Retina & Vitreous

11–20 of 72 articles Page 2 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

8 min read

Anti-VEGFs made Easy for the Postgraduates

The retina is a highly metabolic tissue and needs a constant high supply of oxygen. Insult to either choroidal or retinal vasculature can lead to a hypoxic state. Throughout the years, neovascularization has been seen to occur in areas neighboring such hypoxic areas. In 1989, this hypoxia-inducible and diffusible factor was discovered to be Vascular Endothelial Growth Factor (VEGF), initially coined as Vascular Permeability Factor (VPF). VEGF was found to be answerable for many types of retinopathies and the increased vascular permeability seen in them. VEGF is a heparin-binding dimeric glycoprotein with di-sulfide-linked A and B subunits. VEGF has been found to be produced by many cell types in the retina including vascular endothelial cells, retinal pigment epithelium, pericytes, Muller cells, retinal neurons, and astrocytes. It is necessary for the survival of retinal cells; prenatally for proper embryological development of the retina as well as postnatally for preserving adult mic

Dr. Gunjan Prasai · Dr. Anadi Khatri · +1 other
13 min read

Ten Pearls for Treating A Case of Retinopathy of Prematurity

Introduction Retinopathy of Prematurity (ROP) is a potentially blinding retinal vasoproliferative disorder affecting premature and low birth weight infants. With improving survival of preterm infants with lower birth weights and gestational ages, ROP is reaching epidemic proportions in many middle- income countries.1 Although a majority of infants would develop a mild self-limiting disease, some can progress to tractional retinal detachment and become permanently and irreversibly blind. Timely detection and treatment along with good supportive neonatal care offer the best chance of successful outcomes in these infants. Key pearls of ROP management are described as under: Pearl 1: Which infants should be examined for ROP? The guidelines for screening infants for ROP vary between different countries and geographical regions based on individual incidence rates. For India, the current guidelines recommend that all infants with a birth weight of 2000 grams or less and /or gestational age le

Prof. Mangat Ram Dogra · Dr. Deeksha Katoch
30 min read

Central Retinal Vein Occlusion: A Comprehensive Review

Introduction: The clinical entity of Central Retinal Vein Occlusion (CRVO) has been known since 1878 (1), and it is a common visually disabling disorder that may cause significant ocular morbidity. It commonly affects men and women equally and occurs predominantly in persons over the age of 65 years (2-4). Associated systemic vascular disease, including hypertension and diabetes, are present in these population groups. The prevalence rates range from 0.1% to 0.5% in the older adult population. (3-5) Younger individuals may have an underlying hypercoagulable or inflammatory Etiology (6,7) CRVO is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. (8) The annual risk of developing any type of retinal vascular occlusion in the fellow eye is approximately 1% per year, and it is estimated that up to 7% of persons with CRVO may develop CRVO in the fellow eye within 5 years of onset in the first eye (9-11). CR

Dr. Priyanka Gupta · Dr. Sandeep Kumar · +1 other
10 min read

Ten Clinical Signs A Postgraduate Must Look For While Examining the Fundus

1. Red Dots! : Microaneurysms Seen in Diabetic Retinopathy, retinal vein occlusions, hypertensive retinopathy, radiation retinopathy. Microaneurysms are usually the first ophthalmoscopically detectable sign of diabetic retinopathy. They are focal saccular outpouchings of the capillary wall due to pericyte loss. Arise from the deep part of the inner retinal capillary plexus, and are present in the inner nuclear layer.1 Features: Appear as small round red dots - usually seen at the posterior pole, especially temporal to the fovea. 10- 100 microns in diameter. Only > 30 microns is visible ophthalmoscopically (better on red-free illumination). < 30 microns can be seen on FFA and hence more microaneurysms are seen on FFA than fundus examination. Shapes – saccular, fusiform, pedunculated, focal bulge, irregular, mixed. FFA- Hyperfluorescent with leakage. OCT – Ring sign, span more than 1 retinal layer. Course- disappear in 3-6 months. Can continue to exudate, bleed or thrombose. 2. And it wa

Dr. Sashwanthi Mohan · Dr. Snehal Bavaskar
6 min read

Ten Points One Must Know on Toxic Anterior Segment Syndrome (TASS)

TASS is an uncommon, non-infectious condition causing severe inflammation of the anterior segment structures without vitreous involvement [1],[2],[5]. The name TASS was coined by Monson and colleagues in 1992 [1],[3]. It is usually associated with phacoemulsification surgery but can also happen after procedures like penetrating keratoplasty, descemet stripping automated endothelial keratoplasty, deep anterior lamellar keratoplasty, vitrectomy and anterior and posterior segment phakic intraocular lenses. The alternative names of TASS include sterile post -operative endophthalmitis, toxic lens syndrome, toxic endothelial cell destruction syndrome and localized endophthalmitis [1],[3],[7]. 1. What is TASS? It is an acute sterile post-operative inflammatory condition affecting the anterior segment structures following intraocular surgery. It is usually seen within 12-48 hours of surgery and is due to the reaction of anterior segment structures to some toxic substance usually associated wit

Dr. Priya Rasipuram Chandrasekaran
6 min read

How to Quickly Read a Macular OCT Scan?

