Contents
E5 ditorial 49 Commonly Used Diagnostic and Laser Lenses for Retinal
Diseases - An Overview
Gitumoni Sharma, Sagarmoy Purkayastha, Hemlata Deka,
Harsha Bhattacharjee
D6 OS Annual Conference Programme Squint
Cataract 59 Fraser’s Syndrome
31 Agarwal’s Modification of the Malyugin Ring in Miotic Pupils with Jitendra Jethani, Abhishek Dagar, Renuka Rajgopalan
Broken Posterior Capsules Personal Opinion
Amar Agarwal, Boris Malygin, Dhivya A, Soosan Jacob, Athiya Agarwal,
Larry Laks 63 Recent Advances in Pathophysiology & Prevention
of Diabetic Retinopathy
J. S. Ahluwalia
Glaucoma Clinical Monthly Meeting
35 New Perimetric Techniques 69 Orbital Implants: A Synopsis
Ritu Gadia, Tanuj Dada, Ajay Sharma, Viney Gupta, Ramanjit Sihota, Archana Sood MS
Anita Panda
F75 orthcoming Events
Retina Columns
43 Case Report 79 DOS Quiz
R. Gosh, Shaifali Singla, Lalit Verma, Dinesh Talwar, Avnindra Gupta, Saurabh Sawhney, Ashima Agarwal
H.K. Tewari
Munish Dhawan MD
Vivek Dave MD
4 DOS Times - Vol. 13, No.9, March 2008
Editorial
Pan Ophthalmology Live
Dear Colleagues,
The time for the DOS Mega Event – Pan Ophthalmology Live has come and this time we have made all out efforts to ensure that–
the focus is on scientific sessions on all specialties of ophthalmology.
The three day conference will bring together over 410 leading International & National faculty from around the globe to share
with us their expertise on pivotal medical and surgical developments which are instrumental in changing the scene of ophthal-
mology today.
The Day Long Surgery Session will be telecast live from 3 centers & will showcase surgeries by more than 30 leading ophthal-
mologists.
The Wet Laboratory & Hitec Pavilions will ensure that delegates get a chance not only to view the latest machines but also get
hands – on training on diagnostic skills and surgical techniques.
For the first time we are launching DOS Video Stations. Delegates will get a chance to view video recording of surgeries on
interactive touch screen kiosks.
Conference Proceedings will be recorded and the same will be developed into interactive CDs, which can be viewed offline by the
delegates - giving the feel and knowledge of the DOS Conference.
We look forward to your active participation to make this conference a grand success.
Thanking you,
Namrata Sharma
Secretary,
Delhi Ophthalmological Society
Delhi Ophthalmological Society Teaching (DOST)
……An initiative towards
teaching & imparting Skills
If the roots are good, the plants generally flower well. Similarly good understanding & grasp of a subject is of paramount 5
importance & goes a long way in making a person a better Clinician. This coupled with surgical skills & experience, ultimately
makes the person a highly successful Surgeon.
Good & Caring Teachers are becoming a precious commodity while on the other hand, number of students striving to learn and
reach academic Excellence is on the rise. Further, very few Institutions have Academic Curriculum & adhere to it by holding
regular classes.
DOST, an initiative of Delhi Ophthalmological Society, provides opportunity to our youngsters to learn from the Masters in
respective fields. It also aims to bridge or decrease the gap between the institutes of Excellence & other institutes where Academ-
ics has taken a back seat.
Till Date we have conducted three DOST Programmes . The response has been quite encouraging & overwhelming. It is indeed
a delight to see halls packed with enthusiastic students and the Masters delivering their best.
I would also like to thank M/s CIPLA for all their support in smooth conduction of these programme & also for distribution of
Certificates.
Should have any Suggestions, please do not hesitate to contact & contribute to this Noble Cause.
Lalit Verma
President,
Delhi Ophthalmological Society
0-98102-99934, [email protected]
www.dosonline.org
Dear Colleagues, Table of Contents
On behalf of the Executive Committee of the Delhi Ophthalmological Invited Faculty .................................................................... 4
Society, it gives us great pleasure to invite you to participate in Floor Plan ........................................................................... 8
Live Surgery Session (28th March) ........................... 10
“Pan Ophthalmology Live”, Annual Conference of the Delhi Wet Laboratories & Hitec Pavilions (28th March) 12
Ophthalmological Society from the 28th to 30th March, 2008 at Scientific Program (29th & 30th March) ................ 14
Hotel Ashok, Chanakaya Puri, New Delhi.
Cataract
The three day conference will bring together leading ophthalmologists, Cornea
researchers and surgeons from around the globe to share with us their Glaucoma
expertise on pivotal medical and surgical developments which are Miscellaneous
instrumental in changing the scene of ophthalmology today.
This conference will feature live surgical demonstrations in not only
phacoemulsifciation & excimer laser surgeries but also corneal, squint,
glaucoma and vitreo-retinal surgeries.
Apart from this, Wet Laboratories will be organized both in diagnostic
skills as well as surgical techniques.
We look forward to your active participation.
Thanking you,
Oculoplasty
Refractive Surgery
Dr. Lalit Verma Dr. Namrata Sharma Vitreo-Retina
President Secretary
Squint & Neurophthalmology 77
Mobile: 98102-99934 Mobile: 98108-56988 Trade Index ..........................................................................
E-mail: [email protected] E-mail: [email protected]
INTEIRNNVAITEIODNFAALCUFALTCYULTY
Annual Conference of David Luebeck Donald Tan Dorothea GroB
Jairo Kerr Azevedo James Katz José Augusto Cardillo
Delhi Ophthalmology Society Nachiketa Acharya Nitin Verma
Rasik B. Vajpayee Pankaj Puri
Date: 28th & 30th March, 2008 S. Ruit
Venue: Hotel Ashok, Chanakyapuri,
New Delhi INVITED FACULTY
DOS Executive A.K. Amitava Anita Panda Binita Thakur
A.K. Grover Anita Sethi Buela Chisty
Lalit Verma Executive Member Anjali Mehta Bujor Banaji
President A.K. Jain Anju Rastogi C.M. Wavikar
Rajiv Gupta A.K. Khurana Ankur Sinha Chandra Shekhar
S. Bharti Executive Member Anuj Singh
Vice President A.K. Singh Aparna Ahuja Chawan
Sanjeev Gupta Abhay Vasavada Archana Sood Charu
Namrata Sharma Executive Member Abhinandan Jain Arul Mozhi Varman
Secretary Abhishek Dagar Arun Samprathi Chitra Ramamurthy
Rajendra Prasad Arun Sethi Cyres Mehta
Amit Khosla Executive Member Ajay Agarwal Arvind Jaiswal D. K. Sen
Joint Secretary Ajay Aurora Ashish Bansal
Anita Sethi Ajay Dave Ashish Lall D. Ramamurthy
Sanjay Chaudhary Executive Member Ajay Dudani Ashok Sharma D.K. Mehta
Treasurer Ajay Sharma Ashok Shroff D.P. Vats
Cyrus M. Shroff Ajay Sharma Ashu Agarwal Daljit Singh
Rajpal Insan Executive Member Asim Kandar Damanjot
Editor Ajit Babu Athiya Agarwal Dariel Mathur
B.P. Guliani Ajoy Paul Atul Kumar
Vinay Garodia DOS Representative to AIOS Alkesh Chaudhary Atul Singh Darshan Bavashi
Library Officer Amar Agarwal Avnindra Gupta Debashish Bhattacharya
Kamlesh Amit Gupta B. Ghosh Deepender Vikram Singh
Alkesh Chaudhary DOS Representative to AIOS Amit Gupta B. Venkateshwar Rao
Executive Member Amit Khosla B.N. Choudhary Deven Tuli
Mahipal S. Sachdev Amit Tarafdar B.P. Guliani Devindra Sood
Zia Chaudhuri Ex-Officer Member Amod Gogate B.S. Goel Dheeraj Bansal
Executive Member Amod Gupta Babu Rajendran Dinesh Sharma
Harbansh Lal Amrita Kapoor Baskar Roy Chodhury Dinesh Talwar
Angshuman Goswami Ex-Officer Member Anand Aggarwal Bhawna Chawla
Anand Shroff E.R. Mohan
Dinesh Talwar Angshuman Goswami G. Chandrashekhar
Ex-Officer Member Aniel Malhotra
Anil Mandal G. Mukherjee
G.S. Brar
G.S. Dhami
Gaurav Luthra
6 DOS Times - Vol. 13, No.9, March 2008
INVITED FACULTY INVITED FACULTY
Gaurav Prakash Kamlesh Manish Nagpal Sandeep Saxena Soosan Jacob Uma Sridhar
Geeta Satpathy Kanak Tyagi Manish Shah Sandhya Gupta Sri Ganesh Usha K. Raina
Kapil Midha Manisha Agarwal Sangeeta Abrol
Geetha Iyer Kapil Vohra Manoj Gupta Sanjay Ahuja Sridhar Prasad Usha Singh
Gopal Das Karan Agarwala Mayuri Khamar Sanjay Chaudhary Sridhar Rao Usha Yadava
Gurbax Singh Kavita Natarajan Meenakshi Thakkar Sanjay Dhawan
Gursatinder Singh Keiki Mehta Mohan Rajan Subash Dadeya V. Kenia
H.C. Agarwal Khenoray Nackwal Mohita Sharma Sanjay Kai Subrata Mandal V. Krishna
H.K. Tewari Kiran Tandon Monica Chaudhary Sanjay Khanna Sudershan Khokhar V. Sangwan
H.K. Yaduvanshi Kiranjeet Singh Monica Gandhi Sanjay Lahiri Sudesh Arya V.K. Dada
Hanumantha Reddy Mukesh Sharma Sanjay Sachdeva Sudipto Pakrasi V.K. Jain
Harbansh Lal Kirti Singh Muna Bhende Sanjay Sharma Sujatha Mohan V.K. Tewari
Hardeep Singh Kulbhushan Munish Dhawan Sanjeev Gupta Suma Ganesh V.P. Gupta
Harinder Sethi Kumar Doctor Murali Aasuri Sanjiv Mohan Sumit Monga Vandana Kohli
Harminder K. Rai Kumar Raj N.K. Pattnaik Satanshu Mathur Sumita Agarkar Vijay Mathur
Harsh Kumar L.D. Sota Namrata Sharma Satish Chawdhary Sunandan Sood Vijay Sabharwal
Himanshu Matalia Lalit Verma Nandini Ray Vikas Mahatame
Indu Singh Lopa Das Narinder Singh Satya Karna Sunil Shah Vikas Menon
J. L. Goyal Lovely Sharma Navin Sakhuja Saurabh Chaudhary Suneeta Dubey Vimla Menon
J.C. Das M. Baskaran Neelam Asthana Goel Vinay Garodia
J.K.S. Parihar M. Kalaiveni Neelam Pushker Saurabh Luthra Sunita Lulla Vinita Singh
J.S. Guha M. Vanathi Neera Aggarwal Shailesh G.M. Supriyo Ghose Vipin Sahini
J.S. Thind M.C. Jha Neeraj Dabral Shalini Mohan Suresh Kumar Vipul Baishya
Jagat Ram M.K. Ajwani Neeraj Manchanda Shaloo Bageja Sushil Kumar Virender Agarwal
Jaideep Bajaj M.R. Dogra Neeraj Sanduja Shan D’Souza Sushmita Kaushik Vishali Gupta
Jasmita Popli M.S. Boparai Neeraj Verma Sharad Lakhotia Sushmita Shah Vishnu Gupta
Jaswant Arneja M.S. Ravindra Nibaran Gangopadhyay Shashi Kapoor Vivek Gupta
Jaya Prasad M.S. Sridhar Shibal Bhartiya Suvira Jain Vivek Pal
Jeewan S. Titiyal Madan Mohan Nichlani Shipra Tripathi T.M. Sharma Y.R. Sharma
Jolly Rohtagi Madhu Karna Nikhil Gokhale Shobit Chawla T.P. Lahane Yasmin Bhagat
Jyotirmay Biswas Mahesh Chandra Tanuj Dada Yogesh Desai
K. Satyen Mahipal S. Sachdev Nilesh Thite Shrikanth Tapas Paddi Yogesh Shah
K.P. Reddy Mallika Goyal Nitin Trivedi Siva Kumar Taru Dewan Zaheer Abbas
K.P.S. Malik Mamta Agarwal Noornika Khuraijam Sobi Pandey Tarun Sharma Zia Chaudhuri
Kalpana Narendran Manavdeep Singh Soman Nair Tejas Shah
Kamal Kapoor Mandeep S. Bajaj P. Bhasin Somasheila Murthy
Kamaljeet Singh Manish Kumar P. Bhende Sonu Goel Tinku Bali
P. D’Souza Tushar Agarwal
P. K. Pandey Uma Mallaiah
INVITED FACULTY
P. Sathyan R.S. Dhaliwal Ranjan Dutta
P.C. Bhatia R.V. Azad Rashim Mannan
P.K. Pandey Rashmi Taneja
P.K. Sahu Radhika Tandon Ravi Manocha
P.N. Nagpal Ragini Parikh
P.N. Seth Raj Anand Ravijit Singh
Pankaj Puri Reena Sethi
Pankaj Sharma Raja Ram Reddy Rishi Mohan
Paras Mehta Rajan Dutta Rishi Swarup
Parijat Chandra Rajani Battu Ritu Arora
Partha Biswas Rohit Om Prakash
Parul Shah Rajat Agarwal Rohit Saxena
Parul Sharma Rajat Desi Rohit Shetty
Pawan Goyal Ruchi Goel
Piyush Kapur Rajeev Jain Ryan Desouza
Pooja Sinha Rajeev Gupta
Poonam Jain Rajeev Jain S. Bharti
Pradeep Sharma Rajeev Prasad S. Lakhotia
Pradeep Venkatesh Rajender Khanna S. Natarajan
Prakash Agarwal Rajender Prasad S. Venkatesh
Prashant Agnihotri Rajesh Bhatia S.C. Gupta
Prashant Yadav Rajesh Fogla S.K. Narang
Prateep Vyas Rajesh Sinha S.K. Sharma
Praveen Krishna Rajesh Wadhwa S.N. Jha
Praveen Malik Rajib Mukherjee S.P. Garg
Prema Padmanabhan Rajiv Gupta S.P.S. Grewal
Priyanka Dhingra S.S. Lalwani
Priyanka Singh Rajiv Jain S.S. Pandav
Punit Gupta Rajiv Mohan S.T. Muralidhar
R. Muralidhar Rajpal Insan Sachin Gupta
R. Ramakrishnan Rajshekhar Sachin Mehta
R.B. Jain Rajul Parikh Sajid Fazili
R.M. Pandey Rakesh Maggon Saman Adil
R.N. Mishra Rakesh Mahajan Samar Basak
R.P. Singh Ram Aggarwal Sameer Kaushal
Ram Kishor Sah Samir Sud
Ramanjit Sihota Sandeep Mittal
Ramesh Kekkunnya
Ramesh Murthy
Randhir Jha
www.dosonline.org 7
Annual Dinner Time: 11.40 - 12.35 p.m.
&
Care Group Live Surgery
Cultural Evening
Transmission from Chaudhary Eye Centre
of the Society is on
Saturday, 29th March, 2008 at Topics: Surgeons:
Suncity Garden, Phaco with foldable T.P. Lahne
Village Satbari, Chattarpur Mandir Road,
Alpha Phakic IOL Sanjay Chaudhary
New Delhi – 110 030
from 7.30 p.m. onwards Phaco with Hydrophobic Foldable Gaurav Luthra
Entry by card, for couple only Phaco with Gold foldable Ashu Agarwal
Buses will leave from the Conference Venue at 6.15 p.m. sharp
Moderators (in the hall):
See ! • Believe !! • Learn !!! • Suggest !!!!
Time: 12.35 - 2.15 p.m.
The Executive, Delhi Ophthalmological Society,
launches Bausch & Lomb Live Surgery
DOS VIDEO STATIONS Transmission from R.P. Centre for Ophthalmic Sciences
at the Surgeons: Mohan Rajan, Amar Agarwal, Keiki Mehta, Kamal Kapoor, Rajesh
Bhatia, K.P. Reddy, Sujatha Mohan
59th Annual Conference of DOS Panelist: Cyres Mehta, Kapil Vohra, Gaurav Luthra, Kamal Kapoor, T.P. Lahane,
Athiya Agarwal, M.K. Ajwani
29th & 30th March 2008
Time: 2.15 onwards
at Convention Hall - B
Alcon Session (Pharma) Scott Manning
Abhay Vasavada
1. Opening Remarks
2. Maximizing surgical outcomes: Therapeutic options Rishi Mohan
3. Resistance! Is there a Need For Fourth General
James Katz (USA)
Flouroquinolone S.S. Pandav
4. Differential Diagnosis of Ithcy Red Eye & New Manish Shah
Harsh Kumar
Therapeutic Options
5. Prostaglandins in Glaucoma Management
6. Compliance & it’s Importance in Glaucoma Management
7. Incidence and Management of Closed Angle Glaucoma in India
Alcon Cataract Live Surgery
Transmission from R.P. Centre for Ophthalmic Sciences
Aspheric ReSTOR My Experience : Sudipto Pakrasi
Surgeons: David Luebeck (USA), Abhay Vasavada, J.S. Titiyal & Harpriya Aravind
Moderators (in the hall): James Katz, Ryan D’Souza, Sudipto Pakrasi
Live Surgery Session Wet Laboratory & Hitec Pavilions
Date: 28th March, 2008, Venue: Convention Hall, Ashok Hotel Alcon India Pavilion
Time: 8.00-8.40 a.m. Phacoemulsifcation Surgery & Foldable
IOL implantation
Transmission from Centre For Sight Toric IOL Marking station : Asim Kandar, Munish Dhawan
: Rashim Mannan, Manoj Gupta
Small Incision Cataract Surgery : K.P.S. Malik, Ruchi Goel
Squint Surgery : Pradeep Sharma Allergan Pavilion
Moderators (in the hall): Gautam Kumar, Zia Chaudhuri, Praveen Malik,
M. Vanathi AMO Pavilion
Time: 8.45-10.00 a.m. Phacoemulsification Surgery & Foldable IOLs : Zaheer Abbas, G.S. Brar,
Appasamy Live Surgery Surgery Piyush Kapur
Transmission from Centre For Sight Appasamy Associates Pavilion
Surgeons: Arul Mozhi Varman, Siva Kumar, J.S. Titiyal, Vikas Mahatme,
T.P. Lahane, Nichlani Phacoemulsification & Foldable IOL surgery : Suvira Jain, Neeraj Verma
Moderators (in the hall): A.K. Grover, Rajender Khanna, Tanuj Dada, (28th March only)
Angshuman Goswami Ultrabiomicroscopy
Indirect Ophthalmoscopy : Suvira Jain
: Pooja Sinha, Sandhya Gupta,
Time: 10.00 - 11.40 a.m.
Sanjay Ahuja, Manisha Agarwal,
J.S. Guha
AMO Live Surgery (Cataract & Refractive Surgery) Bausch & Lomb Pavilion
Transmission from Centre For Sight
Topics: Surgeons: Phacoemulsification Surgery & Foldable IOL
ILASIK-Intralase Advanced Custom Vue Surgery Mahipal S. Sachdev, Implantation : Gopal Das, P.K. Sahu
Sri Ganesh Contact Lens : Priyanka Singh,
Whitestar Signature with fusion fluidics Mahipal S. Sachdev, Khenoray Nackwal,
phaco surgery Sri Ganesh, A.K. Grover Monica Chaudhary,
Moderators (in the hall): Lovely Sharma
ILASIK S.P.S. Grewal,Sridhar Prasad Microkeratome : T.M. Sharma, Gaurav Prakash,
Whitestar Signature with fusion fluidics Sameer Kaushal
phaco surgery Yogesh Desai Biomedix Pavilion
Running Lunch from 12.30 to 2.30 p.m.
8 DOS Times - Vol. 13, No.9, March 2008
Care Group Empowering through Innovation
RTVue 100 -3D OCT Hall: Convention-C • Date: 29.3.08 (Saturday) • Time: 8.30 – 10.30 a.m.
