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  Most popular articles (Since June 06, 2017)

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Operation theaters and sterilization requirements — Design consideration and standards for infection control
T Nirmal Fredrick, Murugesan Kumaran
April-June 2018, 56(2):84-90
An operation theater (OT) complex is the “heart” of any hospital. An operating theater, operating room (OR), surgery suite, or a surgery center is a room within a hospital where surgical and other operations are carried out. The patient is the center point of a functioning OT complex. He/she is in isolation for varying times, away from his near and dear ones and is physically sick. Efforts should be directed to maintain vital functions, prevent infections/promote healing with safety, comfort, and economy. A “civil-mechanical-electrical-electronic-biomedical” combo effort driven and coordinated by the needs, preferences, and safety of the medical/surgical team forms the basis for starting and maintaining an OT. Hospitals should exercise great care in proper maintenance of the OR environment, heating ventilation and air-conditioning system (HVAC) system, and medical and nonmedical equipment inside the OR. Personnel involved in disinfection and sterilization process should follow aseptic protocols. Aseptic protocols mean following safe and disciplined procedures to minimize or eradicate the microbiological load in the environment and in the instrument brought into the sterile field during the surgery.
  57,483 2,825 1
Orbital cellulitis- A review
Raghuraj Hegde, Gangadhara Sundar
July-September 2017, 55(3):211-219
Orbital cellulitis is an infection of the orbital soft tissues posterior to the orbital septum. It has the potential to be affect sight and function of the eye and extraocular tissues. Although it is commonly seen in the pediatric age group, adult orbital cellulitis is not uncommon. Infection usually originates from sinuses but sometimes the nidus of infection is in the eyelids, from retained vegetative foreign bodies, or very rarely from distant infection spreading to the orbit spread from blood. It is characterized by pain, proptosis, chemosis, diminution of vision, fever, periorbital erythema, and limitation of ocular motility. Historically orbital cellulitis was a sight and life-threatening condition. However, with the advent of high quality imaging, antibiotics and early surgical intervention to drain the orbital abscess when indicated, the chances of visual loss have reduced significantly. The purpose of this review is to describe current investigative and management paradigms in the treatment of orbital cellulitis and current recommendation in the management of complications resulting from it.
  13,010 1,117 2
Interpreting HFA single field reports
Panda Smita, George Ronnie, Murali Ariga
July-September 2019, 57(3):220-230
Autoperimetry is a very important investigation for glaucoma diagnosis and management. This article deals with the basics and terminologies used in humphrey visual field analysis and deals with the interpretation of humphrey visual field analysis printout.
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Update on optical biometry and intraocular lens power calculation
Nazneen Nazm, Arup Chakrabarti
July-September 2017, 55(3):196-210
Intraocular lens (IOL) power calculation is the single most important determinant of functionally improved result of a technically precise cataract surgery. We have discussed recent advances in the field of optical biometry and IOL power calculation formulae as a means to achieve better postoperative visual outcome. The use of automated optical biometry device, the current 'gold standard' of IOL power calculation, dates back to 1999. We have highlighted the evolution of newer optical biometry devices and the technology they are based on, and their advantages and limitations. We have done technical comparison of contemporary biometers and have included contextual current review of literature. We have described newer generation IOL power formulae, IOL power calculation in high to extreme myopia, toric calculators and intraoperative aberrometry, and concluded our discussion with a note on future prospects of IOL power calculation.
  12,273 1,426 2
Accommodative spasm: Case series
Anjali Kavthekar, N Shruti, M Nivean, M Nishanth
October-December 2017, 55(4):301-303
This study highlights importance of cycloplegic refraction to detect accommodative spasm(AS) patients and role of atropinisation for its management.This retrospective case series study was done at a tertiary care eye hospital in Chennai, India. Four patients, presented with complaints of sudden onset blurring of vision and asthenopic symptoms with history of aggravation of symptoms with prolonged near work and under stressful conditions.Refraction was initially showing myopic refractive error.After cycloplegia,there was hypermetropic shift and VA was 20/20 for distance in all patients with their hyperopic correction,and N6 with upto +3.00 dioptres for near.Diagnosis of AS was made.Bifocal glasses were prescribed and atropinisation(1%) with avoidance of aggravating factors was started . Patients were tapered gradually to prevent recurrence over three months and were observed for six months in which none had reccurence.Post cycloplegia,the condition resolved and asthenopic symptoms were improved.
