Biratnagar Eye Hospital, Biratnagar, Nepal.
Nepal J Ophthalmol. 2020 Jul;12(24):382-332. doi: 10.3126/nepjoph.v12i2.25186.
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.
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.
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.
糖尿病性视乳头病变（DP）是 1 型和 2 型糖尿病患者的一种排除性诊断，他们有短暂的视盘水肿。最初在年轻的 1 型糖尿病患者中描述为双侧疾病，症状轻微，可自发缓解。最近，由于其广泛的临床谱，DP 一直是争议的焦点。
我们描述了 3 例 DP 的变化情况。这些病例包括单侧 DP 合并增殖性糖尿病视网膜病变（PDR）和黄斑水肿（ME）、单侧 DP 合并严重非增殖性糖尿病视网膜病变（NPDR）和缺血性黄斑病变，以及双侧 DP 合并中度 NPDR 和 ME。我们还讨论了可变表现的可行治疗方法。在这个病例系列中，DP 已经在中度 NPDR、严重 NPDR 以及 PDR 中报告过。已经证明黄斑水肿和缺血形式的黄斑受累会导致视力下降。它表现为单侧和双侧病变。这些病例中观察到显著的视力丧失，需要进行干预。
DP 有广泛的表现谱，了解其知识对于做出完整的诊断至关重要。必须针对不同的表现进行个体化治疗，并向患者解释现实的治疗效果。
