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  1. 12 Apr 2021 12 min read

    i-File: Fuchs Endothelial Dystrophy

    A 55-year-old female presented to the Cornea clinic with gradually progressive diminution of vision in both eyes for 1 year, which was associated with intermittent photophobia and colored haloes around lights, especially on waking up in the morning. The blurry vision gradually became clearer as the day progressed. No history of associated pain, watering, redness, itching, or discharge. Past Ocular History: No history of ocular trauma or surgery in the past Past Medical History/ History of Medication: No significant systemic history could be elicited. Patient was not on any medication. No addictions. Family History: No significant family history found Review of Systems/Systemic Examination Systemic examination was within normal limits. All vitals were within normal limits. OCULAR EXAMINATION Best Corrected Visual Acuity (Snellen) Right eye (OD): 6/36 Left eye (OS): 6/12 Ocular Motility/Alignment Full, free, and painless in all gazes Intraocular Pressure (IOP) OD: 16 mm of Hg OS: 16 mm o

    Dr. Hema Joshi, MBBS, DO, DNB
  2. 12 Apr 2021 3 min read

    i-File: Idiopathic Juxtafoveal Retinal Telangiectasia

    Question A 61-year-old presented with OU diminution of vision. He complains of distortion of letters which he has noticed in the last few months. He is a well-controlled diabetic for 13 years. There are no other systemic issues. Examination revealed a BCVA of OD 6/18(P) N8, OS 6/24 N8. The anterior segment is unremarkable except for pseudophakia OU (no e/o PCO). Fundus and FFA as shown What is the most probable diagnosis (give your differential)? Which other investigation will help in the diagnosis How will you treat the patient? Answer: Idiopathic Juxtafoveal Retinal Telangiectasia(IJRT) Classification COATS Subretinal exudation without vascular abnormalities Subretinal exudation with vascular abnormalities Exudation with AV malformation This classification is mostly for interest and not followed anymore GASS and BLODI ( 1993) This classification was a modification of the original Gass and Oyakawa classification of 1982 1A) Congenital in nature, having a UNILATERAL presentation in MAL

    Dr. Bikramjit Pal
  3. 12 Apr 2021 5 min read

    i-File: Retinal arterial macroaneurysm (RAM)

    Question A 52-year-old female presented with sudden onset blurring of vision in OD for 2 weeks. She is a known case of hypothyroidism on regular treatment. There is no other systemic illness. The best-corrected visual acuity in OD was 6/36(p) N12 and 6/6 N6 in OS. The anterior segment is unremarkable. The fundus is as shown: What is the most probable diagnosis? How will you manage the case (investigations and treatment both) Answer: RAM is generally acquired retinal aneurysmal dilation typically occurring within the first 3 bifurcations of the central retinal artery most commonly seen in elderly hypertensive females. 1. Clinical Classification a) Hemorrhagic Hemorrhage is the major component extending more than 1 DD with visual loss b) Exudative Exudation is the major component responsible for visual loss c) Quiescent Either there is no hemorrhage or exudation or there exists minimal hemorrhage and exudation with minimal or no visual loss They can be further subdivided as predominantly

    Dr. Bikramjit Pal
  4. 12 Apr 2021 6 min read

    i-File: Vitreous Haemorrhage

    Question A healthy 26-year-male presented with sudden onset diminution of vision in OS of 1-week duration. The loss of vision was not associated with any trauma, pain, redness. No history of flashes. No previous history of a similar episode. On examination BCVA OD: 6/9 N6; OS: HM. Anterior segment unremarkable OU. Fundus: OD: as depicted in the fundus and FFA, OS: had a dense vitreous hemorrhage What are the differentials for the case based on the fundus picture/ Fundus Fluorescein Angiogram? How do you manage it? Answer: Let’s go in a stepwise fashion to decipher this question. The relevant points from history and FFA are The patient is young with no previous such episodes The loss of visual acuity is 1 week Although not mentioned, we presume the patient to be non-diabetic, and is not hypertensive; however, the same needs to be investigated The better eye has a large frond of NVE( neovascularization elsewhere) in the temporal quadrant So differentials in a young with dense vitreous he

    Dr. Bikramjit Pal
  5. 2 Apr 2021 8 min read

    How to Write Your Thesis

    Getting Started At the very onset, we want to mention that we are no experts writing thesis or papers. But as somebody has correctly mentioned that in our discipline it is time and more time that makes you wise. (hey sorry we don’t have a reference for this). It’s a humble effort on our part to share our experiences with our fellow colleagues, with the hope that it may be helpful to some of them. As the modern lexicon goes Publish or Perish. Unfortunately, it is true. Someday or the other we must write papers, maybe for thesis or for conferences and for somebody just to build up his CV. So we really have to start someday. The toughest part is to begin it. We can really break up it into number of small steps and will be discussing them as we go along. Deciding on a topic It goes without saying that this is the most important part. For many beginners, it is really baffling how to decide on a topic. (more so because of the fact most of the undergraduate curriculums in our country do not r

    Dr. Rupak Roy
  6. 2 Apr 2021 13 min read

    How to examine a case of strabismus ?

