The retina in diabetes

The retina in diabetes

General retinal vascular changes, including those occurring in diabetics, have been considered on p290. The most important factors affecting the incidence of diabetic retinopathy are age and the duration of the disease. More than 90% of insulin-dependent diabetics have some form of retinopathy after 20 years. Established retinopathy is adversely affected by co-cxistent hypertension. The visual symptoms may be gradual when there is slow encroachment on the macula of a ring of exudates surrounding an area of oedema or microaneurysms or rapid when a vitreous haemorrhage occurs. It is important to classify the grades of diabetic retinopathy

pre-proiiferative diabetic retinopathy. Fundal changes of this stage in the

disease process are characterised by the presence of cotton-wool spots

deep and superficial haemorrhages, intra-retinai microvascular anomalies,

venous dilatation, looping and irregularities. By definition, no new vessels

are present.     

Behget's syndrome

This is more common in Mediterranean countries and in Japan and is

believed to be higher in populations around the ancient Silk Road. It is linked with HLA B5 (found in 80% of cases in Turkey) and occasionally C4 antigens.The disease is characterised by recurrent uveitis with hypopyon  and buccal and genital ulceration. The basis of these manifestations is an obliterative vasculitis . Retinal vessels may be affected and can be reduced to thread-like proportions associated with optic atrophy. Thrombo-phlebitis of the legs and aneurysms of large arteries may occur. Antibodies to mucosa from several sites including the mouth have been demonstrated but tests for rheumatoid and antinuclear factor are usually negative. There is also evidence of cell mediated delayed hypersensitivity. Treatment is with immuno-suppressants such as corticosteroids, colchicine, thalidomide and cyclosporin.

Systemic lupus erythematosus

Systemic Lupus Erythematosus (SLE) is a multisystem, inflammatory disease characterised by the presence of autoantibodies leading to the deposition of immune complexes in the small blood vessels with resulting local fibrinoid necrosis due to complement activation. Its prevalence is 4-250/100,000 and is more common and severe in Asians and black Americans, affecting women predominantly (female to male ratio 10:1). Diagnostic features include a macular and discoid skin rash, photosensitivity, oral ulcers, arthritis, serositis, CNS disease such as diplopia, nystagmus and psychosis, haemolytic anaemia, leucopenia, thrombocytopenia, and immunological disorders involving the LE cell, anti-dsDNA, anti-Sm and antinuclear antibodies. Renal involvement makes the prognosis poor. The tissue damage mainly results from activation of complement .Antinuclear factors can be demonstrated by immunofluorescence in almost all patients. The ESR is raised and serological tests for syphilis may be falsely positive.

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