Akhtar N

We are reporting a case of impending hemi-central retinal artery occlusion in a hypertensive patient. A 50 year old male presented with complaints of multiple episodes of transient painless mono-ocular obscuration of vision (Amaurosis fugax) in right eye for last 2 months. He was a known case of hypertension for last 2 years with poor compliance of medicines. At the time of presentation he had best corrected visual acuity in his right eye of 20/40. On fundus examination yellowish white plaques were visible in superior 1st order branches of central retinal artery along with ocular ischemic syndrome and grade III hypertensive retinopathy. Carotid Doppler and Fluorescein Angiography were performed and ECG, Echocardiography, Complete blood count including Lipid profile were advised. The arterio-venous transit time was delayed along with occluded superior 1st order branches of central retinal artery on Fluorescein Angiography and Carotid Doppler showed Type 1 plaque formation in the posterior wall of left carotid bulb. The blood investigations were suggestive of deranged lipid profile. We prescribed Aspirin/Atorvastatin combination (75/10), Cyclandelate Tablets and Brimonidine Timolol combination eye drop.

Rasamanikya is a herbo mineral preparation used extensively in Ayurvedic treatment. This is prepared using haratala (arsenic tri oxide) by the process of bhavana (wet trituration) and exposure to high temperature. This drug in minute quantities is said to be effective against respiratory ailments, skin diseases and fever. Rasamanikya was evaluated for safety in Wistar rats by sub acute (28 days) and chronic toxicity (90 days) studies. The test drug was given up to three times of its therapeutic dose orally. The test drug did not cause mortality or signs of toxicity in Wistar rats in both the studies. No major changes were observed with respect to hematology, and biochemical parameters. Post mortem of the animals did not reveal any gross pathology of internal organs. Histopathology changes observed in few groups were minimal and were of reversible type. Rasamanikya was found to be safe up to 54 mg/kg body weight in Wistar rats.

Threatening Diabetic Retinopathy (DR) is projected to nearly triple in the next forty years1. DR is predominantly a microangiopathy in which small blood vessels are particularly vulnerable to damage from high glucose levels. Direct hyperglycemic effects along with many angiogenic stimulators (like vascular endothelial growth factor) and inhibitors have a role to play in the causation of DR. A consistent screening with timely metabolic control helps prevent ocular disease in diabetic patients, thereby decreasing the need for intravitreal anti-VEGFs and steroids, laser photocoagulation and vitrectomy with or without epiretinal membrane removal or peeling of internal limiting membrane. Therefore, a tight regulation of blood glucose, blood pressure, serum lipids, albuminuria (signifying diabetic nephropathy), anemia is important. Additional risk factors that need to be taken care of include- smoking in males with type1 diabetes, puberty, pregnancy, duration of disease.