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Byline: Ramya. Nadig, Dhanashree. Ratra Background: Double optic disc pit maculopathy is a rare entity. It can be difficult to manage because of excessive leakage and chronic maculopathy. Purpose: To [...]

Byline: Palanikumar. Preethi, Dhanashree. Ratra A 35-year-old female had a sudden onset drop in vision in the left eye, 3 days after she delivered a baby. She was noted to [...]

Byline: Manavi. Sindal, Aashna. Ratra, Dhanashree. Ratra A vital component of fellowship training is surgical training. Imparting surgical competency to trainees is becoming more complex with development in instrumentation, surgical [...]

Byline: Sashwanthi. Mohan, Varsha. Bhambhani, Bhaskar. Srinivasan, Dhanashree. Ratra Schimmelpenning-Feuerstein-Mims syndrome (SFM), also known as organoid nevus syndrome or linear nevus sebaceous of Jadassohn, is a rare congenital phacomatosis. It [...]

Byline: Dhanashree. Ratra, Adwaita. Nag, Hitesh. Sharma Background: Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are [...]

Byline: Dhanashree. Ratra, Sashwanthi. Mohan, Ramya. Nadig, Himanshu. Kashyap Background: Scleral fistulas are known to develop following blunt trauma in patients with retinochoroidal coloboma. These cases can be managed by [...]

Byline: Dhanashree. Ratra, Divya. Pradhana, Parthopratim. Dutta Majumder Purpose: To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD). Methods: A retrospective analysis of eyes with ERD [...]

Byline: Parveen. Sen, Natarajan. Srikrupa, Puja. Maitra, Sundaramurthy. Srilekha, Periyasamy. Porkodi, Harshavardhini. Gnanasekaran, Muna. Bhende, Vikas. Khetan, Sinnakaruppan. Mathavan, Pramod. Bhende, Dhanashree. Ratra, Rajiv. Raman, Chetan. Rao, Sarangapani. Sripriya Purpose: [...]

Byline: Dhanashree. Ratra, Sashwanthi. Mohan, Vineet. Ratra, Angayarkanni. Narayanaswamy Tear film disturbances following any ocular surgery can cause dry eye symptoms (DES). Transconjunctival, sutureless small gauge microincisional vitrectomy surgery (MIVS) [...]

Byline: Ramesh. Venkatesh, Chaitra. Jayadev, Rubble. Mangla, Sai. Chitturi, Sashwanthi. Mohan, Dhanashree. Ratra Dry eye disease (DED) can lead to ocular discomfort as well as visual disturbances. Older adults are [...]

Byline: Munispriyan. Raviselvan, B. Preethi, Dhanashree. Ratra Purpose: To correlate microvascular changes and assess the relationship between microvascular changes and cardiovascular disease (CVD) risk in patients with retinal vein occlusion [...]

Byline: Palepu. Neha, K. Kasim, Raviselvan. Munispriyan, Dhanashree. Ratra Ophthalmomyiasis interna [Figure 1] is a rare infestation of the retina and vitreous due to larvae of a fly. The larvae [...]

Byline: Shobhit. Varma, Sashwanthi. Mohan, Dhanashree. Ratra, Ramya. Nadig, Himanshu. Kashyap Background: The art of scleral buckle (SB) surgery is being largely forgotten. However, it still remains a good option [...]

Byline: Ramesh. Venkatesh, Shama. Sharief, Atul. Thadani, Dhanashree. Ratra, Sashwanthi. Mohan, Raja. Narayanan, Ritesh. Narula, Yusra. Asad, Rupak. Roy, Chaitra. Jayadev, Naresh. Yadav Some degenerations involving the peripheral retina can [...]

Byline: Abhinav. Dhami, Rupak. Biswas, Mohit. Dogra, Ramandeep. Singh, Sangeet. Mittal, Dhanashree. Ratra Purpose: To evaluate the success rate of autologous retinal graft (ARG) for the closure of full-thickness macular [...]

Byline: Dhanashree. Ratra The importance of maintaining detailed and correct medical records can never be emphasized enough. In the increasingly litigious society, not keeping accurate medical records can spell doom [...]

