March-April 2017

SNAPSHOT

Figure 1: Gradually progressive proptosis and severe conjunctival Figure 2: MRI scan suggestive right orbital roof defect with formation
chemosis with exposure keratopathy of right eye of intra-orbital encephalocele and displacement of the right eye globe
laterally, inferiorly, and anteriorly

appearance of the signs and symptoms surgical intervention is manadatory. Craniomaxillofac Trauma Reconstr.
2016;3:255-9.
as the fracture in the orbital wall grows Conclusions 4. Jaiswal M, Sundar IV, Gandhi A, Purohit
D, Mittal RS. Acute traumatic orbital
over time. In a patient with persistent Whenever orbital roof fractures encephalocele: A case report with review of
associated with frontal contusions literature. J Neurosci Rural Pract 2013;4:467-
ocular symptoms and a history of orbital are detected in an acute head-injury 70.
patient and presented with increasing 5. Duhem-Tonnelle V, Duhem R, Mora AR,
trauma, a growing fracture of the orbital proptosis, orbital encephalocele should Allaoui M, Assaker R. Traumatic orbital
wall must be suspected14. Our patient was be suspected. In addition to the history encephalocele in an adult: report of one case.
and clinical examination, imaging studies J.Neuchi 2008;54:28-31.
the victim of traumatic encephalocele are helpful in confirming the diagnosis. 6. Cayli SR, Kocak A, Alkan A, Kutlu R, Tekiner
MRI should be considered if there is high A, Ates O, et al. Intraorbital Encephalocele:
related to orbital roof fracture, which is index of suspicion for encephalocele and An Important Complication of Orbital Roof
CT findings are equivocal. Traumatic Fractures in Pediatric Patients. Pediatr
unusual and has been rarely reported. For orbital encephaloceles nearly always Neurosurg 2003;39:240–45.
need neurosurgical repair, as these have 7. Wei LA, Kennedy TA, Paul S, Wells TS,
such cases, early diagnosis and treatment tendency to enlarge and may lead to Griepentrog GJ, Lucarelli MJ. Traumatic
optic nerve compression and infection. orbital encephalocele: Presentation and
is very essential as the raised intraorbital We emphasize that close clinical follow imaging. Orbit 2016;35:72-7.
up, prompt diagnosis and surgical 8. Cullu N, Deveer M, Karakas E, Karakas
pressure may irreversibly damage the management are very important in any O, Bozkus F, Celik B. Traumatic fronto-
case of orbital roof fracture. ethmoidal encephalocele: a rare case.
optic nerve. Moreover, stretching of Eurasian J Med. 2015;47:69-71.
References 9. Gazioglu N, Ulu M O, Özlen F, Uzan M, Çiplak N.
the nerves innervating the extraocular Acute traumatic orbital encephalocele related
1. Antonelli V, Cremonini AM, Campobassi A, to orbital roof fracture: reconstruction by
muscles may result in their palsy. Pascarella R, Zofrea G, Servadei F. Traumatic using porous polyethylene. Ulus Travma Acil
encephalocele related to orbital roof Cerrahi Derg 2008;14:247-52.
After an acute orbital trauma, fractures: Report of six cases and literature 10. Morihara H, Zenke K, Shoda D, Fujiwara
sufficient evaluation of the vision and review. Surg Neurol 2002;57:117 25. S, Suehiro S, Hatakeyama T. Intraorbital
ocular motions is quite difficult due to encephalocele in an adult patient presenting
the surrounding soft tissue swelling and 2. Bloem JJ, Meulen JC, Ramselaar JM. Orbital with pulsatile exophthalmos. Neurol Med
roof fractures. Mod Probl Ophthalmol Chir (Tokyo) 2010;50:1126-28.
hematoma. To precisely determine the 1975;14:510 2. 11. Rothman M. Orbital trauma. Semin
Ultrasound CT MR 1997;18:437-47.
extent of orbital roof bony involvement 3. Arslan E, Arslan S, Kalkısım S, Arslan A, 12. Takizawa H, Sugiura K, Baba M, Tachisawa
three dimensional CT scan is the first Kuzeyli K . Long-Term Results of Orbital T, Kadoyama S, Kabayama T, et al. Structural
choice. However, it is very challenging Roof Repair with Titanium Mesh in a Case mechanics of the blowout fracture: numerical
of Traumatic Intraorbital Encephalocele: computer simulation of orbital deformation
to identify on CT, as severe trauma often A Case Report and Review of Literature. by the finite element method. Neurosurgery
1988;22:1053-5.
has concomitant orbital and intracranial 13. King AB. Traumatic encephaloceles of the
hematomas, and it is quite difficult to orbit. AMA Arch Ophthalmol 1951;46:49 56.
distinguish it from herniated brain tissue. 14. Jamjoom ZA. Growing fracture of the orbital

Therefore, Magnetic resonance imaging roof. Surg Neurol 1997;48:184 8.

(MRI) is more sensitive for identifying

intraorbital pathologies and to

differentiate from intraorbital tumors &
vessel malformations. So, MRI is beneficial
for definitive treatment planning. If the
encephalocele is confirmed, immediate

Department of Ophthalmology, Dr RPGMC,Tanda, Kangra, H.P., India

Dr.Vandna Sharma MS Dr. Rajeev Tuli MS Dr. Gaurav Sharma MS Dr. Mandeep Tomar MS

Financial Interest: The authors do not have any financial interest in any procedure/product mentioned in this manuscript.

56 DOS Times - march-april 2017

SNAPSHOT

Dermoid

Anubhav Chauhan, Lalit Gupta

An 18 year old female with no past history of Unlike typical cutaneous dermoids, conjunctival dermoids
any systemic disease, trauma,ocular infection are usually located in the nasal or superonasal deep orbit.
presented with a painless, progressively The location and adnexal structures associated with these
increasing mass in the right eye since three lesions suggests derivation from embryonic epithelium
months which was causing her ocular destined to become caruncle3. Dermoid cysts are usually
discomfort. Her visual acquity was 6/6 in both classified as juxtasutural, sutural or of soft tissue types, with
the eyes; pupillary reactions, ocular movements, colour vision, further subdivisions, based on their relationship to the orbital
intraocular pressure and fundus examination were normal bone and location within the soft tissues. However, they can
bilaterally. Examination of her right eye revealed a pinkish mass generally be divided into either superficial (simple, exophytic)
in the upper palpebral conjuctiva on the lateral aspect with a or deep (complicated, endophytic) dermoid cysts based on
single eyelash protruding from it. The mass was mobile, firm their relationship to the orbital septum4.
and valsalva manoeuvre did not cause an increase in its size.
Complete excision was done and histopathological examination The differential diagnosis for conjunctival tumor in children
showed nonkeratinizing conjunctival epithelium with goblet are nevi (64%), dermolipoma (5%) and lymphangioma(3%)5.
cells which was consistent with the diagnosis of dermoid cyst Conjunctival dermoids are rare tumors with Martinez et al
of conjunctival origin. finding only 14 cases in the literature in 1998. Only one case
describing the presenting of dermoid with externalized hair
DISCUSSION follicles in the conjunctival fornix6 has been reported to date to
the best of our knowledge after extensive internet search.
Conjunctival dermoids were first reported by Jakobiec et
al. in 1978. Conjunctival dermoids and cysts are usually noticed REFERENCES
in adulthood, lack an associated osseous defect1 while orbital
dermoid cysts frequently erodes adjacent bone and are the 1. Colombo F, Holbach LM, Naumann GO. Conjunctival cyst and conjunctival dermoid of
most common orbital tumor of childhood. Dermoid cysts of the orbit.Orbit 2000;19:13-19.
conjunctival origin are uncommon orbital tumors and present
as noninflammatory, space occupying lesions that does not 2. Martinez LM, Cohen KL. Conjunctival Dermoid Cyst Seen on Examination as a
threaten vision. Findings from histopathologic examination Chronically Red Eye.Arch Ophthalmol 1998;116:1109-1111.
demonstrates a nonkeratinized, stratified, squamous epithelial
cyst wall that contains goblet cells2. 3. Dutton JJ, Fowler AM, Proia AD. Dermoid cyst of conjunctival origin. Ophthal Plast
Reconstr Surg 2006; 22:137-9.

