A 50-year-old man presented with bilateral progressive visual loss for 5 months. Visual acuity was reduced to counting fingers in the right eye and light perception in the left. Although neovascularizations were detected in the angles of the eyes, neovascular glaucoma and rubeosis iridis were demonstrated only in the left. Fundus examination showed bilateral advanced exudative retinopathy in both eyes. Severe attenuated retinal arteries and enlarged cupping with disc pallor were observed in the left eye. Generalized eruptive xanthomas were found on the back and extremities. Extreme dyslipidemia (serum cholesterol 1,311 mg/dl and triglycerides 6,356 mg/dl) and diabetes mellitus (fasting plasma glucose 325 mg/dl and HbA1c 12.1%) were first diagnosed. The serum lipid profiles and glucose levels were dramatically decreased within a month after treatment with subcutaneous insulin injections and oral hypolipidemic agents; notwithstanding, his vision was not significantly improved, even after treatment with intravitreal anti-VEGF injection, intravitreal steroid injection and panretinal photocoagulation.
Conclusion: The principle causes of advanced exudative retinopathy are severe breakdown of the blood-retinal barrie due
to diabetes mellitus and altered retinal pigment epithelium lipid metabolism. In our patient, central retinal vascular occlusion
was also the suspected cause of neovascular glaucoma.

Keywords: Exudative retinopathy, Dyslipidemia, Neovascular glaucoma, Diabetes mellitus