  11,563 716 1
Interpretation of optical coherence tomography
Ronnie George, Trupti Sudhir Patel, Murali Ariga, Malarchelvi Pazhani, Pratheeba Devi Nivean
January-March 2019, 57(1):34-48
Glaucoma is a progressive disease which can lead to blindness. Early detection is crucial to prevent further damage. Though glaucoma is more a clinical diagnosis but investigative tools like optical coherence tomography can help us diagnose suspicious cupping and early glaucoma. The newer modalities help us to prognostigate the disease by seeing for progression. This article will help the reader interpret OCT with better understanding.
  10,940 1,050 1
Newer drugs in glaucoma management
Sujatha V Kadambi, Ronnie George
April-June 2017, 55(2):134-139
Glaucoma, a chronic progressive neurodegenerative disease, has both intraocular pressure dependent and independent pathogenetic mechanisms. Medical therapy is the first line of treatment in glaucoma management. Patient adherence and persistence to pharmacotherapy is a great barrier to its success. This review highlights the recent advances in medical management and discusses newer pharmacotherapy including new molecules with novel mechanisms of action, novel target molecules/genes/tissues, and newer drug delivery systems, many of which are still in clinical trial phase.
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Pediatric intraocular lens power calculation
Sandra Chandramouli Ganesh, Shilpa G Rao, Farhadul Alam
October-December 2018, 56(4):232-236
Pediatric cataracts pose multiple challenges in terms of management and postoperative rehabilitation. Difficulties in obtaining accurate measurements for axial length and keratometry are encountered due to poor cooperation in children and instrumentation errors. There exist multiple formulae for intraocular lens (IOL) power calculation, which are based on various factors and have varying degrees of accuracy. Children exhibit a tendency for myopic shift due to the anatomical differences from adult eyes and due to the growth of eyeball, as a result of which they require undercorrection, when IOL implantation is planned.
  9,968 805 1
Approach to headache in ophthalmic practice
R Vasumathi
April-June 2018, 56(2):91-97
Headache is one of the most commonly experienced of all the physical discomforts. About half of the adults have a headache in a given year. Headaches can occur as a result of many conditions. Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. The evidence in the literature for a strong association between oculovisual problems and headache is weak. Still, patients who believe that appropriate ocular examination and treatment help to lessen their headache visit ophthalmologists very frequently. Although ophthalmic causes are sometimes diagnosed, eye pain and visual disturbances are often neurologic in origin. Many primary headache disorders have ophthalmic features, and secondary causes of headache frequently involve the visual system. Both afferent and efferent symptoms and signs are associated with headache disorders. Moreover, the frontal or retroorbital pain of some primary ophthalmic conditions may be mistaken for a headache disorder, particularly if the ophthalmologic examination is normal. This review summarizes the common causes of headache encountered in ophthalmic practice and the red flag signs which need referral to other specialists.
  7,428 687 1
Scleral-fixated intraocular lenses
VG Madanagopalan, Parveen Sen, Prabu Baskaran
October-December 2018, 56(4):237-243
Scleral-fixated intraocular lenses (SFIOLs) are important tools for an ophthalmologist when dealing with the eyes that have inadequate capsular support. Since the time of its introduction, SFIOLs and techniques for their implantation have seen many innovations. Initially, sutured SFIOLs were widely performed. In the last two decades, sutureless SFIOLs are gaining popularity. Both these methods and the different surgical techniques to perform them offer unique advantages to the surgeon. Therefore, careful consideration is to be given to the choice of technique and steps to be employed for a particular eye. In this article, we aim to provide an overview of the commonly used techniques in SFIOL surgery and provide certain surgical tips that may help the surgeon in the operating room.