Byline: Dhanashree. Ratra, Raunaq. Khanna The various health benefits of physical exercise are well known. Regular, moderate exercise is included in every cardiovascular risk prevention program, as it has a [...]

Purpose To report a case of inadvertent cystic filtering bleb in a patient with scleral fixated intraocular lens (SFIOL) implantation 7 years after initial procedure.Case presentation A 14-year-old boy underwent lensectomy, vitrectomy and a sutured rigid SFIOL for microspherophakia in the right eye. Seven years later, the patient presented with hypotony related ocular changes. Examination revealed an inadvertent cystic filtering bleb at the scleral section. Anterior segment optical coherence tomography (ASOCT) revealed gap in inner lips of the scleral wound, bridged by a thin strip of scleral tissue. A conservative management with bandage contact lens (BCL) failed after an initial improvement. Injection of trypan blue dye in the anterior chamber confirmed the presence and site of wound filtration. Surgical closure of the fistula was done and patient showed both structural and visual improvement.Conclusion Meticulous wound construction and water tight closure at the end of the surgery can avoid such complications. ASOCT can be helpful in diagnosing the area of fistula. A conservative management with BCL can help by tamponading the filtering bleb. However, in unresponsive cases, surgical closure of the fistula is recommended to improve the hypotony-related changes.

Byline: Dhanashree. Ratra, Sashwanthi. Mohan Any intraocular surgery carries with it the risk of developing a rhegmatogenous retinal detachment (RRD). The risk is less than 1% in a phacoemulsification surgery [...]

Byline: Dhanashree. Ratra Since its introduction by Kelly and Wendel, vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade has become the treatment of choice for closure of full [...]

Byline: Dhanashree. Ratra, Aashna. Ratra The widespread health benefits of physical exercise are acknowledged by all. It is a well-known fact that physical activity reduces the risk of cardiovascular mortality [...]

Byline: Sivapriya. Sivagurunathan, Lakshmi. Selvan, Aafaque. Khan, Sowmya. Parameswaran, Harsha. Bhattacharjee, Krishna. Gogoi, Harsha. Gowda, T. Keshava Prasad, Akhilesh. Pandey, S. Kumar, Pukhraj. Rishi, Ekta. Rishi, Dhanashree. Ratra, Muna. Bhende, [...]

Byline: Dhanashree. Ratra Intravitreal injections of anti-vascular endothelial growth factor (VEGF) are widely accepted as the current gold standard for the treatment of center involving diabetic macular edema (DME). The [...]

Byline: Dhanashree. Ratra Submacular hemorrhage can cause sudden, profound and often irreversible visual loss. Although, it can occur in young patients in the setting of ocular trauma, one is more [...]

Byline: Anshu. Kaushal, Dhanashree. Ratra Retinal vein occlusion is one of the common causes of loss of vision, second only to diabetic retinopathy. Its pathogenesis is still not completely understood. [...]

Byline: Daleena. Dalan, Prakash. Nandini, Narayanswamy. Angayarkanni, Kuppan. Kaviarasan, Sadagopan. Thanikachalam, Undurti. Das, Dhanashree. Ratra Purpose: To evaluate the differences in vascular indices in different scan sizes of optical coherence [...]

Byline: Dhanashree. Ratra, Hitesh. Yadav, Daleena. Dalan, Preet. Sodhi, Vineet. Ratra Sturge-Weber syndrome (SWS) includes facial, leptomeningeal and choroidal hemangioma. The retinal vasculature is essentially normal. Rare cases of retinal [...]

Byline: Kumar. Anshuman, Varshini. Ramesh, Daleena. Dalan, Dhanashree. Ratra A 10-year-old, healthy boy sustained a blunt injury to his right eye with a bicycle handle. He developed lid swelling and [...]

Byline: Kumar. Anshuman, Dhanashree. Ratra The glory of medicine is that it is constantly moving forward, and there is always more to learn. Our understanding of polypoidal choroidal vasculopathy (PCV) [...]

Byline: Kumar. Anshuman, Dhanashree. Ratra Tissue adhesives have a long history of use in ophthalmology. The concept of using fibrin as a biologic adhesive was introduced nearly a century ago. [...]

