DOS Times July-Aug 2015

CLINiCAL SPOTLIGHT - Retina

Post Operative Endophthalmitis –An Update

Lalit Verma, Arindam Chakravarti

Endophthalmitis should be suspected when there is pain and increased in AC
reaction on slit lamp examination on first post operative day.

Worldwide, the reported incidence of TABLE 1: Classification of Endophthalmitis
post-operative endophthalmitis is 0.04-
1. Postoperative
4%. Post cataract surgery incidence
a. Acute-onset postoperative endophthalmitis:
is 0.265% (more with clear corneal
Coagulase-negative staphylococci, Staphylococcus
incision), post keratoplasty 0.382% and
aureus, streptococcus species, gram-negative
post vitrectomy 0.05%. The incidence of
bacteria.
bleb associated infection is 0.2%-9.6%.
b. Delayed-onset (chronic) pseudophakic
Though rare, it is potentially the most feared and
endophthalmitis (>6 weeks postoperative):
devastating complication of intraocular procedures and can
Propionibacterium acnes, coagulase-negative
lead to a permanent, complete loss of vision. Endophthalmitis
staphylococci, fungi.
has been associated with severe visual loss in 20% of patients. c. Conjunctival filtering bleb - associated

A series of endophthalmitis cases may force a temporary endophthalmitis:
Streptococcus species, Hemophilus influenza,
shutdown of the operation theatre.
Infectious endophthalmitis is classified by the events Staphylococcus species

leading to the infection and by the timing of the clinical diagnosis. 2. Posttraumatic (open globe): Bacillus species,

The broad categories include postoperative endophthalmitis staphylococci
(acute-onset, chronic or delayed-onset, conjunctival filtering-
bleb associated), posttraumatic endophthalmitis, and 3. Endogenous: Candida species, S. aureus, gram-negative

endogenous endophthalmitis. Miscellaneous categories bacteria

include cases associated with microbial keratitis, intravitreal 4. Miscellaneous

injections,or suture removal. These categories are important in a. Keratitis: Staphylococcus and pseudomonas

predicting the most frequent causative organisms and in guiding species
therapeutic decisions before microbiologic confirmation of the
clinical diagnosis (Table 1). b. Post Intravitreal injection (intravitreal

Patient symptoms indicative of endophthalmitis include triamcinolone, intravitreal ganciclovir, pneumatic

ocular pain, diminished vision and headache. Although pain is retinopexy, etc): Coagulase negative staphylococci

an important symptom, it is not universal. c. Suture removal: both bacteria and fungi

It is important to differentiate infective endophthalmitis On subsequent post operative days, decrease in vision
from sterile post-operative inflammation. Toxic Anterior following initial improvement along with pain should
Segment Syndrome (TASS) is an acute postoperative immediately raise the index of suspicion. Presence of exudates
inflammatory reaction in which a noninfectious substance in vitreous on indirect ophthalmoscopy is 100% specific.
enters the anterior segment and induces toxic damage to the
Presence of hypopyon and vitreous exudates is usually
intraocular tissues. Almost all cases occurred after uneventful diagnostic of endophthalmitis.

cataract surgery. If there is NO HYPOPYON, role of distant direct
ophthalmoscopy, slit lamp examination, indirect
In TASS, most develop symptoms within 12-24 hrs , there ophthalmoscopy and ultrasound B scan very important in
deciding surgical intervention, rule out other causes like
is decrease in visual acuity, corneal edema is from limbus to masquerade.
limbus, there is moderate to severe AC reaction with cells, flare,
hypopyon and fibrin, pupil may be dilated andnon-reactive and Slit lamp examination helps to see dilatability of pupil,
IOP may be normal or raised. wound margin (many cases related to suture removal).

Post operative endophthalmitis may be early or delayed. In cases with poorly dilating pupils and significant AC
reaction (+++) and best corrected visual acuity better than
Most common causative agents are gram positivecoagulase 6/60, sterile reaction should be considered and treatment
started with intravenous bolus steroids and topical steroids and
negative organisms. However in India, gram negative organisms antibiotics. However if BCVA <6/60, endophthalmitis should
be considered and patient should be administered intravitreal
and fungi are important in aetiopathogenesis. antibiotics. An USG B scan may aid in the diagnosis with non
dilating pupils and severe AC reaction by demonstrating
Differentiation is important as the management and vitreous echoes.
prognosis of TASS is significantly different (Table 2). Delay in
diagnosis leads to delay in initiating appropriate treatment. Presence of vitreous exudates clinches the diagnosis of
endophthalmitis.
Endophthalmitis should be suspected when there is pain
and increased in AC reaction on slit lamp examination on first
post operative day. However pain may be absent in 25% cases.

Decreased glow on distant direct ophthalmoscopy has high
sensitivity but low specificity on first post operative day.

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CLINiCAL SPOTLIGHT - Retina

Table 2: Differences Between Tass and Infective Endophthalmitis although currently many clinicians prefer
oral Gatifloxacin or Moxifloxacin.
TASS Endophthalmitis
After intravitreal antibiotics, patient
Cause Noninfectious reaction to toxic Bacterial, fungal, or viral is monitored for 24-36 hours.
agent present in: infection
BSS solution If there is worsening, patient has to
Antibiotic injection be taken up for surgical intervention in
Endotoxin the form of pars plana vitrectomy.
Residue
If there is no worsening, medical
Onset 12-24 hours 4-7 days treatment can be continued for 48 hours
following which decision regarding
Signs/ Blurry vision Decreased VA additional intravitreal antibiotics or
Symptoms Pain: none, or mild to moderate surgical intervention is to be taken.
*distinguishing Corneal edema: diffuse, limbus to Pain (25% have no pain)
feature limbus* Improvement in fundus glow with
Pupil: dilated, irregular, Lid swelling with edema decrease in hypopyon is indicative of
nonreactive* clinical improvement. Medical treatment
Increased IOP* Conjunctival injection should be continued.
Anterior chamber: mild to severe
reaction with cells, flare, Hyperemia COMMON INTRAVITREAL DRUGS
hypopyon, fibrin USED IN ENDOPHTHALMITIS
Signs and symptoms are limited to Anterior chamber: marked
anterior chamber* inflammatory response with The common intravitreal drugs and
Gram stain and culture negative hypopyon dilutions for constituting the intravitreal
Ultrasound is anechoic concentration in the management of
Vitreous involvement endophthalmitis is outlined in (Table 3).
Inflammation in entire
ocular cavity. Ultrasound CASE SITUATIONS

shows vitreous echoes. A few case situations are elaborated
below (Figures 1-10).
Treatment Rule out infection Culture anterior chamber
Culture anterior chamber and vitreous Decision of whether to give
Intensive corticosteroids Intravitreal and topical Intravitreal Antibiotics OR Topical + S/C
Monitor IOP closely for signs of antibiotics + I/V Steroids
damage to trabecular meshwork Vitrectomy
and side effects of steroids This can be treated as TASS with
Watch closely over next few hours
for signs of bacterial infection

