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Research Article International Ayurvedic Medical Journal ISSN:2320 5091

DIABETIC RETINOPATHY AND ITS MANAGEMENT IN AYURVEDA- A


SPECIAL CASE REPORT
Mamata Dastapure1, Veena Shekar2, Mamatha KV3, Sujathamma K4
1
M.S (Ay) final year, 2Lecturer, 3Reader, 4Professor and HOD,
Department of PG Studies in Shalakya Tantra, SKAMCH & RC, Bangalore, Karnataka, India

ABSTRACT
Diabetes Mellitus is a common metabolic disorder in which there is high blood sugar
level over a prolonged period and occurs in one of two forms: Type1 or Insulin Dependent
Diabetes Mellitus (IDDM) and Type2 or Non-Insulin Dependent Diabetes Mellitus
(NIDDM). Diabetic retinopathy is most common and serious complication of Diabetes and
changes in the retina are observed by 10 years of Diabetes history or even earlier due to mod-
ified lifestyle in present era. This disease results in generalized macro and micro vascular
complications linked to glycaemic control and affect theses resulting in poor vision or even
blindness. Despite of better understanding of its pathogenesis, satisfactory treatment is yet to
be established. Ayurveda is well recognized for its role in preventing the disease, but as such
no description is available in text which clarifies the progression of Prameha to loss of vi-
sion. So Ayurvedic treatment purely lies on the basis to pacify the pathological changes which
occurs in eye as a result of diabetes according to modern parameters. This case presentation
reviews the Pathophysiology of diabetic retinopathy with a view to understand therapeutic
target and discusses the possible role of Ayurveda in its management.
Keywords: Diabetic Retinopathy, Diabetic Mellitus, Exudates, Hemorrhages

INTRODUCTION
PRESENTATION: A moderately fications. His sugar level was not under
built male patient aged 40 years came to control during this presentation and his
ShalakyaTantra OPD of SKAMCH & RC HbA1c was found to be 12.8%. During
with chief complaint of blurred vision. The this phase his blood pressure was said to
Patient’s medical history was significant be raised.
for Diabetes mellitus for 11 years without TREATMENT HISTORY: On
any visual complaints till 6 months. consulting an ophthalmologist it was told
COMPLAINT HISTORY: About that retina is damaged in right eye which
6 months back the patient suddenly devel- was diagnosed as Proliferative Diabetic
oped dragging sensation in the right eye in Retinopathy and cannot be corrected. In
his work place and thus he relaxed for left eye haemorrhages were observed in
about 10 minutes. Later experienced retina for which LASER was done to stop
blurred vision in both the eyes and through the bleeding. Patient underwent LASER
the right eye, the objects appeared to be surgery pan retinal photocoagulation
completely red from lateral side. On gaz- (PRP) in 3 sittings for Left eye but vision
ing straight he was not able to perceive remained same after one and a half month.
light and was unable for any sort of identi- Due to this when the patient consulted an-
Mamata Dastapure at al: Diabetic Retinopathy And Its Management In Ayurveda- A Special Case Report

other ophthalmologist he was diagnosed tachment to disc and nasal Tractional reti-
cataract in left eye and lens extraction nal detachment (TRD) with Haemorrhages
(Phacoemulsification) was done. Even and Exudates.
after the surgery for cataract vision im- EXAMINATION
provement was not appreciated. Visual Acuity For Distant Vision
Apart from this he was also diag- BE – CF (1/2 Metre distance)
nosed as Hypertensive, for which he was RE – On gazing, bright light perception
advised medications. For Diabetes the pa- LE – CF (1/2Metre distance)
tient was taking oral hypoglycaemic agents Test For Color Vision: Ishihara Color
(OHA) and from past 2 years he was on Plates
Insulin. Patient could identify the color of book
His familial history revealed mother was which is black in color and couldn’t identi-
known case of Diabetes mellitus. fy the colored patterns and numbers in the
INVESTIGATIONS: B-scan was plates.
advised prior to the treatment. The impres- TABLE NO. 1: CONFRONTATION
sion in the Right eye showed the total pos- TEST
terior vitreous detachment (PVD) with at-
OCULAR EX- RIGHT EYE LEFT EYE NORMAL VALUES IN
AMINATION DEGREES
Above Not appreciable Not appreciable 50 degree
Below Not appreciable Not appreciable 70 degree
Medial Till 10degree Till degree HM+ve 60 degree
(Nasal side) HM+ve
Lateral Till 20degree Till 20degree HM+ve 90 degree
(temporal side) HM+ve
TABLE NO. 2 : EXTERNAL OCULAR EXAMINATION
STRUCTURE RIGHT EYE LEFT EYE
Conjunctiva No abnormalities No abnormalities
Cornea Sensitivity-Diminished Sensitivity-Normal
Lens Opaque, in centre Pseudophakia, IOL in situ
Pupil Normal Normal
FUNDOSCOPIC EXAMINATION:
TABLE NO. 3: DIRECT OPTHALMOSCOPY
RIGHT EYE LEFT EYE
MEDIA Not clear Clear
FUNDUS Not clear Tractional bands, venous looping and beading
neovascularisation at disc (NVD)
VESSELS Not clear Haemorrhages + ++
MACULA Not appreciated Not appreciated
OPTIC DISC Not appreciated NVD