4. Fasina O, Ogun OG. Giant deep orbital dermoid cyst presenting early in infancy in a
Nigerian child: a case report and review of the literature.J Med Case Rep 2012; 6:320.

5. Shields CL, Shields JA. Conjunctival tumors in children. Curr Opin Ophthalmol
2007;18:351-360.

6. Kim G, Mifflin MD, Mamalis N, Moshirfar M. Conjunctival Eyelashes:A Rare
Presentation of Dermoid. J Ophthalmic Vis Res 2014;9: 106-108.

Department of Ophthalmology, DrYashwant Singh Parmar Govt. Medical
College, Nahan, District Sirmour, Himachal Pradesh

Dr.Anubhav Chauhan MS Dr. Lalit Gupta MS

Figure 1

www. dos-times.org 57

Miscellaneous

IRIS CLAW LENS – The Forgotten Hero

Indeevar V Mishra, Vipul Bhandari

If the present generation of surgeons refrains from deliberately circumventing the
IRIS claw in times of need, overcoming the psychological barrier of the yesteryears
shall help them in discovering the hidden potential of this lens.

The term “Aphakia” can be defined as “absence of 2. Pre-op zonular dialysis11
the lens in the eye, occurring congenitally or as 3. Traumatic dislocation of crystalline lens13
a result of trauma/surgery”1. Another definition 4. Large zonular dialysis during surgery, surgical Aphakia11-16
is “Lenslessness”2. The word “PHAKOS” is Greek 5. Posterior chamber IOL dislocation16,18
in origin representing anything shaped like a 6. As a secondary procedure in aphakia13-16
“lentil3”. The absence of the lens renders the eye 7. Progressive Zonular Dialysis, e.g. Pseudoexfoliation17,18
hypermetropic. The spectacle correction of the aphakic eye
causes optical aberrations, such as a ring scotoma, jack-in-the- Contraindications
box phenomenon, and a pincushion distortion. Because the
image through the spectacles is magnified by 25%, the actual 1. Active Uveitis
field of view through the spectacles is reduced by 25%, which 2. Rubeosis Irides
makes it impossible to see the 25% of the periphery4. 3. Excessive iris chaffing or Iridectomies.
4. Angle abnormalities, e.g. Peripheral anterior synechiae.
Various intraocular lenses such as the scleral fixated 5. Posterior segment pathologies e.g. Cystoid macular
lenses, Glued IOLs, Iris sutured lenses and retro pupillary iris
claw lenses in the absence of sufficient capsular support are oedema, Choroidal neovascular membrane.
available at the surgeon’s disposal. In 1971 at Paris, Worst
first presented the iris-claw lens. It was a biconvex polymethyl Biometry
methacrylate (PMMA) IOL which was fixated above the iridal
plane at the mid-periphery of the iris5. However due to the The Iris claw Intraocular lens (ICIOL) can be used as a
position of the lens, associated corneal decompensation, was primary lens or during a secondary procedure. The original
noted in a mumber of cases. The lens soon went into disrepute. Artisan lens has an A constant of 115, but since the position of
fixation of the lens is retro pupillary the A constant has to be
The retro fixation of the iris claw lens was first described adjusted to 116.5 for a primary ICIOL implantation. In the event
by L. Amar et al in the early 19806. Rijneveld7 in 1994 and of a failure of implantation of the primary lens in the bag, to
Mohr et al.8 in 2002 supplemented the retro fixation of iris claw adjust the power for an ICIOL, a subtraction of 1.5 diopters can
with valid clinical results. With the latest modification in the be done from the calculated power of the PCIOL. Excel iris claw
design and the technique, enough relevant and valid studies are lens (PIC 5590 model; Excel optics [p] Ltd., Chennai, India) has
available for considering the lens as a primary choice in cases an A constant of 117.2.
where sufficient support for Posterior chamber intraocular lens
(PCIOL) is absent. Figure 1

Design

The iris is the most resilient of the ocular structures. The
haptic of the lens is in the form of a claw which holds onto the
iris once positioned correctly. The borders of the lens being
rounded do not cause irritation or pigment release from the iris
tissue. Placing the lens behind the iris preserves the anatomy
of the eye.

The two lenses currently available in the market which are
used widely are the Artisan iris-claw intraocular lenses (IOL)
(Ophthec BV, Groningen, The Netherlands) and Excel iris claw
lens (PIC 5590 model; Excel optics [p] Ltd., Chennai, India)
(Figure 1). The Artisan lens has an added advantage of vaulting
which prevents the iris - lens contact. Another posterior vaulted
Iris claw lens is produced by IOCARE.

Indications

1. Marfan syndrome/ectopia lentis9,10

www. dos-times.org 59

Miscellaneous

Image 1: Showing the dimpling of the iris180o apart with a round Image 2: Showing the well centred ICIOL with 7.5 mm dilatation of
pupil39. the pupil39.

