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33 articles
  1. Articles 20 Jul 2021 13 min read

    Ocular Oncology Basics: Treatment Strategies In Intraocular Malignancies

    “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” Jim Valvano Treating malignancies I believe, brings the true human spirit forward of the treating physician. Breaking the news of malignancy to a patient is as heartbreaking for the physician as it is for the patient. Yet the doctor must keep his feelings aside and do his best. Even though the human eye forms a small fraction of the human body, malignancies of all sorts and sizes can be found inside. Treatment is complex and takes a lifetime to master. In this section, I will summarize the various treatment modalities used in intraocular malignancy with a small write-up on chemotherapy and radiotherapy. 1. CRYOTHERAPY Principle of cryotherapy [1],[2] Direct effect Indirect effects: Initial freezing causes vasoconstriction and then the process of thawing causes vasodilation leading to increased permeability and edema Secondary endothelial damage leads to f

    Dr. Bikramjit Pal
  2. 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
  3. Articles 8 Jul 2021 30 min read

    Anterior Segment Optical Coherence Tomography in Diseases Of The Ocular Surface And Cornea

    I. Introduction : Anterior segment optical coherence tomography (ASOCT) is a sophisticated non-contact imaging device that produces high-resolution images for detailed assessment of the structures of the ocular surface and anterior chamber in various disease conditions. Starting from the earlier generation time-domain devices first described in 1991 by Huang et al [1] to the current Fourier-domain OCT devices, the technological advancement in this device has improved the diagnostic ability tremendously. This imaging modality has evolved into a highly precise tool for clinical diagnosis and management as well as in research and understanding disease pathology. In this review, we describe the evolution of ASOCT, its technology in brief and focus on highlighting the various clinical applications with examples. While Izzat et al first introduced the use of AS-OCT for imaging the anterior segment of the eye [2], it is well known that the OCT initially evolved as a tool for retinal imaging.

    Dr. Supriya Sharma · Dr. Somasheila Murthy
  4. Articles 16 Jun 2021 14 min read

    OCT-Angiography in Retinal Diseases Made Incredibly Simple For Post Graduates

    Introduction: Optical coherence tomography angiography (OCT-A) has emerged as a novel imaging technique for visualizing the retinal and choroidal microvasculature at the macula and optic disc.1 It provides in vivo 3D vascular information by analyzing the movement of flowing red blood cells and thereby enabling the visualization and quantification of functional vessel networks within microcirculatory tissue beds in a non-invasive manner without the use of dye injection.2 Understanding the anatomy of retinal and choroidal microvasculature (figure 1): Retinal microvasculature: Studies have identified 4 retinal vascular capillary networks at the macula which are broadly grouped into 2 vascular plexuses; superficial and deep.3 The superficial vascular plexus (SVP) consists of the superficial capillary plexus and radial peripapillary capillary plexus. The former is located in the ganglion cell layer and the latter in the retinal nerve fibre layer. The SVP receives its blood supply from the c

    Dr. Ramesh Venkatesh · Dr. Nikitha Gurram Reddy · +1 other
  5. 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
  6. Articles 4 Jun 2021 15 min read

    Trials in Glaucoma You Should Know

    Ocular Hypertension Treatment Study (OHTS) This multicentric trial recruited 1,632 patients of ocular hypertension (OHT) to answer two questions. First, if early treatment in patients of OHT with topical medication would prevent the onset of primary open-angle glaucoma (POAG). Second, which patients of OHT are more likely to develop POAG, in other words, what are the risk factors for conversion from OHT to POAG? The patients who had IOP of at least 24 mmHg in one eye and 21 mmHg in other eye, were recruited in this study. They were randomized into two groups-those who received intraocular pressure (IOP) lowering drops (Medication arm) and those who did not receive any IOP lowering drops (Observation arm). The IOP reduction was targeted at 20% in the medication group. After enrollment, patients were examined every 6-months and follow-up included a white-on-white visual field at every visit and stereoscopic disc photograph annually. The endpoint was the development of new, reproducible d

