dos_jan_2017

MONTHLY MEETING KORNER

vitreous hemorrhage. Retina remained post capsulorrehxis. Besides that anterior REFERENCES
attached in 48 eyes (96%). On table re- approach is faster; it reduces the duration
detachment was noted in 1 eye (2%), of surgery and results in rapid visual 1. Jonas JB, Budde WM, Panda-Jonas
where silicon oil had to be reinjected rehabilitation. S. Cataract surgery combined with
through scleral ports. In one eye retina transpupillary silicone oil removal
detached 4 days later needing repeat Concerns are additional procedure through planned posterior capsulotomy.
vitreoretinal surgery. cannot be done, chances of IOL instability, Ophthalmology 1998; 105:1234–237.
increased risk of RD, Cystoid macular
Advantages offered by this technique edema and corneal endothelial damage. 2. Dada VK, Talwar D, Sharma N, et al.
are Clear corneal incision so there is no Šƒ…‘‡—Ž•‹ϐ‹…ƒ–‹‘ …‘„‹‡† ™‹–Š
need of conjunctival peritomies and CONCLUSION silicone oil removal through a posterior
scleral incisions, and it is Less invasive capsulorhexis. J Cataract Refract Surg
reducing the risk of subretinal infusion, Single step micro-incision cataract 2001; 27:1243–247.
vitreous and choroidal hemorrage, it surgery combined with transpupillary
reduces the need of Nd Yag capsulotomy silicon oil removal appears to be a fast, 3. Larkin GB, Flaxel CJ, Leaver PK.
we can remove the preexisting PC plaques safe and effective method that can be Šƒ…‘‡—Ž•‹ϐ‹…ƒ–‹‘ ƒ† •‹Ž‹…‘‡ ‘‹Ž ”‡Ǧ
that are present in many patients who performed in selected cases with stable moval through a single corneal incision.
have undergone VR surgery while doing retina. Ophthalmology 1998; 105:2023–2027

4. Boscia F, Recchimurzo N, Cardascia N, et al.
Šƒ…‘‡—Ž•‹ϐ‹…ƒ–‹‘ ™‹–Š –”ƒ•’—’‹ŽŽƒ”›
silicone oil removal and lens implantation
through a cor-neal incision using topical
anesthesia. J Cataract Refract Surg 2003;
29:1113–1119.

Financial Interest: Š‡ ƒ—–Š‘” †‘‡• ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ
Case presented in the DOS Monthly Clinical Meeting at Centre For Sight, December 18, 2016.

NOTICE for GENERAL BODY MEETING

The General Body Meeting of the Delhi Ophthalmological Society will be held during the Annual Conference on Sunday,
April 9th, 2017 at 4:30 PM at the Ashok Hotel, Chanakyapuri, New Delhi.

The Agenda of the General Body Meeting shall be :
ͳǤ ‘ϐ‹”ƒ–‹‘ ‘ˆ –Š‡ ‹—–‡• ‘ˆ –Š‡ ’”‡˜‹‘—• —ƒŽ
‡‡”ƒŽ ‘†› ‡‡–‹‰ Š‡Ž† ‘ —‰—•– ʹͺ–Šǡ ʹͲͳ͸Ǥ
2. Adoption of the Annual report of Executive Committee presented by the Hony. Secretary.
͵Ǥ ƒ–‹ϐ‹…ƒ–‹‘ ‘ˆ ‡™ ‡„‡”•Ǥ
ͶǤ ‡’‘”– ‘ˆ –Š‡ ‹„”ƒ”› ˆϐ‹…‡”Ǥ
5. Report of the Editor DJO.
6. Report from the Representatives to the AIOS.
7. Presentation of Awards and Momentoes.
8. Suggestions & Resolutions for the General Body Meeting.
9. Announcement of Election results.
10. Address of the outgoing President.
11. Installation of the incoming President.
12. Address of the incoming President.
13. Any other matter with the permission of the Chair.
14. Vote of thanks by the Secretary.

All members are requested to attend.

Thanking you,

Sincerely yours,

Dr. Rishi Mohan Dr. M. Vanathi
President, DOS General Secretary, DOS

www. dos-times.org 65

DIAGNOSTICS DISCUSSION

IMPORTANCE OF MICROBIOLOGICALWORK UP IN IDENTIFICATION OF ATYPICAL
ORGANISMS AND THEIR MANAGEMENT IN CORNEAL ULCERS

Paras Mehta, Ashish Khalsa, Jyoti Batra, Neelam Sapra, Uma Sridhar

CASE 1 Figure 2: (NWQTGUEGKP UVCKPKPI QH EQTPGCN KPſNVTCVG KP (KIWTG

A 46 years old male patient presented to our clinic with the
chief complaint of photophobia, watering, pain and dimness of
vision in his left eye since one month following an accidental
spill of hair dye. He was initially treated by primary referring
ophthalmologist with antibiotic and steroid combination eye
drops for approximately 2 weeks without much relief. He did
not have any systemic illness or any systemic associations.