Surgical Technique down and pushed under the iris with Discussion
gentle manipulation. Simultaneously, a
Surgical steps fine 30 gauge rod/sinskey hook is passed Treatment of aphakia has been a
through the paracentesis on the same one of the most widely discussed topics
The surgery can be performed side. Once the haptic is behind the iris, the in ophthalmology. Various options such
through a superior, supero-temporal haptic of IOL was tilted up to produce an as Sutured transcleral fixated IOLs,
or temporal incision, depending upon indent on the iris. This guides the surgeon (SFIOL) Glued IOLs, Iris sutured IOLs are
the surgeon’s choice. The incision is as to where the iris has to be enclaved. A available. All the techniques have been
preferable a 3 plane self-sealing tunnel. gentle push of the instrument usually widely studied and have their own sets of
Preexisting tunnel from previous surgery suffices. The trailing haptic is similarly advantages and disadvantages.
can also be reopened. For the ease of pushed behind the iris and enclaved.
understanding, the surgical steps for Adequate enclavation is determined by Stability of SFIOLs is affected by
superior incision in an aphakic eye are a full thickness dimple of the iris. The the possibility of degradation of suture
explained. two enclavation marks should be exactly material over time, leading to dislocation
opposite to each other. of SFIOL22. Certain studies have shown
After tunnel construction and entry SFIOLs to be associated with high
into the anterior chamber intracameral The trick is to push the lens below complication rate and subsequent need
pilocarpine or acetyl choline (Miochol the iris just enough for the claw to cross for further surgery. Re surgery was due to
0.01% preservative free from appasamy the mid periphery. The enclavation is Suture breakage in 57% of the cases23. Few
ocular devices) to be injected to constrict done by pushing the iris tissue vertically studies have indicated that trans scleral-
the pupil. OVDs are injected to form downwards or by dragging motion fixated posterior chamber intraocular
the anterior chamber. Alternatively an towards the limbus. In either case it is lenses are associated with more intra
anterior chamber maintainer can be safer to have more of the peripheral part and post-operative complications. The
used. The orientation of the haptics of of the iris before enclaving. This gives most sight threatening complication
the ICIOL should always be at an axis a much rounder pupil with adequate noted was retinal detachment with
parallel to the axis of the tunnel. Small dilatation post operatively [Image 1 & 2]. incidence ranging from 4 – 6%24-26.
side ports/paracentesis at 3’o clock and Other complications which might be
9’o clock to be created. Adequate anterior The wound closure can be done associated with trans scleral – fixated
and posterior vitrectomy to be performed with or without sutures. Routine topical posterior chamber intraocular lenses
followed by a small peripheral iridectomy. medications as preferred by surgeons are ciliary body haemorrhage, Vitreous
in routine cataract surgery to be used in haemorrhage and cystoid macular
Iris claw lens is inserted into the the post-operative period. The patient oedema27.
anterior chamber using the specifically has to be examined on the first day and
designed claw forceps. (Available with thereafter weekly for a month. In the Although latest techniques of
leading instrument manufacturer’s as immediate post-operative period the sutureless transceral glued fixation of
“Claw lens/Iris claw holding forceps”.) intraocular pressure has to be measured lenses have shown promising results, the
Alternatively the lens holder can be used at each visit. technical expertise required is high with a
for the same purpose. Holding the optic steep learning curve28.
with a lens forceps one haptic is tilted

1. Consultant Ophthalmologist,Agarwal Eye Hospital, Chennai
2. Consultant and Head Cornea Service, Netradhama Eye Hospital, Banglore

1Dr. Indeevar V. Mishra DNB 2Dr.Vipul Bhandari DOMS, DNB, FRCE
60 DOS Times - march-april 2017

Miscellaneous

Table 1: Correction factor for ICIOL in paediatric age group39. 2009;93:1273–5.
6. Amar L. Posterior chamber iris claw lens.
Children less than 2 years old
• Do biometry and under correct by 20%, or Am Intra Ocular Implant Soc.1980;6:27.
• Use axial length measurements only 7. Rijneveld WJ, Beekhuis WH, Hassman EF,
Axial length IOL dioptic power
17 mm, 25D Dellaert MM, Geerards AJ. Iris claw lens:
18 mm, 24D anterior and posterior iris surface fixation
19 mm, 23D in the absence of capsular support during
20 mm, 21D penetrating keratoplasty. J Refract Corneal
21 mm, 19D Surg. 1994;10:14–9.
Children between 2 and 8 years old 8. Mohr A, Hengerer F, Eckardt C.
• Do biometry and under correct by 10% Retropupillary fixation of the iris claw
lens in aphakia. 1 year outcome of a new
In comparison the retro pupillary implications. implantation techniques. Ophthalmology.
fixation of Iris claw lens is technically less Retinal detachment rate has been 2002;99:580–3.
challenging and less time consuming. The 9. Faria, Mun Yueh, Nuno Ferreira, and
whole procedure can be completed in 1/3 found to be less than 0.3% in one of the Eliana Neto. “Retropupillary Iris-Claw
the time required to do a trans scleral longest and largest study on iris claw Intraocular Lens in Ectopia Lentis in
fixation. Unlike its predecessor, the retro lenses performed by Matteo Forlini Marfan Syndrome.” International Medical
fixation of the lens doesn’t affect the and Cesare Forlini et al. The cause was Case Reports Journal 9 (2016): 149–153.
endothelial count29-32. attributed to post traumatic aphakia. PMC. Web. 6 Feb. 2017.
Cystoid macular oedema, a common 10. Forlini M, Gramajo AL, Rejdak R, Prokopiuk
Pigment dispersion is another complication of cataract surgery has also A, Levkina O, et al. (2013) Retropupillary
complication encountered by certain not been reported in literature38. Iris-Claw Intraocular Lens in Ectopia
surgeons. However the studies indicate Lentis Due to Marfan Syndrome. J Genet
that the pigment dispersion might be the Iris claw lens has been shown to Syndr Gene Ther 4:170.
result of intraoperative manipulation of safe and efficacious in Post keratoplasty 11. Tomasz Choragiewicz, Robert Rejdak,
the iris33. Spontaneous de-enclavation cases as well as in in cases which Andrzej Grzybowski, et al., “Outcomes of
of both the haptics is very rare, however required iridoplasty. The safety of ICIOL Sutureless Iris-Claw Lens Implantation,”
de enclavation of one haptic has been in pediatric age group with correction Journal of Ophthalmology, vol. 2016,
reported. The incidence is less than 1%. factor applied (Table 1)39, has already Article ID 7013709, 7 pages, 2016.
Posterior dislocation of the lens is very been demonstrated over the period of 2 12. Rao R, Sasidharan A. Iris claw intraocular
rare and is usually intra operative. decades. lens: A viable option in monocular surgical
aphakia. Indian J Ophthalmol 2013;61:74-
No cases have been reported in Conclusion 5
literature with persistent uveitis. The 13. Matteo Forlini, Wael Soliman, Adriana
ovalisation of the pupil was reported Overall Iris claw lens is a reasonable Bratu, Paolo Rossini, Gian Maria Cavallini
in 10-15% of the cases in all the major and safe option for use as primary or and Cesare Forlini., “Long-term follow-up
studies with no major influence on the secondary procedure. The ophthalmic of retropupillary iris-claw intraocular lens
final visual outcome. In my own personal world is yet to recover from the implantation: a retrospective analysis”
experience if adequate iris tissue is initial shock caused by the anterior BMC Ophthalmology201515:143.
grabbed, a round regular and reacting fixation of the lens leading to corneal 14. Brandner M, Thaler-Saliba S, Plainer
pupil can be achieved. decompensation. The safety of iris claw S, Vidic B, El-Shabrawi Y, Ardjomand N
lens has been demonstrated time and (2015) Retropupillary Fixation of Iris-
Although theoretically there is a again in the literature. The ophthalmic Claw Intraocular Lens for Aphakic Eyes in
possibility of pupillary block with the community needs to accept the lens with Children. PLoS ONE 10: e0126614.
ICIOL, it has been rarely reported with open arms. 15. Teng, He, and Hong Zhang. “Comparison
the Artisan model. There is no need for of Artisan Iris-Claw Intraocular Lens
iridectomy in cases of ICIOL. However Disclosure: The authors report no Implantation and Posterior Chamber
in my practice, one case of pupillary conflicts of interest in this work. Intraocular Lens Sulcus Fixation for
block was observed with the Excel iris Aphakic Eyes.” International Journal of
claw lens (PIC 5590 model; Excel optics References Ophthalmology 7.2 (2014): 283–287.
[p] Ltd., Chennai, India) model. Hence PMC. Web. 6 Feb. 2017.
in such cases a prophylactic iridectomy 1. Dorland’s Medical Dictionary for Health 16. Faria, Mun Yueh et al. “Retropupillary
shall be an optional procedure. All the Consumers. © 2007 by Saunders, an Iris Claw Intraocular Lens Implantation
cases of post operative raised IOP can be imprint of Elsevier, Inc. in Aphakia for Dislocated Intraocular
attributed to retained visco elastics and Lens.” International Medical Case Reports
can be managed medically. 2. McGraw-Hill Concise Dictionary of Journal 9 (2016): 261–265. PMC. Web. 6
Modern Medicine. © 2002 by The Feb. 2017.
The patients may complain of dull McGraw-Hill Companies, Inc. 17. Ganesh, Sri, Sheetal Brar, and Kirti
aching pain and blurring of vision on Relekar. “Long Term Clinical and Visual
bending forward. These can be attributed 3. Collins English Dictionary - Complete & Outcomes of Retrofixated Iris Claw Lenses
to the forward movement of the iris Unabridged 2012 Digital Edition. Implantation in Complicated Cases.” The
along with the lens and has no long term Open Ophthalmology Journal 10 (2016):
4. Dabezies OH Jr, “Defects of vision through 111–118. PMC. Web. 6 Feb. 2017.
aphakic spectacle lenses.” Ophthalmology. 18. Olav Kristianslund et al, “Late In-the-
1979 Mar; 86:352-79. Bag Intraocular Lens Dislocation : A
Randomized Clinical Trial Comparing
5. Gicquel JJ, Langman ME, Dua HS. Iris Lens Repositioning and Lens Exchange”,
claw lenses in aphakia. Br J Ophthalmol. Ophthalmology 124:2;2017:151–159.
19. Jayamadhury, G et al. “Retropupillary
Fixation of Iris-Claw Lens in Visual
Rehabilitation of Aphakic Eyes.” Indian
Journal of Ophthalmology 64.10 (2016):
743–746. PMC. Web. 6 Feb. 2017.
20. J. Gonnermann, M. K. J. Klamann, A.-
K. Maier et al., “Visual outcome and
complications after posterior iris-claw
aphakic intraocular lens implantation,”
Journal of Cataract and Refractive Surgery,
vol. 38, no. 12, pp. 2139–2143, 2012.

