1. Articles 8 min read

   Retinoblastoma : Top Ten Tenets for an Ophthalmologist

   1.Common and Curable Retinoblastoma is the most common childhood ocular malignancy. Annually there are about 6000 new cases worldwide. It is most commonly diagnosed at 15-18 months of age although in developing countries, older children also present with the disease. It is potentially curable if detected early and with proper management. Currently, the survival rate is as high as 95% with 90% eye salvage and 85% vision salvage. 2 The root of the Family Tree Retinoblastoma can be associated with germline mutation or somatic mutations of the RB1 gene on the long arm of chromosome 13. Heritable retinoblastoma constitutes 30-40% of all retinoblastomas while the rest are non- heritable. 25% of the germline mutations are familial with autosomal dominant inheritance and the remaining occur de novo. In heritable retinoblastoma, patients are prone to other second primary neoplasia including pinealoblastoma, osteosarcoma and soft tissue sarcomas. Genetic testing for germline mutations are availa

   Dr. Mrittika Sen · Dr. Santosh G Honavar, MD, FACS
2. Articles 11 min read

   ILM Peeling Simplified - Ten Tips for the Beginners

   1 How to choose the right cases to start Idiopathic macular hole in non-myopic eye is a good case. ILM comes off as a single sheet and underlying retina is healthy. Same applies to traumatic macular holes. Beginners can also start peeling ILM in eyes with epiretinal membrane. Unsuccessful peeling may not jeopardize the long-term outcome significantly here. Peeling ILM for Myopic macular holes or in eyes with Diabetic Retinopathy needs more experience but can be achieved easily if one understands the basics of peeling. 2 Arrange your Inventory – Forceps is the key Lander's ring with Macular contact lens, Disposable ILM forceps and BBG dye serve as a formidable low-cost inventory for ILM peeling. A good ILM forceps should match your technique of ILM peeling. Because most of us initiate peel by "Pinch Technique", forcep is desired to have a structure that can "pinch". It needs to have fine teeth on opposing surfaces and good range of movement for its prongs. It should also be light weight

   Dr. Deependra V Singh · Prof. (Dr.) Yog Raj Sharma
3. Articles 8 min read

   Ten Commandments in Squint Workup for Postgraduates

   Squint is the Ocular Imbalance in which visual axes of both eyes do not meet at the point of regard. It can be regarded as a form of One Eye Blindness since both eyes are not seeing simultaneously, with a squinting eye being suppressed. Hence strabismus must be treated with due care. Squint evaluation can be simplified by the following checklist. Every squint patient must undergo this checklist of 10 commandments so as to plan management. 1. Determine whether True squint or a Pseudosquint The architecture of face and orbit may give the impression of a person having an apparent deviation. Careful inspection of lids, adnexa, position of globes will reveal no actual squinting of eyes. Two important parameters to rule out Pseudosquint Hirschberg reflex will always be centered No redressal movement on cover test Epicanthus and broad nasal bridge - extra fold of skin on the medial canthus gives the appearance of esotropia. On pinching the nasal bridge, the squint will disappear. Facial asymm

   Dr. R Krishnaprasad · Dr. Sayali D Mahajan
4. Articles 14 min read

   Ten Pearls for The Management of Pseudophakic Corneal Edema

   Corneal edema refers to the accumulation of excess fluid in the corneal layers, with a loss of corneal clarity, resulting in vision loss. The normal cornea maintains a state of 78% hydration due to a complex interplay between stromal swelling pressure, the barrier function of the epithelium and endothelium, endothelial pump, tear evaporation and intraocular pressure [1]. Any condition that interferes with this balance causes a loss of homeostasis and accumulation of fluid. 1. The Natural History of Corneal Edema In the early stages of corneal edema, reduced vision is often related to an irregular corneal surface and can interfere significantly with daily activities. This impact on vision is often underestimated by quantitative visual acuity measurements in standard lighting conditions using high contrast charts, as in a refracting lane. Initially, these patients often experience blurred vision on awakening, owing to the accumulation of fluid in the closed eye state during sleep. As the

   Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
5. Articles 7 min read

   Ten Pearls for Phacoemulsification in a Hard Cataract

   Phacoemulsification of the very dense cataract presents the surgeon with a series of specific and difficult challenges. How hard is hard and what level of hardness makes it challenging depends largely on the experience of the surgeon. LOCS III classification does not always reveal the real hardness of the cataract, and that aside there is no definition in the literature that classifies the hardness of cataract. A hard cataract is a relative term relative to the surgeon’s experience and confidence! I have over the years put some criteria for myself when I call it a difficult situation. These are dark brown to the black nucleus, no visibility of the posterior slit beam due to the nuclear sclerosis, an older patient, diabetic patient, and preoperative poor vision. Ocular co-morbidities such as pseudo exfoliation, absence of pupillary ruff and calcific spots on the anterior capsule are some of my personal markers which add further to an already challenging surgery Pearl 1: Preoperative con