On ocular examination his BCVA was 6/6 in right eye
and 6/9 in left eye. Slit lamp examination of his affected eye
revealed mild lid edema, circumcorneal congestion and an
element of meibominitis. The examination of cornea revealed
’”‡•‡…‡ ‘ˆ ‘˜ƒŽ •Šƒ’‡†ǡ ϐŽƒ–ǡ †”› Ž‘‘‹‰ •—’‡”ϐ‹…‹ƒŽ •–”‘ƒŽ
‹ϐ‹Ž–”ƒ–‡ ‘ˆ ͷšͶ ‹ •‹œ‡ Ž‘…ƒ–‡† ‹ –Š‡ ’ƒ”ƒǦ…‡–”ƒŽ –‡’‘”ƒŽ
region sparing the pupillary area. The margins of the lesion
†‡‘•–”ƒ–‡† •ƒŽŽ ’‹ Š‡ƒ† •‹œ‡† —Ž–‹’Ž‡ǡ •—’‡”ϐ‹…‹ƒŽ
‹ϐ‹Ž–”ƒ–‡•Ǥ – Ž‘‘‡† Ž‹‡ —Ž–‹’Ž‡ •ƒ–‡ŽŽ‹–‡ Ž‡•‹‘• ‹ ƒ ”‹‰ ‘”
a wreath pattern (Figure 1 and Figure 2). While the base of
–Š‡ …‘”‡ƒŽ ‹ϐ‹Ž–”ƒ–‡ ƒ’’‡ƒ”‡† ϐŽƒ––‡”Ǥ Š‡ ”‡•– ‘ˆ –Š‡ …‘”‡ƒ
appeared clear, the anterior chamber was quiet and pupil was
round and reacting to light. The examination of right eye was
essentially within normal limits.

ƒ•‡† ‘ –Š‡ ƒ„‘˜‡ Š‹•–‘”› ƒ† …Ž‹‹…ƒŽ ϐ‹†‹‰• ˆ‘ŽŽ‘™‹‰
differential diagnosis were kept in mind:

ƒ…–‡”‹ƒŽ …‘”‡ƒŽ —Ž…‡” ™‹–Š ”‹‰ Ž‹‡ ‹ϐ‹Ž–”ƒ–‡ ‘•– Ž‹‡Ž›
to be Nocardial infection

Fungal corneal ulcer with satellite lesions
Viral corneal ulcer with secondary infection
A microbiologic work up was performed to isolate and
identify the causative organism. Multiple scrapings were taken

Figure 3: Gram staining of corneal scraping of patient in Figure 1
UJQYKPI DGCFGF ſNCOGPVQWU ITCO XCTKCDNG DCEKNNK

Figure 1: %QTPGCN KPſNVTCVG KP C [GCT QNF RCVKGPV UJQYKPI YTGCVJG from the base and the margins of the ulcer and subjected for
RCVVGTP YKVJ RKP JGCF KPſNVTCVGU KP OCTIKP smears, direct wet-mount examination and direct inoculation
was done on culture media as well. The smears were subjected
for Gram’s (Figure 3), Giemsa and 1% Acid fast (Ziehl- Neelsen)
stain (Figure 4) and 10% KOH mount. Direct inoculation
was done on Blood Agar& Chocolate Agar plates and Potato-
Dextrose Agar slant.

The smears revealed presence of Gram positive Cocco
„ƒ…‹ŽŽ‹ ƒ† ϐ‹Žƒ‡–‘—• „”ƒ…Š‹‰ ”‘†• ‘ ‰”ƒǯ• •–ƒ‹ ™Š‹Ž‡
on Acid Fast staining weakly acid fast, multiple, thin branching,
„‡ƒ†‡† ϐ‹Žƒ‡–• ™‡”‡ ‘„•‡”˜‡† •—‰‰‡•–‹˜‡ ‘ˆ ‘…ƒ”†‹ƒŽ
organisms. However, there was no growth on culture media.

www. dos-times.org 67

DIAGNOSTICS DISCUSSION

Figure 4: 1% acid fast staining of patient in Figure 1 showing beaded Figure 5: *GCNGF KPſVTCVG QH ECUG
ſNCOGPVQWU DCEKNNK

