1. Articles 40 min read

   Instruments used in Corneal Procedures and Surgeries

   Although tales and myths of ocular surgery and organ transplantation appear in numerous ancient texts, the earliest accounts of ophthalmic diseases were written as a treatise by Sushruta, in the 6th century BC. Sushruta described 76 eye diseases, out of which 51 required surgical treatment. In the western world, the concepts of corneal surgery date back to Greek physician Galen (130-200AD). The concepts to improve corneal clarity by surgery were developed over the next centuries and especially in the 17th and 18th centuries. But the major scientific progress and experimentation in the field of corneal surgeries happened in the 19th century. The progress in corneal surgery was hindered by a lack of understanding of immunology, asepsis, surgical procedures, and of course, the lack of proper instrumentation. Emmert Wolf wrote over a century ago, “A man is only as good as his tools.” Early surgeons were hampered by a lack of proper surgical instruments. Over the centuries, innumerable opht

   Dr. Hema Joshi, MBBS, DO, DNB · Dr. Ankita Patil
2. Students Gallery 9 min read

   Instruments Used in Oculoplasty

   Oculoplasty Instruments Oculoplasty deals with the aesthetic part of ophthalmology. Precision is the key in Oculoplasty as the outcomes depend on it. Good precision can be achieved with good knowledge of the instruments used in oculoplasty and when to use them. This article would give a brief idea on basic instruments used. Nettleship Punctum Dilator It is the instrument with very fine blunt tip, with a tapering end Uses Dilation of puncta during diagnostic and therapeutic probing Before syringing in small puncta, Diagnosing punctal stenosis, Canalicular repair with monoka stent, Silicone tube intubation Nettleship Punctum Dilator Castroviejo Lacrimal Dilator It is the instrument with Double-ended with fine and medium taper end. Uses Dilation of puncta during diagnostic and therapeutic probing Before syringing in small puncta, Diagnosing punctal stenosis, Canalicular repair with monoka stent, Castroviejo Lacrimal dilator Thudicum’s Nasal Speculum It is a thin instrument with flanges, o

   Dr. Rohit Rao
3. Articles 28 min read

   Ocular Surface Squamous Neoplasia

   A. Introduction There have been multiple refinements in the terminology of the epithelial squamous neoplasia until the introduction of the term “Ocular surface squamous neoplasia” (OSSN) by Lee and Hirst in 19951. OSSN is an umbrella term and refers to a spectrum ranging from mild/moderate/severe dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva and/or cornea2-4. OSSN is the most common tumor of the ocular surface. According to the epidemiological studies, the worldwide incidence of OSSN is 0.02 to 3.5 cases per 100,000 people. Incidence increases with decreasing latitude, being higher in countries located close to the equator. OSSN predominantly occurs in the elderly age group (6th to 7th decade) and in male gender 5-9. B. Etiology and pathogenesis10-27 The presumptive risk factors implicated in the etiology of OSSN include: Excessive exposure to ultraviolet radiation Heavy cigarette smoking Immunosuppressive conditions: Human Immunodeficienc

   Dr. Kavya M Bejjanki · Dr. Swathi Kaliki
4. Articles 3 min read

   Five things you should know about Micropulse LASER in Glaucoma Management

   Glaucoma is a leading cause of irreversible blindness worldwide, with more than 70 million people affected. Traditionally treatment options include topical medications, laser trabeculoplasty, incisional surgeries, glaucoma drainage implants (GDD), and cycloablative procedures. GDD and ciliary body destruction is generally reserved for refractory or end-stage glaucoma in eyes with poor visual potential. Transscleral cyclophotocoagulation (TSCPC) Transscleral cyclophotocoagulation (TSCPC) is a cyclodestructive procedure designed to target the melanin in the pigmented ciliary body epithelium, thereby decreasing the rate of aqueous humor production. Numerous studies have confirmed the IOP-lowering ability of TSCPC and also reported the risk of developing serious complications with this procedure, such as persistent ocular inflammation, vision loss, hypotony, phthisis bulbi, and rarely sympathetic ophthalmia. Therefore, TSCPC, which conventionally uses the continuous-wave diode laser, has b

   Dr. Murali Ariga
5. Articles 20 min read

   Ocular Sarcoidosis: A Review for the Postgraduates

   Introduction: Sarcoidosis is a chronic multisystemic granulomatous disorder caused by an exaggerated cellular immune response to a variety of self or non-self-antigens in a genetically predisposed individual resulting in non-caseating granulomas. Ocular involvement occurs in 25-60% of systemic sarcoidosis at some point of time1. In this article, we look at the emerging literature on epidemiology, pathogenesis, clinical profile, and management in ocular sarcoidosis. Epidemiology: Sarcoidosis has an overall incidence of 6-10 per 100,000. Although sarcoidosis occurs worldwide, it is predominant in certain ethnic and racial groups like the Afro-Caribbean, Scandinavian, and Irish populations2-4. Highest incidence of ocular sarcoidosis is in the 20-40-year age group. Some studies show two peaks of incidence for ocular sarcoidosis the first at ages 20-30 and the second at ages 50-605. There is also a higher incidence of ocular involvement in women4. The reported incidence of ocular sarcoidosi

