dos-apr-2011

Contents

E5 ditorial 65 Macular Hole

F ocus Priyank Garg, Arindam Chakravarti, Sundaram Natarajan

7 Glaucoma Potpurri Glaucoma

O13 utgoing Presidential Address 75 Post Traumatic Glaucoma

I15 ncoming President Address Manav Sachdev, Usha Yadava

S17 ecretary’s Report 2009-2011 Miscellaneous
H19 ighlights: Annual DOS Conference
Retina 81 Myopia: An Overview

59 Descemet’s Membrane Detachment Kapil Khurana, S.P. Chaudhary, Manisha Agarwal

Manisha Acharya, Jyoti, Umang Mathur, Kapil Arneja 87 Ocular TB

Bobby Bhalotra, Amit Khosla

F93 orthcoming Events

Columns

95 Membership Form

Attention DOS Member 3

DOS Times is not published in the month
of May & June each year

www.dosonline.org

DO Executive Members DO
Delhi Ophthalmological Society
SOCIET Y SOCIET Y

DELHI DELHI

P.V. Chadha DOMS B.P. Guliani MS Amit Khosla MD, DNB Alkesh Chaudhary DO, MS Ruchi Goel MS
President Vice-President Secretary Joint-Secretary Treasurer
[email protected]
[email protected] [email protected] [email protected] [email protected]

Rohit Saxena MD Harbansh Lal MS Ashu Agarwal MS Rajesh Sinha MD, DNB Subhash C. Dadeya MD
Editor Library Officer Executive Member Executive Member Executive Member
[email protected]
[email protected] [email protected] [email protected] [email protected]

Pawan Goyal MD A.K. Jain DO, MS Rohit Nanda DO, DNB Deependra Vikram Singh MD (Major) Arun Baweja MS
Executive Member Executive Member Executive Member Executive Member Executive Member
[email protected] [email protected]
[email protected] [email protected] [email protected]

Sanjay Chaudhary MS Rajendra Khanna DOMS, FRSM Sharad Lakhotia MS Namrata Sharma MD
Ex-Officio Member & DOS Representative to AIOS Ex-Officio Member Ex-Officio Member
DOS Representative to AIOS [email protected] [email protected]
[email protected] [email protected]

4 DOS Times - Vol. 16, No. 10,April, 2011

Editorial

Dear Colleagues and Friends,
Before I say Goodbye,
This is the last issue of DOS Times that I publish as the secretary of this august institution. The annual
conference was a resounding success and my last waltz is now over.
I do however, leave the DOS secretary ship with a feeling of pride and achievement.
It is not easy to better something that is already the best and this is what i tried to do, with the help of
all of you.
Some firsts and some innovations:
• E Posters-introduced for the first time in DOS conference.
• Live Webcasting-of The Midterm Conf, and of Our Skill Transfer courses.
• Joint Session with BJO at the annual conference.
• DOS on Facebook- hundreds of educational videos uploaded-from Conferences and DOST programme.
• Public Awareness Compaigns On Diabetes and Glaucoma in assoc with the DMA and Glaucoma Society.
• DOS Website-total upgradation and user friendly interface with live webcasted videos available for all members.
• Directory of DOS members on CD-now fully searchable and on your desktop.
Friends, it is not just the achievements we made that make me proud. It is the love and encouragement I recieved from each
and everyone of you. During these two years I have made hundreds of new and valuable friends. My live has been enriched,
intellectually and socially and I am definitely going to miss this excitement.
But life goes on and this whole world will keep on turning.
Kal Aur Aayengey Mehfil mein khilti kaliyan chuneney waley;
Mujh sey behtar kehney waley, tum sey behtar suneney waley:
I danced my last waltz, I sang my swan song and now I wish the incoming secretary all the very best and assure my commitment
to this society till my last breath.
Thanking you,

Dr Amit Khosla
Secretary,
Delhi Ophthalmological Society

Editor-in-chief

Amit Khosla MD, DNB

Advisors Rajpal MD DOS Correspondents DOS Office
S.P. Garg MD, MNAMS
H.K. Tewari MD, FAMS, DNB A.K. Singh MS Nidhi Tanwar MD Room No. 2225, 2nd Floor,
Ashok K. Grover MS FRCS J.L. Goyal MD, DNB Gagan Bhatia DOMS New Building, Sir Ganga Ram Hospital,
J.K.S. Parihar MS, DNB Vipul Nayar DOMS, DNB, MNAMS Rajender Nagar, New Delhi - 110 060
Shashi N. Jha MD Daraius Shroff MS Tel.: 91-11-65705229
Sudershan Khokhar MD Ritika Sachdev MS Email: [email protected]
Website: www.dosonline.org

Editorial Board Rohit Saxena MD S.K. Mishra MS Anuj Mehta MS Cover Design by: Amit Chauhan
Hemlata Gupta MS, DNB J.S. Guha MS Deven Tuli MS Published by: Dr. Amit Khosla for
Ruchi Goel MS, DNB, FICS Rajiv Sudan MD Manisha Agarwal MS Prakash Agarwal MD
Sanjeev Gupta MD, DNB Neera Agarwal MS Hardeep Singh MD V. Rajshekhar MS Delhi Ophthalmological Society
Sanjay Khanna MS Poonam Jain MS Kapil Midha MD Jasmita Popli MS Printers: Symmetrix
Y.C. Gupta MS Neeraj Verma MS Deependra Vikram Singh MD Himanshu R. Gupta MS
Sarita Beri MD Vivek Gupta MD, DNB Sanjiv Mohan MS Palak Shah MBBS E-mail: [email protected]
Devindra Sood MS Amit Gupta MD Ajay Kumar Agarwal MS, DNB
Umang Mathur MS
Rajesh Sinha MD, DNB

Glaucoma Medical Management Focus

Dr. Mayuri Khammar Dr. Sunil Jain Dr. Rajat Maheshwari
MS DNB, DO, FLVPEI MS

Paragraph for related Glaucoma Medical Management

Dr. Mayuri Khammar (MK): Head Glaucoma Service, Raghudeep Eye Clinic, Ahmedabad
Dr. Sunil Jain (SJ): DNB, DO, FLVPEI, The Eye Super Specialities & Infiniti Eye Hospital, Mumbai
Dr. Rajat Maheshwari (RM): MS, Fellow LVPEI (Glaucoma), Maheshwari Eye Center, Muzaffarnagar, U.P.

Dr. Devindra Sood (DS): MS, FACS, DO, MS, Glaucoma Imaging Centre, P-13, South Extension Part-II,, Ground Floor,
New Delhi - 110049

DS: Opportunistic glaucoma screening or case detection in etc is acquired and every patient is subjected to these
the clinic? tests.
b) To be a part of the World Glaucoma Week celebrations,
MK: First of Applanation tonometry is always done as a routine glaucoma diagnostic camps are organized
for all our patients. In both these scenarios, the interest to continue screening
is short lived. This is because glaucoma diagnosis, many
Secondly, all the patients of shallow anterior chamber (< 2 a times is confusing in view of many variables associated
mm) are screen with gonioscopy examination. Sometimes with it. Also most glaucoma patients and glaucoma
we use AS-OCT to see the angle configuration in dark suspects eat into a lot of OPD slots and counseling time and
situation to detect PAC. energy. Hence it is better to avoid opportunistic glaucoma
screening. The enthusiasm to celebrate World Glaucoma
It is also done for family history of glaucoma and suspicious Week should be more focused at creating awareness
looking optic nerve head eg. large cup. campaigns rather than diagnostic camps.
RM: I feel that both have their own importance. the idea is
SJ: I think opportunistic glaucoma screening or case not to miss any opportunity we come across for detecting
detection does not exist to a greater extent especially in glaucoma.
a larger perspective. This is so as majority of the general
ophthalmologist do not measure IOP of every patient. DS: How can we improve case detection?
Most measure the IOP only when they find the disc to be MK: Proper history taking, Applanation tonometry, pachymetry,
suspicious on direct ophthalmoscopy.
gonioscopy, stereoscopic optic disc viewing using 90D or
The scenario in which opportunistic screening for glaucoma 78D lens on slit lamp, use of imaging in special situations
is likely to occur is: improves case detection.

a) When a new diagnostic tool such as perimeter, OCT

www.dosonline.org 7

SJ: Case detection of any disease can be improved by following RM: Depends on what type of glaucoma & what profile of patient
a protocol. What is this protocol? This protocol is important i am dealing with. would not generalize my opinion here.
history taking followed by good clinical examination. In sometimes simple YAG iridotomy is all that is required to
medicine this protocol is taught to us right at the beginning take care of the pathology & hence most cost effective ! but
of our student career i.e. when the clinical postings start in yes patient profile has to be considered before prescribing
undergraduate days. life long expensive medical therapy to them.

However once we step into clinical practice, following this DS: How early case detection helps maintains QOL for our
protocol is what we forget. This results in failure of early glaucoma patients?
case detection.
MK: Appropriate treatment gives better control and delays
In a general OPD, glaucoma case detection can be improved progression maintains good QoL.
by ‘sticking to the basics’ i.e. history taking keeping the
common risk factors in mind such as family history, history Lesser drugs are needed in early disease improves
of trauma, use of steroids etc. Following the history measure compliance and QoL.
the IOP, examine every tissue of the eye from lids to retina
and optic nerve in every patient and perform gonioscopy SJ: Early case detection helps in early awareness on
if any doubt. part of the patient and early treatment on part of the
treating ophthalmologist. Earlier the diagnosis, lesser the
RM: Every patient seen in the clinic needs to undergo screening medications needed, better is the compliance. Also early
for glaucoma. whether the patient has come for simple treatment prevents progression of field damage and hence
change of glasses or just watering & itching in eyes. maintains the QOL.

