Treatment Of NPDR Treatment of NPDR is done by: Laser photocoagulation: DF-ND YAG LASER [DF –Double Frequency] Wavelength → 1064/2 → 532nm Green laser [applied peripherally] 60-80⁰ C heat used [absorbs edema] Anti VEGF Drugs: BEVACIZUMAB RANIBIZUMAB Intra Vitreal Steroids: TRIAMCINOLONE OZURDEX [Implantable Dexamethasone] All the treatment modalities are explained along with images
Superficial VS Deep Haemorrhages Superficial Haemorrhages Deep Haemorrhages Common in Hypertensive Retinopathy Common in Diabetic Retinopathy Flame shaped Haemorrhages Dot & Blot Haemorrhages Present in Nerve fiber layer Present in Inner Nuclear layer
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Location of retinal findings in diabetic retinopathy Micro Aneurysms-Inner nuclear layer Hard Exudates-Outer Plexiform layer Soft Exudates-Nerve fiber layer Flamed shaped Hemorrhages- Nerve fiber layer Dot & Blot Hemorrhages- Inner Nuclear layer
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Diabetic Retinopathy-Types The types of Diabetic retinopathy are: NPDR Non-Proliferative Diabetic Retinopathy Age< 20 yr. PDR Proliferative Diabetic Retinopathy Age> 20 yr.
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Commonest cause of Visual loss overall → Macular Edema Commonest cause of Visual loss in NPDR → Macular Edema Commonest cause of Visual loss in PDR → Vitreous Hemorrhage
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Causes & Screening of Diabetic Retinopathy Diabetic capital of the world [WHO] → India [63 Million diabetics] Risk Factors: Duration → Most important prognostic factor Poor control of Blood glucose Hypertension Pregnancy Timing for Checkup: 5 yrs. from detection → Type 1 / IDDM Immediately from detection → Type 2 / NIDDM Then once
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Watermarks In Chronic Retinal Detachment Watermarks in chronic retinal detachment are: Hyper pigmented lines in retina caused by deposition of pigmented epithelium in chronic RD Sign of long-standing Retinal Detachment
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Exudative Retinal Detachment-Causes No hole, no break, no lattice Sign of long-standing Retinal Detachment The causes of retinal detachment include the following: Malignant Melanoma of Choroid Pregnancy induced hypertension Choroiditis Malignant HTN [ HTN + Papilledema] VKH Syndrome [ VOGT KOYANAGI HARADA SYNDROME] 1. Malignant Melanoma of Choroid Commonest tumor of eye in adult
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Corneal Ulcers → Break in the corneal epithelium with underlying necrosis of cells → Hypopyon formed due to: Accumulation of white blood cells (1st Line of defence) Steroids Contraindicated*** → Earliest symptoms → Photophobia (much before the pain starts) Pain: → Most important symptom → Extremely painful (highest density of nerve endings present) Types:
Rhegmatogenous detachment-Treatment 1. Drain the fluid 2. Close holes, lattices & tears by Photocoagulation by laser beam [60-80⁰C] Causes chorioretinal adhesions-NSL & RPE in apposition 3. In some cases, Tamponade on NSL is required Tamponade by Inj. SILICON OIL through Pars Plana Expansile gases → AIR → SF6 [Sulfur Hexa Fluoride] → C3F8 [Per
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