Diagnostic and Therapeutic Challenges

摘要

A 73-year-old Hispanic man presented with a gradual decrease in visual acuity in the left eye over 3 weeks time. He had longstanding type 2 diabetes meilitus, proliferative diabetic retinopathy, and clinically significant diabetic macular edema for which he has had both panretinal photocoagulation and focal macular laser. Cataract surgery had been performed in both eyes 4 years earlier. Severe diabetic nephropathy led to a dual renal transplant 5 years ago. Other notable medical history includes a history of hypertension, chicken pox as a child, and HIV with recent CD4 count of 166 and viral load of <75. His medications included Sustiva, abacavir, Bactrim, CellCept, Prograf, prednisone, Nor-vasc, Lotensin, and Epogen.