Green / Diode DCR Laser
Carl Zeiss Pavilion
OCT Visante : Virender Agarwal 1. Rationale & Benefits for Stellaris MICS Platform : Amar Agarwal (25 min)
3-D High Resolution OCT : Meenakshi Thakkar,
2. Advancements in Personalised Zyoptix-APT : Kumar Raj (15 min)
Mohita Sharma, Sandhya Gupta
Deepak Enterprises Pavilion 3. Complete Transitioning to MICS with : Mohan Rajan (15 min)
Akreos AO MIL
Ultra Bio Microscope (Paradigm medical USA): Devindra Sood
Automated Perimeter : Suneeta Dubey 4. Aberration free IOLs-contrast sensitivity &
depth of field
Auto Tonometer Pachymeter : Rolli Sharma : Kamal Kapoor (15 min)
KLB Pavilion Panel Discussion: Benefits of SMICS Platform (30 min)
Pentacam : Rajan Dutta, Panelists: Keiki Mehta, Sujata Mohan, KP Reddy, Mohan Rajan, Amar Agarwal
Himanshu Mattalia Moderator: Kamal Kapoor
Field analyzer (Oculus)
Microkeratome : Ajay Sharma
: M. Vanathi, Bhawna Chawla
Mehra Eye Tech Pavilion Level: Advanced Sponsored by: B&L University
Digital slit lamp : Chandra Shekhar,
Specular Microscope Prakash Agarwal
: Shalini Mohan
My Healthscape Pavilion
Conductive Keratoplasty : Sri Ganesh, Tejas Shah
Collagen Cross Linking : Rajib Mukherjee, Ashu Agarwal
Novartis Pavilion
Pfizer Pavilion
Video assisted skill transfer Phaco for beginners Multifocal IOLs: Eye/Eyes/Mix & Match
Hall: Convention Hall-A • Date: 29.3.08 (Saturday) • Time: 8.30–10.30 a.m. Hall: Cocktail-A • Date: 29.3.08 (Saturday) • Time: 8.30 – 10.30 a.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Sudipto Pakrasi Rohit Omprakash Tanuj Dada Rakesh Mahajan Vivek Gupta S. Bharti Ashish Bansal Ravijit Singh Rajesh Bhatia Atul Singh
Keynote address: 1.Understanding phacodynamics: Yogesh Shah (12 min) Keynote address: Tackling Presbyopia: Tejas Shah (10 min)
2. Phaco in posterior polar cataract: Athiya Agarwal (10 min)
Time: 8 min each
Time: 8 min each 1. Patient selection counselling refractive IOLs : Ryan Desouza
1. Wound construction: The perfect way : Ritu Aurora 2. Pearls on IOL Power calculation : Tushar Agarwal
2. Capsulorrhexis: How to get it 100% right each time : Harbansh Lal 3. Rezoom multifocal IOLs: My experience : D. Ramamurthy
3. Hydroprocedures and Nucleus Rotation : Anita Sethi 4. Custom IOLs (Mix & Match) : Darshan Bavashi
4. Phaco and I/A: Tips & sleeves : Sameer Kaushal 5. Indigenous Multifocal IOLs (Appasamy) : Arul Mozhi Varman
5. Nucleotomy Techniques, Epinucleus removal & : Reena Sethi 6. Indigenous Multifocal IOLs (Care Group) : N.K. Pattnaik
Cortical Irrigation – Aspiration
7. Intraocular lens implantation: Rigid and foldable : Pankaj Sharma 7. Apodized diffractive – Aspheric Alcon Restore : Sudipto Pakrasi
8. Intraoperative posterior capsule tear: 8. Accommodative IOL : Cyres Mehta
Step wise approach
: Amit Tarafdar 9. Conductive Keratoplasty : Tejas Shah
9. Vitrectomy for anterior segment complications : Alkesh Chaudhary Level: Advanced
10. Anterior vitrectomy with scleral fixated IOLs : Shrikanth
11. Transition to microphacoemulsification : Sharad Lakhotia
Level: Basic
www.dosonline.org 9
Basics of Squint and Visual Development: Basics of Glaucoma Diagnosis
Symposium
Hall : Sapphire (294) • Date : 29-3-08 (Saturday) • Time : 8.30 – 10.30 a.m.
Hall : Cocktail-B • Date : 29.3.2008 (Saturday) • Time : 8.30 – 10.30 a.m. Chairman Co-chairman Convener Co-convener Moderator
S.S. Pandav Manavdeep Sushmita Gursatinder Deven Tuli
Chairman Co-chairman Convener Co-convener Moderator Kaushik Singh
Singh
D. K. Sen B. S. Goel Vinita Singh V. Krishna Suma Ganesh
Time: 8 min each Keynote address: How to decide which diagnostic test to choose?: Rajul Parikh
(15 min)
1. Essential equipments for squint practice. : Arun Samprathi 1. Pearls for Applanation Tonometry : Manavdeep Singh 12 min
2. Does convergence insufficiency exist? : Abhishek Dagar 2. Which tonometer to use (NCT, GAT,
Tonopen, DCT)
3. Prescription of glasses in patients with strabismus : Zia Chaudhuri : Deven Tuli 12 min
4. Amblyopia treatment: What have we learnt from 3. Clinical Optic Disc Evaluation : Anand Aggarwal 15 min
clinical trials?
: Shailesh G. M. 4. Gonioscopy Pearls. Automated Perimetry : Gursatinder Singh 15 min
5. How much does my child see: visual assessment 5. Basics, Which strategy to use,
How to interpret
in children. : Vinita Singh : Devindra Sood 20 min
6. Evaluation of vision in children with special needs : Sumita Agarkar 6. Determining progression Humphrey
Visual Fields
7. Sensory & motor evaluation in strabismus : Kavita Natarajan : Sushmita Kaushik 20 min
8. I got double vision! : A. K. Amitava Level: Basic
9. Active vision therapy: Is it for real : Karan Agarwala
Level: Basic
Endophthalmitis Lacrimal system - an overview
Hall : Room No. 479 • Date : 29.3.08 (Saturday) • Time : 8.30 – 10.30a.m. Hall: Emerald (293) • Date : 29.3.08 (Saturday) • Time : 8.30 – 10.30 a.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
H.K. Tewari D.K. Mehta J.S. Guha Ajay Aurora Neeraj Manchanda V.P. Gupta Usha Singh Rajiv Gupta Satanshu Mathur Prashant Yadav
Each 8 min each Keynote Address: Repair of canalicular tear: V.P. Gupta (15 min)
1. Ideal OT : Prevention of endophthalmitis : Tinku Bali Time: 8 min each
2. Inflammation or Infection ? : Col. Vijay Mathur 1. Basics of lacrimal system surgery : Sajid Fazili
3. My initial approach to post surgical endophthalmitis : Lalit Verma 2. Conventional DCR - getting it right : Kiran Tandon
4. Vitrectomy for endophthalmitis : When and How ? : Dinesh Talwar 3. Intervention for congenital NLD block – : Manish Kumar
when and how?
5. Intravitreal drug delivery and risk of endophthalmitis 4. Failed DCR - management : Sushil Kumar
(in era of VEGF injections) : Subrata Mandal
6. Traumatic endophthalmitis – approach to 5. Non surgical management of epiphora : Raj Anand
management
: Y.R. Sharma 6. Laser DCR: My results : Satanshu Mathur
7. Management of Fungal Endophthalmitis : Mangat R. Dogra 7. Conventional DCR Vs Endonasal DCR : Anjali Mehta
8. Chronic Endophthalmitis: Therapeutic options : Rakesh Maggon Level: Basic
9. Role of steroids in postoperative endophthalmitis : Mallika Goyal
10. Prophylaxis in endophthalmitis – current thinking : Vipul Baishya
Level: Basic
10 DOS Times - Vol. 13, No.9, March 2008
Contact Lenses Video Theatre: Disasters in Cataract Surgery
Hall: Ruby (292) • Date : 29.3.08 (Saturday) • Time : 8.30 – 10.30 a.m. Hall: Convention Hall-A • Date: 29.3.08 (Saturday) • Time: 10.45 a.m. – 12.45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Murali Monica Keiki Mehta Mahipal S. Shashi
Pamela Nibaran Kirti Singh Aasuri Chaudhary Kapoor Rohit Om Namrata
Sachdev
D’Souza Gangopadhyay Prakash Sharma
Keynote address: Microbial keratitis and sterile peripheral ulcers in contact lens Keynote address:Surgical solutions for subluxated cataract: Abhay Vasavada
users: How to differentiate clinically : Murali Aasuri (15 min) (15 mins)
Time: 8 min each Topic: My Phaco nightmares Speakers: Time: 20 min each
Amar Agarwal
1. Basics soft lens fitting : Rajesh Wadhwa D. Ramamurthy
Sri Ganesh
2. R.G.P. fittings – An overview of basics : Monica Chaudhary J.S. Titiyal
Abhay Vasavada
3. Toric contact lens fitting : Priyanka Dhingra Level: Intermediate
4. Silicone hydrogels – The mother of inventions : Neeraj Dabral
5. Multifocals – Life begins at 40 : Nilesh Thite
6. One day disposables : Amod Gogate
7. Orthokeratology : Yasmin Bhagat
8. Practical demonstration of hybrid colour : Ram Kishore Saha
contact lenses
Level: Intermediate
Video Session Ocular Surface Disorder
Hall: Convention-B • Date: 29.3.08 (Saturday) • Time: 8.30 a.m. – 12.45 p.m. Hall: Convention-C • Date: 29.3.08 (Saturday) • Time: 10.45 a.m. – 12.45 p.m.
Chairman Judges Chairman Co-chairman Convener Co-convener Moderator
P.N. Seth Rajeev Gupta, Rajender Prasad, Tushar Agarwal
Rasik B. Vajpayee J. S. Titiyal Samar Basak V. Sangwan Nikhil Gokhle
1. Combination 20+23G Vitrectomy : Atul Kumar Keynote address: Limbal Stem Cell Transplantation for ocular surface
disorders: V. Sangwan (15 min)
2. Basics of diabetic vitrectomy : Gopal Lal Verma
Time: 8 min each
3. Diabetic vitrectomy following intravitreal avastin : Preetam Singh
4. Medial Wall Fracture-Fate or Miracle of Medical 1. Prevalence of Dry Eye in India and Asia Pacific : Rishi Mohan
Science : Arnab Biswas 2. Diagnosis, Grading & investigation of Dry Eye : A.K. Jain
5. Radial keratotomy as an adjuvant to Lasik : Janak V Mehta 3. Artificial Tears – When & Which : M.S. Sridhar
6. Safe CCC in the intumescent white : Sajjad Fazili 4. Role of Systemic / Topical immune modulation : Namrata Sharma
7. Salvaging the unsalvagable : Rupesh Agrawal
5. Amniotic Membrane Transplant : J.S. Titiyal
8. Scleral Fixated Intraocular Lens implantation in
Vitrectomized Eyes : Vipin Kumar Vig 6. Kerato Prosthesis : Geetha Iyer
9. SICS : Incision is the key, viscoe is the saviour : Sajjad Fazili 7. Interesting Cases : Ajay Dave /
Rishi Mohan
10. Simplified conversion from phacoemulsification to
manual small incision cataract surgery : Vipin Sahni Level: Intermediate Panel Discussions Sponsored by: Allergan
11. Aspiration canula Method of Continuous
Curvilinear capsulorrhexis : Shaunak P. Mokadam
12. Fugo blade capsulotomy in membranous cataract : Kiranjit Singh
13. Unusual presentation of intraocular cysticercosis : Zahir Abbas
14. Cyanoacrylate Glue: An eye saver : Ashu Agarwal
www.dosonline.org 11
Update in Oculoplasty LASIK Surgery
Hall: Cocktail - A • Date: 29.3.08 (Saturday) • Time: 10.45 a.m. – 12.45 p.m. Hall: Room No. 479 • Date: 29.3.08 (Saturday) • Time: 10.45 a.m. – 12.45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
A.K. Grover Nitin Trivedi Neelam Pushker Vandana Kohli Archana Sood Rajender Khanna Vivek Pal Pawan Goyal Aniel Malhotra Ashu Aggarwal
Key note Address: Ophthalmology and aesthetics : ER Mohan (12 min) Keynote Address: iLASIK - The LASIK for Gen i: Sri Ganesh (15 min)
Time: 8 min each Time: 8 min each
: Jasmita Popli
1. Tools in oculoplastic surgery- an update : A.K. Grover 1. Preoperative investigations: The limits of Lasik and
2. Radiosurgery in oculoplasty : Sanjay Sachdeva
3. Endoscopic surgery in the orbit : Sonu Goel surface ablation : Neera Aggarwal
4. Laser DCR current status : Nitin Trivedi
5. Socket reconstruction and implants : Anita Sethi 2. Subclinical keratoconus : Prema Padmanaban
6. Botox in Oculoplasty : Usha Singh
7. Thyroid Eye Disease – Clinical aspects 3. Basics of wave front assessment : Dariel Mathur
8. Ophthalmology and aesthetics (a match made : Milind Naik (12 min)
4. Sterlization of LASIK accessories : Ranjan Dutta
in heaven)
Level: Intermediate 5. The surgical procedure and follow up : P. Bhasin
6. Complications: How to manage them? : Amit Gupta
7. Wave front guided Lasik, is it worth it : Kapil Vohra
8. Aspheric Zyoptix : K.P. Reddy
9. Corneal Biomechanics : Chitra Ramamurthy
10. Corneal ectasia:Management options : Rishi Mohan
Level: Basic
ARMD Challenge Glaucoma Investigations
Hall : Cocktail-B • Date : 29-3-08 (Saturday) • Time : 10:45– 12:45 p.m. Hall: Sapphire (294) • Date: 29-3-08 (Saturday) • Time: 10:45 a.m. – 12:45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
R.V. Azad Nitin Verma Atul Kumar Amit Khosla Lalit Verma H.C. Agrawal Devindra Sood Rajul Parikh Rajeev Jain Taru Dewan
Time: 8 min each Keynote address:Managing complications of glaucoma filtering surgery:Prateep
Vyas (15 min)
1. Understanding VEGF & Anti VEGF : Prashant Agnihotri
2. VEGF Inhibition : Need for selectivity in AMD 1. Role of Cornea thickness & hystersis in : Ruchi Goel 8 min
interpreting IOP
Management : Nachiketa Acharya
2. Current role of FDP and SWAP : M Baskaran 8 min
3. Systemic Safety concerns in Anti-VEGF : Cardiologist 3. Clinical Application of Pentacam
therapy Lectures with case studies
: Rajeev Jain 8 min
4. Macugen in AMD: Real World Experience : Atul Kumar,
(Dr. R.P. Centre)
Charu 4. Optic nerve head imaging with HRT : Rajul Parikh 15 min
(Shroff Eye Centre)
5. Retinal nerve fiber layer evaluation with
GDx VCC : Ritu Gadia 15 min
5. Targeted Anti VEGF treatment: Beyond AMD : Dinesh Talwar 6. Optic nerve head and RNFL imaging with
(RMG Experience)
Stratus OCT : Sushmita Kaushik 15 min
6. Case Series – I (PDR) : K. Satyen
7. Imaging with UBM and ASOCT : M Baskaran 15 min
7. Case Series – II (ROP) : Ajay Dudani
Level: Advanced
8. Case Series – III (Vascular Block) : Indu R. Singh
9. Retinal Chips & Artificial Retina : Rajat Agarwal
Level: Advanced Sponsored by: Pfizer
12 DOS Times - Vol. 13, No.9, March 2008
Free Paper-1 Lunch Time Session
Hall: Emerald (293) • Date: 29.3.08 (Saturday) • Time: 10.45 a.m. – 12.45 p.m.
Chairman : Sunandan Sood Judges : Jolly Rohtagi, Vijay Sabharwal, Rajesh Sinha Hall: Emerald (293) • Date: 29.3.08 (Saturday) • Time: 12.45 p.m. -1.45 p.m.
Time: 7 Min each Asian Ophthalmology Academy Meeting
1. Role of Corneal Cross Linkage with Riboflavin in Sarbjit Singh Satanshu Mathur Gaurav Luthra Anita Panda
Keratoconus
: Gurbax Singh Hot, Hotter, Hottest: Late Breaking News
2. Therapeutic Deep Anterior Lamellar Keratoplasty (DALK) : Gurbax Singh
In Acute Ocular Alkali Burns Hall: Convention Hall-A • Date: 29.3.08 (Saturday) • Time: 1:45 – 3:45 p.m.
: Kapil Bhatia
3. Comparison of Triamcinolone Acetonide (TA) Vs : Naginder Chairman Co-chairman Convener Co-convener Moderator
Indocyanine Green (ICG) As a Staining Agent In Macular
Hole Surgery Vashisht Daljit Singh Rasik B. Vajpayee D. Ramamurthy S. Lakhotia Sanjay Ahuja
: Vinod kumar
4. Intravitreal Bevacizumab in Macular Edema Secondary : Naresh Kumar Keynote address: High-tech Ophthalmology : Amar Agarwal (20 min)
to Retinal Vein Occlusion: One year results
Yadav 1. Fugoblade for ophthalmological procedures : Daljit Singh 20 min
5. OCT Based hole Configuration as Predictive tool for : Manjari Tandon
Visual Outcome after Macular Hole Surgery 2. Toric IOLs : C.M. Wavikar 10 min
: Vinod Kumar
6. Photodynamic Therapy and Intravireal Triamicinolone : Lokendra Tyagi 3. Goal of MCCS : Abhay Vasavada 10 min
Acetonide for Subretinal Neovascular Membrane in
Type 2 Parafoveal Telangiectasia : Neha Goel 4. Benefits of higher vacuum with high : Sri Ganesh 10 min
: Satish Desai end phaco system
7. Retinoblastoma Presenting with Ocular Inflammation
8. Study of Pars Plana Vitrectomy (PPV) With Internal : Neha Goel 5. 100 MIOLs : Mohan Rajan 10 min
: Ruma Gupta
Limiting Membrane (ILM) Peeling In Diffuse Diabetic : Ankur Agarwal 6. Sutureless vitrectomy : Rajiv Jain 10 min
Macular Edema : Smruti Rekha
9. Visual Performance: Comparison of foldable intraocular 7. Femtosecond laser : Mahipal S. Sachdev 10 min
lenses. Priyadarshini
10. Comparative Evaluation Of Intravitreal Bevacizumab 8. ICL : D. Ramamurthy 10 min
Versus Intravitreal Triamcinolone Acetonide (IVTA) In
Refractory Diabetic Macular Edema (DME). Level: Advanced
11. Epidemiology of Ocular trauma in Central India
12. Evaluation and Comparison of Sub-Threshold and
Conventional Threshold Diode Laser Photocoagulation
in Treatment of Diabetic Macular Edema
13. Incidence of refractive error and other ocular
aberrations in school children in Delhi and NCR
14. Triple procedure: Phacoemulsification with intra
ocular lens implantation and pars plana vitrectomy
15. A Study On Preoperative IOL Power Measurement
and Post Operative Refractive Error in 100 Cases
Low Vision Aids and Spectacle Dispensing Cutting Edge Therapies for ARMD
Hall: Ruby (292) • Date: 29.3.08 (Saturday) • Time: 10.45 a.m. -12.45 p.m. Hall: Convention Hall - C • Date: 29.3.08 (Saturday) • Time: 1:45 – 3:45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
H.C. Agarwal Sunita Lulla Ram Aggarwal Rajeev Prasad Ajay Sharma
H.K. Tewari Lalit Verma B. Ghosh Meenakshi Thakkar Navin Sakhuja
1. Evaluation of a patient with low vision : Sunita Lulla 10 min Time: 8 min each
2. Optical low vision devices : Rajeev Prasad 10 min 1. Epidemiology, risk factors and Genetics in ARMD : Manisha Agarwal
3. Non optical devices : Rajeev Prasad 10 min 2. OCT / FA – Which ? When ? : B. Ghosh
4. Rehabilitation services: Overview : Buela Chisty 10 min 3. OCT based management in ARMD : Sanjeev Gupta
5. Rehabilitation services: Back to school : Monica Chaudhary 10 min 4. Pegaptanib : It’s role in ARMD : Ajay Dudani
6. New Assistive technology in low vision : Ram Aggarwal 15 min 5. Ranibizumab in ARMD – Is it ultimate ? : R.V. Azad
7. Types of spectacle lenses : Damanjot 10 min 6. Bevacizumab in ARMD - Will it replace Lucentis ? : S.P. Garg
8. Progressive addition lenses : Kulbhushan 10 min 7. Combo therapy in ARMD (anti VEGF + PDT / PDT +
9. Refracting the child : Monica Chaudhary 10 min anti VEFG) : Dinesh Talwar
Level: Basic 8. Triple therapy: (Anti VEGF + PDT + Steroids) : Charu Gupta
9. Newer Targets : Beyond VEGF : S. Natarajan
10. Surgical Management of CNVM : Manish Nagpal
Level: Intermediate
www.dosonline.org 13
Cornea and External Disease Ocular Trauma: Management Options
Hall : Cocktail-A • Date : 29.3.08 (Saturday) • Time : 1.45 – 3.45 p.m. Hall: Room No. 479 • Date: 29.3.08 (Saturday) • Time: 1.45 – 3.45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Gurbax Singh Pamella D’Souza Ashok Sharma Praveen Krishna Ravi Manocha D.P. Vats J.K.S. Parihar Raj Pal Insan Rakesh Maggon Parijat Chandra
Keynote address: Pathobiology of stem cell culture : Geeta Vemuganti (15 min) Time: 8 min each
Time: 8 min each 1. Demographics of ocular trauma: North Indian –
perspective
1. Preservative-Free therapy in dry eye : Dorothea GroB (10 min) : Deepender V. Singh
2. Computer vision syndrome : Kirti Singh 2. Scleral Perforation after local anesthesia : A.K. Singh
3. Corneal Epithelial defect: How to handle? : Ashish Bansal 3. Lacrimal system trauma : Shaloo Bageja
4. Ocular Surface Squamous Neoplasia: 4. Cornea – scleral perforation : Rashim Mannan
current management strategies
: Anita Panda 5. RIOFB: Management : Atul Kumar
5. Surgical management of pterygium: Current : A.K. Jain 6. Management of Acute chemical burns : Amit Gupta
perspective
6. Vernal catarrh: Current management : Uma Sridhar 7. Orbital Trauma : E.R. Mohan
7. Management of Peripheral ulcerative keratitis : Paras Mehta 8. Traumatic glaucoma : Suneeta Dubey
8. Ocular Surface melts: How to salvage them? : Nikhil Gokhale 9. Suprachoroidal hemorrhage : Neeraj Sanduja
9. Management of Steven Johnson syndrome. Level: Intermediate
When to intervene?