TABLE NO. 4: INDIRECT OPTHALMOSCOPY


RIGHT EYE LEFT EYE

www.iamj.in IAMJ: Volume 3; Issue 8; August- 2015


Mamata Dastapure at al: Diabetic Retinopathy And Its Management In Ayurveda- A Special Case Report

Neovascularisation at disc, Pale Tractional bands, Neo vascularisation at


fundus, Tractional retinal disc,Retinal haemorrhages, Tortous vessels,
bands seen diffused LASER scars seen
TABLE NO. 5: SLITLAMPBIOMICROSCOPY
RIGHT EYE LEFT EYE

2ND Grade Nuclear SCLEROSIS IOL Present


INVESTIGATIONS: Internally Patient was advised with:
 B-Scan  Vasa Guluchyadi Kwatha
 Blood Test  Amruttotaram Kwatha
TREATMENT COURSE AT THE  Tab. Arogya Vardini8
HOSPITAL: The patient was admitted in  Tab. Saptamrutam Louha9
the hospital for a period of 40 days with an During the course of the Treatment
interval of 10 days in between, the follow- Blood Sugars were monitored regularly
ing treatment was employed: which varied between 64mg/dl to
 Amapachana with Trikatuchurna1 123mg/dl. Patient was advised to take in-
 Snehapana with Guggulutiktaka ghri- sulin only when GRBS>200mg/dl but was
ta2 asked to continue his OHA (Oral Hypo-
 Sarvangaabhyanga with Dhanvanta- glycemic Agent).
ram Taila3 followed by bashpa sweda PROSPECTUS AT THE TIME OF
 Virechana with Avipattikarachurna4 DISCHARGE:
After Samsarjana Krama, Madhuthailika  Was able to identify whether the per-
Kala basti5 was administered: son is wearing spectacles or not
 Anuvasana Basti with- Murchita Taila whereas he was not able to do before.
and Maha Triphala Ghrita  Was differentiating the borders on the
 Niruha Basti with- Saindhava, Madhu, floor.
Murchita Taila, Maha Triphala Ghrita,  Could walk confidently without any
Eranda moola kwatha, Yashtimadhu support.
kwatha and Mishreya churna.  Could identify the primary colours like
After Basti Karma the following Kriya red and maroon confidently.
Kalpas and Sthanika upakramas were per-  Blood sugar was under control
formed: throughout the course and HbA1c was
 Netra bandha with Kadalikandha 6.6% at the time of discharge.
 Padabhyanga with Ksheerabala taila6 FOLLOW-UP: During the subsequent
 Netra seka with kwatha of Triphala, follow-ups clarity of vision had improved
Yastimadhu, Lodra and Musta in the right eye and blood sugar was well
 Bidalaka with Triphalachoorna and under control without Insulin.
Rasanjana
 Shirodhara (Takradhara) with vasa- DISCUSSION
guduchyadikwatha There is a common etiological factor
 Tarpana with Mahatriphala ghrita7 for Timira and Prameha. Nidana Sevana
 Prasadana Putapaka of Ajamamsa, like amla rasa, sukta-aranala, maasha,
Yastimadhu, Triphala, Dadima, Khar- vegadharana, swapnaviparyaya10 are
jura, Draksha, Kamala Pushpa. achakshushya factors in Prameha which
www.iamj.in IAMJ: Volume 3; Issue 8; August- 2015
Mamata Dastapure at al: Diabetic Retinopathy And Its Management In Ayurveda- A Special Case Report

