1. Articles 4 min read

   Ten Tips for Managing a Case of Postoperative Endophthalmitis

   1. Suspect : Any unusual post-operative reaction ( out of proportion to surgical trauma ) should be suspected for Endophthalmitis. 2. Differentiate from TASS : All unusual post-operative reactions may not be infective; Pointers towards Toxic Anterior Segment Syndrome could include: Early onset of Limbus to limbus corneal edema with good fundus glow and no exudates in the vitreous cavity. The presence of Lid edema, chemosis, a marked reduction in vision, vitreous exudates, and low intraocular pressure should alert one for Infective Endophthalmitis. 3. Talk : The most difficult part is how to tell the patient about this. This is a very sensitive issue because in Today`s time, no patient is willing to take any negative news ( Thanks to Trivilisation of eye surgery / googlisation etc.) and there is always a potential for medicolegal issues cropping up. Talking requires some degree of compassion. It is advisable to take a picture of the anterior segment & fundus, even if hazy. Take patient

   Dr. Lalit Verma
2. Articles 4 min read

   Ten Pearls for Eyelid Tear Management

   1. Key Points Eyelid injuries may be associated with ocular, orbital, and even intracranial injuries hence always rule out associated systemic trauma, occult globe injuries, or traumatic optic neuropathy. Globe involvement has been reported to be around 61% with eyelid injuries. Management of intra-ocular or systemic injuries takes precedence. The presence of orbital fat in the wound indicates the orbital septum has been breached and the repair requires a higher level of expertise to prevent postoperative complications. Laceration in the medial aspect of the eyelids is likely to involve the canalicular system. It is a myth that upper canalicular tears can be left unrepaired. In case the primary surgeon lacks knowledge or expertise in these structures, a prompt referral to an experienced oculoplastic surgeon would prevent any significant and long-lasting cosmetic was well as functional complications. Since the tissues retract along the fibers of orbicularis oculi, the eyelid defect may

   Dr. Bipasha Mukherjee
3. Articles 11 min read

   Ten Tenets One Should know on Conjunctival Hooding

   Ocular surface anatomy The ocular surface, in a strict sense, consists of the cornea and its major support tissue, the conjunctiva. In a wider anatomical, embryological, and also functional sense, the ocular mucosal adnexa (i.e. the lacrimal gland and the lacrimal drainage system) also belong to the ocular surface. The ocular surface occupies approximately 2.2 cm2 of the human body surface area [1]. The homeostasis of this small area is, however, extremely important for clear vision and comfort. The cornea is one of the most densely innervated structures in the body and hence, surface changes can result in significant discomfort apart from vision loss. The clarity and tectonic integrity of the cornea are maintained by a number of mechanisms, and one of the most important of these is the intactness of the surface epithelium. The limbus provides a constant source of epithelial cells to maintain the normal turnover of the corneal surface but can be impacted by multiple noxious influences

   Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
4. Articles 11 min read

   Ten Tenets on Corneal Collagen Crosslinking

   Corneal collagen crosslinking (CXL) is a minimally invasive procedure that is currently the gold standard treatment to arrest the progression of corneal ectatic conditions. It promotes the induction of crosslinks in stromal collagen of the cornea, thereby strengthening and stiffening the cornea in ectatic conditions. 1.HISTORY It was observed that corneas in diabetic patients were stiffer due to the natural crosslinking occurring from glycosylation and hence had a lower incidence of keratoconus. Based on this observation, various experiments were conducted to crosslink the cornea manually using chemical agents and sugar aldehydes. Following multiple trials, it was found that this could be safely done by making use of the photochemical reaction induced by the absorption of UV light by riboflavin.1 The first in vivo study was done by Wollensak et al., and they reported in 2003 that CXL was effective in stopping the progression of moderate to advanced progressive keratoconus, in 23 eyes f

   Dr. Amanda Mohanan · Dr. Sanjeev P Srinivas · +1 other
5. Articles 15 min read

   Learn from the Masters: Endothelial Keratoplasty

   Endothelial keratoplasty involves selective replacement of the diseased host endothelium with a healthy tissue. Because of its advantages over traditional penetrating keratoplasty, it has become the procedure of choice for corneal endothelial disorders. In last two decades the technique of endothelial keratoplasty has underwent tremendous modifications to improve visual outcome and reduce complications. When we think of endothelial keratoplasty, various terms come to our mind like DLEK ,DSEK,DMEK etc. These can be confusing not only for a resident in training but to a general practitioner as well. To improve our understanding in the field of endothelial keratoplasty, we have invited some prominent endothelial keratoplasty surgeons of our country. Dr. Jagadeesh Kumar Reddy, MS. is the Director (Technical) Sankara Eye Centre, Coimbatore. He has done Fellowship in Cornea and has 30 years of clinical practice. He has performed over 80,000 surgeries and his area of interest is new designs o

