Asian Journal of Biomedical and Pharmaceutical Sciences

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Case Report - Asian Journal of Biomedical and Pharmaceutical Sciences (2022) Volume 12, Issue 90

A clinical case report of diabetic retinopathy.

Mayur Raka1, Sachin Daigavhane2*, Atul Patil2

1Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India

2Ophthalmology Department, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India

*Corresponding Author:
Sachin Daigavhane
Ophthalmology Department
Jawaharlal Nehru Medical College
Datta Meghe Institute of Medical Sciences
Sawangi (Meghe)
Wardha
India
E-mail: [email protected]

Received: 26-April-2022, Manuscript No. AABPS-22-61851; Editor assigned: 02-May-2022, PreQC No. AABPS-22-61851(PQ); Reviewed: 17-May-2022, QC No. AABPS-22-61851; Revised: 25-May-2022, Manuscript No. AABPS-22-61851(R); Published: 02-June-2022, DOI:10.35841/2249-622X.90.128

Citation: Raka M, Daigavhane S, Patil A. A clinical case report of diabetic retinopathy. Asian J Biomed Pharmaceut Sci. 2022;12(90):128

Abstract

A 55-year-old female presented at OPD with acknowledged case of diabetics, which having diminished vision in her each eye, which ended in sluggish diminution of vision Ophthalmic problems, such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, and neuropathies, are common in diabetic patients. Diabetic retinopathy, the most prevalent and likely most blinding of those sequelae, looks to be the leading cause of new blindness in adults aged twenty-five to seventy-four years in industrialized countries. Proliferative diabetic retinopathy affects around 700,000 individuals in the developed countries, with 65,000 cases occurring each year. An assessment of the prevalence of diabetic retinopathy among industrialized countries revealed a high incidence of 28.5 percent among diabetics. Intraocular pressure changed into taken via way of means of gold Mann tonometer and recorded is 16mmHg. Fundus examination demonstrated positive findings for diabetic retinopathy. A pan retinal photocoagulation surgery is done in left eye with proper management.

Keywords

Diabetic retinopathy, Diabetic mellitus, Pan retinal photocoagulation.

Introduction

Diabetic retinopathy (DR) is defined as change in the retina observed within patients suffering from diabetic mellitus. Diabetic retinopathy is correlated to a lot of both, emotional stress as well as hospital visits [1]. Diabetic retinopathy appears to be an eye disease which can result in vision loss as well as blindness in diabetics [2]. The affected person turned into being monitored for 2 intervals. It turned into at the second interim which he turned into recognized with proliferative retinopathy; in fact, the development rate from the first sign of retinopathy, which befell on the center of the primary and 2nd interim, to the factor at which the affected person diminished her vision from the left eye befell inside a year.

In this work, we introduce a brand-new component overlooked thru all of the formerly performed studies, namely, form of profession. This component which contributes to occupational stress performs a crucial position with inside the development of proliferative retinopathy. We speculate that this component can boost up the development of this sickness dramatically, even if the opposite hazard elements aren't present [3,4].

Diabetic retinopathy classified as follows

Non proliferative diabetic retinopathy (NPDR)

a. Mild NPDR

b. Moderate NPDR

c. Severe NDPR

d. Very severe NDPR

Proliferative diabetic retinopathy

a. PDR without HRCs

b. PDR with HRCs

Diabetic vasculopathy & advanced diabetic eye disease.

Above helps treating physicians understand, but it's much more important since the type of retinopathy has a big influence on therapy and prognosis [5].

Clinical approach

History

History is necessary as to incorporate every aspect from witnesses, family or from the emergency personnel if the patient is non-cooperative, unconscious, or is under the effect of alcohol or narcotics or even worse, having other life-threatening conditions. In all these situations there is requirement of prompt and time efficient actions. Types of diabetes are the most important aspect of the history, because specific processes suggest unique diseases that must be studied and treated.

As, commonly we can see that cases of diabetic retinopathy are seen in patient with uncontrolled diabetes so metabolic control of diabetes is essential. For better prognosis of DR stable blood glucose level is greater value if deranged consultation of endocrinologist. The normal value of blood glucose is fasting <120% post-prandial <180% and HbA1c (glycosylated hemoglobin) <7%. Control of dyslipidemia target lipid profile (fasting) <200 mg% cholesterol, triglycerides <150 mg% Renal function test essential to maintains serum creatine 1.0 mg% [6].

Outreach screening has the capability to growth screening insurance of high-chance diabetic retinopathy sufferers in far off and resource-negative settings, in addition to in regions in which no ophthalmologist or retina expert is available, without the chance of lacking diabetic retinopathy and stopping vision loss [7]. Decades of research into the etiology and treatment of diabetic retinopathy has transformed our understanding of the condition. Because neurodegenerative illness precedes and coexists with micro vascular alterations, diabetic retinopathy is now more correctly characterized as a neurovascular disease rather than a micro vascular disease. The intricacies of the pathways implicated in various phases of disease severity, on the other hand, continue to be a difficult challenge for drug discovery. Laser photocoagulation is currently the gold standard for treating proliferative diabetic retinopathy; however it is rapidly being phased out for diabetic macular edema.