DS: Providing cost effective treatment in India : medical/ RM: Putting the patient on multiple IOP lowering drugs &
laser/surgical treatment? increasing field loss, both affect the QOL of patients in a
big way. early case detection helps the patient by taking
MK: Before one decade for India surgical treatment was care of both the issues.
considered cost effective. But for POAG, today with
availability of many cheaper drugs with once daily dose DS: Is Goldmann applanation tonometry (GAT) still the gold
and lesser side effects has improved the compliance of standard for measuring the IOP?
patients and medical treatment is cost effective for POAG.
For PACG the laser PI is still a first choice of the treatment. MK: Yes.
SJ: Yes very much. It is the slit-lamp mounted GAT, which is
SJ: I think the initial modality of treatment in glaucoma is
medical. Laser iridotomy becomes the immediate modality the gold standard and not the hand held Perkins tonometer.
of treatment in angle closure glaucoma. RM: With better understanding of corneal bio-mechanics &

• Medical: In providing cost effective medical treatment, introduction of newer tonometers like Dynamic Contour
one can consider starting with time tested molecules Tonometer (DCT) & Ocular Response Analyzer (ORA),
such as beta blockers, pilocarpine or even generic there is a big question mark on the accuracy of current gold
prostaglandins. However my choice would be based standard GAT. For most of the patients, yes GAT is still the
on the initial IOP, disc and field damage and hence gold standard. Newer tonometers have to withstand the test
the target IOP. Also one has to evaluate the efficacy of times & prove their worth before they can replace GAT
and any contraindications of a particular molecule as the gold standard.
in a particular patient. In providing an effective
treatment, I would not like a tradeoff between cost DS: Should medical treatment come before surgery?
and compliance i.e. cheaper drop but more number MK: Yes for POAG, laser iridectomy first for PACS, PAC &
of instillations.
PACG.
• Laser: In treatment of angle closure glaucoma, SJ: Yes very much. Because at times the post-operative course
laser iridotomy is one of the most cost effective
treatments. The same cannot be said for selective laser in glaucoma surgery can be very unpredictable in the best
trabeculoplasty in treatment of open angle glaucoma. of hands. Also if the surgery fails i.e. IOP rises, one has to
restart medical treatment to control IOP. And the success
• Surgery: Among the different anti-glaucoma surgeries, rate reduces with every subsequent surgery.
trabeculectomy is probably the most cost effective RM: Yes, medical therapy comes before surgical treatment for
surgery. However this should not be the criteria almost all of my patients.
in advising trabeculectomy as the first modality of
treatment in glaucoma management. This is because DS: Solving compliance related issues amongst Indian
of the short and long term risks and complications patients:?
involved with trabeculectomy.
MK: - Surgery
- Select drugs with lesser frequency dosing,no side effects
- good councelling regarding the disease.

8 DOS Times - Vol. 16, No. 10,April, 2011

SJ: The compliance of any patient improves when he or she fear-psychosis about going blind enhances the faith in the
understands the disease, its course, the treatment options treating ophthalmologist.
and the need of a regular follow-up visit. All this has to
be done on the first visit, by the treating ophthalmologist RM: Good & proper counseling is most important. once the
and re-emphasised on follow-up. The unfortunate thing importance of therapy & 24 hour IOP control is impressed
about this counseling is the amount of time required on upon the patient, most of the patients stick to it. another
part of the ophthalmologist especially in a busy OPD. But very important thing is to ask the patient about their routine
this according to me the sure shot solution for improving & discuss with them the timing of instillation of the drops.
compliance. If a doctor is not serious about a chronic This way they realize the importance & ultimately improves
disease, nor will the patient be. In addition reducing the their compliance with therapy.

DOS Correspondent
Devindra Sood MS, FACS

www.dosonline.org 9

Outgoing Presidential Address - 2011

Good Evening, Ladies and Gentlemen.
Last year when I took over the responsibility of this job, I paused to reflect on my role as
the head of the DOS family. My training period as the vice president was a little difficult
and thus this important question caused some distress in my mind. After deliberation
from many quarters, I concluded that it was most important for DOS to function smoothly
and honestly.
Frankly, I never though of making any drastic or dramatic changes in the fabric of the
society. Already, its performance is rated high in all aspects; therefore the credibility factor
was the only major point in my mind. And, I am pleased to say that we have been able to
enhance the society’s credibility over the last one year.
The preceding year saw two major events that were a little different. Three full-day skills
transfer workshops took place in RP Centre and Guru Nanak Eye Centre. About 90-100 ophthalmologists participated
in each one of them. These workshops covered more of the practical aspects of various subjects.
You all are aware of the rising menace of Diabetes and its implications on the eye. A Diabetic retinopathy screening
programme was conducted in the Union Territory of Delhi. In 30 clinics of General Practitioners and Physicians,
our DOS members conducted the screening programme on a Sunday and guided the future treatments of these
patients. These types of programmes do produce an awareness of the disease in the GPS, Physicians and the patients.
Such events need to be continued so as to contain the disastrous effects of Diabetes.
A Glaucoma detection programme was also conducted in the DMA house by DOS members. A large number of
new patients of Glaucoma were diagnosed and their treatment instituted.
Our Executive consisted of the best of talents; their inputs and efforts are commendable. Our secretary, Dr Amit
Khosla, treasurer Dr Ruchi Goel and editor Dr Rohit Saxena made a very comprehensive team. All deserve a strong
pat on their backs.
Professor BP Guliani, the incoming president, is a far sighted person with wisdom and knowledge. I personally
feel that the society is bound to progress and perform better under his guidance. I wish him and his entire team
lots of luck.
Ladies and Gentlemen, finally to each one of you, all I would like to say is a big whole-hearted thank you!

Dr. Prem Vijay Chadha
President DOS (2010- 2011)

www.dosonline.org 13

Incoming Presidential Address -2011 15

Dr. P.V. Chadha outdoing President, Dr. Amit Khosla secretary, Dr. Ruchi Treasure, Respected
seniors and dear friends I am a common ophthalmologist having a tremendous zeal to work
for growth and development of this 3000 strong ophthalmic community known for its integrity,
strength and academic excellence. It is popular all over the world. I am proud to get an opportunity
to head this society for which I am thankful to all of you. I must specially thank Prof. K.P.S.
Malik my mentor. Prof. V.S. Gupta my guide, my parents, my wife and children, my departmental
colleagues and residents.
I joined this society in 1989 as life member when my co senior resident Dr. Arun Sangal who
was secretary of this society asked me to become member of DOS. I have held various executive
posts for more than a decade I got a chance to work under the leadership of Late Dr. Patnaik,
Dr. R.V. Azad, Dr. M.P.S. Sachdev, Dr. A K Grover, Dr. N. Shroff, Dr. S. Bharti, Dr. Lalit Verma,
Dr. Lakhotia, Dr. P.V. Chadha.
Many of my young friends need to know that this society started with humble beginning of half a day of annual conference
has grown to a three day annual conference by day and night efforts of these ophthalmic stalwarts. I salute all those hard
working and academically excellent ophthalmologists who made this possible. My main contribution to the society is my
involvement for obtaining registration as charitable society meaning thereby that the society does not pay any income tax on
its income. This exemption was allowed to the society during my tenure as treasure in year 1999.
What is good about this society?
• Unity in diversity of various streams of ophthalmologists i.e practitioners, teachers and residents
• Rich academic feast throughout the year in the form of DOST, Monthly clinical meetings and two conferences
• Healthy industrial support
• Various social events like picnic and cultural programmes
• All out involvement in strengthening of various community programs involved in alleviating the menace of blindness
like DM and glaucoma
I assure all of you that I will put all my efforts for smooth conduct all such activities.
My vision:
• Motivating all teaching institutions to actively participate in monthly clinical meetings. This is required for strengthening
the roots of society.
• Development of infrastructure for the society something like AIOS house
• the issue of recognition of day care centers,
• Issue of low remuneration by TPAs
I resolve to solve these issues.
What is expected from you?
I need your valuable suggestions for
• Proper utilization of corpus amount
• Improving utilization of library facility
• Quality articles for Delhi journal of Ophthalmology
• Suggestions for constitution of scientific committee
Change is way of life. Exercise for change in constitution has already begun. Feel free for sending your suggestions for any
change to [email protected] or even directly to me at [email protected].
Thank you.

Dr. B P Guliani
Incoming President, DOS

www.dosonline.org

Congratulations

Following members have been elected as Office bearers and executive Members of the
Delhi Ophthalmological Society for the year 2011-2012 & 2013.

