DOS_Sept_2008

Clinical trial of patching versus atropine penalization for the Abstracts
treatment of anisometropic amblyopia in older children

Menon V, Shailesh G, Sharma P, Saxena R.

Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
All India Institute of Medical Sciences, New Delhi,

PURPOSE

To compare conventional patching therapy with atropine penalization in the treatment of anisometropic amblyopia.

METHODS

Prospective, randomized, institution-based clinical trial of patching versus atropine penalization in patients aged 8-20 years. Patients
received either conventional, full-time patching, or atropine penalization.

RESULTS

Fifty-seven patients were enrolled, with visual acuity ranging from 6/12 to 6/60 in the amblyopic eye. Twenty-nine patients received
conventional full-time patching; 28 received atropine penalization. At 6 months, visual acuity improved by 2.38 lines in the conventional
patching group and 2.34 lines in the atropine group (p = 0.889). The speed of visual recovery was faster in the patching group (3.7 months)
than in the atropine group (4.7 months; p = 0.013). There was significant improvement in near vision and contrast sensitivity in both
groups, but improvement in the patching group was significantly better than in the atropine group. No patient had reduced visual acuity
in the unaffected eye. Redness of eyes was observed more in the atropine group than in the patching group. Treatment tended to be
better-accepted by parents and patients in the atropine group, but not significantly more.

CONCLUSIONS

In patients aged 8-20 years with anisometropic amblyopia, both patching and atropine therapy improved visual acuity. Although recovery
was faster with patching, the 2 modalities of treatment appeared to be equally effective.

Infectious keratitis in keratoconus with corneal hydrops without
contact lens wear: a case report

Jhanji V, Sharma N, Agarwal T, Titiyal JS.

Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

PURPOSE

Infectious keratitis after contact lens use is a known complication in cases of corneal hydrops. A case of infectious keratitis is reported in
a case of keratoconus with corneal hydrops without any known predisposing factors.

METHODS

Infectious keratitis was diagnosed in a 58-year-old man with spontaneous onset of pain, redness, photophobia, and decreased vision.
There was no history of contact lens use or any ocular allergy. Noncoagulase staphylococci were cultured from the corneal scrapings, and
treatment was started with fortified antibiotics.

RESULTS

Response to treatment was noted, and the patient is awaiting keratoplasty.

CONCLUSIONS

This case report highlights the occurrence of infectious keratitis in a case of keratoconus with corneal hydrops without any antecedent
history of contact lens use.

www.dosonline.org 59

Post-penetrating Keratoplasty Glaucoma

Dada T, Aggarwal A, Minudath KB, Vanathi M, Choudhary S, Gupta V, Sihota R, Panda A.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Post-penetrating keratoplasty (post-PK) glaucoma is an important cause of irreversible visual loss and graft failure. The etiology for this
disorder is multifactorial, and with the use of new diagnostic equipment, it is now possible to elucidate the exact pathophysiology of this
condition. A clear understanding of the various mechanisms that operate during different time frames following PK is essential to chalk
out the appropriate management algorithms. The various issues with regard to its management, including the putative risk factors,
intraocular pressure (IOP) assessment post-PK, difficulties in monitoring with regard to the visual fields and optic nerve evaluation, are
discussed. A step-wise approach to management starting from the medical management to surgery with and without metabolites and the
various cycloablative procedures in cases of failed filtering procedures and excessive perilimbal scarring is presented. Finally, the important
issue of minimizing the incidence of glaucoma following PK, especially through the use of oversized grafts and iris tightening procedures
in the form of concomitant iridoplasty are emphasized. It is important to weigh the risk-benefit ratio of any modality used in the
treatment of this condition as procedures aimed at IOP reduction, namely trabeculectomy with antimetabolites, and glaucoma drainage
devices can trigger graft rejection, whereas cyclodestructive procedures can not only cause graft failure but also precipitate phthisis bulbi.
Watchful expectancy and optimal time of intervention can salvage both graft and vision in this challenging condition