Based on the clinical appearance as …‘”‡ƒ •Š‘™‡† ƒ Žƒ”‰‡ ‹ϐ‹Ž–”ƒ–‡ was incubated at 25oC. On 4th day small
well as smear examination a presumptive 6x4 mm inferiorly extending almost dry powdery colonies appeared both on
diagnosis of Nocardial Keratitis was upto mid cornea. There was extreme blood agar and chocolate agar plates.
made. Patient was started on intensive stromal thinning, 2mm hypopyon and The thioglycollate broth also showed
–”‡ƒ–‡– ™‹–Š ˆ‘”–‹ϐ‹‡† ‹ƒ…‹ ʹΨ endoexudates. The clinical picure was the turbidity, it was then subcultured on
drops. He responded to the treatment and not typical of any particular organism. …Š‘…‘Žƒ–‡ ƒ‰ƒ”Ǥ ‘–Š
”ƒǯ• ƒ† ‘†‹ϐ‹‡†
‹ϐ‹Ž–”ƒ–‡ ”‡•‘Ž˜‡† …‘’Ž‡–‡Ž› „› –Š”‡‡ Probable fungal or a polymicrobial Acid fast stain (Kinyon’s stain) were done.
weeks of management (Figure 5) however etiology was entertained. The isolate showed thin beaded branched
he was continued on maintenance dose of ϐ‹Žƒ‡–• ƒ† ™‡”‡ ͳ ’‡”…‡– ƒ…‹† ˆƒ•–Ǥ
Amikacin for 2 more weeks to prevent Due to extreme thinning of the
recurrence. cornea, decision to apply tissue adhesive The colony was picked up, was
and bandage contact lens was taken powdery chalk like with a gritty sensation
CASE 2 (Figure 6). Anterior chamber tap was and was then subjected to antibiotic
done at the same sitting in the operatng sensitivity tests both on blood agar
A 60 year old female patient room and the sample was sent for and MHA agar plates with antibiotics
presented with complaints of decreased microbiological work up. (Kirby Bauer) disc diffusion methods.
vision pain and redness in her right It was sensitive to amikacin, pipracillin,
eye since one month. Her left eye was AC tap sample was inoculated on cefazolin, amoxyclav. gentamycin,
phthisical due to injury sustained in the routine cacterialogical and mycologic ‘š‹ϐŽ‘šƒ…‹ǡ …‹’”‘ϐŽ‘šƒ…‹ ƒ†
childhood. Her BCVA in her right eye was culture medias. Smears were done for gatifoxacin.
…‘—–‹‰ ϐ‹‰‡”• ʹ ‡–”‡• ƒ† ‹ Ž‡ˆ– Gram stain and 10% KOH mount. The
eye. There was no history of trauma with Gram stain showed pus cells and Gram Based on microwork up, the earlier
vegetable matter .The patient had been to variable bacilli (Figure 7) and KOH treatment with antifungal eyedrops,
multiple doctors and was using natamycin •Š‘™‡† ˆ‡™ –Š‹ ϐ‹Žƒ‡–•Ǥ ͳΨ ƒ…‹† ˆƒ•– ‘š‹ϐŽ‘šƒ…‹ ‡›‡†”‘’• ™‡”‡ •–‘’’‡† ƒ†
eyedrops hourly, nepafenac eyedrops stain showed red coccobacilli and thin topical 2.5% amikacin was started. The
hourly, tobramycin eyedrops hourly and ϐ‹Žƒ‡–• ȋ ‹‰—”‡ ͺȌǤ patient is now showing slow recovery
‘š‹ϐŽ‘šƒ…‹ ‡›‡†”‘’• ͸ –‹‡• ƒ †ƒ› •‹…‡ and waiting for removal of glue and bcl.
one week. She had used topical steroid The sample was inoculated on
antibiotic combination eye drops earlier 5% sheep blood agar, chocolate agar. DISCUSSION
on the advice of other practitioners. Sabourads dextrose agar, brain heart
infusion and Thioglycollate broth. The NOCARDIA species are classically
On examination, there was lid blood agar plates and BHI were incubated
edema, conjunctiva was congested, at 37o C while chocolate agar in candle gram-positive strictly aerobic,
jar (5% CO2) at 370c. The SDA media
ϐ‹Žƒ‡–‘—•ǡ „”ƒ…Š‹‰ǡ ™‡ƒŽ› ƒ…‹†Ǧ

fast bacilli. They belong to family

1. Cornea Specialist Sameep Eye Centre and Cornea Centre,Vadodara
2. Cornea Services, ICARE Eye Hospital, Noida, U.P.
3. Sapra Microbiology Centre, Gurgaon