President Executive MemberS
Dr. B.P. Guliani
Dr. Amit Gupta
Vice President Dr. Hardeep Singh
Dr. Harbansh Lal
Dr. M. Vanathi
Secretary Dr. Prem Tanwar
Dr. Rohit Saxena Dr. R.K. Bhandari
Dr. Umesh Bareja
Joint Secretary Dr. Vinay Kumar Garodia
Dr. Ajay Aurora Dr. Vipul Nayar

Treasurer
Dr. Ashu Agarwal

Editor
Dr. Rajesh Sinha

Library Officer
Dr. Subhash C. Dadeya

Outgoing President Address for 2009-2010

Respected Senior Colleagues & Dear Friends.
I would like to thank all the DOS members for help extended in carrying out vibrant DOS activities
throughout the year. I’m thankful to Secretary, Jt Secretary, Treasurer, Library Officer and Editor for being
very hardworking & progressive. I’d also like to place on record commandable work done by the entire
executive for smooth running of the entire tenure.
Dos attained new heights and its credibility was all time high as evidenced by record participation during
Annual Conference. Bye Bye & best wishes to all of you.

Dr. Sharad Lakhotia
Past President DOS

16 DOS Times - Vol. 16, No. 10,April, 2011

Outgoing Secretary Report - 2011 17

Dear Friends and Colleagues,
Honorable President Dr. P.V. Chadha, Incoming President Dr. B.P. Guliani, respected Senior
Members of the society and my dear friends. I on behalf of the executive welcome you all to this
General Body Meeting of Delhi Ophthalmological Society 2011.
I begin by expressing my heartfelt thanks to all of you for your kind support and constant
encouragement throughout year. Looking back, we can take some pride in a few achievements
and innovations.
The DOS membership continues to grow. This year we have had a record increase in our
membership. 541 New members were added (out of which 28 are from Delhi) and today we have
6103 members from all over India and abroad.

DOS Times is as popular as ever and we made sure to publish all the issues, sorted out the distribution issues and made it
available online on our website.
The DOST Programme was given a new shot in the arm by arranging a full day DOST live surgery workshop on all topics except
Lasik and Phaco at Army Hospital (R&R) on 26th November, 2010, which included Vitreous, Glaucoma, Squint, Cornea and
Oculoplasty surgery. This was webcast live.
The Mid Term Conference was organized on 27th to 28th November, 2010. The theme of the conference was Techniques and
Innovations. A live surgery workshop was organized on 27th November from Sir Ganga Ram Hospital, Medfort Sharp Sight
Centre, Centre for Sight & Shroff Eye Centre. It was sponsored by M/s. Appasamy Associates, M/s. Intra Ocular Care (IOC)
M/s. AMO, M/s Zeiss and M/s Bausch & Lomb. The Mid term Conference was extremely successful with more attendance than
ever. The conference was attended by 1136 members and the academic content was well appreciated.
Several novel introductions made the conference more lively and contemporary; Viz:
Free Paper Session_ a first time for the midterm DOS Conference
E-Posters- introduced for the first time.
SMS Quiz-again a novel concept which was well appreciated.
Live Webcasting of the Midterm Conference
Cultural programme
Nine monthly clinical meetings were held which were well attended and were of high quality academic content. They were all
recorded and vidoes group on facebook.- DOS online.
DOS Teaching programme was held at Army Hospital (R&R) on 8th & 9th January, 2011. 180 students attended the meeting.
Lecture and Case Presentation and OSCE formed the salient features of this programme. The programme was webcast live.
The DOS library has an online journal facility which was well – utilized by the members. We had OVID access to 18 journals,
we have updated the website so the members can directly request for full text articles which are sent by email.
Delhi Journal Ophthalmology (DJO): The DJO has maintained high scientific quality and has been published regularly. After
a long gap of more than 10 years all the issues of DJO have been published.
The DOS travel fellowship have been increased to 3 per year from 2 per year. The international travel fellowship amount has
been increased from Rs. 25,000 to Rs. 30,000/- and national fellowship increased from Rs. 5000 to Rs. 10, 000/-.
3 Skill transfer programmes were organized Squint Skill Transfer Programme, at R.P. Centre, Oculoplasty Skill Transfer
Programme, at Guru Nanak Eye Centre & Glaucoma Skill Transfer Programme at R.P. Centre held for post graduates and the
comprehensive ophthalmologist which were attended by about 300 doctors.
The Website of DOS has been thoroughly upgraded and made user friendly. Live Webcasting: Skill transfer workshop on squint,
Oculoplasty, Glaucoma. Midterm Conference DOS Teaching programme and DOST live surgery workshop were webcast live-
for the first time ever. Even those who could’nt attend are now able to participate and benefit. All the webcasted videos are
available to the DOS members to see and to learn. The DOS live surgery was seen by 242 visitors DOS Midterm conference 1st
day by 296 and 2nd day by 211.

www.dosonline.org

DOS on Facebook: This was a great effort on the part of the DOS office and entailed a lot of hard work. We have uploaded
hundreds of educational videos from the conferences, DOST and monthly meetings and we continue to do so. A wealth of
info is available to anyone who joins the group.
We have increasing used the medium of SMS, Email & Facebook to keep the members informed of the activities of the society.
Public Awareness Campaigns: A unique concept and a bold initiative on the part of DOS to involve other assoc in the Public
Awareness and Screening camps on Diabetes, Glaucoma etc. The Delhi Medical Assoc, Glaucoma Society of India and the
Indian Optometric Association were involved and jointly we organized this drive for the general public.
Free Diabetic Retinopathy screening programme were held at 22 centres in association with DMA. Posters for Diabetic
Retinopathy were distributed to all DMA members.
Free Glaucoma Screening Camp for the Doctors of Delhi at DMA hall during the glaucoma week where all the investigative
facilities were made available marked the high point of our interaction with other organizations. Many DOS members organized
free glaucoma screening camps in their clinics.
Phaco fellowship Training- Keeping in mind that a large numbers of members do not have access to modern technology and
training, we have started a phaco training followship at Venu Eye Institute and out of 8 seats available at present, 4 have been
reserved for Delhi DOS members and 4 for Non-Delhi, DOS members. We thank M/s. Zeiss for supporting this programme.
The allotment is on DCRS rating and attendance of mid-term and Annual Conference.
The Annual conference was held from 15th to 17th April, 2011. It was attended by more than 3000 delegates. The theme of
the conference was “Trends in Ophthalmology” giving exposure to delegates for contemporary topics and latest cutting edge
technology available. Live surgery was held on 15th April from Venu Eye Institute, Shroff Eye Centre, Centre For Sight and
Chaudhary Eye Centre. It was sponsored by M/s. Appasamy, M/s. AMO, M/s. Carl Zeiss, M/s. Staar Surgicals, M/s. Bausch &
Lomb & M/s. Alcon. The scientific session was spread out across 8 halls with a total of 63 sessions with more than 400 faculty
including foreign faculty. Many Instruction courses were held. The total number of scientific presentations were 219 which
includes 18 video presentation and 68 poster presentation.
Land Marks at the Annual Conference
Dr. Om Parkash Oration has been started for the first time, Prof. Michael Knorz from Germany who is an international Pioneer
in Lasik gave the first oration on femtosecond cataract surgery.
Dr. S.N. Mitter Oration was given Dr. Lalit Verma and Dr. P.K. Jain Oration was given Dr. K.P.S. Malik.
Joint Session with BJO- A new concept has been introduced at the annual conference and the session on “How to Publish”
was successful with the chief editor of the BJO himself participating.
In short Highly Successful annual conference with the maximum attendance ever and a superlative cultural programme are
other points worth mentioning.
The trade exhibition was well attended in the front lawns of the Ashok Hotel.
We have distributed a DVD with a DOS Directory, with a good Search facility. The DVD also contains surgical consent forms
in English & Hindi and last 5 years tear sheets.
For the first time we have recorded the proceeding of the Annual Conference and these will put on the website.
The AIOS is planning to hold the AIOS annual conference (2013) in New Delhi along with the APAO conference.
Dear Friends,
I know I walk in the footsteps of giants, my predecessors have worked hard and tirelessly to make this organization an
international force and it is only be fitting that I put in my utmost hard work and which I did. I feel privileged to be the
secretary of this greatest of all societies and today I feel highly emotional and proud. I wish all the best with full force at my
command for the incoming executive.

Dr. Amit Khosla
Secretary, DOS (2009-2011)

18 DOS Times - Vol. 16, No. 10,April, 2011

ANNUAL CONFERENCE

15th - 17th April 2011, Hotel Ashok, New Delhi

DELHI OPHTHALMOLOGICAL SOCIETY Live Surgery

OPHT HALMOLOGICAL

DOS Delhi Ophthalmological Society
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DELHI OPHTHALMOLOGICAL SOCIETY Cultural Evening

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DELHI OPHTHALMOLOGICAL SOCIETY Cultural Evening

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DELHI OPHTHALMOLOGICAL SOCIETY Oration

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DELHI OPHTHALMOLOGICAL SOCIETY Major Sponsors

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DELHI OPHTHALMOLOGICAL SOCIETY Major Sponsors

ANNUAL CONFERENCE

15th - 17th April 2011, Hotel Ashok, New Delhi

DELHI OPHTHALMOLOGICAL SOCIETY Major Sponsors

Life Time Achievement Award

1. Dr. R.B. Jain 2. Dr. L.D. Sota
Life Time Achievement Award
Life Time Achievement Award

Various Trophies - 2011

Dr. Sudhank Bharti

Dr. Krishna Sohan Singh Trophy

for Best Clinical Talk in Monthly Clinical Meeting

Dr. Neha Rathi

Dr. H.S. Trehan Trophy

for Best Case Presentation in Monthly Meeting

Guru Nanak Eye Centre

Dr. Bodh Raj Sabharwal Trophy

Institution for Holding Best Monthly Clinical Meeting

Dr. Neha Goel

Dr. A.C. Agarwal Trophy

for Best Free Paper Presentation Session - 1

Dr. M. Vanathi

Dr. T.P. Agarwal Trophy

for Best Free Paper Presentation Session (Cornea-2)