   Dr. Prateek Gujar
6. Articles 9 min read

   Ten Pearls for Phacoemulsification in a Soft Cataract

   Soft cataracts are usually seen in pediatric or young adult patients. We encounter them more frequently nowadays due to the increasing patient awareness and evolving lifestyle requirements which bring the patients earlier to the clinic. Another important reason behind the increasing number of soft cataracts in our surgical practice is the fact that the number of pars plana vitrectomies is increasing and we tend to perform combined cataract surgery with pars plana vitrectomy in patients with early cataract. Soft cataract phaco can be quite challenging especially in situations where the pupil starts coming down in the face of an uncooperative patient and positive posterior pressure during surgery. It is no surprise that soft cataract has been termed as “Neither Here-Nor-There” cataract! We will be offering 10 pearls on how to successfully manage such cases with good outcomes. Pearl 1: Need for precise IOL calculations: Most soft cataracts encountered in younger visually active patients c

   Dr. Arup Chakrabarti · Dr. Nirupama Kasturi
7. Articles 9 min read

   Ten Tips for Management of Nystagmus

   Nystagmus is defined as an involuntary rhythmic oscillation of one or both the eyes. Clinical assessment and eye movement recordings are important to diagnose and classify nystagmus. It is essential to have patience while examining a child, as anxiety often increases nystagmus. 1.Classification Physiological eye movements have to be differentiated from pathological eye movements. The older etiology-based classification of nystagmus is redesigned into characteristics-based new classification by CEMAS (Classification of Eye Movement and Strabismus). Infantile nystagmus syndrome (INS) is characterized by horizontal conjugate nystagmus, infantile-onset, accelerating slow phase, increase with fixation attempt, convergence dampening, and presence of null zone with decreased amplitude. Fusion maldevelopment nystagmus syndrome (FMNS) is characterized by decelerating slow phase, associated strabismus, a latent component with fast phase towards fixing eye and decrease in intensity with adduction

   Dr. Ramesh Kekunnaya · Dr. Mayank Jain
8. Articles 18 min read

   Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 2

   Read Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 1 After the discussion on the etiology of pediatric cataracts, and about when and how to operate we go further to know about choosing the IOL formulae, IOL material and power of IOL to be implanted in children. Also, an insight into the post-operative rehabilitation with follow up eOphtha: Considering the varied opinions in choosing the IOL formulae for pediatric cataracts , what’s the formulae used in your practice ? Do you use different formulae in microphthalmic eyes? Dr. Bharti Gangwani : I use Holladay 1 for young children and small eyes with AL < 22 mm and SRK/T for older children with AL > 22 mm. No I do not use different formula in microphthalmic eyes though many of these eyes are left aphakic if the eye is really small. Dr Kalpana Narendran : SRK - T formula is used. If Axial length 22 – SRK T. Dr. Sudarshan Khokhar: We use modified SRK 2 or SRK/T formula for IOL power correction for all eyes. We

   Dr. Sowmya R, MS,FMRF, FAICO
9. Articles 26 min read

   Learn from the Masters: Tips & Tricks in the Management of Pediatric Cataract 1

   Cataracts in children are one of the most common cause of avoidable blindness. The incidence is in the range of 1.8 to 3.6/10,000 per year and the prevalence is about 1.03 per 10,000 children (0.32– 22.9/10,000). Management at the right time and the right way goes a long way in rehabilitating them . To understand the current practices in management of pediatric cataract Dr. Sowmya R. spoke to a few experts across India. Dr. Bharti Gangwani (Bharti Nihalani) is a practicing Pediatric Ophthalmologist, Assistant Professor of Ophthalmology and also the Director of Clinical Research for the department of Ophthalmology at Boston Children’s Hospital, Harvard medical school. She is actively involved in teaching Pediatric Ophthalmology to the residents and fellows. She has about 50 publications in peer and non-peer reviewed journals, books and review articles. She is a co-editor of a renowned book in strabismus management called “Learning strabismus surgery-A case-based approach”. She has focus

   Dr. Sowmya R, MS,FMRF, FAICO
10. Articles 12 min read

    Ten Tips for Phacoemulsification in Small Pupil

    Phacoemulsification in eyes with preoperative non-dilating pupil or with intraoperative miosis is fraught with complications [1,2]. The following tips will help understand the small pupil and optimize strategy to deliver better outcomes. 1. Every eye is an IFIS candidate; Reduce threshold for using Pupil expansion devices: Since its original association with tamsulosin intake, Intraoperative Floppy Iris Syndrome (IFIS) has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter [1,3,4]. The risk of IFIS exists regardless of alpha antagonist treatment, in eyes with 7.0 mm or smaller pupil [5]. Hence, it would be prudent to consider every eye a potential IFIS candidate. Increased patient expectations, surgeon's desire to consistently deliver good outcomes, use of tor

    Dr. Suven Bhattacharjee

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