AYURVEDIC APPROACH ON CYSTOID MACULAR OEDEMA - A CASE REPORT

Cystoid Macular Oedema or CME is a painless disorder that affects the central retina or macula. It refers to the accumulation of fluid in the outer plexiform and inner nuclear layer of the retina with the formation of a fluid-filled cyst. The primary symptom of macular oedema is blurry or wavy vision near or in the centre of your field of vision. Materials and Methods: A male patient of 48 yrs. presented in Shalakya OPD of GAMC Bengaluru with symp- toms of diminished vision in his right eye for one year. The patient was diagnosed with cystoid macular oedema in the right eye for which he was given photocoagulation therapy but did not find much relief. So, he approached our OPD. After thorough examination patient was started with Ayurvedic Medicines. Result: The subject showed marked improvement both subjectively and objectively. Discussion: Oedema which is the terminus of the pathology in this condition has to be understood as Ekanga Shopha. Though Kapha is the predominant dosha involved in forming Shopha here, the lakshanas manifesting are that of Vataja Timira. So, in this case study, Kapha Vata Hara followed by Shopha Hara line of treatment is adopted. Keywords: Cystoid macular oedema, Shopha, Vataja Timira, Nasya, Punarnavadi Kashaya.

Early Photocoagulation for Diabetic Retinopathy

The Early Treatment Diabetic Retinopathy Study (ETDRS) was a randomized clinical trial involving nearly four thousand diabetic patients with early proliferative retinopathy, moderate to severe nonproliferative retinopathy, and/or diabetic macular edema in each eye. This paper (ETDRS report number 9) examined the question of when in the course of diabetic retinopathy it is most effective to initiate photocoagulation therapy. Based on the study findings, the authors recommended that panretinal scatter photocoagulation not be carried out in eyes with mild or moderate nonproliferative diabetic retinopathy; when retinopathy is more severe, however, panretinal scatter photocoagulation usually should not be delayed if the eye has reached the high-risk proliferative stage. Focal treatment should be considered for eyes with macular edema that involves or threatens the center of the macula, preferably before scatter photocoagulation for high-risk proliferative retinopathy becomes urgent.

Laser treatment of twin-to-twin transfusion syndrome (TTTS): preliminary findings from a tertiary center in Greece

Background: Twin- to-twin transfusion syndrome (TTTS) affects approximately 15% of monochorionic twin pregnancies with an estimated incidence of 1 in 1,600 pregnancies. The gold standard of care is considered to be Fetoscopic Laser Photocoagulation Therapy (FLPT). Objective: To present our experience with FLPT in a preliminary prospective observational study. Materials and methods: Fourteen patients who underwent FLPT in the Fetal Maternal Medicine Unit of Attikon University Hospital, between January 2017 and August 2018. Fetoscopic laser photocoagulation was offered to all patients with pregnancies complicated by TTTS (Quintero stage >2), before the completion of 26 weeks of gestation. Results: The mean gestational age at diagnosis was 22.2 ± 2.6 weeks, at surgery 23.1±1.9 weeks and at birth 29.8±3.3 weeks. Mean interval from surgery to delivery was 6.6±3.1 weeks and mean neonatal birthweight was 1426±408 grams. Mean recipient’s weight at delivery was 1652±283gr, whereas mean donor’s weight at delivery was 1299 ± 402gr. Concerning fetal viability, ten (71,4%) donor fetuses survived to full term whereas 4 (28,6%) donor fetuses died in utero. The survival rate of recipient fetuses reached 85,7% which is very good according to the literature. In total 22 fetuses (78,6%) were alive at birth and survived the first 6 months of life and in 6 cases an intrauterine demise occurred (21,4%). In 10 pregnancies (71,4%) both fetuses survived, in 2 (14,3%) both died and in 12 pregnancies (85,7%) there was at least one survivor. Conclusion: These preliminary results support the use of FPLT in Greece as the percentage of live neonates that was reached is comparable to those published in larger studies in the international literature. We are confident that with increasing experience and new instrumentation, these results will become even better and this service will accept more cases all over Greece.

Screening, Follow-up and Treatment Algorithm in Diabetic Retinopathy and Maculopathy

Diabetic retinopathy will be one of the most important public health problems of the coming years with the rapid increase in the incidence of diabetes worldwide. Diagnosis and progress in treatment are being studied to address both the clinical and socioeconomic implications of this difficult situation. As a result of recent intensive clinical investigations, anti-VEGF treatment has taken its place as the first option while laser photocoagulation therapy is no longer recommended as primary treatment in the treatment of diabetic macular edema (DME). Steroids continue to maintain their place in the treatment of chronic persistent DME. In addition to the paradigm shift in treatment methods, there has also been great progress in diagnostic methods. In this article, the diagnostic and follow-up algorithm in DME and diabetic retinopathy was prepared in light of current literature.