Optical Coherence Tomography (OCT) is a quick, non-invasive, reproducible, and optical analog of ultrasound imaging which is as good as in vivo viewing of individual retinal layers histologically. In today’s practice, OCT is indisputably an essential diagnostic tool for every retinal surgeon. And so correct interpretation of OCT scans helps us in understanding the disease pathologically which in turn aids in prognosticating and making treatment decisions. How to quickly read a macular OCT? An OCT image gives you layer by layer information of retinal tissue. So if we segment the OCT image into 5 layer-wise sub-segments, it becomes very easy to read and interpret the retinal pathology. And also just by looking at the diseased/damaged retinal layer, we can identify probable clinical disease. These 5 OCT sub-segments can be used for quick interpretation of macular OCT scans. 1: VR (Vitreo-Retinal) Interface 2: Inner Retina 3: Outer retina 4: RPE/ BRUCHS MEMBRANE 5: Choroid Let us first rev

Dr. Deepak Bhojwani
6 min read

i-File: Asteroid Hyalosis

Chief Complaint: A female patient of 58 years old who came for a routine eye examination. History of Present Illness: No specific complaints. Past Ocular History: No H/O any previous injury. Past Medical History/ History of Medication: Known diabetic for the past 10 years and on control with oral hypoglycemic agents. Family History: No significant family history. Review of Systems/Systemic Examination Pulse rate - 88/min, respiratory rate - 16/minute. BP- 120/80 mm Hg. Examination of other systems were normal. Ocular Examination Best Corrected Visual Acuity (Snellen) Right eye (OD): 6/6 p N6 Left eye (OS): 6/6 N6 Ocular Motility/Alignment Extraocular motility was full and free in all gazes in both eyes. Intraocular Pressure (IOP)- By Applanation tonometry Right eye (OD): 14mm Left eye (OS): 16mm Pupils: Both eyes (OU) - round and briskly reacting to light. Slit-lamp examination: Lids/lashes: Both eyes (OU)- normal. Conjunctiva/sclera: Both eyes (OU) - normal. Cornea: Both eyes (OU) – c

Dr. Priya Rasipuram Chandrasekaran
5 min read

Ten Mistakes to Avoid while Treating a Case of Diabetic Retinopathy

Diabetic Retinopathy is a common retinal disorder that is seen, managed, and followed up by not only a retina specialist but all ophthalmologists. It is a disease that is easy to diagnose, but often difficult to manage in a long run. For achieving optimal results besides the role of an ophthalmologist, one needs to have the involvement of a physician. The single most important factor for achieving a good outcome is patient compliance, as the disease, diabetes needs lifelong care. Here are few mistakes we need to avoid while managing a case of DR. 1. I can detect DME clinically, I don’t need OCT OCT is not mandatory if there are no signs of DR, or in very mild retinopathy (1 D, Amblyopia, Unilateral elevated intraocular pressure, Complete posterior vitreous detachment, Unilateral carotid artery stenosis, and Chorioretinal scarring 5. Ignoring a rapid progression of milder NPDR to PDR A rapidly progressive NPDR to proliferative retinopathy in a span of a few months (4-6 months) is rare a

Dr. Rajiv Raman
10 min read

Making Sclerotomy Ports during a Vitreoretinal Surgery: Tips, Tricks and Concerns

The advancement of vitreous surgery from the 20-gauge (20G) era to the present day Transconjunctival Sutureless Vitrectomy (TVS) has favorably transformed patient outcomes in the surgical management of retinal diseases. The 20G system (O’Malley and Heintz, 1974) has been the gold standard technique in modern vitreous surgery for nearly three decades, beginning from the earliest 17G vitrectomy as introduced by Machemer in 1971. The 20G systems were associated with sutured port closure, longer and irregular wound healing, higher vitreous turbulence, greater incidence of port-related complications like retinal breaks, and a longer surgical time. On the other hand, the trochar and cannula based micro incision vitrectomy surgery (MIVS) are associated with early post-operative recovery, better and uniform wound healing, lesser port related complications, lesser vitreous turbulence and increased patient comfort with earlier visual recovery. As with any surgical procedure, the decision and pla

Dr. Aditya Verma
14 min read

OCT-Angiography in Retinal Diseases Made Incredibly Simple For Post Graduates

Introduction: Optical coherence tomography angiography (OCT-A) has emerged as a novel imaging technique for visualizing the retinal and choroidal microvasculature at the macula and optic disc.1 It provides in vivo 3D vascular information by analyzing the movement of flowing red blood cells and thereby enabling the visualization and quantification of functional vessel networks within microcirculatory tissue beds in a non-invasive manner without the use of dye injection.2 Understanding the anatomy of retinal and choroidal microvasculature (figure 1): Retinal microvasculature: Studies have identified 4 retinal vascular capillary networks at the macula which are broadly grouped into 2 vascular plexuses; superficial and deep.3 The superficial vascular plexus (SVP) consists of the superficial capillary plexus and radial peripapillary capillary plexus. The former is located in the ganglion cell layer and the latter in the retinal nerve fibre layer. The SVP receives its blood supply from the c

Dr. Ramesh Venkatesh · Dr. Nikitha Gurram Reddy · +1 other