Topic

#Top Ten Series

55 articles
  1. Articles 1 Apr 2021 2 min read

    Ten Pearls of Phacoemulsification in Subluxated Cataracts

    Phacoemulsification in subluxated cataracts is a challenging situation for the phaco surgeon due to lot of variables like management of the subluxation, management of the cataract, vitreous etc. Here are the top ten Pearls for Phaco in subluxated Cataracts. 1 Pre-Op Assessment Careful slit-lamp examination for a) Extent of Subluxation b) The density of the cataract c) Presence or absence of vitreous in Anterior chamber d) Status of the corneal endothelium e) Age of the patient 2 Devices & Instrumentation a) Capsular Tension Ring (CTR) size 10 – 12 mm size 11 – 13 mm b) CIONNI Ring (1 or 2 eyelets) c) CT Segment (Ahmed Segment) d) Capsular Hooks e) Iris Hooks f) Micro Surgical instrumentation like Microrhexis forceps etc. 3 Proper Surgical Planning Zonule loss less than 1 quadrant: Place 3 piece IOL in the axis of the Zonular loss 1 to 2 quadrants: CTR Standard 2 to 3 quadrants: CIONNI 1 or 2 or CT segment (Ahmed) More than 3 quadrants: Above or scleral fixated IOL 4 Surgical Plan Site

    Dr. Mohan Rajan
  2. Articles 1 Apr 2021 4 min read

    Ten Pearls for Managing a Case of Tubercular Uveitis

    Pattern recognition is critical in the diagnosis and treatment of any form of uveitis. Here are 10 pearls that will make it easier to recognize patterns of presentation and resolution in tubercular uveitis. The general approach to diagnosis: We are all aware of the role of identifying clinical signs of TB in the eye and that of ancillary tests for systemic TB (immunological and radiological). However, we tend to ignore the last part – the exclusion of non-TB entities. These include various infectious and non-infectious conditions that can match a given clinical sign of ocular TB. Tubercular retinal vasculitis – 1: TB retinal vasculitis typically causes a periphlebitis, though rarely arterioles can also be affected. The most common clue for a tubercular etiology is the presence of active or healed retinitis lesions underlying the blood vessels (subvascular lesions). These are intraretinal granuloma and are highly predictive of tubercular etiology in TB-endemic countries (Kaza et al., 20

    Dr. Soumyava Basu
  3. Interesting Reads 1 Apr 2021 7 min read

    Ten Pearls for a Safe Vitrectomy

    This write up is based on my own learning experience over many years and what I have observed while training fellows. This also includes the common mistakes that I have made and what the fellows make during the training process. Today with micro incisional vitreous surgery (MIVS) and better fluidics, learning basic Vitrectomy is a very quick process for most trainees. I will now enumerate 10 steps which may be useful for a beginner. Step 1 Pre-operatively assess the eye to be operated. Is it the right eye or the left eye I am going to operate? Is it a sunken eye placed in a deep socket? It is more easy to operate the right eye because the dominant right hand performing most of the manoeuvre has a wide field of action. The same is not true for the left eye where the movement of the dominant right hand may be restricted because of the brow and the nose. This becomes even more pronounced in a deep-set eye. Therefore your nasal sclerotomy in the left eye should be about half clock hour tow

    Dr. Giridhar Anantharaman, MS, FVRS
  4. Interesting Reads 1 Apr 2021 9 min read

    Ten Tips on Textbooks to Thrive in Ophthalmology

    At the very outset, please allow us to congratulate you on having chosen to specialize in ophthalmology. Welcome to this fascinating world! Most of us breeze through ophthalmology during our MBBS by reading either Parsons or any other textbook available out there which suits us. Unlike, say medicine, where we are familiar with books like Harrison's, in ophthalmology, we find it rarely necessary to venture beyond the essential texts, unless perhaps for a seminar preparation or the like. As a result, today, as the newly joined ophthalmology resident, it is perfectly normal to feel overwhelmed, and a bit lost when you enter the library and see the whole world of ophthalmic literature available. So, we thought it would be a good idea to make a list of textbooks to help the beginner navigate this world. Of course, each one of us is unique, and we have different learning styles. We have tried to curate a list of the 'most popular' books and it is far from complete, let alone perfect. But ple

    Dr. Amanda Mohanan · Dr. Prabrisha Banerjee
  5. Articles 1 Apr 2021 2 min read

    Ten Tips to Achieve a Complete Curvilinear Capsulorhexis

    1. See clearly: Focus the microscope in such a way that the anterior capsule is exactly in focus. Low magnification would help in increasing depth perception, even though things don’t appear grossly magnified. Even if the patient moves the eye a little, things don’t go out of focus. 2. Stain if needed: If the red glow is not very clearly seen, and the cut end of the anterior capsular flap may not be easily visible, its best to stain the capsule by trypan blue. This should be done before starting the capsulorhexis. 3. The pressure above should be more than the pressure below. The capsulorhexis flap shall not extend to the periphery if the pressure above it is more than the pressure below it. If superior rectus muscle suture has been taken, loosen it. Loosen a tight speculum. Both increase the pressure on the globe, pushing the vitreous up and putting strain on the posterior capsule. 4. Do CCC slowly: The time spent on it is completely worth it. The success of surgery, especially in phac

