DIABETIC RETINAL NEURODEGENERATION MIMICKING GLAUCOMATOUS OPTIC NEUROPATHY (CLINICAL CASE)

Abstract

The article presents a clinical case of a 57-year-old patient with a long history of type 2 diabetes mellitus (T2DM) and chronic decompensation of glycemic control. A distinctive feature of this case is the presence of pronounced diabetic retinal neurodegeneration (DRN), which, in its structural and visual characteristics, mimicked glaucomatous optic neuropathy despite normal intraocular pressure levels.
Using multimodal diagnostic methods, including optical coherence tomography (OCT), OCT angiography, and automated perimetry, diffuse symmetrical thinning of the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCL++) was identified, along with an increase in the optic disc excavation. However, the absence of sectoral defects, the preservation of the neuroretinal rim according to the ISNT rule, and the specific nature of functional changes allowed for the exclusion of glaucoma and the verification of DRN as an independent pathogenetic factor. This case emphasizes the need for a differentiated approach to interpreting OCT data in patients with long-standing diabetes to prevent the overdiagnosis of glaucoma.