Dr. Bikramjit Pal

Director, Pal's Retina Centre

12 articles

Dr. Bikramjit P Pal has done his post-graduation DO from RIO Chennai and then did his DNB from Aravind Eye care Tirunelveli. With a keen interest in retina , he pursued his retinal training from SN Chennai. Dr. Pal was the first Indian ophthalmologist to be chosen by Eye cancer Foundation NY to undergo Oncology fellowship under their fellowship program. He completed the same from Helsinki and then set up the oncology unit in the SN Kolkata branch. Dr Pal has started his own exclusive Retina clinic in Ranchi and aims to make the same the best in the region

  1. Students Gallery 24 Aug 2021 2 min read

    i-File: Systemic Hypertension

    A 60-year male presented with C/O diminution of vision in the Right Eye. The patient is not a known case of any known systemic illness, although gives a vague c/o chest pain and the occasional headache. Examination revealed a vision of 4/60 with an IOP of 16mmHg as measured by GAT. The right Eye reveals the unremarkable anterior segment with minimal lenticular changes. Vitreous cavity quiet with fundus as shown. The left eye reveals a normal anterior and posterior segment. Question What are the positive findings as depicted in the fundus photo.? What are the investigations you would ask for? How will you manage this case? Answer Ocular 1) FUNDUS FLUORESCEIN ANGIOGRAM: disruption of retinal layers. These in turn will again help in educating the patient in terms of visual gain he is expected to gain In this case if one had to choose between FFA and OCT, FFA would be a better option. Management Managing this case is again in collaboration with a physician/ cardiologist Ocular 1) After con

    Dr. Bikramjit Pal
  2. Articles 20 Jul 2021 10 min read

    Ocular Oncology Basics: Diagnosis of Intraocular Malignancies

    “Declare the past, diagnose the present, foretell the future.” Hippocrates In this section, I will deal with various diagnostic methods which are common in practice for the diagnosis of mainly Intraocular malignancies. Diagnostic modalities used for extraocular malignancies will be considered in the respective chapters. 1.History Even though the twenty-first century has seen a boom in the diagnostic armamentarium available to the ophthalmologist, the art of good history taking can never be out of fashion. History of the present complaints, their duration, and associated complaints can provide multiple clues. If the duration of complaints has been seen over a long period of time with minimal change; a chronic condition can be anticipated. A sudden change in vision is an alerting sign. Personal history pertaining to the patient's occupation will provide us the visual needs of the concerned. Any previous history of other malignancies, its treatment history may provide clues with the etiol

    Dr. Bikramjit Pal
  3. Articles 20 Jul 2021 6 min read

    Ocular Oncology Basics: Salient Points from The Pandora's Box

    RETINOBLASTOMA Grouping: Clinical determination of the extent of disease with the focus being the eye. It is a preoperative evaluation with the main outcome being the salvagable status of vision or the eye. Staging: It combines clinical, various imaging, and post-operative histopathological results to determine the extent of the disease. The main outcome is focused on the survival of the patient. International Classification of Retinoblastoma ( grouping) [1] Group A: Tumours smaller than 3mm or less Should be 2DD ( 3mm) from the fovea Should be 1DD (1.5mm) from optic nerve head Group B: Tumours bigger than those in group A Located within 2DD from the fovea Located within 1DD from optic nerve head Localized cuff of subretinal fluid( < 5mm) No seeding is allowed in the group. Group C: Localized tumor dissemination Vitreous seeding not more than 3mm from the base of tumor Subretinal seeding not more than 3mm from the base of tumor Group D: Diffuse tumor dissemination Vitreous seeding may

    Dr. Bikramjit Pal
  4. Articles 20 Jul 2021 8 min read

    Ocular Oncology Basics: Genetics

    Twenty first century has seen a giant leap in the understanding of human genetics. Based on the human genome project humans are supposed to have roughly 20,000 to 25,000 genes. Genes are the fundamental units of heredity. To understand genetics involved in various ocular pathologies a basic understanding is essential. The following discussion will provide an overview of basic concepts in genetics and provide a glimpse into the genetics of Retinoblastoma and intraocular melanoma. The basic structure of a chromosome [1] Chromosomes are formed by a tight packaging of the DNA stored in the nucleus of a cell Each gene in humans are comprised of 2 copies ; one inherited from either parent. Forms of the same gene with differences on the basis of bases are known as alleles. A tightly regulated process of transcription and translation involves the production of basic building blocks called as amino acids to form proteins. Gene regulation is the process whereby certain genes are 'switched on' an

    Dr. Bikramjit Pal
  5. Articles 20 Jul 2021 13 min read

    Ocular Oncology Basics: Treatment Strategies In Intraocular Malignancies

    “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” Jim Valvano Treating malignancies I believe, brings the true human spirit forward of the treating physician. Breaking the news of malignancy to a patient is as heartbreaking for the physician as it is for the patient. Yet the doctor must keep his feelings aside and do his best. Even though the human eye forms a small fraction of the human body, malignancies of all sorts and sizes can be found inside. Treatment is complex and takes a lifetime to master. In this section, I will summarize the various treatment modalities used in intraocular malignancy with a small write-up on chemotherapy and radiotherapy. 1. CRYOTHERAPY Principle of cryotherapy [1],[2] Direct effect Indirect effects: Initial freezing causes vasoconstriction and then the process of thawing causes vasodilation leading to increased permeability and edema Secondary endothelial damage leads to f

