Retina & Vitreous

61–70 of 72 articles Page 7 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

13 min read

Dos and Donts In Managing Cluster Endophthalmitis

“Everything in life has some risk, and what you have to actually learn to do is how to navigate it.” -Reid Hoffman The above quote holds true for any surgical procedure whether minor or major. The biggest fear of any surgical intervention is that of infection postoperatively. Infection can occur in the best of hands and also in the most modern operating rooms. Cataract surgery is one of the most common intraocular surgeries performed in India and around 90% of postoperative endophthalmitis occurs after cataract surgery. 1 Acute endophthalmitis is severe intraocular inflammation presumed to be due to the entry of microbes into the eye during the perioperative period. It is identified usually in the initial weeks after surgery and could present as a red painful eye with severe anterior uveitis, often with fibrin and hypopyon, and vitritis. It is one of the most serious postoperative complications of intraocular procedures and, despite treatment, often results in a very poor visual outcom

Dr. Dhaivat Shah · Dr. Meghna Jain
23 min read

Scleral Fixated Intraocular Lens Implantation- A Comprehensive Review

Introduction Ideally a cataract surgery should result in the placement of an intraocular lens (IOL) within the capsular bag. However, this desirable outcome might be averted due to either preexisting zonular deficit or intraoperative posterior capsular tear, resulting in aphakia. This necessitates the need for an alternate means of IOL implantation. The surgeon can exercise the options of an anterior chamber IOL or iris fixated IOL or a scleral fixated IOL. Developments in IOL designs and modifications in implantation techniques have rendered them safe and efficacious. Recent studies have reported no significant differences in the postoperative visual recovery or complications rate between the 3 approaches.1 However, each option should be analyzed not only in accordance with surgeon’s experience but also with patient’s age, local, and systemic comorbidities.2 Scleral fixated IOL (SFIOL) involves sutured/sutureless fixation of the IOL to the sclera. SFIOL’s position closely approximates

Dr. Dhanashree Ratra · Dr. Abhinav Dhami · +1 other
19 min read

Peripheral Retinal Degenerations: A Ready Reckoner

Introduction Peripheral retinal degenerations (PRD) are considered a risk factor for rhegmatogenous retinal detachment (RRD) [1, 2]. The annual incidence of RRD varies between 6.3 and 18.2 cases per 100,000. RRD develops when liquefied vitreous humor accelerated by rotary eye movements passes through retinal tears or retinal holes into subretinal space and detaches neurosensory retina from the underlying pigment epithelium. PRDs when missed during retinal examination can lead to vision threatening complications.3 Classification [3] Retinal detachment Retinal drusen Lattice with holes Full-thickness tear Honeycomb degeneration Preretinal fibrosis Retinal tuft Unifocal hypertrophy of the retinal pigment epithelium Hemorrhage Grouped congenital hypertrophy of the retinal pigment epithelium (“bear tracks”) Pearl degeneration Retinoschisis Atrophic retinal hole Snail-track degeneration Dark-without-pressure Snowflake degeneration White-without-pressure Flap tear Operculated retinal tear Pav

Dr. Kartikey Singh.MS · Dr. Mridhula Sekar · +2 others
7 min read

The Novice VR Surgeon -Ten mistakes to avoid

Mastering vitreoretinal surgery is a slow and arduous process with each case being different from the other and it is just about possible to have only a “feel” of a kind of case during the fellowship, not mastery of it. The budding VR surgeon would necessarily have to hone her / his skills in the real world outside their alma mater and the following guidelines can aid mitigate the stress and angst. This is just a comprehensive list, not a complete one, an addendum or a reinforcement of what has been imparted at the fellow ship. 1. Not being familiar with the equipment Vitreoretinal surgery is machine dependent and an optimal surgical outcome is the result of efficient use of equipment, be it the microscope, vitrectomy machine, laser console etc., Knowing the equipment’s capabilities and limitations by reading the manuals will help exploit the machine’s capabilities to the maximum, resulting in an optimal surgical outcome and also minimize complications during surgery. Equipment at the

Dr. P. Mahesh Shanmugam
4 min read

Ten Things You Should Know about Brolucizumab

1. Brolucizumab is a humanized, single-chain variable fragment (scFv) antibody with a molecular mass of approximately 26 kDa that inhibits VEGF-A.[1] (An scFv is an autonomous binding agent that is no longer dependent on a heavy molecular support structure but still retains the full binding capacity to its target). Mechanism of Action of Brolucizumab Unique Properties of Brolucizumab 2. The pharmacokinetics of a single intravitreal (IVT) injection of Brolucizumab in cynomolgus monkeys revealed a mean terminal half-life of 2.4 ± 0.3 days in all ocular compartments. It was cleared from the serum with a mean half-life of 51 hours (approximately 2 days).[2] Brolucizumab Bevacizumab Ranibizumab Aflibercept Molecule Short-chain variable fragment Full antibody (IgG) Monoclonal humanized antibody format Fusion protein Clinical dose in neovascular ARMD 6 mg 1.25 mg* 0.5 mg 2 mg Equivalent Molar dose 11.2-13.3 0.4-0.5 0.5-0.6 1.0 Table: Molecular properties of anti-VEGF agents (ARMD= Age-related