  6,996 695 4
Kayser fleischer ring: A strong clinical indicator of neuro-wilson's
Rajalakshmi Selvaraj, Subashini Kaliaperumal, Pooja Kumari
October-December 2017, 55(4):307-309
A female child presenting with features of lupus nephritis was referred for ophthalmic evaluation related to autoimmune diseases. It turned out to be a dense yellow-brown deposit of Kayser Fleischer (KF) Ring and sunflower cataract following which diagnostic tests for Wilson disease (WD) were carried out and treated for the same. However, the child died in a month due to hepatic encephalopathy and sepsis. The dense KF ring conveys that it has been long-standing and a definite indicator of Neuro WD. In this brief report, the authors would like to insist on the significance of early identification of KF ring and its neurological relevance.
  6,077 264 1
Clinical profile of nonstrabismic binocular vision anomalies in patients with asthenopia in North-East India
Damaris Magdalene, Pritam Dutta, Mitalee Choudhury, Saurabh Deshmukh, Krati Gupta
July-September 2017, 55(3):182-186
Aim: To report the clinical profile of non-strabismic binocular vision anomalies (NSBVA) in patients with asthenopia in North-East India. Materials and methods: A hospital based study was conducted on 131 patients from age group 10-40 years attending the vision therapy clinic. Patients were divided into the age groups 10-20 years, 21-30 years and 31-40 years. A detailed orthoptic evaluation was carried out including sensory and motor testing and a diagnosis was made comparing various orthoptic parameters of the particular patients. Results: Of the 131 patients, 81 were female and 50 were male. The number of patients was 62 in the 10-20 years age group, 49 in 21-30 years age group and 20 in 31-40 years age group. The prevalence of NSBVA in age group 10-20 years was 69.35%, 21-30 years was 67.35% and 31-40 years was 50.00%. It was observed that the most common NSBVA was convergence insufficiency across all age groups followed by accommodative insufficiency and convergence excess. Conclusion: Early detection of NSBVA is important because these deviations may decompensate without treatment and become strabismic resulting in loss of stereopsis and development of suppression. Early detection and treatment provides best opportunity for academic success in school going age groups.
  5,667 471 1
Nummular keratitis – A modern-day conundrum
Srinivas K Rao, Sanjeev P Srinivas, Anil K Nair
October-December 2019, 57(4):308-310
  5,778 276 1
Peanuts: A common migraine trigger
R Vasumathi
July-September 2018, 56(3):206-206
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Posterior staphyloma
Baskararajan Gopalakrishnan, Bhuvanasundari Baskarajajan
April-June 2018, 56(2):76-83
Introduction: Very high myopia is usually associated with posterior staphyloma. The pathology, management and our experience reported in the article. Methods: We studied a total of 3737 student population in schools and colleges in the year 2001 — 2002 with the help of the Principals and teachers. High myopic patients treated in our hospital (242 patients) who underwent B—Scan and surgical management in two stages, posterior scleral support operation followed by low power intraocular lens implantation, have been included in the study(14). Discussion: High myopia and keratoconus have opposite effect in the anatomy of eye ball. In high myopia, the anterior segment of the eye is usually normal or there may be slight variation in the depth of anterior chamber whereas in keratoconus the posterior segment is normal. Staphyloma, usually occurs in the posterior pole of the eye ball involving the macular region can also expand anteriorly leading to thinning of sclera to be observed as bluish bulging. As the posterior staphyloma progresses, the retina undergoes degenerative changes due to stretching in the macular region, around the ora-serrata and around the optic disc also. In the posterior pole, the thinning of sclera and retina leads to a decrease in the functional efficiency of the retina which is often misconstrued as amblyopia especially in uni-ocular high myopes. In majority of such cases, surgical compression of the posterior pole by preserved donor sclera from behind reverses the damage and restores full vision when followed by low power intra ocular lens implantation. Results and Conclusion: 242 high myopes, among which 212 patients with Bilateral and 30 patients with unilateral involvement were included in this report and final visual outcome analyzed. In the surgical management of very high myopes, it is mandatory to manage the posterior staphyloma to get good visual outcome. To arrest the myopic progression, P.S.S.O. should be performed in young age itself.