DOS Correspondent
Shubha Bansal DNB

Sale of Opthalmic Machinery

The following ophthalmic machinery/equipments are available for disposal newly bought
by a hospital, set up in month of March 2008 in NCR Delhi, due to doctors leaving abruptly
for non professional reasons
1). Microscope takagi OM-8. 2) Autorcf with K. 3) KeratoMeters (2). 4) Slit lamps with motorized
stand (2). 5) A Scan ‘300 A’ Sona med. 6) Triat sets (United) + N.V. & D.V. Drums (2). 7) Surgical
Instruments, catract sets & others (6). 8) Generator 30 KVA (Kirloskar). 9) Patients Beds, Attachment
beds, Side locker (10, 05 & 02). 10) Hospital Furniture, Table, Chairs, Visitor’s Chair, Racks, Almirah.
11) OT Table(1), Examination Tables (5). 12) Wheelchair (1), OT light (1). 13) Auto cleave (DD)
&(SD)(2). 14) Liner & Garments (Unused). 15)Inveror 1400 kva + 2 battery. 16)Water cooler 40/80
(Sidwell). 17) Optical shop frames (900) & Accessories. 18) Split Air Conditioners (2), Surgical
Items Sutures Lenses, Hospital Utensils etc.19) Surgeon Stool 20)lensometer
21) Lab MicroscopeMost of the Material /Equipment are in packed condition not opened
for use. (The aforesaid material is available in Delhi for inspection)

Contact: G.D. Medical & Herbal Research (P) Ltd.

11, Central Market Phase-I, Ashok Vihar, Delhi-110052.
Ph. 27214439 (R) 27345521 Contact Person: Mr. R. P. BASIA

(M) 9312277978,9910162636

60 DOS Times - Vol. 14, No.3, September 2008

Delhi Ophthalmological Society
Monthly Clinical Meeting, October 2008

Venue: Auditorium, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi

Date and Time : 2nd November, 2008 (Sunday) 10:30 a.m. onwards

Case Presentation: : Nayanshi Sood 10 Mins
: Shaloo Bageja 10 Mins
1. Ciliary body mass in a child : Nidhi Tanwar
Discussant : Tinku Bali 15 Mins

2. A case of Exudative Retinal detachment : S.N. Jha
Discussant

Clinical Talk:
Optical Coherence Tomography Defining new horizons in the management of
Vitreoretinal disorders.

Mini Symposium: Ophthalmology - Making the Right Choices
Chairman: A.K. Grover

1. Ophthalmic Career - Fellowships, Govt., Practice or abroad? : A.K. Grover 12 Mins
Making the Right Choice 8 Mins
8 Mins
2. I am to be operated tomorrow for cataract Multifocal it will be : Harbansh Lal 8 Mins
8 Mins
3. I am to be operated tomorrow for cataract - Has to be monofocal : K.P.S. Malik

4. A R M D with C N V M - Lasers and PDT have a role to play : Lalit Verma

5. A R M D with C N V M - It is Anti Veg F, Anti Veg F and Anti Veg F : Amit Khosla

Panel Discussion: Kya Yahi hai right choice : 12 Mins

Diagnostic dilemmas, therapeutic webs & surgical traps

Panelists: Sanjay Chaudhary, Ruchi Goel, Sharad Lakhotia, Noshir Shroff, Dinesh Talwar

Gastronomic Delights : 1 P.M.

Sponsored: M/s. Ajanta Pharmaceuticals - (ILLUMA DIVISION)

Missed DOS Times Copy 61

If you have missed your copy of DOS Times.

Please Contact:
Secretary DOS : Dr. Namrata Sharma

Room No. 474, 4th Floor,
Dr. Rajendra Prasad Centre for Ophthalmic Sciences

All India Institute of Medical Sciences,
Ansari Nagar, New Delhi – 110029

Ph.: 91-11-65705229, Fax: 91-11-26588919,
E-mail: [email protected],
Website: www.dosonline.org

www.dosonline.org

Forthcoming Events : National

October 2008 18-20 NEW DELHI
2-5 CHENNAI
Annual Conference of Strabismological
A National Board Post Graduate Program Society of India
Contact Person & Address Contact Person & Address
Prof. Amar Agarwal Dr. Subash Dadeya
Dr. Agarwal’s Eye Hospital Room No. 205 OPD Block,
19, Catheral Road, Chennai-600086 Guru Nanak Eye Centre,
Tel.: 91-44-28112811, Fax: 91-44-28115871 Maharaja Ranjit Singh Marg, Delhi-110 002
Email: [email protected] Tel.: 91-011-23234622 Extn.-292
Website: www.kalpavriksha.dragarwal.com Mobile: 981057899, 9868245792
E-mail: [email protected],
October 2008
2th NEW DELHI [email protected]

