1. Articles 8 min read

   Ten Pearls for Multifocal IOL

   1. Science behind Multifocal Intraocular Lens (MFIOL) Multifocal intraocular lenses are IOLs which can separate incoming light into two or more foci, thus resulting in multiple coexisting retinal images. At any given point, only one of the images (distance, intermediate or near) is the sharpest, and hence selected by the brain for visualisation. This concept is known as simultaneous vision. The visual system in any mammal is not known to be multifocal, hence the implantation of these IOLs initiate a process of neuroadaptation in the recipient’s brain, and its best effect is seen only after some days to weeks. The splitting of light to form multiple images leads to loss of contrast for each image. However, despite these limitations, MFIOLs continue to be one of the best technologies to provide spectacle independence for all distances after cataract surgery. 2. Types of MFIOL MFIOL can be classified in two ways: Based on focality or the number of foci or images created by the lens: Tradi

   Dr. Partha Biswas · Dr. Sneha Batra
2. Articles 18 min read

   Angioid Streaks

   Angioid streaks are visible irregular crack-like dehiscences in Bruch’s membrane that are associated with atrophic degeneration of the overlying retinal pigmented epithelium. Despite 50 % of cases being idiopathic, this condition grabs attention as it requires good history taking and workup to determine the cause. Historical background The first description of angioid streaks was provided in 1889 by Dr. Robert W. Doyne, an English ophthalmologist. He noticed irregular, jagged deeply pigmented lines especially around the discs of both eyes in a patient who sustained trauma in both eyes and attributed it to be due to the rupture of pigment layer of retina. [1] Because of their resemblance to blood vessels, Herman J. Knapp, a German-born American ophthalmologist coined and introduced the term "angioid streaks" in 1892. [2] They are also known as Knapp’s striae. Clinical examination with histopathological findings by Bock in 1938 in two patients with pseudoxanthoma elasticum confirmed that

   Dr. Remya Paulose · Dr. Bhavik Panchal · +1 other
3. Articles 15 min read

   Paediatric Retinal Vascular Diseases

   Introduction This chapter will discuss pediatric retinal vascular diseases like Persistent Fetal Vasculature, Familial Exudative Vitreo Retinopathy and Incontinentia Pigmenti Persistent Fetal Vasculature (Persistent Hyperplastic Primary Vitreous) Definition Persistent hyperplastic primary vitreous (PHPV) is a congenital ocular disorder in which fetal vasculature does not regress after birth. It is unilateral approximately 90% of the time. No single gene has been identified. It can vary from very subtle with no visual disturbance to as severe as phthisis bulbi or secondary glaucoma. The prognosis can be good if early intervention is planned. Due to its wide spectrum of presentation, it has now been renamed as persistent fetal vasculature (PFV).1 Pathogenesis The fetal vasculature is composed of two parts: Tunica vasculosa lentis. It is situated anteriorly encircling the lens. It has anterior and posterior divisions. Anteri­or division has additional attachments to the pupillary frill of

   Parag K. Shah, DNB · Dr. V. R. Saravanan · +1 other
4. Interesting Reads 7 min read

   How to search PubMed: A Ready Reckoner for Postgraduates

   “Search or perish” A thorough and up-to-date knowledge of the subject is indispensible for both patient care and academics. A good literature search is an essential pre-requisite for performing quality research. It is a key step in formulating a research question, planning a study, and interpreting and discussing the results. In addition, this may be required during writing thesis or manuscripts for publication and also for presentations and seminars. Of the many search engines available, MEDLINE / PubMed ® is one of the most popular and easily accessible. It contains articles published in 5200 journals in 30 languages from 1946 covering medicine, nursing, dentistry, veterinary medicine. Approximately 42% of articles published in the last 5 years contain links to free full text (link to PMC). However, it does not include meeting abstracts or conference proceedings (which are present in EMBASE / scopus). The Cochrane Library is apt for meta-analysis and systematic reviews. On the other

   Dr. Neha Goel, MBBS MS MNAMS DNB FRCS (Glasgow)
5. Articles 11 min read

   Tips on Management of Intraocular Foreign Body

   Introduction Open globe injuries (OGI) are associated with retained intraocular foreign body (IOFB)in 18 to 41% of cases1. Retained IOFB is an important cause of visual morbidity and blindness, especially in working-age population with male predominance. Majority of the IOFBs are related to trauma at workplace1. Types of IOFB Majority of IOFB are metallic1,2. It is followed by organic IOFB and metallic non magnetic IOFB. Metallic IOFB like iron or copper can cause metallosis leading to poorer visual outcomes if left untreated. Organic IOFB are associated with high incidence of fungal endophthalmitis and need treatment on emergency basis. Inert IOFB like glass or noble metal like gold can be present in a minority of patients. Theoretically these can be managed conservatively, however with advancements in Vitreoretinal Surgery it is seldom done. Location of IOFB Most common resting place for IOFB is vitreous cavity. Though it may be lodged in any part of the eye. IOFB might be present in