  5,369 275 -
Scleral buckling: Principles, utility, and relevance today
VG Madanagopalan
October-December 2017, 55(4):286-292
With time, any surgical specialty or procedure invariably undergoes change. New techniques and technologies become available and the next generations of surgeons innovate to modify established methods. The surgical management of retinal detachment has come a long way from the days of Custodis and Schepens. Scleral buckling (SB), which was once the “gold standard” when reattachment of the retina was desired, no longer enjoys the coveted standing of yore. Despite being in use for more than six decades, the many “modifications” of this surgical procedure are rather superficial - although some may argue that the procedure itself is superficial - and the original surgical principles described have remained constant. In this article, we focus on the utility of buckling, the dynamic physical forces at work when a buckle attempts to reattach the retina and the role of SB in this era of microincision surgeries.
  4,450 465 -
Generic drugs in ophthalmic practice: Boon or bane?
Murali Ariga, M Rajalakshmi, C Praveena
July-September 2017, 55(3):220-222
Generic pharma products are inexpensive as compared to the original innovator branded drugs. True generics are not freely available in India. There have been concerns about efficacy and quality of generics that are available. This review outlines these issues and the legislation regarding the availability and use of generics in our practice.
  4,423 286 -
Maintenance and Management of an ophthalmic operation theater in sub-Saharan Nigeria
Prabu Baskaran, Ashok Rangarajan, Seema Ramakrishnan, Sudeep Singh Gadok
October-December 2019, 57(4):299-307
In today's era, the operation theatre (OT) is like the heart of an ophthalmic hospital set up. The maintenance and management of this sensitive area is quite often missed or not taught during the training period. It becomes imperative to have a sound knowledge about OT maintenance and management, particularly if the set up is located in a remote area with limited resources and all the more it makes sense if an ophthalmologist has to manage the entire set up single handedly. The objective of this article is to meet this requirement. Based on accepted clinical guidelines and our own experience, we have to compiled most of the important aspects of OT set up and maintenance.
  4,398 166 -
Quality healthcare and clinical processes: An amalgamation needed to achieve clinical excellence
Suneeta Dubey, Deepika Verma, AK Arora
July-September 2017, 55(3):187-191
Quality improvement is an essential component of 21st-century medicine. Dr. Shroff's Charity Eye Hospital is National Accreditation Board for Hospitals and Healthcare Providers-accredited organization which firmly believes in amalgamating quality measures with clinical processes and bringing out the most effective clinical environment for best patient care, one of the values of the organization. Clinical excellence is achieved through a stepwise approach.
  4,289 233 -
Profile of brain tumors having ocular manifestations in a Tertiary Eye Care Institute: A retrospective study
Saurabh Deshmukh, Dipankar Das, Harsha Bhattacharjee, Ganesh Ch Kuri, Damaris Magdalene, Krati Gupta, Prabhjot Kaur Multani, Vivek Paulbuddhe, Shriya Dhar
April-June 2018, 56(2):71-75
Aim: To form a profile of brain tumors having ocular manifestations presenting to a tertiary eye care institute. Materials and Methods: The medical records of patients diagnosed with primary brain tumors between January 2012 and December 2017 were reviewed. Patients underwent a detailed ocular examination and neuroimaging to confirm the diagnosis. Results: Out of the 17 patients, 11 (65%) were female and 6 (35%) were male. The mean age was found to be 43.17 ± 11.04 years and the majority of the patients belonged to the age group 21—40 years (47.06%). The most common presenting symptom was found to be diminution of vision (100%), followed by headache (41.14%) and vertigo (23.52%). The most common sign was optic disc changes, namely optic atrophy (47.05%), followed by disc pallor (29.41%) and papilledema (11.76%). Meningioma (41%) was the most common tumor followed by pituitary macroadenomas (29%). At the time of presentation, two patients had the restriction of extraocular movements, seven patients had a positive relative afferent pupillary defect, and four had defective color vision. Conclusions: Ophthalmic signs and symptoms form a major part of the presentation in patients with intracranial tumors. Majority of the patients diagnosed by ophthalmologists with brain tumors presented with optic disc pallor or edema resulting in diminution of vision. By careful neuro-ophthalmic evaluation, early diagnosis of intracranial space occupying lesions can be made and prompt referral to neurosurgeon can reduce the morbidity and mortality.
