Retina & Vitreous

1–10 of 72 articles Page 1 of 8

All Cornea 36 Cataract 17 Glaucoma 14 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 16

7 min read

Retinopathy Of Prematurity: 10 Things for the Ophthalmologist to Know

1. The birth of ROP: Retinopathy of prematurity ROP was born as a corollary of improved neonatal care when smaller/ more premature babies began to survive with oxygen support. While a number of risk factors have been studied, prematurity and oxygen have emerged as major driving factors in the pathogenesis of ROP. Animal models have provided deeper insights into understanding this relatively new blinding disease in mankind. 2. The Burden: An estimated 13.4 million babies were born preterm in 2020, of which 3.02 million were from India, accounting for over 23% of all preterm births worldwide. [1,2] Also, in India, it is not uncommon for heavier and older babies to develop treatment?requiring ROP, unlike in the developed countries, due to the more rampant use of unregulated oxygen as a lifesaving measure.[3] With this, the burden of retinopathy of prematurity (ROP) screening has increased tremendously in the backdrop of a preexisting strained doctor?to?preterm child ratio with

Dr. Puja Maitra
6 min read

Do's and Don'ts of Managing a Nucleus Drop: A Guide for Beginners

Managing a nucleus drop during cataract surgery is one of the most challenging and critical situations an ophthalmic surgeon may encounter. While it’s a rare occurrence, its management demands quick thinking, precise action, and a thorough understanding of both anterior and posterior segment techniques. The goals are always to preserve vision, prevent complications, and optimize the long-term outcomes for the patient. Different surveys in India have found the incidence rate of nucleus drop between 0.04-0.1%. (1,2) Dropped nucleus and cortical remnants occur most commonly in phacoemulsification, than other techniques of cataract surgery. (3) Certain conditions associated with posterior capsular or zonular weakness have a higher risk of nucleus drop in cataract surgery. These include the following (4): Pseudoexfoliation syndrome Advanced or intumescent cataract Traumatic cataract Previous intraocular surgeries like vitrectomy or glaucoma procedures Difficult situations like shallow AC, s

Dr. Dhanashree Ratra · Dr. Sakshi Ramnani
16 min read

Current Trends and Techniques in Pneumatic Retinopexy

Introduction Over the past few decades, the approach to treating primary rhegmatogenous retinal detachment (RRD) has undergone significant changes. Initially, scleral buckle (SB) was the standard method, followed by the occasional use of pneumatic retinopexy (PnR), and more recently, pars plana vitrectomy (PPV). This shift has primarily been driven by technological advancements rather than considerations of post-operative functional outcomes or the effectiveness of retinal reattachment.1 However, there is now a growing interest in ensuring both the integrity of reattachment and the resulting functional outcomes, spurred by the availability of multimodal imaging. The goal is not only to increase the success rate of retinal reattachment but also to optimize the reattachment process for the best possible functional results. One challenge observed with PPV is post-operative retinal displacement, also known as a low-integrity retinal attachment (LIRA)2–4. This displacement occurs due to the

Dr. Abhinav Dhami · Dr. Aditya Bansal · +1 other
9 min read

Seven Important OCT Signs in CNVM

1. Type of macular neovascularisation (MNV): Macular neovascularisation (MNV) is a broad disease entity characterised by the development of the abnormal vessels arising either from the retinal vasculature (deep capillary plexus) or choroidal vasculature (choriocapillaris). Choroidal neovascular membrane (CNVM) is a subtype of MNV, characterised by the abnormal growths of blood vessels from the choroidal capillaries that penetrate the retina, specifically into the sub-RPE and subretinal spaces. These vessels are extremely immature and extremely fragile, so they bleed and leak, de-structuring the macula, causing severe visual impairment. The classification of MNV is depicted below in Figure 1: Figure 1: A simple classification of macular neovascularisation (MNV): 2. Cause of CNVM: A CNVM is primarily classified based on the etiology into two categories: A) Age-related Macular Degeneration (AMD) associated CNVM and B) Non-AMD associated CNVMs. Causes of non-AMD associated CNVMs: Central s

Dr. Ramesh Venkatesh · FVRF (Sankara Nethralaya) · +2 others
11 min read

Optical Coherence Tomography Biomarkers in Diabetic Macular Edema

One of the major microvascular complications of diabetes mellitus is diabetic retinopathy. Diabetic macular edema (DME) and proliferative diabetic retinopathy are the most common causes of vision loss in diabetic retinopathy. Pathogenesis of DME: A simplified understanding of the pathogenesis of DME formation is depicted in Figure 1: The role of vascular endothelial growth factor (VEGF) and inflammation in the pathogenesis of DME is depicted in Figure 2: OCT is a non-invasive imaging technique that is widely used in routine retina practice to obtain a high-definition cross section of all retinal layers and to measure their thickness. Recent advances in OCT imaging, such as the introduction of spectral-domain and swept source-based optical coherence tomography (OCT) and enhanced depth imaging, have enabled clinicians to detect and understand the various aspects of DME formation and treatment. This article will discuss the role of various OCT imaging biomarkers in identifying diabetic ma