www. dos-times.org 61

Miscellaneous

21. M. Schallenberg, D. Dekowski, A. Hahn, T. intraocular lenses. J Cataract Refract Surg Artisan iris-fixated intraocular lens
Laube, K.-P. Steuhl, and D. Meller, “Aphakia 1996;22:247-52. implantation. Acta Ophthalmol Scand.
correction with retropupillary fixated iris- 27. Hara S, Borkenstein AF, Ehmer A, Auffarth 2006;84:197–200.
claw lens (Artisan)—long-term results,” GU. Retropupillary fixation of iris-claw 33. Rufer F, Saeger M, Nolle B, Roider J.
Clinical Ophthalmology, vol. 8, pp. 137– intraocular lens versus transscleral Implantation of retropupillar iris claw
141, 2013. suturing fixation for aphakic eyes lenses with and without combined
without capsular support. J Refract Surg penetrating keratoplasty. Graefes Arch
22. Price MO, Price FW Jr., Werner L, 2011;27:729-35. Clin Exp Ophthalmol. 2009;247:457–62.
Berlie C, Mamalis N. Late dislocation 28. Kumar DA, Agarwal A. Glued intraocular 34. Dick HB, Augustin AJ. Lens implant
of scleral-sutured posterior chamber lens: a major review on surgical technique selection with absence of capsular
intraocular lenses. J Cataract Refract Surg and results. Curr Opin Ophthalmol. 2013 support. Curr Opin Ophthalmol
2005;31:1320-6. Jan;24:21-9. 2001;12:47-5
29. Wolter-Roessler M, Kuchle M. [Correction 35. Singh D. Intraocular lenses in children.
23. Vote BJ, Tranos P, Bunce C, Charteris of aphakia with retroiridally fixated Indian J Ophthalmol 1984;32:499-500
DG, Da Cruz L. Long-term outcome of IOL]. Klin. Monbl. Augenheilkd. 36. Lifshitz T, Levy J, Klemperer I. Artisan
combined pars plana vitrectomy and 2008;225:1041–4. aphakic intraocular lens in children with
scleral fixated sutured posterior chamber 30. Baykara M, Ozcetin H, Yilmaz S, Timucin subluxated crystalline lenses. J Cataract
intraocular lens implantation. Am J OB. Posterior iris fixation of the iris-claw Refract Surg 2004;30:1977-81.
Ophthalmol 2006;141:308-12. intraocular lens implantation through a 37. Van der Pol BA, Worst JG. Iris-claw
scleral tunnel incision. AmJ Ophthalmol. intraocular lenses in children. Doc
24. Asadi R, Kheirkhah A. Long-term 2007;144:586–91. Ophthalmol 1996-1997;92:29-35
results of scleral fixation of posterior 31. Gicquel JJ, Guigou S, Bejjani RA, Briat 38. Schallenberg M, Dekowski D, Hahn A,
chamber intraocular lenses in children. B, Ellies P, Dighiero P. Ultrasound Laube T, Steuhl KP, Meller D. Aphakia
Ophthalmology 2008;115:67-72. biomicroscopy study of the Verisyse correction with retropupillary fixated iris-
aphakic intraocular lens combined with claw lens (artisan) – Long-term results.
25. Evereklioglu C, Er H, Bekir NA, Borazan penetrating keratoplasty in pseudophakic Clin Ophthalmol 2014; 8:137-41.
M, Zorlu F. Comparison of secondary bullous keratopathy. J Cataract Refract 39. Bhandari V, Reddy JK, Karandikar S,
implantation of flexible open-loop Surg. 2007;33:455–64. Mishra I. Retropupillary iris fixated
anterior chamber and scleral-fixated 32. Dighiero P, Guigou S, Mercie M, Briat intraocular lens in pediatric subluxated
posterior chamber intraocular lenses. J B, Ellies P, Gicquel JJ. Penetrating lens. J Clin Ophthalmol Res 2013;1:151-4.
Cataract Refract Surg 2003;29:301-8. keratoplasty combined with posterior

26. Bellucci R, Pucci V, Morselli S, Bonomi
L. Secondary implantation of angle-
supported anterior chamber and
scleral-fixated posterior chamber

Financial Interest: The authors do not have any financial interest in any procedure/product mentioned in this manuscript.