Byline: Anmol. Naik, Dhanashree. Ratra, Aniruddha. Banerjee, Daleena. Dalan, Sourabh. Jandyal, Girish. Rao, Parveen. Sen, Muna. Bhende, V. Jayaprakash, Pradeep. Susvar, Jaydeep. Walinjkar, Chetan. Rao Purpose: Enhanced S-cone syndrome (ESCS), [...]

Byline: Abhinav. Dhami, Kunal. Shah, Dhanashree. Ratra Purpose: To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a [...]

ABSTRACTSpasm of accommodation refers to constant contraction of the ciliary muscles of the eye, which fail to relax. Neurological issues, head injury, and psychogenic factors can lead to spasm of accommodation, which is generally bilateral. This case report describes the clinical presentation of traumatic, unilateral accommodative spasm in an army person. A 26-year-old male presented with complaints of diminution of near vision in the left eye noticed accidentally. History revealed a blunt injury in the eyebrow region of the left eye two months back. His best corrected visual acuity was 6/6, 0.8 M (N6) in the right eye and 6/9, 2.5 M (N18) in the left eye. Accommodative response was documented using an open-field autorefractometer that showed asymmetry in the accommodation response and pupillary diameter between the two eyes. One percent Atropine sulfate eye ointment – twice a day for 3 days – was prescribed. On the fourth day, the spasm was resolved in the left eye. Pre- and post-Atropine administration, lens thickness measurements were documented, which showed significant changes. Accommodative facility exercise was initiated after the pharmacological management. Unilateral accommodative spasm is rare and needs careful investigations. Objective assessment of accommodative response and lens thickness measurement play a vital role in confirming the diagnosis.

Byline: Pukhraj. Rishi, Ekta. Rishi, Minal. Sharma, Aditya. Maitray, Muna. Bhende, Lingam. Gopal, Tarun. Sharma, Dhanashree. Ratra, Parveen. Sen, Pramod. Bhende, Chetan. Rao, Pradeep. Susvar Purpose: To evaluate the incidence, [...]

Byline: Dhanashree. Ratra, Dhileesh. Chandrasekharan, P. Aruldas, Vineet. Ratra We report a unique case of a patient with retinitis pigmentosa (RP) phenotype in one eye and pigmented paravenous retinochoroidal atrophy [...]

Purpose: To evaluate the efficacy and safety of intravitreal dexamethasone implant in treatment naïve eyes with diabetic macular edema (DME).Methods: A retrospective analysis of treatment naïve eyes with DME which received intravitreal dexamethasone implant between January 2016 and March 2018 was done. Demographic details of the patients, ocular examination findings at baseline and on follow up visits were noted. Morphological features of DME and central macular thickness were noted on optical coherence tomography at each visit. The details regarding additional treatment for macular edema on follow up were noted.Results: Sixty five eyes were included in the study. The mean age was 59.14 ± 9.59 years. The follow up ranged from 6 to 48 months. Psuedophakic eyes showed visual improvement whereas the phakic eyes showed stable vision. The central foveal thickness showed significant reduction (p= 0.05) in all the eyes. The best corrected visual acuity at final follow up (+0.65 logMAR) was slightly less as compared to baseline (+0.62 logMAR). Retreatment was needed in 37% eyes and antiglaucoma medications in 8% eyes. Cataract progression was noted in 24 eyes (37%); 17 eyes (26.1%) underwent surgery. Notably, 27 eyes (41.5%) had some degree of macular ischemia at baseline. And five eyes (7.7%) showed progression of retinopathy leading to vitreous hemorrhage.Conclusion: Dexamethasone implant is helpful in reducing the macular thickness and stabilizing the vision in treatment naïve DME; requiring less number of treatment sessions. However, it does not prevent progression of diabetic retinopathy. The visual improvement may be affected by cataract and macular ischemia.

