Lipid-rich vitreous hemorrhage associated with lipemia retinalis in a young patient with proliferative diabetic retinopathy

BACKGROUND: To report a rare case of coexisting lipemia retinalis and proliferative diabetic retinopathy in a young patient, complicated by chylous vitreous hemorrhage. CASE PRESENTATION: A 22-year-old female with a 10-year history of type 2 diabetes mellitus and hyperlipidemia presented with progressive bilateral vision loss over two weeks. Visual acuity was counting fingers at 20 cm in the right eye and 20/63 in the left eye. Fundus examination revealed creamy-white retinal vessels in both eyes and yellow-white, lipid-rich material in the right vitreous cavity, consistent with lipemia retinalis and vitreous hemorrhage. Laboratory testing demonstrated severe hypertriglyceridemia. After systemic lipid-lowering therapy, the appearance of the retinal vessels returned to normal, but visual impairment persisted. The patient subsequently underwent pars plana vitrectomy in the right eye and received bilateral intravitreal anti-vascular endothelial growth factor injections. At the five-month follow-up, visual acuity improved to 20/20 in the right eye and 20/25 in the left eye. CONCLUSIONS: Lipemia retinalis reflects severe disturbances in lipid metabolism. Early metabolic control and individualized ophthalmic management are essential to optimize visual outcomes.