62 DOS Times - march-april 2017

Miscellaneous

Dyes and Stains Used in Ophthalmology

J.S. Bhalla, Pooja Lal, Rini Katiyar

In ophthalmology diagnosis and therapeutics is Concentration
incomplete without use of dyes and stains. They are of Topical
indispensable use in Ophthalmology. In the following
article we are describing dyes and histopathological Sterile strips – 0.6 mg, 1 mg and 9 mg strips. Solution – - 2%
stains used in OPD, operative room and microbiology. in 2ml, 5 ml and 15 ml packs. 5ml pack contains 0.25 % Sodium
Fluorescein, 0.1 % Proparacaine, and 0.01 % Thiomersal.
History of dyes
Systemic Intravenous
M Straud in 1888, was the first person to use fluorescein for For intravenous use 5%, 10% and 25% injection are
vital staining of eye. Foster in 1980 described various chemical
substances that have been used for vital staining of the eye ie available in 10 ml, 5 ml and 2 ml ampoules. Orally it is given
magadala red, safranin, brilliant black and victorian blue. Norn by mixing Sodium fluorescein powder or several vials of 10 %
(1972) laid down an extensive scheme for the testing of dyes for injection in citrus drink.
vital staining of the cornea and conjunctiva. • Uses2 Fluorescein is used in identifying and monitoring

Properties of an Ideal Dye/ Stain progess in size/ shape of corneal epithelial defects and
corneal ulcers (Figure 2).
• An ideal dye should be water soluble because vehicles • It is also used in applanation tonometry while using either
other than water will be toxic and/or interfere with Goldmann tonometer/Perkins hand-held tonometer.
staining patterns. • Seidel’s test: Concentrated fluorescein dye (from a
moistened fluorescein strip) is applied directly over the
• Stains should selectively stain certain cells or structures in potential site of perforation/bleb in cases of operated
the eye. trabeculectomy while observing the site with the slit lamp.
If a perforation and leak exist, the fluorescein dye will be
• They should not stain skin, clothes, contact lenses or any diluted by the aqueous and will appear as a green (dilute)
instrument that is likely to come in contact with eye when stream within the dark orange (concentrated) dye under
the stain is present. blue light of the slit lamp.
• Fluorescein dye can be used in Jones dye disappearance
• The effect should be reversible, either as a result of tear test for assessment of lacrimal passage functional patency.
flow or by use of an irrigating solution. This dye can be injected in the lacrimal apparatus using a
syringe for identification of canalicular ends in traumatic
• There should be no interference with vision or any other laceration of the lid margins and for repair of the
pharmacological effect. canaliculus.
• It can also be used in dry eye conditions to assess tear
• Stains should be non -irritant to the surface of the eye,
non -toxic and compatible with other stains and any other Figure 1a: fluorescent strips. Figure 1b: Fluorescent solution
compound with which they are likely to be used.
Figure 2: Staining of corneal ulcer with Fluorescein
Dyes used in OPD settings
www. dos-times.org 63
Fluorescein stain1: It is Resorcinolphthalein (C2H12O5Na),
sodium salt of fluorescein. It is an orange red dye, weakly
dibasic acid with a molecular weight of 376 Da .When exposed
to light, fluorescein absorbs wavelength maximally at 493 nm
and emits peak wavelength at 520 nm.

Mechanism of Staining: The normal corneal epithelium
is impermeable to the tear film and substances dissolved in it,
because the lipid membranes at the surface of the eye act as
an effective barrier against polar and water soluble substances.
If this barrier is breached then the tear film can gain access
to deeper tissues and this causes a green color in the area of
desquamation. It diffuses rapidly into the corneal stoma when
there is loss of epithelial integrity.

Available as – Fluorescein is available as sterile strips
(Figure 1a) and solution form (Figure 1b). Fluorescein
impregnated strips are preferred over solution because the
former is sterile and there is chance of growth of pseudomonas
in bottles of fluorescein solution.

Miscellaneous

meniscus, tear flow and tear film Figure3a: Fundus flourescein angiography. Figure 3b: Sodium Fluorescein ampoules for
break up time. It is also used in intravenous injection
contact lens fitting.
• Fluorescein is also used extensively Figure 4: Rose Bengal strips Figure 5: Dendritic ulcer stained with Rose
in photographic retinal vasculature Bengal
imaging during fundus flourescein
angiography (Figure 3a). The dye from staining the ocular surface where mucus strands heavily contaminated
sodium fluorescein can be used molecules such as mucins, albumin, or by lipids, dead or dying epithelial
either in concentration of 5%, 10% even an artificial tear compound such as cells and stains the leading edges
or 20% (Figure 3b) in the form of carboxymethylcellulose are present. of viral proliferation of a dendritic
intravenous bolus injection. It is ulcer, while fluoresces stain tend to
used to image retinal, choroidal, Disadvantages stain its central bed.
optic disc, or iris vasculature, or a • Also used in evaluating the ocular
combination of these. Rose bengal has been discovered to surface in Keratoconjunctivitis Sicca.
• It is used diagnostically as well as have intrinsic cellular toxicity. It has a It better tolerated than Rose Bengal
in planning for many retinal laser dose-dependent, toxic effect on human stain.
procedures. It has a very important corneal epithelial cells in vitro that is
role in management of diabetic further enhanced by light exposure. It is Indocyanine green5
retinopathy, vein occlusion, and age- widely known that patient discomfort,
related macular degeneration. particularly stinging upon instillation. First introduced in early 1970.
• It is also used extensively in diagnosis • Used in grading severity of dry eye It is a Tricarbocyanine dye which
of macular ischemia. is water soluble. It has a molecular
according to Van Bijsterveld grading weight of 774.96 Da. Peak absorption
Rose Bengal3 system. in near infrared spectrum at 805 nm
and maximum emission at 835 nm. It is
It is an Aniline dye derivative of Lissamine Green rapidly and completely bound to plasma
fluorescein .It is a brownish red, water proteins after iv injection in blood.
soluble powder. Lissamine green4 is a vital stain
with staining quality similar to that of Availability- Available as dry dye
Mechanism of staining rose Bengal. It has a molecular weight of powder (25mg)
577Da available as impregnated sterile
This is derivative of fluorescein paper strips (Figure 6). Concentration- Dosages up to 40 mg
stain but has marked different staining ICG dye in 2 ml of aqueous solvent have
characteristics crossing the cell USES been found to give optimal angiograms,
membranes of dead cells but not living • Stains dead or degenerated epithelial depending on the imaging equipment and
ones hence it stains damaged conjunctival technique used. The dye is injected into
and corneal cells (Figure 4). cells green (Figure 7). the antecubital vein as bolus, immediately
• Stains lipid like structure such as followed by a 5 ml bolus of normal saline.
Available as- Sterile strips (Figure 5)
and solution

Concentration -1 micro drop of 0.5-
1% solution is used.