: Geetha Iyer
10. Is it mandatory to get HIV testing before : Ritu Arora
ophthalmic surgery
Level: Intermediate Sponsored by: Ursa
Venous / Arterial Occlusive Diseases / Primary Glaucoma
Macular Diseases
Hall : Sappihre (294) • Date : 29-3-08 (Saturday) • Time : 1:45 – 3:45. PM
Hall : Cocktail-B • Date : 29th March 2008 (Saturday) • Time : 1.45 – 3.45 p.m.
Chairman Co-chairman Convener Co-convener Moderator
Chairman Co-chairman Convener Co-convener Moderator Ramanjit Sihota Usha K. Raina P. Sathyan Suneeta Dubey Monica Gandhi
Atul Kumar Dinesh Talwar Ajay Aurora Mallika Goyal Mohita Sharma
Keynote address: Primary congenital glaucoma : R Ramakrishnan (15 min)
Keynote address: Recent advances in ROP: M.R. Dogra (15 min)
1. Diagnosing a Glaucoma Suspect : G. Chandrashekhar 15 min
Time: 8 min each
2. Risk factors for progression in OHT & POAG : R Ramakrishnan 10 min
1. Retinal arterial occlutive disease – My approach to : S.N. Jha 3. PACG : Diagnosis and Classification : Ramanjit Sihota 10 min
investigation & management
2. Vascular block – role of Anti – VEGF therapy : Lalit Verma 4. Role of Cataract Surgery in PACG : S.S. Pandav 10 min
3. Eales disease : What have we learnt and what is new? : Sandeep Saxena 5. Laser Procedures in glaucoma : Harsh Kumar 10 min
4. Exudative RD : How to approach ? : Indu Singh
6. Determining progression in Glaucoma : G. Chandrashekhar 15 min
5. Recurrent CSR / Bilateral CSR – How to approach? : S.T. Muralidhar
7. Long term prognosis of glaucoma in India : Ramanjit Sihota 10 min
Level: Intermediate
6. Intravitreal steroids in vascular occlusions : Mohita Sharma
7. Changing trends in medical retina : Ajit Babu
8. Polypoidal choroidal vasculopathy-Difficulties in : Muna Bhinde
diagnosis & management approaches
9. Avastin in ROP : Saurabh Luthra
10. Basics of stem cell transplantation : Rajpal Insan
Level: Intermediate
14 DOS Times - Vol. 13, No.9, March 2008
Free Paper-2 Small Incision Cataract Surgery
Hall: Emerald (293) • Date: 29.3.08 (Saturday) • Time: 1.45– 3.45 p.m. Hall: Convention - A • Date: 29.3.08 (Saturday) • Time: 4.00 – 6.00 p.m.
Time: 7 Min each Chairman Co-chairman Convener Co-convener Moderator
Chairman: Vishnu Gupta Judges: Mahesh Chandra, Lopa Das, P.K. Sahu Anita Panda KPS Malik A.K. Khurana R.S. Dhaliwal H.K. Yaduvanshi
1. Intravitreal Bevacizumab (Avastin) for Idiopathic : Subrata
Choroidal Neovascularization: One and half year results Mandal Keynote address: Role of extra capsular cataract surgery in era of SICS &
Phaco emulsification today : Dr. R.N. Mishra (15 min)
2. A comparative study between two visual field
Time: 8 min each
grading scales: Hoddap-Parrish-Anderson (H-P-A) and
Field Damage likelihood Scale (FDLS). : Tutul Chkravarti
3. Optical Coherence Tomography Staging of Bietti’s 1. SICS: which anesthesia? : Jaswant Arneja
Crystalline Dystrophy : Subrata Mandal
4. Bevacizumab in Proliferative Diabetic Retinopathy & 2. Wound construction : B.N. Choudhary
Vascular Occlussions with Neovascular Glaucoma : Manisha Agarwal
5. Pediatric Primary IOL Implantation-’A Challenge’ : Jaspreet Sukhija
6. High Cerebrospinal Fluid Protein and Optic 3. Easy approach to SICS : S.K. Sharma
Atrophy in Children with Tubercular Meningitis : Archana Singh
7. Normative Data for Central Corneal Thickness in 4. Blumenthal technique : Parul Shah
Indian Paediatric Population : Uday Vithal Naik
8. To evaluate the clinical and epidemiological profile of : Renu Bajaj Nee 5. Irrigating vectis : Debashish Bhattacharya
Retinopathy of Prematurity at a centre in Delhi Grover
9. “Cost effective ,much faster & more comfortable 7. Versatality of ACM : Ruchi Goel
schwind Pendular Microkeratome : Comparable with
Intralase : N.K. Pattnaik 8. Cortical Aspiration and IOL implantation : Kamaljeet Singh
10. Efficacy and safety of small incision cataract surgery
for management of traumatic cataract : Satish Desai 9. Astigmatic considerations in SICS : A.K. Khurana
Level: Basic
11. Visual and Refractive Outcomes and to Determine
Patient Satisfaction Following Multifocal Intraocular
Lens Implantation in Cataract Surgery : Shweta Verma
12. Isolated Cranial Nerve Dysfunction as the
Sole Presentation of Intracranial SOl : Sukhdeep Bains
13. Optic nerve glioma presenting as an anteriorly
palpable mass : Sukhdeep Bains
14. “Visual performance of a foldable diffractive multifocal
IOL with prolate optics; a foldable monofocal IOL with
prolate optics - a comparative study” : Shilpa Taneja
Free Paper-3 Panel Discussion: Glaucoma Investigations
and Management
Hall: Ruby (292) • Date: 29.3.08 (Saturday) • Time: 1.45– 3.45 p.m.
Time: 7 Min each Hall : Convention-C • Date : 29.3.08 (Saturday) • Time : 4.00 – 6.00 p.m.
Chairman: Neeta Guha Judges: V.K. Jain, B.P. Guliani, Alkesh Chaudhary
1. Role of Frequency Doubled Nd:YAG (532 NM) Laser Chairman Moderator
Photocoagulation in Treatment of Corneal S.S. Pandav Devindra Sood
Neovascularization
: Sukant Pandey Panelists : Harish C. Agarwal, Ramanjit Sihota, G. Chandrashekhar,
R. Ramakrishna,
2. Rise of Intraocular Pressure (IOP) after Supratarsal
Triamcinolone Injection: Series of Three Cases : Pankaj Maccani J.C. Das, Harsh Kumar, Prateep Vyas, P. Sathyan, Rajul Parikh
Level: Intermediate
3. Knowledge, Attitude and Practices Regarding Cataract
Surgery among Senile Cataract Cases in Surat : Deepika Singhal
4. Eyelid Reconstruction- Different Surgical Techniques : Gautam Paul
5. Graded Anterior Blepharotomy For Stable Upper Eyelid
Retraction Due To Symptomatic Graves’ Eye Disease : Sachin Mehta
6. Lacrimal Gland Disorders : Pankaj Gupta
7. Injection Sodium Tetradecyl Sulphate : Usha Singh
8. A new technique for treatment of chalazion by a : Hanspal Singh
rotating burr.
9. Conventional lasik v/s zyoptix laser” : Rohit Nanda
10. Early diagnosis and work up in a case of : Vijay Mathur
Endophthalmitis.
11. UBM Analysis in the Lens Study : Suvira Jain
www.dosonline.org 15
Pediatric Cataract Premium IOLs
Hall: Cocktail - A • Date: 29.3.08 • Time: 4:00 – 6:00 p.m. Hall: Room No. 479 • Date: 29.3.08 (Saturday) • Time: 4.00 – 6.00 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
V.K. Dada Jagat Ram Murali Aasuri R. Muralidhar Sanjiv Mohan
Shashi Kapoor Sri Ganesh Sanjay Dhawan Praveen Malik S. Khokhar
Keynote address : Surgical caveats in pediatric cataract surgery : Abhay Keynote address: Violet Blocking IOL Technology : Keiki Mehta (10 min)
Vasavada (15 min) Time: 8 min each
Time: 8 min each
1. IOL power calculation : R. Muralidhar 1. Overview of aberration free IOLs : Ashish Bansal
2. Capsulorhexis and hydroprocedures in pediatric eyes : Ravijit Singh 2. Tecnis technology: The power of asphericity : S.K. Narang
3. Anterior vitrectomy: When indicated how much? : Anju Rastogi 3. Superior outcomes with zero aberration IOLs : V. Kenia
4. IOL: Which material & design? : Rajat Desi 4. ZO: A new aspheric concept : Ajoy Paul
5. Non fiction: Evidence on the value of blue light
5. Management of VAO after pediatric cataract surgery : Jagat Ram filtration : Baskar Roy Chodhury
6. Secondary IOL implantation in children : Sudarshan Khokhar 6. Optimizing outcomes with toric IOL : Abhay Vasavada
7. Challenging situations in pediatric cataract surgery : Murali Aasuri (12 min) 7. Multifocals: An overview : Nandini Ray
8. Improved contrast and image quality with : Rohit Om Prakash
Acrysof IQ
Level: Intermediate
9. Telescopic IOLs : Pankaj Puri
10. Ultra thin IOLs : Gaurav Luthra
11. Ultra smart IOL: My experience : Vikas Mahatme
12. Explantation of IOLs : Angshuman Goswami
Level: Advanced
Target- Orbit Squint and Neuro-ophthalmology: Difficult Situations
Hall: Cocktail - B • Date: 29.3.08 • Time: 4:00 – 6:00 p.m. Hall: Sapphire (294) • Date: 29.3.08 (Saturday) • Time: 4.00 – 6.00 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Mandeep S. Bajaj ER Mohan Raj Anand Mukesh Sharma Sanjeev Gupta Vimla Menon Kamlesh Kalpana Narendran Sumita Agarkar Gopal Das
Keynote address: Complications of Ptosis surgery : Nitin Trivedi (15 min) 1. Resurgery: are there any standard nomograms : Kalpana Narendran 10 min
Time: 8 min each 2. Botulinum toxin in Squint : Sobi Pandey 10 min
1. Evaluation of proptosis : Raj Anand 3. Surgical management of III n palsy : Ramesh Murthy 10 min
2. Surgical approaches to the orbit : Neelam Pushker 4. Acquired strabismus: Find etiology before
the blade
: P. K. Pandey 10 min
3. Management of orbital blow out fractures : Mukesh Sharma
4. Thyroid Ophthalmopathy- Clinical impact : Sanjay Sachdeva 5. Complications of squint surgery Unusual : Arun Samprathy 10 min
Cases for discussion (Case Presentation)
5. Orbital Infections : Anju Rastogi 6. Acquired Brown’s Syndrome : Ankur Sinha 4 min
6. Orbital tumours: An appraisal : Noornika Khuraijam 7. Amblyopia: Are you sure of the diagnosis? : Kanak Tyagi 4 min
7. Pseudotumours: Is it a valid diagnosis? : ER Mohan 8. DEP with horizontal deviation : Subash Dadeya 4 min
8. Top 20 radiological diagnosis : Sanjay Sharma (15 min) 9. Unilateral disc edema: What is the cause? : Satya Karna 4 min
Level: Basic 10. Inferior oblique palsy : R. Muralidhar 4 min
11. Isolated Inferior rectus palsy : Sachin Mehta 4 min
12. Dissociated vertical deviation : Madhu Karna 4 min
13. Ocular Myasthenia : Rajani Battu 4 min
Level: Intermediate
16 DOS Times - Vol. 13, No.9, March 2008
Anterior Segment Investigations in Ophthalmology Video assisted glaucoma surgery
Hall : Emerald (293) • Date : 29-3-08 (Saturday) • Time : 4:00 – 6:00. PM Hall : Convention - A • Date : 30-3-08 (Sunday) • Time : 8:30– 10:30 a.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Harsh Kumar Tanuj Dada Cyres Mehta Binita Thakur Suresh Kumar
G. Mukherjee Ajay Dave Abhinandan Jain Rajib Mukherjee Shipra Tripathi
Keynote address: Corneal diseases: Newer advances in management: Rohit Keynote Address: Critical Appraisal of Literature in Glaucoma : G. Chandrashekhar
Shetty (10 min) (15 min)
Time: 8 min each 1. Basics of Trabeculectomy : Binita Thakur 8 Mins
1. Specular Microscopy: How to analyze results : M. Vanathi 2. Releasable sutures in Trabeculectomy : Suresh Kumar 8 Mins
2. Ocular response analyzer : Rishi Mohan 3. Trabeculotomy-Trabeculectomy : Usha K. Raina 8 Mins
3. IOL Master: In which cases is it useful? : Rashim Manan 4. Basics of NPDS & combo with phaco : Cyres Mehta 8 Mins
4. Pentacam: Benefits and Limits : Himanshu Matalia 5. Surgical Pearls for Implantation of AGV : Harsh Kumar 8 Mins
5. Current application of confocal microscopy : Praveen Krishna 6. Techniques for Combined Surgery : Tanuj Dada 8 Mins
6. UBM: Application in anterior segment imaging : Suvira Jain 7. Choroidal Drainage : Rajul Parikh 8 Mins
7. Anterior segment OCT: seeing the unseen : Virender Aggarwal 8. Cataract surgery in glaucoma patients : Tarun Sharma 8 Mins
8. Ultra High resolution OCT: It is worth it? : Rajeev Jain 9. Glaucoma Surgery Nightmares : Soosan Jacob 15 min
9. Pachymetric pearls : Uma Sridhar Level: Intermediate
10. Newer generation diagnostics Orbscan II Z : Rohit Shetty
Level: Intermediate
Dr. A.C. Agarwal Trophy Session Small Incision Cataract Surgery:
May not be that easy always
Hall : Ruby (292) • Date : 29-3-08 (Saturday) • Time : 4:00 – 6:00. PM
Chairman: D.K.Mehta Hall: Convention - C • Date : 30-3-08 (Sunday) • Time : 8:30– 10:30 a.m.
Judges: R.B. Jain, H.C. Aggarwal, Meenakshi Thakkar, Umesh Bareja
Chairman Co-chairman Convener Co-convener Moderator
Time: 8 min each K.P.S. Malik T.P. Lahane R.N. Mishra M.C. Jha Ragini Parikh
1. Prognostic factors for open globe injuries Analysis : Rupesh V. Keynote address: SICS in challenging situations: M.S. Ravindra (15 min)
of 669 eyes Five year study Agrawal 1. Improper wound architecture? What to do? : K.P.S. Malik 8 min
2. Tuberculosis of the orbit : Usha Singh
3. Dacryocystorhinostomy : A Comparision of 2. White cataract / hard cataract : Debashish Bhatacharya 8 min
External Versus Transcanalicular Endolaser : Vipul Arora
4. How beneficial are glasses alone in the treatment of 3. The subluxated cataract : Ragini Parikh 8 min
anisometropic amblyopia? : Anu Jain
6. Laser Trabeculoplasty as supplement treatment in 4. Glaucoma and small pupil : Ruchi Goel 15 min
primary open angle glaucoma uncontrolled on medication : Deven Tuli
7. Stereoscopy vs Digital imaging for ONH evaluation. 5. SICS: It is always easy : T.P. Lahane 8 min
A statistical Analtsis : Rakesh Maggon
8. Fungal And Bacterial Isolates In Microbial keratitis 6. Cataract with corneal opacity:Combined
patients of western rajasthan & it’s prevelance in desert procedure : Samar Basak 8 min
areas : Ajeet Jakhar
9. M-Flap modification of single-incision combined : Shaunak 7. SICS in cases with Iris coloboma : Parul Shah 8 min
Trabeculectomy with SICS and IOL. P. Mokadam
10. Ocular Manifestations As Presenting Signs 8. SICS versus Phaco : Parikshit Gogate 8 min
In Chronic Myeloid Leukemia Case Series : Mamta Agarwal
11. Change in the Phoria state of the eye after refractive 9. Why SICS is a must learn technique for phaco
surgery for myopia : Archana Gupta surgeons : Vipin Sahini 8 min
12. Just sub conjunctival xylocaine for SICS- no need of
peribulbar injection : Jaswant Arneja Level: Advanced
www.dosonline.org 17
New Horizons in Phacoemulsification & IOLs Fundamentals of Lid Surgery
Hall: Banquet Hall • Date : 30-3-08 (Sunday) • Time : 8:30– 10:30 a.m. Hall: Sapphire (294) • Date : 30-3-08 (Sunday) • Time : 8:30– 10:30 a.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Keiki Mehta David Lubeck Kapil Vohra C.M. Wavikar Anand Shroff M.S. Boparai V.K. Tewari Saman Adil Narinder Singh Kiran Tandon
Keynote address: Customization in cataract surgery: David Lubeck (15 min) Keynote Address : An overview of eyelid tumors: Dr Usha Singh (15 min)
Time: 10 min each Time: 8 min each
1. Wave form from phaco : Rajshekhar 1. Decisions in ptosis surgery : Saman Adil
2. Coaxial microphaco with indigenous machine : Jaya Prasad 2. Levator resection for congenital ptosis : Anita Sethi
3. Clinical impact of microincision cataract surgery : Kamal Kapur 3. Lateral tarsal strip procedure : V.P. Gupta
4. Comparative evaluation of micro IOLs : Kapil Vohra 4. Cicatricial Entropion : Neelam Asthana Goel
5. Visual outcomes with Tecnis multifocal : Anand Shroff 5. Traumatic Ptosis : Usha Yadava
6. Optimizing phaco outcomes with ICE/signature : Yogesh Desai 6. Jaw winking ptosis – an innovative approach : A.K. Grover
8. Managing Toric & Restor – how it has changed 7. Levator Plication : An alternative to resection? : Mandeep Bajaj
my practice
: C.M. Wavikar 8. Senile Entropion : Hardeep Singh
9. Microphaco made easy : S. Venkatesh 9. Lid coloboma repair : Mukesh Sharma
10. Implantation of IOLs : Ajay Sharma Level: Basic
Level: Advanced
Instrumentation, Techniques & Surgical Adjuvants DOS Quiz
in Vitreo-retinal Surgery
Hall: Emerald (293) • Date: 30.3.08 (Sunday) • Time: 8.30 a.m. – 10.30 a.m.
Hall : Room No (479) • Date : 30-3-08 (Sunday) • Time : 8:30– 10:30 a.m. Quiz Masters: 1. Kapil Midha 2. Ashish Lall
Level: Intermediate
Chairman Co-chairman Convener Co-convener Moderator
R.V. Azad Y.R. Sharma S. Natarajan Nitin Verma B.P. Guliani
1. Adjunct Dye & drug assisted vitrectomy: Time 8 min each Management Options in Infectious Keratitis
Chromo Vitrectomy
: Atul Kumar Hall: Ruby (292) • Date : 30-3-08 (Sunday) • Time : 8:30– 10:30 a.m.
