Retina what are your concerns

Somdutt Prasad MS FRCSEd FRCOphth FACS

Consultant Ophthalmologist
I4vison, 13 A, Jatin Bagchi Road, Kolkata 70029
AMRI Medical Centre, 97 A, Kolkata 700029
Divyadrishti, Howrah
Westbank Hospital, Andul Road, Howrah

sprasad@rcsed.ac.uk

098 30 50 7754

UK Training
Dorchester Rick Powell 1994
Swindon Paul McCormack 1995
Oxford 1996 Paul Rosen & Hung Cheng
Wirral Russell P Phillips -1997-1999
Sheffield Prof Ian Rennie, John Talbot,
James West 2000-2001

MS Kolkata 1993
FRCS Edinburgh 1994
CCST - 2001
FRCOphth (London) 2006
FACS American College of Surgeons 2008
AAO Achievement Award 2008
AAO International Education Award 2009
ASCRS Film Festival Award 2010
ASRS Honors Award 2013

The Retinal Surgeon - 1995

Is your retina detached?
Do you have a cataract?
No!
What are you doing in my clinic?

DIABETIC VITRECTOMY

What do I do?
Medical Retina
Vitreo-retinal surgery
Cataract surgery
Premium IOLs
Toric IOLs
Multifocal IOLs

Diabetes
1550 BC - Ebers Papyrus of ancient
Egypt
too great emptying of urine
the river Nile between the thighs

Remedies recommended
diet of wheat grains, grapes, honey
and berries
Papyrus discovered - Luxor 1872
George Maurice Ebers

Diabetes
17.1 crores worldwide
India 2000 3.17 crores
36.6 crores in 2030
Maximum increase in India
7.94 crores India
4.23 crores China

Behaviour & Environment

Vital Function %

100

Good

Bad

0
Failure

25

50

75

Life Expectancy of Function (Years)

100

India
One Ophthalmologist / 1 lakh
population
UK 2.3 Ophthalmologists / 1 lakh
population

70% + specialists - Urban

70% + population - Rural

Diabetic Retinopathy Classification

Background

Preproliferative

Maculopathy

Proliferative
Advanced Diabetic Eye Disease
The commonest cause of decreased visual acuity due to
diabetic retinopathy is maculopathy

Examination
Slit lamp
External exam
Pressure measurements
Fundus examination

Retinal Examination
Direct Ophthalmoscope
small field
2 D view
Uniocular

11 November 1998

Retinal Examination (2)

Slit lamp biomicroscopy
Large field
3 D view
Binocular

Binocular indirect ophthalmoscope

Retinal Examination
Fundus photography
Large field
Can be done by technician

Laser treatment for diabetic

retinopathy is effective.

Diabetic maculopathy

Diabetic maculopathy
12% of treated eyes developed
moderate visual loss in spite of
treatment
Less than 3% of treated eyes
improved VA significantly (15
ETDRS letters)

Intra vitreal triamcinolone

IVTA

Personal experience10+ years

Pre 6/60

d
5

s
y
a
Post 6/9

Case 2
Pre RE 6/36

Pre LE 6/60

Post RE 6/9

Post LE 6/12

Steroids
Triamcinolone
Pseudophakic eyes
Resistant cases

Dexamethasone
Ozurdex

Fluocinolone Acetonide
Iluvien, Retisert

Sustained Delivery Fluocinolone Acetonide Vitreous

Inserts Provide Benefit for at Least 3 Years in
Patients with Diabetic Macular Edema
Peter A. Campochiaro, MD, David M. Brown, MD, Andrew Pearson, MD,
Sanford Chen, MD, David Boyer, MD, Jose Ruiz-Moreno, MD, Bruce
Garretson, MD, Amod Gupta, MD, Seenu M. Hariprasad, MD, Clare Bailey,
MD, Elias Reichel, MD, Gisele Soubrane, MD, Barry Kapik, MS, Kathleen
Billman, BS, Frances E. Kane, PhD, Kenneth Green, PhD
Ophthalmology
Volume 119, Issue 10, Pages 2125-2132 (October 2012)

Copyright 2012 American Academy of Ophthalmology Terms and Conditions

Figure 5

Ophthalmology 2012 119, 2125-2132DOI: (10.1016/j.ophtha.2012.04.030)

Copyright 2012 American Academy of Ophthalmology Terms and Conditions

Ranibizumab
9 RCTS in DME

READ-2
REVEAL
RESOLVE
RESTORE
RISE & RIDE
DRCRN trial
2 years 10 letters gain in BCVA
No difference between
Ranibizumab + prompt laser (deferred laser
worse)
Laser alone

Bevacizumab
8 RCTS in DME
BOLT Avastin vs Laser
N=80, two years
iVB +8.6 letters
Laser -0.5 letters

Key points
Laser therapy = standard of care
non-center-involving oedema
DME without decreased VA

anti-VEGF treatment standard in

center-involving DME and
VA of 6/9 or worse

Ranibizumab injections
monthly for 3 visits,
then as needed depending on VA (with
or without OCT) stability

somduttprasad@gmail.com 09830507754