MANAGEMENT Table 3 A: Intravitreal Drugs used in Bacterial Endophthalmitis

At present, best choice of intravitreal • Vancomycin • Amikacin

antibiotics is Vancomycin (1 mg in 0.1 ml) (1 mg in 0.1 ml) (400 microgm in 0.1 ml)

combined with Ceftazidime (2.25 mg in 500 mg powder 100 mg in 2 ml vial/50 mg in 1.0

0.1 ml) in separate syringes. ml/10 mg in 0.2 ml

Alternatively, Vancomycin may be Add 10 ml 500 mg in 10 ml Take 0.2 ml 10 mg

combined with Amikacin (400 µg in 0.1 50 mg in 1.0 ml Add 2.3 ml 10 mg in 2.5 ml

ml). 10 mg in 0.2 ml Take 0.1 ml 0.4 mg in 0.1 ml
Topical treatment comprises
Take 0.2 ml has 10 mg
Ciprofloxacin/Gatifloxacin/Moxifloxacin
1 hourly or Fortified Cefazoline + Make it 1.0 ml 10 mg in ml
Tobramycin 1 hourly along with • Gentamycin
cycloplegics in the form of Atropine every • Ceftazidime/Cefazoline (200 microgm in 0.1 ml)
six hourly. The topical drug dosage is
tailored according to response. Topical (2.25 mg in 0.1 ml) 80 mg in 2 ml vial/40 mg in 1.0 ml
steroids are added 1-2 days later.
500 mg powder Take 0.1 ml 4 mg
Intravenous Ciprofloxacin 200 mg
twice daily is required in very severe Add 2.0 ml 500 mg in 2 ml Add 1.9 ml 4 mg in 2 ml
cases.
250 mg in 1.0 ml Take 0.1 ml 0.2 mg
Oral Steroids administered as 1-1.5
mg / kg single dose along with oral Take 0.1 ml 22.5 mg in 0.1 ml • Diluent used (Water for Injection/Ringer
antibiotics. Ciprofloxacin 750 mg twice lactate)
daily for 7-10 days usually preferred Make it to 1.0 ml 22.5 mg in 1.0 ml
• All preparations done by Surgeon himself,
Take 0.1 ml 22.5 mg in 1.0 ml under strict aseptic conditions.
• Dexamethasone
• Recommended (for Bacterial endophthalmitis)
(0.4 mg in 0.1 ml) Vancomycin+Ceftazidime

8 mg in 2 ml vial/4 mg in 1.0 ml Vancomycin+Ambikacin
• For fungal endophthalmitis
Take 0.1 ml directly 0.4 mg Voriconaxole or Amphotericin B

Vitreo-Retina Services, Centre for Sight, Safdarjung Enclave, New Delhi, India

Dr. Lalit Verma Dr.Arindam Chakravarti
62 DOS Times - July-August 2015

Table 3B: Intravitreal Drugs used in CASE 2: CLINiCAL SPOTLIGHT - Retina
Fungal Endophthalmitis (A)
(B)
• Amphotericin B
(5 microgm in 0.1 ml

50 mg powder

Add 10 ml 50 mg in 10 ml

5% dextrose 0.5 mg in 0.1 ml

Take 0.1 ml 0.5 mg

Add 9.9 ml 0.5 mg/10 ml

of 5% dextrose 0.05 mg/1.0 ml

Take 0.1 ml 0.005 mg Figure 2a&2b: Clinical picture of post cataract surgery on Post op day 1: BCVA 6/24,
Unusual post op reaction, good glow.
• Voriconazole
(50-100 microgm in 0.1 ml) (C) (D)

200 mg powder Figure 2c&2d: Treatment with intensive steroids, and DAY 2: BCVA 6/18, reaction
significantly less, fundus details much clearer.
Add 19 of 200 mg in 20 ml
(E) (F)
d/w 10 mg in 1.0 ml

Take 1.0 ml

Add 9.0 ml of 10 mg in 10 ml

d/w 1.0 mg in 1.0 ml

Take 0.05 50/100 micro

ml/0.1 ml gm

CASE 1: Decision of whether to give
Intravitreal Antibiotics OR Topical + S/C
+ I/V Steroids. This can be treated as TASS
with topical and IV steroids but requires
close follow up

Figure 2e&2f: Day 14: BCVA 6/6, quiet AC, normal appearance of fundus.

Figure 1: Clinical picture of post cataract for endophthalmitis may be indicated Treatment options:
surgery. Post op day 1: Good glow, AC in severe endophthalmitis, P acne 1. ‘In the bag’ Vancomycin 1mg / 0.1 ml
reaction 2-3 +, No Hypopyon endophthalmitis, fungal endophthalmitis 2. PPV + Partial Capsulectomy
and recurrent endophthalmitis. 3. PPV + Total capsulectomy + IOL
topical and IV steroids but requires close
follow up. The eye is usually quite where signs Explantation
are more prominent than symptoms. This condition is extremely severe
However in situations where there Vitreous Balls, fungal granuloma may due to direct inoculation of organism
is a partial response to intravitreal be seen. Smears, cultures may help if in vitreous. Prognosis is very poor and
antibiotics with resolution of hypopyon on initial treatment, there is no/ partial vitrectomy is the only answer.
but persisting AC reaction (3-4+), further response or worsening, Vitrectomy is Lucentis scores over Avastin because
intravitreal antibiotics are not preferred, the only hope. Treatment includes oral of its efficacy and safety. Safety with
conservative medical management is and intravitreal voriconazole (50-100 regard to preparation of Avastin is always
continued and patient is readied for ug) or intravitreal amphotericin (5-10 a source of concern as there is no uniform
surgical intervention. ug). Steroids should be stopped. Oral/ method; Multiple Pricks are involved
intravenous antibiotics, cycloplegics and during alliquoting. There have been
In situations where there is no topical antibiotics are usually continued. incidents of Cluster Endophthalmitis with
response to intravitreal antibiotics or Avastin
in very severe infection, RADICAL pars CHRONIC ENDOPHTHALMITIS Prognosis is generally poor.
plana vitrectomy with peeling of hyaloid Management requires the help of a
and base dissection is required. There Typical is Propionibacterium acnes cornea specialist. Have to depend upon
is no role for core vitrectomy in this related endophthalmitis. It runs a chronic intravitreal antibiotic injections +
situation. course with multiple recurrences. Intensive topical treatment. Definitive
Vitreous surgery is difficult.
IOL removal during vitrectomy Usual Intravitreal antibiotic injection
not of much help.

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CLINiCAL SPOTLIGHT - Retina

CASE 3: Case Situation of Definite Endophthalmitis, Vision of at least HM, Has not received Intravitreal antibiotics
(A) (b) (c)

Figure 3a: Post cataract surgery (phacoemulsification) day 4: BCVA - HM+, no glow. Patient treated with intravitreal Vancomycin +
Ceftazidime and medical management. Figure 3b: Post op day 3: BCVA FC ½ meters. Figure 3c: Post op day 6: FC 3 meters.

(d) (e) (f)

Figure 3d&3e: Post op 2 weeks: BCVA 6/24. Figure 3f: Post op 3 weeks: BCVA 6/6

CASE 4: IOL removal during vitrectomy for endophthalmitis may be indicated in severe endophthalmitis, P acne endophthalmitis, fungal
endophthalmitis and recurrent endophthalmitis.

