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#Top Ten Series

55 articles
  1. Articles 1 Apr 2021 11 min read

    Ten Tenets One Should know on Conjunctival Hooding

    Ocular surface anatomy The ocular surface, in a strict sense, consists of the cornea and its major support tissue, the conjunctiva. In a wider anatomical, embryological, and also functional sense, the ocular mucosal adnexa (i.e. the lacrimal gland and the lacrimal drainage system) also belong to the ocular surface. The ocular surface occupies approximately 2.2 cm2 of the human body surface area [1]. The homeostasis of this small area is, however, extremely important for clear vision and comfort. The cornea is one of the most densely innervated structures in the body and hence, surface changes can result in significant discomfort apart from vision loss. The clarity and tectonic integrity of the cornea are maintained by a number of mechanisms, and one of the most important of these is the intactness of the surface epithelium. The limbus provides a constant source of epithelial cells to maintain the normal turnover of the corneal surface but can be impacted by multiple noxious influences

    Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
  2. Articles 1 Apr 2021 11 min read

    Ten Tenets on Corneal Collagen Crosslinking

    Corneal collagen crosslinking (CXL) is a minimally invasive procedure that is currently the gold standard treatment to arrest the progression of corneal ectatic conditions. It promotes the induction of crosslinks in stromal collagen of the cornea, thereby strengthening and stiffening the cornea in ectatic conditions. 1.HISTORY It was observed that corneas in diabetic patients were stiffer due to the natural crosslinking occurring from glycosylation and hence had a lower incidence of keratoconus. Based on this observation, various experiments were conducted to crosslink the cornea manually using chemical agents and sugar aldehydes. Following multiple trials, it was found that this could be safely done by making use of the photochemical reaction induced by the absorption of UV light by riboflavin.1 The first in vivo study was done by Wollensak et al., and they reported in 2003 that CXL was effective in stopping the progression of moderate to advanced progressive keratoconus, in 23 eyes f

    Dr. Amanda Mohanan · Dr. Sanjeev P Srinivas · +1 other
  3. Articles 1 Apr 2021 9 min read

    Ten Pearls for Phacoemulsification in a Soft Cataract

    Soft cataracts are usually seen in pediatric or young adult patients. We encounter them more frequently nowadays due to the increasing patient awareness and evolving lifestyle requirements which bring the patients earlier to the clinic. Another important reason behind the increasing number of soft cataracts in our surgical practice is the fact that the number of pars plana vitrectomies is increasing and we tend to perform combined cataract surgery with pars plana vitrectomy in patients with early cataract. Soft cataract phaco can be quite challenging especially in situations where the pupil starts coming down in the face of an uncooperative patient and positive posterior pressure during surgery. It is no surprise that soft cataract has been termed as “Neither Here-Nor-There” cataract! We will be offering 10 pearls on how to successfully manage such cases with good outcomes. Pearl 1: Need for precise IOL calculations: Most soft cataracts encountered in younger visually active patients c

    Dr. Arup Chakrabarti · Dr. Nirupama Kasturi
  4. Articles 1 Apr 2021 9 min read

    Ten Tips for Management of Nystagmus

    Nystagmus is defined as an involuntary rhythmic oscillation of one or both the eyes. Clinical assessment and eye movement recordings are important to diagnose and classify nystagmus. It is essential to have patience while examining a child, as anxiety often increases nystagmus. 1.Classification Physiological eye movements have to be differentiated from pathological eye movements. The older etiology-based classification of nystagmus is redesigned into characteristics-based new classification by CEMAS (Classification of Eye Movement and Strabismus). Infantile nystagmus syndrome (INS) is characterized by horizontal conjugate nystagmus, infantile-onset, accelerating slow phase, increase with fixation attempt, convergence dampening, and presence of null zone with decreased amplitude. Fusion maldevelopment nystagmus syndrome (FMNS) is characterized by decelerating slow phase, associated strabismus, a latent component with fast phase towards fixing eye and decrease in intensity with adduction

    Dr. Ramesh Kekunnaya · Dr. Mayank Jain
  5. Articles 1 Apr 2021 12 min read

    Ten Tips for Phacoemulsification in Small Pupil

    Phacoemulsification in eyes with preoperative non-dilating pupil or with intraoperative miosis is fraught with complications [1,2]. The following tips will help understand the small pupil and optimize strategy to deliver better outcomes. 1. Every eye is an IFIS candidate; Reduce threshold for using Pupil expansion devices: Since its original association with tamsulosin intake, Intraoperative Floppy Iris Syndrome (IFIS) has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter [1,3,4]. The risk of IFIS exists regardless of alpha antagonist treatment, in eyes with 7.0 mm or smaller pupil [5]. Hence, it would be prudent to consider every eye a potential IFIS candidate. Increased patient expectations, surgeon's desire to consistently deliver good outcomes, use of tor

