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#Tips & Pearls

50 articles
  1. Articles 10 Jan 2025 6 min read

    Do's and Don'ts of Managing a Nucleus Drop: A Guide for Beginners

    Managing a nucleus drop during cataract surgery is one of the most challenging and critical situations an ophthalmic surgeon may encounter. While it’s a rare occurrence, its management demands quick thinking, precise action, and a thorough understanding of both anterior and posterior segment techniques. The goals are always to preserve vision, prevent complications, and optimize the long-term outcomes for the patient. Different surveys in India have found the incidence rate of nucleus drop between 0.04-0.1%. (1,2) Dropped nucleus and cortical remnants occur most commonly in phacoemulsification, than other techniques of cataract surgery. (3) Certain conditions associated with posterior capsular or zonular weakness have a higher risk of nucleus drop in cataract surgery. These include the following (4): Pseudoexfoliation syndrome Advanced or intumescent cataract Traumatic cataract Previous intraocular surgeries like vitrectomy or glaucoma procedures Difficult situations like shallow AC, s

    Dr. Dhanashree Ratra · Dr. Sakshi Ramnani
  2. Articles 21 May 2023 9 min read

    Seven Important OCT Signs in CNVM

    1. Type of macular neovascularisation (MNV): Macular neovascularisation (MNV) is a broad disease entity characterised by the development of the abnormal vessels arising either from the retinal vasculature (deep capillary plexus) or choroidal vasculature (choriocapillaris). Choroidal neovascular membrane (CNVM) is a subtype of MNV, characterised by the abnormal growths of blood vessels from the choroidal capillaries that penetrate the retina, specifically into the sub-RPE and subretinal spaces. These vessels are extremely immature and extremely fragile, so they bleed and leak, de-structuring the macula, causing severe visual impairment. The classification of MNV is depicted below in Figure 1: Figure 1: A simple classification of macular neovascularisation (MNV): 2. Cause of CNVM: A CNVM is primarily classified based on the etiology into two categories: A) Age-related Macular Degeneration (AMD) associated CNVM and B) Non-AMD associated CNVMs. Causes of non-AMD associated CNVMs: Central s

    Dr. Ramesh Venkatesh · FVRF (Sankara Nethralaya) · +2 others
  3. 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
  4. Articles 9 Mar 2022 11 min read

    i-File: Pigmentary Glaucoma

    A 30-year-old male presented to the glaucoma clinic with complaints of gradually progressive diminution of vision in both eyes, left eye more than right, since 5 years. The visual disturbance was not associated with redness, pain, photophobia, or colored haloes. Past Ocular History: He was diagnosed with glaucoma elsewhere 5 years ago and started on anti-glaucoma medications(AGM). His baseline intraocular pressure (IOP) according to the old records was 52 mmHg In both eyes. At the time of his visit to the hospital, he was using 3 AGMs which he had stopped using for the past 7 days. No history of trauma or laser in the past Past Medical history: No history of any systemic illness Family history: No family history of glaucoma Systemic Examination: All vitals and systemic examination was within normal limits Ocular Examination Best Corrected Visual Acuity (Snellens) Right Eye (OD) 6/9 Left Eye (OS) 3/60 Ocular Motility/Alignment Full, free and painless in all gazes Intraocular pressure (I

    Dr. K. Sugepriya · Dr. Rathini David
  5. Articles 6 Dec 2021 4 min read

    Ten Pearls of Phacoemulsification with PPC

    Posterior Polar Cataract is associated with remnants of Tunica vasculosa lentis. (1) It presents as a white opacity situated on the posterior capsule appearing as a circular plaque with concentric whorls. (2) Surgical management of posterior polar cataracts is a challenge even for skilled surgeons due to high risk of posterior capsular rupture and vitreous loss during surgery. (3) 1. Preoperative Considerations: It has to be identified correctly on slit lamp examination – with its characteristic onion peel or bull’s eye appearance. Patient has to be counselled regarding increased surgical time, higher chances of posterior capsular rupture and even the possibility of posterior segment intervention and delayed visual recovery. (3,4) The fellow eye also needs to be evaluated. Image showing: Characteristic onion peel appearance of Posterior Polar Cataract (Courtesy of Rajan Eye Care Hospital). 2. The Preferred Anaesthesia: Peribulbar anaesthesia is preferred because of longer surgical time

    Dr. Madhuvanthi Mohan · Dr. Sashwanthi Mohan · +1 other
  6. 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
  7. Articles 7 Oct 2021 6 min read

    Normal flora /Microbiome of the Eye: 10 Facts

    1. Definition of Microbiome Microbiomes are communities of organisms (bacteria, fungi, viruses) that normally reside on any part of the human body (both external and internal) and are in a symbiotic relationship with the host. The members of the microbiome live in close harmony, sharing food and shelter and offering benefits to each other, e.g. some members give protection by secreting extracellular polymeric substances to form a protective covering of biofilm around the community, while some excrete metabolic by-products which are useful substrates for the others. 2. Relation of Microbiome with the host Most of the organisms of the microbiome provide support to the good health of the host (like preventing colonization by harmful pathogens by competing for shelter and food niches, occupying the pathogen receptor sites, or secreting antibiotics and metabolic by-products like acetic and lactic acids which harm such pathogens). But some of the members can also act as opportunistic pathoge

    Dr. Sanchita Mitra
  8. 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
  9. 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
  10. Articles 17 Sep 2021 6 min read

    Visual Fields in Neuro-Ophthalmology : 10 Pearls for the Postgraduates

    1. Is there something we can do before ordering a visual field in neuro-ophthalmology? Confrontation visual field testing is an important clinical examination, especially when it comes to neuro-ophthalmology cases. A simple test can give us clues as to what may be the underlying cause of patients’ symptoms. The test is done presuming the visual field of the examiner is normal. Both the patient and the examiner should be seated at an equal height at a distance of 1 meter. The right eye field is tested by asking the patient to close their left eye and the examiner closes his/her right eye. The first question the examiner must ask the patient, if they are able to see the examiner’s face clearly, without any parts missing. The examiner then moves a pin-point target from out to in all 4 quadrants, while instructing the patient to continuously look into the examiner’s eye. When the patient sees the object, they inform the examiner, who is then able to compare when they themselves saw the obj

    Dr. Simranjeet Aulakh

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