1Dr. Paras Mehta MS 2Dr.Ashish Khalsa MBBS 2Dr. Jyoti Batra MS, DNB 3Dr. Neelm Sapra MD 2Dr. Uma Sridhar MS, DNB, FRCS

68 DOS TIMES - JANUARY- FEBRUARY 2017

DIAGNOSTICS DISCUSSION

Figure 6: Corneal abscess in 60 year old female patient after application Figure 7: Gram staining of AC tap of patient in Figure 6 showing
of TA+BCL DGCFGF ſNCOGPVQWU DCEKNNK

Mycobacteriacae. They may be isolated Figure 8: 1% Acid fast staining of patient in KOH mount, Gram stain, Geimsa stain, 1%
on routine bacterial, fungal, and (KIWTG UJQYKPI DGCFGF ſNCOGPVQWU DCEKNNK and 20% acid fast staining and culture
mycobacterial media. Colonies may from the same sources is necesary.
appear within 4 days, but may require up to to lack of awareness or inadequate or
2-4 weeks of culture. Pre-treament of the no microbiological support. The clinical  –Š‡ ϐ‹”•– …ƒ•‡ –Š‡ †‹ƒ‰‘•‹• ‘ˆ
patient with antibiotics that slow but do picture is altered by cocktail therapy, use infection by Nocardia sps was by an
not kill Nocardia will most often increase of NSAIDS or steroids and presence of experienced cornea specialist and
the time required to grow Nocardia more than one organism may confuse the …‘ϐ‹”‡† „› ‹…”‘„‹‘Ž‘‰‹…ƒŽ ™‘”—’Ǥ
from clinical isolates. If nocardiosis is clinician as to the etiological diagnosis. In the second case, clinically fungal ulcer
suspected clinically, the bacteriology was suspected. The clinical picture was
laboratory should be informed and Included in the category of not typical of Nocardia as described in
cultures should be kept longer than usual. atypical organisms, Nocardia, atypical literature and was altered by treatment.
‘…ƒ”†‹ƒ …ƒ ƒŽ•‘ „‡ †‹ˆϐ‹…—Ž– –‘ ‹•‘Žƒ–‡ „› mycobacteria and microsporidia. Microbiological work up of the anterior
culture because of overgrowth by faster- Awareness of the infection by these chamber tap gave an entirely different
growing nonpathogenic colonizers that organisms in non-healing ulcers is diagnosis.
may mask its presence. necessary. Proper microbiological work
up by means of corneal smears from The importance of microbiological
Nocardia colonies may be smooth corneal scraping or anterior chamber tap work up cannot be overemphasised.
and moist, or have a “mold-like” verrucous or from corneal biopsy and examined by
grey-white waxy or powdery appearance SUGGESTED READINGS
from aerial hyphae. They have a very
distinct, strong mildew odor that allows 1. Sharma S, Sridhar M.S, Diagnosis and
experienced microbiologists to suspect Management of Nocardia Keratitis Journal of
their presence. clinical microbiology, July 1999, p. 2389

Nocardia are classically Gram- 2. Garg P .Fungal, Mycobacterial, and Nocardia
˜ƒ”‹ƒ„Ž‡ǡ ™‹–Š ƒ Ǯ„‡ƒ†‡†ǯ ƒ’’‡ƒ”ƒ…‡ ‘ˆ infections and the eye: an update, Eye 2012;
alternating Gram-positive and Gram- 26: 245–51
‡‰ƒ–‹˜‡ •‡‰‡–• ƒŽ‘‰ ƒ ϐ‹Žƒ‡–Ǥ
3. Lalitha Prajna, Srinivasan M, Rajaraman R,
Atypical organisms are often not Ravindran M, Mascarenhas J, Jeganathan
diagnosed in corneal ulcers either due Lakshmi Priya, et al. Nocardia Keratitis:
Clinical Course and Effect of Corticosteroids
American Journal of Ophthalmology,
154;6:934- 39.

Financial Interest: Š‡ ƒ—–Š‘”• †‘ ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

www. dos-times.org 69

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PAPILLOEDEMA

Dr.Arun Kumar Patidar MD Figure 2
Dr. R.M.L. Hospital,
New Delhi (2) No elevation of the disc borders
(3) Disruption of the normal radial NFL arrangement with
Papilloedema refers to swelling of the optic disc from
increased intracranial pressure (ICP)]. It must be ‰”ƒ›‹•Š ’ƒ…‹–› ƒ……‡–—ƒ–‹‰ ‡”˜‡ ϐ‹„‡” Žƒ›‡” „—†Ž‡•
distinguished from optic disc swelling from other (4) Normal temporal disc margin
causes which is simply termed “optic disc edema”. (5) Subtle grayish halo with temporal gap (best seen with
Papilledema must also be distinguished from
pseudo-papilledema such as optic disc drusen. indirect ophthalmoscopy)
Since the root cause of papilledema is increased intracranial (6) Concentric or radial retrochoroidal folds
pressure (ICP) this is an alarming sign which may presage
•—…Š ‡–‹–‹‡• ƒ• „”ƒ‹ –—‘”ǡ ‹ϐŽƒƒ–‹‘ǡ ‘” ‹†‹‘’ƒ–Š‹…
intracranial hypertension (IIH)1.