   Dr. Vinaya Kumar Konana · Dr. Kalpana Babu
6. Articles 8 min read

   Slit-lamp Biomicroscopy

   A slit-lamp is a binocular microscope used for eye examination using a slit-like light beam. In 1911, Allvar Gullstrand a Swedish Ophthalmologist designed table-mounted binocular eyepiece for 3-dimensional visualization of optically clear eye structures. Later Otto Henker, combined Gullstrand slit lamp with Czapski’s binocular microscope resulting in first slit lamp biomicroscope, allowing hand-free examination of an eye.1 The optical design of the Slit-Lamp Biomicroscope (SLB). Due to the miniature size of the anterior segment of the eye, we need high magnification and clarity to appreciate finer details. This can be achieved by having 2 convex lenses at the observer end (eyepiece) separated at its focal distance (astronomical telescope type alignment) and, a concave-convex combination (Galilean telescope type alignment) at the examinee’s end for further magnification of the image. Telescopic arrangements of lenses need to be focused at near, hence a plus power objective lens is fixed

   Dr. Nagesha C K · Dr. Shruthi M N
7. Students Gallery 57 min read

   Syndromes in Ophthalmology

   A syndrome is a recognizable complex of symptoms and physical findings that indicate a specific condition for which a direct cause is not necessarily understood. While medicine has innumerable syndromes, a similar scenario exists in ophthalmology too. It is crucial for a clinically astute ophthalmologist to be aware of these syndromes to initiate necessary workup for more sinister lesions associated with certain ocular findings. This article aims at addressing various syndromes related to ophthalmology highlighting the ocular findings. A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z A Aarskog’s syndrome: Ocular symptoms include megalocornea, hypertelorism, antimongoloid palpebral fissures. Systemic features are short stature, syndactyly. Aberfeld Syndrome Ocular features include blepharophimosis, exotropia, myopia, congenital cataracts, microcornea. Systemic features are myopathy, bone deformities, arachnodactyly, dwarfism, hypoplas

   Dr. Niranjan Karthik Senthil Kumar
8. Articles 5 min read

   Ten Pearls for Performing Vitrectomy in Diabetic Retinopathy

   Important terms: Truncation: To relieve all the surrounding traction 360 degree Segmentation: Dividing a larger membranes/FVP into smaller islands of FVP by 360-degree truncation around them. Delamination: Separation of these membranes/FVP from the retinal surface to which they are firmly adherent by creating a plane of dissection between them. Pearl #1 When not to perform vitrectomy in diabetic retinopathy? Answer: In cases of extramacular tractional retinal detachment (TRD) when the fovea is attached and the patient has a comparative good vision the extramacular TRD can be observed. Charles and Flinn reported only 21% of extramacular TRD extending into macula without any surgical intervention. Also, DRVS (Diabetic retinopathy vitrectomy study) reports that only 23% of eyes with TRD developed severe visual loss at 2 years. Also, early intervention in such extramacular TRD’s can sometimes lead to more harm than benefit owing to the surgery itself. Pearl #2 First step should always be c

   Dr. Raja Narayan
9. Articles 43 min read

   Visual Electrophysiology Made Simple for the Postgraduates

   Visual electrophysiology is an extremely useful tool to study the retinal function objectively. It assesses the functional aspects of not only the retina but also the visual pathway as a whole. Even in this era of advanced imaging, one cannot ignore the importance of the functional aspects of the cellular network in the retina. The commonly used tests with their salient applications are enumerated in Table 1. S.no Test Application 1. Electroretinogram(ERG) Elicits mass response from the Retina 2. Electro-oculogram(EOG) Assesses the function of the Retinal pigment epithelium 3. Pattern ERG(PERG) Differentiates macular and optic nerve pathology 4. Multifocal ERG(MfERG) Picks up focal retinal pathology and maps out the topography 5. Photopic Negative Response(PhNR) Tests the function of retinal ganglion cells 6. Visual Evoked Potentials(VEP) Assesses the visual pathway up to the occipital cortex 7. Multifocal VEP(MfVEP) Picks up focal dysfunction of the visual pathway and maps the topogra

   Dr. Parveen Sen · Karthika Pandurangan · +1 other
10. Interesting Reads 16 min read

    Ten Clinical Trials in Retinal Diseases Every Postgraduate Should Know

    1. CATT (Comparison of Age-related Macular Degeneration Treatments Trials)1 Description A prospective, multicenter, single-blind, noninferiority randomized clinical trial. 1208 patients with neovascular AMD were enrolled from February 2008 and randomly assigned to receive intravitreal injections of ranibizumab (0.5 mg/0.05 ml) or bevacizumab (1.25 mg/0.05 ml) on either a monthly schedule or as needed with monthly evaluation. Patients aged ? 50 years with active, subfoveal CNV, fibrosis < 50% of total lesion area, visual acuity 20/25-20/320 and at least 1 drusen (>63?) in either eye or late AMD in fellow eye were eligible. The primary outcome was the mean change in visual acuity at 1 year, with a noninferiority limit of 5 letters on the eye chart. Results At one year, all four groups had similar improvements in visual acuity. Groups had similar rates of adverse events, though patients receiving bevacizumab had more occurrences of ?1 serious adverse event than those in the ranibizumab gr

    Dr. Neha Goel, MBBS MS MNAMS DNB FRCS (Glasgow)

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