Variable presentation of diabetic papillopathy and treatment dilemma- A case series.

INTRODUCTION: Diabetic papillopathy (DP) is a diagnosis of exclusion in type 1 and type 2 diabetics with transient disc edema. It was initially described in young patients with type1 diabetes mellitus (DM) as a bilateral disease with minimal visual symptoms which resolved spontaneously. Lately, DP has been a focus of controversy because of its wide clinical spectrum. CASES: We describe three variable cases of DP. These are unilateral DP with Proliferative Diabetic Retinopathy (PDR) with macular edema (ME), unilateral DP with severe Non Proliferative Diabetic Retinopathy (NPDR) with ischemic maculopathy and a case of bilateral DP with Moderate NPDR with ME. We also discuss viable treatment for the variable presentation. DP has been reported in this case series in moderate NPDR, severe NPDR as well as PDR. Macular involvement in the form of macular edema as well as ischemia has been demonstrated to result in diminution of vision. It shows both unilateral and bilateral presentation. Remarkable visual loss seen, in these cases, call for intervention. CONCLUSIONS: DP has a wide spectrum of presentation and its knowledge is eminent to make a complete diagnosis. Individualisation of treatment has to be done for variable presentation and realistic outcomes should be explained to the patients.

Inverted temporal internal limiting membrane flap technique for chronic large traumatic macular hole.

Various modifications of surgical techniques and surgical adjuncts are adopted with standard pars plana vitrectomy (PPV) to improve the outcome of traumatic macular hole (TMH) surgeries. We describe a successful closure of a chronic large TMH of three years duration with inverted temporal internal limiting membrane (ILM) flap technique. A 36-year-old male patient had an optical coherence tomography (OCT) documented chronic macular hole (MH) for three years following blunt trauma. Fundus examination also showed choroidal rupture scar temporal to fovea. The minimum MH diameter was 769 µ and the basal diameter 1431 µ in OCT. Standard PPV with inverted temporal ILM flap and gas tamponade was done. The postoperative period was uneventful. The best corrected visual acuity improved from 6/60 preoperatively to 6/18 six months postoperatively, and OCT showed a closed MH with anatomical type 1 closure. This case highlights that the inverted temporal ILM flap technique is a safe and effective technique for patients with even chronic and large TMH.