13th Dr. R.K. Seth Memorial Symposium 31st Oct. CHANDIGARH (U.T.)
on Glaucoma 2nd Nov.
Contact Person & Address
Dr. Abhishek B. Dagar 18th Annual Conference of the Glaucoma
Venu Eye Institute & Research Centre, Society of India
1/31, Sheikh Sarai , Institutional Area, Contact Person & Address
Phase II, New Delhi-110017 Dr. S.S. Pandav
Tel.:- 011-29251155/56, 29250757, Fax - 01129252370 Advanced Eye Centre,
Email : [email protected] Postgraduate Institute of Medical Education & Research,
[email protected] Chandigarh (U.T.)
Telefax: 0172-2747837, Email: [email protected]

3-4 NEW DELHI November 2008

National Workshop on Strabismus 22-23 NEW DELHI
Contact Person & Address
Prof. Pradeep Sharma Mid-term Conference
Dr. Rohit Saxena, Assistant Professor Delhi Ophthalmological Society
Room No. 485, Dr. Rajendra Prasad Centre for Contact Person & Address
Ophthalmic Sciences, All India Institute of Dr. Namrata Sharma
Medical Sciences, Ansari Nagar, New Delhi - 110 029 Room No. 474, 4th Floor,
Tel.: 011-26593185, Fax: 011-26588919, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
Email: [email protected] All India Institute of Medical Sciences,
Ansari Nagar, New Delhi – 110029
10-12 DEHRADUN, UTTARAKHAND Ph.: 011-65705229, Fax: 26588919,
E-mail: [email protected],
Uttara-Eyecon 2008 Website: www.dosonline.org
Contact Person & Address
Dr. S.K. Mittal, Organizing Secretary (9412909375) 23rd GWALIOR, M.P.
Dr. Maneesh, Joint Organizing Secretary (9411712604)
Sri Guru Ram Rai Institute of Medical & Health Sciences Sports Trauma
& Sri Mahant Indiresh Hospital, Dehradun, Uttarakhand Contact Person & Address
Dr. Purendra Bhasin, Organizing Secretary
17-19 UJJAIN, MADHYA PRADESH C/o. Ratan Jyoti Netralaya
18, Vikas Nagar, Near Sai Baba Mandir,
Nayan Kumbh’08 Gwalior (MP)
Annual Conference of M.P. State Ophthalmic Society Ph.: 0751-2423350/51, Mob. 09826253355
For details contact : E-mail: [email protected]
Dr. Arvind Bhatnagar,
Chairman, Organizing Committee
Celll : 98260 56021

www.dosonline.org 63

December 2008 February 2009
4-6 WEST BENGAL 5-8 JAIPUR

XVII Annual Conference of Vitreoretinal AIOS Annual Conferences
Society of India Contact Person & Address
Fort Radisson, RAICHAK, West Bengal Prof. (Dr.) P.K. Mathur
4th to 6th December, 2008 C-126, Moti Nagar, Bapunagar, Jaipur-302015
Contact Person & Address Ph.: 0141-2705972, 0141-2701030, (M) 0-9314614932
Secretary, VRSI Fax: 0141-2705246, Email: [email protected]
Dr Ajit Babu Majji
L V Prasad Eye Institute,, L V Prasad Marg, March 2009
Banjara Hills, Hyderabad- 500 034, India 20-22 NEW DELHI
E-mail: [email protected], Website: vrsi.in
Annual Conference of
5-7 GURGAON, HARYANA Delhi Ophthalmological Society
Oculoplasty Panorama 2008 Contact Person & Address
19th Annual Conference of the Oculoplasty Dr. Namrata Sharma
Association of India Room No. 474, 4th Floor,
Contact Person & Address Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
Dr. Anita Sethi, Organizing Secretary All India Institute of Medical Sciences,
Venue: Artemis Health Institute, Gurgaon, Haryana Ansari Nagar, New Delhi – 110029
Ph.: +91-1246767999 Ext. 1925, 1234, +91-9810199636 Ph.: 011-65705229, Fax: 26588919,
E-mail: [email protected] E-mail: [email protected], Website: www.dosonline.org

