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#Vitreoretina

79 articles
  1. 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
  2. Students Gallery 12 Aug 2021 10 min read

    Retina Case Presentation in Practical Exam: 10 Tips

    DNB practical exam is a time-bound test of knowledge, presentation skills, swiftness and presence of mind. In the exam, a candidate usually gets 4 long cases with 20 mins per case (a whole 2 minutes more than you can take to write each answer in the theory exam). That usually includes 2 anterior and 2 posterior segment cases. Although 2 posterior segment cases may seem like a daunting task, there are ways to excel the viva; otherwise, the sheer stress of exam often changes the performance, pace and quality and a lot of brilliant minds start fumbling under stress. The 20 minutes that are provided are for not just taking the case (which includes history taking and examination) but also writing the case sheet and in retina cases- a good diagram or illustration preferably on the Amsler-Dubois chart. Here are 10 simple tips for presenting a retina-based case in a DNB practical exam. 1. Don’t screw the basics: In the exam, unlike in the clinics of most DNB hospitals (where we have an optomet

    Dr. Puja Maitra · Dr. Dhaivat Shah
  3. Articles 20 Jul 2021 10 min read

    Ocular Oncology Basics: Diagnosis of Intraocular Malignancies

    “Declare the past, diagnose the present, foretell the future.” Hippocrates In this section, I will deal with various diagnostic methods which are common in practice for the diagnosis of mainly Intraocular malignancies. Diagnostic modalities used for extraocular malignancies will be considered in the respective chapters. 1.History Even though the twenty-first century has seen a boom in the diagnostic armamentarium available to the ophthalmologist, the art of good history taking can never be out of fashion. History of the present complaints, their duration, and associated complaints can provide multiple clues. If the duration of complaints has been seen over a long period of time with minimal change; a chronic condition can be anticipated. A sudden change in vision is an alerting sign. Personal history pertaining to the patient's occupation will provide us the visual needs of the concerned. Any previous history of other malignancies, its treatment history may provide clues with the etiol

    Dr. Bikramjit Pal
  4. Articles 20 Jul 2021 8 min read

    Ocular Oncology Basics: Genetics

    Twenty first century has seen a giant leap in the understanding of human genetics. Based on the human genome project humans are supposed to have roughly 20,000 to 25,000 genes. Genes are the fundamental units of heredity. To understand genetics involved in various ocular pathologies a basic understanding is essential. The following discussion will provide an overview of basic concepts in genetics and provide a glimpse into the genetics of Retinoblastoma and intraocular melanoma. The basic structure of a chromosome [1] Chromosomes are formed by a tight packaging of the DNA stored in the nucleus of a cell Each gene in humans are comprised of 2 copies ; one inherited from either parent. Forms of the same gene with differences on the basis of bases are known as alleles. A tightly regulated process of transcription and translation involves the production of basic building blocks called as amino acids to form proteins. Gene regulation is the process whereby certain genes are 'switched on' an

    Dr. Bikramjit Pal
  5. Articles 20 Jul 2021 13 min read

    Ocular Oncology Basics: Treatment Strategies In Intraocular Malignancies

    “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” Jim Valvano Treating malignancies I believe, brings the true human spirit forward of the treating physician. Breaking the news of malignancy to a patient is as heartbreaking for the physician as it is for the patient. Yet the doctor must keep his feelings aside and do his best. Even though the human eye forms a small fraction of the human body, malignancies of all sorts and sizes can be found inside. Treatment is complex and takes a lifetime to master. In this section, I will summarize the various treatment modalities used in intraocular malignancy with a small write-up on chemotherapy and radiotherapy. 1. CRYOTHERAPY Principle of cryotherapy [1],[2] Direct effect Indirect effects: Initial freezing causes vasoconstriction and then the process of thawing causes vasodilation leading to increased permeability and edema Secondary endothelial damage leads to f

    Dr. Bikramjit Pal
  6. Students Gallery 1 May 2021 7 min read

    i-File: Commotio Retinae

    Chief Complaint: A 12-year-old boy presented with redness and a decrease in vision in the left eye within four hours of injury with a top. History of Present Illness: Redness and decrease in vision in the left eye. No other significant complaint. Past Ocular History: No H/O any previous injury. Past Medical History/ History of Medication: No significant ocular past history for which he has used medications. Family History: No significant family history. Review of Systems/Systemic Examination The child was conscious, well oriented in time and space, afebrile, pulse rate was 88/min, respiratory rate was 16/minute. Examination of other systems were normal. Ocular Examination Best Corrected Visual Acuity (Snellen) Right eye (OD): 6/6 Left eye (OS): 6/36 with pinhole – 6/18p Ocular Motility/Alignment Extraocular motility was full and free in all gazes in both eyes. Intraocular Pressure (IOP)- By Applanation tonometry Right eye: 14mm Left eye: 16mm Pupils: Right eye - round and briskly react