Dr. Anmol Naik
7 min read

Ten points A Postgraduate Should Know while Reading a Fundus Fluorescein Angiogram

Fundus Fluorescein Angiography (FFA) is still a gold standard investigation, for studying the circulation of the retina and partly choroid and highlights the dynamic interaction of the dye with the same. Many adjunct investigations like Optical Coherence Tomography (OCT), Fundus autofluorescence (FAF), Optical Coherence Tomography Angiography (OCTA), etc. help in retinal diagnosis and management, but FFA still remains indispensable. The procedure is relatively simple, involving serial photographs of the fundus, after injecting sodium fluorescein intravenously. However, the information given is immense, and proper interpretation requires a good understanding of retinal anatomy. This article aims at a better understanding of the FFA pictures on digital capture, which is mostly used now as against the old film-based technique. 1. Differentiating pseudofluorescence from true fluorescence The excitation and the barrier filter play a very important role in the interpretation of the FFA pictu

Dr. Neha Mohan
13 min read

Endophthalmitis Management in India: a decade and half after the Endophthalmitis Vitrectomy Study

The current management of post-cataract surgery acute endophthalmitis is greatly influenced by the Endophthalmitis Vitrectomy Study (EVS). The EVS was a multicentric randomized clinical trial that had asked two important questions: (1) Is vitrectomy necessary in all cases of post intraocular lens (IOL) acute bacterial endophthalmitis? and (2) Does systemic antibiotics help in these cases? The EVS recruited 420 patients with acute bacterial post IOL endophthalmitis in 24 centers in the USA. The study recommended that while intravitreal antibiotics must be given to all eyes, vitrectomy should be reserved for eyes with worse presenting vision (light perception, LP, only) and the study did not find any additional benefit of intravenous antibiotics. [1] The major findings of the EVS are listed in Table 1. Are these recommendations followed strictly a decade and half after its first publication in 1995? We will discuss in this article the management strategies we currently practice at the L

Taraprasad Das · Tapas R Padhi · +1 other
24 min read

Diabetic Maculopathy

Diabetic maculopathy is the most common cause of visual impairment in patients with diabetes mellitus. Classification Diabetic maculopathy is classified as – Exudative Maculopathy Ischemic Maculopathy Mixed Maculopathy 1. Exudative Maculopathy (Diabetic Macular Edema) It is diagnosed stereoscopically as retinal thickening within 1 disc diameter of the center of the macula using fundus biomicroscopy. To characterize the severity of macular edema and for treatment guidelines, the term clinically significant macular edema (CSME) is used. Macular edema is clinically significant if one of the following conditions is present: Retinal thickening at or within 500 mm of the center of the macula; and/or Hard exudates at or within 500 mm of the center of the macula if associated with thickening of the adjacent retina; and/or A zone or zones of retinal thickening 1 disk area in size, at least part of which is within 1 disk diameter of the macular center. It is more common in type 2 diabetes (Adult

Priyank Garg · Samarth Agarwal · +2 others
17 min read

OCT in Age Related Macular Degeneration (ARMD) and Polypoidal Choroidal Vasculopathy (PCV)

Optical Coherence tomography (OCT) has revolutionized the way we look at retinal disorders. The earliest version of OCT was the time domain OCT following which spectral domain OCT arrived. Advances such as enhanced depth imaging and swept source OCT have furthered our understanding of retinal disorders. Beginning from the early 90s , OCT has vastly improved the way we diagnose, prognosticate , treat and follow-up retinal disorders.(1) Why OCT? OCT has established itself as one the main imaging modalities in retinal conditions or macular disorders to be more specific. OCT is the most précised method measuring retinal thickness in-vivo.(1) Let us take age related macular degeneration (ARMD) as an example. Understanding the location of the neovascular membrane and its consequences such as intra/subretinal fluid can be clearly understood with the help of an OCT.(2) Prognostic factors such as integrity of the outer retinal layer , RPE alterations such as thickening or fragmentation and the

Dr. Vishal Gowindhari · Dr. Jay Chhablani
22 min read

Management of Rhegmatogenous Retinal detachments- Evidence based Review

Introduction Rhegmatogenous retinal detachment (RRD) although rare, it is a serious ophthalmic condition that can lead to significant loss of vision or blindness without timely and appropriate management. It has been nearly a century (1918) since Jules Gonin demonstrated the importance of localizing and sealing retinal breaks, a procedure termed ignipuncture.1 Scleral buckling techniques, introduced by Custodis2 and refined by Schepens and later Robert Machemer’s pars plana vitrectomy, revolutionized repair of RRDs. Pneumatic retinopexy introduced in the mid 1980s allowed treatment of retinal detachments as an outpatient procedure in selected retinal detachments 3 Above techniques either alone or in combination has resulted in surgical success rates close to 90%. For most surgeons, choice of surgical procedure for primary retinal detachment will depend on the individual clinical situation combined with each surgeon's experience; bias and comfort level with a particular procedure. Recen

Dr. Raju Sampangi MD (AIIMS) · Dr. Hemalatha BC