It is available as topical 1% solution
which contains 1% Rose Bengal with
povidone iodine, sodium borate and
0.01% thiomersal in 5 ml pack.

Uses

It’s been used for the evaluation of
numerous ocular pathologies including
herpetic corneal epithelial dendrites,
superficial punctate keratitis, meibomian
gland dysfunction, and dysplastic or
squamous metaplastic cells of conjunctival
squamous neoplasms. Research on rose
bengal has revealed that it’s blocked

Deen Dayal Upadhyay Hospital, Delhi

Dr. J.S. Bhalla MS, DNB Dr. Pooja Lal DNB Dr. Rini Katiyar MBBS
64 DOS Times - march-april 2017

Miscellaneous

Figure 6: Lissamine Green strips Figure 7: Lissamine green staining dead and Figure 8: ICG angiography showing choroidal
degenerating cells of conjunctival and corneal vessels, blue arrow
epithelium

Uses2 Figure 9: Staining of anterior capsule with approved by the FDA for intraocular
Trypan Blue use including use. It comes as a 1
• Compared with fluorescein mL vial containing a suspension of
angiography ICG provides better stripping the endothelium from triamcinolone with concentration of 40
resolution of choroidal vasculature, the donor lenticule in DALK (deep mg/ml. Recommended dosing is 1–4 mg
but lesser resolution of retinal blood anterior lamellar keratoplasty). (25–100 μl) administered intravitreally.
vessels (Figure 8). • Trypan blue 0.15% is used in retinal Also available as a single-use syringe
procedures to ophthalmic solution is with 8 mg (80 mg/mL) of triamcinolone
• ICG is used in evaluating suspected useful to identify and delineate pre suspension. It is often diluted with
occult choroidal neovascular retinal membrane to allow complete balanced salt solution at about 1:4 before
membranes (CNVMs). removal. The dye stains the posterior instilling in the eye during vitrectomy.
hyaloid, internal limiting membrane,
• It is also be used to identify and epiretinal membranes blue, Uses
recurrence of CNVM after treatment making these structures highly
and choroidal polyps (PCV: visible against the unstained retina. • It can be used in anterior segment
polypoidal choroidal vasculopathy). This facilitates macular hole and surgery to help manage vitreous
macular pucker surgery, and makes loss (Figure 10) during complicated
DYES USED IN OPERATIVE ROOM these procedures safer. cataract surgery.

Trypan blue Triamcinolone acetonide (TA) • It has been used to visualize the
posterior cortical vitreous during
Trypan blue2,6 is derived from Triamcinolone7,8,9 is a water pars plana vitrectomy.
toluidine, also known as diamine blue and insoluble steroid with anti-inflammatory
Niagara blue. Trypan red and Trypan blue and antifibrotic properties. • In addition, it can be useful in the
were first synthesized by the German visualization and peeling of the
scientist Paul Ehrlich in 1904. Trypan Mechanism of action- It aids in internal limiting membrane.
blue is a vital stain used to selectively visualization of ophthalmic structures,
colour dead tissues or cells blue. such as vitreous and internal limiting • Triamcinolone has been advocated
membrane because of the insoluble in surgical repair of proliferative
Availability Trypan blue 0.06% nature of the white crystals and the vitreoretinopathy both for its
ophthalmic solution is FDA-approved for integration of these crystals into loosely visualizing properties and its anti-
intraocular surgery and is available in organized collagen matrices. These inflammatory properties.
ready-to-use vials for cataract procedures. crystals are thought to be interwoven into
the collagen bundles of the vitreous. Indocyanine green (ICG)-
Uses described above
Availability- as a preservative-free
• It is used in cataract surgery to stain preparation of triamcinolone that is Apart from ICG angiography, it
the anterior capsule (Figure 9). The is also used in chromovitrectomy,
dye is injected onto and painted over which is the use of chemicals to stain
the anterior lens capsule under an air semitransparent preretinal structures as
bubble. This produces a blue-stained an aid in successful vitreoretinal surgery.
capsule that is clearly identifiable ICG is a water-soluble dye that is used
throughout surgery. in vitrectomy because it binds to type
IV collagen, allowing visualization of the
• The use of dye reduces the risk ILM.
of capsule-related complications
because any radial tear or shift of the Multiple adverse effects have
capsular bag is readily apparent from been linked to ICG, including retinal
the clearly outlined capsulorrhexis. pigment epithelial defects, optic nerve
damage, long-term retinal staining, and
• Trypan blue 0.06% ophthalmic photosensitivity to retinal laser after
solution is also used to stain administration. It has been postulated
Descemet’s membrane during that the use of ICG at low concentrations
DSAEK (Descemet’s stripping of 0.5 mg/mL (0.05%) or less, and an
endothelial keratoplasty).

• It is also used in staining and

www. dos-times.org 65

Miscellaneous

Colloidal Iron It stains Acid

Mucopolysaccharide blue. Used in

Macular Dystrophy

Congo Red It stains Amyloid orange.

Used in lattice dystrophy

Crystal Violet It stains Amyloid

purple. Used in Lattice dystrophy.
Thioflavin It stains Amyloid

Fluorescent Yellow. Used in Lattice

dystrophy.

Masson Trichome It stains Collagen

Figure 11: Infracyanine Green Dye Blue. Used in Granular Dystrophy

Figure 12: BBG guided ILM peeling Prussian Blue It stains Iron Blue. It is

an elegant procedure that may facilitate used in Hemosiderosis Bulbi
negative staining of the overlying ERM,
which does not stain, but is visible against Immunohistochemical Stains in
a surrounding blue-stained ILM. The non-
Figure 10: staining of vitreous with stained ERM is first peeled off, and then Ophthalmology12
triamcinolone acetonide BBG dye is injected a second time to stain • Cytokeratin is a marker for Epithelial
the unstained ILM, which lay directly
osmolarity of approximately 290 mOsm under the now peeled ERM, and is now Cell tumors. (Adenoma, Carcinoma)
in ILM peeling could be a safer alternative. peeled off. • Desmin, Myoglobin, or Actin