Monthly Clinical Meetings Calendar 2008-2009

Dr. R.P. Centre for Ophthalmic Sciences Centre for Sight
3rd August, 2008 (Sunday) 7th December, 2008 (Sunday)

Venu Eye Institute & Research Centre DOS Picnic
7th September, 2008 (Sunday) To be decided (December)

Army Hospital (R&R) Mohan Eye Institute
28th September, 2008 (Sunday) 28th December, 2008 (Sunday)

World Sight Day New Hospital/Institute
8th October, 2008 (Wednesday) 25th January, 2009 (Sunday)

Sir Ganga Ram Hospital Guru Nanak Eye Centre
2nd November, 2008 (Sunday) 22nd February, 2009 (Sunday)

Midterm Conference of DOS New Hospital/Institute
22nd & 23rd November, 2008 (Saturday - Sunday) 15th March, 2009 (Sunday)

Annual Conference of DOS 20th-22nd March, 2009 (Friday, Saturday & Sunday)

Congratulations

• Dr. Amar Dev HOD (Eye), Dr. B.S.A. Hospital, Rohini, Delhi, who has been presented with State Award for the year
2007-08 by Delhi Government for his meritorious services in the field of health care in Delhi.

64 DOS Times - Vol. 14, No.3, September 2008

Forthcoming Events : International

September 2008 8-11 ATLANTA, GEORGIA
3-6 NEW JERSEY
American Academy of Ophthalmology
Clinical Trials Education Series: Principles and Concepts Annual Meeting
in Clinical Trials for Eye Researchers Atlanta , Georgia , United States
Florham Park , New Jersey, United States Phone: 415-561-8500 ext. 320
Contact Name: Grammer, Jot Fax: 415-561-8576
Phone: 240.221.2933, Fax: 240.221.0370 Email: [email protected]
Email: [email protected] Web Site: http://www.aao.org
Web Site: http://www.arvo.org
16-19 FLORIDA, UNITED STATES

5-6 SWITZERLAND XXX Inter-American Course in
Clinical Ophthalmology
2008 European Professors in Ophthalmology Miami, Florida, United States
Contact Name: Department, CME
(EUPO) Course on Neuro-Ophthalmology and Strabismus Phone: 305-326-6110 Fax: 305-326-6518
Email: [email protected]
Contact: EUPO Office Web Site: http://www.bascompalmer.com/

Marlene Verlaeckt, Kapucijnenvoer 33 site/info/info_inter.asp

3000 Leuven, Belgium

Email: [email protected] Fax: +32 16 23 40 97

Web Site: http://eupo.eu/ December, 2008
6th PALM BEACH, FLORIDA
13-17 BERLIN, GERMANY
Retinal & Glaucoma Imaging 2009
XXIV Meeting of the European Society of Cataract and Palm Beach, Florida, United States
Refractive Surgeons Contact Name: Department, CME
Contact: Phone: 305-326-6110 Fax: 305-326-6518
M Events Cross Media GmbH Email: [email protected]
Heimstr. 5 a, 82152 Krailling, Germany Web Site: http://www.bascompalmer.org
Phone: +49 - (0) 89 - 43 56 96 58
Fax: +49 - (0) 89 - 43 56 96 59 January, 2009
E-mail: [email protected], Website: www.m-events.eu 15-18 HYDERABAD, INDIA

October, 2008 Asia-ARVO
Hyderabad, Andhra Pradesh, India
18-19 SWITZERLAND Contact Name: Honavar, Santosh
Email: [email protected]
Glaucoma Meeting Basel 2008 Web Site: http://www.arvo.org/asiaarvo
Basel, Switzerland
Contact: Haunstein, Daniela March, 2009
Phone: 41-61-2658718, Fax: 41-61-2658652 17-22 CHICAGO
E-mail: [email protected]
Website: www.glaucoma-meeting.ch Illinois Eye Review
Chicago , Illinois , United States
24-25 GERMANY Contact Name: Cindy
Phone: 312.996.6590 Fax: 312.996.7770
From Eye to Mind: International Interdisciplinary Email: [email protected]
Symposium on Neuro-Ophthalmology and Low Vision Web Site: http://www.IllinoisEyeReview.org
Tuebingen, Germany
Contact Name: Susanne, Trauzettel-Klosinski, MD WANTED
Phone: +49 7071 2987427 Fax: +49 7071 293774
Email: [email protected]
Web Site: http://www.amd-read.net/from_eye_to_mind.html

