Diabetes can affect the eyes in various ways leading to loss of vision. Two of the most common causes of vision loss due to diabetes are diabetic cataracts and diabetic retinopathy. Diabetic cataracts are harder to operate on than age-related-cataracts because they are challenging to emulsify and aspirate. One can prevent or minimise vision loss in the earlier stages of diabetic retinopathy with good glycemic control, laser photocoagulation and intravitreal injections. However, in the advanced stages, if a patient has not received proper treatment, the patient may experience profound loss of vision due to extensive intraocular bleeding, tractional retinal detachment, macular degeneration etc. Commenting on this, Dr. Boopathy Murugavel says “not all is lost in such cases and a good amount of vision can still be salvaged if surgery is performed at the earliest opportunity.” In most instances, diabetic cataracts and diabetic retinopathy are treated with independent procedures. We present a case of diabetic Retinopathy complicated by vitreous hemorrhage and tractional retinal detachment, with the presence of diabetic cataract. For the first time at Aster Hospitals, UAE, a combined procedure of cataract removal with IOL implantation followed by retinal detachment surgery with intraocular oil injection was performed, by Dr.Boopathy Murugavel and Dr.Vikram Mohindra.
A 54-year-old male patient, who was a known diabetic, hypertensive and kidney disease patient currently undergoing treatment, presented with loss of vision in both eyes, with the right eye more affected than the left eye. The patient had a history of laser photocoagulation in both eyes for diabetic retinopathy a year before the current presentation. On examination, his vision in the right eye was reduced to only permitting counting of fingers close to the face. The left eye vision was 20/200 according to Snellen’s chart. Examination revealed diabetic cataracts with pterygium in both eyes in the anterior segment. A fundoscopy revealed a dense vitreous hemorrhage with subhyaloid hemorrhage and tractional retinal detachment in the right eye. The left eye fundoscopy showed a mild resolving vitreous hemorrhage following laser photocoagulation.
Cataract surgery and retinal surgery preparation was completed and the patient was admitted at the Aster Day Care Surgery Unit in Mankhool. Dr. Vikram performed cataract surgery with IOL implantation, following which Dr. Boopathy took over the case and proceeded with clearing of the vitreous and sub-hyaloid hemorrhage and relieving the traction causing detachment of retina. Silicone oil was injected to replace the vitreous as a tamponading agent to settle the retina. The patient was discharged on the same day. By post operative day 5, the patient’s vision had improved from counting fingers close to the face to 20/200 unaided. He was advised to follow up regularly and has been scheduled for silicone oil removal after 2 months.
Following the successful completion of the procedure, Dr. Boopathy stated, “The prompt referral of the patient by Dr.Vikram for Diabetic Retinopathy, good coordination between the two Aster branches, excellent support by the insurance team, timely arrangement of the necessary equipment by the biomedical and operations team, and support from the management enabled such a complex procedure to be done for the first time at Aster Hospitals, UAE. We are surely looking forward to improving the quality of life and vision for many more similar patients at Aster Hospitals.”