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All Cornea 36 Cataract 17 Glaucoma 13 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 15

7 Apr 2024 5 min read

Cyclic Esotropia

Cyclic esotropia is a rare form of non-accommodative convergent strabismus which present as 24-hour period of straight eye position followed by 24 hours of large-angle esotropia1. Burian in 1958 described Cyclic esotropia for the first time in English literature2. Duke-Elder3 described the “Cyclic Squint” as a “rare and curious condition which invariably takes the form of a temporary esotropia.” Etiopathogenesis/Theories The etiology of this rare form of convergent strabismus is unknown. Possible theories behind the evolution of such a strabismus include progressive loss of compensation of a latent strabismus, change of a central clock mechanism, and incomplete cerebral dominance, with interhemispheric conflict1 spontaneously or may be precipitated by a trigger. The trigger can be traumatic brain injury, strabismus surgery, extracapsular cataract surgery, retinal detachment with scleral buckling, orbital surgery and ocular trauma 4 . However, many cases have been associated with other

Dr. Sunanda Nandi · Dr. Manju Bhate
26 Feb 2024 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
2 Jan 2024 17 min read

Iris Repair Techniques

Trauma to the iris can present in various ways depending on its severity and location. Tear at the iris root leads to Iridodialysis, while tears at the pupillary border can damage the sphincter muscle, leading to a partially reactive, atonic or Mydriatic pupil. Tears can be full thickness or partial thickness. Full thickness defect involves the iris stroma and partial thickness involves only the posterior pigment epithelium leading to trans-illumination defects. Traumatic Iridodialysis Traumatic Mydriasis Etiology of iris defects: Iris defects can be a consequence of either: Congenital (iris coloboma) Acquired Iatrogenic (iris lesion removal) Traumatic (traumatic mydriasis or injury resulting in pupil irregularity or muscle tear) Complicated intraocular surgery (can cause dialysis, atonic dilated pupil or iris tissue loss and injury) Symptoms: Patients with photic symptoms due to iris defects complain of: Glare, Haloes in bright light conditions, Diplopia, and Trouble reading Patients

Dr. Hema Joshi, MBBS, DO, DNB · Dr. Sasmita Sanghai
21 May 2023 11 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, MS, FMRF, FVRF · Dr. Rubble Mangla · +1 other
20 Apr 2023 8 min read

Intraocular Lymphoma: Ten Points Every Ophthalmologist Should Know

1. Epidemiology of Intraocular Lymphoma: Intraocular Lymphoma is a rare malignancy accounting for 0.01% of ophthalmic conditions. The term includes primary intraocular lymphoma (PIOL) with or without primary central nervous system lymphoma (PCNSL). 1 Majority of the patients with lymphoma are over 50 years of age. 2 2. Presentations and Potential for Misdiagnosis of Intraocular Lymphoma: PIOL has varied presentations; but most commonly, it masquerades as intermediate and/or posterior uveitis; seen mostly as subretinal yellowish creamy lesions with an associated leopard skin type of retinal hyperpigmentation (Figure 1). 3 Figure 1: Shows typical subretinal yellowish creamy lesions with an associated leopard skin type of retinal hyperpigmentation seen in a 44-year-old lady with biopsy proven CNS lymphoma It usually originates from vitreoretina, thus known as primary vitreoretinal lymphoma (PVRL) or from uveal tissue and also the optic nerve. 4 In our experience it has masqueraded and bee

Dr. Mayur R. Moreker, MS (Ophthalmology); MA (Counselling Psychology) · Dr. Sunila Jaggi, MD (Radiology) · +1 other
23 Mar 2023 9 min read

Ten Tenets Every Ophthalmologist should know about Collaborative Ocular TB Study (COTS)

“Ocular tuberculosis, a disease that we fear, Stealthily attacks the eyes, year after year. In the dark and quiet, it spreads its deadly grime, Causing pain and inflammation, and a loss of sight sometimes. Choroidal TB is the commonest sight, With serpiginous-like choroiditis, it takes its flight. Retinal vasculitis too, causes so much pain, Ocular tuberculosis, an insidious foe, it will remain. But hope remains, with the Collaborative Ocular TB Study, Bringing us ten tenets, so clear and so sturdy. To help diagnose and treat, with accuracy and care, And fight against this disease, with the best of our repair. So let's raise awareness, and educate all we can, For ocular TB, we must take a stand. With early diagnosis and prompt treatment in mind, We'll fight this disease, and leave it far behind” *Poem generated by AI # 1: Collaborative Ocular Tuberculosis Study (COTS): What does it represent? The conundrum faced by uveitis specialists is the challenge of establishing a clear and irrefu

Prof. Vishali Gupta · Dr. Rupesh Agrawal
2 Mar 2023 5 min read

Top Ten Tips - Shaping and Sharpening a Clinical Survey

Surveys are helpful in understanding trends in the management of disease, the changes in the way a disease is treated and also how different factors can affect the choices a clinician makes. But the best surveys are the ones that bring out new information on topics, questions or trends that may seem familiar. Here are a few ways on maximising the responses to your survey questions: 1. Brief honest introduction: Usually invitations to participate in surveys are shared through email, social media platforms like Facebook or WhatsApp. It is important to include a brief and crisp introduction about who the investigators are and what does the survey aim to do. Also mention if the survey is anonymous or not: i.e. whether it requires the respondents to identify themselves or not and how long would it approximately take to fill up the survey form and who should be taking this survey. For example: Hello, Greetings. Request all ophthalmology residents in India to take this survey on cataract surg

Dr. Akshay Gopinathan Nair
13 Feb 2023 15 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, MS, FMRF, FVRF · Aishwarya Joshi · +1 other
24 Jan 2023 7 min read

Ten Points A Surgeon Should Know About the Phaco-probe

1. Basic structure of phaco probe Phaco Probe has two attachments (For aspiration & Irrigation) and one wire coming out of back end for power supply and sensors. In the front there is the tip attached to the hand piece, which has a silicon sleeve around it with two apertures. The irrigation tubing are wider in diameter than aspiration and both tubings are colour coded Fig 1 Basic Structure of Phaco Probe 2. Fluid Inflow and Outflow pathway: The fluid flows from the irrigation tube to the handpiece and comes out via two apertures in the silicon sleeve cooling the tip. It then traverses in the AC and is aspirated back via phaco tip and comes out via aspiration tube. Irrigation is gravity based in traditional machines and Active in newer generation machines. Aspiration is always active can be via either peristaltic and venturi pump based. Fig 2 Fluid inflow and Outflow via Phaco Probe 3. Phaco Tip design: Phaco tip is made of titanium alloy. The end of the tip has a bevel, which can be of

Dr. Rohit Rao · Dr. Charudutt Kalamkar
6 Jan 2023 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