2. Why I prefer 23 gauze vitrectomy : R.V. Azad
Chairman Co-chairman Convener Co-convener Moderator
G. Mukherjee Sandeep Mittal M.S. Sridhar Ashish Bansal Uma Shridhar
3. Why I prefer 25 gauze vitrectomy : Y.R. Sharma Keynote address: Urban Allergies: A myth or reality: James Katz (15 min)
4. Advanced MIVS - A reality today : Manish Nagpal
5. Macular hole surgery : R.P. Singh Time: 8 min each
6. Wide angle surgery : Raja Ram Reddy
7. Pharmacologic therapy : prevention & 1. Work up of a case of Infectious keratitis : Tushar Agarwal
: Sandeep Saxena
treatment of PVR : S. Natarajan 2. Importance of in house laboratory for microbiological
8. Stem cell in retinal disorders : P. Bhinde
9. Management of Intraocular cysticercosis diagnosis in infectious keratitis : Sushmita Shah
10. Approach to dropped Nucleus in Quiet eye / : Vinay Garodia
: J.S. Guha 3. Fungal keratitis: Current & emerging treatment
Inflammed eye/ eye with RD
11. VR surgery in difficult situations modalities : M.S. Sridhar
4. HSV keratitis: Is systemic Acyclovir the answer for : Nibaran
Level: Intermediate
HSV keratitis related conditions Gangopadhyay
5. Clinical pearls in managing bacterial keratitis : Sudesh Arya
6. Therapeutic grafts in difficult clinical situations : Paras Mehta
7. Corneaoplastique in corneal ulcer: Adhesives : Ashu Agarwal
8. Indigenous DNA chip for ocular infections : Geeta Satpathy
9. AMG in corneal ulcer : M. Vanathi
Level: Intermediate
18 DOS Times - Vol. 13, No.9, March 2008
The Big Fight: My machine is the best Endothelial Keratoplasty
Hall: Convention -A • Date: 30.3.08 (Sunday) • Time: 10.45 a.m. – 12.45 p.m Hall: Banquet • Date : 30-3-08 (Sunday) • Time: 10.45 a.m. – 12.45 p.m
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Rasik B. Donald Tan Ritu Arora Samar Basak Nibaran
V.K. Dada Jeewan S. Shashi Kapoor Ashu Agarwal Angshuman Vajpayee
Gangopadhyay
Titiyal Goswami
Time: 10 min each Keynote address: Femtosecond guided DSAEK surgery : Donald Tan (15 min)
1. Signature Machine : Mahipal S. Sachdev Time: 8 min each
2. Stellaris Machine : Kamal Kapoor 1. DSAEK: Which patients is it indicated? : Rishi Swarup
3. Infiniti Machine : Rohit Om Prakash 2. DSAEK the conventional technique : Rajesh Fogla
4. Appasamy : Jaya Prasad 3. DSAEK pull through technique : Namrata Sharma
5. Oertelli : Dinesh Sharma 4. DSAEK with hitch suture technique : Jeewan S. Titiyal
6. Nidek CV7000 : A.K. Grover 5. Sutureless DSAEK with glide : Rasik B. Vajpayee
6. DSAEK: with inserter : Donald Tan
Level: Advanced
7. DSAEK: Are Redo’s possible? : Rajesh Fogla
8. Endothelial keratoplasty versus penetrating : Prema Padmanabhan
keratoplasty
Level: Advanced
Diabetic Retinopathy Neuro-Ophthalmology Symposium
Hall: Convention - C • Date: 30-3-08 (Sunday) • Time: 10.45 a.m. – 12.45 p.m Hall: Room No. (479) • Date: 30-3-08 (Sunday) • Time: 10.45 a.m. – 12.45 p.m
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Amod Gupta R.B. Jain Atul Kumar P.C. Bhatia Manisha Agarwal
Hanumantha J. L. Goyal Sobi Pandey B. Venkateshwar Zia
Keynote address:Current trends in pars plana vitreous surgery for diabetic Reddy Rao Chaudhuri
retinopathy: Amod Gupta (10 min)
S.N. Mitter Oration: Optic neuritis: Then and now Prof Vimla Menon (20 min)
Time: 8 min each
Time: 8 min each
1. How to evaluate a case of diabetic retinopathy - : Amit Khosla 1. Analyzing disc edema. : Ankur Sinha
My approach
2. How has OCT changed my Management? : Rajiv Mohan 2. Bright flashes, dark room/ lights in a bowl: : J. L. Goyal
: Atul Kumar fields/VER in neuro cases : Harinder Sethi
3. How effective are anti-VEGF drugs in diabetic
macular edema 3. Vision loss with normal fundus
4. Current management of diffuse diabetic macular edema : Ajay Aurora 4. Options in the management of Traumatic Optic : V. Krishna
Neuropathy : Ramesh Kekkunnya
5. Proliferative diabetic retinopathy – Lasers/ : S.N. Jha : Satya Karna
role of Avastin, when, how many injections 5. Isolated cranial nerve palsy in >40 year old: : Randhir Jha
Is imaging required?
6. Keynote address:Current trends in pars plana : Amod Gupta
vitreous surgery for diabetic retinopathy 6. Patient with ophthalmoplegia with vision loss:
Diagnosis & Management
7. Simultaneous cataract and vitreous surgery – : Shobit Chawla
my experience 7. Ischemic optic neuropathy: Can we salvage
the vision
Level: Intermediate Panel discussion
Level: Intermediate
www.dosonline.org 19
Clinical Challenges In Glaucoma ARMD- Cost Effective Solutions: i-MP+ in CNV
Hall : Sapphire (294) • Date : 30-3-08 (Sunday) • Time: 10.45 a.m. – 12.45 p.m Hall : Ruby (292) • Date : 30.3.08 • Time : 10.45 a.m. – 12.45 p.m
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Babu Rajendran Nitin Verma Jairo Kerr
J.C. Das Kirti Singh M. Baskaran Mayuri Khamar Amrita Kapoor R.V. Azad José Augusto
Azevedo
Cardillo
Keynote: Management of acute hydrops in infantile glaucoma: Anil Mandal (15
min)
1. The Future of AMD Management: Making Sense of
1. Managing Complications of Glaucoma Current Treatment Modalities : Nitin Verma
drainage devices
: J.C. Das 15 min
2. A New Tool for Photothrombosis of CNV: The Opto
2. Drainage devices for Pediatric Glaucoma : Usha Yadava 15 min Maculas™ laser : José Augusto Cardillo
3. Neovascular glaucoma : Amrita Kapoor 8 min 3. Technical Aspects of the Opto Maculas™ Laser
Design and Rationale
: Jairo Kerr Azevedo
4. Drug Induced Glaucoma : Parul Sharma 8 min
4. A Modified Protocol for the i-MP Maculas™ Laser:
5. Post Lasik Glaucoma : M. Baskaran 8 min The i-MP2 Protocol : Babu Rajendran
6. Malignant Glaucoma : M. Baskaran 5. My Clinical Experience with i-MP in India : Partha Biswas
7. Management of shallow AC after : Mayuri Khamar 8 min
trabeculectomy
Level: Intermediate Panel Discussion Sponsored By : M/S Opto Global I-mp
8. Managing overhanging bleb : Mayuri Khamar 8 min
Level: Intermediate
Ablation strategies and Re-dos Lunch Time Session
Hall: Emerald (293) • Date : 30-3-08 (Sunday) • Time: 10.45 a.m. – 12.45 p.m Hall: Convention-A • Date: 30.3.08 (Sunday) • Time: 12.45 p.m. -1.45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Product Launch
1. Laser DCR
D. Ramamurthy J.S. Thind Sanjay Khanna Amit Gupta Anuj Singh 2. Signature 25 min
3. Stellaris 10 min
Keynote address: Topolink: Bujor Banaji : 15 min 4. Toric IOL - Alcon Restore IQ 10 min
5. IOMTA 10 min
Time: 8 min each 10 min
1. Aspheric profiles are better : Gaurav Prakash
2. Custom profiles are better : Yogesh Desai Phacoemulsification: Conquering Challenges
3. Active online iris registration for correction of : S. Bharti Hall: Convention -A • Date: 30.3.08 (Sunday) • Time: 1:45 - 3:45 p.m.
astigmatism and aberration
Chairman Co-chairman Convener Co-convener Moderator
4. How do I enhance after LASIK Surgery : Gaurav Luthra V.K. Dada Keiki Mehta Kapil Vohra Amit Tarafdar Piyush Kapur
5. How do I enhance after surface ablation : M.S. Ravindra Keynote address: Cataract Blindness and control: A global perspective : S. Ruit
(15 min) Time: 8 min each
6. Hyperopic Lasik: What are the results and limits : Rajender Prasad 1. Atraumatic small pupil phacoemulsifcation : Rohit Om Prakash
7. Presbyopic lasik: How has it fared up till now : S.K. Narang 2. Phaco in white cataract : Sanjay Chaudhary
3. Phaco in hard cataract : Ajay Sharma
8. Epilasik surgery: Is it complicated and expensive PRK? : T.M. Sharma 4. Phaco in posterior polar cataract : Jeewan S. Titiyal
9. Vitreoretinal complications of refractive surgery : Chitra Ramamurthy 5. Phaco in the presence of pre-existing capsular : Kiranjeet Singh
deficiency
Level: Intermediate 6. Slit lamp guided posterior polar cataract surgery : Kumar Doctor
7. Traumatic aniridia with coloboma and subuluxation : K.P.S. Malik
8. Phacoemulsification after vitreoretinal surgery : Mahipal S. Sachdev
9. Phaco in uveitic cataract : Somshiela Murthy
Level: Advanced
20 DOS Times - Vol. 13, No.9, March 2008
Customized Component Surgery of Cornea Uveitis
Hall: Convention - C • Date: 30.3.08 (Sunday) • Time: 1:45 - 3:45 p.m. Hall : Room No. (479) • Date : 30.3.08 (Sunday) • Time: 1:45 - 3:45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Madan Mohan Donald Tan G. Mukherjee Ritu Arora Namrata Sharma
S.P. Garg Amod Gupta Jyotirmay Biswas Neeraj Sanduja Arvind Jaiswal
P.K. Jain Oration Award: Current concepts in corneal transplantation surgery : Keynote address: Current Management of uveitis: Jyotirmay Biswas (10 min)
Rasik B. Vajpayee (15 min.)
Time: 8 min each
Time: 8 min. each
1. Assessment of a case of uveitis : Avnindra Gupta
1. Automated lamellar therapeutic keratoplasty : Donald Tan
2. Investigations in uveitis : Mamta Agarwal
2. Deep anterior lamellar keratoplasty – Big bubble technique : J.S. Titiyal
3. Challenging cases in uveitis : Amod Gupta
3. Deep anterior lamellar keratoplasty – Melles technique : Samar Basak
4. Intraocular tuberculosis : Vishali Gupta
4. Deep anterior lamellar keratplasty with limbal stem cell
Transplantation : Ritu Arora 5. Ophthalmic manifestations of HIV in HAART era : Rajesh Sinha
5. Descemet’s stripping automated endothelial keratoplasty : Rajesh Fogla 6. Posterior subtenon injection of corticosteroids:
Comparative study results
: Pradeep Venkatesh
6. Patch grafts : Rajib Mukherjee
8. Management tips in scleritis : Somasheila Murthy
Level: Advanced
9. Biopsy, Pathology in Uveitis : Jyotirmoy Biswas
Level: Basic
Basics of Glaucoma Surgery Beyond Excimer Laser
Hall : Banquet • Date: 30.3.08 (Sunday) • Time: 1:45 - 3:45 p.m. Hall: Sapphire (294) • Date: 30.3.08 (Sunday) • Time: 1:45 - 3:45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Rajender Prasad Amit Gupta
Usha Yadava J.K.S. Parihar Suneeta Dubey Parul Sharma Sanjay Kai MS Ravindra Sudharshan Sanjay
Khokhar Chaudhary
Keynote: Update on glaucoma surgery : R. Ramakrishnan :15 Mins Keynote address: Pearls for safe refractive surgery : D. Ramamurthy (12 min)
1. How to enhance success of Trabeculectomy : Suneeta Dubey 15 min Time: 8 min each
2. Management of a failing filter : Kirti Singh 10 min 1. Phakic IOL Verisyse, on the iris….. to Veriflex : Partha Biswas
3. Surgical Caveats for implanting AHMED : J.K.S. Parihar 15 min 2. Phakic IOL: ICL, behind the iris : Sanjay Dhawan
Glaucoma Valve
4. Basics of phaco trabeculectomy : Kirti Singh 15 min 3. My experience with ICL : J.S. Thind
5. Manual SICS with trabeculectomy : P. Sathyan 10 min 4. Intacs for keratoconus : Himanshu Matalia
6. Cyclocryo and DLCP : Parul Sharma 10 min 5. Presbyopic lens exchange : Sudipto Pakrasi
Level: Basic 6. Bioptics : Kumar Doctor
7. Phakic IOL vs clear lens extraction in high myopia : Sunil Shah
8. Collagen cross linking : S.P.S. Grewal
9. Customized laser vision correction: An overview : G.S. Dhami
and decision making
Level: Advanced
www.dosonline.org 21
Concepts in Strabismology The Big fight: Which Spectral OCT is the best?
Hall : Emerald (293) • Date : 30.3.08 (Sunday) • Time: 1:45 - 3:45 p.m. Hall: Ruby (292) • Date: 30.3.08 (Sunday) • Time: 3:00 - 3:45 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
H.K. Tewari Lalit Verma Prashant Vaishali Gupta Punit Gupta
Pradeep Sharma Vinita Singh P.K. Pandey Ajay Agarwal Rohit Saxena
Agnihotri
Time: 8 min each
Time: 5 min each
1. Decision making in Squint Surgery: simplified : Rohit Saxena
1. Optoview (Care Group) : SPS Grewal
2. Infantile esotropia: Optimal time of surgery? : Hanumantha Reddy
2. Copernicus (KLB) : Dheeraj Bansal
3. A/V patterns: Do I have to touch the obliques? : Pradeep Sharma
3. Cirrus (Zeiss) : Vaishali Gupta
4. Duane’s Syndrome: Diagnosis & management : Ajay Agarwal
4. SLO-OCT (Biomedix) : Dinesh Talwar
5. Brown’s Syndrome: when & how to intervine? : B. Venkateshwar Rao
5. Topcon 3D OCT 1000 (Mehra Eye Tech) : Shan D’Souza
6. IDS: When to operate? : Suma Ganesh
6. Spectral OCT: New findings : Punit Gupta
7. Nystagmus – Management options : Kamlesh
Level: Advanced
Level: Advanced
Aesthetic Ocular Surgery The Big fight: Excimer laser Machine
Hall: Ruby (292) • Date: 30.3.08 (Sunday) • Time: 1:45 - 3:00 p.m. Hall: Convention - A • Date: 30.3.08 (Sunday) • Time: 4.00 – 6.00 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
Bujor Banaji SPS Grewal Sanjay
Satish Chawdhary A.K. Grover Poonam Jain Neelam Asthana Anju Rastogi Dhawan Sameer Saurabh
Kaushal Chaudhary
Keynote Address : Trends in cosmetic treatments and surgery in west : Satish Time: 8 min each
Chawdhary (15 min)
1. Facial rejuvenation surgeries : Rashmi Taneja Machines
2. Filler treatments : Satish Chawdhary 1. VISX STAR : Mahipal S. Sachdev
3. Ocular prosthetics : Sachin Gupta 2. Zeiss Mel 80 : Sanjay Lahiri
4. Managing Facial Nerve Palsy : Vikas Menon 3. Nidek EC 500 : S. Bharti
5. The Science and art of blepharoplasty : Poonam Jain 4. Allegretto wave : Yogesh Desai
Level: Advanced 5. Bausch & Lomb Zyoptix : D. Ramamurthy
6. Schwind : Kumar Doctor
7. Solid State Excimer : Samir Sud
Level: Intermediate
22 DOS Times - Vol. 13, No.9, March 2008
Complications of Phacoemulsification Medical Management of Glaucoma
Hall: Convention - C • Date: 30.3.08 (Sunday) • Time: 4.00 – 6.00 p.m. Hall : Sapphire (294) • Date : 30.3.08 • Time: 4.00 – 6.00 p.m.
Chairman: Harbansh Lal, Panelists: Kumar Doctor, Yogesh Shah, Ashok Shroff Chairman Co-chairman Convener Co-convener Moderator
Level: Basic Prateep Vyas Tarun Sharma Soosan Jacob Sangeeta Abrol Harminder K. Rai
Keynote : Managing complications of Mitomycin C: P. Sathyan (20 min)
Practical help for Budding Ophthalmologists 1. Role of IOP in the management of glaucoma : Prateep Vyas 10 min
Hall: Banquet • Date : 30.3.08 (Sunday) • Time: 4.00 – 6.00 p.m. 2. Salient features on pharmacology of glaucoma
medications and Principles of Medical
Chairman Co-chairman Convener Co-convener Moderator Management of POAG : Gursatinder Singh 10 min
Y.R. Sharma Rajpal Insan Aparna Ahuja Soman Nair Shibal
3. Improving Compliance and adherence to
Bhartiya glaucoma medications : Mayuri Khamar 10 min
Keynote address: Study designs in ophthalmology : R.M. Pandey (20 min) 4. Landmark glaucoma trials: A synopsis : Shalini Mohan 15 min
1. Basic statistical analysis : M. Kalaiveni 15 min
5. Clinical pearls in managing Glaucoma patients : Tarun Sharma 15 min
2. How to write a good scientific publication : Zia Chaudhuri 10 min
Level: Basic
3. How to write a protocol for clinical trial : Rajesh Sinha 10 min
4. Resident doctors perception of their residency
training programmes : Parikshit Gogate 10 min
5. Academic aspects of ophthalmological career : Soman Nair 10 min
6. How to make a good video presentation : Tushar Agarwal 10 min
7. Designing a low coast slit lamp digital : Ashu Agarwal 10 min
imaging system
Level: Basic
Practice Management Pediatric Ophthalmology
Hall: Room No. 479 • Date: 30.3.08 (Sunday) • Time: 4.00 – 6.00 p.m. Hall: Emerald (293) • Date : 30-3-08 (Sunday) • Time : 4:00 – 6:00 p.m.
Chairman Co-chairman Convener Co-convener Moderator Chairman Co-chairman Convener Co-convener Moderator
D. Ramamurthy Amit Khosla Kamal Kapoor Jaideep Bajaj Arun Sethi Supriyo Ghose R.V. Azad Usha K. Raina Anju Rastogi Abhishek Dagar
Keynote address: Clinical Sciences Hijacked: Vinita Singh (10 min) Keynote address: Government Guidelines for visual certificates (Low Vision,
blind, colour vision blind): Rachel Jose (15 min)
Time: 8 min each
Time: 8 min each
1. Planning Ophthalmic career in the Middle East : Fazal Algabaly 1. Evaluation of a visually inattentive child : Sumit Monga
2. How to start your own practice? Elements of a 2. Pediatric Trauma : Suma Ganesh
business plan
: Jaideep Bajaj
3. Common pediatric tumours : Usha Raina
3. How to market your practice? Elements of branding
and marketing : J.P. Singh 4. Congenital glaucoma : Usha Yadava
4. How to management finances of your practice? : Saimant Chadha 5. Screening in ROP : Uma Mallaiah
Elements of cash flow and financial management : Rishi Kapoor 5. Congenital Stationary night blindness : Tapas Paddi
6. Orbital cellulitis in children : Noornika Khuraijam
5. Legal knowledge every clinician should know. 7. Acute chemical burns in children : Amit Gupta
Elements of agreements, practice liability
Level: Intermediate
8. Limbal lensectomy in pediatric subluxated lens : Kanak Tyagi
Level: Intermediate In collaboration with ORBIS International
www.dosonline.org 23
26 First contact management of ocular trauma patient : Kranti Reddy
Collagen Crosslinking: What is the consensus 27 Foldable IOL Scleral Fixation with Flapless Suturing : P. Ratan Kumar
28 How beneficial are glasses alone in the treatment of anisometropic amblyopia? : Anu Jain
29 Initial experience with Ahmed Glaucoma Valve Implant in patient with
Hall: Ruby (292) • Date : 30.3.08 • Time : 4:00 – 5.00 p.m. refractory glaucomas. : Rita Hansaria
30 Isolated Cranial Nerve Dysfunction as the Sole Presentation of Intracranial SOL: Kumudini Sharma
31 Management of Microphthalmos : Sachin Gupta
Chairman Co-chairman Convener Co-convener Moderator 32 Mega Dose Intravenous Methylprednisolone (Ivmp) In Indirect Traumatic Optic
Madan Mohan Anita Panda G. Mukherjee Ritu Arora Bhavna Chawla Neuropathy (ITON)( 30mg/kg bolus f/b 5.4mg/kg/hr for 48 hrs), Assessment : Smita Srivastava
33 Metastatic Adenocarcinoma of Lung Presenting As ILL-Fitting Prosthesis : Anu Jain
Panelist: Mahipal S. Sachdev, SPS Grewal, S. Bharti, Rishi Mohan, Ajay Dave, 34 Ophthalmic Referral Patterns in Bihar - An Overview : Ranjana
Ashu Agarwal, Rajib Mukherjee
35 Optic nerve glioma presenting as an anteriorly palpable mass : Sukhdeep Bains
36 Orbital abscess of uncommon aetiology : Anu Jain
37 Periocular Capillary Hemangioma at a Tertiary Care Center in North India : Usha Singh
Level: Advanced 38 Prevention is Better than Cure: Recurrence in OSSN : Vipul Arora
39 Primary Posterior Capsulorhexis with Posterior Chamber IOL Implant for
Traumatic Cataract in Children-A prospective Study on 12 eyes: : Chandrakanth K.S.
