P. Shukla1*,
John Masih2, Thakur Amit
K.2 and Kar P. K.3
1Associate
Professor, Ophthalmology, Govt. Medical College, Jagdalpur
2Assistant Professor, Medicine, Govt. Medical
College, Jagdalpur 3Professor
& H.O.D., Dermatology and STD, Govt. Medical College, Jagdalpur
ABSTRACT:
On fundoscopy it
was noted that 05.26 % and 08.33 % males and females respectively suffering
from IHD with Diabetes were having hypertensive retinopathy in comparison to
only 05.7% males and nil percentage of females suffering from IHD without
Diabetes. Regarding hard exudates /microneurysm was
observed in 07.89 and 08.33 percent males and females respectively of IHD
without Diabetes in comparison to none of the patients of IHD with Diabetes. up
Cataract /media hazy, on fundoscopy was observed only
amongst 05.26 % IHD with Diabetics. Similarly, Tessellation was noted in 02.85
%males belong to IHD without Diabetes while none of the patient found in IHD
with Diabetes. Almost equal proportion of patients belong to both group (IHD
with Diabetes and IHD with Diabetes).It
was further noted that as age advances proportion of tessellation goes except
in 71 + years of age group patients.
KEY-WORDS: Hypertensive Retinopathy, Tessilation,
Media hazy cataract
INTRODUCTION:
Around 79 % of men and 83 %of women
were found to be physically in active, while 51 % men and 48 % women had high
fat diets." About 60 % men and 57 % women were found to have low intake of
fruit and vegetables, while 12 % men 0.5 % women smoke". Around 41 % of
men and 45 % of women were overweight or obese .High blood pressure was
reported in 33 % men and 30 % women, while high cholesterol was found in one
quarter of all men and women. Diabetes was also reported in 34 % men and 37 %
women (1).By taking in to consideration the above facts and as per
recommendations of the World Health Organization (W.H.O.) study group in 1957,
that in order to get a comprehensive picture of a disease, more and more such
studies have to be carried out, Garg Narendra K.(2) and Garg Narendra K. and Sharma A.B.(3), the authors have under
taken this study with the objective to analysis the fundus
findings of IHD patients with or without diabetes.
MATERIAL AND
METHOD:
There were one hundred patients (fifty of
IHD with diabetes and fifty of IHD without diabetes) of both sexes included in
the present study. The study was conducted in Pt. J.N.M. Medical College,
Raipur, Deptt of Medicine from May 2003 to May 2004. Fundus of all sampled patients were examined systematically
and the findings were recorded. Patient was instructed to look straight ahead
of the examiner approaches with an ophthalmoscope or +78 D or 79 D lense for the temporal side, so that disc or optic nerve
head is brought in to view. The shape and color of the disc, arrangement of the
vessels, their pulsation if any, and the color of the choridal
reflex and gross abnormalities were noted.
Table-I: Fundus
findings as per gender and ihd with or without
diabetes
|
Findings
|
IHD
with Diabetes |
IHD
without Diabetes |
Total |
||
|
Male |
Female |
Male |
Female |
||
|
Mild
Art-Att + RTW,
Mild Art-Att, Art-Att Ro Art-Att |
16 |
05 |
13 |
10 |
44 |
|
HTN
Retinotathy |
02 |
01 |
02 |
nil |
05 |
|
Hard
Exudata/Hard Esudata Microanuerysm |
03 |
01 |
nil |
nil |
04 |
|
(Madiahazy) Cataract |
02 |
nil |
nil |
nil |
02 |
|
Tessiletion |
nil |
nil |
01 |
nil |
01 |
|
WNL
|
14 |
05 |
19 |
05 |
43 |
|
Normal |
01 |
nil |
nil |
nil |
01 |
|
Total
|
38 |
12 |
35 |
15 |
100 |
Table-II: Fundus findings as per age and ihd
with or with out diabetes
|
|
IHD WITH DIABETES |
IHD WITHOUT DIABETES |
|||||||||||||||||||
|
|
31-40 |
41-50 |
51-60 |
61-70 |
71 and above |
31-40 |
41-50 |
51-60 |
61-70 |
71and above |
Total |
||||||||||
|
|
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
|
|
Mild
Art-Att + RTW, Mild
Art-Att, Art-Att Ro
Art-Att |
00 |
01 |
04 |
01 |
02 |
01 |
06 |
01 |
04 |
01 |
02 |
01 |
02 |
02 |
05 |
03 |
03 |
03 |
01 |
01 |
44 |
|
HTN Retinotathy |
00 |
00 |
01 |
01 |
00 |
00 |
00 |
00 |
01 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
02 |
00 |
00 |
00 |
05 |
|
Hard Exudata /Hard
Esudata Micro-anuerysm |
00 |
00 |
00 |
00 |
02 |
01 |
01 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
04 |
|
(Madiahazy) Cataract |
00 |
00 |
00 |
00 |
01 |
00 |
01 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
02 |
|
Tessiletion |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
01 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
01 |
|
WNL |
01 |
00 |
02 |
00 |
05 |
01 |
04 |
04 |
02 |
00 |
05 |
00 |
03 |
02 |
06 |
02 |
05 |
01 |
00 |
00 |
43 |
|
Normal |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
01 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
00 |
01 |
|
Total
|
01 |
01 |
07 |
02 |
10 |
03 |
12 |
05 |
08 |
01 |
07 |
01 |
06 |
04 |
11 |
05 |
10 |
04 |
01 |
01 |
100 |
The patient than were directed to look up,
to the right, to the left, and down. In this manner periphery of the fundus were brought in to view.