Infracyanine green10 Histopathological Stains in are markers for tumors
Ophthalmology11
Iodine and its derivates may be toxic derived from smooth or
to the RPE. Therefore, infracyaninegreen Hematoxylin and Eosin (HandE) It
(IFCG) (Figure 11), a dye free of iodine stains the nucleus blue and cytoplasm red skeletal muscles (Leiomyoma,
is believed to have less potential for RPE .It is used to stain fungi, Chlamydia and
toxicity than ICG. IFCG may represent blood cells. Rhabdomyoma, Leiomyosarcoma,
an alternative to ICG during ILM peeling
in chromovitrectomy due to the lack of Periodic Acid-Schiff – It stains Rhabdomyosarcoma)
iodine in its formulation and physiologic cytoplasm, some species of fungi, • S-100 is a marker of tumors
osmolarity. Inclusion bodies, blood cells and
Mucopolysaccharide magenta. Used in of Neuroectodermal origin
Brilliant blue Green (BBG) Fungal Infection to demonstrate fungi.
(Schwannoma, Neurofibroma,
Also known as acid blue, has recently Gomoriʹs Methamine Silver- it stains
been reported to be a safe tool for the fungal cell wall black. Used in Fungal Melanoma).
chromovitrectomy. Infection to demonstrate fungi. • Neuron Specific Enolaseis amarker

Concentration-It is used in an Gramʹs Stain Bacteria It is used of tumors of Neuroectodermalorigin
isosmolar solution of 0.25 mg/ml to differentiate bacteria into two large
(0.025%) to 0.50 mg/ml (0.05%) with groups-Gram positive and Gram negative. (Schwannoma, Neurofibroma,
good clinical results and no signs of The gram positive bacteria retain the dye
toxicity on multifocal electroretinogram. and are stained violet due to presence of Melanoma).
Peptidoglycan in their cell wall. • HmB 45 is a marker of Melanocytic
USES-It has good ILM staining
property (Figure 12) and is a non- Alizarin Red It stains calcium Red. Lesions (Nevus, Melanoma)
fluorescent. This stain has become Hence used in diagnosis of Band shaped • Leucocyte Common Antigen (LCA) is
a good alternative to ICG and IFCG keratopathy.
in chromovitrectomy because of its a marker of tumors of Haematopoetic
remarkable affinity for the ILM. Toxicity Von Kossa It stains Calcium Origin (Leukemia / Lymphoma).
data regarding its application are limited, Phosphate black. Used in Band shaped
so further investigations to confirm these keratopathy. REFERENCES
observations are warranted.
Oil Red O It stains lipid red. Used in 1. Badaro E, Novais AM, Penha FM, Maia
Membrane Blue-Dual is a dye to the diagnosis of Sebaceous cell carcinoma. M, Farah ME, Rodrigues EB. Vital dyes in
stain both the ILM as well as the ERM and ophthalmology:a clinical perspective.
PVR membrane, without compromising Alcian Blue It stains Acid Mucopoly Curr Eye Res 2014.
the staining effect with one injection. It Saccharide Blue. Used in Macular
is a 100% stable combination of Trypan Dystrophy. 2. Kumar A, Thirumalesh MB. Use of dyes
Blue 0.15% + Brilliant Blue Green 0.025% in ophthalmology. J Clin Ophthalmol
+ 4% Polyethylene glycol. Res 2013;1:55-58. 3. Kim J. The use of
vital dyes in corneal disease. Curr Opin
Double Staining Technique (in Ophthalmol 2000;11:241-7.
macular ERM eyes)
4. Norn MS. Lissamine green. Vital
The double-staining technique is staining of cornea and conjunctiva. Acta
Ophthalmol (Copenh) 1973;51:483–
491.

5. Rodrigues EB, Meyer CH, Farah ME,
Kroll P. Intravitreal staining of the
internal limiting membrane using
indocyanine green in the treatment
of macular holes. Ophthalmologica
2005;219:251-62.

6. Jacobs DS, Cox TA, Wagoner MD,
Ariyasu RG, Karp CL. Capsule staining
as an adjunct to cataract surgery: A
report from the American Academy
of Ophthalmology. Ophthalmology
2006;113:707-13.

7. Peyman GA, Cheema R, Conway MD,
Fang T. Triamcinolone acetonide as an

66 DOS Times - march-april 2017

Miscellaneous

aid to visualization of the vitreous and the posterior hyaloid East Delhi Eye Centre
during pars planavitrectomy. Retina 2000;20:554-5.
8. Shah GK, Rosenblatt BJ, Blinder KJ, et al. 2005. Triamcinolone- Price 75 LAC
assisted internal limiting membrane peeling. Retina, 25:972–5. MIG Free Hold Flat
9. Couch SM, Bakri SJ. Use of triamcinolone during vitrectomy All Equipment’s in good condition
surgery to visualize membranes and vitreous. Clin Ophthalmol Phaco Machine chexu 2012
2008;2:891–896. Alcon Microscopic 2012
10. Ullern M, Roman S, Dhalluin JF, Lozato P, Grillon S, Bellefqih S, Nidex Auto Ref. 2009
et al. Contribution of intravitreal infracyanine green to macular
hole and epimacular membrane surgery: preliminary study. J A scan optikon
Fr Ophtalmol 2002;25:915–920. Neitz Indirect 20D NIKON LENS
11. Hani A Alturkistani HA, Tashkandi FM, Mohammedsaleh ZM. Welsh Allyn Ophthalmoscope + Streak
Histological Stains: A Literature Review and Case Study. Glob J
Health Sci. 2016;8:72–79. Ready OT with Furniture
12. S. Sharma. Tumor markers in clinical practice: General
principles and guidelines. Indian J Med Paediatr Oncol Contact: 011-22586206
2009;30:1–8. 9205515593

Financial Interest: The authors do not have any financial interest Note: Individual Instruments are not .
in any procedure/product mentioned in this manuscript.

www. dos-times.org 67

DOS Crossword DOS CROSSWORD
Episode-5 4

Dr. Manish Mahabir MD 14
Senior Resident,
Dr. R.P. Centre,All India Institute of Medical Sciences,
New Delhi, India

1

5 23
6 9

7
8

10 11 13
12
15

Across Down

2. Photoreceptor renews its outer segment every 10(4) 1. Protective mechanism against oxidation in the lens(11)
6. Uveitis most common in ocular sarcoidosis(8) 3. Tear layer containing immunoglobulin A(7)
10. First nitric-oxide donating prostaglandin F2α analog for 4. Likely etiologic agent for the keratitis if post PK granulomatous

ophthalmic use(14) reaction to descemet membrane(6)
13. IOP lowering drug to be avoided in bronchoconstrictive lung 5. Hyperintense on a T2-weighted MRI(8)
7. Oral drug for CMV retinitis(14)
disease(7) 8. Leopard skin pattern of yellowish RPE with subretinal
15. Nerve passes through Superior orbital fissure(9)
infiltration is suggestive of(8)
9. Embryonic origin of schlemm canal(8)
11. Hamartoma found in association with tuberous sclerosis(10)
12. Drug used during general anesthesia associated with an

increase in IOP(8)
14. Disorder with mitochondrial inheritance pattern(5)

www. dos-times.org 69

DOS quiz

DOS Times Quiz 2016-17

Episode-5

Last date: completed responses to reach the DOS OFFICE by e-mail or mail before 5 pm on 28th March 2017

