Abstract

Background: Circinate maculopathy is a morphological variant of diabetic maculopathy characterised by circinate deposition of hard exudates around the macula, resulting in progressive central visual impairment. Conventional management includes intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy and laser photocoagulation; however, visual improvement may be limited in some patients. In Ayurveda, this condition can be conceptually correlated with Pramehajanya Dweetiya Patalagata Timira (visual impairment affecting the second layer of the eye caused by diabetes) based on clinical features and aetio-pathogenesis. Objective: To evaluate the effect of classical Ayurveda management in a case of Circinate maculopathy Secondary to Proliferative diabetic retinopathy with suboptimal response to conventional therapy. Case details: A 48-year-old female with type 2 diabetes mellitus presented to the outpatient department with complaints of gradual, painless bilateral diminution of distant and near vision for six months, He was diagnosed as bilateral proliferative retinopathy with circinate maculopathy and was treated for 90 days with internal medications (Tab. Chandraprabha Vati, Tab. Nishamalaki, Bruhat Vasakadi Kashaya, Varunadi Kashaya), Tiktaka Ksheera Basti (Enema) and Netra Tarpana (Ayurveda ocular therapy involving medicated ghee) with Patoladi Ghrita. Visual acuity, fundoscopic findings and glycemic parameters were assessed before and after treatment. Results: Visual acuity improved from 6/60 to 6/6 in the right eye and from 6/36 to 6/9 in the left eye. Fundoscopy revealed reduction in hard exudates and macular oedema. Glycemic parameters also improved. No adverse events were reported. Conclusion: This case suggests a possible supportive role of Ayurveda interventions in managing circinate maculopathy associated with diabetic retinopathy. Further controlled clinical studies are required.

Key words: Circinate maculopathy, Pramehajanya Dweetiya Patalagata Timira, Proliferative diabetic retinopathy.