The increased lipid level is nowadays common problem in urban areas. The life style modification is essentiality for documentation whether any protective steps taken by prone people or not. The symptoms of the patient like: thrust, polydipsia restlessness is suggestive of DM after diagnosis of it people are more prone to secondary effect like retinopathy, Cushing syndrome, Pancreatitis hemochromatosis etc. These factors overall can change the course of diagnosis as well as prognosis. For a person who has a corneal transplant earlier, the chance of getting an infection is high even with minimal power projectile. Likewise, the globe ruptures at the site of prior cataract, glaucoma, or radial keratotomy surgery in those who have had previous cataract, glaucoma, or radial keratotomy surgery.

Second, prior ocular history is critical because underlying disease may need different treatment choices following damage. The threshold for surgical rapture of retinal artery in a patient with severe glaucomatous optic neuropathy, for example, would be significantly lower than in a patient with intact optic nerves. A patient’s systemic history is also of upmost importance since it might impact treatment choices. For example, hyphemia, which is collection of blood in anterior chamber, is tackled differently for patients with sickle cell disease. Pseudoxanthoma elasticum patients, for example, almost always exhibit angioid streaks and are at a much higher probability of choroidal rupture. Other systemic disorders that can induce non-traumatic vitreous hemorrhage, one of which is diabetes mellitus, which causes diabetic retinopathy.

Anticoagulants and antiplatelet medicines in the patient's pharmacological history are significant since they will impede surgical repair. Furthermore, identifying drug allergies is essential [8]. As the only, most effective management in these types of cases is surgical management, during the system-wise evaluation, the ability of patient to endure an aesthetic and surgical repair must be evaluated. Patients who are unable to undergo surgery safely may benefit from medical management, even if the risk of losing of both eye sights is preventable, from proper management and care on such problems.

Therapeutic intervention

In ophthalmology, Inj. Intra orbital anti-VEGL (Benvacizumab1.25 mg) in right eye followed by PPV+MP+EV +SOI and GVP reduce in Right eye after anesthesia and cardiac fitness. Laser Pan retinal Photocoagulation (PRP) is done in left eye in three setting. Ophthalmologic examination showed when highest and best corrected visual acuity (BCV.A.) of 6/24 In left eye and 6/18 P right eye and that of both eyes to counting fingers (CF) at 1.5 m distance.

Follow-ups

Informed consent was taken. Patient was kept on regular follow-up. Symptomatically improvement was seen. Treatment was strictly monitored. Patient was advised about the treatment. Left eye Pan Retinal photo coagulation done and follow for second setting in seven days. Both eye prognosis and treatment explained to patient and relatives.

Case Report

A fifty-five-year-old female from bochadi presented at ophthalmology OPD on 12th Nov 2021 with complaints of diminution of vision in both eyes, patient is also known case of diabetes mellitus in the last 5 years, hypertension in the past 4 years and also history of IND 3 years ago, which resulted in diminution of vision in both eyes Progressively.

Ophthalmologic examination showed best corrected visual acuity (BCVA) of 6/24 in left eye and 6/18 in right eye that of right eye to counting fingers (CF) at 1.5 m distance. And IOP by non-contact tonometer for left eye has result 23 and right eye 19.

Fundus examination by direct ophthalmoscope revels that blot hemorrhages superior and infer nasal to optic disc in left eye and in right eye multiple dot and blot hemorrhages. The c-d ratio is 0.6. A complete ocular exam and dilated retinal exam with the aid of using an ophthalmologist, retina specialist, or retina healthcare professional is the gold standard for detecting diabetic retinopathy. Dot and blot hemorrhages: It arise as micro aneurysms rupture with inside the deeper layers of the retina, including the internal nuclear and outer flexi form layers. These seem just like micro aneurysms if they're tiny; fluorescein angiography can be wanted to differentiate among the two [9].

Flame-shaped hemorrhages: They are splinter hemorrhages that arise with inside the greater superficial nerve fiber layer. Retinal edema and tough exudates: These are because of the blood-retina barrier, demolition permitting leakage in the vessels of serum proteins, lipids, as well as proteins.

Cotton-wool spots: They are fibres of nerve layer infarcts from obstruction of precapillary arterioles. With using angiography (fluorescein), there may be no capillary perfusion. The following are often bordered with the aid of using micro aneurysms as well as vascular hyper permeability. Venous loops as well as venous beading: These often arise adjoining to regions of non-perfusion as well as reflect enlarging retinal infarction. Their incidence is the maximum large predictor of development for proliferative diabetic retinopathy [10-14].

Boat-shaped prentinal hemorrhage associated with neovascularization. New vessel formation on the surface of the retina (neovascularization elsewhere) and both dot and blot hemorrhage are visible.

Conclusion

This is a case report of proliferative type of diabetic retinopathy in left eye. A common cause of diabetic retinopathy in known history of diabetics and hypertension. To prevent such conditions the continuative in checkup is important and diagnosis and treatment, particularly within the first 3 years after positive finding to diabetics are critical for the best prognosis. Proper medication for control of sugar level and blood pressure help to reduce DR cases, patient age with more than 50 years are the most affected. In this case, we report a 55-year-old female who had both eye retinopathy with blot hemorrhage with multiples dot that was successfully treated only with left eye pan retinal photocoagulation with 2 different setting within 7 days and right eye surgery done after a consultation of cardiologist.

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