leads to Timira samprapti11. retinal tissue in an attempt to revascu-


ने िज वा वणोपदे ह by Astanga
told larise hypoxic retina.
 Further causing siragranthi can be jus-
Sangrahakara and Charakacharya in
tified to formation of aneurysms where
Pramehasamprapti and Prameha purva-
there will be localised saccular out-
roopa respectively, which clearly indicates
pouchings due to physical weakening
involvement of vital organs like Netra. Di-
of the retinal vessels.
abetic Retinopathy is silent disorder as the
patient will not realize the condition until  The utkleshana of doshas in srotas due
he experiences blurred vision. Timira is to srotorodha deranges the vasculature
important disease one among the and permeability of retinal vessels
drishtigata rogas, which means darkness / causing srotoabhisyanda and giving
increased dampness (kleda) in the eye. rise to hard exudates.
Prameha is a kapha dominant disease and  Due to increased kapha and kleda in
the major sampraptighataka is kleda Prameha it incresaes sara guna and
which contributes to upadrava rogas. drava guna of pitta and rakta in srotas
Timira explained based on different dosha and also the abhisyandi srotas causes
predominance can be compared to DR and leakage of the blood vessels causing
can be termed as Madhumehajanya Timira dot and blot haemorrhages, which sim-
and in this patient as it was a advanced ulates raktapitta samprapti.
stage Chaturtha patalagata Timira treat-  The srotorodha in siras resulting in
ment was employed. agnimandya at the level of dhatwagni
 Tejo guna dominated by Pitta dosha in and bhutagni causes lack of circulation
netra will always have fear from kapha of pitta and rakta in those areas where
dosha. The combination of kleda and there will best shanika pandu lakshana
kapha in Prameha, through pratiloma- which represents as cotton wool spots
gati of vyana vayu and rasavahinis of the ischaemic area of the retinal
reaches netra and stimulate the process nerve fibre layer.
of srotorodha in sukshma raktavahi The treatment planned in this pa-
srotases which can be correlated to mi- tient possessed properties like madhume-
crovascular occlusion due to loss of hahara properties, shothagna properties,
pericytes and thickening of basement shonitasthapana, ropana, kaphanisaraka,
membrane causes occlusion (Capil- raktaprasadana, srotodushtinirharana,
laropathy). Deformation of erythro- chakshushyaand balya properties.
cytes and rouleaux formation, in- The drugs used for the bahya and
creased plateletsstickiness and aggre- abhyantara chikitsa had content of tannins
gation of platelets (Haematological which are astringent in nature help to re-
changes) causes endothelial cell dam- duce the exudates and haemorrhages, Fla-
age12. vonoids a remarkable group of phytonutri-
 Subsequently due to srotorodha their ents have good effect on permeability of
causes atipravritti of utkleshitadoshas vascular capillaries and inhibiting hard ex-
which can be neovascularisations udates and are also antioxidants. They help
caused by vasoformative substances to improve circulation in the retina by re-
(growth factors) elaborated by hypoxic ducing microvascular and capillary block-
ages. The alkaloids contains oxygen and
www.iamj.in IAMJ: Volume 3; Issue 8; August- 2015
Mamata Dastapure at al: Diabetic Retinopathy And Its Management In Ayurveda- A Special Case Report

sulphur which are bitter in taste helps to in blurring of vision. All these can be
oxygenate vessels there by reducing local- combated with the efforts of Ayurvedic
ised ischaemia and endothelial cell dam- treatment modalities.
age. Saponins are immune stimulants, kills As a prophylactic treatment a proper
protozoans and mollusces and are antioxi- screening of patients by chakshu
dants causes hypoglycaemia. The antioxi- visharada's at regular interval with proper
dant property of most of the drugs scav- intervention of kriyakalpa, life style modi-
enges free radicals and releases prostacy- fication, pathyapathya along with oral
clin from the endothelium which releases medicines at appropriate time will definite-
the blockages and inhibits platelet aggre- ly retard the progression of the disease and
gation. Triphala used in all the combina- maintains the retinal function.
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www.iamj.in IAMJ: Volume 3; Issue 8; August- 2015
Mamata Dastapure at al: Diabetic Retinopathy And Its Management In Ayurveda- A Special Case Report

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Part-2. CORRESPONDING AUTHOR
11. Sushruta, Sushruta Samhita – by Dr. Mamata Dastapure
Acharya Kaviraja Ambikadutta Shas- Email: mamatad10@gmail.com
tri, Chaukamba Sanskrit Sansthan Va-

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