Dr. Ramesh Venkatesh · Isha Acharya
7 min read

Ten Tenets of Diagnostic Vitrectomy

Diagnosis of posterior segment inflammatory or infectious disease is mostly based on clinical presentation, ocular imaging and specific laboratory tests. However, in the absence of a characteristic clinical picture of a specific disease the diagnosis of uveitis can be challenging. It has been reported that upto 33% of uveitis remain undiagnosed. Moreover, some of the malignant or infective diseases of the eye may mimic an inflammatory pathology leading to delay in diagnosis and subsequently poor outcomes. Intraocular biopsy may be helpful in clinching the diagnosis in these situations. With the improvement in laboratory testing and vitrectomy instrumentations, diagnostic vitrectomy is increasingly being performed in clinical practice. 1. Indications 1,2 Diagnostic dilemma Patient fails to respond to standard systemic anti-inflammatory therapy Atypical clinical presentations Inconclusive non-invasive laboratory work-up Significant vitreous inflammation concerning for malignancy, infecti

Dr. Jayanti Singh · Dr. Alok Sen
9 min read

Practical Tips for Retinopathy of Prematurity Screening

Retinopathy of Prematurity (ROP) is a proliferative disease of the retina which affects developing retinal vessels of prematurely born infants. The screening process should be carried out within 1 month of delivery of the infant. Delaying this or missing out on screening could result in the progression of abnormal neovascularization, which can lead to the development of tractional retinal detachment in the absence of treatment and this could result in irreversible blindness. There are various aspects one needs to take care of while carrying out ROP screening. Here are a few practical tips for carrying out an effective screening and follow-up in premature infants for ROP. This might be useful for paediatricians / hospital staff as well, to understand the importance of screening and ways to aid in carrying out a successful screening procedure. 1. Infant to be screened: Whom to screen? Different countries have different screening guidelines. Ours is a developing nation with even bigger in

Dr. Deepanshu Agrawal
21 min read

Endogenous Endophthalmitis: A Review

Introduction Endophthalmitis is defined as an inflammation of the inner layers of the eye with exudation in the vitreous cavity resulting from intraocular colonization by microorganisms. It can be exogenous or endogenous. It is an ocular emergency with poor visual prognosis and multifactorial etiology. Endogenous endophthalmitis is much less common than exogenous endophthalmitis and is estimated to account for 2% to 8% of all endophthalmitis cases.1,2 It occurs when bacteria or fungi are hematogenously disseminated into the ocular circulation. The visual prognosis is often poor. The risk of septicaemia with a mortality rate of 5-15%.2 is reported, and therefore a prompt diagnosis of the underlying cause of endogenous endophthalmitis along with the control of eye infection is of utmost importance. Risk factors Endogenous endophthalmitis has multiple factors playing a role in its occurrence. (Table 1) The following are the risk factors for endogenous endophthalmitis- long-term indwelling

Dr. Manisha Agarwal · Dr. Isha Agarwal
7 min read

Ten Pearls for Managing A case of Proliferative Diabetic Retinopathy

Diabetes has reached epidemic proportions in many developing economies, such as China and India. Type 2 DM contributes to 90% of the cases. An astonishing 53 % of these cases remain undiagnosed(1). Health-seeking behaviour in India is amongst the poorest with 90% of patients being not aware of the need for regular fundus examination(2). The onus of imparting knowledge on such patients lies with the primary health care provider at the time of diagnosis. It is also the prime duty of the patient to gain knowledge about the disease. Catch them early Advice on the need for regular fundus examination should be given during the time of diagnosis. For type 2 diabetes, screening guidelines are fundus examination at the time of diagnosis and thereafter yearly, mild NPDR - yearly, moderate NPDR - 6 monthly, severe NPDR - 3 monthly follow up are mandatory. High resolution fundus images can be used for follow-up and patient education. Deep learning, a state-of-the-art machine learning technique is

Dr. Indu Govindaraj · Dr. Anand Rajendran
4 min read

Pearls for Indirect Ophthalmoscopy

Using the indirect ophthalmoscope proficiently is a difficult skill to master, nevertheless is an indispensable one. With adequate practice, you will eventually come to terms with it. Here are a few tips and tricks to help you with it. Important but often likely to be missed: Every day, check if the optics of the indirect ophthalmoscope is working properly and, if wireless- that the battery pack is charged. (Finding out that the optics is not working properly or the indirect ophthalmoscope switching off in the middle of the examination is not only embarrassing but may also undermine the impression that your patient will have about you). Have a dedicated switch to turn off the room light nearby your examination station. It is often easier to “do it yourself” than to command to others/assistant for the lights on and off. Ask them if they are driving or riding or have an important work immediately after the visit at your clinic. Defer the examination to a later time/date if any of the abo

Dr. Anadi Khatri · Dr. Gunjan Prasai