Articles

211–220 of 232 articles Page 22 of 24
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
  1. 1 Apr 2021 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, MBBS, DO, FRCSEd, PhD, FAICO
  2. 1 Apr 2021 14 min read

    Evaluation of a case of Diplopia

    What is diplopia or double vision? Diplopia or double vision by definition is the simultaneous perception of two images of a single object that may be displaced in any direction. Other terms could be blurred vision, shadowing, or confusion. Is it uniocular or binocular diplopia? The first step to evaluate diplopia is to differentiate between uniocular and binocular diplopias as the management varies completely. If the diplopia disappears on covering either eye the diplopia is binocular. If diplopia is persistent or worsens if one of the eyes is occluded then it’s uniocular diplopia of the other eye. Uniocular diplopia Any corneal surface problems like tear film abnormalities, uncorrected astigmatism, early stages of cataract, subluxated lens, or early macular issues can cause uniocular diplopia. A simple pinhole test can confirm the same. The management of this is to address the cause. Binocular diplopia Binocular diplopia is double vision typically arising as a result of strabismus or

    Dr. Kavitha Kalaivani · Dr. Hennaav Kaur Dhillon
  3. 1 Apr 2021 2 min read

    Ten Pearls for Treatment of TB Uveitis

    1. In TB-endemic countries, think of TB as a probable/possible etiology of uveitis in Presence of one or a few large full-thickness choroidal granulomas that show enhanced vascularity/RAP on FFA Retinal periphlebitis with subvascular retinitis/choroiditis lesions/scars that show extensive peripheral retinal ischemia. Multifocal serpiginoid choroiditis/Serpiginous-like choroiditis lesions with vitreous cells. 2. In the presence of any of the above clinical phenotypes, collect evidence of MTB infection by way of tuberculin skin test/QuantiFERON-TB Gold; X-ray/CT chest. The 2-step testing (Bayesian probability) improves the likelihood of MTB as a probable/possible etiology of uveitis in TB-endemic regions. 3. Polymerase chain reaction to detect MTB DNA from ocular fluids has low sensitivity limiting its utility in clinical practice. If positive, it confirms the diagnosis of TBU but a negative test does not rule out MTB. 4. Start 4-drug anti-TB drug regimen in consultation with an internis

    Prof. Amod Gupta
  4. 1 Apr 2021 9 min read

    Ten Pearls in Interpreting Humphrey Visual Field

    A visual field encompasses the area of space or area of the external environment that is seen by a steadily fixating eye. Advances in the technology of visual field testing have changed our clinical perception of normal and abnormal fields of vision. It is of great importance to diagnose and monitor optic nerve diseases, notably glaucoma. Automated perimetry is now the current gold standard for both diagnosis and follow-up of glaucoma. The Humphreys visual field analyzer by Zeiss technology is the most widely used machine for visual field assessment. In this write-up, we will illustrate ten pearls to interpret a Humphrey’s Automated visual field printout. 1. Pre-requisites For a reliable visual field test, a good understanding between the operator (usually an ophthalmic technician) and the patient is important. It is a good practice for the technicians to undergo self-testing in order to get an idea about the procedure and would help in explaining the procedure better. The patient need

    Dr. Faisal Thattaruthody · Prof. Sushmita Kaushik
  5. 1 Apr 2021 8 min read

    Monocular elevation Deficit/ Double elevator palsy

    Definition: Double elevator palsy is classically defined as a congenital inability to elevate one eye, with the limitation more in abduction than adduction.1 MED is most often associated with ptosis/pseudoptosis. The word Double elevator palsy was coined by Dunlap to describe the weakness affecting both muscles of elevation i.e. superior rectus and inferior oblique. Pathogenesis/Theories: 2 Superior Rectus palsy: Superior rectus is the main elevator in abduction, adduction, or primary position. Thus, the defective elevation can be explained by the presence of superior rectus palsy alone. Inferior rectus restriction: Subsequently it was found that inferior rectus restriction can also cause such a limitation. The word double elevator palsy is a misnomer, Nearly 70% of cases, the cause for limitation was found to be IR restriction and not palsy. This was confirmed in several studies using saccadic velocity measurement and forced duction test. Supranuclear palsy: The nucleus for upgaze is

    Dr. Tarika Perikal · Dr. Sowmya R, MS,FMRF, FAICO
  6. 1 Apr 2021 8 min read

    Down's Syndrome: Ten Points All Ophthalmologists Should Know

    Down’s syndrome is a trisomy caused by an extra copy of chromosome 211. The extrachromosomal material is transmitted either by non-disjunction, unbalanced translocation, or mosaicism. It is the most common chromosomal anomaly seen in live births2. As an ophthalmologist, it is important to screen for ocular abnormalities since the incidence of ophthalmic disorders is between 46-100%3. One study found 97 % of children with Down’s syndrome with at least one ocular abnormality4. This proves the necessity to carefully screen these children for any disorders and their prompt treatment. It is recommended that all children diagnosed with Down’s syndrome must undergo evaluation by a Pediatric ophthalmologist before the age of 6 months and then annually thereafter if no abnormalities are found at the first visit 5 Although there are many ophthalmological anomalies seen in Down’s syndrome, we will be discussing only the ten most clinically significant ones below. 1. Refractive Error and Visual ac

    Dr. Nikita Pathare
  7. 1 Apr 2021 5 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, MS, DNB, FMRF, FICO (UK), MRCS (Ed), MNAMS
  8. 1 Mar 2021 8 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
  9. 5 Apr 2020 16 min read

    Dry Eye – A Review

    INTRODUCTION: There are several definitions for dry eye available in world literature. The one that I prefer is the following: Dry eye is a disease in which there is a qualitative and /or quantitative decline in the tears accompanied by disorders of the ocular surface. The new definition proposed by the Dry Eye Workshop (DEWS) in 2006-07 states: Dry eye is a multifactorial disease of tear film & ocular surface resulting in symptoms of ocular discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. This is associated with hyperosmolarity of the tear film and inflammation of ocular surface It is important that dry eye is recognized as a disease entity and not merely regarded as a nuisance. This definition also makes clear that one can have dry eye even in the presence of epiphora, as the quality of the tears may be inadequate to provide lubrication, with normal quantity of tear production. Also, even if the quality and quantity of tears is ini

    Dr. Quresh Maskati, MS, FCPS, DOMS, FICS
  10. 5 Apr 2020 15 min read

    Acute Retinal Necrosis

    Acute retinal necrosis was first described in Japan by Urayama and colleagues who described six otherwise healthy patients, presented with panuveitis and retinal arteritis developing retinal detachment. At that point of time, this entity was known in the Japanese literature as “Kirisawa uveitis”1.Young and Bird first used the term “bilateral acute retinal necrosis” in 1978 2. In 1982 Culbertson and associates 3 first reported the possible involvement of a herpes group virus as the causative agent of acute retinal necrosis syndrome after histopathology and electron microscopy evaluation of an enucleated eye. The Executive Committee of the American Uveitis Society 4 de?ned the disease by its clinical characteristics and disease course in 1994. Epidemiology: Acute retinal necrosis generally affects healthy, immunocompetent individuals regardless of sex or race. However, Fisher et al found little male preponderance in their study 5. The disease affects typically young adults. Bimodal age d

    Dr. Parthopratim Dutta Majumder