(A) (b) (c)

Figure 4a: Parsplana vitrectomy (PPV) Post 4 days, VA: PL +, no glow. Figure 4b&c: Post radical PPV + IOL removal, Day 9, VA: FCCF

If there is no response, choices can lacrimal drainage system, tear drainage eyelid and conjunctival microflora both
obstruction, contaminated eye drops, preoperatively and intraoperatively.
be: contact lens wear, a prosthesis in This goal may be accomplished by
• Core Vitrectomy can be tried if the fellow eye, and active nonocular using preoperative topical antibiotics
infections. These conditions may lead and topical antiseptic agents. Second,
possible; and to an abnormally elevated population of administering subconjunctival antibiotic
• Keratoprosthesis ocular surface microbes or colonization at the time of surgery should be
of the ocular surface by atypical considered.
vitrectomy followed by PK organisms with greater virulence than
• Endoscopic Vitrectomy the normal microflora. Host factors that Studies evaluating the effectiveness
lower resistance to infection such as of preoperative administration of
PREVENTION & PROPHYLAXIS chronic immunosuppressive therapy antibiotics and povidone-iodine have
and diabetes mellitus have also been reported a significant decrease in
Eyelid and ocular surface microflora reported to be significant risk factors for conjunctival bacterial colony counts.
have been implicated as the source of postoperative endophthalmitis. Topical antibiotics were reported to be
infection in most cases of postoperative most effective in decreasing conjunctival
endophthalmitis. Because bacteria can be To reduce the incidence of bacterial colony counts when
cultured from the ocular surface of almost postoperative endophthalmitis, each of administered 2 hours before surgery
any person, certain risk factors may make the factors implicated in the pathogenesis rather than one or more days before
patients more susceptible to infection should be addressed. First, an attempt surgery. The combination of topical
by their ocular surface microflora. should be made to decrease or eliminate antibiotics and povidone-iodine was
Risk factors for endophthalmitis
include chronic bacterial blepharitis,
active conjunctivitis, infections of the

64 DOS Times - July-August 2015

CLINiCAL SPOTLIGHT - Retina

CASE 5: (b) examination will help to identify the
(A) high-risk patient as previously described.
In these patients, eyelid and conjunctival
Figure 5a&5b: Endophthalmitis with corneal abscess, VA: PL+ at presentation. cultures can be performed before
(c) (d) performing intraocular surgery. Based
on the culture results and the overall
Figure 5c&5d: 4 weeks after radical vitrectomy with silicone oil, BCVA 6/24 clinical evaluation, preoperative topical
antibiotic treatment may be considered.
Fungal Endophthalmitis possibility of emergence of resistant In patients with eye diseases requiring
bacteria. The various strategies to prevent chronic administration of topical
postoperative endophthalmitis are based medications, new sterile medications
on current knowledge regarding the should be provided to the patient before
pathogenic mechanisms of postoperative and after intraocular surgery.
endophthalmitis. Perhaps of greatest
importance, the preoperative ocular On the day of cataract surgery,
treating patients with prophylactic
topical antibiotics that have activity
against organisms commonly causing
endophthalmitis can be considered. A
thorough surgical prep, which includes
lid margins, is performed. Instillation of
5% povidone-iodine on the conjunctiva
followed by irrigation with saline is
part of the surgical prep. The eyelids
and eyelashes can be draped out of the
surgical field with a plastic eye drape.
A dry surgical field can be maintained
when instruments are passed in and
out of the eye. Attention to watertight
wound closure is a priority, particularly
in complicated surgical procedures or in
reoperations that tend to have a higher
incidence of postoperative wound leak.
Vitreous incarceration in the wound
should be eliminated by anterior

CASE 6:

Figure 6: Predisposing History may include (A) (b)
Diabetes Mellitus, immunocompromised
patient, injury with Vegetable Matter, On Figure 7a&7b: Suspected fungal endophthalmitis with VA: HM+.
Intravenous Line
Post op day 1 (c) Post op day 21 (d)
found to sterilize the conjunctiva in more
than 80% of treated patients. Figure 7c&7d: Patient underwent radical vitrectomy with posterior hyaloid peeling and
removal of subhyaloid pus pockets.
Subconjunctival antibiotics are
commonly administered after intraocular
surgery. The rationale for subconjunctival
antibiotic administration at the
completion of the ocular procedure is to
inhibit growth of bacteria that may gain
entry into the eye during the operative
procedure. Studies performed evaluating
the effectiveness of prophylactic
subconjunctival antibiotics in reducing
the incidence of postoperative
endophthalmitis reported conflicting
results.

Administering antibiotics in the
irrigating fluid for cataract surgery has
become a common technique for infection
prophylaxis. This technique carries the
risks of antibiotic toxicity, cost, and the

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CLINiCAL SPOTLIGHT - Retina

CASE 7: Patient with recurrent attacks of uveitis with PC plaque and improvement with steroids underwent PPV + Partial Capsulectomy
+ In-the-bag Vancomycin
(A) (b) (c)

Figure 8a: Post op day 1: BCVA FCCF. Figure 8b&8c: Post op day 9 BCVA 6/60. (f)
(d) (e)

Figure 8d: Post op day 27: BCVA 6/18. Figure 8e&8f: Post op day 49: BCVA 6/9

vitrectomy techniques. At the conclusion of polypeptide antibiotics which includes of action and resistance as does colistin.
of surgery, subconjunctival antibiotic five different chemical compounds Colistin sulphate has greater activity
injection using a combination of agents (polymyxins A, B, C, D and E). Colistin binds than polymyxin B against P. Aeruginosa.
effective against the majority of causative to Gram-negative bacterial cell membrane Intravitreal dose was - 0.1 mg/0.1 ml
gram-positive and gram-negative phospholipids, producing a disruptive (1000 IU/0.1 ml) and IV dose was 2.5-5
organisms can be considered. physiochemical effect, which leads to mg/kg daily in 2-4 doses.
the cell membrane permeability changes
NEWER INTRAVITREAL ANTIBIOTICS and ultimately cell death. Most Gram- Imipenem has a broad spectrum
negative microorganisms are susceptible of activity against both aerobic and
Intravitreal injection of piperacillin to colistin, including multidrug- anaerobic and Gram-positive and Gram-
and tazobactam could be effective in the resistant Acinetobacter baumannii negative bacteria including Pseudomonas
management of multi-drug-resistant and P. aeruginosa strains. Two forms andEnterococcus species. It acts by
endophthalmitis caused by gram- of colistin are commercially available, inhibiting cell wall synthesis of various
negative bacteria. Enterobacter spp. colistin sulfate and colistimethate sodium Gram-positive and Gram-negative
develop resistance rapidly to antibiotics (also called colistin methanesulfate, bacteria. It is stable to hydrolysis by
due to their capacity to produce extended pentasodium colistimethanesulfate and the common plasmid-mediated beta-
spectrum beta-lactamases. Piperacillin colistin sulfonylmethate). The target lactamases produced by various bacteria
and tazobactam complement in their of antimicrobial activity of colistin is and lacks cross resistance with penicillins
mechanism of action against beta- a bacterial cell membrane. The initial and third-generation cephalosporins.
lactamase-producing organisms. Due association of colistin with bacterial Intravitreal imipenem may limit
to the production of high levels of beta- membrane occurs through electrostatic intraocular inflammation and retinal
lactamase, combination therapy with interactions between the cationic tissue damage when given early in the
piperacillin and tazobactam is a safe and polypeptide (colistin) and anionic course of Pseudomonas endophthalmitis.
effective alternative in the management lipopolysaccharide (LPS) molecules in the It is generally nontoxic in animal models
of multi-drug-resistant gram-negative outer membrane of the Gram-negative at concentrations that are far higher
sinfections. Combination of tazobactam bacteria, leading to derangement of the than the MIC 90 of 3.6 to 12.5 μg/ml
and piperacillin is given in dosage of cell membrane. The endotoxin of Gram- against Pseudomonas infection and
225 µgm /0.1 ml intravitreally based on negative bacteria is the lipid A portion may offer promise in the treatment of
available experimental data. of LPS molecules and colistin binds and endophthalmitis after intraocular surgery
neutralizes LPS. Polymyxin E (colistin), or perforating eye injuries.
Intravitreal injection of colistin could only polymyxin B has been used in
be an option effective in the management clinical practice in several countries. When to Refer? (After giving 1st
of multi-drug-resistant endophthalmitis Polymyxin B has the same mechanism Intravitreal Antibiotic Injection)
caused by Gram-negative bacteria. 1. Severe Infection.
Colistin belongs to polymyxins, a group • Very Poor Vision (PL + / -).

