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Abstract
Purpose
To report a case of bilateral diabetic papillopathy related to rapid hemoglobin A1c (HbA1c) decrease in a type I diabetic patient.
Case summary
A 39-year-old female who was diagnosed with type I diabetes mellitus for the first time at this hospital was pre-sented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms, including blurred vision or visual defect. Her best corrected visual acuity in both eyes was 1.0, but her fundus resembled mild nonproliferative diabetic retinopathy. When diagnosed with type I diabetes mellitus, her HbA1c was 15.3%. She used insulin to control her blood glucose and her HbA1c reached 7.3% two months after controlling the blood glucose. Three months after her diabetic diagnosis, there were no differences in subjective symptoms and best corrected visual acuity. Fundus examination showed optic disc swelling in both eyes. To evaluate for the etiology of optic disc swelling, we did the examinations of the optic disc, fundus, and brain mag-netic resonance imaging. No specific signs were observed. We diagnosed diabetic papillopathy and observed the patient without any treatments. Her optic disc swelling showed gradual improvement.
Conclusions
This case shows that the rapid HbA1c decrease in type I diabetes mellitus is related to the occurrence of bilateral diabetic papillopathy. This supports previous studies that estimated that the rapid HbA1c decrease in type I diabetes mellitus in response to insulin treatment is one of the risk factors for bilateral diabetic papillopathy.
References
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Figure 1.
Fundus photography of the both eyes. (A) At patient’s first visit, when diabetes mellitus was diagnosed, fundus photog-raphy shows dot hemorrhages. (B) 3 months after diabetes mellitus diagnosis, fundus photography shows optic disc swelling in both eyes.
Figure 2.
Optical coherence tomography, fluorescein angiography and perimetry of the both eyes and brain MRI. (A) 3 months after diabetes mellitus diagnosis, optical coherence tomography shows macular edema in right eye. C/D ratios are 0.31 in right horizon, 0.30 in right vertical, 0.39 in left horizon and 0.46 in left vertical. (B) Fluorescein angiography shows early leakage from optic disc, resulting in vaguely visible vessels at late phase. Perimetry (C) and brain MRI (D) shows no specific finding. Rt. = right; Lt. = left; R = right eye; L = left eye; MRI = magnetic resonance imaging; C/D = cup-to-disc ratio; R/D = rim-to-disc ratio.
Figure 3.
Fundus photography of the both eyes. (A) 3 weeks after diabetic papillopathy diagnosis, fundus photography shows con-tinued optic disc swelling in both eyes. (B) 9 weeks after diabetic papillopathy diagnosis, fundus photography shows slightly de-creased optic disc swelling in both eyes. (C) 18 weeks after diabetic papillopathy diagnosis, fundus photography shows distinct disc margin and arteries look like becoming sclerotic especially in left eye. (D) 26 weeks after diabetic papillopathy diagnosis, fundus photography shows nearly normal optic disc but optic discs look pale in both eyes.
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