Diabetic Retinopathy & Medical Retina - aioseducation

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Diabetic Retinopathy and Medical Retina Free Papers 27. Wessing R. Changing concept of central serous retinopathy and its treatment. Trans Am Acad Otolaryngol 1973;77:275-80. 28. Yamada K, Hayasaka S, Setogawa T. Fluorescein– angiographic patterns in patients with central serous chorioretinopathy at the initial visit. Ophthalmologica 1992;205: 69–76. 29. Gass JDM. Stereoscopic atlas of macular diseases; diagnosis and treatment (4thedn), St Louis: Mosby, Mosby. 1997;52–70. 30. Ojima Y, Tsujikawa A, Hangai M, et. al. Retinal sensitivity measured with microperimeter 1 after resolution of central serous chorioretinopathy. Am J Ophthalmol. 2008;146:77-84. 31. Puliafito CA, Hee MR, Lin CP et. al. Imaging of macular diseases with optical coherence tomography. Ophthalmology 1995;102:217–29. 32. Hee MR, Puliafito CA, Wong C et. al. Optical coherence tomography of central serous chorioretinopathy. Am J. ophthalmol 1995;120:65-74. 33. Hayashi K, Hasegawa Y, Tokoro T. Indocyanine green angiography of central serous chorioretinopathy. Int Ophthalmol 1986;9:37–41. 34. Lida T, Kishi S, Hagimura N, Shimizu K. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy. Retina 1999;19:508–12. 35. Piccolino FC, Borgia L. Central serous chorioretinopathy and indocyanine green angiography. Retina 1994;14:231-42. 36. Scheider A, Nasemann JE, Lund OE. Fluorescein and indocyanine green angiographies of central serous choroidopathy by scanning laser ophthalmoscopy. Am J. Ophthalmol 1993;115:50–6. 37. Bujarborua D, Nagpal PN. CSR–Idiopathic central serous chorioretinopathy. Jaypee brothers 2005. Comprehensive Modern Classification of Diabetic Retinopathy Dr. A.K. Dubey, Dr. Benu Dubey Present management of diabetic retinopathy is largely based on DRS , ETDRS and DRVS. The present system most commonly followed for classifying diabetic retinopathy is modified ETDRS classification. This is an exhaustive classification based on a large multi centric study. However this study was conducted when our understanding of relationship between diabetes mellitus and diabetic retinopathy was different than present, and also tools like OCT and intra vitreal drugs such as anti VEGF and steroids were not available. Our understanding towards indications for surgical treatment was also not so refined. We present an extended classification which includes the alteration 861
70th AIOC Proceedings, Cochin 2012 caused in the course of diabetic retinopathy with use of intra vitreal drugs and also the helpful information given by OCT. MATERIALS AND METHODS A total of 1500 cases of diabetic retinopathy of varying presentations and severity treated between 2002 to 2009 were studied. The study included detailed analysis of clinical features, outcome of non surgical and surgical treatment and also alteration caused in the course of both surgically and non surgically treatable cases by intra vitreal anti VEGF and steroid drugs. Manifestations in the vitreous with and without active proliferative or non proliferative diabetic retinopathy were studied in particular with the help of OCT. All cases were subjected to careful history taking including duration of diabetes, type of diabetes, other systemic association such as hyper tension or renal pathology and also any ocular surgery or concurrent ocular disease. Detailed ocular examination included indirect opthalmoscopy, macular examination with three mirror contact lens /90D lens, FFA and OCT. Treatment methods included laser photocoagulation of varying ranges with 532 green laser or 810 red diode laser. Diode laser was preferentially used for cases with lenticular opacities. Cases requiring vitreous surgery were subjected to pars plana vitrectomy with suitable endo laser and tamponade as needed. RESULTS We observed incidence of PDR was significantly high in type 1 DM and was observed to increase with duration. PDR with or without CSME was most common in the age group of 40 to 60 years. Indications for vitreo retinal surgery were more common in type 1 DM. We further observed that about 28% of the cases required vitreous surgery despite complete regression of the neovascular process after PRP. The main indications were recurrent vitreous haemorrhage, traction retinal detachment, taut posterior hyaloids, combined retinal detachment. Another 12% of cases diagnosed as CSME required vitreous surgery for indications of traction over the macula diagnosed as traction macular edema with the help of OCT and showing no vascular lesions on FFA. DISCUSSION Review of literature indicates that diabetes mellitus can induce changes in vitreous before any vasculpathy. These changes are mainly in the form of liquefaction and partial detachment of vitreous. This explains why it is possible to have traction macular edema in non proliferative diabetic retinopathy without any new vessels. Proliferation of new vessels can result 862
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