RESUMO
Thiazolidinediones are oral hypoglycemic drugs that have been recently used for patients of type 2 diabetes. Review of literature shows that their side effect of systemic fluid retention aggravates diabetic macular edema. This research work was designed to see the effect of Thiazolidinediones (Pioglitazone) on early diabetic retinopathy. Optical Coherence Tomography (OCT) was used to measure average and central foveal thickness. 122 consecutive eyes of metabolically stable Type 2 diabetes were taken up for study and followed for three months who fulfilled the exclusion criteria. Patients were divided in two groups. Group one included patients with no diabetic retinopathy. Group two included patient with mild / moderate retinopathy without macular edema. As group two was further randomized into two subgroups. First subgroup received standard systemic medical therapy for diabetes and second subgroup received 30mg Pioglitazone in addition to standard treatment. All subjects underwent complete ocular systemic examination including Optical Coherence Tomography (OCT) at baseline, 6 weeks and 3 months. In this study, there was increase in central foveal thickness and average cube thickness in both the subgroups on Pioglitazone. Pioglitazone therapy is related to statistically significant increase in macular thickness at three month follow up. Optical Coherence Tomography (OCT) is an important tool for picking up subclinical changes in macular thickness that do not reflect in visual acuity.
RESUMO
PURPOSE: A retrospective tertiary care center-based study was undertaken to evaluate the visual outcome in Eales' disease, based on a new classification system, for the first time. MATERIALS AND METHODS: One hundred and fifty-nine consecutive cases of Eales' disease were included. All the eyes were staged according to the new classification: Stage 1: periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages; Stage 2a: capillary non-perfusion, 2b: neovascularization elsewhere/of the disc; Stage 3a: fibrovascular proliferation, 3b: vitreous hemorrhage; Stage 4a: traction/combined rhegmatogenous retinal detachment and 4b: rubeosis iridis, neovascular glaucoma, complicated cataract and optic atrophy. Visual acuity was graded as: Grade I 20/20 or better; Grade II 20/30 to 20/40; Grade III 20/60 to 20/120 and Grade IV 20/200 or worse. All the cases were managed by medical therapy, photocoagulation and/or vitreoretinal surgery. Visual acuity was converted into decimal scale, denoting 20/20=1 and 20/800=0.01. Paired t-test / Wilcoxon signed-rank tests were used for statistical analysis. RESULTS: Vitreous hemorrhage was the commonest presenting feature (49.32%). Cases with Stages 1 to 3 and 4a and 4b achieved final visual acuity ranging from 20/15 to 20/40; 20/80 to 20/400 and 20/200 to 20/400, respectively. Statistically significant improvement in visual acuities was observed in all the stages of the disease except Stages 1a and 4b. CONCLUSION: Significant improvement in visual acuities was observed in the majority of stages of Eales' disease following treatment. This study adds further to the little available evidences of treatment effects in literature and may have effect on patient care and health policy in Eales' disease.