   Dr. Maneesh Bapaye
6. Articles 20 min read

   Fungal Endophthalmitis and it's Management

   Endophthalmitis is a potentially devastating ocular disease that may lead to permanent loss of vision. It is caused by bacteria in the majority of the cases. However, fungal endophthalmitis though rare has a poor prognosis and usually diagnosed late. The incidence of fungal endophthalmitis has increased in recent years, particularly in developing countries. 1-3 Unlike bacterial infections, we do not have much choice of medications in fungal infections. The fungus is slow-growing and we have limited choice of antifungals which act slowly. These are usually diagnosed late as patients are less symptomatic but have more signs. Moreover, fungal culture takes longer time and identification requires more expertise. Polymerase chain reaction (PCR) techniques can even detect dead remnants. Patients are usually treated as bacterial infections and would have received steroids before they are diagnosed to have fungal endophthalmitis. The prognosis of fungal endophthalmitis depends on the magnitude

   Dr. Sugandha Goel · Dr. Ekta Rishi
7. Interesting Reads 10 min read

   Ten Things You Should Know about 3D Viewing System in Ophthalmology

   1. Evolution of this latest state of the art technology in ophthalmology: Three-dimensional (3D) display systems were first developed for aircraft and military use. The term “heads-up surgery” derived from the so-called “head-up display”, a display system first used in aircraft flight decks that projects an image into the normal field of view. This display system allows visualization in a “heads-up” position. In this procedure, the operating surgeon does not perform by looking at the eyepieces of the microscope, but by viewing the microscopic image on a panel display sent from a 3D camera[1]. After the creation of the TrueVision 3D Visualization System for Microsurgery, this innovative, ground-breaking technological boon has entered the operating room. 2. Major types of 3D visualization technique: Conventional 3D systems are classified as either active or passive systems. In active systems, the 3D image is obtained by showing high-speed consecutive images for the right and left eyes al

   Dr. Aniruddha Maiti, MBBS, DO, DNB, MNAMS,FRVS, FICO, MRCSED(Ophth) · Dr. Joydeep Majumdar, MBBS,DNB
8. Articles 10 min read

   Ten Pearls for Descemet's Membrane Detachment Repair

   1. Embryology Understanding the embryological development of the cornea helps us appreciate the reasons for a Descemet's membrane (DM) detachment during surgery. After the lens vesicle separates from the surface epithelium, a wave of mesenchyme forms the primary corneal stroma. A second wave then forms the endothelium, which secretes the DM. The DM, hence, has a potential plane of separation from the corneal stroma, which we use to our benefit in DMEK surgery and which works against us in an inadvertent DM detachment. Throughout the life of an individual, the DM thickens as the posterior non-banded layer is secreted by the endothelium. The anterior fetal banded layer tends to remain the same. However, in most instances, the separation happens between the DM and the cornea stroma1. The thickness of the DM varies between 10 and 15 microns, increasing with age. DM does not regenerate after any damage2. 2. Cataract Surgery and DM Detachment A post-cataract DM detachment occurs in 0.26% of

   Dr. Amanda Mohanan · Dr. Sanjeev P Srinivas · +1 other
9. Articles 9 min read

   Esotropia Made Simple for the Postgraduates

   As like other strabismus, esodeviation can be, True esodeviation Pseudo esodeviation A prominent epicanthic folds 1, 2 Negative angle kappa in high myopes. True esodeviation can be either comitant or incomitant 1,2 A. Comitant I. Accommodative esotropia. Refractive accommodative esotropia (normal AC/A ratio) Non Refractive accommodative esotropia (high AC/A ratio) Hypo accommodative esotropia (reduced NPA) Partially accommodative esotropia II. Non-accommodative esotropia Essential infantile esotropia Non-accommodative convergence excess Acquired esotropia Acute Onset esotropia Divergence insufficiency or paralysis Cyclic esotropia Recurrent esotropia III. Microtropia IV. Nystagmus blockade syndrome. B. Incomitant Paralytic - Neurogenic (VI nerve palsy) Nonparalytic- Myogenic (ocular myasthenia) A & V pattern syndromes Duane’s retraction syndrome Mechanical – restrictive esodeviation Congenital fibrosis syndrome Acquired Dysthyroid eye disease Trauma to the orbital wall Myositis (IOID)

   Dr. Sowmya R, MS,FMRF, FAICO
10. Articles 16 min read

    Herpetic Eye Disease Study: All You Should Know

    Herpes simplex virus (HSV) keratitis is the leading cause of corneal blindness in developed as well as developing countries. The ocular disease affects approximately 10 million people worldwide. Herpes viruses are a group of double-stranded DNA viruses with three subfamilies: alpha-, beta- and gamma- herpes viruses. HSV-1, HSV-2, and varicella-zoster virus (VZV) belong to the alpha-subfamily. HSV spreads by direct contact with virus shed by saliva or genital secretions. During primary infection, HSV-1 infiltrates the corneal epithelial cells. Here it lyses the host cells and releases virions which in turn infect neighboring cells. Then the HSV travels via neuronal cells to trigeminal ganglion and establishes a latent infection. HSV can remain latent for lifetime by storing its genome in the nucleus of the host neuronal cell. While latent, it produces latency-associated transcripts (LATs) that maintain the integrity of the viral genome. The latent HSV-1 can reactivate and return to the

    Dr. Hema Joshi, MBBS, DO, DNB

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