    There is no substitute to good history obtained at the start of the examination As history gives us a direction to look for, and find pertinent signs aiding in diagnosis and management. The various presenting complaints could range from abnormal head posture, deviation noticed by parents or friends, intermittent eye closure, double vision and so on. Some important points to be noted in patients with squint include, Family history of squint and wear of glasses (amongst parents, siblings and distant relatives) Personal history starting from birth history- Factors such as prematurity and birth weight, nature of delivery (normal/forceps/cesarean) Deviation – the age at which it was noticed, the direction of deviation (inward/ outward/ other) the eye deviated, constant or intermittent nature of deviation. Further, if deviation becomes more obvious when the child is inattentive, tired or ill. The diurnal or cyclic pattern if any also has to be noted. Any history of convulsion, illness or tra

    Dr. Sowmya R, MS,FMRF, FAICO · Dr. Prerana Tripathi, DO, DNB, FICO
  7. 2 Apr 2021 4 min read

    Tips To Achieve Ideal Rhexis

    Capsulorhexis was pioneered and popularized by Howard Gimbel. Capsulorhexis is probably the most challenging to learn in cataract surgery, in other words, once a good rhexis is done half the battle is won. All the Post- Graduates and beginners struggle to do rhexis. This article has compiled small tips and tricks to do rhexis better. Ideally, rhexis should be continuous and curvilinear i.e Circular, Central & of Correct size (5.5-6 mm). Circular: for proper IOL centering and stabilization in the bag Continous: to prevent rhexis extension Correct size: for IOL centering and to ensure anterior capsule overlapping IOL optic 360 degrees. It can be done with the help of a double bent 26 G/27 G needle or rhexis forceps. Let's break the table and use the advantages of a needle Needle Utrata Forceps Advantages Cheap Disposable Universally available Customized Small diameter, lightweight Can be done through side port so less chance of AC shallowing Precise control Disadvantages Less precise con

    Dr. Rohit Rao · Dr. Charudutt Kalamkar
  8. 2 Apr 2021 3 min read

    FIve Points You Must Note While Examining An Optic Disc

    Disc size A normal disk can be of small size and a normal disk can be of a larger size; size by itself does not determine glaucoma. It is relevant because the disk size determines the C:D ratio and the neuroretinal rim thereof. In a large disc one would expect a large cup and a large neuroretinal rim and in a small disc there is usually no cup. Disc size should be grouped as normal, small or large. Graticule on the slit lamp can be used. In cases with CDR discrepancies disc size should be compared to determine true discrepancy. Disc Shape A normal optic disk is vertically oval with the vertical diameter being the maximum diameter and the horizontal being the minimum diameter. Figure: Vertically oval disc. Note that the vertical diameter is longer than the horizontal diameter The variations in shape may be accompanied with astigmatism and amblyopia. An optic disk is considered torted when the vertical axis of the optic disk is rotated >15° from the vertical meridian. A tilted optic disk

    Dr. Amit Pandey
  9. 2 Apr 2021 6 min read

    Documentation & Drawing in Ophthalmology

    Anterior segment finding Documentations From the days of Hippocrates documentation has been a cornerstone of clinical science. But somewhere down the line this has become a lost art rarely ever practiced by many of us. We tend to ignore or to say correctly run away from it under many pretexts like its time consuming, it’s of no use, etc. And surprisingly this resistance to document is prevalent not only among juniors but spans across the whole spectrum of practitioners. So at times we really ponder is documentation really necessary? The answer is an emphatic yes – the reasons being It’s a standard clinical practice worldwide Follow up is possible only if you can compare it with your previous records. Will help you medico legally Last but not the least unless you are documenting it you have not probably seen it correctly(you think you have seen it all but the moment you come to draw it you find that you don’t remember where the break was it at 1 o’clock or 3 o’clock position and so on).

    Dr. Parthopratim Dutta Majumder
  10. 2 Apr 2021 9 min read

    How to Excel In Microsoft Excel

    Introduction: Microsoft Excel is a vital tool for collecting and analyzing research data. It is available on the Windows platform and seamlessly works on different versions of the Windows operating system. It comes as a part of the Microsoft Office suite and is available with most basic Office versions. Though working on Excel does not require extraordinary knowledge of computers; it does require basic knowledge of the controls on the Excel workbook. Apart from that, Excel has a jargon of its own which needs to be understood to make use of all its features. The aim of this chapter is to enable readers to understand entry, storage, and analysis of data in the Excel sheet. The chapter is divided into three sections dealing with various aspects of Excel. Readers are suggested to use this chapter for a basic overall understanding of Microsoft Excel workspace. At any point, clicking on the “Help” button in Excel will guide them to the Windows Help link on that issue. Section 1: Excel Compon

    Dr. Kumar Saurabh · Dr. Bikramjit Pal