1. All of the following diagnoses are associated 6. A horizontal gaze palsy is indicative of which of
with cystoid macular edema (CME) on clinical the following?
examination with no associated macular leakage
on fluorescein angiography except for which one? a. A lesion of the ipsilateral frontal lobe
b. A lesion of the contralateral frontal lobe
a. Nicotinic acid maculopathy c. Damage to the pontine gaze centres
b. Idiopathic juxtafoveal (parafoveal) retinal d. Carotid territory cerebral infarction

telangiectasis 7. Vitreous amyloidosis is associated with
c. Goldman Favre Syndrome a. Cranial nerve paralysis
d. Juvenile X-linked Retinoschisis b. Peripheral neuropathy
e. Enhanced S-cone dystrophy c. Lattice dystrophy
d. Peripheral vascular disease
2. Which of the following is false regarding Fuchs
hetrochromic iridocyclitis? 8. Blepharophimosis is generally associated with all
of the following except
a. Seen bilaterally in only 10-15% of cases
b. Peak incidence in 3rd decade a. Ptosis
c. Antibody development against corneal epithelium b. Ectropion
d. Could be associated with toxoplasma c. Distichiasis
d. Epicanthus inversus
3. Which of the following is seen in Vogt–Koyanagi– e. Telecanthus
Harada disease (VKH)?
9. Which structure is deep to the plane of the facial
a. Granulomatous necrotizing inflammation of uveal nerve branches in the lower face?
tissue
a. Parotidomassetric fascia
b. HLA DR 1 association more commonly seen than b. Deep temporal fascia
HLA DR 4 c. Parotid gland
d. Masseter muscle
c. Most common affected region is perifoveal choroid
d. Persistent CSF lymphocytic pleocytosis 10. Which is not true regarding the duration of
e. Cataract may develop in upto 25-30% of cases storage of donor corneo-scleral rim in the
following media?
4. Which of the following is not true regarding Merkel
cell carcinoma? a. McCarey-Kaufman (MK) media – 3 days
b. Organ culture – 30-35 dyas
a. Rapidly growing c. Chen’s media – 7-10 days
b. Highly malignant d. Optisol GS – 14 days
c. Arises from dermis
d. Most commonly lower lid is affected

5. A one year old child with 3 month history of
intermittent, rapid, asymmetrical, fine nystagmus.
Ophthalmic and neurological examination are
otherwise normal. Further MRI should include MRI
of the

a. Cerebellum
b. Chaismal area
c. Brain stem
d. Foramen magnum

www. dos-times.org 71

DOS quiz

DOS TIMES Quiz Rules

1. DOS TIMES QUIZ will now feature as 5 Episodes (Episode 1: July-August, Episode 2: September – October, Episode 3: November – December, Episode 4:
January – February, Episode 5: March – April). Entries will have to be emailed before the last date mentioned in the contest questions form. Late entries
will not be entertained.

2. Please email (as scanned PDF ONLY) completed responses for the quiz along with details of the contestant filled in and signed to dostimes10@gmail.
com (with cc to [email protected]) or mail to DOS Times Quiz, Dr. M. Vanathi, Room No. 479, 4th Floor, Rajendra Prasad Centre for Ophthalmic
Sciences, All India Institute of Medical Sciences, New Delhi.

3. Nonmembers may also send in their entries but will be required to send along with their completed entries, the completed membership application
(with the required documents) to enroll as member. Failing this their entries into the contest will not be considered.

4. Contestants are requested to attempt all the 5 episodes of the QUIZ contest and send in their applications within the date specified. No entries will be
entertained after the last date. The scores of each contestant for all 5 episodes together will be compiled at the end of episode 5 and the winner will be
announced in the DOS Annual Conference in April 2017. In the event of more than one winning contestants, a draw of lots will decide the winner. Winner
of each episode will also be published in the next episode along with the previous episode answers.

5. Please write to [email protected]/[email protected] further clarifications if any.

Compiled by:
Cornea & Refractive Surgery Services, Dr. Shroff ’s Charity Eye Hospital, New Delhi

## # Dr.Abhishek Dave MD, FICO, FMRF

#
#

Q. No. Completed Responses for DOS Times Quiz: Episode 5

1. __________________________________________________________________ 6. __________________________________________________________________
2. __________________________________________________________________ 7. __________________________________________________________________
3. __________________________________________________________________ 8. __________________________________________________________________
4. __________________________________________________________________
5. __________________________________________________________________ 9. __________________________________________________________________
10. __________________________________________________________________

Contestant Details

Name: ________________________________________________________________________________________________ Degree: _______________________________
Designation:_________________________________________________________________________ Address:_______________________________________________
_______________________________________________________________________ State _______________________________ Pin _______________________________
Mobile No: ________________________________________________________________________________________ DOS Membership no: ___________________
Email ID: _______________________________________________________________________________________Signature: ___________________________________

Answers of DOS Crossword Episode-5 ACROSS
2. Days
Down 6. Anterior
10. Latanoprostene
1. Glutathione 13. Timolol
3. Aqueous 15. Trochlear
4. Herpes
5. Vitreous
7. Valgancyclovir
8. Lymphoma
9. Mesoderm
11. Astrocytic
12. Ketamine
14. Leber

72 DOS Times - march-april 2017

news watch

DOS Clinical Monthly Meet – VI (Centre For Sight)

The DOS Clinical Monthly Meet – VI was held at Centre For Sight, B5/24, Mini-Symposium:
Safdarjung Enclave, New Delhi on December 18, 2016 from 11:00 A.M. to Oculoplasty 3D theatre
1.00 P.M. The meeting which was well attended by 110 ophthalmologists,
commenced at 11.00 AM and concluded on time at 1.00 PM followed by lunch. Chairpersons: Dr. V.K. Dada,
Dr. Mahipal Sachdev,

Dr. Lalit Verma, Dr. Harsh Kumar,

Dr. Santosh Honavar

Dr. V.K. Dada, Dr. Lalit Verma &
Dr. Mahipal Sachdev chairing the Mini

symposium

Dr. Rishi Mohan President DOS and Dr. M. Vanathi General Secretary DOS chairing the
monthly meeting presentations

Case Presentations and Clinical Talk

Dr. Vikas Menon
delivering talk on Orbital odyssey

Dr. Ritesh Narula, presenting the first Dr. Sumit Monga, presenting the Clinical
clinical case - I believe in miracles Talk on Glass prescription in children –
Practical pointers

Dr. Santosh Honavar, delivering talk
on Tumor Tales

Dr. Hemlata Gupta, presenting the second Dr. Rahul Sharma making the guest case
clinical case - Cataract in the silicon oil presentation - Multifocal choroiditis
filled eye

Dr. Poonam Jain, delivering talk on Lid
and lacrimal lesions

www. dos-times.org 75