Dr. Anoop Kishore Gupta & Dr. Mohit Jain (RPC)

Dr. V.K. Kalra Memorial Trophy

Trophy for Quiz Winners

Sir Ganga Ram Hospital

Dr. Minoo Shroff Trophy
for Most Popular Monthly Clinical Meeting

Certificates of Merit

1. Dr. Supita Ghosh 4. Dr. Shivcharan L. Chandravanshi
for Best Free Paper Cornea Session – 3
for Best Free Paper Oculoplasty Session – 6

2. Dr. Nandini Chandak 5. Dr. Neha Mohan

for Best Free Paper Glaucoma Session – 4 for Best Free Paper Cataract Session – 7

3. Dr. Neha Goel 6. Dr. Subhender Kumar Boral
for Best Free Paper Retina Session – 5 (A) and (B)
for Best Video Presentation

7. Dr. Parul Jain

for Best E-Poster Presentation

48 DOS Times - Vol. 16, No. 10,April, 2011

Dr. P.K. Jain & Dr. S.N. Mitter Oration - 2011

1. Dr. K.P.S. Malik 2. Dr. Lalit Verma
Dr. P.K. Jain Oration
Dr. S.N. Mitter Oration

Dr. Om Prakash Oration 2011

Prof. Dr. Michael C. Knorz
Dr. Om Prakash Oration

Dr. R.N. Sabharwal Gold Medals

for 100% Attendance of Monthly Clinical Meetings

1. Dr. N.K. Pattnaik 2. Dr. Prabin Basumatary
3. Dr. Rajendra Prasad 4. Dr. Sucheta Tripathy
5. Dr. Vinod Kumar

Distinguished Resource Teachers of the Society

For achieving more than 200 DCRS Credits

1. Dr. Amit Khosla 2. Dr. Neha Goel 3. Dr. Vinod Kumar

List of Members Achieving more than 100 DCRS Credits

1. Dr. Dinesh Kalra 13. Dr. Rajendra Khanna 25. Dr. Anita Panda
2. Dr. Namrata Sharma 14. Dr. S. Bharti 26. Dr. Rajesh Kumar Chhoker
3. Dr. Sanjit Kumar Saha 15. Dr. Ashok Kumar Dubey 27. Dr. Parveen Kumar Mongre
4. Dr. Satish Kumar Mehta 16. Dr. Ashok Kumar Grover 28. Dr. (Major) Arun Baweja
5. Dr. Amit Raj 17. Dr. B. Ghosh 29. Dr. Alkesh Chaudhary
6. Dr. (Col.)J.K.S. Parihar 18. Dr. Om Prakash 30. Dr. S.C. Lakhotia
7. Dr. Harbansh Lal 19. Dr. Rajesh Sinha 31. Dr. Sucheta Tripathy
8. Dr. K.P.S. Malik 20. Dr. Raj Anand 32. Dr. Prabin Basumatary
9. Dr. Subhash C. Dadeya 21. Dr. Rohit Saxena 33. Dr. Ruchi Goel
10. Dr. Umesh Bareja 22. Dr. P.V. Chadha 34. Dr. Deven Tuli
11. Dr. V. Jaya Prakash 23. Dr. Rishi Mohan Bhatnagar 35. Dr. N.K. Pattnaik
12. Dr. Mahipal S. Sachdev 24. Dr. Suresh Kumar Verma 36. Dr. Rajendra Prasad

www.dosonline.org 49

Application Invited from Institutions for Holding the DOS Monthly Clinical Meetings

As per the DCRS ratings two institutions will be dropped from the monthly calender of 2011-2012. We request all the institutions/hospitals interested in holding
the DOS monthly meeting to kindly see if they fulfill the criteria given below. They may apply to the Secretary’s Office with details latest by 15th June, 2011.
No meeting is held in May and June. Meetings are usually held on the last Saturday or Sunday of the month.

Criteria for selection of a place:
(a) Seating capacity of 100-200 persons, preferably AC mini auditorium / hall definitely within the premises of the institutions.
(b) Audio Visual facilities to be available
– moving mike 1 set – multimedia projector 1 set – double slide projectors 1 set
(c) Institute should send the details of the meetings/CME etc., held at that institute in past 1 years to the DOS office.
(d) A sizeable staff in Ophthalmology who would be able to conduct the meeting themselves without any major outside participation as speakers/presenters.
– Before the submission of application for holding the DOS clinical meeting, all the above mentioned criteria should be met.
– These may be verified by President and Secretary.

Secretary, DOS

Proceeding Protocol for Monthly Clinical Meetings

1. The Host (usually the ophthalmic chief of the Hosting Institution) will welcome the DOS and request the President and Secretary of the
DOS to come to the Dais and start the Meeting.

2. The President and the Secretary will take up their seats on the side of the Dais, which is opposite to the Lectern. (They would continue
to be in the same position through out the Meeting, including the Mini Symposium.) The Chairman of the Symposium will be invited
to a Third seat next to the President on the same table, after the ‘Clinical Talk’. The Speakers, who if they form a Panel would be seated
on the same side as the Lectern.

3. The President will declare the Meeting open.
4. The President and the Secretary will then conduct the meeting.
5. The case presentations (2 in no.) will form the first part of the clinical meeting. Each presenter will be allotted 10 min. time for his/her

presentation. This will be followed by discussion with the audience on both the cases (Total time allotted is 15 min.). The case presentation
will be followed by a Clinical Talk of 15 min. duration. This will be followed by discussion with the audience on the topic for 10 min.
6. After the first part of the meeting is over, the President will introduce the subject of the Mini Symposium (which will be of 1 hour
duration) and invite the Chairperson of the Symposium to the Dais to conduct the Symposium. All the speakers may be invited to
assume their seats on the Dais at this time or one by one after they have presented their Talks (at the discretion of the chair person of
the symposium).
7. After the Symposium is over, the President will thank the Speakers and the Chair person and request Secretary to make any Announcements,
including the Prizes etc.
8. By the time, the Clinical Meeting is to be declared closed by the President, the Host or his representative would be at the Lectern to
(take the floor immediately after the Meeting is closed) thank people, firms who had helped him in hosting the Meeting and invite the
Members of the DOS for Refreshments.
9. Venue : The monthly clinical meeting will definitely be held in the premises of the allotted institution.
10. Day : The meeting shall be held on the last Saturday / Sunday of the month, whichever the institution deems feasible.
11. Presenter : The presenting faculty / resident / fellows should be from the same institute for clinical case presentations and the clinical
talk.
12. One person will be allowed only one-presentation for the award-wining session in the same academic year.
13. Exchange of dates : In case two institutions want to exchange the date of the meeting, it can be done with mutual agreement by the
heads of the department and with information to the secretary’s office, well in advance.
14. Mini Symposium : It shall be organized by the institution but other DOS members can be invited to participate, if required. There should
not be more than 3 speakers in the mini symposium.
15. To qualify for the retention in the monthly meeting calendar, a minimum attendance of 70 members is required (inclusive of the members
of the host institute).
16. For the Best Clinical Meeting award i.e. Bodhraj Sabharwal Trophy, the overall assessment of the meeting will be made purely on the
overall marks by outside delegates and for Dr. Minoo Shroff Trophy the award will be given to the most popular meeting (based on total
attendance including outside and inside delegates as per the attendance register).
17. The attendance will be marked in the register which will be at a separate counter and will be managed by the DOS Staff. At the close of
the clinical meeting, the attendance register will be signed by the Secretary and the President on the same day.
18. Meetings in the month of May and June may be opened from the next year if there are applications for the same.
19. No alcoholic drinks will be served during or after the meeting; only refreshments / snacks/ lunch will be served.

