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Physicians have to play the role of a team leader and counselor and take written informed consent for high-risk surgeries in many cases. This is the first step toward initiating a mutually trustworthy relationship with the patient and family. The situation is more sensitive when vulnerable patients like small premature babies or the elderly are under consideration. In the event of a death, leadership and processes in place become extremely critical. We share our experience and practice pattern during this process, especially suited to India, but the broad principles would apply to most human situations. Hopefully, some of these can be incorporated into the existing training curriculum for team building and the art of effective physician-patient communication that should be intricately woven into the curriculum for the Science of Ophthalmic care.

Abstract Background The close structural and microcirculatory co-relation between anterior and posterior segments of eye make them very vulnerable to complications when one of them is affected surgically. With the advent of anti-fibrotic agents in the management of glaucoma, the rates of vitreoretinal complications have become more frequent. Main body Common retinal complications after glaucoma surgeries include choroidal detachment; ocular decompression retinopathy; haemorrhagic choroidal detachment; hypotony maculopathy; malignant glaucoma; vitreous haemorrhage; bleb endophthalmitis; retinal detachment. Similarly, intraocular pressure rise is often noted after scleral buckle; pars plana vitrectomy; intravitreal gas injection; silicone oil injection; intravitreal steroid injection. Conclusion The article provides some insight into some of the complications after glaucoma and retina surgeries, including the pathogenetic mechanisms behind each complication and available management options.

Abstract Background To study the interaction between idiopathic macular telangiectasis type 2 (MacTel2) and coexistent diabetic retinopathy (DR) during long term follow up. Methods A retrospective chart review was done for all eyes with MacTel2 and DR with a minimum 2 years follow up. Eyes with other retinal disorders and poor quality imaging were excluded. Data collected included demographics, presenting visual acuity, systemic evaluation, treatments done, duration of follow up, and final visual outcomes. Results Out of 951 patients with MacTel2, 277 patients had diabetes. Out of 277 patients, 44 eyes of 22 patients had MacTel2 coexisting with DR. Twenty-eight eyes of 14 patients were included in this study. All cases of MacTel2 were bilateral with a preponderance of women (71.42%). Mean follow up was 93.07 ± 84.03 months with a mean random blood sugar level of 135.41 ± 45.47 mg% at presentation. Twenty-five (89.28%) eyes presented with mild non-proliferative diabetic retinopathy. Two (7.14%) eyes progressed in their DR staging from baseline. Stage III MacTel2 were noted in 11 (39.28)% eyes at baseline. None of these eyes progressed to stage V during follow up. Mean presenting logMAR BCVA was 0.214 ± 0.227 which dropped to 0.399 ± 0.301 at last visit (p = 0.0005). Diabetic macula edema (DME) was not noted in any eye till last follow up. Conclusions 12.5% of eyes with MacTel2 in diabetic patients had coexistent DR. MacTel2 led to slowly progressive visual loss irrespective of the presence of DR.

Hydroxychloroquine (HCQ) in recent times has been used in treatment for a variety of autoimmune diseases and dermatological and rheumatological conditions. Retinal toxicity from HCQ and its analog chloroquine has been recognized for many years. Retinal toxicity secondary to HCQ is irreversible and can continue to progress even after cessation of therapy. Prompt screening and serial monitoring, with the utilization of imaging modalities, is of paramount importance to early detection.