CLASSIFICATION OF PAPILLOEDEMA2,3

Š‡”‡ ƒ”‡ •‡˜‡”ƒŽ ’”‘’‘•‡† …Žƒ••‹ϐ‹…ƒ–‹‘ ˆ‘” ‰”ƒ†‹‰ ‘ˆ
Papilloedema Frisen Scale (based on observation) is most
™‹†‡Ž› ƒ……‡’–‡† …Žƒ••‹ϐ‹…ƒ–‹‘Ǥ Š‹• •…ƒŽ‡ ‰”ƒ†‡• ’ƒ’‹ŽŽ‘‡†‡ƒ
(based on severity) by the appearance of the optic disc borders,
the diameter and degree of protrusion of the optic nerve head,
the appearance of nearby blood vessels and the optic cup and
•‹‰• ‘ˆ ”‡–‹ƒŽ ‡”˜‡ ϐ‹„”‡ †‹•”—’–‹‘ …Ž‘•‡ –‘ –Š‡ †‹•…Ǥ

Stage 0 – Normal Optic Disc

(1) Blurring of nasal ,superior and inferior poles in Inverse
proportion to disc diameter

ȋʹȌ ƒ†‹ƒŽ ‡”˜‡ ϐ‹„‡” Žƒ›‡” ȋ Ȍ ™‹–Š‘—– –‘”–—‘•‹–›
(3) Rare obscuration of a major blood vessel, usually on the

upper pole

Stage 1 – Very Early Papilledema

(1) Obscuration of the nasal border of the disc

Figure 1 Figure 3

Stage 2 – Early Papilledema
(1) Obscuration of all borders
(2) Elevation of the nasal border
(3) Complete peripapillary halo

Stage 3 – Moderate Papilledema
(1) Obscurations of all borders
(2) Increased diameter of optic nerve head

www. dos-times.org 71

QUICK PICKS

Figure 4 Figure 5 Figure 6

(3) Obscuration of one or more segments Stage 5 – Severe Papilledema REFERENCES
of major blood Vessels leaving the
disc (1) Dome-shaped protrusions 1. Ehlers JP, Shah CP, eds. Papilledema. In: The
‹ŽŽ• ›‡ ƒ—ƒŽǣ ˆϐ‹…‡ ƒ† ‡”‰‡…›
(4) Peripapillary halo–irregular outer representing anterior expansion of Room Diagnosis and Treatment of Eye
ˆ”‹‰‡ ™‹–Š ϐ‹‰‡”ǦŽ‹ ‡š–‡•‹‘• Disease. 5th ed. Baltimore, Md: Lippincott
the optic nerve head Williams & Wilkins; 2008:252-54.
Stage 4 – Marked Papilledema
(2) Peripapillary halo is narrow and 2. Sinclair AJ, Burdon MA, Nightingale PG,
(1) Elevation of the entire nerve head et al; Rating papilloedema: an evaluation
(2) Obscuration of all borders smoothly demarcated ‘ˆ –Š‡ ”‹•‡ …Žƒ••‹ϐ‹…ƒ–‹‘ ‹ ‹†‹‘’ƒ–Š‹…
(3) Peripapillary halo intracranial hypertension. J Neurol.
(4) Total obscuration on the disc of a (3) Total obscuration of a segment of a 2012;259:1406-12.

segment of a major blood vessel major blood vessel may or may not 3. Frisen L; Swelling of the optic nerve head:
a staging scheme. J Neurol Neurosurg
be present Psychiatry. 1982;45:13-8.

