Topic

#Vitreoretina

79 articles
  1. Articles 1 Apr 2021 10 min read

    Binocular Indirect Ophthalmoscopy : The Beginner's Guide

    The technique of examining the fundus of the eye is called ophthalmoscopy. In direct ophthalmoscopy, a virtual and erect image of the fundus is seen. In indirect ophthalmoscopy, a real and inverted image is formed between the condensing lens and the observer. The advantage of stereopsis (depth perception) and a larger field of view makes indirect ophthalmoscope (IDO) more useful both in retina clinics and during posterior segment surgeries. Inventions and innovations The journey of developing ophthalmoscopy began with an idea by the great physicist, Hermann von Helmholtz, who described the optical principles of direct ophthalmoscopy in 1851 (Fig:1a). This was followed by series of innovations and methods of examination including the indirect method of ophthalmoscopy developed by Reute in 1852 (Fig:1b), binocular model by Marc-Antoine Giraud-Teulon (Fig:1c) and more practical hand-held reflex-free binocular ophthalmoscope by Allvar Gullstrand (Fig:1d). It was Charles Schepens who popula

    Dr. Nagesha CK
  2. Articles 1 Apr 2021 4 min read

    Ten Tips for Managing a Case of Postoperative Endophthalmitis

    1. Suspect : Any unusual post-operative reaction ( out of proportion to surgical trauma ) should be suspected for Endophthalmitis. 2. Differentiate from TASS : All unusual post-operative reactions may not be infective; Pointers towards Toxic Anterior Segment Syndrome could include: Early onset of Limbus to limbus corneal edema with good fundus glow and no exudates in the vitreous cavity. The presence of Lid edema, chemosis, a marked reduction in vision, vitreous exudates, and low intraocular pressure should alert one for Infective Endophthalmitis. 3. Talk : The most difficult part is how to tell the patient about this. This is a very sensitive issue because in Today`s time, no patient is willing to take any negative news ( Thanks to Trivilisation of eye surgery / googlisation etc.) and there is always a potential for medicolegal issues cropping up. Talking requires some degree of compassion. It is advisable to take a picture of the anterior segment & fundus, even if hazy. Take patient

    Dr. Lalit Verma
  3. 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
  4. 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
  5. Articles 1 Apr 2021 17 min read

    Learn from the Masters : Tips and Tricks of Vitreoretinal Surgery

    “If you are brave enough to start the right way, you will be strong enough to finish at the right place.” The most crucial aspect of vitreoretinal surgery is learning it the right way. And if you have the guidance of teachers with experiences of a lifetime, there is an abundant pool of knowledge you can extract. Plenty of young VR surgeons are facing difficulties in the basic principles and doctrines of surgery. Some of these basic questions were compiled together and addressed to the top-notch VR surgeons of India, owing to a simple and lucid explanation for the same. Dr. Atul Kumar, MD, FAMS, FRCS(Ed) is the Chief & Professor of Ophthalmology at Dr. R.P. Centre, AIIMS, New Delhi since 1st January 2016. He completed MD & Sr. Residency from Dr. R.P. Centre, AIIMS New Delhi India & joined as Assistant Professor in the same institute in 1987 (Discipline: -Vitreous-Retina). He pursued Retina Fellowship from the University of Maryland, Baltimore, USA, 1990. He has 313 indexed & non-indexed

    Dr. Dhaivat Shah
  6. 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
  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. Students Gallery 1 Apr 2021 27 min read

    Instruments Used in Vitreoretinal Surgery: A Comprehensive Guide for the Post Graduates

    History : While writing about the instrumentation of retinal surgery, the first name came in my mind was the none other than the Jules Gonin, who not only identified the Retinal tear as a prerequisite for the retinal detachment in the way back in 1904 in his first paper with series of 3 cases but also described the management of the same later on after constant hard work over the next two decade. He made major contribution and impact in the field of retinal surgery, immediately after his major presentation at the International Congress of Ophthalmology in 1929, and hence it is worth starting the topic recalling him. From the Gonin era to date, there were three major events in terms of development. 1st – improvement in instrumentation used to evaluate vitreoretinal pathology. 2nd – Evolution of the methods to create a chorioretinal adhesion around retinal breaks. 3rd – the development of a variety of techniques to tackle the vitreoretinal adhesion and hence to close the break permanentl

    Dr. Pratik Shah
  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. Articles 1 Apr 2021 43 min read

    Visual Electrophysiology Made Simple for the Postgraduates

    Visual electrophysiology is an extremely useful tool to study the retinal function objectively. It assesses the functional aspects of not only the retina but also the visual pathway as a whole. Even in this era of advanced imaging, one cannot ignore the importance of the functional aspects of the cellular network in the retina. The commonly used tests with their salient applications are enumerated in Table 1. S.no Test Application 1. Electroretinogram(ERG) Elicits mass response from the Retina 2. Electro-oculogram(EOG) Assesses the function of the Retinal pigment epithelium 3. Pattern ERG(PERG) Differentiates macular and optic nerve pathology 4. Multifocal ERG(MfERG) Picks up focal retinal pathology and maps out the topography 5. Photopic Negative Response(PhNR) Tests the function of retinal ganglion cells 6. Visual Evoked Potentials(VEP) Assesses the visual pathway up to the occipital cortex 7. Multifocal VEP(MfVEP) Picks up focal dysfunction of the visual pathway and maps the topogra

    Dr. Parveen Sen · Karthika Pandurangan · +1 other

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