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#Review

86 articles
  1. Articles 2 Apr 2021 49 min read

    Viral Uveitis

    Viral uveitis has myriad presentations. They may present as anterior uveitis, intermediate uveitis, acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN) and neuroretinitis. The causative viruses mainly include herpes group of viruses and human immunodeficiency virus (HIV). Other DNA viruses which cause uveitis are poxviruses, adenoviruses especially those that produce epidemic keratoconjunctivitis and pharyngoconjunctival fever. RNA viruses isolated are influenza virus, mumps virus, measles virus, rubella virus, rift valley fever virus and Newcastle virus. Here we have discussed all the different types of viral uveitis except opportunistic viral infections in HIV. ANTERIOR UVEITIS Viral anterior uveitis is caused mainly by herpes simplex virus (HSV) type 1 and 2, varicella zoster virus (VZV), cytomegalovirus virus (CMV), Epstein-Barr virus (EBV) and human herpes virus (HHV) type 6, 7 and 8 (1-3). Herpes literally means ‘to crawl’ from the Greek word ‘herpein’. Herpes

    Dr. Vinita Rao · Dr. Gunjan Deshpande
  2. Articles 2 Apr 2021 35 min read

    Idiopathic Macular Hole

    Introduction Recent advances in the pathogenesis, classification, and surgical intervention of idiopathic macular holes have generated a renewed interest in this entity. Better indicators of the visual outcome, as well as refinements in the surgical technique, have led to improvements in the success of macular hole surgery. Clinical characterization and theories on the pathogenesis of macular hole have continued to evolve. Although originally thought to be the result of trauma, it is now recognized that most macular holes occur in the absence of antecedent injury and are referred to as idiopathic. Theories for the pathogenesis of idiopathic macular holes have included progressive thinning of the foveal tissue and pre hole cyst formation. The primary pathogenic role of the vitreous was suggested by studies that indicated a low relative risk for macular hole formation in eyes with complete posterior vitreous detachment. Gass proposed a theory whereby shrinkage of adherent cortical vitreo

    Sandeep Saxena, M.S., MAMS
  3. Articles 2 Apr 2021 12 min read

    Eales Disease: Current Concepts in Etiopathogenesis and Management

    Introduction Eales’ disease is an idiopathic retinal periphlebitis that primarily affects the peripheral retina in young adults. Eales’ disease was first described by Henry Eales, a British ophthalmologist, in 1880 and 1882.1,2 He found it in seven young, male patients ranging in age from 14 to 29 years with recurrent vitreous hemorrhage. In addition, these patients had history of headache, variation in peripheral circulation, chronic constipation and epistaxis. In the next century, the disease was redefined by several investigators. 3-6 Elliot first recognized the inflammation of retinal vein and described it as periphlebitis retinae.4 Subsequently several investigators documented both venular and arteriolar inflammation.5,7 Eales’ disease most commonly affects healthy young adult males and is an important cause of preventable blindness in young adults. The predominant age of onset of symptoms is 20-30 years. The disease is more commonly seen in the Indian subcontinent. However, it ha

    Sandeep Saxena, M.S., MAMS
  4. Articles 2 Apr 2021 6 min read

    Malarial Retinopathy: A Diagnostic Clue

    Introduction Malaria is the most important of parasitic diseases of humans and remains today, as it has been for centuries a large burden on tropical communities. Cerebral malaria is the most important complication of falciparum malaria and also the leading cause of death in malaria 1. It is defined as an acute, symmetric encephalopathy associated with sequestration of parasite-infected erythrocytes in the cerebral vessels and capillaries in patients with falciparum malaria 2. WHO Criteria for Diagnosis The World Health Organization has laid down definite guidelines for diagnosis and management of cerebral malaria 3. This definition requires the presence of unarousable coma using the Glasgow Coma Scale (GCS), exclusion of other encephalitides, especially bacterial meningitis and if possible, locally prevalent encephalitis and the presence of asexual forms of P. falciparum in the blood film. Retinal Involvement in Cerebral Malaria Eye being an extension of the brain, retina provides a u

    Sandeep Saxena, M.S., MAMS · Shaili Misra, MBBS · +1 other
  5. Articles 2 Apr 2021 13 min read

    Perfluorocarbons in Ophthalmology

    INTRODUCTION Perfluorocarbon liquids (PFCLs) were first developed in 1970s as possible substitutes to erythrocytes[1],[2] because of their capacity to dissolve relatively large amounts of oxygen. Initial trials with these compounds focused on their feasibility to be used as blood substitutes. These experiments proved the biocompatibility of these compounds. Based on their properties, they were then introduced for intraocular use, in what has become a milestone in vitreoretinal surgery. After animal studies confirmed the safety of PFCL compounds as vitreous substitutes, Chang et al in 1987 first described the successful intraocular use of low viscosity liquid fluorocarbons (perfluorotributylamine and perfluorodecalin) in four patients with complicated retinal detachments.[3],[4] Long-term tamponade in animal models demonstrated retinal atrophy and retinal necrosis at the perfluorocarbon aqueous interface after 4 weeks even when highly purified PFCL compounds (perfluorodecalin) were used

