International Journal of Innovative Pharmaceutical Sciences and Research

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International Journal of Innovative Pharmaceutical Sciences and Research www.ijipsr.com AYURVEDIC MANAGEMENT OF DIABETIC RETIPATHY - CASE STUDY 1 Sandhya Rani. D *, 2 Seetha Devi.

College, Mysuru- 570028, Karnataka, INDIA 3 Physician, Arvinda hospital, mysuru-570024, Karnataka, INDIA ABSTRACT Diabetic retinopathy, a micro-angiopathic diabetic complication though preventable,

1 International Journal of Innovative Pharmaceutical Sciences and Research AYURVEDIC MANAGEMENT OF DIABETIC RETIPATHY - CASE STUDY 1 Sandhya Rani. D *, 2 Seetha Devi.P, 3 Partha sarathy Kulkarni 1 Reader, Dept, of Shalakya Tantra, JSS Ayurveda Medical College, Mysuru , Karnataka, INDIA 2 Assistant Professor, Dept, of Panchakarma, JSS Ayurveda Medical College, Mysuru , Karnataka, INDIA 3 Physician, Arvinda hospital, mysuru , Karnataka, INDIA ABSTRACT Diabetic retinopathy, a micro-angiopathic diabetic complication though preventable, leads to blindness if neglected, which needs care & better management. There are various modalities of treatment in conventional medicine, which may not give promising results in all patients. Diabetes can be coined with madhumeha & Diabetic retinopathy with madhumehajanya nethra vikara of ayurvedic classics. General approach for avaranajanya vikaras can be adopted in such cases. Five patients were subjected for Virechna followed by Netra kriya kalpas for 15 days and thereafter managed with shamanoushadhis. Results were assessed with visual acuity and funduscopy. All patients showed good response towards the treatment and medicines used. Keywords: Diabetic mellitus, diabetic retinopathy, shodhana, netrakriyakalpas, Shaman aushadhi. Corresponding Author Dr. Sandhya Rani. D Reader, Dept, of Shalakya Tantra, JSS Ayurveda Medical College, Mysuru , Karnataka, INDIA sandhyaranid30@yahoo.in Mobile: Available online: August Issue 1185

2 INTRODUCTION Stress and strain of modern age change in life style and habits have crabbed the humanity with a sphere of ailments. Diabetes is a leading disease affecting a large population and long standing diabetes is the mother of series of complications. Diabetic Retinopathy is one such complication which is most frequently seen with visual impairment and progressive vision loss. Diabetic Retinopathy refers to retinal changes seen in patients with diabetic mellitus, with increase in life expectancy of diabetics, the incidence of diabetic retinopathy (DR) has increase, and it has become one of the leading causes of blindness [1]. It is ocular manifestation of systemic disease. Risk Factors: Duration of Diabetics: Roughly 50% of patients develop DR after 10 years. 70% of patients develop DR after 20 years. 90% of patients develop DR after 30 years of onset of DM. Sex: Females are more affected than males (4:3). Heredity: If parents were diabetic in their early age then offspring will have DR and is more on proliferative Diabetic Retinopathy. Pregnancy: It accelerates the chances of DR. Hypertension: Along with diabetes, hypertension accelerates the changes of DR. Other factors: Smoking, obesity, hyperlipedemia, accelerates the DR. Pathogenesis: DR is a vascular disease of retina, especially affecting retinal pre capillary arterioles, capillaries and venules. The pathogenesis is as fallows [1, 2]. Because of Diabetic Mellitus Thickening of capillary basement membrane capillary endothelial cell damage change in RBC s increase stickiness of platelets Micro vascular occlusion Retinal Ischemia Retinal Odema Capillary Leakage Micro Aneurysms Hemorrhages Hard exudates NEOVASCULARIZATION Available online: August Issue 1186

Classification: Depending on the stage of DR, it is classified as [1]: 1. Non proliferative Diabetic Retinopathy (NPDR) Mild NPDR Moderate NPDR Severe NPDR Very Severe NPDR 2.

Black spots or patch on the visual field. Sometimes vision becomes clear sometimes blurring. Micro aneurysms in macular area Flame shaped Retinal hemorrhages.

3 Classification: Depending on the stage of DR, it is classified as [1]: 1. Non proliferative Diabetic Retinopathy (NPDR) Mild NPDR Moderate NPDR Severe NPDR Very Severe NPDR 2. Proliferative Diabetic Retinopathy (PDR) 3. Diabetic Maculopathy (DM) 4. Advanced Diabetic Eye Disease (ADED) Symptoms: Signs: The eye appears normal to look at. Black spots or patch on the visual field. Sometimes vision becomes clear sometimes blurring. Micro aneurysms in macular area Flame shaped Retinal hemorrhages. Hard exudates, yellowish white, waxy looking, patches are arranged in clumps. Macular Edema Cotton wool spots (>8 high risks of developing PDR) Neovascularization. On the basis of severity of these signs and symptoms, stages of DR can be assessed. Vision by normal person Vision by diabetic retinopathy person Fig.1: Showing vision by normal person & vision by DR affected person Available online: August Issue 1187

Fig. 2: showing normal Fundus & DR fundus photos [3] 4. Advanced diabetic eye diseases: It is the end result of uncontrolled proliferative diabetic retinopathy.

