Diabetic colour & ffa 11 4-2010

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Dr. Anand Sudhalkar

Assessment of diabetic retinopathy by FFA to plan the precise treatment.

Health & Medicine

Dr. Anand Sudhalkar, Baroda Diabetic Maculopathy Dr. Anand Sudhalkar

Dr. Anand Sudhalkar, Baroda Major cause of blindness FOVEAL INVOLVEMENT Macular Edema Hemorrhage Exudates Ischemia

Dr. Anand Sudhalkar, Baroda Macular Edema Retinal Thickening

Dr. Anand Sudhalkar, Baroda Macular Exudation Foveal Dot Exudates

Dr. Anand Sudhalkar, Baroda Macular Exudation Circinate

Dr. Anand Sudhalkar, Baroda Massive exudates

Dr. Anand Sudhalkar, Baroda Macular Hemorrhage

Dr. Anand Sudhalkar, Baroda Ischemia FAZ Enlargement

Dr. Anand Sudhalkar, Baroda Diagnosis Vision testing : Best Corrected VA, . Rule out CATARACT Amsler Chart, Macular fields Indirect Ophthalmoscopy 90 D biomicroscopy FFA

Dr. Anand Sudhalkar, Baroda Macular Fields

Dr. Anand Sudhalkar, Baroda FLUORESCEIN ANGIOGRAPHY

Dr. Anand Sudhalkar, Baroda Microaneurysms

Dr. Anand Sudhalkar, Baroda Types of Macular Oedema Focal: M.A., High MW lipoproteins, Hard exudates, Circinate patterns. 7

Dr. Anand Sudhalkar, Baroda Types of Macular Oedema Diffuse : Capillary bed leakage, Low MW watery fluid, cystoid spaces, Bilaterality - Systemic causes, HT, Renal Failure, Hypoprotein ,[object Object],[object Object]

Dr. Anand Sudhalkar, Baroda FFA Reveals NVE

Dr. Anand Sudhalkar, Baroda Treatment Options Medical Management : Control of Diabetes, HT, Renal failure, anaemia, hypoprotemia, pregnancy, carotid artery diseases Laser Photocoagulation : Patz 1973, British Multicenter Trial 1975, Blankenship 1979, Olk 1986, ETDRS 1985 (ongoing)

Dr. Anand Sudhalkar, Baroda ETDRS Multicentric Trial Treated 754, Deferred 1490 After 3 yr. visual loss 12% in treated, 24% in untreated. When centre of macula was involved, treatment effect was more significant at 3 yr.. Visual loss 13% against 33%

Dr. Anand Sudhalkar, Baroda Treatment Protocol FFA to identify microaneurysms /capillary leakage & dropouts Focal / grid laser Follow-ups 3 to 6 weekly Repeat FFA & Additional laser if required

Dr. Anand Sudhalkar, Baroda Principles of Management : Laser delivery Enlarged & Steady View Slit-Lamp Magnification

Dr. Anand Sudhalkar, Baroda Focal Oedema : Focal Laser Identify Culprit M.A. by FFA Identify Centre of Fovea Green Wave, Mainster lens, Short duration, 100um size, minimum treatment Be OnTarget

Dr. Anand Sudhalkar, Baroda FFA IN REPEAT TREATMENTS

Dr. Anand Sudhalkar, Baroda Grid for Diffuse Edema

Dr. Anand Sudhalkar, Baroda Thank You all for patient hearing

Dr. Anand Sudhalkar, Baroda Leaking Microaneurysms

Dr. Anand Sudhalkar, Baroda FFA Progress

Dr. Anand Sudhalkar, Baroda PDR POST TREATMENT

Dr. Anand Sudhalkar, Baroda Progress of NVE

Dr. Anand Sudhalkar, Baroda FFA Reveals Venous Beading

Dr. Anand Sudhalkar, Baroda FFA in Dense VH

Dr. Anand Sudhalkar, Baroda Compare colour picture with FFA

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Title: Choosing amongst current modalities to manage Diabetic Retinopathy At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore Objective: 1. To review the current management options for DR 2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore. 3. Discussion on future Trends in management of DR. Synopsis: Diabetic retinopathy is the leading cause of new blindness in the world, Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other. Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options. Dr. Zia ul Mazhry FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK) Asstt Professor Central Park Medical College Lahore. Consultant Eye Surgeon and Head of Eye Department Wapda Teaching Hospital Complex 210 Feroz Pur Road Lahore. Website: www.EyeAcuity.com mazhry@yahoo.com 03004401151

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