    Dr. Suven Bhattacharjee
  6. Articles 1 Apr 2021 8 min read

    Retinoblastoma : Top Ten Tenets for an Ophthalmologist

    1.Common and Curable Retinoblastoma is the most common childhood ocular malignancy. Annually there are about 6000 new cases worldwide. It is most commonly diagnosed at 15-18 months of age although in developing countries, older children also present with the disease. It is potentially curable if detected early and with proper management. Currently, the survival rate is as high as 95% with 90% eye salvage and 85% vision salvage. 2 The root of the Family Tree Retinoblastoma can be associated with germline mutation or somatic mutations of the RB1 gene on the long arm of chromosome 13. Heritable retinoblastoma constitutes 30-40% of all retinoblastomas while the rest are non- heritable. 25% of the germline mutations are familial with autosomal dominant inheritance and the remaining occur de novo. In heritable retinoblastoma, patients are prone to other second primary neoplasia including pinealoblastoma, osteosarcoma and soft tissue sarcomas. Genetic testing for germline mutations are availa

    Dr. Mrittika Sen · Dr. Santosh G Honavar, MD, FACS
  7. Articles 1 Apr 2021 11 min read

    ILM Peeling Simplified - Ten Tips for the Beginners

    1 How to choose the right cases to start Idiopathic macular hole in non-myopic eye is a good case. ILM comes off as a single sheet and underlying retina is healthy. Same applies to traumatic macular holes. Beginners can also start peeling ILM in eyes with epiretinal membrane. Unsuccessful peeling may not jeopardize the long-term outcome significantly here. Peeling ILM for Myopic macular holes or in eyes with Diabetic Retinopathy needs more experience but can be achieved easily if one understands the basics of peeling. 2 Arrange your Inventory – Forceps is the key Lander's ring with Macular contact lens, Disposable ILM forceps and BBG dye serve as a formidable low-cost inventory for ILM peeling. A good ILM forceps should match your technique of ILM peeling. Because most of us initiate peel by "Pinch Technique", forcep is desired to have a structure that can "pinch". It needs to have fine teeth on opposing surfaces and good range of movement for its prongs. It should also be light weight

    Dr. Deependra V Singh · Prof. (Dr.) Yog Raj Sharma
  8. 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
  9. Articles 1 Apr 2021 14 min read

    Ten Pearls for The Management of Pseudophakic Corneal Edema

    Corneal edema refers to the accumulation of excess fluid in the corneal layers, with a loss of corneal clarity, resulting in vision loss. The normal cornea maintains a state of 78% hydration due to a complex interplay between stromal swelling pressure, the barrier function of the epithelium and endothelium, endothelial pump, tear evaporation and intraocular pressure [1]. Any condition that interferes with this balance causes a loss of homeostasis and accumulation of fluid. 1. The Natural History of Corneal Edema In the early stages of corneal edema, reduced vision is often related to an irregular corneal surface and can interfere significantly with daily activities. This impact on vision is often underestimated by quantitative visual acuity measurements in standard lighting conditions using high contrast charts, as in a refracting lane. Initially, these patients often experience blurred vision on awakening, owing to the accumulation of fluid in the closed eye state during sleep. As the

    Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
  10. Articles 1 Apr 2021 7 min read

    Ten Pearls for Phacoemulsification in a Hard Cataract

    Phacoemulsification of the very dense cataract presents the surgeon with a series of specific and difficult challenges. How hard is hard and what level of hardness makes it challenging depends largely on the experience of the surgeon. LOCS III classification does not always reveal the real hardness of the cataract, and that aside there is no definition in the literature that classifies the hardness of cataract. A hard cataract is a relative term relative to the surgeon’s experience and confidence! I have over the years put some criteria for myself when I call it a difficult situation. These are dark brown to the black nucleus, no visibility of the posterior slit beam due to the nuclear sclerosis, an older patient, diabetic patient, and preoperative poor vision. Ocular co-morbidities such as pseudo exfoliation, absence of pupillary ruff and calcific spots on the anterior capsule are some of my personal markers which add further to an already challenging surgery Pearl 1: Preoperative con

    Dr. Ashok Rangarajan, MS; DNB; FRCS (Glasgow)

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