Ayurvedic Management Of Non- Proliferative Diabetic Retinopathy And Diabetic Macular Edema- A Case Report

Abstract

Non-Proliferative Diabetic Retinopathy (NPDR) is silent microvascular damage of retina developed as the complication of diabetes mellitus. Diabetic Macular Oedema (DME) happens by the accumulation of fluid in macula causing swelling and it can occur at any course during the progression of diabetic retinopathy. This results in distorted visual impairment in Diabetic patients. Currently, Intravitreal anti- VEGF drugs, intravitreal steroids, photocoagulation and laser therapy has revolutionised the management of DR. In Ayurveda there is no direct correlation for DR & DME, but analysing the etiopathogenesis it can be a Premehajanya netra vikara and somewhat specifically Saraktha sannipathika kacha.

           A 60-year-old moderately built male patient with a known history of DM approached the OPD with gradual painless defective vision in his right eye since 6 months ago along with wavy vision and floaters in front of his right eye since 4 months. Ocular examination reveals visual acuity during presentation UCVA OD - 6/18(P) & N36 OS- 6/6(P) & N24 and BCVA OD - 6/18 & N8 and OS - 6/6 & N6. Fundus examination revealed microaneurysms and dot & blot haemorrhages in both eyes. Hard exudates were present in right eye. Oct showed cystoid spaces with subretinal fluid collection. Admitted treatment was given for one month and Internal medication & external applications had continued for three months. Observations were noted as per subjective and objective parameters.

        Treatment mainly focused on pitta raktha samaka along with balancing anubhandha kapha. Considering timira chikitsa, procedures such as snehana(oleation), virechana(purgation), nasya(errhine), Anjana(collyrium), murdhavasthi, tarpana, putapaka and kriyakalpa were adopted. Parallely samana chikitsa (palliative therapy) was also underwent based on dosha and dhatu involved.

        Finally, the outcome showed, the medications and procedures done in the case were significant in reducing the DME and retinopathic changes. By reducing edema, patient got improvement in visual acuity.