Topic

#Pediatric Ophthalmology

19 articles
  1. Articles 1 Apr 2021 15 min read

    Paediatric Retinal Vascular Diseases

    Introduction This chapter will discuss pediatric retinal vascular diseases like Persistent Fetal Vasculature, Familial Exudative Vitreo Retinopathy and Incontinentia Pigmenti Persistent Fetal Vasculature (Persistent Hyperplastic Primary Vitreous) Definition Persistent hyperplastic primary vitreous (PHPV) is a congenital ocular disorder in which fetal vasculature does not regress after birth. It is unilateral approximately 90% of the time. No single gene has been identified. It can vary from very subtle with no visual disturbance to as severe as phthisis bulbi or secondary glaucoma. The prognosis can be good if early intervention is planned. Due to its wide spectrum of presentation, it has now been renamed as persistent fetal vasculature (PFV).1 Pathogenesis The fetal vasculature is composed of two parts: Tunica vasculosa lentis. It is situated anteriorly encircling the lens. It has anterior and posterior divisions. Anteri­or division has additional attachments to the pupillary frill of

    Parag K. Shah, DNB · Dr. V. R. Saravanan · +1 other
  2. Articles 1 Apr 2021 9 min read

    Esotropia Made Simple for the Postgraduates

    As like other strabismus, esodeviation can be, True esodeviation Pseudo esodeviation A prominent epicanthic folds 1, 2 Negative angle kappa in high myopes. True esodeviation can be either comitant or incomitant 1,2 A. Comitant I. Accommodative esotropia. Refractive accommodative esotropia (normal AC/A ratio) Non Refractive accommodative esotropia (high AC/A ratio) Hypo accommodative esotropia (reduced NPA) Partially accommodative esotropia II. Non-accommodative esotropia Essential infantile esotropia Non-accommodative convergence excess Acquired esotropia Acute Onset esotropia Divergence insufficiency or paralysis Cyclic esotropia Recurrent esotropia III. Microtropia IV. Nystagmus blockade syndrome. B. Incomitant Paralytic - Neurogenic (VI nerve palsy) Nonparalytic- Myogenic (ocular myasthenia) A & V pattern syndromes Duane’s retraction syndrome Mechanical – restrictive esodeviation Congenital fibrosis syndrome Acquired Dysthyroid eye disease Trauma to the orbital wall Myositis (IOID)

    Dr. Sowmya R, MS,FMRF, FAICO
  3. Articles 1 Apr 2021 18 min read

    Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 2

    Read Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 1 After the discussion on the etiology of pediatric cataracts, and about when and how to operate we go further to know about choosing the IOL formulae, IOL material and power of IOL to be implanted in children. Also, an insight into the post-operative rehabilitation with follow up eOphtha: Considering the varied opinions in choosing the IOL formulae for pediatric cataracts , what’s the formulae used in your practice ? Do you use different formulae in microphthalmic eyes? Dr. Bharti Gangwani : I use Holladay 1 for young children and small eyes with AL < 22 mm and SRK/T for older children with AL > 22 mm. No I do not use different formula in microphthalmic eyes though many of these eyes are left aphakic if the eye is really small. Dr Kalpana Narendran : SRK - T formula is used. If Axial length 22 – SRK T. Dr. Sudarshan Khokhar: We use modified SRK 2 or SRK/T formula for IOL power correction for all eyes. We