    Dr. Priya Rasipuram Chandrasekaran
  7. Students Gallery 14 Apr 2021 3 min read

    i-File: Stargardts Disease

    Question A 35-year-old otherwise healthy female ( computer professional) presented with OU diminution noticed recently. BCVA OD 6/12 N6 and OS 6/18 N8. Anterior segment including IOP were normal in both eyes. Fundus examination revealed as depicted in the color fundus photo. What is the diagnosis( a differential is preferred) How do you manage this case Answer: The diagnosis is Stargardt’s Disease(SD)/Fundus flavimaculatus (FFM) Few Features: The onset of SD is generally in the first or second decade of life whereas FFM generally manifests after the 3 decades. The main presenting symptoms generally decrease in central vision. VISUAL ACUITY DOES NOT CORRELATE WITH FUNDUS APPEARANCE. Dyschromatopsia, nyctalopia, and visual field loss are generally not present. The earliest clinical sign is the loss of the foveolar reflex with symmetrical RPE alterations. Atrophy of fovea is generally marked by granularity, mottling, and presence of FLECKS(irregular-shaped yellow-white lesions with shapes

    Dr. Bikramjit Pal
  8. Students Gallery 12 Apr 2021 6 min read

    i-File: Valsalva Retinopathy

    Brief Scenario of The Case: A 50-year-old male patient was seen on 27th January 2021 with a chief complain of sudden painful loss of vision in his right eye for 1 week after lifting a heavyweight object at work. History of Present Illness: The patient’s only complain was a black spot and decreased vision in an otherwise normal right eye, which occurred after lifting a heavyweight object (100 kg) at work. Past Ocular History: The patient was using glasses for near vision (+1.00DS) for both eyes. Past Medical History: The patient was a chronic tobacco chewer. He had no other significant medical history. Family History: No family history of hypertension, diabetes, any neurological disease, or coagulopathy condition. Systemic Examination: The patient had a blood pressure of 120/80, RBS was 127 mg%, his Pulse rate was 78/min. His central nervous system, circulatory system, and respiratory system examinations were normal. Ocular Examination: 1. Best-corrected visual acuity (Snellen) • Right

    Dr. Maradula Gangawar · Dr. Dhaivat Shah
  9. Students Gallery 12 Apr 2021 3 min read

    i-File: Idiopathic Juxtafoveal Retinal Telangiectasia

    Question A 61-year-old presented with OU diminution of vision. He complains of distortion of letters which he has noticed in the last few months. He is a well-controlled diabetic for 13 years. There are no other systemic issues. Examination revealed a BCVA of OD 6/18(P) N8, OS 6/24 N8. The anterior segment is unremarkable except for pseudophakia OU (no e/o PCO). Fundus and FFA as shown What is the most probable diagnosis (give your differential)? Which other investigation will help in the diagnosis How will you treat the patient? Answer: Idiopathic Juxtafoveal Retinal Telangiectasia(IJRT) Classification COATS Subretinal exudation without vascular abnormalities Subretinal exudation with vascular abnormalities Exudation with AV malformation This classification is mostly for interest and not followed anymore GASS and BLODI ( 1993) This classification was a modification of the original Gass and Oyakawa classification of 1982 1A) Congenital in nature, having a UNILATERAL presentation in MAL

    Dr. Bikramjit Pal
  10. Students Gallery 12 Apr 2021 5 min read

    i-File: Retinal arterial macroaneurysm (RAM)

    Question A 52-year-old female presented with sudden onset blurring of vision in OD for 2 weeks. She is a known case of hypothyroidism on regular treatment. There is no other systemic illness. The best-corrected visual acuity in OD was 6/36(p) N12 and 6/6 N6 in OS. The anterior segment is unremarkable. The fundus is as shown: What is the most probable diagnosis? How will you manage the case (investigations and treatment both) Answer: RAM is generally acquired retinal aneurysmal dilation typically occurring within the first 3 bifurcations of the central retinal artery most commonly seen in elderly hypertensive females. 1. Clinical Classification a) Hemorrhagic Hemorrhage is the major component extending more than 1 DD with visual loss b) Exudative Exudation is the major component responsible for visual loss c) Quiescent Either there is no hemorrhage or exudation or there exists minimal hemorrhage and exudation with minimal or no visual loss They can be further subdivided as predominantly

    Dr. Bikramjit Pal

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