50 DOS Times - Vol. 16, No. 10,April, 2011

DOS New Members List

A-4310 DR. ANJALI A. B-4594 DR. ASHISH BANSAL D-4301 DR. BANSRI HARSHAD DAWDA
R-4343 DR. ARYA A.R.
T-4463 DR. MANOJ A.T. B-4505 DR. MANU BANSAL D-4571 DR. ARINDAM DEB
A-4195 DR. TANUJA ABHILASH
A-4296 DR. JAGMOHAN PRASAD AGARWAL B-4264 DR. SONAWANE ASHWINI BARKU D-4200 DR. NEHA K. DESAI
A-4367 DR. MANOJ AGARWAL
A-4455 DR. VISHNU KUMAR AGARWAL B-4429 DR. NABANITA BARUA D-4268 DR. MAMTA SHANTHNU DESHPANDE
A-4495 DR. SHRI KANT AGARWAL
A-4568 DR. SAMARTH AGARWAL B-4538 DR. SUNIL BATRA D-4406 DR. SMITA BHARAT DESHRAJ
A-4570 DR. ARTI ELHENCE AGARWAL
A-4579 DR. PRERANA AGARWAL B-4119 DR. ABHISHEK C. BAWDEKAR D-4140 DR. SABITA DEVI
A-4257 DR. MUKESH AGGARWAL
A-4350 DR. PARUL AGGARWAL B-4137 DR. MADHUSMITA BEHERA D-4282 DR. KUNWAR VIKRAM SINGH DHALIWAL
AD-1477 DR. SHIKHA AGGARWAL
A-4484 DR. NAMITA AGGARWAL B-4144 DR. FATHIMA BENAZIR D-4448 DR. VRUSHALI DILIP DHAMALE
A-4131 DR. PRASHANT SOMES AGNIHOTRI
A-4221 DR. ANUGYA AGRAWAL B-4516 DR. VIMLA BENIWAL D-4300 DR. MRS. SUPRIYA DHAR
A-4432 DR. RAJ KUMAR AGRAWAL
A-4554 DR. SURABH JWALAPRASAD AGRAWAL B-4519 DR. SUMANTA KUMAR BERA D-4430 DR. JASDEEP SINGH DHESI
A-4569 DR. SANTOSH AGRAWAL
A-4193 DR. FAREED AHMAD B-4277 DR. RENU BERI D-4117 DR. VIVEK DHILLON
A-4368 DR. SOFIA AHMAD
A-4402 DR. VAZEEM AHMAD B-4229 DR. SHARADA BHAGAWAT D-4112 DR. BHAG SINGH DHIMAN
A-4509 DR. FURQUAN AHMAD
AD-1470 DR. ISHITA ANAND B-4587 DR. SHYAM BHARGAVA D-4302 DR. PARIKSHIT DHIR
A-4433 DR. ATUL ANAND
A-4468 DR. ABHISHEK ANAND B-4466 DR. GAURAV BHATI V-4265 DR. MAYUR KUMAR DILIPSINGH VAGHELA
A-4405 DR. AMRITA ANEJA
T-4425 DR. TIWARI ANJANA BD-1482 DR. HARSIMRAN KAUR BHATIA D-4313 DR. BRAHMBHATT DIVYANG
A-4483 DR. ANKITA
A-4502 DR. BENAZIR ANSARI B-4254 DR. GATI MARKANDBHAI BHATT D-4428 DR. WANGCHUK DOMA
A-4412 DR. ANSHUMAN
A-4408 DR. KAMSON ANTHONY B-4361 DR. DEBANSHU BHATTACHARYA D-4165 DR. UDBHAV DORWAL
A-4242 DR. ATIF ANWAR
A-4120 DR. S.D. ARAIYER B-4122 DR. ANUBHA BHATTI D-4497 DR. ASHISH KUMAR DUTTA
A-4218 DR. AMAN SUMEET ARORA
A-4369 DR. MEGHANA R. ARORA B-4299 DR. DHARMESH PRAVIN CHANDRABHUPTANI D-4314 DR. DAISY DWIVEDI
A-4385 DR. PRIYANKA ARORA
A-4403 DR. PRIYANKA ARORA B-4225 DR. KARMA LODAY BHUTIA E-4451 DR. DUKALE SAGAR EKNATH
A-4416 DR. DIVYA JYOTI ARORA
A-4443 DR. VISHAL ARORA B-4280 DR. TWINKEY BHUTIA E-4472 DR. EKTA
A-4590 DR. GAGANDEEP ARORA
A-4558 DR. NOWSHEEN ABDULIAH ATTAR B-4435 DR. ANKITA BISANI F-4556 DR. SHEIKH MOHO FAROOQ
B-4238 DR. NAVEEN B.
B-4283 DR. JAYA SHREE B. B-4549 DR. GOVIND BALLABH BISHT FD-1488 DR. JAVED HUSSAIN FAROOQUI
B-4255 DR. PANMAND PRATIBHA BABAN
B-4400 DR. AADITYA BAJAJ B-4184 DR. SHEKHAR PRASAD BISWAS G-4173 DR. VAIJAYANTI PRASANNA GADRE
B-4480 DR. PRACHI N. BAKARE
BD-1478 DR. UANDANA BALACHANDRAN B-4488 DR. MRINAL MODHUR BORGOHAIN G-4187 DR. VIVEK GAGNEJA
B-4513 DR. POOJA BANDIVADEKAR
B-4138 DR. KARISHMA P. BANDIVDEKAR B-4426 DR. SANJIB BURAGOHAIN G-4234 DR. UDAY RANCHHODDAS GAJIWALA
B-4181 DR. CHITRABHANU BANDYOPADHYAY
B-4212 DR. ADITYA BANSAL BD-1469 DR. SHALINI BUTOLA G-4427 DR. HEGDE DEEPA GANAPATI
B-4334 DR. REENA BANSAL
BD-1475 DR. SMRITI BANSAL A-4398 DR. ANTONY C.L. G-4322 DR. DEEPTI GANAPULE
B-4422 DR. PREETI BANSAL
BD-1479 DR. MAYANK BANSAL P-4139 DR. SHARMILA C.P. G-4237 DR. MOIZA TABIR GANI
B-4504 DR. NISHAT BANSAL
L-4607 DR. MADHAVI CATHA G-4445 DR. GURPREET SINGH GARCHA