  4,115 383 2
Small eyes, big problems: Cataract surgery in nanophthalmos
PV Tejaswi Prasad, Nivean Madhivanan, Murali Ariga, Abhinaya Sridhar
July-September 2018, 56(3):188-190
Nanophthalmos is characterized by bilateral and symmetrical small eyes with shortened axial length of 20 mm or less (two standard deviation below average axial length), high lens-to-eye volume ratio with shallow anterior chamber, enophthalmos, and narrow palpebral fissures. All these features make it challenging for cataract surgery, in this case report, we suggest few necessary steps taken for an uncomplicated outcome.
  4,165 254 -
Zepto cataract surgery: The way forward
Nishanth Madhivanan, Shruti Nishanth, Nivean Madhivanan, Madhivanan Natarajan
April-June 2018, 56(2):98-101
Continuous curvilinear capsulotomy (CCC) is one of the most crucial steps of cataract surgery because of numerous surgical and anatomic advantages. The introduction of cataract surgery assisted by femtosecond laser has improved the repeatability and the accuracy of a perfectly rounded capsulotomy, as compared to the manual CCC. However, multiple surgical steps and the relatively high cost-per case have rendered this technology useful only to the affordable. This article describes a cost-effective and convenient new technique of perfecting the circular capsulotomy using a device called precision pulse capsulotomy or Zepto.
  4,137 276 -
Duane retraction syndrome: Clinical presentation and management strategy
Manjula Jayakumar, B Prashanthi
January-March 2019, 57(1):49-54
Duane retraction syndrome (DRS) is a special strabismus with variable presentation. It has been best classified by Huber based on electromyography in 1974 into three types. Huber type I is the most common form of DRS with an earlier presentation and also has satisfactory surgical outcomes. Huber type II is the least common presentation. Ahluwalia et al. in 1988 have further divided it into subgroups A, B, and C based on the alignment in primary position, indicating esotropia, exotropia, and orthophoria. Type I has esotropia, type II has exotropia, and type III has esotropia and exotropia equally common. DRS can be associated with other ocular abnormalities and systemic issues when present in syndromes. Hence, these patients need a more detailed evaluation. Management strategy aims at alignment in primary position, correcting anomalous head posture, improving palpebral fissure size, and alleviating upshoots and downshoots. It is challenging to address these patients and they need to be counseled before surgery regarding the outcome that is expected of the surgery.
  4,096 278 1
Corneal biomechanics in glaucoma – A review of the current concepts and practice
Prasanna Venkataraman, MB Madhuri, Neethu Mohan
April-June 2020, 58(2):94-100
Intraocular pressure (IOP) is currently the only modifiable risk factor in glaucoma. Since all our efforts are directed towards maintaining a stable IOP to halt glaucoma progression, proper understanding about the science behind IOP measurement and biomechanics of cornea becomes paramount. In this paper, we address the basics of corneal biomechanics, recent developments and its impact on glaucoma diagnosis and management. An extensive literature search was done using PubMed and Google Scholar with the search terms such as biomechanics, hysteresis, and glaucoma. Relevant articles published in English language were reviewed.
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Remembering Dr. Charles D. Kelman and Development of phacoemulsification
R Vasumathi
January-March 2018, 56(1):45-50
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