Résumé
AlM: To study the pattern/distribution of retinal vascular diseases in the hilly terrain of Himachal Pradesh (altitude ranging from 500-4500m above sea level). METHODS: lt is a retro/prospective study of patients with retinal diseases attending the general ophthalmology clinic of a tertiary care facility at Shimla from August 2008 to April 2013. Out of 5600 subjects, 4323 were taken as a sample. The data were taken from the hospital records and thereafter analyzed to determine their age, sex distribution and diagnosis. All patients underwent visual acuity, refraction, slit lamp examination and fundus evaluation. The diagnosis was confirmed from fundus clinic records and evaluation of fundus photographic records retro/prospectively. The photographs were taken on the fundus camera (Kowa Fundus Camera VX-10) and fundus fluorescein angiography done where ever indicated. RESULTS:Out of the 4323 patients, there were more males 2563 ( 59. 29%) than females 1760 ( 40. 71%) with retinal diseases. Out of the 525 ( 12. 14%) diabetic retinopathy ( DR) subjects, mild non-proliferative diabetic retinopathy was present in 133 (3. 08%), moderate non-proliferative diabetic retinopathy in 156 (3. 60%), severe non-proliferative diabetic retinopathy in 120 (2. 78%) and proliferative diabetic retinopathy in 116 (2. 68%) subjects. Amongst the 393 (9. 10%) subjects of hypertensive retinopathy, hypertensive retinopathy-grade 1 ( was present in 130 ( 3. 01%) , hypertensive retinopathy - grade 2 in 111 (2. 57%), hypertensive retinopathy-grade 3 in 131 (3. 03%) and hypertensive retinopathy - grade 4 in 21 ( 0. 49%) subjects. Of all the 660 (15. 27%) subjects of other retinal vascular disorders, branch retinal vein occlusion ( BRVO) was present in 229 (5. 30%), central retinal vein occlusion (CRVO) in 55 (1. 27%), hemi central vein occlusion in 8 (0. 19%), central retinal artery occlusion ( CRAO) in 20 (0. 46%), branch retinal artery occlusion in 4 (0. 09%), ocular ischaemic syndrome in 1 (0. 02%), retinopathy of prematurity in 9 (0. 21%), retinal artery macroaneurysm in 5 (0. 12%), juxtafoveal telangiectasia in 6 (0. 14%), anaemic retinopathy in 16 (0. 37%), leukemic retinopathy in 10 (0. 23%), preretinal haemorrhage in 52 (1. 20%), Coats disease in 8 (0. 19%), cilioretinal artery occlusion in 1 (0. 02%), Eales disease in 10 (0. 23%), vasculitis in 17 (0. 39%) and clinically significant macular edema in 209 (4. 83%) subjects. CONCLUSlON: DR was the most common retinal vascular disorder. Retinal disorders appear to be a major public health problem in lndia. The present study shall help us in planning the management of such disorders in the hilly state of Himachal Pradesh to reduce the visual morbidity arising out of such disorders.