November, 2008 Wanted a Phaco Surgeon for
8th ATLANTA, GEORGIA well established

Clinical Trials Education Series: Lion’s Eye Care Centre,
Design, Conduct and Management of Jaitu, Faridkot, Punjab
Clinical Trials in Eye Research
Atlanta, Georgia, United States Contact:-
Contact Name: Grammer, Jot Mr. Romana : 09417248923
Phone: 240.221.2933 Fax: 240.221.0370
Email: [email protected]
Web Site: http://www.arvo.org/eweb

startpage.aspx?site=clinictria

www.dosonline.org 65

Delhi Ophthalmological Society

(LIFE MEMBERSHIP FORM)

Name (In Block Letters) __________________________________________________________________________
S/D/W/o _____________________________________________________________ Date of Birth _____________
Qualifications _________________________________________________________ Registration No. __________
Sub Speciality (if any) ___________________________________________________________________________
ADDRESS

Clinic/Hospital/Practice ______________________________________________________________________
_______________________________________________________________ Phone __________________
Residence ________________________________________________________________________________
_______________________________________________________________ Phone __________________
Correspondence ___________________________________________________________________________
_______________________________________________________________ Phone __________________
Email ___________________________________________________________ Fax No. ________________
Proposed by
Dr. ____________________________________ Membership No. _________ Signature __________________
Seconded by
Dr. ____________________________________ Membership No. _________ Signature __________________
[Must submit a photocopy of the MBBS/MD/DO & State Medical Council / MCI Certificate for our records.]

I agree to become a life member of the Delhi Ophthalmological Society and shall abide by the Rules and
Regulations of the Society.
(Please Note : Life membership fee Rs. 3100/- payable by DD for outstation members. Local Cheques acceptable, payable
to Delhi Ophthalmological Society)
Please find enclosed Rs.___________in words ____________________________________________________ by Cash
Cheque/DD No.____________________ Dated_____________ Drawn on______________________________________

Three specimen signatures for I.D. Card. Signature of Applicant
with Date

FOR OFFICIAL USE ONLY

Dr._______________________________________________________________has been admitted as Life Member of

the Delhi Ophthalmological Society by the General Body in their meeting held on________________________________

His/her membership No. is _______________. Fee received by Cash/Cheque/DD No._______________ dated_________

drawn on __________________________________________________________________.

(Secretary DOS)

www.dosonline.org 67

INSTRUCTIONS

1. The Society reserve all rights to accepts or reject the application.
2. No reasons shall be given for any application rejected by the Society.
3. No application for membership will be accepted unless it is complete in all respects and accompanied by a Demand Draft of Rs.

3100/- in favour of “Delhi Ophthalmological Society” payable at New Delhi.
4. Every new member is entitled to received Society’s Bulletin (DOS Times) and Annual proceedings of the Society free.
5. Every new member will initially be admitted provisionally and shall be deemed to have become a full member only after formal

ratification by the General Body and issue of Ratification order by the Society. Only then he or she will be eligible to vote, or apply
for any Fellowship/Award, propose or contest for any election of the Society.
6. Application for the membership along with the Bank Draft for the membership fee should be addressed to Dr. Namrata Sharma,
Secretary, Delhi Ophthalmological Society, R.No. 474, 4th Floor, Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar,
New Delhi - 110 029.
7. Licence Size Coloured Photograph is to be pasted on the form in the space provided and two Stamp/ Licence Size Coloured
photographs are required to be sent along with this form for issue of Laminated Photo Identity Card (to be issued only after the
Membership ratification).
8. Applications for ‘Delhi Life Member’ should either reside or practice in Delhi. The proof of residence may be in the form Passport/
Licence/Voters Identity Card/Ration Card/Electyricity Bill/MTNL (Landline) Telephone Bill.