(4) Obliteration of the optic cup

Financial Interest: Š‡ ƒ—–Š‘” †‘‡• ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

If you want to sell your used Ophthalmic

Equipments at Good Price

OR
If you are Interested to Purchase
Second hand Ophthalmic Equipments at

Reasonable Prices in Good Condition

Please Contact: Manoj Pandey

B-503, Plot No. 23, Sector-6, Dwarka, NEW DELHI-75
Ph.: 011-43557387, 9350257387
Email: [email protected]

72 DOS TIMES - JANUARY- FEBRUARY 2017

DOS QUIZ

DOS Times Quiz 2016-17

Episode-4

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

1. Which of the following is not consistent with a classic 6. This is the histology picture of an upper eyelid
diagnosis of multiple evanescent white dot syndrome lesion. What is the diagnosis?
(MEWDS)? a. Basal cell carcinoma
a. Unilateral involvement b. Dermal nevus
b. Foveal involvement of the white dots c. Squamous cell carcinoma
c. Vitreous cell d. Hemangioma
d. Venous sheathing
e. Optic nerve edema 7. This is the fundus picture of a child. What is the
most likely diagnosis?
2. The inheritance of which variant of Ehlers-Danlos
Syndrome is Not autosomal dominant
a. Type I
b. Type II
c. Type III
d. Type IV
e. Type V

3. Which of the following is false regarding stromal
keratitis in congenital syphilis
a. Twice as many females are affected compared to
males
b. Stromal keratitis is the most common sign of late
congenital syphilis
c. Onset in females is usually before 2 years of age

†Ǥ ‡…—””‡– ‹ϐŽƒƒ–‹‘ ‹ –Š‡ •ƒ‡ ‡›‡ ‹• ‘–‡† ‹
5-10% of cases

4. The anterior banded zone and the posterior
nonbanded zone of Descemet’s membrane are largely
composed of the following collagen respectively
a. Type IV and Type III
b. Type VIII and Type IV
c. Type I and Type IV
d. Type IV and Type VII

5. Which of the following is false regarding Short Wave
Automated Perimetry (SWAP)

ƒǤ ’‡…‹ϐ‹…ƒŽŽ› ‡˜ƒŽ—ƒ–‡• –Š‡ ‘‹‘…‡ŽŽ—Žƒ” ”‡–‹ƒŽ
ganglion cells

b. Utilizes a Goldmann size V narrow-band stimulus
c. Stimulus transmission of 440 nm
d. Utilizes a 100cd/m2 blue background

www. dos-times.org 73

DOS QUIZ

8. In Duane syndrome DOS TIMES Quiz Rules
a. Type 3 is associated with the largest face turns
b. Lateral rectus resection should be included in the 1. DOS TIMES QUIZ will now feature as 5 Episodes (Episode 1: July-
treatment of Duane syndrome with esotropia August, Episode 2: September – October, Episode 3: November –
c. Exotropia in gaze away from the affected eye of a December, Episode 4: January – February, Episode 5: March – April).
unilateral case can sometimes be seen Entries will have to be emailed before the last date mentioned in the
d. Upshoots and downshoots are manifestations of severe contest questions form. Late entries will not be entertained.
oblique muscle dysfunction
2. Please email (as scanned PDF ONLY) completed responses for the
9. Which of the following statement is false regarding quiz along with details of the contestant ϐ‹ŽŽ‡† ‹ ƒ† •‹‰‡† to
myasthenia [email protected] (with cc to [email protected]) or mail
a. Anti-acetylcholine receptor antibodies are positive in to DOS Times Quiz, Dr. M. Vanathi, Room No. 479, 4th Floor, Rajendra
only about 60% of patients with ocular myasthenia Prasad Centre for Ophthalmic Sciences, All India Institute of Medical
b. About 85-90% of patients who present with ocular Sciences, New Delhi.
myasthenia go on to develop systemic myasthenia
c. If the patient has ocular myasthenia for 2 years, the 3. Nonmembers may also send in their entries but will be required to
conversion rate is about 25-30% send along with their completed entries, the completed membership
d. Concurrent thyroid eye disease occurs in about 5% of application (with the required documents) to enroll as member.
patients Failing this their entries into the contest will not be considered.

10. Visual hallucinations may occur as a result of all of the 4. Contestants are requested to attempt all the 5 episodes of the QUIZ
following except …‘–‡•– ƒ† •‡† ‹ –Š‡‹” ƒ’’Ž‹…ƒ–‹‘• ™‹–Š‹ –Š‡ †ƒ–‡ •’‡…‹ϐ‹‡†Ǥ ‘
a. Bilateral visual loss (Charles Bonnet syndrome) entries will be entertained after the last date. The scores of each
b. Cancer- associated retinopathy contestant for all 5 episodes together will be compiled at the end
c. Parietal lobe lesions 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
†Ǥ ‹Ž†‡ƒϐ‹Ž …‹–”ƒ–‡ 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]
ˆ—”–Š‡” …Žƒ”‹ϐ‹…ƒ–‹‘• ‹ˆ ƒ›Ǥ

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 4

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: ___________________________________

74 DOS TIMES - JANUARY- FEBRUARY 2017

ROSSWORD DOS CROSSWORD

Episode-4 4
7
Dr. Manish Mahabir MD
Senior Resident,
Dr. R.P. Centre,All India Institute of Medical Sciences,
New Delhi, India