C-4199 DR. AMAR KANTI CHAKMA G-4373 DR. RAJNEESH GARG

C-4353 DR. PRAGYAN CHAKRABORTY G-4377 DR. RAHUL GARG

C-4652 DR. RISHAB CHAND G-4521 DR. PAYAL GARG

C-4274 DR. VINIT CHANDAK G-4419 DR. HARSHAVARDHAN G. GHORPADE

C-4493 DR. NANDINI CHANDAK G-4365 DR. KAJAL PRASAD GHOSH

C-4149 DR. B.S. ANIL CHANDRA G-4189 DR. VIPUL GOEL

M-4591 DR. BISEN PRIYANKA CHANDRAMOHAN D-4473 DR. VAISHALI GOKHALE NEE DESHMUKH

C-4344 DR. NEHA CHATURVEDI R-4550 DR. GANISETTI GOPALA RAO

C-4160 DR. MANISHA PRANAV CHAUDHARY G-4258 DR. PREETI GOYAL

C-4323 DR. KANAN NANUBHAI CHAUDHARY GD-1463 DR. ISHA GULATI

C-4391 DR. KULBHUSHAN PRAKASH CHAUDHARY G-4330 DR. PARMOD GULERIA

C-4565 DR. BRAJESH CHANDRA CHAUDHARY G-4147 DR. DIVYA GUPTA

C-4182 DR. JAYASHREE CHAUDHURI G-4203 DR. NAMRATA RAJIVKUMAR GUPTA

C-4295 DR. DEBARPITA CHAUDHURY G-4232 DR. ARUNIMA GUPTA

CD-1465 DR. NEHA CHAWLA G-4249 DR. PINAKI SEN GUPTA

C-4518 DR. RUPALI CHOPRA G-4279 DR. SHWETA GUPTA

C-4414 DR. VINEET CHOUDHARY G-4292 DR. SANDEEP GUPTA

C-4602 DR. HIMADRI CHOUDHURY G-4307 DR. PRABHA GUPTA

C-4152 DR. RACHNA CHOURASIA GD-1474 DR. SHUCHI GUPTA

C-4520 DR. RAVINDRA KUMAR CHOWDHURY G-4363 DR. DEEPSHIKHA GUPTA

D-4116 DR. RUCHI DABAS G-4371 DR. NAVDEEP GUPTA

D-4186 DR. SONAL DANGDA G-4389 DR. VINAY GUPTA

D-4557 DR. MOHAMMAD AHSAN DAR G-4475 DR. REENA GUPTA

D-4561 DR. MOHAMAD AYOUB DAR G-4485 DR. PAYAL GUPTA

D-4394 DR. TAPAS DAS GD-1483 DR. SHYAM KUMAR GUPTA

S-4104 DR. KAILASH DAVE G-4506 DR. AMISHA GUPTA

DD-1467 DR. ABHISHEK DAVE GD-1485 DR. POOJA GUPTA

D-4512 DR. MANISH DAVE G-4517 DR. RAJEEV GUPTA

www.dosonline.org 51

DOS New Members List

G-4567 DR. VIBHOR KUMAR GUPTA W-4560 DR. EJAZ AKBAR KIANI M-4439 DR. KAMLESH KUMAR MAYWAD
G-4585 DR. HIMANSHU RAVI GUPTA K-4179 DR. ZAINULIDDIN AHMAD KIDWAI M-4370 DR. RAVINDRA KUMAR MEENA
G-4275 DR. MAUSAM GUTPA K-4563 DR. RAJITHA KONDAM M-4543 DR. MEENAKSHI
H-4128 DR. SUHAS HALDIPURKAR K-4267 DR. LEENA SANTHOSH KONDE M-4359 DR. NAMRATA MEHRA
P-4529 DR. PAREKH MUKUL HARKISHOR K-4510 DR. JACOB KOSHY M-4537 DR. JUNI MENON
H-4464 DR. SMITA WASUDEORAO HARNE K-4379 DR. ANITA ARORA KOUL M-4609 DR. SONALI AJAY MHETRE
HD-1473 DR. RAZI HASSAN K-4124 DR. KUMAR KRISHNA M-4105 DR. REWTI SHARAN MISHRA
H-4583 DR. SHEERAZ HASSAN K-4610 DR. VARHA NITIN KULKARNI M-4141 DR. SUCHI SMITA MISHRA
H-4333 DR. AARTI SUBHASH HEDA K-4121 DR. RAJIV KUMAR MD-1480 DR. SHAILY MISHRA
K-4297 DR. POURNAMI I.K. K-4127 DR. ANIL KUMAR M-4454 DR. ANURAG MISHRA
I-4577 DR. JASIYA ISHTIAQ K-4151 DR. ARVIND KUMAR M-4462 DR. SANTOSH KUMAR MISHRA
I-4490 DR. RAFI UL ISLAM KD-1462 DR. VISHAL KUMAR M-4226 DR. CHANDANA MISRA
J-4153 DR. SWETHA JADAPALLI K-4176 DR. AMARENDRA KUMAR M-4305 DR. SOMEN MISRA
J-4233 DR. VIJAYKUMAR NARAYAN JADHAV K-4180 DR. SANJEEV KUMAR M-4388 DR. SHAILI MISRA
J-4312 DR. RANA JAGDISH K-4208 DR. PRADEEP KUMAR M-4205 DR. APOORVA MITTAL
J-4108 DR. NEHA JAIN K-4241 DR. ASHOK KUMAR M-4207 DR. SAURABH MITTAL
J-4174 DR. RUPA JAIN K-4260 DR. P. ARUN KUMAR M-4276 DR. RUCHI MITTAL
J-4251 DR. PARUL JAIN K-4270 DR. ARVIND KUMAR M-4407 DR. DEEPAK MITTAL
J-4486 DR. SANDEEP JAIN K-4294 DR. SATISH KUMAR M-4526 DR. NITIN MITTAL
J-4487 DR. ASTHA JAIN K-4308 DR. SUSHIL KUMAR M-4582 DR. (MRS.) BELA MOHAN
J-4496 DR. ALOK JAIN K-4337 DR. BIRENDRA KUMAR N-4163 DR. NAIR DIVYA MONANCHANDRAN
J-4514 DR. AMIT BHURMAL JAIN K-4360 DR. ASHISH KUMAR M-4342 DR. LAKSHMI P. MOORTHY
J-4541 DR. PRACHI JAIN K-4395 DR. BIPUL KUMAR M-4211 DR. MEETA MUNGALE
J-4601 DR. POONAM JAIN K-4396 DR. PANKAT KUMAR M-4552 DR. SURAJ MUNJAL
J-4340 DR. VISHAL JAISWAL K-4397 DR. ANAND KUMAR M-4612 DR. DEEPA MUZUMDAR
K-4458 DR. DIPAK KUMAR JALANI K-4503 DR. ASHOK KUMAR T-4474 DR. SRINIVAS NAYAKA N.T.
J-4410 DR. RANADE KAUSTUEH JAYANT KD-1486 DR. (MRS.) DIMPY KUMAR N-4230 DR. VIPUL KUMAR NAGAR
M-4449 DR. MEHTA RACHARA JAYESHKUMAR K-4588 DR. PRADEEP KUMAR N-4508 DR. SONALI G. NAGPURE
J-4404 DR. AMIT KUMAR JAYSWAL K-4592 DR. SAROJ KUMAR N-4362 DR. KARTIK KUMAR NAMDEV
J-4357 DR. MONIKA J. JETHANI S-4597 DR. SANJAY KUMAR N-4418 DR. ASHOK KUMAR NANDA
J-4164 DR. MAHENDRA KUMAR JHARWAL KD-1468 DR. REENA KUMARI N-4522 DR. RUPALI NANDWANI
V-4236 DR. AANAL JIGISH VYAS K-4303 DR. ANUPAMA KUMARI N-4527 DR. DEEPTI NANWANI
J-4311 DR. MADHAV RANCHHODBHAI JODHANI K-4327 DR. SUNITA KUMARI ND-1481 DR. ARJUN NARANG
J-4332 DR. LIBY JOSEPH K-4372 DR. ARCHANA KUMARI N-4476 DR. ANURAG NARULA
J-4145 DR. JYOTI L-4465 DR. NIKHIL A. LABHSETWAR N-4564 DR. D. DWARAK NATH
K-4262 DR. MANJULA K. L-4420 DR. ROSHAN LAL N-4243 DR. MANJIRI SANJAY NATU
P-4491 DR. PRASAD K. L-4386 DR. NINGTHOUJAM LINTHOINGAMBI J-4492 DR. JADEJA JAGRUTI NAVALSINHJI
S-4413 DR. PRIYA K.S. L-4209 DR. MILIND LOTKE N-4381 DR. SHAH NAWAZ
B-4191 DR. BALAN RESHMA K.T. L-4331 DR. SAURABH KUMAR LUTHRA N-4341 DR. DEEPAK N. NAWKHARE
K-4528 DR. CHANDAN KALLA M-4142 DR. DEEPA M. N-4188 DR. PRAFULLA KUMAR NAYAK
K-4123 DR. RAVI PREET KALSI M-4202 DR. SAJITHA M. N-4224 DR. ASHA NEGI
K-4457 DR. SURESH PRASAD KALWANIYA M-4326 DR. BHANUPRAKASH M. N-4380 DR. RAHUL NEHATE
K-4574 DR. HARSHLI KAMAT M-4593 DR. KAVITHA M. N-4256 DR. SIRISH NELIVIGI
K-4135 DR. SAURABH KAPOOR J-4133 DR. VENKATESAN M.J. D-4132 DR. (MISS) MANECK D. NICHOLSON
K-4269 DR. STOTI KAPUR K-4206 DR. KANWALJEET H. MADAN N-4457 DR. VISHAL NIGAM
K-4584 DR. MANISHA KARKI M-4479 DR. MADHU N-4159 DR. KUNAL HARICHANDRA NIKALE
K-4540 DR. ANJU KATIYAR M-4566 DR. SABNIS MILIND MADHUKAR N-4470 DR. SABINA NISAR
K-4284 DR. RAVLEEN KAUR M-4576 DR. RITU MAHANA T-4194 DR. RAJESH O.T.
K-4321 DR. MANDEEP KAUR M-4383 DR. PRAFULLA KUMAR MAHARANA O-4287 DR. (SQN. LDR) AVADHESH OLI
K-4605 DR. LOBO ANEESHA KENNETH M-4143 DR. MAHESH S-4436 DR. SUVITHA P.K.S
K-4178 DR. NABAB ALI KHAN MD-1471 DR. CHARU MALIK T-4239 DR. JYOTHI P.T.
K-4347 DR. ASIF KHAN M-4316 DR. ANU MALIK P-4125 DR. MEENAKSHI PANDE
K-4555 DR. SHABANA KHAN M-4335 DR. MAMTA P-4235 DR. UMA PANDEY
K-4614 DR. TEJASWINI PRASHANT KHANDGAVE M-4217 DR. SEEMA KRISHNA MANE P-4288 DR. PRADEEP KUMAR PANDEY
KD-1487 DR. TANVI KHANNA A-4444 DR. TARANNUM MANSOORI P-4390 DR. M.L. PANDEY
K-4603 DR. GAURISH KHANNA M-4559 DR. AAKIFA MAQBOOL P-4338 DR. RANJANA PANDEYA
K-4240 DR. ANITA ARORA KHANOOJA M-4589 DR. SANGITA MARLECHA P-4114 DR. ARUN KUMAR PANIGRAHI
K-4409 DR. VARUN KHARBANDA M-4185 DR. SURENDRA MATHUR D-4450 DR.DESAI SAUDHAN PANKAJBHAI