66 DOS Times - July-August 2015

CLINiCAL SPOTLIGHT - Retina CASE 9:

CASE 8:

Figure 9: Endophthalmitis after intravitreal Avastin Figure 10: Endophthalmitis with corneal involvement

• Post –Trab Infection. antibiotics and supportive therapy. LEGAL ISSUES RELATED TO
• After Intravitreal Injections. • OT should be sealed and cultures for ENDOPHTHALMITIS
• Suspected Fungal
microbiological evaluation should be Legal issues related to
endophthalmitis / endophthalmitis are multifold and can
taken. be patient related, surgeon related,
panophthalmitis. • Batch numbers of all solutions used institution related, media related or
government related.
2. Non- Response to 1st Intravitreal should be noted and samples sent for
Handling of the media is of particular
Injection. culture. importance and one must ensure that the
• All solutions used should be sealed surgeon involved does not speak to the
3. Associated Choridal detachment / press. The Institutional head or some
and kept in safe custody. other Institutional representative should
retinal detachment. • Seek help from Legal Cell of AIOS. handle the press. One wrong quote by the
surgeon may be misquoted and made a
4. Associated Corneal Abscess. WHATIS TO BE DONE IN CLUSTER huge issue. The surgeon should however
5. Unsatisfied Patient. INFECTIONS OR OUTBREAK ensure that he/ she has completely
6. Cluster Infection. documented each and every clinical
• Cluster infection is defined as record of every patient to protect oneself
Early, Prompt and Appropriate from such eventualities.
occurrence of two ormore than two
treatment with Intravitreal Antibiotics/ There have been certain landmark
infections at a time, or the occurrence court rulings in the recent past on the
Vitrectomy/Re- Vitrectomy) may show issue of medical negligience. Some of
of repeated post operative infection the rulings are not favourable to medical
gratifying results. • Inform authorities (CMO, Medical professionals. One approach towards a
more objective measure in determining
WHAT IS TO BE DONE, IN CASE OF Superintendent, Senior Authority) the legal standard of care could be the
INFECTION? use of clinical guidelines decided upon
• Institute Infection Control by an expert medical body. This is where
• Dialogue with patient and relatives. the printed guidelines on prevention
• Clearly explain the possible causes Committees of intraocular infections assume vital
• Inform AIOS and seek help of Legal importance.
and pathophysiology of infection
cell
and further management. Need for
• Engage and seek help of lawyer.
co-operation and referral should be • Press has to be handled carefully

emphasized. to prevent pandemonium from
• All findings should be documented.
• Review all sterility factors. spreading.
• Have a peer review. • It is desirable that Medical
• Referral to higher centre.
• Treat energetically with intravitreal Superintendent/Hospital Committee
does press briefing

Financial Interest: The authors do not have any financial interest in any procedure/product mentioned in this manuscript.

67 DOS Times - July-August 2015

DOS quiz

DOS Times Quiz 2015-16

Episode-1

Last date: completed responses to reach the DOS OFFICE by e-mail or mail before 5 pm on 17th August, 2015

Q.1: Who is this well known Q.3: 60 year old female with history Q.7: A 8-year-old boy presented
pioneer in the field of of cataract surgery with with severe itching in the
Retina? foldable IOL 3 weeks back. On month of March.
examination her visual acuity
Q.2: 18 year old girl with is 6/12 and was found to have Give your diagnosis of the 2
diminution of vision in the posterior capsular opacity. presentations in the same
right eye. Diagnosis? What is the most appropriate child on two different follow
way to handle this case? up visits.

a. Wait for another 5-6 weeks (a)
b. Yag capsulotomy
c. Membranectomy (b)
d. none of the above
Q.4: When considering diabetic Q.8: Identify the image and its
components?
retinopathy which of the
following statements is Most
accurate:
a) Microaneurysms represent

sacular dilatation of retinal
arterioles.
b) Hard exudates represent
calcium deposites in the retina
c) Cotton wool spots represent
infarcts of the nerve fibre layer
of the retina.
d) Haemorrhages close to the
fovea are not potentially sight
threatening.
Q.5: Steroids are indicated topically
in:
a) Hypopyon ulcer
b) Dendritic ulcer
c) Mycotic ulcer
d) Disciform keratitis
Q.6: Pathologic examination of
cystoid macular edema reveals
cysts in which retinal layer?
a) Outer plexiform.
b) Bruch membrane.
c) Internal limiting membrane.

d) Retinal pigment epithelium.

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

Dr. Ravi Bypareddy Dr. Noopur Gupta
Senior Resident Asst. Prof. of Ophthalmology
Retina Services Cornea Services

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DOS quiz

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Designation:_________________________________________________________________________ Address:_______________________________________________
_______________________________________________________________________ State _______________________________ Pin _______________________________
Mobile No: ________________________________________________________________________________________ DOS Membership no: ___________________

Email ID: _______________________________________________________________________________________Signature: ___________________________________
70 DOS Times - July-August 2015

DOS Crossword DOS CROSSWORD
Episode-1
TEAR SHEET – QUICK PICKS

Dr. Manish Mahabir MD
All India Institute of Medical Sciences,
New Delhi

1
2

3

4 6
5 7

11 9 8
13 12 10

14 15

Across Down
1. Intracameral antibiotic found to be useful for prevention of
2. Nystagmus seen in cerebellopontine angle tumours such
as acoustic neuroma (5). postoperative endophthalmitis following cataract surgery
in ESCRS study (10).
4. AcrySof IQ ReSTOR and Tecnis Multifocal IOL are ______ 3. Imaging principle in which lens plane is not parallel to the
type of multifocal IOL (11). image plane (11).
5. Corneal endothelium is derived from (11).
7. Botox treatment is named after this beautiful Egyptian 6. Rate limiting step in visual cycle is (14).
queen (9). 9. Sheridan screening test for ywowunwg. dcohs-itilmdrese.onrgand79retardates
(6).
8. Antiviral activated by viral thymidine kinase and relatively 12. Images reflected from the surfaces of the eye (8).
nontoxic to mammalian cells (9). 15. Cornea is flatter centrally, steep peripherally (6).