40 PRK with MMC in patients with flap related complications after LASIK : Rakesh Gupta
41 Pseudoaccomodation, do the Factors Really Exist to Support it : Manoj Gautam
Beyond Keratoplasty 42 Ptechial Haemorrhage, New clinical sign in F.B. conjunctiva : G.C. Jain
43 Retinal Implants: A Ray of Hope : Lokesh Jain
44 Reversal of Optic Disc Cupping in Adults Following Trabeculectomy :
A Series of two cases Snehangsu Basu
Hall: Ruby (292) • Date : 30.3.08 • Time : 5:00 – 6.00 p.m. 45 Role of Close Chamber Thermometry & Humidity in Dry Eye : Hanspal Singh
46 Role of frequency doubled Nd:Yag (532 nm) laser photocoagulation
Chairman Co-chairman Convener Co-convener Moderator in treatment of corneal neovascularization : Sukant Pandey
Donald Tan Rishi Mohan S.C. Gupta Radhika Tandon S.S. Lalvani
47 Role of Frequency Doubled Nd:Yag (532 NM) Laser Photocoagulation
in Treatment of Corneal Neovascularization : Sukant Pandey
48 Role of Nasal Endoscopy in the management of Congenital Nasolacrimal
Keynote address: Osteo odonto keratoprosthesis: The Singapore experience : duct block : Usha Singh
Donald Tan (10 min)
49 Role of Persistent Epithelial Defects in influencing ultimate graft survival : (Lt Col) Vijay Mathur
50 SICS. New Calliper and Blades - SICS Made Easy & Cheap : G.C. Jain
51 Sodium Bicarbonate Buffering in Ocular Anaesthesia. Is it a more Effective and
Time: 8 min each cost Effective Alternative to Hyaluronidase? : Archana Singh
52 Specular microscopy of corneal endothelium in diabetic and non diabetic
patients in manual small incision cataract surgery : I.P Singh
1. Before keratoprosthesis: Bostonscleral lens : Chandra Shekhar Chawan 53 Spontaneous filtering bleb in a case of localized scleroderma – rare case report : T. Chakraborty
54 Spontaneous filtering bleb in a case of localized scleroderma – rare case report : Reena Manchanda
55 Surgical repair of selected cases of open globe injuries under topical
2. Boston Dohlman keratoprosthesis : Radhika Tandon anaesthesia : Rupesh Agrawal
56 Surgically Induced Astigmatism after Phacoemulsification: 5.5mm versus 3.2mm
3. Osteodonto keratoprosthesis: Indian experience : Geetha Iyer Limbal Tunnel Incision : Archana Sood
57 Sutureless Vitrectomy under topical : Lokesh Jain
58 The IOL-Vip system for visual rehablitation inpatients with Dry Macular
4. Champagne Cork keratoprosthesis : Indu Singh Degeneration : Pankaj Puri
59 The use of Perforated Silicone Prosthesis Following Eviseration : Prashant Bhushan
60 To study the Anatomical and Functional Outcome of Transpupillary
Level: Advanced Thermotherapy
Posters (TTT) in Idiopathic Central Serous Retinopathy (ICSC) : Meenakshi Thakar
61 Toric Intraocular Lenses- Clinical Results And Rotational Stability : Rohit Nanda
Judges: Anita Sethi, Amit Khosla, Sanjay Chaudhary 62 Treatment of mild to moderate keratoconus with the help of semi soft
: Kenshuk Marwah
Hall: Convention -B • Date : 29-30 March, 2008 and piggy back contact lens : Rakesh Gupta
63 Unusual case of bilateral fungal keratitis after PRK with mitomicin-c. : Neeru Gupta
1. Changing spectrum of fungal species causing mycotic keratitis in Northern India : Garima Jain 64 Unusual case of conjunctival ulceration following eye injury. : Amit Garg
65 Unusual presentation of cysticercosis : Kiran kumar
66 Unusual Presentation of Tuberous Sclerosis : Kiranjit Singh
67 Veiled Incision
2. A Case of Progressive Supranuclear Palsy (PSP) with convergence : Mayee Rishikesh
insuffiency as initial presentation Charudatta
3 A profile of Ocular manifestations in Head trauma : Snehal Radke
4 A Rare Case Of Optic Nerve Head Drusen : Lokesh Jain
5 Age wise Microbiological Profile in Chronic Dacryocystitis : Eesh Nigam
6 Atypical ocular toxoplasmosis in immunocompetent patient : Kranti Reddy
7 Bevacizumab In Macular Edema : Manisha Agarwal
8 Bilateral Orbital Leukemic Tumor with Unusual Presentation of Unilateral
Facial Nerve Palsy : Saumendra N. Ghose
9 Bone Saving Orbitotomy for Removal of Retro Orbital Mass : Preetinder Kaur
10 Botulinum toxin A in the treatment of Phthiriasis palpebrarum : K. Vaitheeswaran
11 Causes of Childhood blindness in tertiary care hospital : Shubha B. Bhargava
12 Clear corneal tunnel infection with fungus after phacoemulsification : Neeru Gupta
13 Clinical Assessment of Various Factors Responsible for Posterior
Capsular Opacification and Varied Methods to Alleviate it. : Saras Jain
14 Clinical Features And Management Outcome of Pediatric Orbital Abscess : Priyata Seth
15 Clinical Profile, Laboratory Investigations, Treatment and Visual Outcome
of Sarcoidosis with Extraocular Manifestations : Mamta Agarwal
16 Comparison of Results of Laser Interferometry. In Silicone Oil Filled Eyes Versus
Intra-Operative Biometry after Silicone oil Removal for Measurement of Axial
Length of the Eye : Neelima Gulati
17 Comprehensive Management of True Congenital Anophthalmia: A case report : Priyata Seth
18 Correlation of age, serum ferritin levels and chelation therapy with ocular
manifestations in children with beta thalassemia : Kenshuk Marwah
19 Diunral variation an important diagnostic tool for normotensive glaucomatous
patients : Prekshah V. Shah
20 Efficacy and Tolerability Of Dorzolamide In Comparison With Timolol In Primary : Open Angle
Glaucoma Patients : Sowbhagya
21 Evaluation and Comparison of Sub-Threshold and Conventional
Threshold Diode
Laser Photocoagulation in Treatment of Diabetic Macular Edema : Neha Goel
22 Evaluation Of Effectiveness And Safety Of Intravitreal Bevacizumab
[1.25mg/ml] As a Primary Therapy in Choroidal Neovascularization Secondary
to Patho : Smita Srivastava
23 Evaluation of small incision Traceculectomy avoiding Tenon’s Capsule as an
alternative to conventional trabeculectomy. : Prateek Gujar
24 Eyes on the “Thrones” : Sachin P. Mehta
25 Final Visual Outcome Following IOL Implantation in Children for Unilateral
Traumatic Cataract : Manoj Gautam
24 DOS Times - Vol. 13, No.9, March 2008
Trade Index Stall No. Company Name
Stall No. Company Name 77 International Medical Devices Pvt. Ltd
114-115 Iscon Surgicals Ltd.
F Bausch & Lomb 36-37 Jaggi Brothers
C Advanced Medical Optics 54 Jawa Pharmaceuticals (India) Pvt. Ltd.
D&E Appasamy Assocaties 20-22 Jaypee Brothers Medical Publishers P. Ltd
A&B Care Group 129 Jyoti Surgicals
G&H Mehra Eyetech Pvt. Ltd. 48 K.S.M. Industrial Corporation
M My Healthscape 102 Keeler
N Pfizer 18 Khosla Surgicals
P Novartis 46 Lensai International
R Allergan India 39-40 Madhu Instruments
I&J KLB Instruments 127 Major Surgical & Engg. Works
Q Zeiss 85 Marks Marketing Pvt. Ltd.
L Biomedix 128 Maxcare Pharmaceuticals Pvt. Ltd.
Registration Raymed 32 Medelec Instruments
Alcon India 86 Medica International
O Deepak Enterprises 19 Medicure Instruments
Tea / Coffee Area Micro Vision 9,10 Narang Enterprises
116-119 National Industrial Co.
Stall No. Company Name 44 Nox India Corporation
93,94 Omni Lens Pvt. Ltd.
71 Addax Medical Corporation 122-125 Ophthalmic Marketing & Services Pvt. Ltd.
130 Ahmed Glaucoma Valve 33 Opitca Pharmaceuticals
42 Ajanta Pharma Ltd. 131 Optho Remedies Pvt. Ltd.
29-30 Akas Medical Equipment 1-2 Opto Global Pty. Ltd. (Kee Dee)
15-17 Allied Medical Technologies 47 Parasonic Industries
14 Ankur Metal Works 55 Pest Control(I) Pvt. Ltd.
49 Ascon Medical Instruments
7-8 Aurolab Stall No. Company Name
99-101 Baliwalla & Homi Pvt. Ltd.
60 Basco India 120-121 Pharmtak Ophthalmics (I) Pvt. Ltd.
81-82 Biotech Vision Care Pvt Ltd 11 Prime Surgicals
92 Chona Surgical Co. 58 Purecon Lenses Pvt. Ltd.
3-4 Cipla India 104 Samir Surgitech Pvt.Ltd.
26-28 Epsilon Eye Care Pvt.Ltd. 50 Segal Optics
41 Excel Optics (Pvt) Ltd. 88 Shree Balaji Surgicals
53 Fine Vision - Mumbai 13 Silklens Pvt. Ltd.
87 Forsight Medica 79 SMR Lens
75 Freedom Ophthalmic Pvt. Ltd 73 Solar Opto Medic Pvt. Ltd.
72 G. Surgiwear Ltd. 84,89 Speedways Surgical Co.-Delhi
56 G.S.M. Surgicals Pvt. Ltd. 95 Staar Surgical Ag India
18 GTB Surgical Industries 109-110 Sun Pharmaceuticals Industries Ltd.
6 Hi - Tech Solutions 83 Sunways (India) Pvt. Ltd
12 ICON Medicare (Retikare) 52 Surgi Edge (India)
105 Indigo Impex (P) Limited 80,133,134 Surgicon Healthcare Pvt. Ltd.
57 Indo German Surgical Corpn. 78 Techno Vision India Pvt. Ltd
31 Indo Webal Surgical 51 Timpac Engineers
96-98 Toshbro Medicals Pvt. Ltd.
23-25 Towa Sales Corporation
90 Tulip Surgicals
106 Ursapharm India Pvt. Ltd.
126 Venus Medical Products
45 Venus Surgitech
91 Visine Instruments
34, 35 Vision Impex
38, 43 Vision World
107 Zabby’s
www.dosonline.org 25
26 DOS Times - Vol. 13, No.9, March 2008
www.dosonline.org 29
Agarwal’s Modification of the Malyugin Ring in Cataract
Miotic Pupils with Broken Posterior Capsules
Amar Agarwal1 MS, FRCS, FRCOpth, Boris Malygin2 MD, Dhivya A1 MD, Soosan Jacob1 MS, DNB, FRCS, MNAMS,
Athiya Agarwal1 MD, DO, Larry Laks3
Poor or non dilating small pupils have always been a challenging leading curl (Figures 2, 3) of the ring and tied a knot. The ring is then
situation for both cataract and vitreoretinal surgeons. injected in the pupillary plane with the leading curl touching the iris
Numerous techniques 1,2,3 have been devised and tried to enlarge margin at 6’o clock (Figure 4). As the ring unfolds, the suture knot
the intraoperative pupil size. automatically slips down from the curled position of the ring and
moves slightly away (Figure 5). Now with the help of a sinkey hook
Agarwal Modification of the Malyugin Ring the ring is positioned centrally and each angle is placed gently
entrapping the iris tissue within the curls. The single long end of the
Boris Malyugin3 devised a new iris expander that can pass through suture is secured outside the anterior chamber. Once in place, the
a 2.8mm clear corneal incision. It is a square shaped, transitory ring expands the pupillary opening to 6.0 mm. Then,
implant with four circular ‘scrolls” that holds the iris at equidistant Phacoemulsification surgery or the vitreoretinal surgery is
points. It is one-piece designed with the curls at each angle of the performed followed by intraocular lens implantation (Figure 6). At
ring that provides balanced stretching and gentle holding of the iris the end of procedure the ring is dislodged from all four angles
tissue. One of us (Am A) then modified the Malyugin ring in (Figure 7) and removed from the main port by resetting into the
nondilating small pupil cataract surgeries with preexisting posterior injector.
capsular rent. We placed a 6-0 polygactil suture in the leading curl
of the Malyugin ring and made the end of the suture to stay at the
main port incision. This prevents the inadvertent dropping of the
iris expander into the vitreous during intraoperative manipulation.
Surgical Technique
In the conventional technique, the Malyugin ring is carried through
the main port incision via the injector which unfolds in the pupillary
margin. It is then placed centrally and a sinskey hook is used to
entrap the iris tissue within all the four scrolls. We modified the
technique in complicated cataract surgery with posterior capsular
defect (Figure 1). We placed a 6-0 polyglactic vicryl suture in the
Figure 2: Agarwal’s modification of the Malyugin
ring: A 6-0 polyglactic vicryl suture passed in
the leading curl of the ring
Figure 1: Complicated cataract with posterior Figure 3: The end of the suture is secured outside the
capsular defect and non dilating pupil injector. A simple tie knot in put by passing the needle
1. Dr Agarwal’s eye hospital and Eye research centre, 19, through the leading curl.
Cathedral road, Chennai, India
31
2. Department of cataract and implant surgery, S.Fyodorov Eye Microsurgery
Complex State Institution, Moscow, Russia
3. MST( MicroSurgical Technology), Redmond WA 98052, USA
www.dosonline.org
Figure 4: The ring is then injected in the Figure 6: Shows the posterior capsular defect after
pupillary plane with the leading curl touching lens removal and the suture lying laterally providing
the iris margin at 6’o clock clear operative field
Figure 5: Shows the ring in place with Figure 7: Ring removed.
the suture seen.
Discussion Conclusion
We believe our method of placing suture in the curl has several Thus we believe our modified technique of placing Malyugin ring
advantages. First, while injecting the ring, the chances of the iris in nondilating pupil in complicated cataract surgeries with absent
ring dropping into the vitreous due to poor capsular support is posterior capsule and vitreoretinal surgeries is simple and effective
removed as it is well secured with the suture. Second, if in case of in removing unwanted complications like iris ring dropping in the
large defect where the ring slips into the vitreous, it can be pulled vitreous and thereby preventing unnecessary vitreous manipulation
back easily with the suture end. Thus the surgeon can work effectively and unpredictable outcomes.
below the pupillary plane without the fear of ring slipping into the References
vitreous. Third, intraoperatively one can manipulate the suture to 1. Giardini P, Buratto L. Phacoemulsification in narrow pupil .In S
change the shape of the pupil by rotating through the side port at
least upto 45 degrees. Fourth, this technique can also be used in agarwal, A Agarwal. A Agarwal’s Phacoemulsification volume two,
vitreoretinal surgeries with absent posterior capsule with small pupil. 3rd edition, Jaypee Brothers Medical Publishers, 2004; section 8,
Fifth, the suture does not require additional incisions. The suture is chapter 47: 486-499
carried along with the ring via the injector such that the end remains 2. Agarwal A, Jacob S. Small pupil phacoemulsification: In Amar
always in the main port. Sixth, the suture knot induced trauma is Agarwal’s Phaco Nightmares, Thorofare, NJ, Slack, 2006; 117-130
absent since the knot slips down as it is injected and stays below the 3. Malygin B.Small pupil phaco surgery: new technique. Annals of
iris. Seventh, the suture does not come in the operative field since it Ophthalmology 2007; 39(3):185-193
is always lateralized to one side. Other advantages of Malyugin ring
is always there; like well distributed stretching of iris, decreased First Author
surgical trauma to iris sphincter, no additional incisions, less Amar Agarwal MS, FRCS, FRCOphth
postoperative reaction and normal postoperative pupil shape and
function.
32 DOS Times - Vol. 13, No.9, March 2008
New Perimetric Techniques Glaucoma
Ritu Gadia MD, Tanuj Dada MD, Ajay Sharma BSC, Viney Gupta MD, Ramanjit Sihota MD, Anita Panda MD
Conventional visual field testing, with a standard white-on- 2.75 log units above the background. The dots are positioned
white stimulus, is used routinely to diagnose and follow randomly on a gray background with a luminance of 50 asb using a
patients with glaucoma. However conventional perimetry may not 640 × 480 pixel VGA video display. The motion target is a circular
detect early visual dysfunction and a large number of ganglion cells random dot cinematogram within which 50% of the dots move
may be lost before visual field defects are apparent in patients with centrifugally and rest move in random directions. The circular target
glaucoma. 1-4 itself is stationary (ie. dots move within the target). Each trial is
composed of 10 cinematogram frames displayed in 174 msec. Each
There is a sharp distinction between detection of early visual field dot moves 2 pixels per frame, giving a velocity of 11.76 deg/sec.
damage and detection of early progressive visual field damage. It is Dots moving out of the circular window are wrapped back to the
therefore likely that a test may be very sensitive at detecting early point 180° from the dot exit position.
visual field damage but poor in detecting progressive damage and
vice versa. Visual field testing strategies in the future may need The stimuli are of 17 sizes with a diameter step factor of 10.1 (1.259).
modification, such that different strategies are used to detect these The angle subtended by the stimuli ranges from 0.13° to 8.46°. The
two equally important aspects of clinical glaucoma management. size of the stimulus varies from trial to trial, and a 2/1 staircase
procedure is used to bracket the threshold. The test, therefore,
Newer perimetric techniques include: continues until the smallest circle size seen, defined as the size
threshold at each test point, is bracketed by the staircase procedure.
A. Subjective perimetric techniques: Fixation is monitored by the visual field technician. For clinical
testing, 44 locations are tested; these match the 24-2 Humphrey
• Motion perimetry perimetry test points, except absence of the top and bottom rows
and the two most eccentric points along the nasal horizontal.
• High-pass resolution perimetry
Valid response is one with a reaction time greater than 100 mseconds
• Pattern discrimination perimetry but less than 1 second and having a localization error of no more
than 10° from the center of where the target is presented. The
• Flicker perimetry testing distance from the screen is fixed at 22 cm by a lens holder
attached to the monitor. The 17-inch diagonal monitor gives a 21°
• Rarebit perimetry test field (42° by 42° total).
B. Objective perimetric techniques: Test times for normals range from 12 to 20 minutes.
• Accumap (multifocal VEP) Sensitivity and Specificity
• Pupil Perimetry Motion detection perimetry appears to be more sensitive in
detecting visual loss than conventional automated perimetry in
• Multifocal ERG various optic neuropathies including glaucoma and ocular
hypertension.10
Motion Perimetry
Magnocellular retinal ganglion cell function has been evaluated
with various types of stimuli in patients with glaucoma, suspected
glaucoma, and ocular hypertension (OHT).5-7
Principle
Motion detection perimetry is a method that measures a subject’s
ability to detect a coherent shift in position of dots in a circular area
against a background of non-moving dots (Figure 1). Motion
Perimetry detects the minimum displacement required to detect
movement (Motion displacement thresholds are found elevated in
patient at risk of glaucoma with normal visual fields).
Motion detection perimetry is performed in a darkened room
using an IBM compatible computer.8-9 The test background is
composed of 10,000 randomly positioned white dots with 3.26%
of pixels illuminated at a time. Each one pixel dots is 580 asb or
Figure 1. Motion perimetry video display.
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, 35
All India Institute of Medical Sciences, New Delhi
www.dosonline.org
High Pass Resolution Perimetry
High-pass resolution perimetry (HPRP, also known as ring
perimetry) is thought to test the parvocellular system selectively. It
measures resolution threshold, the ability of the retina to resolve
varying target sizes, in comparison to differential light sensitivity
measured with standard automated perimetry.
Principle
Figure 2. Conventional and motion perimetry High pass resolution perimetry focuses on the ability of the
show similar results (Wall et al10) peripheral retina to resolve smaller and smaller rings, rather than
on the differential light threshold. In areas where ganglion cells are
numerous, resolving ability is high and small stimuli should be
detected. On the other hand, in areas where ganglion cells are less
dense, only large stimuli will be seen.
Procedure
The test is available as the Ophthimus system (Visumetrics and
High Tech Vision, Goteberg, Sweden). The stimulus employed in
high-pass resolution perimetry is a ring with dark borders and a
bright core (Figure 3) presented on a computer screen. The stimulus
is high-pass filtered10 such that the space-averaged luminance of
the borders (15 candelas [cd]/m2) and the core (25 cd/m2) equal
that of the background (20 cd/m2). This technique forms a stimulus
type known as the “vanishing optotype”. In contrary to the
conventional perimetry, here thresholds are expressed in size
increments with fixed contrast. Stimulus design is thus chosen
because it corresponds to the center-surround arrangement of
retinal ganglion cells receptive field. Fourteen target sizes in 1 db
steps are available.
