Sandeep Saxena MS MAMS
Member, National Academy of Medical Sciences, India
DAAD Visiting Professor, University of Bonn, Bonn, Germany
Visiting Professor, University of North Carolina at Chapel Hill, Chapel Hill, USA
Fellow, Barnes Retina Institute and Anheuser-Busch Eye Institute, St Louis, USA
Fellow, New York-Presbyterian Hospital, New York, USA
Professor and In-charge Retina Service Department of Ophthalmology Chhatrapati Shahuji Maharaj Medical University (Erstwhile, King George's Medical University) Lucknow, Uttar Pradesh, India
Foreword Carsten H Meyer
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© 2012, Jaypee Brothers Medical Publishers
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This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Jaypee Gold Standard Mini Atlas Series®: Diabetic Retinopathy
First Edition: 2012
9789350255810
Printed at
5Dedicated to
My Parents
Dr RC Saxena and Mrs Madhu Saxena
and my family
Sangeeta, Shreeya and Aishwarya
7Foreword
Diabetic retinopathy is one of the leading causes of blindness in the working population or patients aged 65 years or younger. The impact of this eye disease on individual visual function and associated consecutive socioeconomic effects has initiated many programs to enhance the awareness of this disease and to improve its therapeutic options.
With improved medical screening programs and novel treatment approaches, today we monitor and treat the underlying disease at an earlier stage and more efficiently, lowering the incidence and severity of the disease.
While angiography remains the gold standard to image and classify diabetic retinopathy, spectral-domain optical coherence tomography is essential to 8diagnose and monitor patients with diabetic macular edema on a micrometer scale before and after treatment.
Our treatment options have also improved dramatically in the last decade. While panretinal laser photocoagulation remains a milestone in the treatment of early diabetic retinopathy, pars plana vitrectomy with new surgical instruments has opened a new area to save vision in previously lost eyes with severe diabetic retinopathy. Finally, novel intravitreal anti-VEGF injections have been shown to play a key role in the treatment of diabetic macular edema.
Jaypee Gold Standard Mini Atlas Series®: Diabetic Retinopathy, by Dr Sandeep Saxena, highlights in an excellent manner all essential aspects of the current diagnostic and treatment approaches in diabetic retinopathy.
Carsten H Meyer md
Professor of Ophthalmology
Head of the Department
Pallas Clinic
Olten, Switzerland
9Preface
Ophthalmology is one of the most technology-driven disciplines of medicine. Rapid technological advances in the diagnosis and management of diabetic retinopathy have had dramatic impacts.
Findings of Diabetic Retinopathy Study (DRS), the Early Treatment Diabetic Retinopathy Study (ETDRS), the Diabetic Retinopathy Vitrectomy Study (DRVS) and the Diabetes Control and Complications Trial (DCCT) have provided insights into the understanding and management of diabetic retinopathy.
An evidence-based medicine is a reality today. Spectral-domain optical coherence tomography has begun a new era in ocular imaging. The unprece dented visualization provided by this technology 10enables determination of specific alterations in retinal anatomy characteristics. On fluorescein angiography, identification of abnormal areas of fluorescence and the identification of hypofluorescence and hyperfluorescence is crucial in interpretation. B-scan is a useful method for clinical examination in establishing the density and location of vitreous hemorrhage and also aids in determining the etiology of clinically unexplained hemorrhage.
Diabetic Retinopathy aims at updating knowledge of the reader on the current status of diagnosis and management of diabetic retinopathy. Medical, pharmacological, laser and surgical management has been included.
The aim of this book is to provide current concepts and a better understanding of diabetic retinopathy. I am confident that this mini atlas will be useful to all postgraduate students, vitreoretinal specialists and practicing ophthalmologists.
Sandeep Saxena