    Dr. Parikshit Gogate
  6. Articles 1 Apr 2021 6 min read

    Ten Tips for Youngsters to Increase Proficiency in Phacoemulsification

    Phacoemulsification, like any other surgery, comes with its learning curve. Here are some pearls, from my experience, to help you ‘shorten’ and ‘Flatten the curve’. 1. Believe in yourself: The first step to successfully doing anything in life is to believe in yourself. Believe you can and you are half way there. 2. Observe, Observe, Observe & Learn I am a firm believer of this quote by Marilyn vos Savant, “To acquire knowledge, one must study; but to acquire wisdom, one must observe.” Each skill in life can be improved by observing others. It is the same case for surgeries too. The more you observe a particular type of surgery, the better you get at it. Observe your seniors. Observe their hand movements, observe how they complete a straight-forward case and observe how they tackle complications. Try and observe as many people surgeons as you can, as each and every phacoemulsification procedure teaches you something new. Residents in today’s era are blessed with easy availability of the

    Prof. (Dr.) Mahipal S. Sachdev
  7. Articles 1 Apr 2021 5 min read

    Ten Tenets of Fundus Autofluorescence

    1. What is fundus autofluorescence? Fundus autofluorescence is a study of the topographic distribution of naturally occurring molecules in the human fundus. These molecules are called fluorophores. In principle, FAF is similar to fundus fluorescein angiography as both of them study the fluorescence pattern of molecules. However, the fluorophore molecules are naturally occurring compounds in the former while in later sodium fluorescein dye is injected. Hence FAF is a non-invasive imaging modality. 2. What are fluorophores? Fluorophores are molecules that emit fluorescence when excited by a suitable wavelength of light. Fluorophores are not exclusively present in the fundus and are distributed in various ocular tissue which includes the cornea, lens, uvea melanocyte, retinal pigment epithelium (RPE), and sclera.1,2 The knowledge about fluorophores other than fundus is still evolving. The commonly studied fundus fluorophores lipofuscin and melanin. 3. Lipofuscin and melanin Lipofuscin is

    Dr. Kumar Saurabh · Dr. Suraj Mistry
  8. Articles 1 Apr 2021 3 min read

    Five things you should know about Micropulse LASER in Glaucoma Management

    Glaucoma is a leading cause of irreversible blindness worldwide, with more than 70 million people affected. Traditionally treatment options include topical medications, laser trabeculoplasty, incisional surgeries, glaucoma drainage implants (GDD), and cycloablative procedures. GDD and ciliary body destruction is generally reserved for refractory or end-stage glaucoma in eyes with poor visual potential. Transscleral cyclophotocoagulation (TSCPC) Transscleral cyclophotocoagulation (TSCPC) is a cyclodestructive procedure designed to target the melanin in the pigmented ciliary body epithelium, thereby decreasing the rate of aqueous humor production. Numerous studies have confirmed the IOP-lowering ability of TSCPC and also reported the risk of developing serious complications with this procedure, such as persistent ocular inflammation, vision loss, hypotony, phthisis bulbi, and rarely sympathetic ophthalmia. Therefore, TSCPC, which conventionally uses the continuous-wave diode laser, has b

    Dr. Murali Ariga
  9. Articles 1 Apr 2021 5 min read

    Ten Pearls for Performing Vitrectomy in Diabetic Retinopathy

    Important terms: Truncation: To relieve all the surrounding traction 360 degree Segmentation: Dividing a larger membranes/FVP into smaller islands of FVP by 360-degree truncation around them. Delamination: Separation of these membranes/FVP from the retinal surface to which they are firmly adherent by creating a plane of dissection between them. Pearl #1 When not to perform vitrectomy in diabetic retinopathy? Answer: In cases of extramacular tractional retinal detachment (TRD) when the fovea is attached and the patient has a comparative good vision the extramacular TRD can be observed. Charles and Flinn reported only 21% of extramacular TRD extending into macula without any surgical intervention. Also, DRVS (Diabetic retinopathy vitrectomy study) reports that only 23% of eyes with TRD developed severe visual loss at 2 years. Also, early intervention in such extramacular TRD’s can sometimes lead to more harm than benefit owing to the surgery itself. Pearl #2 First step should always be c

    Dr. Raja Narayan
  10. Interesting Reads 1 Apr 2021 16 min read

    Ten Clinical Trials in Retinal Diseases Every Postgraduate Should Know

    1. CATT (Comparison of Age-related Macular Degeneration Treatments Trials)1 Description A prospective, multicenter, single-blind, noninferiority randomized clinical trial. 1208 patients with neovascular AMD were enrolled from February 2008 and randomly assigned to receive intravitreal injections of ranibizumab (0.5 mg/0.05 ml) or bevacizumab (1.25 mg/0.05 ml) on either a monthly schedule or as needed with monthly evaluation. Patients aged ? 50 years with active, subfoveal CNV, fibrosis < 50% of total lesion area, visual acuity 20/25-20/320 and at least 1 drusen (>63?) in either eye or late AMD in fellow eye were eligible. The primary outcome was the mean change in visual acuity at 1 year, with a noninferiority limit of 5 letters on the eye chart. Results At one year, all four groups had similar improvements in visual acuity. Groups had similar rates of adverse events, though patients receiving bevacizumab had more occurrences of ?1 serious adverse event than those in the ranibizumab gr

    Dr. Neha Goel, MBBS MS MNAMS DNB FRCS (Glasgow)

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