Diabetic Retenopathy Management - A Case Study

Abstract

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging Retina. It usually takes several years for diabetic retinopathy to reach a stage where it could threaten the sight, if left undiagnosed and untreated. Starting with only a mild vision problem, retinopathy usually appears five years after a type 1 diabetes diagnosis. But it may already be present when type 2 diabetes is diagnosed. We present one such case in a lady of 38 years old, tailor by profession, diagnosed as Type 2 diabetes since 2019, suspected to have had proliferative diabetic retinopathy in January 2020, reported at a Medical College Hospital on 15th December 2020 with periorbital headache for fifteen days. Fundal examination revealed hard exudates and Neo vascularization in both eyes. She was advised Photocoagulation but after her blood sugar was controlled. In the meantime, she was advised to use Nepafenac eye suspension four times daily for pain and redness of the right eye. Investigations had revealed her RBS was 392mg/dl, for which a general physician (internal medicine) was consulted who put her Tab. Metformin 500mg 1-1-1 B/F, Tab. Teneligliptin 20mg 0-1-0 A/F. Unfortunately, 2 months of follow up and diabetes management did not allow her to be taken up for photocoagulation. The institution was firm on their decision to plan her laser photocoagulation for both eyes only when the blood sugar levels come to a range of 140 to 160mg/dl. On 26th March 2021, she was rushed to the Medical College hospital as she complained of loss of vision in the Right eye. The fundus examination revealed multiple dot and blot hemorrhages in both eyes, bleed in oculus dexter and oculus sinister, hard exudates in the right eye that needed Vitreoretinal surgery. Since the Medical College Hospital did not have the Vitreoretinal surgery facility, she was taken to a private dedicated eye hospital, where she underwent laser photocoagulation of left eye on 12/04/21 followed by Vitrectomy of right eye for proliferative diabetic retinopathy on 24th April 2021. There were no postoperative hemorrhages until three days or any other complications after surgery. Now she can recognize some shapes with her right eye by closing left eye.