68 DOS Times - Vol. 14, No.3, September 2008

70 DOS Times - Vol. 14, No.3, September 2008

DOS Quiz Columns

Anagram Time

Each of the following words is a jumbled ophthalmic or related term. There is, however, an extra letter in every set of letters. These
extra letters will also form a eight letter ophthalmic word when unjumbled.

So get cracking.

1. BRIDG ___ ___ ___ ___ ____

2. GROAAN ___ ___ ___ ___ ___ ____

3. SIDSTOP ___ ___ ___ ___ ___ ___ ____

4. LEGOCAMAU ___ ___ ___ ___ ___ ___ ___ ___ ____

5. SEISTURBO ___ ___ ___ ___ ___ ___ ___ ___ ____

6. CASTCARAT ___ ___ ___ ___ ___ ___ ___ ___ ____

7. PAINTHIERTOY ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____

8. MOREICEANSRMUY ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____

Answers on page number 25 Saurabh Sawhney DO, DNB Ashima Aggarwal MS, DNB
Insight Eye Clinic, New Delhi

Required

Murlidhar Kripa Hospital &
Research Centre, Maksi

Distt. Sahajapur (M.P.)
Require following Staff for our new upcoming
Eye Hospital at Biaora

Š Ophthalmologist 6 Post
Essential qualification – M.S./D.O./D.N.B in
ophthalmology with at last 1 year experience.

Goyal Eye Institute Š Optometrist : 4 Post

1/10, East Patel Nagar, New Dlehi-110008 Essential qualification – Degree/Diploma in reputed
Ph. 25881259, 25888145, Fax: 25880114
hospital
REQUIRES
Š O.T. Technician : 6 Post
Š Resident Doctors M.D. / DNB in ophthalmology.
Š Consultant Ophthalmologists with following sub Essential qualification – O.T. Technician course from

specialties : reputed hospital.Attractive & Negotiable salary with
z Vitreo – retina z Glaucoma z Cornea
free accommodation please apply with CV.
Contact: Dr. Pawan Goyal
Mobile: 9810132464 Medical Superintendent
Murlidhar Kripa Hospital & Research Centre,
www.dosonline.org
Maksi, Distt. Shajapur (M.P.) – 465 106
Tel.: No. (07363) 233426 to 27,

E-mail: [email protected]

71

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: [email protected]

www.dosonline.org 73

Metabolic Control of Diabetes: Guidelines Tearsheet

Metabolic control in diabetics assumes a great importance The table shows the levels of HbA1c levels and the
especially with regard to outcomes of cataract surgery. Blood corresponding blood sugar levels in the preceding 4-12 weeks
glucose levels are an important but not the only factor one should period
assess for the metabolic control of the patient. There are many
challenges in a diabetic patient like increased blood sugar levels, HbA1c (%) Average Blood Sugar levels in 4-12 week period
increased blood pressure, dyslipidemia, Patient is on antiplatelets
and Nephropathy resulting in proteinuria and anemia (mmol/L) (mg/dL)

Fasting plasma glucose (FPG) test is preferred test 6 7.5 135
to diagnose diabetes
7 9.5 170
Criteria of diagnosis of Diabetes
8 11.5 205

• FPG 126mg/dl (7.0 mmol/l) (Fasting is defined as no calorie 9 13.5 240
intake for 8 hours) 10 15.5 275
11 17.5 310
• After administration of 75g of anhydrous glucose the 2 12 19.5 345
hour plasma glucose levels is 200mg/dl
Post Surgery blood sugar control
• Symptoms of hyperglycemia like polyuria, polydipsia, weight
loss AND casual plasma glucose 200 mg/dl Post Operative blood sugar levels are also very important. This
is often overlooked by the patient and the ophthalmologist alike.
Glycemic recommendations for adults with diabetes There might be increased levels of blood sugar due to the surgical
trauma however small it may be due to uncomplicated surgery.
Pre-prandial capillary plasma glucose These increased levels if not detected can lead to increased
inflammation, poor wound healing and progression of diabetic
70-130 mg/dl (3.0 -7.2 mmmol/l) retinopathy. The patient must be instructed to monitor his
glucose levels and seek the physician’s advice if required during
Post prandial capillary plasma glucose a post operative period of 4 weeks

