfoveal fluid together with RPE detachment (red line). E. Fundus photography of the right eye only demonstrated macular retinal microaneurysms. F. Late-stage fluorescein angiography of the right eye revealed more retinal microaneurysms and normal background fluorescence originating from the RPE.