1. Articles 13 min read

   Choroidal Melanoma: Ready Reckoner for the Postgraduates

   Introduction Uveal melanoma is the most common primary intraocular malignant tumor in adults [1]. Second most common type of primary malignant melanoma after cutaneous melanoma. It arises from neuroectodermal melanocytes within the uveal tissue. Epidemiology There is strong racial variation in the incidence, with the white population most commonly affected. The mean age-adjusted incidence of uveal melanoma in the United States is 5.2 per million per year [2]. Males had a significantly higher age-adjusted incidence of 6.0 per million population compared to females, where the average age-adjusted incidence was 4.5 [3]. Malignant melanoma of the choroid is rare in dark pigmented races and has been reported infrequently in the Asian Indian population.[4] Ultraviolet (UV) radiation has been suggested as a major cause of malignant melanoma of the skin and uvea[5] because of the increased incidence and mortality among Caucasians living in tropical regions, where solar radiation is more intens

   Dr. Isha Agarwal · Dr. Vikas Khetan
2. Articles 17 min read

   Fundus Fluorescein Angiography and Indocyanine Green Angiography: Made Easy for the Postgraduates

   Introduction and Gross Anatomy: The retinal and choroidal circulatory system can be visualized in vivo in the presence of normal media clarity. Many important diseases of the retina are related to or associated with the changes in the vasculature of the retina and/or choroid. Hence, it is important to understand the circulatory systems involved to better recognize disease states of the posterior segment. The retinal and choroidal vascular anatomy can be basically divided into 3 parts: Retinal and choroidal vasculature Superficial and deep capillary plexus Inner and outer blood-retinal barriers A: Retinal and Choroidal Vasculature: The retina receives its nutrition from two discrete circulatory systems—the retinal and the choroidal blood vessels. Both are derived from the ophthalmic artery, which is the first branch of the internal carotid artery. The major branches of the ophthalmic artery are the posterior ciliary arteries, the central retinal artery, and the muscular branches. [1] Th

   Dr. Ramesh Venkatesh · Dr. Sajjan Sangai · +1 other
3. Articles 14 min read

   Recurrent Corneal Erosion Syndrome - A Review

   Introduction: Recurrent corneal erosion syndrome (RCES) is a chronic, relapsing condition first described by Hansen1, who termed it as ‘‘intermittent neuralgic vesicular keratitis.’’ Stood in 1901 suggested that trauma to the corneal epithelium and anterior stroma resulted in an inability of the new epithelium to form normal attachments to the injured anterior Bowman’s layer 2. Despite more than a century of advances in corneal science, RCES remains one of the most challenging conditions to manage3. Most patients have a history of epithelial trauma or associated corneal dystrophy and respond initially to a conservative regimen of lubrication. However, they often experience frequent and debilitating recurrences. In this review, we will investigate the etiology and pathogenesis of this challenging disorder, discuss the histopathological changes with a highlight on ASOCT findings, current therapies, and present future directions for research. Etiology and epidemiology: Recurrent corneal e

   Dr. Rishi Swarup D.O · Dr. Divya Jain M.S
4. Articles 25 min read

   An Approach to a Case of Retinitis

   Inflammation of retinal tissue causes characteristic fundus findings depending on whether it is full-thickness or partial-thickness or outer or inner retinal involvement. Figure 1A: A case of epidemic retinitis: Bright yellow superficial fluffy lesion superiorly to the disc obscuring retinal vessels passing through it is typical of inner or full-thickness retinitis. 1B: A case of progressive outer retinal necrosis: Yellowish lesions with clear retinal overlying vasculature suggests outer retinitis. Full-thickness or inner retinal involvement produces bright yellow fluffy lesions with indistinct borders. (Figure 1A) Retinal vasculature passing through these lesions appears obscured. At times, such lesions can mimic cotton-wool spots and may produce moderate to severe vitritis. Outer retinal inflammatory lesions appear dull orange or yellow with indistinct borders, retinal vessels may remain clear over the lesions (Figure 1B) and vitritis could be mild-moderate. Differentiating retinitis

   Dr. Ankush Kawali · Dr. Sanjay Srinivasan · +1 other
5. Interesting Reads 7 min read

   Ten Pearls to Write a Case Report

   A thorough and detailed analysis of a single patient history, clinical presentation, course, and outcomes often helps in improving our understanding of the pathophysiological mechanisms of disease. However, at times, there are certain nuances in every patient that cannot be explained by large dataset-based manuscripts, where there is every chance that several minor, but relevant aspects can be ignored. Therefore, single patient case reports or a short series of patients provided valuable information that can be very useful clinical snippet and has the potential to lead into newer research ideas. I am sharing below some of my thoughts on how one should focus on writing a case report (disclaimer: I am not an expert!). Before I list my “pearls”, I would like to state that the scientific depth and accuracy of your thought process at the time of the clinical visit with the patient will ultimately guide your chances to the publication. 1. Identify phenotype and presentation It is vital for t

