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#Tips & Pearls

50 articles
  1. 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
  2. Articles 27 Jul 2021 13 min read

    Astigmatism - The clinical pearls in Refractive care

    Preface: Astigmatism is a common type of refractive error that we come across in vision clinics on a regular basis. It causes the deterioration of retinal image quality and leads to specific vision-related symptoms. Prevalence of this condition is reported to vary with age, gender, and ethnicity. The clinical diagnosis and management of astigmatism necessitate an understanding of its nature and characteristics. Hence, this particular write-up is prepared as a consolidation of integrated information related to ‘astigmatism’ by focusing on its definition, classic types, relevant clinical evaluation components, and appropriate management options. What is astigmatism? Astigmatism is a type of refractive error/ametropia that occurs when parallel rays of light entering the ocular media (non-accommodative state) are not focused well on the retina. In an optical system with astigmatic error, light rays propagate in two different planes and the incident light rays fail to converge at a single f

    Najiya Sundus K. Meethal · Dr. Krishna Kumar Ramani
  3. 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
  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 25 May 2021 9 min read

    Seven Tips to Treat A Treatment Resistant Microbial keratitis

    Microbial keratitis is a common potentially sight-threatening condition and is considered an ocular emergency. Managing them brings forth multiple challenges to the ophthalmologist one of them being to primarily distinguish an infective from non-infective keratitis. Based on signs, symptoms, history, and laboratory investigations a treatment plan is laid out which is modified based on clinical response and antimicrobial sensitivity. However, if the response to treatment is inadequate or the microbial keratitis is resistant to treatment it becomes mandatory to assess the factors causing it and change the therapeutic strategy accordingly. The present article attempts to look at the different factors which cause resistant microbial keratitis and means to manage them. Both local/ocular and systemic factors can contribute to the resistant nature of the ulcer and are listed in table 1. The need to address systemic concerns with the help of a physician along with the ocular factors cannot be

    Dr. Shweta Agarwal · Dr. Bhaskar Srinivasan · +1 other
  9. Articles 18 May 2021 9 min read

    Ten Pearls for the Diagnosis & Management of Binocular Vision Anomalies

    The prevalence of non-strabismic binocular vision anomalies is on the rise over the last decade. The prevalence reports from various parts of the globe quote a high prevalence ranging between 28.5-31.5% among school children (1,2). It is also shown in a recent study that clinically significant convergence insufficiency can impair stereo-acuity in children necessitating the diagnosis and management of convergence insufficiency (3). Here are some pearls to ensure accurate diagnosis and provide appropriate management to patients afflicted with binocular vision anomalies. This article specifically focuses on non-strabismic binocular vision anomalies as they are often missed out due to their latent nature, unlike strabismic anomalies. The efficiency of the visual system is beyond 20/20 Many eye care practitioners unfortunately still assume that 20/20 visual acuity ensures an optimally functioning visual system. The efficiency of the visual system is not just dependent on the integrity of th

    Dr. Jameel Rizwana Hussaindeen M.Phil, M.Phil Opt, Ph.D.,FCOVD-I, FAAO
  10. Interesting Reads 11 May 2021 8 min read

    Seven Points You Should Know about Mucormycosis

    What is Mucormycosis? Mucormycosis is a fungus that is ubiquitous. This organism is present in the soil and all around us and is also a commensal that is present in the nose and oropharynx. It is an opportunistic organism – this means that it invades and causes infection only when the host’s immune system is compromised. A normal healthy person’s immune system would easily be able to fight a fungal infection like mucormycosis. It invades the nose and the paranasal sinuses. It then gradually spreads to the neighboring structures which is the orbit-it then affects the extraocular muscles, the optic nerve and the orbital apex beyond which it then spreads intracranially involving the cavernous sinus, the leptomeninges, and the brain. This form of invasive mucormycosis which is the commonest clinical manifestation is called Rhino-Orbital-Cerebral Mucormycosis (ROCM). Why are we seeing so much of it now? Typically one would come across fewer than a handful of cases of mucormycosis in an enti

    Dr. Akshay Gopinathan Nair

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