52 DOS Times - Vol. 16, No. 10,April, 2011

DOS New Members List

P-4223 DR. PRAVEEN KUMAR PANWAR S-4349 DR. SHWETA VASVDEO SABNIS S-4272 DR. TEJPAL SINGH
P-4525 DR. SAMIR RAMESH PARAB S-4536 DR. ABU OBAID BANI SADAT S-4289 DR. KRISHNA PRATAP SINGH
P-4102 DR. (CAPT.) CHANDRA PRAKASH PATEL S-4613 DR. RAKHEE SANJAY SAGAR S-4339 DR. VISHWA PAL SINGH
P-4107 DR. RAMESHBHAI NARAYANBHAI PATEL S-4271 DR. R.N. SAHA S-4384 DR. HARSH INDER SINGH
P-4201 DR. BHARATI DASHARATHLAL PATEL S-4535 DR. RINKI SAHA S-4440 DR. GANPATI BAHADUR SINGH
P-4213 DR. AMIT KUMAR PATEL S-4599 DR. SAIRENGLIANA SAILO S-4441 DR. RAJMISH BAHADUR SINGH
P-4507 DR. ASHWINI S. PATIL S-4376 DR. MURALI SAJJA S-4481 DR. SONALI SINGH
P-4595 DR. BIJAY KUMAR PATTANIK K-4216 DR. KUMAR SAMBHAV S-4489 DR. GYANENDRA SINGH
P-4219 DR. REMYA MAREEN PAULOSE N-4499 DR. NARANG SAMIR S-4498 DR. KULVINDER SINGH
P-4355 DR. GRANTHALI ATMARAM PAWAR S-4261 DR. JASDEEP SINGH SANDHU S-4531 DR. SUBODH KUMAR SINGH
P-4545 DR. SUNEEL KUMAR PENTYALA S-4319 DR. SMRITA SANDHU S-4598 DR. PUNIT KUMAR SINGH
P-4150 DR. PIYUSH PRABHAKAR PATIL S-4227 DR. AGASHE VAIBHAVI SANJEEV S-4600 DR. KUNWAR KANT SINGH
PD-1476 DR. ABHINAV PRAKASH S-4434 DR. RASHMI SANKHE S-4604 DR. TANPREET PAL SINGH
P-4431 DR. PRAGYAN PRAKASH S-4608 DR. ARTI SAREEN S-4175 DR. REKHA SINGHAL
P-4246 DR. K. SRINIVAS PRASAD S-4231 DR. SAPNA DEB SARKAR SD-1484 DR. AMIT SINGHAL
P-4304 DR. MUKTA PRASAD S-4399 DR. SAMIR SARKAR S-4351 DR. VINOD SINGLA
P-4596 DR. CHANDRA SHEKHAR PRASAD S-4501 DR. HEMA SAROCH S-4378 DR. VIJAY RAJ SINGH SINGRAUR
P-4228 DR. PANIKKAR KARTIK PRASANNAKUMAR S-4171 DR. MADHU SWAROOP SAXENA S-4523 DR. NEHA SINHA
P-4546 DR. PRASHANTHI S-4197 DR. MANISH SAXENA S-4309 DR. BARKHA SOLANKI
P-4245 DR. RAJSHREE PRAVEEN S-4318 DR. T. SELVARANI S-4459 DR. SHREYANS SONI
N-4500 DR. NARANG PRIYA S-4534 DR. KETAN SELWARIA S-4524 DR. SURABH KUMAR SONI
P-4573 DR. PRASHANT PRIYADARSHI S-4417 DR. SAURABH SEVERIA S-4581 DR. ANKIT SONI
P-4411 DR. DAVID PUDUKADAN S-4106 DR. ALKA BHUPENDRABHAI SHAH S-4259 DR. SHISHIR SOOD
P-4253 DR. SURESH PRASAD PUTHALATH S-4192 DR. SMITESH KIRAN SHAH S-4575 DR. SUSHANK SOOD
R-4248 DR. SANDHYA R.. S-4198 DR. SONALI S. SHAH SD-1489 DR. SHAGUN SOOD
R-4548 DR. TASNA RABIA RAHMAN S-4244 DR. MIKEEN KAMLESH SHAH P-4346 DR. DUDU SREEDEVIPRIYA
R-4146 DR. JAINENDRA SHIVADAS RAHUD S-4324 DR. MAYUR RAMESHCHANDRA SHAH S-4190 DR. RAMYASHRI SRIKANTAIAH
R-4329 DR. NIRAV DILIP RAICHURA S-4364 DR. ANKIT ARVINDBHAI SHAH S-4266 DR. ASHITA SUD
R-4196 DR. (MAJOR) BIRESH RAJ S-4356 DR. PURVA PRAKASH SHAHAPURKAR S-4421 DR. CHANDAN SUD
R-4129 DR. BASA DIVYA RAJESHWARRAO S-4170 DR. RAJA ABU SHAHMA S-4477 DR. POONAM SUNDER
R-4478 DR. K.C. RAJINI C-4115 DR. AVINASH SHANDRA K-4580 DR. KARANDE SUNITA SUNIL
R-4320 DR. BAL RAM S-4166 DR. PAWAN SHARMA S-4162 DR. CHITRA SUNOV
R-4110 DR. MINU RAMAKRISHNAN S-4169 DR. VIVEK SHARMA S-4328 DR. SAMEER SUBHASHBHAI SURATWALA
R-4606 DR. MEET MAVJIBHAI RAMANI S-4204 DR. DHARMIK R. SHARMA C-4424 DR. CHHAJED SHAILESH SURESH
R-4113 DR. MODI ROHIT RAMESH S-4222 DR. ARPANA SHARMA P-4325 DR. PATEL CHETNA SURESHBHAI
T-4215 DR.THORAT MANISHA RAMESH S-4263 DR. NEHA SHARMA S-4547 DR. PEREIRA SAVIO SYLVAN
R-4447 DR. RAJASREE P. RAMKRISHAN S-4285 DR. VIKAS SHARMA T-4453 DR. BIMISHA T.
B-4154 DR. CHAUDHARY MRUGESH RAMSANGBHAI S-4382 DR. SOURABH SHARMA T-4109 DR. OMKAR JAGDISH TELANG
R-4155 DR. PUSHPANJALI RAMTEKE S-4387 DR. BHUMIKA SHARMA D-4511 DR. NEEPA THACKER DAVE
R-4168 DR. RANVIR SINGH RANA S-4392 DR. VINOD SHARMA T-4317 DR. RAJARATHNA THANGAVEL
R-4118 DR. VEERABHADHRA RAO S-4415 DR. RAM PRAKASH SHARMA T-4293 DR. ANKUJ TINNA
R-4467 DR. M. SAMBASIVA RAO S-4438 DR. SNEHA SHARMA T-4469 DR. SANA TINWALA
R-4214 DR. ABDUL RASHID S-4515 DR. ASHOK KUMAR SHARMA T-4172 DR. EVA RANI TIRKEY
R-4134 DR. RAMIT ASHOK KUMAR RASTOGI S-4533 DR. ANUJ SHARMA T-4290 DR. SATYA PRAKASH TIWARY
RD-1464 DR. VANDANA RATHI S-4247 DR. HARSHA SAHEBRAO SHEJAO T-4452 DR. ROSE MARY TOMY
R-4210 DR. PRATIBHA M. RATHI SD-1466 DR. HIMANSHU SHEKHAR T-4298 DR. PARAG TUPE
R-4161 DR. PRADEEP SINGH RATHORE S-4530 DR. SHIKHA U-4482 DR. VALVEKAR PURVA UMAKANT
R-4136 DR. VANRAJ RATHWA S-4611 DR. KHUSHBOO SHIKHANGI V-4315 DR. JARIWALA MANAN UMESHCHANDRA
R-4306 DR. ASHISH RAWAL S-4183 DR. VIJAY BHAGWAN SHINDE U-4157 DR. ANAND UPADHYAY
R-4273 DR. ACHIN RAWAT S-4220 DR. PRADEEP SHINGAL U-4544 DR. ASHOK KUMAR UPADHYAY
R-4539 DR. MOTI LAL RAWAT S-4130 DR. LOKHANDE SWATI SHIVLING U-4494 DR. ATUL TRIVIKRAM URSEKAR
R-4375 DR. MARAM VENKATA RAMANA REDDY S-4336 DR. ZAMBRE PRACHI SHRIKANT V-4471 DR. M.S. USHA
R-4126 DR. SANGEETHA KOLLAPURI RENUKAY S-4532 DR. HIMANSHU SHUKLA V-4354 DR. BIJU V.
T-4423 DR. SANTOSH TIB REWALA S-4250 DR. MANISH V. SHYAMKUL V-4393 DR. JYOTHI V.
R-4252 DR. RASHMI RHAINA S-4156 DR. AYUSH SINGAL V-4461 DR. ARJUN V.
J-4446 DR. RIMALJEET S-4103 DR. AMANDEEP SINGH V-4542 DR. RAVI KUMAR VADAPALLI
R-4278 DR. JONAKI ROY S-4148 DR. KARAMJIT SINGH V-4366 DR. ALKA VARGHESE
R-4553 DR. SANGEETA ROY S-4167 DR. IRWINDER PAL SINGH V-4401 DR. PRASHANT VASHISHTContd.. page 73

www.dosonline.org 53

Descemet’s Membrane Detachment Retina

Manisha Acharya MS, DNB, Jyoti MS, Umang Mathur MS, Kapil Arneja MS

Descemet’s membrane detachment (DMD) is an important Causes of Descemet’s Membrane Detachment
cause of surgery related corneal edema that may lead to
corneal decompensation. As clear corneal incision cataract Surgical
surgery has advanced, increased surgical manipulation at the Complicated / uncomplicated Cataract surgery
edge of descemet’s membrane (DM) has increased the prevalence • Phacoemulsificaton
of DM detachment. Prompt recognition and management of this • SICS
complication gives dramatic improvement in corneal edema and • ECCE
thus enhances visual outcome. Glaucoma surgery –
The first systemic description of DMD was made by Bernard • Viscocanalostomy
Samuels in the American literature in 1928.1 Descemet's membrane • Deep sclerectomy
detachment is neither rare, nor always a benign problem. The • Trabeculectomy
most common cause is a localized detachment occurring during • Iridectomy
instrumentation in cataract surgery. When and how to intervene • holmium laser sclerostomy
for DMD has been an area of controversy because the prognosis Inadvertent intracorneal injections
and natural history of DMD are still unclear. In addition, non- • Viscoelstics
surgical detachments have been reported in birth injury, blunt • Balanced salt solution
or sharp trauma, congenital glaucoma and keratoconus. Some • Adrenaline
patients may be anatomically predisposed to DMD possibly • Antibiotics
because of an abnormality in the fibrillary stromal attachment to Penetrating keratoplasty
descemet’s membrane.2 Pars plana vitrectomy
The most common cause of descemet’s membrane detachment Non- surgical
is mechanical separation near the incision site by an instrument, Birth injury
fluid or viscoelastic substance.3,4,5 Trauma- blunt/sharp
Predisposing Factors Congenital glaucoma
• Shallow anterior chamber Corneal ectasia- keratoconus
• Complicated or repeated surgeries Anatomical predisposition
• Inadvertent insertion of instruments between the corneal
• Non- Planar (>1mm separation from the stroma)
stroma and descemet's membrane • Peripheral detachment only
• Anterior and shelved incisions • Combined peripheral & central detachment
• Blunt blades Dr Jacob’s Classification based on etio-pathogenesis6
• Engaging the descemet's membrane during intraocular lens • Stripped descemet’s membrane detachment
• Taut descemet’s membrane detachment
implantation or with the irrigation/aspiration device (when
mistaken as an anterior capsular remnant).
Classification
• Mackool and Holtz’ Classification based on clinical
presentation - Classification by Mackool and Holtz helps
in determining the prognosis of DMD. Planar detachments
are likely to resolve spontaneously and non-planar should be
repaired early.3,4
• Planar ( <1mm separation from the stroma)
• Peripheral detachment only
• Combined peripheral & central detachment