    Dr. Bikramjit Pal
  6. Students Gallery 14 Apr 2021 3 min read

    i-File: Stargardts Disease

    Question A 35-year-old otherwise healthy female ( computer professional) presented with OU diminution noticed recently. BCVA OD 6/12 N6 and OS 6/18 N8. Anterior segment including IOP were normal in both eyes. Fundus examination revealed as depicted in the color fundus photo. What is the diagnosis( a differential is preferred) How do you manage this case Answer: The diagnosis is Stargardt’s Disease(SD)/Fundus flavimaculatus (FFM) Few Features: The onset of SD is generally in the first or second decade of life whereas FFM generally manifests after the 3 decades. The main presenting symptoms generally decrease in central vision. VISUAL ACUITY DOES NOT CORRELATE WITH FUNDUS APPEARANCE. Dyschromatopsia, nyctalopia, and visual field loss are generally not present. The earliest clinical sign is the loss of the foveolar reflex with symmetrical RPE alterations. Atrophy of fovea is generally marked by granularity, mottling, and presence of FLECKS(irregular-shaped yellow-white lesions with shapes

    Dr. Bikramjit Pal
  7. Students Gallery 12 Apr 2021 3 min read

    i-File: Idiopathic Juxtafoveal Retinal Telangiectasia

    Question A 61-year-old presented with OU diminution of vision. He complains of distortion of letters which he has noticed in the last few months. He is a well-controlled diabetic for 13 years. There are no other systemic issues. Examination revealed a BCVA of OD 6/18(P) N8, OS 6/24 N8. The anterior segment is unremarkable except for pseudophakia OU (no e/o PCO). Fundus and FFA as shown What is the most probable diagnosis (give your differential)? Which other investigation will help in the diagnosis How will you treat the patient? Answer: Idiopathic Juxtafoveal Retinal Telangiectasia(IJRT) Classification COATS Subretinal exudation without vascular abnormalities Subretinal exudation with vascular abnormalities Exudation with AV malformation This classification is mostly for interest and not followed anymore GASS and BLODI ( 1993) This classification was a modification of the original Gass and Oyakawa classification of 1982 1A) Congenital in nature, having a UNILATERAL presentation in MAL

    Dr. Bikramjit Pal
  8. Students Gallery 12 Apr 2021 5 min read

    i-File: Retinal arterial macroaneurysm (RAM)

    Question A 52-year-old female presented with sudden onset blurring of vision in OD for 2 weeks. She is a known case of hypothyroidism on regular treatment. There is no other systemic illness. The best-corrected visual acuity in OD was 6/36(p) N12 and 6/6 N6 in OS. The anterior segment is unremarkable. The fundus is as shown: What is the most probable diagnosis? How will you manage the case (investigations and treatment both) Answer: RAM is generally acquired retinal aneurysmal dilation typically occurring within the first 3 bifurcations of the central retinal artery most commonly seen in elderly hypertensive females. 1. Clinical Classification a) Hemorrhagic Hemorrhage is the major component extending more than 1 DD with visual loss b) Exudative Exudation is the major component responsible for visual loss c) Quiescent Either there is no hemorrhage or exudation or there exists minimal hemorrhage and exudation with minimal or no visual loss They can be further subdivided as predominantly

    Dr. Bikramjit Pal
  9. Students Gallery 12 Apr 2021 6 min read

    i-File: Vitreous Haemorrhage

    Question A healthy 26-year-male presented with sudden onset diminution of vision in OS of 1-week duration. The loss of vision was not associated with any trauma, pain, redness. No history of flashes. No previous history of a similar episode. On examination BCVA OD: 6/9 N6; OS: HM. Anterior segment unremarkable OU. Fundus: OD: as depicted in the fundus and FFA, OS: had a dense vitreous hemorrhage What are the differentials for the case based on the fundus picture/ Fundus Fluorescein Angiogram? How do you manage it? Answer: Let’s go in a stepwise fashion to decipher this question. The relevant points from history and FFA are The patient is young with no previous such episodes The loss of visual acuity is 1 week Although not mentioned, we presume the patient to be non-diabetic, and is not hypertensive; however, the same needs to be investigated The better eye has a large frond of NVE( neovascularization elsewhere) in the temporal quadrant So differentials in a young with dense vitreous he

    Dr. Bikramjit Pal
  10. Articles 2 Apr 2021 17 min read

    Primary Intraocular Lymphoma

    Introduction Intraocular lymphoma, a great non-infective masquerader occurs intraocularly in either the vitreoretinal( primary vitreoretinal lymphoma PVRL)) or in the uveal space( primary choroidal, iris lymphoma). By definition, PVRL denotes the presence of pathology limited to vitreoretinal space without its occurrence in the central nervous system. The term ‘primary’ is however controversial as almost 56-90% of PVRL patients will ultimately go on to involve the CNS over few months to years( 8-29 months) and is considered a subset of primary CNS lymphoma( PCNSL) [1]. Incidentally, 25% of patients with PCNSL will have concurrent ocular involvement at presentation [2]. Primary choroidal and iridial lymphomas are rarer, less aggressive as compared to their vitreoretinal counterpart and due to their rarity, the following section will deal primarily with PVRL. Pathophysiology of Primary Vitreoretinal Lymphoma The origin of lymphoma cells in the retina is a point of debate. Two etiologies

    Dr. Bikramjit Pal