    Dr. Sowmya R, MS,FMRF, FAICO
  4. Articles 1 Apr 2021 26 min read

    Learn from the Masters: Tips & Tricks in the Management of Pediatric Cataract 1

    Cataracts in children are one of the most common cause of avoidable blindness. The incidence is in the range of 1.8 to 3.6/10,000 per year and the prevalence is about 1.03 per 10,000 children (0.32– 22.9/10,000). Management at the right time and the right way goes a long way in rehabilitating them . To understand the current practices in management of pediatric cataract Dr. Sowmya R. spoke to a few experts across India. Dr. Bharti Gangwani (Bharti Nihalani) is a practicing Pediatric Ophthalmologist, Assistant Professor of Ophthalmology and also the Director of Clinical Research for the department of Ophthalmology at Boston Children’s Hospital, Harvard medical school. She is actively involved in teaching Pediatric Ophthalmology to the residents and fellows. She has about 50 publications in peer and non-peer reviewed journals, books and review articles. She is a co-editor of a renowned book in strabismus management called “Learning strabismus surgery-A case-based approach”. She has focus

    Dr. Sowmya R, MS,FMRF, FAICO
  5. Articles 1 Apr 2021 8 min read

    Ten Commandments in Squint Workup for Postgraduates

    Squint is the Ocular Imbalance in which visual axes of both eyes do not meet at the point of regard. It can be regarded as a form of One Eye Blindness since both eyes are not seeing simultaneously, with a squinting eye being suppressed. Hence strabismus must be treated with due care. Squint evaluation can be simplified by the following checklist. Every squint patient must undergo this checklist of 10 commandments so as to plan management. 1. Determine whether True squint or a Pseudosquint The architecture of face and orbit may give the impression of a person having an apparent deviation. Careful inspection of lids, adnexa, position of globes will reveal no actual squinting of eyes. Two important parameters to rule out Pseudosquint Hirschberg reflex will always be centered No redressal movement on cover test Epicanthus and broad nasal bridge - extra fold of skin on the medial canthus gives the appearance of esotropia. On pinching the nasal bridge, the squint will disappear. Facial asymm

    Dr. R Krishnaprasad · Dr. Sayali D Mahajan
  6. Articles 1 Apr 2021 8 min read

    Intermittent Exotropia Simplified for the Postgraduates

    Intermittent exotropia (IXT) is the most common type of strabismus in children as well as adults, especially in the Asian and South Asian populations. Owing to the intermittent nature of exotropia there is usually good binocular function and stereoacuity at near fixation Small-angle exotropia is observed in normal neonates which usually disappears by the age of 2-4 months. Most adults will have small exophoria usually less than 10 when fully dissociated. Epidemiology Like all forms of strabismus, exotropic deviations can be manifest or latent, and if the former, intermittent or constant. Intermittent exotropia is by far the most common form of manifest XT. Exodeviations occur about one-third less frequently than esodeviations in North America and Europe and occur more frequently in the Asian population. Intermittent exotropia is more common in females with a ratio of 2:1 (F: M). Intermittent exotropia usually noticed by parents in early childhood (2-5 years). Clinical features Intermit

    Dr. Amr Mohamed · Dr. Sowmya R, MS,FMRF, FAICO
  7. Articles 1 Apr 2021 16 min read

    Peek into the Past - Strabismus as a Subspecialty in India

    The most exciting thing is to revisit and know when and how it all started. As the saying goes, "You've got to always go back in time if you want to move forward," so what better way than to talk to pioneers in the field of strabismus to know the past to forge into a great future in strabismology. Dr. Sowmya R spoke to the pioneers in the field to know the history of strabismology and share their experiences. Dr. Pradeep Sharma MD, FAMS. is currently working as the Professor and Head of Section of Pediatric Ophthalmology, Strabismus, and Neuroophthalmology at Dr. RP Centre, AIIMS, New Delhi. He is also the Vice President of the Ophthalmic Research Association at RPC, AIIMS. After having finished his graduation ( 1979) and postgraduation (1982) at All India Institute of Medical Sciences, New Delhi, he did his Fellowship for Advanced training in strabismus in the USA at Jules Stein Eye Institute UCLA, Wills Eye Hospital Philadelphia and Richmond awarded by International Strabismological

    Dr. Sowmya R, MS,FMRF, FAICO
  8. Articles 1 Apr 2021 13 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
  9. Articles 1 Apr 2021 6 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

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