AYURVEDIC MANAGEMENT OF BRANCH RETINAL VEIN OCCLUSION – A CASE STUDY

Divya Stuvert* and Ashwini M. J.

ABSTRACT

Retinal vein occlusion (RVO) is the second most common retinal vascular disorder after diabetic retinopathy. Branch Retinal Venous Occlusion is a venous occlusion at any branch of the central retinal vein. BRVO has many known ophthalmic and systemic risk factors including age, hypertension, hyperlipidemia, ocular hypertension, and glaucoma. BRVO presents as sudden onset of painless unilateral visual field defect, metamorphopsia. Its complications are Retinal hemorrhage and chronic Cystoid macular edema (CME) leading to poor visual acuity. The pathogenesis of BRVO includes a combination of mechanical compression, degenerative changes in vessel walls or hypercoagulable factors. The arteriosclerotic changes occurs specifically arteriovenous crossing which result in venule occlusion through endothelial cell damage and thrombosis. Arteriosclerosis results in arteriolar insufficiency leading to BRVO. This can lead to retinal non perfusion area and even macular edema or vitreous haemorrhage, seriously hampering vision. A male patient of 53 years came to OPD with field vision defects and sudden painless blurred vision in right eye since 2 months. He was a known case of hypertension since 20 years. Vision in right eye was 6/60 partial and near vision N-18 with and without spectacles. Associated with double vision, abnormal colour vision and distorted vision. Patient uses laptop daily for 10 to 12 hours daily. Disturbed sleep at night about 4 to 5 hours daily. Clinical diagnosis of Branch Retinal Venous Occlusion was conformed with OCT and Fundus Angiography. On examination fundus shows Retinal haemorrhage and chronic Cystoid Macular Edema (CME). Patient was treated with topical steroids followed by intra ocular injection in modern hospital before visiting our hospital. He was admitted and treated in S.D.M Institute of Ayurveda and Hospital, Bangalore with Kriya Kalpa Treatments and internal medicines for 20 days. Hypertension, stress, disturbed sleep and exposure to laptop were found to be Nidanas of BRVO in this patient. The whole pathology of Central Retinal Vein Occlusion which starts with Srotodusti of Raktavaha Srotas manifested in the form of Sanga as haemorrhages (Tomato splash appearance or flame shaped). In this context of Siro Abhisyanda in eye diseases the Ashraya Sthana is Rasavaha Srotas, affected Dhatu is Rakta and vitiated Dosha is Pitta. Based on Lakshanas this condition was diagnosised as Pitha Kapha Pradhana Tridoshaja Tritiya Palatagatha Timira and was treated. Treatment was planed after Virechana Karma, followed by Kriyakalpas like Seka with Yashtimadhu Ksheera Paka, Bidalaka with Triphala, Vasa Patra Kalka, Thalapodichil Lodra, Chandhana, Yastimadhu, Laksha, Amalaki churna and Kashaya Dhara with Mustha Amalaki Kashayam was done for 9 days. The internal medicines like Kaishora Guggulu, Vasaguluchyadi Kashaya, Punarnava Kashaya and lifestyle changes were advised for 1 month. The fundus photographs and OCT were taken before and after treatment. The patient was assessed clinically for visual symptoms. Visual acuity has been improved to 6/12 and N-8 after 1 month. Metamorphopsia (Distortion of images) was significantly reduced which was recorded by Amsler grid. Color vision was recorded by Ischiara colour chart. The results proved to be significant on the basis of clinical assessment and OCT. According to the contemporary science, no known effective medical treatment is available for the treatment of Branch Retinal Vein Occlusion. Main aim of the treatment is to identify and treat any systemic medical problems to reduce the further complications. The present case study showed marked improvement in visual acuity with reduction in retinal haemorrhage and macular oedema. It proves that Ayurvedic management in retinal disorders is quite encouraging and it is an area of research in future.

Keywords: BRVO, CME, Retinal haemorrhage.