1 2
3 5

6
8

9 10 11
12 13
14

ACROSS DOWN

6. Score for grading the severity of intermittent exotropia(9) 1. Drug for the treatment of Stargardt disease(9)
ͺǤ ƒ”•‘…‘Œ—…–‹˜ƒŽ ϐŽƒ’ ˆ‘” ”‡…‘•–”—…–‹‘ ‘ˆ –Š‡ ’‘•–‡”‹‘” 2. Dexamethasone bioresorbable intracanalicular insert, designed to

lamella(6) release drug for up to 30 days(8)
9. Mercury 2 trial tests combination of ..... with latanoprost(10) 3. Data analysis to ensure that the conclusions are not a result of
11.. Electrical nanopulses delivered to a nitinol ring to create
confounding variables(12)
capsulotomy(5) 4. Dye disappearance test to assess functioning of lacrimal system(5)
12. First FDA-approved anti-VEGF therapy to treat myopic CNV(11) 5. Drug for glaucoma, may have potential as a treatment for
13. Mutation associated with aniridia(4)
14. Most common bacterial etiology in acute dacryocystitis(11) Alzheimer’s disease(11)
͹Ǥ ‹–—• ϐŽ› –‡•– ‡ƒ•—”‡• ǤǤǤǤǤǤȋͳͲȌ
9. All-digital system to digitally pre-plan the entire laser therapy on

fundus images(7)
10. First extended depth of focus IOL(7)

www. dos-times.org 75

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DOS Clinical Monthly Meet – V (Goyal Eye Institute)

The DOS Clinical Monthly Meet – V was held at Goyal Eye Institute, 1/10, East Mini-Symposium:
Patel Nagar, Opposite Metro Pillar Number 176, New Delhi on November 27, Addressing Cosmesis
2016 from 11:00 A.M. to 1.00 P.M. The meeting which was well attended by through Ophthalmology
151 ophthalmologists., commenced at 11.00 AM and concluded on time at
1.00 PM followed by lunch. Chair: Dr. Pawan Goyal
Co-Chair: Dr. Saurabh Sawhney

Dr. Pawan Goyal, Dr. Saurabh Sawhney

DOS General Secretary Dr. M. Vanathi on the dais along with the Ex-DOS President Dr. Cyrus
Shroff and (left to right).

Case Presentations and Clinical Talk Dr. Shilpa Taneja
delivering her lecture on Oculofacial
Aesthetics – Our Expanding
armamentarium

Dr. Narottama Sindhu, Glaucoma Dr. Ritin Goyal, presenting the Clinical Dr. Saurabh Sawhney, delivering talk on
%QPUWNVCPV RTGUGPVKPI VJG ſTUV ENKPKECN ECUG Talk on Oral Mucous Membrane Grafting Toric IOLs: How to Complicate a Simple
of Asymmetric Ocular Hypertension in a KP 1EWNCT 5VGXGP ,QJPUQP 5[PFTQOG Thing
Young Adult: A Diagnostic Conundrum

Dr. Anshul Goyal, presenting the second Dr. Uma Sridhar making the guest case Dr. Pawan Goyal, delivering talk on
clinical case of IOFB Removal… via an presentation of Managing peripheral corneal Tackling suboptimal refractive outcomes
impromptu approach diseases QH /WNVKHQECN +1.U YKVJ .#5+-

www. dos-times.org 77

NEWS WATCH

LIFE TIME ACHIEVEMENT AWARD - 2017
Recommendations and Suggested Names are invited for the Life Time Achievement award:
General Conditions
1. Maximum of TWO Awards in a year may be awarded.
2. Any Member of the Society who is eligible for the Award shall be entitled to be considered for the same.
3. Recommendations can be sent by one of the following:
a) Any of the Past Awardees
b) Any of the Past Presidents
c) At least 5 members of the Executive Committee
d) At least 15 Delhi Members of DOS.
4. Recommendations should be sent to the Secretariat, DOS.
ͷǤ Š‡ ’‡”•‘ •Š‘—Ž† Šƒ˜‡ •‹‰‹ϐ‹…ƒ– ‹ˆ‡ ‹‡ …Š‹‡˜‡‡–• ‹ –Š‡ ϐ‹‡Ž† ‘ˆ ’Š–ŠƒŽ‘Ž‘‰›Ǥ
͸Ǥ ‡…‹’‹‡– ‘ˆ –Š‡ ™ƒ”† •ŠƒŽŽ „‡ •‡Ž‡…–‡† ƒ† ”‡…‘‡†‡† „› –Š‡ ™ƒ”† —„Ǧ…‘‹––‡‡ǡ ™Š‹…Š Šƒ• –‘ „‡ ”ƒ–‹ϐ‹‡† „› –Š‡
Executive.
7. The Award sub-committee can ask for the Biodata and latest photograph of the individuals recommended.
Eligibility
1. The Member should be at least 65 years of age
2. Active participation in Society for 20 years
3. Contribution in improvement of standard of Ophthalmology in India
4. Award will carry a citation.
The Recommendations and Suggested Names must be received in DOS Secretariat not later than 5:00 PM on 15th February,
2017.