    Dr. Parveen Rewri
  7. Articles 1 Jun 2021 10 min read

    Ten Microbiological Facts on Mucormycosis All Ophthalmologists Should Know

    The present overview highlights major microbiological aspects of mucormycosis and attempts to increase the awareness of this ubiquitous group of fungi that are responsible for the difficult-to-manage infections presently being encountered in the setting of the ongoing COVID-19 pandemic. 1. What is Mucormycosis and why is mucormycosis emerging as a serious threat in the present COVID-19 pandemic? Mucormycosis (previously called zygomycosis; sometimes called black fungus infection) is a serious, but rare fungal infection caused by a group of molds belonging to the order Mucorales(1). Mucormycosis is a fulminant disease with high rates of morbidity and mortality that mainly affects immunocompromised patients. Depending on the location of the infection, the mucormycosis can be rhino-orbito-cerebral (most common), pulmonary, gastrointestinal, cutaneous, or disseminated. Although it has a low incidence rate, varying from 0.005 to 1.7 per million population, a sudden rise in cases of rhino-or

    Dr. A.R Anand
  8. Articles 5 May 2021 23 min read

    Simple Limbal Epithelial Transplantation: A Review

    I. Introduction The cornea is lined by non-keratinized, stratified squamous epithelium. At the limbus, there is a gradual transition of these cells to non-keratinized, stratified columnar epithelial cells, along with mucin-secreting goblet cells, forming the conjunctival epithelium. The corneoscleral limbus lies between these two epithelia in a healthy eye. The limbus contains palisades of Vogt, the basal layer of which function as a repository for the corneal epithelial stem cells.(1, 2) These limbal epithelial stem cells (LESC’s) divide whenever the corneal epithelium is required to be replenished. As the stem cells divide, one of the daughter cells retains the primitive nature of the parent cell and functions to maintain the stem cell pool. The other daughter stem cell differentiates to acquire the physiological nature of a specific tissue, like the corneal epithelium. These cells are known as ‘transient amplifying cells’, which then divide and migrate centripetally, circumferential

    Dr. Supriya Sharma · Dr. Swapna Shanbhag · +1 other
  9. Interesting Reads 28 Apr 2021 5 min read

    Balancing Clinical and Research Work

    How does one balance between clinical and research work? This is an often-repeated question-probably because the answer is never clear. The fulcrum of the balance is not the same for everyone. Let us pause for a while and try to define certain things to bring clarity. What is clinical work? This is perhaps best defined as the time and effort involved in direct care of patients. Obviously, it also involves the time spent on organising the system that permits the above activity to take place smoothly. What constitutes research work? Technically research involves trying to find answers to the unknown or partially known. This should mean trying to understand the etiopathology of diseases which are poorly understood and finding new ways of managing them better. Broadly clinicians can be involved in clinical research, basic research or both. Clinical research can be prospective research such as observational studies, clinical trials, epidemiological studies etc but could also be retrospectiv

    Dr. Lingam Gopal
  10. Articles 12 Apr 2021 25 min read

    Choroidal Neovascular Membrane: Made Easy For Postgraduates

    Introduction Choroidal neovascularization (CNV) or choroidal neovascular membrane (CNVM) is a growth of new choroidal vessels into the subretinal space through breaks in the Bruch's membrane. Ophthalmoscopically the CNVM appears as a greenish-grey lesion, often with a detachment of the sensory retina, subretinal blood, and exudates. Choroidal neovascularization can be multifactorial with the commonest being due to age-related macular degeneration (AMD), called the wet or exudative AMD. The other causes of include high myopia, angioid streaks, presumed ocular histoplasmosis syndrome, choroidal rupture post-trauma, osteoma, macular telangiectasia, inflammatory and idiopathic. Since the most common cause of CNVM remains age-related, this writeup will focus on the same. Age-related macular degeneration is the most common cause of blindness in the western world over the age of 65 years. With a worldwide UN estimate of about 20-25million, 8 million individuals are in the USA alone.1 The numb

    Dr. Santosh Gopi Krishna Gadde · Dr. Nikitha Reddy Gurram · +1 other

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