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Photo Essay
December 1998

Neovascularization of the Optic Disc: What Is the Origin of the Blood Flow?

Arch Ophthalmol. 1998;116(12):1694. doi:10.1001/archopht.116.12.1694

A 28-YEAR-OLD white man with type 1 diabetes mellitus of approximately 19 years' duration was seen for evaluation of decreased visual acuity of 5 days' duration. His visual acuity was 20/100 OU. Ophthalmic examination revealed rubeosis but no neovascularization of the angle in the anterior segment of the right eye and more extensive rubeosis and neovascularization of the angle in the anterior segment of the left eye. Dilated ophthalmoscopic testing revealed extensive neovascularization of the optic disc (NVD), neovascularization elsewhere, and clinically significant macular edema in each eye. Extensive NVD is shown in the left eye (Figure 1). Fluorescein angiography was performed in preparation for treatment of his clinically significant macular edema and proliferative diabetic retinopathy. At 11 and 12 seconds after injection of fluorescein (Figure 2 and Figure 3), the angiogram shows early filling of the NVD in his left eye. Neovascularization of the optic disc clearly fills prior to filling of the retinal arteries, with the latter occurring at 14 seconds (Figure 4). The patient underwent panretinal and focal laser photocoagulation in each eye.

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