Dr. Shroff ’s Charity Eye Hospital
Daryaganj, New Delhi-110002

www.dosonline.org 59

Conservative approach Interventional approach

Topical steroids
Hyperosmotic agents Internal temponade – Air
Descemetopexy -14% C3F8,
20% SF6)
Transcorneal suturing
Descemetotomy
Penetrating keratoplasty

Stripped descemet’s membrane detachment - Stripped descemet’s Figure 1: anterior segment OCT of a stripped
membrane detachment is generally induced during viscoelastic planar DMD
injection or during insertion of blunt instruments or intraocular
lens.
Taut descemet’s membrane detachment - A long-standing stripped
descemet’s membrane detachment could sometimes adhere to
intraocular contents with secondary fibrosis, thus turning into
a taut descemet’s membrane detachment. It could be due to
inflammation involving the descemet’s membrane, secondary
incarceration of the descemet’s membrane in an inflammatory
process, eg, in peripheral anterior synechiae or within the graft-
host junction; or secondary incarceration in a wound/suture with
subsequent contraction.

Morphological classification7
• DMD with non- scrolled edges
• DMD with scrolled edges

Role of Imaging Technology

Diffuse corneal edema can obscure the slit-lamp view into the Figure 2: anterior segment OCT of a stripped
anterior chamber, making the diagnosis and subsequent surgical non-planar DMD
planning difficult. Ultrasonographic biomicroscopy (UBM)
has been advocated as a means of imaging DMD through an nature of this reattachment is unclear. It has been hypothesized
opaque cornea, but this procedure requires a skilled technician, that the persistent pumping action of the healthy endothelium
a cooperative patient, and substantial time investment.8Anterior might exert an appositional force to appose detached corneal
segment OCT may be superior alternative to UBM because of the descemet’s membrane. Fortunately, the viability of the endothelial
speed and ease of image acquisition, the ability to acquire images cells is maintained, and they function well even after months of
without direct corneal contact, and the ability to image patients descemet’s membrane separation. The descemet’s ridges present
in the upright position.9 It determines the extent of detachment following reattachment are usually visually insignificant.10
(planar or non-planar) and degree of tautness. A stripped Interventional Approach: Non-planar DMDs may cause vision loss
descemet’s membrane detachment is seen as an undulating linear because of subsequent corneal decompensation. Swift action in
hyper-reflective echo in the anterior chamber whereas a taut nonplanar DMD is essential
descemet’s membrane detachment is seen as a straight, taut line Internal temponade : One should be vigilant enough to notice even
between two points of attachment.6 a small DMD intra-operatively, immediately on its occurrence. If
Management
Conservative Approach: Planar DMDs are visually insignificant
and resolve spontaneously (reattachment) within few weeks to few
months. Conservative approach including medical treatment in
the form of topical steroids and hyperosmotic agents is indicated
with a close follow-up.
Reattachment: Spontaneous resolution of descemet’s membrane
detachment has been reported within days to 3 months. The actual

60 DOS Times - Vol. 16, No. 10,April, 2011

Figure 3: Descemet’s membrane detachment Figure 5: 14% C3F8 Bubble in anterior chamber

Figure 4: optical section illustrating DMD Figure 6: Optical section (descemetopexy)

stripping of descemet's mem¬brane is recognised at the time of disposable syringe is inserted through a stab incision near the
surgery attempt may be made to reposit the same using an iris area of attached descemet’s membrane (opposite to the area of
re¬positor. Sterile air should be injected at the end of surgery. Due detached descemet’s membrane). Cannula may be be placed in
to its short life, air is reserved for small incision detachments.11 If areas of previous corneal/scleral or paracentesis incision sites.
anterior chamber gas injection cannot be carried out at the end The plunger on the syringe is slowly depressed to inject 14% C3F8
of the surgery, it must be done on the first day after the surgery. or 20% SF6 to fill approximately 60% of the anterior chamber.
Descemetopexy: Intracameral injection with either iso-expansile When adequate gas injection has occurred, cannula is removed
sulfur hexafluoride (SF6) or iso-expansile perfluoropropane from the eye. The eyelid speculum is then removed following
(C3F8) gas has gained increasing acceptance as an efficient and the instillation of topical antibiotic drops. Postoperative regimen
effective treatment option for descemet’s membrane detachments. includes topical antibiotic 4 times daily for 1 week and topical
SF6 (20%) is the least toxic for the endothelium.12 However, C3F8 steroid administration in tapering doses. Regular follow-up is
(14%) had lowest number of complications in the studies found mandatory to monitor the position and size of intraocular gas
in literature13. In addition, this procedure can be performed at bubble and reattachment of the descemet’s membrane. Figures 3
the slit-lamp and may be repeated if necessary. It may also be to 8 illustrate complete reattachment of DMD 2 weeks following
combined with transcorneal suturing if DMD is very large or descemetopexy with iso-expansile C3F8 (14%).
having scrolled edges. Complications of descemetopexy
Technique of descemetopexy: After appropriate sterile draping, • Raised intraocular pressure due to pupillary block due to large
a few drops of topical anaesthetic are applied to the eye, and
the eyelid speculum is inserted. A 26 G cannula on a 5 ml gas bubble or because of movement of the gas bubble behind
the iris. A simple paracentesis will relieve the pupillary block.

www.dosonline.org 61

Figure 7: 1 week after descemetopexy Figure 8: 2 weeks after descemetopexy
(partial re-attachment) (complete rereattachment)

• Endothelial fallout may occur due to increased instrumentation • The incision's inner corneal aspect should be equal to, or
associated with descemetopexy slightly greater than, the incision's outer scleral aspect to
prevent undue trauma during insertion and removal of phaco
• Despite successful reattachment, a horizontal opacity, or probes or irrigation/aspiration devices with irrigating sleeves.
descemet's membrane haze may remain at the location of the
original detachment. Conclusion
A careful slit-lamp examination augmented by an anterior segment
• Irregular astigmatism may result owing to the formation of OCT if needed, can diagnose descemet’s membrane detachment in
wrinkles in descemet's membrane. cases of corneal oedema following cataract surgery, especially if the
procedure has been uneventful. Various management approaches
Transcorneal Suturing: It is reserved for refractory large non- have been described in literature but an early descemetopexy with
planar DMD. It is not recommended as the initial treatment 14% iso-expansile C3F8 or 20% SF6 offers better surgical outcome
due to the risk of severe complications and infections, wrinkles both in terms of visual acuity and resolution of corneal edema.
in the membrane and residual leucoma.14 Manipulations with Descemetopexy should be undertaken even if detection of DMD
surgical instruments should be limited due to the risk of causing is as late as 2 months postoperatively.
endothelial damage.11 References
Combined Descemetotomy and Descemetopexy: A detached
descemet membrane that is scrolled, shredded, or severely 1. Samuels B. Detachment of Descemet’s membrane. Trans Am
damaged is unlikely to be repaired using descemetopexy and Ophtahlmol Soc 1928;26:427-37.
may require more delicate surgical manipulation.7 Relaxing
descemetotomy incisions act by breaking the stress forces that 2. Kansal, Sukesh M.D.; Sugar, Joel M.D.Consecutive Descemet
are acting on the descemet’s membrane and holding it taut. It Membrane Detachment After Successive Phacoemulsification.
makes the descemet’s membrane lax and thus allows an air or gas Cornea:August 2001 - Volume 20 - Issue 6 - pp 670-671
bubble to appose it against the corneal stroma. Long-acting gas
is preferred, as it may sometimes take longer time to adhere well, 3. Mackool RJ, Holtz SJ. Descemet membrane detachment. Arch
thus requiring a longer period of tamponade.6 Ophthal 1977;95:459-63
Penetrating keratoplasty: It is the last resort for visual rehabilitation
of scarred cornea due to DMD. 4. Iradier MT, Moreono E et al. Late spontaneous resolution of a massive
Prevention detachment of Descemet’s membrane after phacoemulsification.
Descemet’s membrane detachment is a remediable but potentially JCRS 2002;28:1071-3
blinding cause of postoperative corneal oedema. Several factors
should be borne in mind to help minimise the risk of DMD: 5. Ho ove r DL , Gi ang i acomo J, B e ns on RL . D es cemet’s
• Instrumentation should be gentle and minimal, membrane detachment by sodium hyaluronate. Arch
• Use of Blunt keratomes and blades should be avoided, Ophthalmol.1985;103:805-808
• Early intraoperative detection is imperative to avoid rapid
6. Soosan Jacob, Amar Agarwal. Relaxing descemetotomy relieves
progression, stress forces in taut Descemet’s membrane detachment. Ocular
surgery news.U.S. EDITION October 10, 2010

7. Marcon AS, Rapuano CJ, Jones MR, Laibson PR, Cohen,
EJ.Descemet's membrane detachment after cataract surgery
management and outcome. Ophthalmology 2002;109:2325-30

62 DOS Times - Vol. 16, No. 10,April, 2011