4 Fig. 2: showing normal Fundus & DR fundus photos [3] 4. Advanced diabetic eye diseases: It is the end result of uncontrolled proliferative diabetic retinopathy. It is marked by complications such as, Persistent vitreous hemorrhage. Tractional Retinal detachment. Neovascular glaucoma. Management: Strict metabolic control of blood sugar. Lipid reduction. Correction of anemia/hypoprotenamia. Intra vitrial steroid injections. Laser surgery. (Pan retinal photo coagulation) Pars plane vitrectomy in advanced PDR. Case Report Name: Mr. Ram Rao OP Number: Patient is 60 years male, known case of diabetic since 18 years, has lost the vision of left eye because of diabetic retinopathy. He has undergone vitrectomy, laser surgeries several times for DR of left eye but presently no vision. His right eye is functioning and was diagnosed as NPDR stage II. Since 10 years he is taking Ayurvedic treatment. Since 3 years he is regularly taking treatment in JSS AYURVEDA HOSPITAL. Available online: August Issue 1188

5 Table 1: showing Visual acuity of the pt Before treatment During treatment After treatment D.V N.V D.V N.V D.V N.V BE 6/60P N24/10 6/60 N24/10 6/36P N24/10 RE 6/60P N24/10 6/60 N24/10 6/36P N24/10 LE Table 2: Chart showing Funduscopy before and after treatment Funduscopy before treatment: funduscopy after treatment: RE: pseudophakia RE: pseudophakia Fundal glow present fundal glow present Optic disc appears normal optic disc appears normal Macular Edema ++ mild macular Edema Flame shaped hemorrhages ++ hemorrhages + Cotton wool spots ++ cotton wool spots+ Neovascularisation +++ neovascularisation + Treatment adapted: As patient is diabetic, sadyo Virechana is fallowed. 2 days deepana pachana 3rd day- Snehapana with sukumara grutha. 4th day- sarvanga abhyanga and bashpa sweda. 5th day- Virechana with trivruth lehya. 6th day- samsarjana krama. 7th day- vishrama kala. 8th day onwards Netra seka with triphala kashaya and kshera for 20 minutes. - fallowed by Netra Tarpana with jeevanthyadi grutha for 7 days - Shiro dhara - takra processed with mustha, amalaki, jatamansi for 7 days From 15th day onwards shamanoushadhis, -Shilajithu Nishaamalaki 3 Gms with warm water, twice a day. -Mahavasakadi kwatha. 15 ml in empty stomach once a day. Available online: August Issue 1189

6 DISCUSSION Diabetes or madhumeha is a metabolic disorder which silently harms the vital organs of the body like kidneys i.e., nephropathy, heart etc, in due course it has an effect over the nerves leading to Neuropathy. As retina is a nervous layer of the eye, in chronic diabetic patient there are certain changes seen in retina, these changes as a whole termed as DIABETIC RETIPATHY2. Ayurveda is a life science in which the nidana, samprapthi, bheda, sadhyasadhyatha of various diseases has been explained. Acharya Madhavakara has explained madhumeha as santharpanajanya vyadhi [4]. While explaining the poorvaroopa of madhumeha, Charaka has coated the word- hrunetra jihwa shravanopadheha i.e, dhamani upalepa (cha chi 6/13-14) [5]. i.e, coating or occlusion in the vessels of Heart, Eyes, Tongue, and Ears etc is seen. By observing the pathology of DR it is clear that there is occlusion in the retinal vessels, so there is ischemia of retina, leading to development of neovascularization, hemorrhages, formation of exudates. Charaka in sutra sthana while explaining margavarana, has coated the same pathology like Comparing the pathology [6]: Table 3: chart showing pathogenesis according to Ayurveda and modern science Santarpanajanyanidana Kapha-medo vridi Shonita pradooshana Dhamani upalepa Dhamani pratichaya Sirajagranthi Margaavarodha Sedentary lifestyle metabolic syndrome Dyslipidemia Athrogenesis Atherosclerosis Occlusion Ischemia\Hemorrhage Hence the signs and symptoms of ischemia are seen, so our chikithsa should aim in relieving ischemia of retina. Virechana is one of the best and easy ways of kaya shodhana [7]. Available online: August Issue 1190

7 Netra seka, takra dhara are beneficial in improving the local circulation there by relieves ischemia. Netra Tarpana helps in nourishment of local cells and nerve endings and improves the visual perception. Internally Shilajithu helps in relieving the avarana and clears the rakthavaha srothas. Nishaamalaki prevents further hemorrhage. Mahavasakadi kwatha which is a sthambaka helps to check the formation of exudates. CONCLUSION After observing the cases it is clears that both sthanika and abhyantara chikithsa gives good result in the management of Diabetic retinopathy. REFERENCES 1. Comprehensive Ophthalmology-A K Khurana 4 th edition published by New Age International (P) limited,2007,page no 259, Parson Diseases of eye-parson, 20th edition, edited by Ramajjit sihoto and Radhika Tandon published by Elsevier http//en.wikipedia.org/file. 4. Madhavakara, Madhavanidana with commentary of Vijayarakshita & Srikantadatta, published by, Choukamba Varanasi, Charaka samhita-agnivesha, with Vidhodini Teeka, edited in Hindi by Rajeshwaradatta shastry Vol 1& Vol 2, 22 editions Varanasi, Choukamba, Sushruta, Sushruta samhita, Hindi, edited by Kaviraja Ambikadatta shastri 11 th edition, published by, Choukamba Varanasi, Available online: August Issue 1191

Diagnosis and treatment of diabetic retinopathy. Blake Cooper MD Ophthalmologist Vitreoretinal Surgeon Retina Associates Kansas City

Diagnosis and treatment of diabetic retinopathy Blake Cooper MD Ophthalmologist Vitreoretinal Surgeon Retina Associates Kansas City Disclosures Consulted for Novo Nordisk 2017,2018. Will be discussing