DR. P.K. JAIN ORATION & DR. S.N. MITTER ORATION-2017
Nominations are invited for the above orations. The nominee should be a voting member of the Delhi Ophthalmological
Society.
Selection Procedure
Nomination should be signed by one of the following:
1. Any of the Past Awardees
2. Any of the Past Presidents
3. At least 5 members of the Executive Committee
4. At least 15 Delhi Members of DOS.
The nomination must include an introductory paragraph justifying the nomination, a biodata of the nominee, a statement
to the effect that the nominee would accept the Oration, if awarded and would deliver an oration of his choice at the Annual
Conference of the DOS. The topic should be intimated to the society at least 4 weeks before the Conference and a typed script of
the same should be submitted at least 15 days before. The awardee will have to transfer the copyright of the text of his talk to the
Society.

DR. B.N. KHANNA & DR. HARI MOHAN ORATION-2017
Nominations are invited for the above Orations. The nominee should be a voting member of the Delhi Ophthalmological
Society.
Selection Procedure
Nomination should be signed by one of the following:
1. Any of the Past Awardees
2. Any of the Past Presidents
3. At least 5 members of the Executive Committee
4. At least 15 Delhi Members of DOS.
The nomination must include an introductory paragraph justifying the nomination, a biodata of the nominee, a statement to
the effect that the nominee would accept the award if awarded and would deliver an oration of his choice at the annual conference
of the DOS. The topic should be intimated to the society at least 4 weeks before the conference and a typed script of the same
should be submitted at least 15 days before. The awardee will have to transfer the copyright of the text of his talk to the Society.
Selection Process for above Awards
The selection will be made by the Award Committee consisting of the President, Secretary and 3 senior, distinguished
‡„‡”• ˆ”‘ ͵ †‹ˆˆ‡”‡– •—„Ǧ•’‡…‹ƒŽ–‹‡• ‘ˆ ’Š–ŠƒŽ‘Ž‘‰›Ǥ Š‡ ™ƒ”† ‘‹––‡‡ ™‘—Ž† –ƒ‡ –Š‡ ϐ‹ƒŽ †‡…‹•‹‘ ‘ –Š‡ „ƒ•‹• ‘ˆ
the recommendations of the Award Committee.
The nominations must be received in DOS Secretariat no later than 5.00 p.m. on 15th February, 2017.
Advance copy of the nominations may be sent by email at [email protected]. The hard copy must however be received
in the DOS Secretariat by the last date for receiving the nominations (5.00pm on February 15, 2017).

Dr. Rishi Mohan Dr. M. Vanathi
President-DOS General Secretary – DOS

DOS SECRETARIAT:

Prof. M. Vanathi
General Secretary, Delhi Ophthalmological Society, R.No. 479, 4th Floor, Dr. R.P. Centre for Ophthalmic Sciences,

AIIMS, Ansari Nagar, New Delhi – 110029, Ph : +91-11-65705229, Email: [email protected], Website: www.dosoline.org

78 DOS TIMES - JANUARY- FEBRUARY 2017

NEWS WATCH

House in attention for the Indian National Anthem

Inauguration of the meeting with traditional lamp lightingLeft
to Right: Dr Cyrus Shroff (DOS past President), Dr Dilruwani
Aryasingha (COSL Jt Secretary), Dr M. Vanathi (DOS Secretary),
Dr Rishi Mohan (DOS President), Dr Pradeepa Siriwardena (COSL
President), Dr Madhuwanthi Dissanayake (COSL President Elect)

Lamp lighting: (clockwise) Dr M.Vanathi, Dr Pradeepa Dilruwani, Dr Pradeepa Siriwardena & Dr Rishi Mohan delivering the
Dr Dilruwani Aryasingha, Dr Cyrus Shroff, Dr Kusum Ratnayake, welcome address

Dr Madhuwanthi DIssanayake

Exchange of momentos between DOS & COSL

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82 DOS TIMES - JANUARY- FEBRUARY 2017

NEWS WATCH

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NEWS WATCH

84 DOS TIMES - JANUARY- FEBRUARY 2017