    Dr. Abhishek R. Kothari
  6. Articles 2 Apr 2021 28 min read

    Optical Coherence Tomography- Evolution and Clinical Applications

    1. Introduction Optical coherence tomography (OCT) is a noninvasive imaging modality that has revolutionized the practice of clinical ophthalmology over the past decade. OCT provides high-resolution cross-sectional images of the retina, optic nerve head and retinal nerve fibre layer (RNFL) unobtainable by any other current modality, and enables qualitative and quantitative evaluation. As opposed to other retinal imaging modalities that provide én face images, it provides for sectional information, and in that sense is analogous to an in vivo “optical biopsy” (Figure 1). It is safe, fast, reproducible, does not require greatly skilled technicians, and has minimal, if any, interobserver issues. Several advances in recent times have contributed to vast improvements in resolution and speed of OCT devices, and expanded their applications manifold. In 2010, in the US alone, an estimated 16 million OCT procedures were done, amounting to $ 780 million in reimbursement.[1] Fig 1. Macular OCT wi

    Dr. Abhishek R. Kothari
  7. Articles 2 Apr 2021 13 min read

    Management of Subluxated cataract

    Zonular compromise complicates every step of cataract surgery and poses a serious challenge in terms of safety and visual outcome. When the lens is displaced from its normal position, it is considered subluxated if it remains in the pupillary area and luxated or dislocated if it is completely displaced from the pupil. Ectopia lentis is the term used to describe congenital dislocations.1 Lens displacements may be traumatic, heritable, and spontaneous.( Table 1) Table 1: Causes of Lens Dislocation Causes Features Traumatic Responsible for >50% lens displacements Heritable Associated systemic anomalies Marfans’s syndrome: Triad of skeletal, cardiovascular & ocular anomalies. Autosomal dominant. Generalized thinness and elongation of limbs, sternal deformities, kyphoscoliosis, joint hyperextensibility, low ratio between upper and lower segment, arachnodactyly, cardiopathy, aortic dilatation, dissecting aneurysm, mitral regurgitation. Ectopia lentis: B/L superotemporally, usually partial, r

    Dr. Ruchi Goel · Dr. KPS Malik
  8. Articles 2 Apr 2021 9 min read

    Seasonal Hyperacute Panuveitis (SHAPU)

    Introduction: Seasonal Hyperacute Panuveitis (SHAPU) is a mysterious eye disease with grave prognosis, reported only from Nepal. Though it was reported for the first time in 1975,1-3 no definite etiopathogenesis has been established to date. It occurs as an outbreak in certain regions of Nepal in a cyclical pattern during the autumn season and peaks during the winter season (August–December) only in odd years. Thus, after the first outbreak of 1975, the next outbreaks occurred in 1977,1979, 1981, and so on and the last outbreak was reported in 2019. SHAPU predominately occurs among children4 and the youngest reported case is a 38- day-male baby.5 No gender predilection has been identified in SHAPU.4 All cases are mainly immunocompetent with no prior history of systemic or ocular illness/trauma.4, 6 SHAPU is very devastating and generally leads to the loss of sight within a week, followed by cosmetic disfigurement due to phthisis bulbi, which can have a significant emotional impact on t

    Dr. Ranju Kharel (Sitaula)
  9. Articles 2 Apr 2021 17 min read

    Epiretinal Membrane

    Epiretinal membranes(ERM) are acquired formation of semi-transparent cellular sheets on the macular surface, which are formed due to varied etiologies. These membranes have contractile properties, often leading to mechanical distortion of macula. The proliferation of ERM on the inner retinal surface along the internal limiting membrane was first described by Iwanoff in 1865 1. In 1971, Roth and Foos reported that in a series of autopsied eyes, ERM were present in 2 percent of patients aged 50 yr and in more than 20 percent of patients by age 75 yr2. Pearlstone reported an incidence of 6.4 percent in 1000 consecutive routine eye examinations in patients older than 50 yr, with 20 percent being bilateral 3,4. Other authors report bilateral involvement in 10 to 20% of cases5,6,7.The Los Angeles Latino Eye Study (LALES) found that of the participants with ERM, 19.9% had bilateral ERMs. The prevalence of ERM increased from 10.1% in persons 40 to 49 years of age to 35.7% in those aged 70 to 7

    Dr. Pravin Jain · Dr. P.N.Nagpal
  10. Articles 2 Apr 2021 25 min read

    Vitrectomy: A Review

    INTRODUCTION Pars plana vitrectomy as a technique has revolutionized retinal surgery since its advent and initial report by Machemer et al 1. It allowed the removal of traction by an internal method, essential in retinal detachment procedures, as well as provided an active management modality for vitreous haemorrhage and opened the door for surgical intervention in a myriad of retinal pathologies. Since that time, the evolution of vitrectomy surgery has seen experimentation and implementation of smaller surgical instruments aimed at greater functionality and minimalization of ocular trauma. The basis of a sutureless pars plana sclerotomy was to stabilize intraocular pressure (IOP) during surgery, with a truly closed system, as well as reduce surgical time by removing the need for sutured wound closure. Wound and suture related complications such as leakage, irritation, and scleral pigmentary changes could also be avoided. Concerns regarding wound competence in a sutureless procedure ha

    Dr. Gaurav Paranjpe · Dr. Pravin Jain · +1 other

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