Tip-438..... In general, on Fundus autofluorescence (FAF), hyperautofluorescence from RPE indicates sick (diseased) RPE as the lipofuscin is not getting metabolised; while hypoautofluorescence indicates dead RPE (provided blocked autofluorescence is ruled out). Tip-439...... Flanged versions of 3-mirror fundus contact lenses are more stable on the eye but they are generally larger and more cumbersome for the patient. They always require coupling fluid. Tip-440...... Intracameral antibiotics at the conclusion of cataract surgery is more effective than topical antibiotics in preventing postoperative endophthalmitis. Surgeons giving periocular antibiotics are commonly not prescribing the post-op topical antibiotics. Tip-441....... Adaptive optics (AO) utilises the wave front sensors to detect the higher order aberrations in optics of the eye and correct them by using deformable mirrors. This allows to see the retina at an individual 'cellular' level
with great resolution (2 microns). Theoretically it can be used with any imaging modality in ophthalmology, however presently AO is mainly restricted to research activities only. Tip-442..... Patients with peripheral field constriction e.g. in diffuse peripheral chorioretinitis or extensively lasered retina, etc. also commonly complain of poor night vision (rods function). Tip-443....... While Neovascular glaucoma (NVG) can occur commonly in CRVO (in 30% of ischemic CRVOs in 1-6 months, (see Tip No.-25), NVG is a rarity in BRVO. Tip-444...... Vitreous is strongly attached to the anterior margin of lattice degeneration, hence it is very important to fully surround the lattice especially the anterior margins during Barrage laser (laser retinopexy), hence always start lasering from anterior margins. If the anterior margin is not reachable, extend the laser spots on sides till the ora. Surround each lattice separately with laser spots and NOT two or more lattices
together. See Tip-59 for indications for treating lattice. Tip-445....... Nephropathy (proteinuria and elevated BUN/creatinine) is an important predictor for developing Diabetic retinopathy (DR). Controlling nephropathy slows progression of DR. Maintaining HbA1C upto 6-7% can markedly reduce the incidence of DR. Mild NPDR is indicated by at least one microaneurysm, which is the earliest clinical sign of DR & its rupture in deeper layers (INL & OPL) causes dot and blot hemorrhages. Tip-446....... General advices to patients with the family history of AMD or those having Dry AMD: 1. Stop smoking. 2. Control your BP, cholesterol and weight. 3. Eat red and yellow fruits (contain Lutein and zeaxanthin), green leafy vegetables and oily fish. Nutritional supplements (AREDS2 formula drugs) are only for those with Intermediate AMD. See Tip-62. 4. Use UV filter glasses. 5. Do Amsler grid check regularly (weekly in Dry AMD). 6. Regular follow up is essential.
Tip-447...... Tips on Posterior subtenon injection of Triamcinolone: 1. 0.5-1ml (40mg/ml) given with 26G, 1/2" needle in superotemporal quadrant. 2. Prick as posterior as possible (2-3mm from fornix) after picking conjunctiva & tenon firmly with lim's forceps in superotemporal quadrant & patient looking inferonasally. Conjunctival ballooning indicates drug going subconjunctivally and not subtenon. 3. Keep bevel of the needle down & keep it moving sideways while passing (noting eyeball movements for inadvertent scleral engagement). 4. Beware of steroid responder (try Prednisolone drops qid x 2-3 weeks as a trial first, but is not foolproof). 5. Useful for CME of any cause (pseudophakic, RVO, non-infectious uveitis, etc.) & refractory DME. 6. Some use Subtenon cannula or IV cannula instead of needle. Tip-448...... Suspect anterior uveitis to be Herpetic (rare with H. Simplex but common with Zoster), in absence of skin lesions of HSV or VZV: 1. IOP elevated (hypertensive uveitis).
2. Stellate (star like) KPs throughout the cornea & not just in inferior third (Arlt's triangle). 3. Large granulomatous KPs. 4. Decreased corneal sensations. 5. Dilated or corectopic (decentered) pupil without mydriatic. 6. Iris pigmentary atrophy leading to transillumination defects. Topical antivirals are not useful, instead give systemic antivirals along with topical steroids and cycloplegics (if >1+ cells). Tip-449...... Pseudo-rubeosis is dilated or tortuous normal iris vessels which traverse radially unlike the true rubeosis in which vessels have irregular distribution. On FA, iris vessels leak only in rubeosis. Tip-450..... Most common cause of Acute retinal necrosis (ARN) is Varicella zoster virus (VZV) and HSV is much less likely, while PORN (Progressive outer retinal necrosis) most commonly occurs due to AIDS virus, occurring in immunocompromised individuals and without any vitreous reaction.
CMV retinitiis is usually bilateral with granular or hemorrhagic necrotising retinitiis without any vitreous or AC cells. ---THE END ---
Ninth Edition Unabridged