   Dr. Aniruddha Agarwal
6. Articles 42 min read

   Optical Coherence Tomography Angiography Made Simple

   Introduction Recent advances in ophthalmic imaging have opened new avenues for a more thorough and extensive understanding of various retinal diseases. Quite a few of these pathologies are attributed directly or indirectly to vascular abnormalities. This renders the need to develop technology capable of providing intricate data of the ocular vasculature. Amongst these is Optical Coherence Tomography Angiography or OCTA. It is a novel, non-invasive imaging modality which provides rapid visualization of the retinal and choroidal microcirculation. Being a dyeless procedure, it eliminates the potential side effects of conventional angiography - i.e Fundus Fluorescein Angiography (FFA)(1) and Indocyanine Green Angiography (ICGA) (2), which require an intravenous injection of a contrast agent. OCTA is a dyeless procedure OCTA derives both functional as well as structural details of the vasculature by detecting the intrinsic motion of the red blood cells within the vessels. (3) By detecting m

   Dr. Nasiq Hasan · Dr. Manasi Tripathi · +1 other
7. Articles 9 min read

   Management of Dropped Nucleus and Retained Lens Fragment

   Introduction: Drooped nucleus and retained lens fragment is a complication not so rare in clinical practice. In the era where cataract surgery is being performed for visual enhancement rather than visual rehabilitation, the management of a dropped nucleus saves the patient from unnecessary anxiety and hastens visual recovery. In this chapter risk factors, the timing of surgery, various approaches for removal of the lens will be discussed. Incidence: Dropped nucleus and cortical remnants occur more frequently in phacoemulsification than other techniques of cataract surgery 1,2 . Surveys in developed nations like U.S and U.K have reported incidences of 0.3 % 1 and 1.1 % respectively. In India, few studies have quoted its incidence to be around 0.8 %. [3] Risk Factors: The exact cause for the posterior displacement of the nucleus is difficult to determine but certain conditions predispose for complication4 Pseudoexfoliation syndrome Traumatic cataract Fellow eye of complicated cataract su

   VR SP Dr. Dhanashree Ratra · Vineet Ratra · +1 other
8. Articles 14 min read

   Ultrasound B-Scan: A Ready Reckoner for the Postgraduates

   The importance of ultrasound imaging cannot be stressed upon more than the fact that whether you are an anterior segment surgeon, posterior segment surgeon or oculoplastic surgeon, the indications for this modality transcend across all genres of ophthalmology. Many a time, postgraduates find this topic daunting to interpret. This article aims to simplify Ultrasound B-scan in terms of mechanics, terminology, actual procedure, and interpretation without delving deep into the confusing jargon. Some common conditions and their typical presentations will also be touched upon. For ease of understanding, we will divide this article into the following sections: History Basic physics and instrumentation Terminology Indications Examination techniques: basic and special Features of commonly encountered posterior segment conditions History Though the concept of ultrasound waves was known to humans in the 18th century (Lazzaro Spallanzini’s observation on the use of ‘sound whistles’ by bats in dark

   F Dr. Anmol Naik · Dr. Shveta Gadewar · +1 other
9. Articles 13 min read

   Thyroid Eye Disease : A Review for the Postgraduates

   Introduction: Thyroid eye disease (TED) or thyroid-associated orbitopathy (TAO) also called Basedow-Grave’s disease. It is an autoimmune inflammatory disorder characterized by enlargement of the orbital fat and extraocular muscles.1 It is a consequence of thyroid gland dysfunction, where antibodies are targeted against thyrotropin receptors (TSHR) known as thyroid-stimulating globulin(TSI).1 It is independent of the serum level of the circulating hormone levels. 2 TED is characterized by an active or inflammatory stage and an inactive or fibrotic stage. The active or the inflammatory stage is characterized by inflammation, adipogenesis, and accumulation of extracellular fluid, glycosaminoglycans which in turn causes enlargement of the extraocular muscles and expansion of the orbital fat. Once the inflammation settles, there is predominant scarring of the orbital tissues which marks the onset of the fibrotic stage. The natural course of the disease is quite variable. The majority of TED

   Dr. Amber Dubey · Dr. Vazhipokkil Anju Chandran · +1 other
10. Articles 19 min read

    A (VAST)IN Saga

    Vascular endothelial growth factor (VEGF)-A is a key mediator of angiogenesis. The discovery of VEGF-A, like many other major discoveries in medicine, happened partly by observations and partly by chance. Napoleone Ferrara and his team were working on a population of non-hormone-secreting cells from the anterior pituitary of cows. (1) One day Ferrara mixed some isolates from cultures of follicular cells with endothelial cells. Ferrara was surprised to see the rapidly proliferating endothelial cells started rapidly. Ferrara understood that the pituitary cells were secreting an angiogenic protein. With this observation, Ferrara worked on the isolation and cloning of this angiogenic protein. In 1989, Napoleone Ferrara and Hazel at Genentech laboratory were the first to isolate and clone vascular endothelial growth factor (VEGF). Ferrara recalls, “I worked on the isolation of VEGF in my spare time during my first six months to a year at Genentech. Once we cloned VEGF in 1989, the company b

    Dr. Bikramjit Pal · Dr. Parthopratim Dutta Majumder

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