Hypertensive (HTN) Retinopathy; Grade
I-Mild to moderate narrowing; Grade II-Sclerosis of the smaller arterioles;
Grade III-Moderate to marked narrowing of retinal arterioles; Retinal hole,
horse shoe shaped flap tear with rolled posterior ends. Retinal fixed fold in a
detached retina; New vessels in the retina; Venous sheath; Pre retinal
hemorrhage; New vessels on the disc; Circumferential sclera buckle with round
hole surrounded by diatruxsing; Elevated nerve
vessels with proliferate tissues; Old blood in vitreous (green) along with
fresh hemorrhage (red); Retinal dialysis with surrounding retinal detachment; Latticle degeneration with atroplec
hole exudates; Macular edema
Retinal hemorrhage; Choroidal
pigmentation with such as nevus (4-8).
OBSERVATIONS AND DISCUSSION:
On analysis of the recorded data it was
noted that that Mild Art-Att + RTW, Mild Art-Att, Art-Att Ro Art-Att were more common
in amongst males in comparision to their female
counter parts as far as IHD with Diabetes was concerned while amongst IHD
without Diabetes was concerned ,it was noted that more or less equal proportion
of the patients of both sexes were the sufferers.
HTN Retinopathy –Amongst IHD with
diabetes one male and one female patient of 41-50 years of age group was found
suffering from Hypertensive retinopathy. While in case IHD without diabetes
only two males image group of 61-70 found with HTN Retinopathy. Hard Exudata/ Microanuerysm-hard
exudates/microneurysm was observed in 07.89 and 08.33 percent males and females
respectively of IHD without Diabetes in comparision
to none of the patients of IHD with Diabetes. On further analysis that all
patients who showed hard exudates or microaneurysm
belongs to 51-70 years of age group. (Madiahazy)
Cataract Cataract/media hazy, on fundoscopy was
observed only amongst 05.26 % IHD with Diabetics male patients belonging to
51-70 years of age group. Similarly, Tessellation was noted in 02.85 %males belong
to IHD without Diabetes in the age group of 41-50 years while none of the
patient found in IHD with Diabetes. It
was further noted that as age advances proportion of tessellation goes up
except in 71 + years of age group patients Regarding WNL it was noted that 19
patients (14 male and 05 female) of IHD with diabetes were found and belongs to
all age group in comparison to their non diabetic IHD counterparts 24 (19 male
and 05 females) belong to all age group except extreme age group i.e. 71 +
years. Almost equal proportion of patients belongs to both group (IHD with
Diabetes and IHD with Diabetes). Normal findings were noted only in 1.00 %of
cases who belongs IHD with diabetes and in the age group of 71 +years.
(i)Simple
Hypertension-Arterioles straighter and narrower than normal. Venules may are compressed where crossed, and may be
somewhat engorged and tortuous.
(ii)Hypertension with
arteriosclerosis-Degrees or stages of hypertensive retinal diseases (a) minimal changes in the retina with only
mild attenuation or sclerosis of the arterioles; mild depression of veins at
the points of arteriolar crossing. (b) moderate to marked sclerosis with
increased luster of arterioles (coppery color or copper wire arteries). (c)
polished silver co; our of arterioles ("silver wire" artery);
widening of arteriovenous crossing spaces, with
changes in the course of and dilation of veins. (d) arterioles visible as
fibrous cords.
(iii) Malignant hypertension
(retinopathy)- (a) diffuse and marked contraction of retinal arteries (b)swelling of optic nerve resembling papilloedema (c)
numerous flame shaped superficial hemorrhage (d)"cotton wool"
exudates in retina (e) star shaped figure at the macula.
ACKNOWLEDGEMENT :
The
authors expresses their sincere thanks to Dr. A.K.Bansal,
Ex-Professor and H.O.D., Department of Community Medicine, Govt. Medical
College, Jagdalpur (Bastar)
India, for his constant guidance and encouragement in preparing the manuscript.
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Received on 23.08.2012
Modified on 20.10.2012
Accepted on 08.11.2012
© A&V Publication all right
reserved
Research J. Pharmacology and
Pharmacodynamics. 5(1): January –February 2013, 36-38