10. Corneal graft endothelial rejection line (10). www. dos-times.org 71
11. Most common cause of Infectious Crystalline Keratopathy

(21).
13. myope with spectacle converges ____ than the emmetrope

or the contact lens wearer (4)
14. Photochromatic lenses contain crystals of (14).

Quick Picks

Oculocardiac Reflex

Dr.Amreen Aslam MBBS RISK FACTORS include younger age group, light general
Dr. Rajendra Prasad Centre for anaesthesia, hypoxia, hypercarbia, acidosis, use of opiod
Ophthalmic Sciences, All India Institute narcotics(sufentanil, alfentanil), beta blockers, calcium channel
of Medical Sciences, New Delhi, India blockers

Definition: Oculocardiac reflex (OCR) (Aschner MANIFESTATIONS include sinus bradycardia, junctional
phenomenon, Aschner reflex or Aschner – rhythm, ectopic beats, bigeminy, atrioventricular blocks,
Dagnini reflex) is defined clinically as decrease ventricular tachycardia, asystole
in heart rate by 10% following pressure to globe
or traction of the ocular muscle usually seen INTRAOPERATIVE MANAGEMENT
while applying traction on the medial rectus.
Ashner in 1908 first described a decrease in heart rate as a • Notify the surgeon to stop ocular manipulation.
consequence of applying pressure directly to eyeball. Incidence • Optimise oxygenation and ventilation.
of OCR varies from 14% to 90%. • Deepen the anaesthesia.
• If bradycardia occurs consider 20mcg/kg intravenous
PATHWAY
AFFERENT LIMB: The afferent limb of the reflex is atropine
• In extreme cases, such as the development of asystole,
ophthalmic division of trigeminal nerve > gasserian ganglion >
trigeminal sensory nucleus > motor nucleus of vagus cardiopulmonary resuscitation may be required.

EFFERENT LIMB: The efferent limb of the reflex is visceral PROPHYLAXIS
motor nucleus of vagus located in reticular formation > vagus
nerve> heart > decrease conduction via sinoatrial node • Careful cardiovascular monitoring during anaesthesia
especially in those with risk factors for OCR.
TRIGGERED by traction on extraocular muscles
medial rectus especially, direct pressure on the globe, any • The surgeon can prophylactically block the afferent limb
ocular manipulation, retrobulbar block, ocular trauma, and of the reflex by injecting peribulbar or retrobulbar local
manipulation of tissue in orbital apex after enucleation. anaesthetics.

• The anaesthesiologist can prophylactically block or
attenuate the efferent limb of the reflex with an intravenous
injection of an antimuscarinic acetylcholine antagonist
such as atropine or glycopyrrolate.

• Deeper general anaesthesia.

www. dos-times.org 73

CORRESPONDENCE PORTAL

The Ethics of Live Surgery

For any surgeon, a vital part of training is watching the procedure as it is performed. General surgical residents do it all
the time, holding retractors while the lead surgeon operates. Ophthalmological trainees watch through the assistant
microscope tube, or on a display screen. Observing a surgery as it happens is totally different from watching spruced
up videos of the same procedure. The trainee gets a sense of participation, as the result is not yet known, and things
might take an uncharted course. A sense of timing is implicit in live surgery. The trainee gets to understand that some
manoeuvres take more time than others, while certain surgical events themselves might require quick thinking and quick
action on the part of the surgeon. These are the reasons that observing a live surgery is different, and more useful, than observing an
edited video of the same.
Most ophthalmological conferences today have a special session of live surgery, wherein experts are called in from various parts
of the world. These experts perform live surgery, watched by an audience of thousands. At times, there are questions that the surgeon
fields while operating.
As a surgeon, and I like to think of myself as a good one, I have serious misgivings about the whole concept of live surgery.
Without mincing words, I think it is unethical. No matter how confident the surgeon, there is always some extra pressure to do well
publicly. In addition, there is the distraction of responding to audience questions as the surgery proceeds. This means, quite simply,
that the surgeon is not devoting the attention that the patient has every right to expect.
There are other issues as well. Many times, these expert surgeons have never met the patient or conducted their own assessment.
The doctor-patient relationship is never established. Though I have never been part of a live surgery schedule, I strongly suspect that
there may exist situations where the patient has not explicitly consented to be part of the ‘show’. In fact, I doubt that any person would
consent to be part of such an exercise without some kind of coercion or some concealment of facts. I wouldn’t, for one.
I have a growing conviction that the concept of live surgery today is becoming more of an exercise in showmanship than any real
intent to educate. Other surgeons may disagree, I expect. So I offer a solution.
The advantages of live surgery can be totally preserved by having the surgeon operate prior to ‘showtime’, and present raw,
unedited footage for the audience to watch and respond to. The time frames are immaterial. The surgeon may fly in a day before the
conference, record the surgery, and present it the next day. The key element here is presentation of raw, unedited video. If the surgery
does not go as well as anticipated, the surgeon always has the choice of not airing that particular surgery. This provides a mental
‘safety net’. If the world is not watching, there is no pressure.
Presenting at a later time, the surgeon can interact with the audience, answer all questions without fear of distraction, and
even share the postoperative outcome. The patient is treated with the respect that he or she deserves, as a fellow human being. The
audience loses nothing, and there is the possibility of pausing or reverting back to an earlier step of the surgery should the interaction
demand it.
I see only advantages of this deferred live surgery. TV channels do it, to prevent inadvertent telecast of inappropriate material.
Even live matches are actually deferred. I think we should, as responsible surgeons, adopt this policy as well. Let all live surgeries be
deferred live. It is the right thing to do.

Dr. Saurabh Sawhney DOMS, DNB
Ophthalmic Surgeon
Insight Eye Clinic
J-9/5, Rajouri Garden, New Delhi, India

www. dos-times.org 77

NEWS Watch

DOS CREDIT RATING SYSTEM (DCRS)

DOS has always been in the forefront of efforts to ensure that its members remain abreast with the latest developments in
Ophthalmology. Among the important objectives formulated by the founders of our constitution was the cultivation and promotion
of the Science of Ophthalmology in Delhi.
The rapid strides in skills and knowledge have created a need for an extremely intensive Continuing Medical Education programme.
In a bid to strengthen our efforts in this direction DOS has been following the DOS Credit Rating System (DCRS), the details of
which are given below. Our Primary objective is to promote value-based knowledge and skills in Ophthalmology for our members
and give recognition and credit for efforts made by individual members to achieve standards of academic excellence in Ophthalmic
Practice.



DCRS Max.

