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This forum has been disseminating information for the past 6 years. The amount of scientific deliberations done by this forum is immense.

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Dr. Lalit Verma
Chairman, Scientific Committee - AIOS
 
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 61 
 on: November 25, 2013, 05:51:30 AM 
Started by admin - Last post by admin
This is a followup on the patient with accidental intracameral betadine . POD1 the central cornea shows central "Mosaic SK" . The good news is that the eye is quiet and the peripheral cornea is clear and pupil is reacting normally and iris details are seen around the central 4-5 mm corneal haze.

Ramesh Dorairajan

 62 
 on: November 25, 2013, 05:50:59 AM 
Started by admin - Last post by admin
This is a followup on the patient with accidental intracameral betadine . POD1 the central cornea shows central "Mosaic SK" . The good news is that the eye is quiet and the peripheral cornea is clear and pupil is reacting normally and iris details are seen around the central 4-5 mm corneal haze.

Ramesh Dorairajan

 63 
 on: November 25, 2013, 05:50:32 AM 
Started by admin - Last post by admin
Friends

My friend has injected 5% betadine intracameral instead of trypan blue and washed it out a few seconds later. The surgery went off well and the cornea remained transparent for that duration. Can anyone advice me about how to manage the patient tomorrow.

Thanks and regards
Ramesh Dorairajan

 64 
 on: November 25, 2013, 05:50:01 AM 
Started by admin - Last post by admin
Friends

My friend has injected 5% betadine intracameral instead of trypan blue and washed it out a few seconds later. The surgery went off well and the cornea remained transparent for that duration. Can anyone advice me about how to manage the patient tomorrow.

Thanks and regards
Ramesh Dorairajan

 65 
 on: November 25, 2013, 05:49:11 AM 
Started by admin - Last post by admin
Dear sir
anybody having experience of switching to LED microscope. Which one is better plz suggest

Dr vinod gedam
Parasia,

Responses:

No: 1

Dear Dr.
I trialed the LED microscope and found the color of the lamp disconcerting. Tissue and blood looked different in the LED light with more blue and less red in  its spectra and so did not purchase it.

Regards
Ramesh D

No: 2

Dear doctor,

I purchased a 1FR pro with LED illumination 1.5 yrs back because it had features like foot controlled step magnification as well as on /off switch for the light which are essential for retina surgeons. It is not difficult to operate with it but the red glow is definitely less and hence the quality of the recording is not that good.

Regards,
Dr Dilip Gaitonde
Thane

 66 
 on: November 20, 2013, 06:43:32 AM 
Started by admin - Last post by admin
Dear all

I have a child 2 months old with bilateral total cataract , rubella positive. Whether both eyes to be operated in one sitting or separately, any specific precaution to be taken. Would like have comments from the experts for the same.

Thanks
Dr. Sanjay

Responses:

No: 1

Dear doctor

It is preferable to do both eyes in 2 separate sittings to avoid risk of infection .However-if child has high risk for anaesthesia related complications simultaneous bilateral surgery can be done ,but treat it like 2 different surgeries changing the instrument sets and scrubbing again like you would do for 2 procedures . Postoperatively you may need a close watch on inflammation and aggressive topical steroids with cycloplegic agents . Needless to say these children will need lifelong followup and care to achieve good outcome

Dr Sumita Agarkar

No: 2

Dear Dr Sanjay

An echocardiogram would be helpful to ascertain the fitness for surgery under GA,  apart from the routine tests. Regarding bilateral simultaneous cataract surgery there are two schools of thought - one would like to do it in two different sittings. Their logic is - even if one child in their lifetime ends with bilateral endophthalmitis, it would be disastrous for that infant. Another group is willing to take that risk - but if you do so, please treat both eyes as separate new cases. The trolley should be laid separately for both the eyes, and no consumables should be common for both eyes.

Best regards
Dr Lav Kochgaway
Kolkata

 67 
 on: November 20, 2013, 06:42:41 AM 
Started by admin - Last post by admin
There is a parent with 4 month old baby pre term with end stage ROP in both eyes with Bscan showing total closed funnel retinal detachment with anterior looping with thinned retina with normal choroid and ONH looking for a solution.If there is anyone who can do something about it looking at nil visual prognosis please let me know.

Thanks
Dr Chetan Bhatia

Expert Comment:

Some stage 5 ROP are operable and can get ambulatory vision and we routinely do this surgery in our hospital both by myself and dr. divya balakrishnan.
Will need to examine the child and the Bscan
Generally eyes that have no light response, severe subretinal cholestrol and significant flattening of AC with corneal scarring and hypotony would be poor candidates for surgery. Others we generally operate but depends on clinical and USG findings

Sincerely
Dr.Subhadra Jalali

 68 
 on: November 20, 2013, 06:37:27 AM 
Started by admin - Last post by admin
what the experts think about Refractive lens exchange( how much should it be encouraged)

Regards
Dr Randhir Kumar
Patna

Responses:

No: 1

Dear Dr.Randhir Kumar,

I do not approve of refractive lens exchange in high myopes.It is a good option for high hyperopes.This procedure is for patients who can not be treated with prk or lasik.For hyperopes more than +6D this could be an option.For high myopes ICL is a safer option.

