Severe Diabetic Retinopathy - Venous Beading, Neovascularization Arising from A Retinal Venule, and Preretinal Hemorrhag

This fundus photograph was taken from a 28 year old woman with type 1 diabetes for 14 years and poor control. She had been followed by an optometrist annually, but the seriousness of her condition had not been recognized until she developed headache and was referred because of suspected pseudotumor cerebri. Her visual acuity in this eye was 20/40. She manifests venous beading (white arrow), a sign of severe retinopathy. A stalk of neovascularization emanates from a retinal vein (blue arrow is the stalk, black arrow the fan at the end of the stalk). A preretinal hemorrhage (green arrow) is present in association with a different locus of retinal neovascularization. These signs constitute high risk proliferative diabetic retinopathy. Not shown in this picture, she had diabetic macular edema too. She was treated with an intravitreal injection of bevacizumab on the day of presentation, and panretinal photocoagulation one week later. The fellow left eye was in a similar condition.