Purpose: This study was undertaken to investigate the neurovascular changes in the retina of prediabetic subjects. Methods: Subjects enroled in a prospective study were separated into prediabetic and normal control groups based on their glycosylated haemoglobin (HbA1C) levels, fasting and postprandial blood sugar levels and glucose tolerance test. All the subjects underwent detailed ophthalmic evaluation, which included fundus examination, fundus photography, optical coherence tomography angiography (OCTA), and multifocal electroretinogram (mfERG). Comparisons were done between the groups using the Wilcoxon signed rank test. Results: The median age was 48 years for the normal controls (n= 40), and 49.5 years for prediabetic subjects (n= 45) (p= 0.306). There was no difference in the vision, contrast sensitivity, thickness of the ganglion cell complex or the foveal avascular zone parameters between the groups. But the central foveal thickness and subfoveal choroidal thickness were significantly reduced in prediabetics (p< 0.01). The mfERG showed significant differences in the amplitude. The average amplitude was 35 ± 12 nv/deg2in the normals and 29 ± 11 nv/deg2in the prediabetics (p= 0.003). A weak positive correlation was noted between the mfERG and vascular parameters in the prediabetic group. Conclusions: The prediabetic stage reveals earliest functional neuronal changes in the retina. The neuronal function seems to be affected much earlier than clinically appreciable structural changes in the ganglion cell complex and precedes vascular changes in the retina.

Purpose To objectively assess the immediate response to intravitreal treatment for macular edema and compare it across different agents.Methods This retrospective, comparative study included patients with macular edema due to diabetic retinopathy (DME) or vein occlusion who were treated with intravitreal injections of either steroids (triamcinolone acetonide or dexamethasone sustained release implant) or anti-vascular endothelial growth factor antibodies (VEGF). The central retinal thickness (CRT) and the best corrected visual acuity (BCVA) were measured 1 day after the injection and compared with immediate pre-injection values.Results There were 79 eyes (57 patients) including 51 eyes with DME, 18 with branch retinal vein occlusion edema (BRVO-ME), and 10 eyes with central retinal vein occlusion edema (CRVO-ME). The intravitreal agents were triamcinolone acetonide (TA)(n= 15), dexamethasone sustained release implant (DEX)(n= 22), ranibizumab (n= 19), and bevacizumab (n= 23). Statistically significant improvement in CRT was seen in all injection groups (p< 0.05) while improvement in mean BCVA was significant only in the TA group (p= 0.009). The mean change in CRT was maximum with steroids than with anti-VEGFs; viz. 159.47 µ in TA, 115.45 µ in DEX, 86.10 µ in ranibizumab, and 78.78 µ in bevacizumab group. Least amount of change was noted in the spongy type of macular edema (18.73 µ) while improvement in mean BCVA was statistically significant only in the cystoid group (p= 0.01).Conclusions Comparatively, steroid agents showed better immediate response to therapy than anti-VEGFs. Maximum reduction in central retinal thickness was seen following triamcinolone acetonide injection. Cystoid edema showed better immediate response than spongy retinal thickening.

Byline: Dhanashree. Ratra, Maneesh. Dhupper Purpose: To determine the systemic associations in retinal arterial occlusions (RAO) in young Indian individuals less than 40 years of age. Materials and Methods: Case [...]

Byline: Pukhraj. Rishi, Ekta. Rishi, Anusha. Venkataraman, Lingam. Gopal, Tarun. Sharma, Muna. Bhende, Dhanashree. Ratra, Pratik. Sen, Parveen. Sen This retrospective, interventional case series analyses treatment outcomes in eyes with [...]

Byline: Dhanashree. Ratra, Chekitaan. Phogat, Maneesh. Singh, Nikhil. Choudhari We report two cases of intraocular cysticercosis which showed a peculiar presentation of neovascular glaucoma which is hitherto unreported. Two young [...]

Byline: Lingam. Gopal, Anand. Ramaswamy, Hajib. Madhavan, Rajani. Battu, Tarun. Sharma, Mahesh. Shanmugam, Pramod. Bhende, Muna. Bhende, Dhanashree. Ratra, Nitin. Shetty, Madhav. Rao Dear editor, We thank Dr. Vedantham for [...]

Byline: Lingam. Gopal, Anand. Ramaswamy, Hajib. Madhavan, Rajani. Battu, Tarun. Sharma, Mahesh. Shanmugam, Pramod. Bhende, Muna. Bhende, Dhanashree. Ratra, Nitin. Shetty, Madhav. Rao Purpose: To report the clinical and microbiological [...]

To identify the risk factors associated with endophthalmitis after pars plana vitrectomy (PPV).

To report a case of unilateral postsurgical bacterial endophthalmitis, which presented in an unusual manner with frosted branch angiitis.