   Dr. Ashok Rangarajan, MS; DNB; FRCS (Glasgow)
6. Articles 2 min read

   Ten Pearls of Phacoemulsification in Subluxated Cataracts

   Phacoemulsification in subluxated cataracts is a challenging situation for the phaco surgeon due to lot of variables like management of the subluxation, management of the cataract, vitreous etc. Here are the top ten Pearls for Phaco in subluxated Cataracts. 1 Pre-Op Assessment Careful slit-lamp examination for a) Extent of Subluxation b) The density of the cataract c) Presence or absence of vitreous in Anterior chamber d) Status of the corneal endothelium e) Age of the patient 2 Devices & Instrumentation a) Capsular Tension Ring (CTR) size 10 – 12 mm size 11 – 13 mm b) CIONNI Ring (1 or 2 eyelets) c) CT Segment (Ahmed Segment) d) Capsular Hooks e) Iris Hooks f) Micro Surgical instrumentation like Microrhexis forceps etc. 3 Proper Surgical Planning Zonule loss less than 1 quadrant: Place 3 piece IOL in the axis of the Zonular loss 1 to 2 quadrants: CTR Standard 2 to 3 quadrants: CIONNI 1 or 2 or CT segment (Ahmed) More than 3 quadrants: Above or scleral fixated IOL 4 Surgical Plan Site

   Dr. Mohan Rajan
7. Articles 3 min read

   Five Things You Should Know About Intracameral Bimatoprost Sustained Release Implant

   The Implant Durysta (ALLERGAN) is the first-ever intracameral sustained-release bimatoprost implant. The glaucoma treatment paradigm has shifted towards earlier intervention and targeting the actual pathology. The main problem one faces with glaucoma management is compliance with the medications. The intracameral bimatoprost addresses the problem satisfactorily. Durysta, a 10-microgram bimatoprost implant, becomes the first biodegradable, intracameral sustained release implant indicated to reduce Intraocular pressure (IOP). It is hard for patients to maintain quality of life while being on topical anti-glaucoma medications – The Intracameral Bimatoprost makes it possible. Administration of the Implant Durysta is a rod-like implant preloaded within a sterile applicator with a 28-gauge needle tip. The needle is inserted under an aseptic condition in the anterior chamber and then with the press of a trigger button implant is released. After the implantation, the needle is removed and the

   Dr. Tamonash Basu
8. Articles 6 min read

   Learn from the Masters : Tips & Tricks of Managing Dry Eye

   As we all know that India is on the brink of a dry eye disease epidemic, this interview with the maestros in this field will help us to streamline our approach in managing the increasing number of dry eye patients. The availability of innumerable diagnostic tests always baffles us about how to use what in which time. The need for an integrated scheme in assessing and prognosticating dry eye cases is of utmost importance for a successful treatment outcome. Some of the very basic but most important areas are discussed by the unparallels in their field to clear the doubts of young ophthalmologists. Dr. Srinivas K. Rao DO, DNB, FRCSEd has worked as a Senior Consultant at Sankara Nethralaya for 15 years before joining as Professor in the Chinese University of Hong Kong from September 2004 till August 2006. Since October 2006 he is Director of Darshan Eye Care and Darshan Surgical Centre, Chennai. He is also Visiting Professor, Sri Ramachandra Medical University, Cornea Head at Sankara Hospi

   Dr. Sumana Chatterjee
9. Articles 17 min read

   Learn from the Masters : Tips and Tricks of Vitreoretinal Surgery

   “If you are brave enough to start the right way, you will be strong enough to finish at the right place.” The most crucial aspect of vitreoretinal surgery is learning it the right way. And if you have the guidance of teachers with experiences of a lifetime, there is an abundant pool of knowledge you can extract. Plenty of young VR surgeons are facing difficulties in the basic principles and doctrines of surgery. Some of these basic questions were compiled together and addressed to the top-notch VR surgeons of India, owing to a simple and lucid explanation for the same. Dr. Atul Kumar, MD, FAMS, FRCS(Ed) is the Chief & Professor of Ophthalmology at Dr. R.P. Centre, AIIMS, New Delhi since 1st January 2016. He completed MD & Sr. Residency from Dr. R.P. Centre, AIIMS New Delhi India & joined as Assistant Professor in the same institute in 1987 (Discipline: -Vitreous-Retina). He pursued Retina Fellowship from the University of Maryland, Baltimore, USA, 1990. He has 313 indexed & non-indexed

   Dr. Dhaivat Shah
10. Articles 4 min read

    Ten Pearls for Managing a Case of Tubercular Uveitis

    Pattern recognition is critical in the diagnosis and treatment of any form of uveitis. Here are 10 pearls that will make it easier to recognize patterns of presentation and resolution in tubercular uveitis. The general approach to diagnosis: We are all aware of the role of identifying clinical signs of TB in the eye and that of ancillary tests for systemic TB (immunological and radiological). However, we tend to ignore the last part – the exclusion of non-TB entities. These include various infectious and non-infectious conditions that can match a given clinical sign of ocular TB. Tubercular retinal vasculitis – 1: TB retinal vasculitis typically causes a periphlebitis, though rarely arterioles can also be affected. The most common clue for a tubercular etiology is the presence of active or healed retinitis lesions underlying the blood vessels (subvascular lesions). These are intraretinal granuloma and are highly predictive of tubercular etiology in TB-endemic countries (Kaza et al., 20

    Dr. Soumyava Basu

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