Dr. Sahil Kumar
Resident, Na
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Retina Vitreous › Diabetic retinopathy
Fundus photo of Lasered Proliferative diabetic retinopathy post PRP
Two key studies of PRP were published in the 1980s: the ETDRS9 and the Diabetic Retinopathy Study (DRS). The ETDRS recruited people with NPDR and people with PDR but without HRCs, and one aim was to determine when PRP should be used. In the EDTRS, laser treatment reduced the risk of moderate visual loss (a loss of three ETDRS lines) by 50%, but visual acuity (VA) improved in only 3% of patients. Laser has adverse side effects. Foveal burns, visual field defects, retinal fibrosis and laser scars have been reported. Ability to drive can be affected. Hence laser treatment is not undertaken lightly, and to extend it to people with NPDR would require careful consideration.
Ocular Trauma › Intraocular foreign body
Ncct orbit showing intraocular metallic foreign body
OFBs can cause perforating or penetrating open globe injuries. The visual prognosis depends on the zone of injury, type and size of foreign body and the subsequent complications. Increased awareness about eye protection, improved surgical techniques, and advancements in bioengineering are responsible for an improved outcome in injuries with IOFB. FBs can cause direct damage via entry into the eye but can also ricochet in the eye causing further damage. Subsequent damage depends on the composition of IOFB. For example, iron or copper FBs can cause siderosis bulbi or chalcosis, respectively. Inert substances such as glass, stone, and plastic are better tolerated than metals such as copper or iron. Metallic and magnetic objects are the most common IOFBs. Organic material such as vegetable matter or cilia cause severe tissue reaction, are highly contaminated, and associated with a significant risk of endophthalmitis. In addition, the mechanism of entry and size of the object are also factors in extent of injury. Foreign bodies entering the sclera usually cause more damage than those entering the cornea. High-speed, small FBs will cause a small linear laceration that is less damaging than blunt trauma. Large irregular IOFBs, however, can cause significant initial damage.
Retina Vitreous › Choroidal melanoma
Hamartoma of retina and retinal pigment epithelium
Retinal astrocytic hamartomas (RAH) are benign retinal tumors composed of glial cells. They are typically encountered as an asymptomatic lesion in patients with tuberous sclerosis complex (TSC); however, may be isolated tumors or found in association with other ocular or systemic disease. RAH are diagnosed clinically based on characteristic ophthalmoscopic appearance Classically, three morphological subtypes of RAH have been described.These are: Type 1 (most common): relatively flat, smooth, semitransparent, grey-white lesions without calcification Type 2: raised, multinodular (‘mulberry-like’), opaque, calcified lesions Type 3: transitional lesion with features of Type 1 and Type 2 Lesions typically remain stable with age, and do not evolve between types Spectral-domain (SD) optical coherence tomography (OCT) features of RAH are well described. Tumors are localized in the retinal nerve fiber layer, with dome-shaped thickening and hyperreflectivity present at the inner retina. Characteristic optically empty spaces (‘moth eaten’ areas) are present representing intralesional calcification or cavitation. Outer retinal layers may be compressed or disorganised by the tumor. Calcification and may cause posterior optical shadowing. OCT may also demonstrate CNVM.
Oculoplasty › Orbital cellulitis
Aspergillus flavus on SDA culture
Aspergillosis and mucormycosis are the most common orbital fungal infections, while aspergillosis is the most common cause of paranasal mycoses. Orbital mycoses typically occurs via extension from the paranasal sinuses, however, organisms can also gain access to the orbit from direct trauma or hematogenous spread from distant sites. The two species, Aspergillus flavus and Aspergillus fumigatus, most commonly affect the orbit. Management of aspergillosis consists of reversal of any immunosuppression, aeration and drainage of the paranasal sinuses involved, and treatment with systemic antifungals. Retrobulbar injection of amphotericin B can be considered. Surgical debridement of the orbit, sinuses and skull base with intravenous and local irrigation of antifungals may indicated for widespread invasive disease. Intravenous amphotericin B is considered the gold standard for medical treatment of sino-orbital aspergillosis. A lipid formulation of amphotericin B is available for patients with impaired renal function. Oral itraconazole is also commonly used as an alternative to or in combination with amphotericin B.Oral voriconazole has also been shown to be equally effective as primary therapy with fewer side effects.
Uvea › Scleritis
Episcleritis(nodular)
Episcleritis is a mild, superficial inflammation of the eye that usually resolves on its own or with artificial tears. Scleritis is a severe, deep inflammation often tied to autoimmune diseases. Blood vessels blanch (turn white) when 2.5% phenylephrine eye drops are applied in episcleritis.