Diabetic Retinopathy & Medical Retina - aioseducation

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
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