1. 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
[email protected] 098 30 50 7754
2. 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
3. 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
4. The Retinal Surgeon - 1995 Is your retina detached? Do you
have a cataract? No! What are you doing in my clinic?
5. DIABETIC VITRECTOMY
6. What do I do? Medical Retina Vitreo-retinal surgery Cataract
surgery Premium IOLs Toric IOLs Multifocal IOLs
7. 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
8. 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
9. Life Expectancy of Function (Years) Behaviour &
Environment Good Bad VitalFunction% Failure 0 100 10025 50 75
10. India One Ophthalmologist / 1 lakh population UK 2.3
Ophthalmologists / 1 lakh population 70% + specialists - Urban 70%
+ population - Rural
11. Diabetic Retinopathy - Classification Background
Proliferative Advanced Diabetic Eye Disease Preproliferative
Maculopathy The commonest cause of decreased visual acuity due to
diabetic retinopathy is maculopathy
13. 11 November 1998 Retinal Examination Direct Ophthalmoscope
small field 2 D view Uniocular
14. Retinal Examination (2) Slit lamp biomicroscopy Large field
3 D view Binocular
15. Binocular indirect ophthalmoscope
16. Retinal Examination Fundus photography Large field Can be
done by technician
17. Laser treatment for diabetic retinopathy is effective.
18. Diabetic maculopathy
19. 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)
20. Intra vitreal triamcinolone IVTA
21. Personal experience10+ years Pre 6/60 Post 6/9
22. Case 2 Pre RE 6/36 Pre LE 6/60 Post RE 6/9 Post LE
6/12
24. 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
25. Figure 5 Ophthalmology 2012 119, 2125-2132DOI:
(10.1016/j.ophtha.2012.04.030) Copyright 2012 American Academy of
Ophthalmology Terms and Conditions
26. 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
27. Bevacizumab 8 RCTS in DME BOLT Avastin vs Laser N=80, two
years iVB +8.6 letters Laser -0.5 letters
28. 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