Dr.K.Madhukar Reddy

No:2

Refractive Lens Exchange Phaco Surgery in patients above 35 years with moderate to high myopia / hyperopia does give excellent results and is definitely desirable.
 
Dr Ashok Mehta (MS-Oph, UGCF)
Vadodara

No: 3

Dear Dr.Randhir Kumar,

I personally feel that refractive lens exchange for myopes is risky proposition because of higher rates of retinal detatchment.How ever for high hyperopes its a option because of lower risk.

Madhukar Reddy.K
Hyderabad.

 69 
 on: November 20, 2013, 06:36:03 AM 
Started by admin - Last post by admin
I am at present working in a Govt. Hospital where Biometry machine is out of order for a long time. Hence I am doing Cataract Surgery without doing Biometry Test and implanting Lens arbitrary(as available from stock of IOL ). Can any pt. raise a MEDICO-LEGAL issue against me ?

Bidyut Chatterjee

Responses:

No: 1

Dear Dr. Chatterjee,

Yes, it can be a medicolegal issue, because the standard of care expected in today's world is more than what you are doing Sir. In fact, before you think of legal issues, it is the attitude to try to excel in every case which helps you achieve greater heights. Keep on writing to the government to provide the equipment. Sometimes they listen! Till then send your patients to the nearest ophthalmologist in private sector for biometry. He can do it for a nominal charge.

Dr. Amandeep Singh 

No: 2

Dr. Chatterjee, The Doctor is solely responsible for all the eventualities of a surgery. All the factors that you have mentioned are not counted at all by law. Doing cataract surgery without a Biometry is not right. Please get the biometer repaired or replaced, immediately, or ask patients to get the test done in a nearby eye hospital.

M.S.Ravindra

No: 3

Doing IOL implantation without biometry is definitely a deficit in service and can invite medico-legal problem. I too served in a Govt Medical College where such problem comes up from time to time. Fortunately there are 2-3 private optical shops where biometry is done for a small fee and the patients are advised to get it done there before the surgery is undertaken. 

Dr.H.K.Rajguru, Cuttack

No: 4

Dear Dr Chatterjee,

By definition, not doing something which in ordinary prudence should have been done, constitute a medical negligence.Therefore you get your answer.

Dr. P. Roy.

No: 5

Dear Dr Bidyut Chatterjee,
Few Facts for you :
1. The Supreme Court has ruled that the Surgeon is the CAPTAIN OF THE SHIP and responsibility direct and vicarious finally rests on the shoulders of the operating surgeon . This includes errors by sister /OT staff / OPD Staff which have a direct  bearing on the surgical result  . We as operating surgeon are supposed to be overlooking and supervising the entire sequence of events/ rocedures which have a bearing on the surgical and visual outcome.

2.  Pl refer to "Guidelines to the management of catraract in India' - developed by Vison 2020: The Right to Sight - India. This manual released in Nov 2011 has foreword by The Director General of
NPCB,Ministry of Health & Family Welfare , Govt of India who has officially endorsed it as the guideline to cataract surgery in India.Cataract surgery module number 4 of this manual deals with IOL power calculation and it explicitly mentions that either ultrasound Biometry / parital interference interferometry (IOL Master/Lenstar) should be used for IOL power calculation.. The Summary at the end of the module reads "  Biometry and correct IOL power calculation is a critical factor for good visual outcome and a satisfied patient' In view of both the above , there always exists the possibility of the surgeon being sued /taken to court if a patient  has marked sub optimal vision. Being in a government set up , you cannot be taken to consumer court but no one can stop the patient from initiating criminal proceedings on the grounds of negligence of accepted/official norms for cataract surgery. Remember the administration will wash their hands off as they will call it a medical procedure problem which falls in the surgeon's purview.
You have two options to get around your problem :
 1. Get the biometry done elsewhere and use it .
 2.  Quote the Govt of India manual which I referred to in para 2 and write a letter to your administrative head explaining why you cannot do  cataract surgery in your present set up Chances are your A scan machine will get repaired/ replaced soon !

Regards
Dr Vasanth Kumar Ramanathan
Coimbatore

No: 6

Apart from litigation, IOL implant without Biometry should not be done.

Dr Ashok Mehta

No: 7

Thanks to all of you .I understand that doing IOLs without Biometry is very bad job which I was not able to impress my seniors administrators (non ophthalmologists).Now with your all  hard evidence I hope  to make them realize it.

Bidyut Chatterjee

 70 
 on: November 20, 2013, 06:35:25 AM 
Started by admin - Last post by admin
In patients with Topiramite induced myopia or acute congestive glaucoma should we advise patient to avoid other sulpha drugs like Septran and even Diamox. Also are there chances of aggravating congestive glaucoma if we give Diamox during attack?

Dr.Tarachands

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