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#Learn from Masters

28 articles
  1. Articles 13 Feb 2023 11 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 · Aishwarya Joshi · +1 other
  2. Articles 2 Nov 2021 5 min read

    Diplopia Charting: A Ready Reckoner for the Postgraduates

    Diplopia charts are kept in postgraduate examinations during viva sessions. Even in theory examinations also, these topics may be asked. It is not difficult to interpret the charts and all PGs should practice recording the results of these charts. Principle: Dissociation of eyes by means of complementary colors. We use red and green goggles (Armstrong google). In diplopia charting, Red is always in the Right eye and patients perceive one object as two fused images. Let us see the method of interpretations of these charts See the chart Remember red and green goggles are used. Red in front of the right eye and Green in front of the left eye. To your right side (The right side of the picture). Version positions. Dextrum version. Elevation and Depressions are there. The left side of you is the left side positions like levoversion, elevation and levodepression are there Primary position elevation and depressions are noted. Totally we have nine quadrants Never forget to write the name of the

    Dr. (Capt) V.R Vijayaraghavan
  3. Articles 28 Sep 2021 4 min read

    Top-Ten-Must-Not-Forget-In-Strabismus-Evaluation

    1. External face features affecting the eye position Facial asymmetry and palpebral fissure shape changes alter the ocular position, possibly due to extra-ocular muscle heterotopy The common extra-ocular features affecting ocular position are craniosynostosis, hydrocephalus, facial fracture, mongoloid and anti-mongoloid slant, telecanthus, congenital superior oblique palsy (face fuller on the affected side), facial nerve palsy. 2. Head posture Head does what eye cannot do Look for abnormal head posture when a patient is reading best-corrected visual acuity with proper refractive correction. The target should preferably be at the eye level of the patient in order to avoid a false chin-up position Head tilt, turn, chin-up/down Head turn is the opposite side of the ear seen Measure with a goniometer Look for incomitant strabismus and nystagmus Keep patient’s head straight throughout the examination – eg. In patients with Duane syndrome, small change in head posture can cause large ocular

    Dr. Goura Chattannavar · Dr. Virangi Doshi · +1 other
  4. Articles 23 Sep 2021 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
  5. Articles 17 Aug 2021 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
  6. Students Gallery 9 Aug 2021 5 min read

    Pearls for Practical Exam in Ophthalmology for Postgraduates

    Facing PG practical examination in ophthalmology is not difficult. However, the student must prepare properly to face it. Please remember the examiners are coming to help only. Therefore, the student should not be afraid of the examiners. Preparations for the practical exams During the course The preparation to face the exams is a continuous process starting from the beginning of the course. Students must discuss about the patients with classmates, seniors also, apart from presenting to the teachers. Always take the guidance of teachers. Don’t feel shy to ask any doubts to your teachers. Teachers will definitely help you. Don’t hesitate to present cases many times before appearing for the exams. Nothing wrong with presenting the same patient to different consultants. This will help you to know the different views of different teachers. These types of approaches during your residency period will give you enough confidence. Learn the method of interpreting different investigations charts

    Dr. (Capt) V.R Vijayaraghavan
  7. Students Gallery 5 Aug 2021 2 min read

    Ten Tips for OSCE

    Objective structured clinical exam (OSCE) has regained popularity as a significant part of practical examinations in recent times. This is in part due to the pandemic making it difficult to hold exams with actual patients. It also removes subjective bias and is considered a fair way to examine candidates. There are certain strategies that enable the student taking an OSCE based exam to do well and score maximum points. Here are some tips Preparation stage 1. Go through images in an atlas. Most OSCEs are image-based. So pay attention to clinical features by going through as many online free atlases that are available on the internet. Practice describing findings to your study partner. 2. Go through surgical videos. Videos of surgery may be shown as part of OSCEs with a review of steps and complications may be asked as an OSCE. 3. Revise the clinical trials and the acronyms. These are often asked as well. Many websites and textbooks have comprehensive tables that make revising trials eas

    Dr. Meenakshi Swaminathan
  8. Articles 28 Jul 2021 16 min read

    Papilledema- A Ready Reckoner for Postgraduates

    Introduction Papilledema is used to describe optic disc edema resulting from increased intracranial pressure while disc edema could be due to any cause. While disc edema can be unilateral or bilateral, papilledema is usually bilateral, however, it can be asymmetric, to begin with. Another important differential of true papilledema is pseudo papilledema which is seen in conditions like a small hyperopic optic disc or optic disc drusen, etc. This chapter shall entail a discussion on the etiopathogenesis of papilledema and the approach to diagnosis and management of papilledema. Papilledema and its mechanism It’s a form of bilateral optic disc swelling associated with increased intracranial pressure. An increase in intracranial pressure can occur secondary to an intracranial space-occupying lesion, cerebral venous thrombosis, or can be idiopathic as in the case of Idiopathic Intracranial hypertension (IIH). Figure 1 depicts the mechanism of the development of papilledema. Pseudo vs true p

    Prof. Rohit Saxena · Dr. Monika Yadav · +1 other
  9. Articles 20 Jul 2021 11 min read

    Ten Pearls for the Management of Posterior Capsular Rupture

    Posterior capsular rupture (PCR) is an important complication of cataract surgery whose timely recognition and appropriate management can ensure a good visual outcome. Here are ten pearls for its prevention and management. Pearl 1: Understand the risk/predisposing factors It is imperative to assess the preoperative and intra-operative risk to prevent the development of a PCR. Elderly, anxious, and uncooperative patients are at a higher risk of developing posterior capsular rupture. Extraocular factors include a deep socket, narrow palpebral fissures, exaggerated bell’s phenomenon, hazy cornea, and intraocular factors are poor mydriasis, shallow or excessively deep anterior chamber, pseudoexfoliation, and type of cataract (like posterior polar, traumatic, post-intravitreal injections, intumescent or hard cataract), previous vitrectomy or oil-filled eyes. Surgical factors like inexperience of the surgeon, leaking incisions, small capsulorhexis, radial tears in rhexis, fluid imbalance in

    Dr. Arup Chakrabarti · Dr. Nirupama Kasturi
  10. Articles 7 Jun 2021 5 min read

    Pearls in the Diagnosis and Management of Rhino-Orbito-Cerebral-Mucormycosis

    “The more you know about the past, the better you are prepared for the future.” – Theodore Roosevelt 1. Elicit adequate history Considering the lethal and angio-invasive nature of Rhino-Orbital-Cerebral-Mucormycosis (ROCM) supplemented in this COVID-19 era, it is mandatory to understand the causative factors of the disease. Diabetes mellitus, oral and systemic corticosteroids, immunosuppressive drugs like tocilizumab, remdesivir, hospital admission, supplemental oxygen, mechanical ventilation, primary or secondary immunodeficiency, hematological malignancies, stem cell transplantation, solid organ malignancies and solid organ transplantation, iron overload etc have been considered the important predisposing factors. The history acts like the guiding lantern onto the path towards appropriate management. “Ignoring the signs is a good way to end up in the wrong destination” 2. Identify the Red Flag signs In-depth knowledge about the red flag signs enables the clinicians to recognize the w

    Dr. Rolika Bansal · Dr. Santosh G Honavar, MD, FACS

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