Atypical diabetic retinopathy

A 61 year old white man was referred urgently to the ophthalmology department from the English national diabetic screening programme for severe non-proliferative diabetic retinopathy.

He had been diagnosed with type 2 diabetes five years earlier, and his glycated haemoglobin a month before referral was 9.1%. He had no ophthalmic symptoms and denied any visual distortion, floaters, flashing lights, eye discomfort, or headaches.

He was on treatment for hypercholesterolaemia but had no other relevant medical history. He was otherwise well and had no systemic problems, such as fevers or rigors.

On examination, his right visual acuity was 6/12 and left visual acuity was 6/6. He had mildly pale conjunctiva. Slit lamp examination was normal with no signs of inflammation or infection. His conjunctivas were not injected and his corneas were clear. No cells were present in the anterior chamber or vitreous body. Fundus examination showed retinal haemorrhages in both eyes (fig 1⇓).