1) Attending Monthly Clinical Meeting* † (For full attendence) 10 90

2) Speaker/Instructor** in

: Monthly Clinical Meeting 10 10

: DOS Winter Conference 15 30

: DOS Annual Conference 15 30

: DOS Teaching Programme/Subseciality meeting 15 30

3) Free Paper Presentation at Annual Conference

As Chief Presenter ** 15 30

As co-authors 10 20

4) Registered Delegate at:

DOS Winter Conference 10 10

DOS Annual Conference 10 10

DOS Teaching Programme 10 10

5) Full Article publication in DJO/DOS Times/DOS subspeciality programmes
45
As first author/corresponding author 15

As co-authors 10 30

6) Letter to editor in DOS Times / DJO 5 10

7) Bonus points for > 3 Monthly Clinical Meeting: 10 bonus points

8) Bonus points for > 5 Monthly Clinical Meeting: 30 bonus points

9) All Monthly Clinical Meeting: 50 Bonus Points

If any of the presentations wins an Award – Additional 20 bonus Credits

Members who have earned 100 Credits, are entitled to the following:
a) Certificate of Academic Excellence in Ophthalmology
b) Eligible for DOS Travel fellowship grant

If any member earns 200 Credits, he/she shall, in addition to above, be awarded Certificate of Distinguished Resource-Teacher
of the Society.

PLEASE NOTE that awards for best clinical case presentation, clinical talk, guest presentation, best institute and popular monthly
meeting will decided based on the DCRS points awarded by the attending member delegates.

* Based on Signature in DCAC
** Subject to Submission of Full Text to Secretary, DOS
† Credits will be reduced in case attendance is only for part of the meeting

FOR KIND ATTENTION

* Members are requested to mark presentations in a FAIR & UNBIASED MANNER
* Members are required to sign on monthly meeting attendance register and put their membership number.
* The DCRS paper will be issued only after the valid signature of the member in the attendance register.
* Please submit your DCRS papers to the designated DOS Staff only.
* The collected DCRS papers will be countersigned by Head of the Institute & President / Secretary or designated
DOS Executive and sealed immediately after the meeting is over.

78 DOS Times - July-August 2015

NEWS Watch

Honours for Our Esteemed Members of Dos

Delhi Ophthalmological Society is proud to felicitate its members Prof Yograj Sharma (Chief & Head of
Dr. R. P. Centre, AIIMS, New Delhi) & Dr Harsh Kumar (Head - Glaucoma Services of Centre for Sight, New
Delhi) for being awarded the prestigious Padmashri Award in March/April 2015.

Hearty Congratulations to Prof. Yograj Sharma

Dr. Prof YOGRAJ SHARMA, Chief of Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, receiving the
prestigious Padmashri award from the President of India in March 2015.

Hearty Congratulations to Dr. Harsh Kumar

Dr. HARSH KUMAR, Head – Glaucoma Services, Centre for Sight , New Delhi, receiving the prestigious Padmashri award
from the President of India in March 2015.
www. dos-times.org 79

NEWS Watch

Dos Library Online

Message from Library Officer

Dear DOS Members

DOS Online Library Service now offers 45 e-books in addition to journals.

Instructions to access:
Ø Please visit dosonline.org
Ø Log in with your DOS Id & password
Ø Click on DOS Library Link
Ø Choose the journal or e-Book link and click
Ø Once the new page opens, choose books from top left of page
Ø If you do not have a login password, please email to [email protected] from your registered email id. Please

mention DOS id in the email
Ø Please feel free to contact me for further details ([email protected])

Thank you for using the DOS Library Service

Dr. Deven Tuli
Library Officer
Phone: 011-26588074
[email protected]/[email protected]

DOS Library Online Journals and e-books

w Cornea Journals
w Current Opinion in Ophthalmology
w International Ophthalmology Clinics w Journal of Neuro-Ophthalmology
w Journal of Glaucoma w Retina
w RETINAL Cases & Brief Reports

E-Books

1. Age-Related Macular Degeneration (2nd Edition) 24. Macular Surgery (2nd Edition)
2. Atlas of Oculofacial Reconstruction: Principles & 25. Manual of Ocular Diagnosis and Therapy (6th Edition)
26. Massachusetts Eye and Ear Infirmary Review Manual for
Techniques for the Repair of Periocular Defects
3. Atlas of Oculoplastic and Orbital Surgery Ophthalmology, The (4th Edition)
4. Color Atlas & Synopsis of Clinical Ophthalmology (Wills 27. Ocular Applications of Fugo Blade
28. Ocular Differential Diagnosis (7th Edition)
Eye Institute): Glaucoma (2nd Edition) 29. Ocular Inflammatory Disease and Uveitis Manual:
5. Color Atlas & Synopsis of Clinical Ophthalmology (Wills
Diagnosis and Treatment
Eye Institute): Neuro-Ophthalmology (2nd Edition) 30. Ocular Syndromes and Systemic Diseases (3rd Edition)
6. Color Atlas and Synopsis of Clinical Ophthalmology (Wills 31. Ocular Therapeutics Handbook: A Clinical Manual (3rd

Eye Institute): Retina (2nd Edition) Edition)
7. Color Atlas of Oculoplastic Surgery (2nd Edition) 32. Orbital Surgery: A Conceptual Approach (2nd Edition)
8. Color Vision Examination Plates 33. Pediatric Cataract Surgery: Techniques, Complications,
9. Color Vision Test Plates
10. Diabetic Retinopathy: The Essentials and Management (2nd Edition)
11. Digital Stereoscopic Test Plates 34. Pediatric Retina (2nd Edition)
12. Diseases of the Eye and Skin: A Color Atlas 35. Review Questions in Ophthalmology (3rd Edition)
13. Diseases of the Orbit: A Multidisciplinary Approach (2nd 36. SERI: Singapore’s World-Class Research
37. Shields Textbook of Glaucoma (6th Edition)
Edition) 38. Smolin and Thoft’s The Cornea: Scientific Foundations and
14. Duane’s Ophthalmology (13th Edition)
15. Evidence-Based Eye Care (2nd Edition Clinical Practice (4th Edition)
16. Eye Pathology: An Atlas and Text (2nd Edition) 39. Therapy for Ocular Angiogenesis: Principles and Practice
17. Eyelid, Conjunctival, and Orbital Tumors and Intraocular 40. Ultrasonography of the Eye and Orbit (2nd Edition)
41. Visual Development, Diagnosis, and Treatment of the
Tumors: An Atlas and Textbook (2nd Edition)
18. Fast Facts: Glaucoma Pediatric Patient
19. Fundus Autofluorescence 42. Vitreous Microsurgery (5th Edition)
20. Harley’s Pediatric Ophthalmology (6th Edition) 43. Walsh & Hoyt’s Clinical Neuro-Ophthalmology (6th
21. Henderson’s Orbital Tumors (4th Edition)
22. Hospital for Sick Children’s, The: Atlas of Pediatric Edition)
44. Wills Eye Hospital Atlas of Clinical Ophthalmology , The
Ophthalmology & Strabismus
23. LASIK Handbook, The: A Case-Based Approach (2nd (2nd Edition)
45. Wills Eye Manual, The: Office and Emergency Room
Edition)
Diagnosis and Treatment of Eye Disease (6th Edition)

80 DOS Times - July-August 2015

NEWS Watch

DOS TIMES 2015 – 2017 AUTHOR GUIDELINES

Our Author Guidelines is available online at www. dos-times.org

Manuscript Submission
DOS TIMES is published once in two months (i.e six issues in a year: July – August, September – October, November – December, January –
February, March – April, May – June). Solicited and unsolicited manuscripts of good quality academics are accepted provided that they are not
under consideration for publication in any other journal. All submitted manuscripts are subject to editorial review before acceptance.