Figure 3. HPRP ring target The test is performed at a distance of 16.7 cm after a suitable near
correction. Resolution thresholds are established for 50 locations
Baez et al11 have shown that psychophysical tests may demonstrate over the 30 degree visual field. The computer runs the entire test
abnormalities of visual function before the appearance of and adapts automatically to the patient´s reaction time as well to
conventional visual field loss in glaucoma. An initially abnormal responses to fixation control tests and “blank” and “catch” targets.
MDT (motion detection threshold) test showed a sensitivity of 73% Fixation in HPRP is monitored using the Heijl-Krakau technique.
and a specificity of 90% in predicting field deterioration within the The patient can, at any time, request a pause by simply holding
cluster of four Humphrey locations closest to the original MDT test down the response button.
site. Sensitivity was lower (40%) in predicting progression at retinal
locations distant from the MDT test site, though specificity remained A large target (20db) is shown twice in each quadrant. If it is not
high (90%). seen, the quadrant is deleted from further testing. The threshold is
determined in each quadrant with one point using 3 db steps, four
to five points with 2 db steps for bracketing, and 1 db step for
remaining points. The testing strategy requires 5 to 6 minutes per
eye.
Advantages CentRing is an adaptation of the Ring Visual Field Test (HPRP)
intended for testing the central 50 visual field. It uses 33 test locations
• Early glaucomatous damage detection. in a fixed, symmetrical pattern. The test strategy is closely similar to
that of the Ring Test. The smaller number of test locations reduces
• Resistant to blur and media opacity. average test time to about 4 minutes. CentRing offers the possibility
of binocular testing, which is useful for evaluating binocular
Limitations summation and inhibition.
• Lack of longitudinal studies in normals, glaucoma suspects Chauhan et al12, 13 demonstrated that high-pass resolution
and glaucoma patients. perimetry detected progression of glaucomatous visual field loss
a median of 12 months earlier than conventional perimetry in
• A stimulus duration of 420 milliseconds necessitates careful 54% of the 26 patients who showed progression with both
fixation monitoring in the administration of MAP. techniques. High-pass resolution perimetry, which has a
substantially reduced test time compared with conventional and
• High normal variability. The normal variability creates a
relatively high SD (between 8.0% and 11.6% coherence).
36 DOS Times - Vol. 13, No.9, March 2008
Figure 4. Right eye HPRP of a 45-year-old subject. Figure 5. Right eye HPRP result of 65 years old subject.
Fixation and reproducibility are good as indicated by no Reproducibility is borderline, due to excessive retest changes.
responses to the blind spot target, a single false response, Inability to see 14-dB target in the lower temporal quadrant,
and retest changes well within normal limits. Ring plot
shows that thresholds rise fairly uniformly with increasing and most 12-dB targets in the lower nasal quadrant,
motivates a label like severe lower altitudinal depression, but
eccentricity. There are no significant deviations in the there is scattered superior abnormality also. This is a case of
probability plot. All indices are within normal limits.
glaucoma; with severe damage (71% of normal neural
So, it is a normal field. capacity has been lost).
short-wavelength automated perimetry and better patient • It cannot present equally fine detail as a full perimetric
acceptance, is also more efficacious than conventional perimetry at • examination.
detecting progression. A study14 of high-pass resolution perimetry •
in the early diagnosis of primary open-angle glaucoma The use of targets with large visual angles naturally works
demonstrated that HRP was more sensitive than automated against detection of very small, circumscribed defects.
perimetry in detecting the glaucomatous visual field defects, its
sensitivity was 93.75% and specificity was 97.7%. It is difficult to show linear nature of defects such as hemianopia
or a nerve fiber layer defect that splits fixation.
Example of a normal (Figure 4) and glaucomatous field (Figure 5) •
are given below. There is a lack of standardization of computer monitors so
that the tests may not be comparable between different
Advantages instruments.
The HPRP has many advantages which are Pattern Discrimination Perimetry
• Quicker examination (5 minutes duration) Pattern discrimination perimetry (PDP), which requires detection
• Early detection and monitoring of glaucomatous damage of both form and motion, may be a better test for detection early
• Earlier detection of progression glaucoma as compared to conventional perimetry, which requires
detection of spots of light.
• Continuous feedback helps to improve concentration Principle
• Excellent test-retest reliability Pattern discrimination perimetry is a test that requires the subject
to detect a static black and white checkerboard stimulus against a
• It uses a standard PC and monitor, which can also be used for background of black and white dots that are randomly reversing
visual acuity testing and other clinical tasks within a standard (i.e., black to white and white to black) over time. The concept
consulting room. underlying this test is that a patterned stimulus would require a
response from an integrated unit of ganglion cells rather than a
Limitations single cell.15,16
• The HPRP Test can not delineate the exact location of the blind
spot.
www.dosonline.org 37
Figure 6. 20 x 20 pixel checkerboard stimuli used in pattern discrimination perimetry,
decreasing in coherence from left to right. The spatial coherence percentage is given below
each stimulus. A percentile scale can be defined from 0% to 100%.
Procedure modulation perimetry (TMP) measures contrast thresholds for a
fixed temporal frequency, and critical flicker frequency (CFF)
It tests 28 locations in the central 30° of the visual field. The size of measures the highest frequency for which flicker is detected at a
the checkerboard varies from 2.5° close to fixation to 12.5° in the fixed contrast. Versions of flicker perimetry exist in both the
midperiphery. The visibility (or coherence) of the checkerboard is Medmont perimeter (Medmont Pvt. Ltd, Camberwell, Victoria,
varied by changing the percentage of pixels used in forming the Australia) and the Octopus perimeter (Interzeag AC, Schlieren,
stimulus. This is done by randomizingthe positions of the remaining Switzerland).
pixels so that they blend into the background. Threshold is defined
as the least percentage coherence of the checkerboard required to The Octopus perimeter measures the critical flicker fusion frequency
perceive the stimulus. A 100% coherence stimulus represents a (CFF), which is the maximum flicker rate at which the subject still
complete checkerboardso that all 20 x 20 pixels were used in forming reports the perception of flicker. This has been shown to be useful
the stimulus. In a 0% coherence stimulus, all 20 x 20 pixels are for the detection of glaucoma and deficits in ocular hypertensives.20
randomized so that the stimulus is indistinguishable from the
background. A percentage coherence scale can be defined between The Medmont perimeter utilizes a different form of flicker
these two limits (Figure 6). The test time for this strategy is perimetry, known as temporal modulation perimetry (TMP), which
approximately 14 to 18 minutes per eye. measures contrast thresholds for a fixed temporal frequency. TMP
better differentiates glaucoma patients from normals compared
Studies have shown that pattern discrimination perimetry can detect with CFF perimetry.21
significant visual field damage in glaucoma suspects when compared
with normal controls.16,17 The same studies have found that pattern Advantages
discrimination perimetry can detect an equal number of visual field
defects in glaucoma patients when compared with conventional • More resistant to optical degradation (from blur, cataract, etc),
perimetry. Flicker perimetry is largely independent from disturbances of
the ocular media and provides a means to identify eyes with
Advantage pressure-produced functional loss.
• Can detect glaucomatous damage at an early stage. • Defects in temporal modulation perimetry may precede the
onset or progression of defects in conventional light-sense
Limitations perimetry.
• As time-consuming as conventional perimetry. • Quickly performed
• Less effective than conventional perimetry in evaluating Limitations
progressive glaucomatous visual field damage.
• Still in an experimental stage
• Difficult test for most patients
• Lack of standardization
Flicker Perimetry
• Not too patient- friendly
Flicker perception is thought to be conveyed through the
magnocellular (M) pathway.18 There are some evidence to suggest Rarebit Perimetry
that automated flicker perimetry might represent a specific functional
test of the retinal Y-ganglion cells.19 Current clinical tests have a poor sensitivity to low to moderate
degrees of neuro-visual damage, possibly because their test targets
Procedure involve numerous receptive fields. In an attempt to detect minor
degrees of damage more readily, Frisen22 developed a new test
Two different forms of flicker perimetry are temporal modulation known as rarebit perimetry. Rarebit perimetry represents a new
perimetry (TMP) and critical flicker frequency (CFF). Temporal
38 DOS Times - Vol. 13, No.9, March 2008
approach, and while still in its infancy, may provide benefits for the
detection of early loss.
Principle
Rarebit perimetry derives its name from the use of test targets that
present a minimum of information (rare bits) to the visual system.
It is thought to test the receptive field of the parvocellular pathway.
This test uses briefly exposed microdots of high contrast. Multiple
visual field areas are probed repeatedly, with new microdot
positions.
Two dots are presented at a time, with each circular area being Figure 7. Left eye combined topographic map
probed five times, resulting in a total of 10 micro-dots. For each of recorded from a 6 year old child using four
these presentations, the micro-dots are presented at a new, random
position within the five degree circle. Subjects are required to indicate channel recording. Upward deflections on the
the number of dots seen for each presentation (that is, none, one traces represent positive peaks.
or two) by single or double mouse click depending on the number
of dots perceived. A total of 10% of stimuli are used for control non-communicative patients. The AccuMap may also have the
purposes and contains only one or no dot at all. Test time can be potential to identify glaucomatous defects earlier than conventional
varied from less than 1 min to about 5 mins for more thorough perimetry.
examination.
Procedure
A normal subject has a complete receptor matrix without any gaps
between the receptive fields and thus should return close to a 100 The mVEP amplitudes for each individual zone in the combined
percent hit-rate, implying that the visual neural architecture is trace array are compared with those found in the normal database,
complete in such individuals. Any disease affecting the RG and probability of abnormality plots are constructed. The intereye
population results in subjects having a lower hit rate. An abnormal asymmetry is also calculated for every segment of the tested visual
RB test is defined as having at least one of the following: mean hit field. A probability plot for asymmetry is constructed based on the
rate of less than 80%; more than 15 areas with hit rates <90%; normal database distribution of asymmetry between the 2 eyes.
atleast two areas with hit rate <50%; or at least one area with a hit AccuMap Severity Index (ASI) is calculated. The ASI provides an
rate <30%.23 overall index of whether the mVEP amplitude results are within
normal limits (score, 0-11), borderline (score, 11-19), or outside the
The test has been shown to have a high sensitivity (97.4%) and normal range (score, e”20).
specificity in detecting early glaucomatous visual field defects.23
Goldberg et al24 evaluated the ability of a multifocal objective
Advantages perimetry to identify glaucomatous visual field defects. In 95%
patients with glaucoma, Humphrey field defects were correlated
• Rapid with visual evoked potential amplitude reductions, identifying a
cluster of three or more abnormal zones. They concluded that
• Comfortable multifocal objective perimetry may have the potential for identifying
defects earlier than conventional perimetry.
• Easily available perimetric test (requiring only a PC device)
Pupil Perimetry
• Patient friendly
In this objective method, the amplitude or the latency of pupillary
• High sensitivity and specificity in detecting early glaucomatous responses to a bright stimulus are recorded by linking an automated
visual field defects perimeter to an infra-red electronic pupillometer. Pupil perimetry
provides objective evidence for a diagnosis of functional visual field
Limitation loss in selected patients and may circumvent the need for other
investigations.25
• Lack of longitudinal data
References
Objective Perimetry
1. Breton, ME, Drum, B. Functional testing in glaucoma. Visual
AccuMap psychophysics and electrophysiology Ritch, R Shields, MB Krupin,
This relatively new instrument uses multifocal visual evoked
potentials (VEPs) (Figure 7) to detect defects in the visual field.
Multiple domains/loci of the visual field are simultaneously
stimulated using a cortically scaled pseudorandomly reversing
pattern stimulus. Visual evoked potentials corresponding to each
of the loci of the visual field tested can be recorded within a short
period of time to generate a perimetry of VEP. A major advantage
of the device is that a subjective response by the patient is not
required therefore the device can use for retarded or otherwise
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T eds. The Glaucomas , 1996: 677-700. Mosby St. Louis. Study of Patients With Glaucoma and Healthy Controls. Arch
Ophthalmol. 1999;117:24-33.
2. Quigley, HA, Dunkelberger, GR, Green, WR. Retinal ganglion cell
atrophy correlated with automated perimetry in human eyes with 14. Yu M, Zhou W, Ye T. A study of high-pass resolution perimetry in the
glaucoma Am J Ophthalmol. 1989;107:453-464 early diagnosis of primary open-angle glaucoma. Zhonghua Yan Ke
Za Zhi. 1996; 32(4):267-71.
3. Sommer, A, Katz, J, Quigley, HA, et al. Clinically detectable nerve
fiber atrophy precedes the onset of glaucomatous field loss Arch 15. Drum, B, Breton, M, Massof, R, O’Leary, D, Severns, M. Early
Ophthalmol 1991;109:77-83 glaucoma detection with pattern discrimination perimetry. OSA Tech
Dig Ser 1987;4:130-133
4. Johnson, CA. Selective versus nonselective losses in glaucoma J
Glaucoma 1994;3:S32-S44 16. Drum, B, Severns, M, O’Leary, D, et al. Pattern discrimination and
light detection test different types of glaucomatous damage Heijl, A
5. Bosworth CF, Sample PA, Weinreb RN. Perimetric motion thresholds eds. Perimetry Update 1988/89; 341-347.
are elevated in glaucoma suspects and glaucoma patients. Vision Res.
1997;37:1989-1997. 17. Drum, B, Severns, M, O’Leary, D, et al. Pattern discrimination
perimetry and conventional perimetry in early glaucoma detection.
6. Wall M, Ketoff KM. Random dot motion perimetry in patients with OSA Tech Dig Ser 1988,172-175
glaucoma and in normal subjects. Am J Ophthalmol. 1995;120:587-
596. 18. Tyler CW. Specific deficits of flicker sensitivity in glaucoma and
ocular hypertension. Invest Ophthalmol Vis Sci. 1981; 20 (2):204-
7. Fitzke F, Poinoosawmy D, Nagasubramanian S, Hitchings RA. 12.
Peripheral displacement thresholds in glaucoma and ocular
hypertension. In: Heijl A, ed. Perimetry Update. Amsterdam, the 19. Lachenmayr B, Gleissner M, Rothbacher H. Automated flicker
Netherlands: Kugler & Ghedini Publications; 1989:399-405. perimetry. Fortschr Ophthalmol. 1989;86(6):695-701.
8. Wall M, Ketoff KM. Random dot motion perimetry in glaucoma 20. Dudzinski A, Zawojska I, Kinasz R. Flicker perimetry (CFF) in
patients and normal subjects. Am J Ophthalmol 1995; 120:587-596. glaucoma diagnosis. Klin Oczna 2003; 105: 283-287.
9. Wall M, Montgomery EB. Using motion perimetry to detect visual 21. Yoshiyama KK, Johnson CA. Which method of flicker perimetry is
field defects in patients with idiopathic intracranial hypertension: A most effective for detection of glaucomatous visual field loss? Invest
comparison with conventional automated perimetry. Neurology 1995; Ophthalmol Vis Sci 1997; 38: 2270-2277.
45:1169-1175.
22. Frisen L. New, sensitive window on abnormal spatial vision: rarebit
10. Wall M, Jennisch CJ, Munden PM. Motion perimetry identifies probing. Vision Res 2002; 42: 1931-1939.
nerve fiber bundlelike defects in ocular hypertension. Arch Ophthalmol
1997; 115(1):26-33. 23. Brusini P, Salvetat ML, Parisi L, Zeppieri M. Probing glaucoma visual
damage by rarebit perimetry. Br J Ophthalmol. 2005;89(2):180-4.
11. Baez KA, McNaught AI, Dowler JG et al. Motion detection threshold
and field progression in normal tension glaucoma. Br J Ophthalmol. 24. Goldberg I, Graham SL, Klistorner AI. Multifocal objective perimetry
1995; 79(2):125-8. in the detection of glaucomatous field loss. Am J Ophthalmol. 2002;
133 (1):29-39.
12. Wall M, Chauhan B, Frisen L et al. Visual field of high-pass resolution
perimetry in normal subjects. J Glaucoma. 2004;13(1):15-21 25. M S Rajan F D, Bremner P. Riordan-Eva Pupil perimetry in the
diagnosis of functional visual field loss. J R Soc Med 2002; 95:498-
13. Balwantray C. Chauhan, Philip H. House, et al. Comparison of 500.
Conventional and High-Pass Resolution Perimetry in a Prospective
First Author
Ritu Gadia MD
40 DOS Times - Vol. 13, No.9, March 2008
Case Report Retina
R. Gosh MBBS, Shaifali Singla MS, Lalit Verma MD, Dinesh Talwar MD, Avnindra Gupta MS, H.K. Tewari MD
Metestatic endophthalmitis is an uncommon but challenging, Figure 2: Yellowish Submacular lesion.
clinical problem. A high degree of suspicion is necessary to
make an early diagnosis of metastatic endophthalmitis.
A 30 year old married lady previously diagnosed to be having a
macular cyst in the right eye came to us for a second opinion
regarding vitreous surgery for the same. She had a one month
history of sudden painless diminution of vision in her right eye.
There were no forthcoming complaints in the left eye. On
examination vision in her right eye was finger counting at 2m with
accurate projection and left eye had a vision of 6/5. Slit-lamp
examination revealed a normal anterior segment in both eyes. Slit-
lamp biomicroscopy and indirect ophthalmoscopy revealed the
presence of yellowish subretinal lesion in macular area with cells in
the posterior vitreous cavity (Figure 1). The submacular lesion was
2 disc diameters in size, yellowish in co lour with irregular margins
(Figure 2). No scolex or hyper dense structure could be visualized.
B scan ultrasonography revealed presence of a cystic lesion in the
submacular area with low internal reflectivity (Figure3).
On eliciting the past history we found that she had undergone
lower segment caesarean section two months back. After reviewing
her record we came to know that lower segment caesarean section
got complicated due to hollow viscous perforation and subsequent
peritonitis for which she had undergone exploratory laprotomy.
Hollow viscous perforation was closed with colonostomy
(cecostomy). She was on intravenous fluids during that time. One
week later she developed high grade fever and sudden loss of vision
in her right eye.
Based on biomicroscopic findings of cells in the vitreous cavity and
look of the macular lesion, history of recent abdominal surgery and
Figure 3: Ultrasomography showings cystic lesion
in submacular area with for internal reflaction
Figure 1: Yellowish Submacular lesion with intravenous fluid therapy a diagnosis of focal metastatic
irregular margins. endophthalmitis was made. She was put on oral antibiotics (Tab
Ceftum 500 mg twice a day). Oral Pyralfin (Sulphadoxine 500 mg
Centre For Sight, and Pyrimetamine 25 mg) was added empirically to cover for
B5/24, Safdarjung Enclave, New Delhi-110029 toxoplasmosis pending reports of blood cultures.
www.dosonline.org Blood cultures for both aerobic and anaerobic organisms showed
no growth. Blood investigations for hemoglobin, TLC, DLC, ESR
were with in normal limits.
However, clinically patient started improving (both subjectively
and objectively) with in two days of oral antibiotic treatment. After
3 days of antibiotic cover oral steroids (Tab Omnacortil 50 mg
once a day after breakfast) were added. Her vision in the right eye
improved to 6/60 after 10 days of starting treatment. Oral antibiotics
were continued for 14 days. Fundus flourescein angiography
43
(a) (b)
(c) (d)
Figure 4(a)-(d): FFA shows hypoflourscent Lesion in early phase
with increasing hyperflourescence in late phase
showed a hypoflourescent lesion around foveal avascular zone in very sure of transparent cystic structure, mobility of the cyst and
early phase with increasing hyperflouresence in late phase, presence of scolex. Ultrasonic features of a cystic lesion in the macular
suggestive of a healing lesion. area in the absence of typical features of cyst should guard against
making a diagnosis of submacular cysticercosis and subjecting the
Visual acuity of right eye as well as the macular lesion improved patient to trauma of unwarranted and unnecessary complex surgical
gradually. Her final vision at 2 month follow up improved to 6/18 procedure. Further even an inflammatory lesion in our case could
with a faint scar in the macula. mimic a cystic structure. However the importance of careful history
taking cannot be overemphasized.
This case emphasizes that surgery in a patient suspected to be
having a macular cystic lesion should not be hurried unless one is
Author
Shaifali Singla MS
44 DOS Times - Vol. 13, No.9, March 2008
Commonly Used Diagnostic and Laser Lenses for Retina
Retinal Diseases - An Overview
Gitumoni Sharma DNB, FSSN, Sagarmoy Purkayastha DNB, FSSN, Hemlata Deka MS, Harsha Bhattacharjee MS
This write up provides an overview of the various laser lenses
commonly used in ophthalmic retinal photocoagulation
therapy.
Various laser lenses have been introduced following Goldmann 3-
mirror and Goldmann fundus contact lens for retinal
photocoagulation. Here we describe some of the time-tested lenses
in widespread use. Precise knowledge of these lenses is necessary
for safe retinal photocoagulation.
Activation of the laser can be done by :
• Lens-mirror contact lens system used with a slit lamp Figure 1: The concave Hruby lens forms a
• Fiber optic system (endophotocoagulation) virtual,erect image,R1, of the illuminated retina, R.
