DOI: 10.4103/jras.jras_253_24 ISSN: 2456-5601

Effect of leech therapy (hirudotherapy) combined with Ayurveda intervention in macular branch retinal vein occlusion in a case of sarcoidosis: A case report

Shikha Sharma, Ankur Tripathi, Pankaj Kundal, Narayan Bavalatti, Manjusha Rajagopala
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Abstract

INTRODUCTION:

Macular Branch Retinal vein occlusion (BRVO) comprises conditions caused by the blockage of the small or large-caliber vessels carrying blood away from the retina, resulting in visual disturbance. Although it may be reasonable to observe the progression of Macular BRVO, it can become complicated, resulting in irreversible visual loss, which underscores the need for early intervention. The retinal hemorrhagic condition can be correlated with Urdhwaga Raktapitta (a disorder characterized by bleeding from the upper orifices of the body, including the eyes).

PATIENT INFORMATION:

A 56-year-old male presented to the out patient department of Shalakya Tantra (Ophthalmology) with blurred vision in the left eye for 3 months. He had a 10-year history of sarcoidosis. Unaided distance visual acuity was 6/60P in the left eye and 6/6 in the right eye. Unaided near visual acuity (NVA) was N36 in the left eye and N6 in the right eye. Neither pinhole testing nor refraction improved vision in the left eye. The macula was elevated, with intraretinal hemorrhage, subretinal fluid (SRF), and cystic spaces. Optical coherence tomography showed an average macular thickness of 830 µm.

THERAPEUTIC INTERVENTION:

Oral regimen involving Shothahara (anti-inflammatory), Raktaprasadaka (enhancing blood circulation), Raktastambhaka (homeostasis of vitiated blood), Raktapittahara (pacifying Rakta and Pitta Dosha ), Medhya (supporting intellect), Chakshushya (beneficial to eye sight), and Rasayana (rejuvenating) Chikitsa were adopted along with external application of Leech ( Hirudo medicinalis L. ).

RESULTS:

The patient was followed up from November 25, 2023, to April 20, 2024, during which seven sittings of Jalouka Karma were performed. Visual acuity in the left eye improved from 6/60P at baseline to 6/12 at the final assessment, while NVA improved from N.36 to N.9. Central macular thickness decreased from 830 to 182 µm. Treatment was discontinued on April 20, 2024. These findings indicate improvement in visual acuity and macular thickness during the treatment period; however, a causal relationship cannot be established from this single case.

CONCLUSION:

This case suggests that Ayurvedic interventions may offer a viable approach in managing Macular BRVO, highlighting the need for further exploration of their role in retinal vascular pathologies.

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