You may submit your manuscripts along with a covering letter addressed to
Dr. M. VANATHI MD
Editor-in-chief DOS TIMES
DOS Secretariat
Room No 479, 4th Floor, Dr. R.P. Centre
AIIMS, New Delhi-110029
or by email to [email protected] / [email protected]
In case of any queries please contact Mr. Sunil Kumar, DOS TIMES assistant @ 011-65705229 or by email ([email protected]).

Manuscript submission & processing
DOS TIMES publishes solicited and unsolicited articles. Acknowledgement of receipt of all manuscripts will be sent to the corresponding author,
once the editorial desk reviews the manuscript for conforming to the requirements of the journal. The initial screening of the articles by the
internal editorial staff assesses the formatting, topicality and importance of the subject, the clarity of presentation, and relevance to the target
audience of the journal.
If you are interested in submitting an article, or have any queries regarding article submission, please contact the Editor-in-chief (see Contact
details above).
We also have an active commissioning program whereby, under guidance from the Editorial Committee, we solicit articles directly for publication.
External review: In order to ensure that manuscript acceptance is unbiased, scientifically accurate and clinically relevant, all articles are reviewed
by the Editorial Board and /or other specialists in the related fields. The identities of reviewers and authors are kept confidential. Authors and
Reviewers are required to disclose potential conflicts of interests/ financial interests.
Revision: Most manuscripts require some degree of revision prior to acceptance. Corresponding authors are requested to submit the revised
manuscript along with one highlighted copy with revisions highlighted. The final decision on acceptance of the manuscript for publication lies
with the Editor-in-chief.
Authors Responsibility: Authors are responsible for the content of material and views expressed in the manuscripts. Authors must disclose
explicitly conflicts of interest, financial disclosures (or the lack of it) that may be relevant to the manuscript under consideration. This should
figure at the end of the manuscript.

Manuscript Preparation
Manuscripts of the following types may be submitted:
Ø FEATURING SECTIONS: Reviews, Perspectives, Experiences in the various subspecialties of Cataract, Refractive surgery, Cornea, Ocular

Surface, Oculoplasty, Glaucoma, Pediatric Ophthalmology, Ocular Oncology, Retina, Trauma, Squint and Neurophthalmology, Miscellaneous,
etc
Ø CLINICAL SPOTLIGHT: on issues of current interest in clinical practice
Ø INNOVATIONS: on new innovations of surgical technique or device
Ø DIAGNOSTICS DISCUSSION: on diagnostic characteristics of a rare / uncommon clinical condition with good photographic documentation
and investigative details
Ø PRACTICE REQUISITES: on Investigative modalities of importance in ophthalmic practice
Ø SNAPSHOT: on reports of clinical case scenarios of special interest with good clinical documentation
Ø CORRESPONDENCE: Letter to editor on published articles / issues of concern
Ø Quick Picks: Tear sheet brief write-up for quick reading / revision

All manuscripts are required to include the following details:
Ø Title of the manuscript, Type of manuscript
Ø Forename(s) and surnames of authors (see Authorship section below)
Ø Author affiliations: Department, Institution, and contact details (mailing address, email and contact mobile number) of all authors
Ø Figures, References, , figures, tables & references cited in text, figures and references numbered in the order of appearance in text, figure /

table legends
Ø Good resolution face photographs of all authors
Ø Photographs, diagrams etc from internet, other manuscripts / books are not to be included. Copyright permission is required wherever

applicable, at the time of submission.
Ø Please spell out acronyms in the first instance of appearance in the abstract and paper
Ø THE AUTHORS WILL BE RESPONSIBLE FOR ANY CONCERNS ARISING OUT OF TO PLAGIARISM, AUTHORSHIP OR RELATED ISSUES.
Ø THE BULLETIN OR THE SOCIETY WILL NOT BE RESPONSIBLE FOR THE VIEWS PROJECTED IN THE MANUSCRIPTS.

www. dos-times.org 81

NEWS Watch

www. dos-times.org 83

NEWS Watch

DOS Membership Benefit

With a total membership of over 7500 members, the Delhi 5. Free Access to full text articles of numerous international
journals through OVID available at the DOS ONLINE
Ophthalmological Society is one of the largest state ophthalmic Library

societies in the world. The hallmark of our society is the excellent 6. Attend DOS Teaching Programme for PG Students (DOST is
a structured resident training module)
academics in the form of regular academic programmes which
7. Travel Fellowships: National & International Travel Grants
includes the following: 8. Receive Digital Directory of Members
w DOS monthly clinical meetings (I – IX) Download application from the website www.dosonline.
w Winter Conference
w Sub-specialty Meetings [DOS-Enhanced Subspecialty org
For any further queries:
Korner (DESK)] Please E-mail [email protected] or visit our website:
w DOS teaching Programme (DOST) www.dosonline.org
w International DOS Conference (i-DOS) [Biennial]
w Annual Conference DR. M. VANATHI
Member Benefits of Delhi Ophthalmological General Secretary - Delhi Ophthalmological Society
Society DOS SECRETARIAT
Room No. 479, 4th Floor, Dr. R.P. Centre for
1. Complimentary DOS Times [Bulletin Magazine (published Ophthalmic Sciences, AIIMS, Ansari Nagar,
New Delhi, Delhi, India
once in two months)] Tel.: +91-11-26588074
2. Complimentary DJO [Scientific Journal (published Email: [email protected]
Website: www.dosonline.org
quarterly)]

3. Free Access to the members section of website providing
• Access to Digital Directory of Members
• Access to past issues of DOS Times & DJO
• Access to hundreds of hours of surgical videos, talk

and recordings of past conferences, workshop and

meetings

4. Discounted registration fees for National and other

conferences of DOS

DOS Members News

Dear DOS Members
(​ i) Status of Suit No. 302 of 2013 (Subhash C Dadeya vs. Delhi Ophthalmological Society & ors.)
Please be informed that the said case mentioned above, that was going on before the SAKET DISTRICT COURT since April

2013, has been dismissed as the plaintiff Dr Subash C Dadeya has withdrawn the said case on April 29, 2015.
​(ii) Incident of Mika Singh slapping doctor in the 66th Annual DOS Dinner Programme​

The singer Mika Singh, who assaulted a doctor during the 66th DOS Annual Dinner Programme was arrested on the 11th of
June 2015 and then released on bail. The matter of unconditional and written apology from him is being vigorously pursued.
There has also been a good response to our call to the medical fraternity to boycott the performer.