The image lies within the focal range of the slit lamp.
• Indirect ophthalmoscope with a handheld +20 or +28 diopter
(D) lens
For optimal visualization and treatment of retinal structures, the
accessory lenses are used1. They are used to image these structures
at a point where they can be reimaged by the slit lamp. In a Haag-
Streit Model 900, the stereoscopic slit lamp is in focus at about 95
mm in front of the objective lens of the microscope or about 280
mm from the examiner's eye. The slit lamp cannot focus directly
on the patient's retina due to the intervening optical system of the
patient's eye. So, accessory optical aids are required in the form of
lenses in front of the patient's eye to nullify the optical effects of
the various intervening optical systems of the patient's eye. Laser
should be delivered through a Slit-Lamp system for optimal
viewing.
Coupling solution like Hydroxypropyl methylcellulose (2- 2.5%) is
commonly used to form a bond between the cornea and the
contact lens. Several contact lens solutions have been described
that provide excellent post contact lens examination clarity for
subsequent clinical examinatio or photography. 1%
carboxymethylcellulose sodium has a viscosity and adherence
greater than saline and at the same time provides excellent optical
clarity after contact lens removal.
Types of Lens Design Figure 2: Hruby lens mounted on
Slit Lamp
Non- contact: Hruby lens, +90 diopter (D) lenses and +60 (D) diopter
lenses. +90 and +60 lenses has been used for retinal a high resolution, upright image of structures in the posterior pole.
photocoagulation in retinal tears, post-vitrectomy laser treatment But, the small field of view makes it difficult to be certain of the
of a giant retinal tear and for treating proliferative diabetic relationship of nearby structures. Visualization of more peripheral
retinopathy. Treatment of macular lesions is not encouraged as the structures is limited by the entrance pupil, which is minified by the
surgeon has less control over patient eye movement. negative optics. This lens should be used only for observation
purposes and not laser surgery.
The Hruby lens (Figure 1 & 2) is a high minus (originally - 58.6 D)
non-contact lens mounted on the slit lamp for stability. It provides
Sri Sankaradeva Nethralaya, The +90 D lens (Figure 3 & 4) is also more commonly being used
Guwahati, Assam. as a diagnostic lens as it is a noncontact lens thereby avoiding
www.dosonline.org 49
Figure 3: High power condensing lens +90D Shorten • A flange to stabilize the lens and prevent blinking
the path of light from the retina to bring the retinal
image within the focal range of the slit lamp forming • Knurled edge to facilitate lens manipulation.
a real inverted image. • Laser lenses generally consist of a conical
polymethylmethacrylate or aluminium shell
• Glass anterior surface, lenticular elements and mirrors.
Antireflection coatings are usually applied to each optical surface in
a laser lens that reduces reflected white light (from the slit lamp
source) that could decrease contrast or the slit lamp image, and
laser light (from the treatment beam) that could pose a potential
hazard to an observer standing behind the laser operator. The
hazard distance is 7 meters for an uncoated lens and 1.6 meters for
a coated lens. Most laser lenses use broad-spectrum, multilayer,
antireflection coatings that reduce reflected light between 400 nm
and 700 nm from approximately 4 per cent to less than one per
cent.
Mirror lenses
Mirror lenses provide high magnification and high resolution but
only a small part of the fundus or chamber angle can be viewed at
any one time. Therefore, the mirrors at various degrees of
inclinations are necessary. e.g.Goldmann 3 mirror lenses. The image
formed in the Goldmann 3 mirror lens is the mirror image of the
area focused.
Figure 4: + 90 Dioptre Lens Figure 5: Goldmann lens with flat anterior surface.
Produces an erect, virtual image located near the
contact lens solutions and potential compromise in corneal clarity.
It shows a relatively wide field of view with a good resolution. posterior surface of the crystalline surface.
However, subtle amounts of clinically significant fluid associated
with a choroidal neovascular membrane or central serous Figure 6: Goldmann lens
retinopathy may be missed. DOS Times - Vol. 13, No.9, March 2008
Contact: Pan retinal laser lenses, Focal laser lenses.
Two types of laser lenses are available to assist in slit-lamp delivery
of photocoagulation:
Plano-concave lenses: provide an upright image with high resolution
of small retinal area. The plano-concave lenses have mirrors
angulated at 590 , 690 and 730.
High plus power lenses: provide an inverted image with mild loss of
fine resolution, but provide a wide field of view, making these lenses
very suitable for pan-retinal photocoagulation. These are also called
indirect lens.
Some common characteristics of the laser lenses are:
• Concave posterior surface conforming to the corneal curvature
and a flat or convex anterior surface
• Planar mirrors allowing observation of the anterior chamber
angle or peripheral retina.
• A prism to allow visualization of the mid-periphery of the
retina.
50
Magnification and field of view
Magnification and field of view are critical parameters for
determining which lens is best for a particular clinical problem. The
three main lenses - Goldmann three mirror lenses, Panfundoscope
and Mainster lens - are compared in Table 1.
Focal Laser Lenses
Figure 7: Krieger lens with concave anterior Goldmann Lens (Figure 5 & 6) The premier lenses to be used for
surface. Produces an erect, virtual image located retinal lasers are the Goldmann fundus lens and the Goldmann
three -mirror lens. The Goldmann fundus lens with either a single
in the anterior vitreous humor. mirror inclined at 620, or the three- mirror style with the Gonioscopy
mirror angled at 590 provides a large field of view but must be
rotated 3600 to view the angled structures. It has a flat anterior
surface and produces an erect, virtual ophthalmoscopic image
located near the posterior surface of the crystalline lens. The chief
disadvantage of the Goldmann lens is its limited field of view without
rotation.
Lenses without Mirrors Yannuzzi fundus lens (Figure 7). It is a modification of an earlier
model developed by Krieger in 1966 designed to facilitate macular
The field of view may be increased to a variable extent by use of photocoagulation. It has a concave corneal surface which is steeper
biconcave contact lenses based on the simple Goldman lens (without and of greater diameter, so also has a better optics than a simple
mirrors). Goldman fundus lens. The concave corneal surface allows posterior
lens pressure to be transmitted to the sclera without distorting the
Another entirely different way of increasing the field of view involves cornea. It produces an erect, virtual ophthalmoscopic image located
using contact lenses based on the EL Bayadi lens. Both Rodenstock in the anterior vitreous humor.
Panfundoscope and Mainster lens are excellent examples of such
lenses. All wide-angle systems of this category are derived from the Volk Area centralis lens (Figure 8). This is an indirect contact lens
principle of indirect ophthalmoscopy and the common that provides a good field of view with an excellent magnification.
denominator of all these lenses is a large and inverted field of view. The field of view is 700/840. Image magnification is 1.06x. Laser spot
Thus both the panfundoscope and the Mainster lenses produce magnification is 0.94x.
inverted real images.
Table 1: Characteristics of Focal Laser and PRP Lenses
Parameter Goldman Panfundoscopic Mainster
Anterior surface Flat convex spherical convex aspherical
Image type Virtual erect Real inverted Real inverted
Power +85 +61
Lateral magnification - 67 -0.71 -0.96
Relative magnification +0.93 0.76 1.03
Axial magnification 1.00 0.51 0.92
Field of view 0.86 +/-600 +/-450
Working field of view (With 150 tilting) +/-180 +/-700 +/-600
Spot size setting (microns) +/-380
141 105
100 108 282 210
200 216 704 524
500 541 1409 1048
1000 1081
www.dosonline.org 51
Figure 8: Volk Area centralis lens Figure 9: Volk PDT lens Figure 10: Volk Transequator lens
Volk PDT lens (Figure 9). The field of view is 1150/1370. Image Figure 11a: Mainster lens with biconvex, aspherical
magnification is 0.67x. Laser spot magnification is 1.5 x which allows anterior lens element.Produces an inverted, real image
treatment of Choroidal neovascular membranes upto maximum
spot size of 6400um with providing excellent visualization of the located anterior to the biconvex lens.
CNVM. The Volk PDT lens comes standard with SupraCoat which
covers the 689nm laser wavelength indicated in this type of Figure 11b: Mainster Standard lens
procedure.
Figure 11c: Mainster wide field lens
Volk Transequator lens (Figure 10) It is designed for focal laser DOS Times - Vol. 13, No.9, March 2008
therapy and mid-to-far peripheral fundus diagnosis. Its unique
optical design presents a realistic contour of the retinal concavity,
offering an impressive wide-field of view of the entire posterior
pole extending to the equator. Its superior optics allow dynamic
movement on the globe, therefore increasing its functional field of
view. The field of view is 1100/1320. Image magnification is 0.70x.
Laser spot magnification is 1.44x.
Mainster: Introduced in 1986, this lens has more field of view (58%
greater than Goldman) and a greater magnification. Although the
field of view is 14% less than the Panfundoscope, but the lateral and
axial magnification are better which makes it useful for detecting
retinal thickening. It has a biconvex, aspherical anterior lens element
and a concave lens element to fit the corneal curvature. It produces
an inverted, real image located in front of its biconvex aspheric
anterior lens element (Figure 11a).
Mainster Standard lens (Figure 11b) This lens is designed for focal
and grid laser treatment from the posterior pole to the mid-
periphery. The field of view is 900/1210. Image magnification is 0.96
x. Laser spot magnification is 1.05x.
High resolution, high magnification of image allows appreciation
of subtle intra-retinal details and retinal thickening. So, it is excellent
for diagnosis and treatment of macular oedema, branch retinal
vein occlusion, choroidal neovascular membrane in age-related
macular degeneration and presumed ocular histoplasmosis.
PRP Lenses2
Mainster wide field lens (Figure 11c) This allows a very wide range
of slit lamp magnification to be used. It has excellent ophthalmic
resolution and image binocularity is maintained across the entire
field of view. It is used for panretinal photocoagulation in proliferative
diabetic retinopathy. The field of view is 1180/1270. Image
magnification is 0.68x. Laser spot magnification is 1.50 x.
52
Mainster Ultrafield PRP lens: This lens has the widest field of view
available for pan retinal photocoagulation. It has a unique optical
design to provide a clear, bright image across the entire field. It is
light- weight, has a secure fit flange for easy manipulation besides
having a high efficiency laser light anti-reflective coating. The field
of view is 1650/1800. Image magnification is 0.51 x. Laser spot
magnification is 1.96x.
Rodenstock Panfundoscopic lens (Figure 12 & 13) Introduced in Figure 12: Panfundoscope lens with a biconvex
1969 by Schlegel this lens is used for panretinal photocoagulation spherical anterior lens element. Produces an
from the posterior pole to beyond the equator without the use of inverted, real image inside the biconvex lens.
mirrors. It gives a panoramic view, produces an inverted, real
image located in its spherical biconvex anterior lens element. Thus,
the biomicroscope must be located further from the patient's eye
than using a Goldman lens. This low biomicroscopic magnification
produces adequate magnification with a large field and acceptable
depth of focus. The working field is 84% greater than a Goldman
but lateral magnification is 24% lesser than a Goldman. The spot
size is 40% larger than the photocoagulator setting or twice larger
than the conventional contact lens.
Disadvantage of this lens is that it produces peripheral distortion. It
can produce marked laser beam astigmatism while treating the
peripheral retina. Reflexes compromise retinal image thereby
causing oblong burns when treating through the periphery of the
lens.
Common Features of Mainster and Panfundoscopic lens
• Large areas of the fundus may be treated in Panretinal Figure 13: Panfundoscope lens
photocoagulation without lens rotation.
• Visualization of the optic disc and macula during peripheral
treatment prevents disorientation. The experienced laser
surgeon can achieve a more peripheral view by tilting the lens
off-axis. The field of view is increased in myopes and decreased
in hyperopes and will lead to differences in how far peripherally
laser photocoagulation can be applied.
• Working distance on these lenses are greater.
• Anterior segment irradiance becomes excessive with large
spot sizes (1000μm) but should be acceptable at a spot size of
500μm.
Volk Quadraspheric lens (Figure 14) The original 130 Figure 14: Volk Quadraspheric lens
Quadraspheric lens has grown in popularity since its introduction
in 1989 as the preferred wide field fundus laser lens for diagnosis 1650 , image magnification is 1.97x and laser spot magnification is
and treatment of the retina. The four aspheric surfaces also employ 2.0x. This has become the ideal lens for visualization and treatment
high-efficiency antireflection coatings thereby improving lens of proliferative diabetic retinopathy, ischaemic retinal vein
performance by reducing astigmatism across the entire field of occlusion and peripheral retinal holes and tears. Laser beam
view. It also enhances visualization through a small pupil. It produces transmission and fundus image quality are sharp and undistorted
an inverted and reversed image. Its sleek 28.6mm diameter housing to the full extent of the viewing field.
provides a definite advantage over competitive wide field lenses
for peripheral retinal viewing, reflection displacement and ease of
use. The laser spot magnification is 1.97x and the image
magnification is 0.51x.
Volk Super Quad 160 lens (Figure 15) This lens offers the widest
field of view. Its ideal 0.5x image magnification provides
simultaneous visualization of the posterior pole to the peripheral
retina providing a greater margin of safety even during extreme
wide angle panretinal photocoagulation. The field of view is 1600/
www.dosonline.org 53
Table 2: Magnification and field of view of different types of laser contact lenses
Type of lens Image Laser spot Contact LensHeight Static FOV Dynamic
FOV
Magnification Magnification Diameter 700
1150 840
Volk Area centralis 1.06x 0.94x — — 1100 1370
Volk PDT lens 0.67x 1.5x — — 900 1320
Volk Transequator 0.70x 1.44x — — 1180 1210
Mainster Standard 0.96x 1.05x 16mm 31.8mm 1650 1320
Mainster ultrafield 0.68x 1.50x 16mm 27.8mm 1200 1800
Ultrafield PRP 0.51x 1.96x 17mm 28.1mm 1600 1440
Volk Quadraspheric 0.51x 1.97x — — 1650
Volk Super Quad 160 0.50x 2.00x — —
Table 3: Comparing the parameters of ophthalmoscopic laser contact lens
Parameters Goldman Kreiger Panfundoscope Mainster
Anterior surface Flat Concave, spherical Convex, spherical Convex, aspherical
Power -67 -92 -85 +61
Image type Virtual erect Virtual erect Real inverted Real inverted
Image location Posterior capsule Vitreous humor Biconvex lens Air
Figure 15: Volk Super Quad 160 lens Conclusion
Selection of the proper lens for a particular laser is a compromise
between the individual's experience with the lens and the need to
keep abreast of relevant, new technological developments of lens
designs3 and the treatment strategy that makes the procedure more
acceptable.
References:
1. Mainster MA, Crossman JL, Erickson PJ, Heacock GL. Retinal laser
lenses: magnification , spot size and field of view. Br J Ophthalmol
1990; 74:177-179
2. Weingeist TA, Sneed SR. Contact and non- contact lenses in
photocoagulation therapy. Laser Surgery in Ophthalmology: Practical
Applications. 1992; 2: 7-14.
3. Das T. Retinal laser optical aids. Indian Journal of
Ophthalmology.1991; 39:3: 115-117.
First Author
Gitumoni Sharma DNB, FSSN
54 DOS Times - Vol. 13, No.9, March 2008
Fraser’s Syndrome Squint
1Jitendra Jethani MS, DO, DNB, FNB, 2Abhishek Dagar MS, DNB, FPOS, 3Renuka Rajgopalan MBBS
Fraser syndrome1 as orginally described consists of various inheritance. Isolated cryptophthalmos has been reported as an
combinations including cryptophthalmos; absent or autosomal dominant trait. Cryptophthalmos can be complete /
malformed lacrimal ducts; middle and outer ear malformations; incomplete/ abortive.4 Complete cryptophthalmos is where the
high palate; cleavage along the midplane of nares and tongue; patient shows poor or absent eyebrows, eyelids, conjuctival sac,
hypertelorism; laryngeal stenosis; syndactyly; wide separation of microphthalmos, symblepharon, anterior chamber abnormalities.
symphysis pubis; displacement of umbilicus and nipples; primitive Skin fold extends from brow to cheek, completely covering the
mesentery of small bowel; maldeveloped kidneys; fusion of labia globe. Incomplete cryptophthalmos is where eyelids are partially
and enlargement of clitoris; and bicornuate uterus and malformed formed, conjuctival sac is small. But most of then globe is covered
fallopian tubes. by skin. Abortive cryptophthalmos is where the upper eyelid
adheres to the globe forming the anterior surface of the cornea. Of
Also known as cryptophthalmos – syndactyly syndrome; it is the117 patients, with Fraser syndrome surveyed, ophthalmologic
preferably known as Fraser syndrome as presence of signs were present in 109 (93%) patients5 and cryptophthalmos in
cryptophthalmos is not mandatory for the diagnosis. It is variable 103 (88%) patients.6 Of these 103 patients with cryptophthalmos, 62
the extent that cryptophthalmos might not be present in all cases. (53%) were bilateral, and 32 (27%) were unilateral. Complete
However, the main features are a “hidden eye”, other craniofacial cryptophthalmos was more prevalent than incomplete
abnormalities, renal abnormalities, syndactyly and abnormal cryptophthalmos.
genitalia.2 It was Thomas et al3 who proposed the diagnostic criteria.
The criteria for diagnosis are divided into major and minor criteria. The cornea usually lacks epithelium and anterior stroma.7 The
patients of Fraser syndrome usually normal posterior segment,8
Major criteria but patients with hypoplasia or atrophy of the optic nerve have
been reported.9
• cryptophthalmos
Some of the most characteristic malformation occur in areas that
• syndactyly remain fused in utero. Separation of eyelids and digits involve
programmed cell necrosis in utero, it is speculated that these defects
• sibling with cryptophthalmos are due to defect in programmed cell death. Malformations similar
to Fraser syndrome has been reported experimentally in animals
• abnormal genitalia by inducing hypovitaminosis A. Hence, it is proposed that defects
in metabolism of retinoids may play a role in pathogenesis.
Minor criteria
Genetics
• congenital malformation of nose
Fraser syndrome gene was located to gene 4q 21.10 In 5 families
• malformation of ear studied the mutation was in FRAS1 gene which encodes an
extracellular matrix protein.10 In 2 families a homozygous missense
• malformation of larynx mutation was seen in FREM2 gene.11 The Fraser syndrome
• skeletal defects
• umbilical hernia
• renal agenesis
• mental retardation
The presence of two major or one major with four minor criteria is
considered diagnostic of fraser syndrome.3 The prognosis of
mental retardation is not known if these patients survive
cryptophthalmos though not mandatory , but it is the single most
important diagnostic malformation.
It may be classified as isolated cryptophthalmos or
cryptophthalmos sequence and cryptophthalmos syndrome.2 The
cryptophthalmos syndrome has an autosomal recessive mode of
1. T.V. Patel Eye Institute, Salatwada, Baroda Figure 1: Shows a young boy with unilateral
2. Venu Eye Institute, New Delhi partial cryptophthalmos
3. M&J Western Regional Institute of Ophthalmology, Ahmedabad 59
www.dosonline.org
Figure 2a: Shows the complete cryptophthalmos on Figure 2b: Same patient shows the webbing,
left side in a young adult syndactyly of fingers
phenotype is complex and pleiotrophic. Hence it has significant 6. Slavotinek AM, Tifft CJ. Fraser syndrome and cryptophthalmos:
overlap with other malformation syndromes like Bardet-Biedl review of the diagnostic criteria and evidence for phenotypic modules
syndrome, MURCS9 mullerian duct aplasia,renal aplasis, cerviacal in complex malformation syndromes. J Med Genet 2002;39:623–
aplasia)9 this suggested that there is a conservation of subset of 633.
phenotypic features between different syndromes and that the
unusual mechanisms of inheritance such as modifier genes may be 7. Pe’er J:cryptophthalmos syndrome: in Regenbogen LS(ed):diseases
present. affecting the eye and kidney, Basel S Karger, 1993 pg 36
Prognosis 8. Ide H. Histopathology of cryptophthalmos. Jpn J ophthal 1975; 19:
199
The outcome of the operation was very poor and the end result
was disappointing.12 However, successful surgical reconstruction 9. Slavolinek AM , Tifft CJ. Fraser’s syndrome and cryptophthalmos:
has been reported which may provide excellent long-term visual areview of diagnostic crtiteria and evidence of phenotypic modules
results in a patient with incomplete cryptophthalmos. 13 in complex malformations syndroem. J med. Gen. 2002; 39: 623-33
Many procedures may be required. For optimal results, close 10. McGregor L et al. Fraser syndrome and mouse blebbed phenotype
comprehensive follow-up with corneal and pediatric specialists is caused by mutations in FRAS1/Fras1 encoding a putative extracellular
suggested to limit complications such as keratitis sicca, infection, matrix protein. Nature Genetics 2003; 34: 203-208.
scarring, or amblyopia.