<180 mg/dl (<10.0 mmol /l) Summary of Recommendations for Adults with Diabetics

Importance of Glycemic Control Pre-prandial capillary 70-130 mg/dl (3.9 -7.2 mmol/l)
plasma glucose
The importance of controlled blood sugar levels cannot be
underestimated in cataract surgery. It is pertinent to mention Peak postprandial <180 mg / dl (<10.0 mmol/l)
here that it is not a single reading of normal blood sugar levels
which is important for the patient whether for surgery or capillary plasma glucose
otherwise, it is the control of blood sugar levels over 4-12 weeks
which is important for the patient welfare. The control of blood HbA1C <7.0 % < 6.0% if possible
sugar levels over this period cannot be assessed by estimation of avoiding hypoglycemia (Goals
blood sugar levels alone. A parameter to assess the control of may be individualized based on
blood sugar levels over a period is by estimation of Glycosylated duration of diabetes, pregnancy
Hemoglobin levels (HbA1c) status, age and co morbid
conditions)
What are the normal and accepted Glycosylated (or glycated)
hemoglobin levels in Diabetic’s? Lipid Levels ( LDL <100 mg / dl (<2.6 mmol /l)
Cholesterol )
Normal Levels

The reference range (that found in healthy persons), is about
4%–5.9%.

Levels in Diabetics

The International Diabetes Federation and American College Blood Pressure <130/80 mmHg
of Endocrinology recommend HbA1c values below 6.5%, while Albuminuria <30 μ / mg of creatinine
American Diabetes Association recommends that the HbA1c
be below 7.0% for most patients. A high HbA1c represents poor
glucose control

www.dosonline.org 75

Recommended Protocol of Metabolic Assessment and Management of Diabetic Patient

S No Fasting Blood HbA1c Cataract Retinopathy Recommendations
Sugar Levels levels Status Status

1 Normal Levels Not Available Grade 1 2 3 No / Mild / Obtain Hb1Ac levels. If normal
Moderate then operate otherwise refer for
metabolic control; Reassess in 4 weeks
with HbA1c levels

2 Normal levels Normal Levels Any grade No / Mild / Operate and if angiographic
permitting Moderate DR / macular edema occurs:
fundus No CSME Consider Invine Gass Syndrome and
evaluation wait for 6 months to resolve. If
Cystoid macular edema occurs
consider Photocoagulation

3 Normal levels Normal Levels Grade 1 to 2 CSME / Severe Do laser first and then operate as
Posterior NPDR or PDR macular edema is said to increase
Segment after phacoemulsification. Inform
Visible /FA patient of this possible situation
possible

4 Normal Levels Normal levels Total Cataract Not Visible Operate immediately and then do
FA and assess for retinopathy.
Photocoagulation if required

5 Normal levels Increased / Grade 1, 2, 3 No / Mild / Refer the patient for metabolic control.
Outside normal cataracts. Can Moderate DR / Reassess after 4-6 weeks
limits wait for 4 No CSME
weeks

6 Normal Levels Increased levels Mature Not Visible Operate immediately and take care
for metabolic / sugar control
cataract/ postoperatively

Hypermature

cataract /

Phacomorphic

glaucoma

7 Normal levels Increased levels Grade 1,2,3 CSME / Severe Do laser and refer the patient for metabolic
NPDR control. Reassess after 4 weeks and
operate

8 Increased levels Increased Grade 1,2,3 Mild / Moderate Refer for metabolic control. Do
NPDR Photocoagulation if required. Then
Operate

9 Increased Increased Grade 1,2,3,4 Severe / PDR/ Do laser if media clarity adequate.
CSME If not deduce blood sugar levels slowly
as rapid reduction may accentuate
retinopathy. Operate and ensure post
operative sugar control

It is important for the Ophthalmologist to assess the fasting and post prandial blood sugar levels in a patient and also to assess the long
term glucose control over 16 weeks by assessing the HbA1c levels and other metabolic factors to ensure less risk of postoperative surgical
complications and infection as well as less risk of severe postoperative ocular inflammation and the occurrence/progression of retinopathy

* Lamba Pankaj FRCS, DNB **Ahuja Ashish MS **Lamba Prem Avtar MS FACS
*Lamba Eye Clinic New Delhi **Sant Parmanand Hospital, Delhi

76 DOS Times - Vol. 14, No.3, September 2008