Treatment of foveal neovascularization in a patient with type 1 diabetes

A man in his 30s with type 1 diabetes presented with bilateral, high-risk, proliferative diabetic retinopathy and previously had received panretinal photocoagulation. Visual acuity was 20/25 OD and 20/30 OS. Fluorescein angiography demonstrated extensive, multifocal areas of retinal capillary nonperfusion extending into the macular region and multiple areas of neovascularization elsewhere in the posterior pole and midperiphery. In the left eye, foveal retinal neovascularization was identified arising from the margins of an enlarged, irregular foveal avascular zone (Figure). He received additional panretinal photocoagulation in both eyes and received 3 intravitreal injections of bevacizumab, 1.25 mg/0.05 mL, before regression of neovascularization was achieved. Visual acuity was 20/20 OD and 20/25 OS 8 months after the most recent intravitreal injection. Previous case reports described foveal retinal neovascularization and its association with macular capillary nonperfusion,1,2 decreased choroidal perfusion,3,4 and regression with panretinal photocoagulation.1,3,5,6