11. Jadeja S et al. Identification of a new gene mutated in Fraser syndrome
Prenatal diagnosis by ultrasound is possible.14It was demonstreated and mouse myelencephalic blebs. Nature Genetics 2005; 37: 520-
that ultrasonography can be used for prenatal diagnosis at 18 525.
weeks.15 It was suggested that diagnosis could be made if any the of
the following signs were present 12. Sinha S, Chaudhary SN.Cryptophthalmos—syndactyly syndrome. J
Indian Med Assoc. 2006;104 :474-5.
Obstructive uropathy, Microphthamia, Syndactyly,
Oligohydroamnios 13. Bergwerk K, Schorr N, Rabinowitz YS. Visual function in an 11 year
old with Fraser cryptophthalmos syndrome. Am J Ophthalmol. 2004;
References 137: 591-3
1. Fraser GR. Our genetic load: a review of some aspects of genetic 14. Rousseau T, Lauurent N, Thauvin-Robinet C, et al. Prenatal diagnosis
variation. Annals of human genetics 1962; 25: 387-415 and intrafamilial clinical heterogeneity of Fraser syndrome. Prenat
Diagn 2002;22:692–696.
2. Kabra M, Gulati S, Ghosh M, Menon PS. Fraser-cryptophthalmos
syndrome. Indian J Pediatr. 2000; 67: 775-8. 15. Boyd PA, Keeling JW, Lindenbaum RH. Fraser syndrome
(cryptophthalmos-syndactyly syndrome): a review of 11 cases with
postmortem findings. Am. J. Med. Genet. 1988; 31: 159-168.
3. Thomas IT, Frias JL, Felix V, Sanchez de Leon L, Hernandez RA, Jones
MC. Isolated and syndromic cryptophthalmos. Am J Med Genet
1986; 25: 85-98
4. Albert and Jackobiec: Principles of ophthalmology, WB Saunders, First Author
2nd edition; pg 4674 Jitender Jethani MS, DO, DNB, FNB
5. Hadjadj E, Conrath J, Denis D. Description des atteintes palpebrales
au cours du syndrome de Fraser. J Fr Ophtalmol 1999;22:755–759.
60 DOS Times - Vol. 13, No.9, March 2008
Recent Advances in Pathophysiology & Prevention Personal Opinion
of Diabetic Retinopathy
J. S. Ahluwalia MS, DOMS, MAeMS, FIMSA, FABI (USA)
Diabetic Retinopathy (DR) is the major cause of blindness Demand & Supply
between 20-74 yrs of age group. 8% of patient with DM above
40 years, become blind every year. Destruction of damaged retina Fibers of the ganglion cells in inner layers are non medullated for
by photocoagulation has been the standard line of treatment right transparency requirement but need greater energy for membrane
from its induction more than 50 years ago. It is something like potential, but to these areas supply of energy & O2 is less, hence
amputating a gangrenous foot is diabetic patient or starting dialysis inner layers are more vulnerable for damage as compared to the
in end stage renal disease. Study of pathophysiological features of outer layers.
DR has encouraged researchers to find new modalities so that its
onset can be delayed, its severity can be reduced & patient. can DR Is NeuroVascular Lesion
retain useful vision.
DR is not just a simple microangiopathy but is a neurovascular
Peculiar Anatomy & Physiology of Retina degeneration & is similar to peripheral diabetic neuropathy (PDN).
(Figure 5) shows DME seen by ophthalmoscope as retinal thickness
95% of retina is neural tissue, being transparent is not visible by but what ophthalmologist doesn’t see is degeneration of ganglion
ophthalmoscope & starts getting damaged as early as IGT level, cells which has already occurred. Functional tests like Multifocal
where as BV are only 5% & are visible by ophthalmoscope due to ERG (Figure 6), shortwave automated perimetery (SWAP),
the presence of Hb a pigment (Figures 1&2). Visible changes what frequency doubling perimetery, changes in color perception, dark
we see of typical DR as shown in (Figures 3&4) take many yrs to adaptation & contrast sensitivity are more sensitive & reveal changes
develop & by this time damage to neural tissue has already occurred which can be detected much earlier before the visible changes seen
even though the retina may appear normal. by FA, OCT or fundus photography. Loss of oscillatory potential in
ERG is a predictor of PDR.
Blood Supply of Retina
Pathophysiology of DR
Outer layers of retina get blood supply from highly vascularized
network of choroidal vessels which supply 80% O2 to these areas Pericyte apoptosis, thickening of basement membrane & endothelial
where as inner layers get O2 from retinal vessels which are lesser in cell damage of capillaries are the basic changes seen in all
number & can saturate these areas with only 25% of O2. Hence microangiopathies of DM. Pericyte apoptosis causes MA formation.
inner layers are more hypoxic. They can be regenerated by activating PDGF. Endothelial cells are
tightly glued due to inter cellular Proteins occludin & claudin. In
Metabolism hyperglycemic state these proteins get phosphorelated thus losing
their adhesive quality allowing a gap to set up in between the
Outer layers get their energy by phosphorelation which generates endothelial cells thus allowing the serum to leak out resulting in
greater energy, where as inner layers get energy by glycolysis which edema.
librates lesser energy.
Figure 1: 3D picture of Retina showing 95% Figure 2: Normal Retina as seen by
as neural tissue 5% B.V. (Animated) ophthalmoscope
Ahluwalia Eye & Diabetes Clinic 63
113, Suvidha Apts, GH-10, Sec-56, Gurgaon-122002 (Hr.)
www.dosonline.org
Figure 3: BDR with DME Figure 5: Shows DME
Figure 4: PDR Figure 6: Shows Multifocal ERG, Extreme RT picture is
a normal response and left and middle shows
subnormal response
Mechanism of Microangiopathy in DM DR is an Inflammatory Disease
In DM normally all cells are soaked with hyperglycemic blood but DR should be termed as retinitis because all signs of inflammation
all cells don’t get damaged, only some cells of target organs like are present like edema, presence of cytokines & chemokines, tissue
endothelial cells of BV, schwann cells of neurons & mesengial cells destruction, loss of function & response to repair by releasing VEGF,
of glomeruli are affected because these cells don’t have glucose IGF-1, Interlukin-1B & TNF-alfa. Hence the role of various anti
detectors on their cell membrane & glucose can freely enter in side inflam drugs like Aspirin, Sodium salicylate, Sulfa salazine, Steroids
the cells making them hyperglycemic. When intracellular & antibiotics like Doxicycline.
hyperglycemia occurs there is excessive production of Superoxide
(a FR) which activates PARP which in turn inactivates intracellular VEGF
enzyme GAPDH & then the triggering pathways get activated which
are responsible for causing complications. These pathways are:- Hypoxia is the greatest stimulus for VEGF production. VEGF by
mitogenesis and migration of endothelial cells is responsible for
• Polyol(Aldose-Reductase) pathway:-increases sorbitol, Role of neovascularization. It is also produced in response to PKC, increased
A R inhibitors→sobinol, epalrestat, fidarestat, in reducing progesterones and tissue ischemia. In carcinomas it is responsible
sorbitol deposition in Tissues for metastasis, hence various anticancer drugs have been tried.
They are Ruboxistaurin, Pegaptanib, Infliximab, Ranibizumab,
• Advance glycation End Products:- e.g. HbA1C → Role of amino Bavacizumab and Squalamine.
guanidine to reduce AGEP
Role of Somatostatins in Vitreous
• Diacylglycerol:- activates PKC
Vitreous of PDR contains various growth factors and cytokines.
• PKC:- activates VEGF Some are proangiogenic and some are antiangiogenic.
Somatostatins are the most potent antiangiogenic factors.
• Hexosamine Pathway:- Increases Insulin Resistance
64 DOS Times - Vol. 13, No.9, March 2008
Important are SS14 and SS28. Normally SS28 is five times greater
than SS14. In PDR SS28 is reduced to three times or even less.
Various SS analogues like Octreotide have been tried to suppress
the effect of growth hormones produced by Pituitory. Sandostatin
is one of the examples of Octreotide.
Dysfunction of Endothelial Progenitor Cells
These are the stem cells of endothelium which are produced by Figure 7: Shows effect of Insulin of Retina Astrocytes
bone marrow. They are released whenever endothelium gets
damaged. However, their release is controlled by another hormone
called SDF-1. In DM SDF-1 activity is reduced and this can be
activated by supplementing Omega3 FA and Omega6FA and by
increasing supply of NO which activates EPC. Hence the role of
essential FA and nitrates.
Evidence of Impaired Insulin Action in DR
Retina is very sensitive to insulin deficiency and is responsible for • Neuropathy
neuro retinal degeneration. DCCT had studied two groups of DR • C-reactive proteins
having same HbA1C. One group on insulin treatment and another • HbA1C
group with conventional oral treatment and they discovered there • Anaemia
was less incidence of DR in cases treated with insulin. Insulin acts • Pregnancy
only on those cells which have IRS-2. In DR IRS-2 is reduced due to • Smoking
reduced activity of another enzyme IRS-Kinase which can be • Increased BMI
activated by supplementing insulin. (Figure.7) Hence earlier the • Homocystinuria
insulin better is the visual prognosis. Prevention is Better than Cure
Metabolic Memory
AGEP is deposited in skin collagen and can be studied by skin biopsy.
Presence of AGEP in skin collagen predicts the progress of DR and
at this stage can still be controlled by insulin.
Role of Transketolase Regular Eye Checkup For
This enzyme is present in inactive form. When activated it converts • Visual acuity
the toxic products of triggering pathways into nontoxic • Fundus
Pentosephosphate thus preventing complications. Vitamin B1 which • Amslar
is water soluble can activate only 25% of transketolase whereas its • Color perception
precursor Benfotiamine which is lipid soluble can activate 250 times • SWAP or blue light perimetery or double frequency perimetery
more transketolase. Hence recommended in preventing the progress • ERG/multifocal ERG
of DR. Once changes seen by ophthalmoscope, in addition to above also
FA, Fundus photography and OCT.
Role of Alpha Lipoic Acid (ALA) Early Prediction of PDR
• Loss of oscillatory potential in ERG.
This is an antioxidant which reduces cell death by activating • Reduction of SS-28 by radio immunoassaying.
intracellular Mn-SOD which is an important AO. It also inhibits • Increase of MMP-2 to thirteen times in AC by ELISA.
PARP which is a nuclear enzyme activated by FR which causes DNA • Increase of monocytes in blood.
damage and cell death and is an important factor for PDN. ALA is • H/O Keloids.
an important PARP inhibitor. Other drugs on study are 3-Amino Follow the Rule of 100
Benzomide and 1:5 Isoquinolinediol. • Tight glycemic control FG-100mg., PP-140mg., HbA1C<6
• BP 120/70mmHg.
Risk Factors for DR
• Duration of DM
• Severity of DM
• Hypertension
• Dyslipidemia
• Microalbuminuria and Nephropathy
• Increased IOP
www.dosonline.org 65
• Lipids TRG-150mg., LDL-65mg., HDL>50 • Essential FA - 3FA + 6FA in the ratio of 1:6.
• Diet 15x100 kcal. • Nitrates – monotrates 10 – 20mg. / day.
• Waistline < 100cms. • Once microangiopathy treat with anti VEGF.
• Ideal weight 2/3rd to 3/4th of 100kgs. • Lasers should only be given as a last resort because they cause
more hypoxia by causing tissue ischemia and there by
• BMI < 1/4th of 100 increasing the release of VEGF .
• Brisk walk of 100kms. Per month Conclusion
• Expected life 100yrs. DR is a Neurovascular lesion which can be detected much earlier
by functional tests. It is a preventable condition which can be treated
Medical Management of DR easily by tight metabolic control. Start insulin at the earliest since
retina is very sensitive to its deficiency. Follow the rule of 100. Avoid
• Tight metabolic control by insulin. routine lasers.
Advantages of Insulin – it not only controls hyperglycemia but also References
controls protein and fat metabolism. It controls atherogenic
lipoproteins. It has anti inflammatory properties by suppressing 1. Bernard Zimmerman, Rayaz A Malik, Thomas W Gardener, Ray
NFK-B and ICAM-1. It is a vasodilator by releasing NO and Tailor & John B Buse; pathways leading to micro vascular complications
therefore improves blood circulation. It improves platelet function of diabetes & latest clinical therapies. Symposium held at Hilten New
by reducing tPA and it also improves myocardial performance. Orleans, Louisiana on June 16, 2003.
• Control of BP by ACE-ARB. If microalbuminuria > 16mg. 2. M Brownlee; Dept of medicine & pathology Albert Einstein college
start ACE/ARB even if BP is normal. of medicine New York-pathobiology of DR, transketolase activators-
ADA 2005;54(6):1615-1625.
• Statins with ezetimibe.
3. Maria Grant;role of EPC-65 scientific session of ADA, 2005, San
• Ecosprin–150mg. / day. Diego California Abstract 28-OR
• TZG like pioglitazone as PPAR activator to reduce IR. 4. Hans Peter Hammes; role of somatostatins, 65 scientific session of
American Diabetic Association 2005.
• Benfotiamine 150mg. / day.
5. Schmind Schonbein; role of nsaids & steroids, pericyte regeneration-
• ALA 100 - 200mg. / day. Angiology 1993;44:45.
• Methylcobalamine 1500mg. / day. 6. DCCT; role of insulin in DR
7. Ahluwalia JS; rule of 100 & effect of IOP on DR, 2007-annual
symposium DDF, Hotel Asoka, New Delhi.
Author
J.S. Ahluwalia MS, DOMS,
MAeMS, FIMSA, FABI (USA)
Answer Quiz No. 9
Extra Word: CATARACT
ZONULAR 3. PHACO 2. 1. POLAR
EMBYONAL 6. METABOLIC 4. TRAUMATIC
SUBLUXATED 5. 7. MULTIFOCAL
8.
66 DOS Times - Vol. 13, No.9, March 2008
Orbital Implants: A Synopsis Clinical Meeting: Clinical Talk
Archana Sood MS
Surgical procedures like enucleation or evisceration relieve the • Is non antigenic, biologically inert
patient of painful disease or tumor, BUT cause a distressing
cosmetic appearance of an empty socket. Same is the plight of • Provides socket motility transmitted to prosthesis
patients born with anophthalmos or microphthalmos(Figure 1).
Orbital implants allow replacement of the lost volume and support • Is completely buried, simple in construction without
of the orbit along with optimal fitting and motility of ocular projections/angulations which erode conjunctiva
prosthesis
• Is light weight, centered within muscle cone, anchored to orbital
History tissues to minimize extrusion or migration
The first implant was a glass sphere after evisceration performed • Is able to be integrated into extraocular muscles and orbital
by Mules (1845) whereas Frost (1887) reported the first implant soft tissues without fibrous adhesions of the orbital connective
after enucleation. Ruedeman(1941) implanted the1stpartially tissues
exposed integrated with attached extraocular muscles.These
implants were later discontinued due to high extrusion rates. The • Is able to be directly integrated with prosthesis for transfer of
1st completely buried integrated implant was performed by Cutler motility
(1945). Allen and Iowa pioneered the buried non spherical implants
or buried quasi integrated implants.In 1985, Arthur Perry implanted • Is affordable & easily available
the first hydroxyapatite orbital implant made of natural coral (Trade
name Bio eye) after which synthetic hydroxyapatite was also Implant size estimation
manufactured. Later Porous Polyethylene (Medpore) and
aluminium oxide implants (Bioceramic) also came into vogue. Keeping in mind that the average volume of globe is 7.2ml and an
average prosthesis has a volume of 2.5ml, the volume of implant,
Characteristics of an Ideal Implant wrap (if used) and prosthesis should be equal to the volume of the
eye removed. The axial length of the eye to be enucleated/
• Mimics normal globe as closely as possible eviscerated or that of the other eye can be used as a guideline to
calculate the size of the implant using the above principle.
• Replaces sufficient volume but allows for a prosthesis of
adequate ant chamber depth Types of Implants
• Has minimal rate of exposure, extrusion, infection, Nonintegrated
inflammation
These implants are non porous, do not integrate with orbital tissues
and do not allow attachment of muscles unless wrapped.e.g Pmma
spheres (Figure 2), Silicon spheres.
They are indicated in evisceration, enucleation, congenital
anophthalmos/microphthalmos and as secondary implants in
secondary anophthalmos.
Figure 1: Unilateral clinical anophthlmos Figure 2: PMMA Mules implant
Venu Eye Institute & Research Centre 69
1/31, Sheikh Sarai, Phase-2,
New Delhi - 110017
www.dosonline.org
Semi integrated
These implants allow attachment of extraocular muscles in the
tunnels on their anterior surface for better motility. e.g Allens
(Figure 3), Iowa, Universal,Castroveijo.They are implanted after
enucleation.
Advantages
• They give good motility
• Are inexpensive and easily available
• Are made of polymethylmethcrylate (time tested material)
Disadvantages
Figure 3: Allens semi-integrated implant • The anterior surface is irregular causing the conjunctiva &
tenons capsule to be pinched between the implant & prosthesis
• Leads to discomfort, and rates of erosion & extrusion are high
• Special customised prosthesis are needed to fit its shape
Fully integrated
These porous implants allow fibrovascular ingrowth of the orbital
tissues for full integration.e.g Hydroxyapatite, Aluminium Oxide,
Polyethylene, Porous PMMA (Figure 4).
Their indications are same as for non integrated implants. Their
main disadvantage is their expense and availability.
Natural lHydroxyapatite implants (Calcium phosphate inorganic
salt) (Figure 5)
Figure 4: Porous PMMA integrated implant It was discovered that marine corals have skeleton with
Advantages microarchitecture identical to human cancellous bone. Coral have
a chemical makeup that allows them to be converted to HA. HA is
the mineral that makes up hard part of bone This coincidence
enables coral to be invisible to the immune system thus causing
no foreign body reaction with minimal tissue inflammation
• Are made of time tested materials like polymethylmethacrylate
or silicon
• Are cheap, easily available
• Have smooth surfacewhich avoids irregular pressure on tissues
anterior to it, so exposure is rare
• Have the least complication rates
• Can attach muscles if wrapped with sclera
Disadvantages
• Have poor motility if not wrapped
Wrapping materials
• Implants are wrapped to ease insertion of rough surface
implants which catch tissues
• To serve as a protective barrier against extrusion
To enable attachment of muscles in non integrated implants Figure 5: Intergrated HA in evisceration
• Do not allow fibrovascular ingrowth so they may migrate
70 DOS Times - Vol. 13, No.9, March 2008
The porosity of an HA implant allows orbital vasculature to invade
its structure completely and allows it to fight infections from within
the implant via the vascular bed infiltrating the implant thus
preventing migration or extrusion. The integration also supports
healing from within, of any defect in the conjunctiva or tenons
closure. This implant allows attachment of recti for good motility.
True integration via a motility peg allows direct transfer of all
available movement from rectus muscles to prosthesis. Available
as BioEye Implants.
Synthetic HA implants
• Are comprised of synthetic medical grade HA
• They are composed of highly porous, fully interconnected Figure 6: Polyethylene implants (Medpore)
biocompatible ceramic matrix similar to human cancellous
bone
• They are permanent & do not resorb
• They can be drilled with a motility peg
• Trade name: Ocupore porous orbital implants (Ceramsys)
Polyethylene Implants (Figure 6)
• Are made of polymerisation of ethylene molecules under high
temperature & pressure which creates straight chains called
polyethylene
• They are biocompatible, porous and have interconnecting
omnidirectional pore structure which allows fibrovascular
ingrowth
• They cause less tissue friction and are not brittle
• Muscles can be attached without wrapping on the suture
tunnels provided on the anterior surface
• Trade name: Medpore (Porex Surgical products)
Aluminium Oxide implants
• They are porous implants which insert easily into the socket
and do not cling to surrounding tissue
• The improved connectivity between pores enhances Figure 7: Orbita expanders, Hemispheric
vascularization Socket expanders
• They can be easily drilled without crumbling
• Trade name: Bioceramic Orbital Implants (FCI ophthalmics)
Expandable implants They are made of osmotically active hydrogel (Vinylpyrrolidone &
methylmethacrylate)-a material also used in contact lenses. It is a
These implants expand in vivo and stimulate orbital growth if safe reliable well tolerated material with controlled expansion rates.
implanted in congenital clinical anophthalmos/microphthalmos and SETEs expand by absorbing body fluid to almost 8 times of the
can be used to fill defects in enophthalmic sockets.e.g Silicon balloon original volume
expanders, Hydrogel socket & orbita expanders.
Types of SETE’s (Figure 7)
Indications
Hemispherical Socket Expanders (0.4-2ml) (Figure 8a)
• Volume deficit in the orbita
The expansion of the palpebral aperture, conjunctival sac and
• Congenital anophthalmos fornices by the hemispheric expanders enables the placement of a
bigger and cosmetically attractive eye prosthesis.
• Congenital micropohthalmos
SETE (Self Expanding Tissue Expanders) Devices Orbita Expanders(1-5ml)(Figure 8b)
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