Featureless retina in diabetic retinopathy: Clinical and fluorescein angiographic profile

PURPOSE: “Featureless retina” (FLR) has been only briefly mentioned in textbooks; this deceptively benign appearance of diabetic retinopathy (DR) merits a detailed description. Here we report the clinical profile, diagnosis, and management of FLR. METHODS: The case records of consecutive type 2 diabetic patients clinically diagnosed as FLR were reviewed. The case selection was based on suggestive signs (white thread-like arterioles and atrophic retina), asymmetric presentation of DR, and fluorescein angiographic (FA) demonstration of retinal capillary nonperfusion (CNP) with/without proliferative disease (PDR). Panretinal photocoagulation (PRP) was performed as needed. The extent of CNP was correlated with diabetic macular ischemia (DMI) and neovascularization on FA, and DMI was correlated with best-corrected visual acuity using Pearson Chi-square test (P < 0.05). IBM SPSS Statistics 26 was used for analysis. RESULTS: Out of 46 patients, 21 (46%) patients had bilateral and 25 (54%) had unilateral involvement (67 eyes with FLR). PDR was clinically discernible in two (3%) eyes; 65 (97%) eyes had clinical features of mild-moderate NPDR. However, FA revealed extensive CNP areas in 49 (73%) and PDR in 59 (88%) eyes. DMI was found in 83% of the eyes which had best-corrected visual acuity <6/12; this association was statistically significant (P = 0.024). Fifty-seven (85%) eyes underwent panretinal photocoagulation (PRP) for extensive CNP or PDR. CONCLUSION: Behind the mild-moderate clinical profile of FLR lay extensive CNP and PDR, which were unmasked by FA, with a complete overhaul of the treatment and follow-up.