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#Top Ten Series

55 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 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
  3. 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
  4. 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
  5. 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
  6. Articles 10 Sep 2021 10 min read

    Ten Clinical Signs A Postgraduate Must Look For While Examining the Fundus

    1. Red Dots! : Microaneurysms Seen in Diabetic Retinopathy, retinal vein occlusions, hypertensive retinopathy, radiation retinopathy. Microaneurysms are usually the first ophthalmoscopically detectable sign of diabetic retinopathy. They are focal saccular outpouchings of the capillary wall due to pericyte loss. Arise from the deep part of the inner retinal capillary plexus, and are present in the inner nuclear layer.1 Features: Appear as small round red dots - usually seen at the posterior pole, especially temporal to the fovea. 10- 100 microns in diameter. Only > 30 microns is visible ophthalmoscopically (better on red-free illumination). < 30 microns can be seen on FFA and hence more microaneurysms are seen on FFA than fundus examination. Shapes – saccular, fusiform, pedunculated, focal bulge, irregular, mixed. FFA- Hyperfluorescent with leakage. OCT – Ring sign, span more than 1 retinal layer. Course- disappear in 3-6 months. Can continue to exudate, bleed or thrombose. 2. And it wa

    Dr. Sashwanthi Mohan · Dr. Snehal Bavaskar
  7. Articles 4 Sep 2021 6 min read

    Ten Points One Must Know on Toxic Anterior Segment Syndrome (TASS)

    TASS is an uncommon, non-infectious condition causing severe inflammation of the anterior segment structures without vitreous involvement [1],[2],[5]. The name TASS was coined by Monson and colleagues in 1992 [1],[3]. It is usually associated with phacoemulsification surgery but can also happen after procedures like penetrating keratoplasty, descemet stripping automated endothelial keratoplasty, deep anterior lamellar keratoplasty, vitrectomy and anterior and posterior segment phakic intraocular lenses. The alternative names of TASS include sterile post -operative endophthalmitis, toxic lens syndrome, toxic endothelial cell destruction syndrome and localized endophthalmitis [1],[3],[7]. 1. What is TASS? It is an acute sterile post-operative inflammatory condition affecting the anterior segment structures following intraocular surgery. It is usually seen within 12-48 hours of surgery and is due to the reaction of anterior segment structures to some toxic substance usually associated wit

    Dr. Priya Rasipuram Chandrasekaran
  8. Articles 17 Aug 2021 5 min read

    Ten Mistakes to Avoid while Treating a Case of Diabetic Retinopathy

    Diabetic Retinopathy is a common retinal disorder that is seen, managed, and followed up by not only a retina specialist but all ophthalmologists. It is a disease that is easy to diagnose, but often difficult to manage in a long run. For achieving optimal results besides the role of an ophthalmologist, one needs to have the involvement of a physician. The single most important factor for achieving a good outcome is patient compliance, as the disease, diabetes needs lifelong care. Here are few mistakes we need to avoid while managing a case of DR. 1. I can detect DME clinically, I don’t need OCT OCT is not mandatory if there are no signs of DR, or in very mild retinopathy (1 D, Amblyopia, Unilateral elevated intraocular pressure, Complete posterior vitreous detachment, Unilateral carotid artery stenosis, and Chorioretinal scarring 5. Ignoring a rapid progression of milder NPDR to PDR A rapidly progressive NPDR to proliferative retinopathy in a span of a few months (4-6 months) is rare a

    Dr. Rajiv Raman
  9. Students Gallery 5 Aug 2021 2 min read

    Ten Tips for OSCE

    Objective structured clinical exam (OSCE) has regained popularity as a significant part of practical examinations in recent times. This is in part due to the pandemic making it difficult to hold exams with actual patients. It also removes subjective bias and is considered a fair way to examine candidates. There are certain strategies that enable the student taking an OSCE based exam to do well and score maximum points. Here are some tips Preparation stage 1. Go through images in an atlas. Most OSCEs are image-based. So pay attention to clinical features by going through as many online free atlases that are available on the internet. Practice describing findings to your study partner. 2. Go through surgical videos. Videos of surgery may be shown as part of OSCEs with a review of steps and complications may be asked as an OSCE. 3. Revise the clinical trials and the acronyms. These are often asked as well. Many websites and textbooks have comprehensive tables that make revising trials eas

    Dr. Meenakshi Swaminathan
  10. 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

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