Dr. Cyrus M. Shroff M. Vanathi

President, DOS General Secretary, DOS

84 DOS Times - July-August 2015

NEWS Watch

Forthcoming Events

JULY 7th-10th EVER (European association of Vision and
Eye Research), Nice, France
9th-12th ISOPT Clinical, Berlin, Germany

10th-12th OSKON (Ocular Surface and 7th-10th Annual Conference of Australasian Society
Keratoprosthesis), Chennai, Tamil Nadu of Cataract and Refractive Surgeons, Noosa
Heads, Australia

11th-14th Annual Meeting of American Society of 9th-11th Annual NZOS Conference (North Zone
Retina Specialist (ASRS), Wien, Austria Ophthamological Society), Panchkula, Haryana

23th-26th Tamil Nadu Ophthalmological association 23rd-25th Annual Conference of Maharashtra
(TNOA) Conference, Madurai Ophthalmological Society, Goa

26th DOS Monthly Meeting – Dr. R.P. Centre, AIIMS, 25th DOS Monthly Meeting – Dr. R.M.L. Hospital,
New Delhi New Delhi

July 31st–Aug Asia Pacific Vitreoretina Congress, Sydney, November
2th Australia

AUGUST 3rd-5th Annual Conference of VitreoRetina Society
of India (VRSI), Kumarakom, Kerala
4th-8 th Pan american Glaucoma Society Congress,
Bogota, Columbia 4th-6th Odyssey Oculoplasty Association of India
(OPAI), Bhubaneshwar, Orissa
5th-8th Asia Pacific Association of Cataract and
Refractive Surgery (APACRS), Kuala Lumpur, 14th-17th American Academy of Ophthalmology
Malaysia (AAO), Las Vegas, USA

4th-6th International Conference on Clinical & 29th DOS Monthly Meeting – Safdarjung Hospital,
Experimental Ophthalmology, Valencia, Spain New Delhi

4th-8th Pan-American Associstion of Ophthalmology, December
Bogota, Columbia
5th- 6th Winter DOS Conference

13th-16th EIVOC (Eso’s International Vision Science & 11th-13th KERACON, Kolkata
Optometry Conference), Mahabalipuram, India
12th-13th Annual Conference of Strabismus and
Paediatric Ophthalmological Society of India
22nd DOS Enhanced Subspecialty Korner DESK - I (SPOSI), Coimbatore

30th DOS Monthly Meeting – Army Hospital, New 27th DOS Monthly Meeting – Deen Dayal Upadhyay
Delhi Hospital, New Delhi

September

3th-4th International Conference on Ocular Forthcoming Events 2016
Infections 2015 (ICOI), Barcelona, Spain
January

4th-6th World Congress of Paediatric Ophthalmology 1st-3rd Asia Pacific Glaucoma Society Congress, Thailand
and Strabismus 2015
31st DOS Monthly Meeting – Center for Sight, New
(WSPOS), Barcelona, Spain Delhi

5th-9th European Society of Cataract and Refractive February
Surgery Congress (ESCRS), Barcelona, Spain
5th-9th World Ophthalmology Congress (WOC)
10th-12th European society of Ophthalmic Plastic and 2016, Guadalajara, Mexico
Reconstructive Surgery, Brussels, Belgium
17th-20th Congress of International Society for
11th-13th Annual Scientific Meeting of Ophthalmic Glaucoma Surgery, Muscat, Oman
Anaesthesia Society, Chicago, USA
21st DOS Monthly Meeting – Bharti Eye Hospital,
12th-14th European Vitreo Retinal Society Meeting, New Delhi
Venezia, Italy
25th-28th Annual Conference of All India
17th-20th Euretina Congress, Nice France Ophthalmological Society (AIOS), Kolkata

23th-25th Annual Meeting British and Irish Paediatric 27th Feb. – 3rd Annual Meeting of North American
Ophthalmology and Strabismus Association,
Cardiff, UK Mar. Neurophthalmology Society (NANOS),

Tuscan, AZ

25th-27th Annual Conference of Uttarakhand State March
Ophthalmological Society, Jim Corbett
National Park, Nainital 3rd-6th Annual Meeting of American Glaucoma
Society, Ft. Lauderdale, FL, USA
27th DOS Monthly Meeting – Dr. Shroff Charity Eye
Hospital, New Delhi 27th DOS Monthly Meeting – Guru Nanak Eye
Centre, New Delhi
October
April
2nd-4th Glaucoma Connect 2015 (Annual Conference
of Glaucoma Society of India)- Silver Jubilee, 6th-10th Annual Meeting of American Association of
Mumbai Paediatric Ophthalmology and Strabismus
(AAPOS), Vancouver, Canada
3rd-4th Eye Bank Association of India (EBAI) CME,
New Delhi 15th-17th 67th DOS Annual Conference, New Delhi

www. dos-times.org 87

DOS ANNOUNCEMENT

88 DOS Times - July-August 2015

NEWS Watch

ProceedingS Protocol for Monthly Clinical Meetings

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

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

3. The President will declare the Meeting open.
4. The President and the Secretary will then conduct the meeting.
5. The case presentations (2 in no.) will form the first part of the clinical meeting. Each presenter will be allotted 10 min. time for his/
her presentation. This will be followed by discussion with the audience on both the cases (Total time allotted is 15 min.). The case presentation
will be followed by a Clinical Talk of 15 min. duration. This will be followed by discussion with the audience on the topic for 10 min.
6. After the first part of the meeting is over, the President will introduce the subject of the Mini Symposium (which will be of 1 hour
duration) and invite the Chairperson of the Symposium to the Dais to conduct the Symposium. All the speakers may be invited to assume their
seats on the Dais at this time or one by one after they have presented their Talks (at the discretion of the chair person of the symposium).
7. After the Symposium is over, the President will thank the Speakers and the Chair person and request Secretary to make any
Announcements, including the Prizes etc.
8. By the time, the Clinical Meeting is to be declared closed by the President, the Host or his representative would be at the Lectern to
(take the floor immediately after the Meeting is closed) thank people, firms who had helped him in hosting the Meeting and invite the Members
of the DOS for Refreshments.
9. Venue : The monthly clinical meeting will definitely be held in the premises of the allotted institution.
10. Day : The meeting shall be held on the last Saturday / Sunday of the month, whichever the institution deems feasible.
11. Presenter : The presenting faculty / resident / fellows should be from the same institute for clinical case presentations and the clinical
talk. The guest case presentation will be done by the invited guest faculty.
12. One person will be allowed only one-presentation for the award-wining session in the same academic year.
13. Exchange of dates : In case two institutions want to exchange the date of the meeting, it can be done with mutual agreement by the
heads of the department and with information to the secretary’s office, well in advance.
14. Mini Symposium : It shall be organized by the institution but other DOS members can be invited to participate, if required. There
should not be more than 3 speakers in the mini symposium.
15. To qualify for the retention in the monthly meeting calendar, a minimum attendance of 70 members is required (inclusive of the
members of the host institute).
16. For the Best Clinical Meeting award i.e. Bodhraj Sabharwal Trophy, the overall assessment of the meeting will be made purely on
the overall marks by outside delegates and for Dr. Minoo Shroff Trophy the award will be given to the most popular meeting (based on total
attendance including outside and inside delegates as per the attendance register).
17. The attendance will be marked in the register which will be at a separate counter and will be managed by the DOS Staff. At the close
of the clinical meeting, the attendance register will be signed by the Secretary and the President on the same day.
18. Meetings in the month of May and June may be opened from the next year if there are applications for the same.
19. No alcoholic drinks will be served during or after the meeting; only refreshments / snacks/ lunch will be served.

www. dos-times.org 91