March 28, 2000
RE: MORALES, Pablo
Bascom Palmer Eye Instituto BPEI
DATE SEEN: 03/16/2000
I had the pleasure to see Pablo Morales in consultative evaluation within the Vitreoretinal Surgical Service of the Bascom Palmer Eye Instituto on 3/16/00. You are weil aware of the complex history of this charming young man who presentes with total hemorrhagic retinal detachment in the right eye. He has a bare light perception outcome with severe iris neovascularization and complex hemorrhagic retinal detachment. The left eye developed progressive proliferative diabetic retinopathy with severe ischemic alterations and progressive massive neovascularization. He underwent surgical management of this left eye undergoing pars plana vitrectomy, membrane peeling, and silicone oil tamponade. As you know, he had an outstanding response to surgery without complications. His vision though has been at the hand motions level and he has marked posterior segment exudative alterations. He has been evaluated in consultation with Dr. Harry Flynn. He continuas to have ocular discomfort, right eye as we have discussed and has considered the potencial for primary enucleation of the right globe. He is seen in evaluation by Dr. George Burke within the Diabetic Research Instituto. He continuas on Bacitracin, Pred Forte, Trusopt and Betagan to the right eye and Pred Forte, Trusopt and Voltaren to the left eye.
On evaluation, the visual acuity is bare light perception in the right eye, and hand motions in the left eye. lntraocular pressure is 18 and 8.
The lids and lashes show ptosis, right eye. The sciera and conjunctiva are injected, right eye. The cornea shows neovascularization with transpupillary fibrin and hemorrhagic retinal detachment stabilized posterioriy. The left eye shows the cornea to be clear. The anterior chamber is 3+ deep, without cell or fiare. The iris is flat, without rubeosis or mass.
Dilated funduscopic examination of the left eye shows a smali cup/disc ratio, good rim, coloration and perfusion. Peripheral laser photocoaquiation placed 360º is present. Diffuse macular edema with macular thickening and elevation remains stable under silicone oll tamponade. No evidence of rhegmatogenous component to this posterior detachment is noted.
My impression is that Pablo Morales presents with severe bilateral proliferative diabetic retinopathy with hand motions vision in the setting of hemorrhagic retinal detachment, with severe posterior segment ischemic alterations, right eye and hand motions vision in his fellow left eye. The left eye shows visual compromise secondary to diffuse extensiva macular edema with elevation in the setting of peripheral retinal re-approximation with excellent panretinal photocoagulation. I believe that continued follow-up is appropriate. I have suggested that decrease in macular edema associated with alterations in dialysis would be appropriate. Pablo has continued on topical Pred Forte and Voltaren. lntraocular pressures are markediy improved on follow-up. He would benefit from consideration of tapering of Trusopt medication. He wears protective eyewear at all times. He does understand the importance of face- down positioning.
Again, thank you for allowing us to assist in his care.
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