Diabetes and its complications are a leading cause of morbidity and mortality in developing and developed countries. The control of hyperglycemia, blood pressure, and lipid levels delays these complications. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are the most sight-threatening complications of diabetes. The established gold standard for high-risk PDR and focal DME is laser photocoagulation. Early Treatment Diabetic Retinopathy Study (ETDRS) and the Diabetic Retinopathy Study provided strong evidence for this modality. Pharmacologic interventions involving modification of mediators of the pathological angiogenesis (aptamers, steroids, macrolides, small interfering RNAs, etc.) and increased understanding of the pathway and mediators has expanded the scientific horizons. The evidence for these interventions is increasingly becoming credible. Improvement in visual acuity in addition to the decrease in retinal thickness is an added advantage derived from many of these drugs. Better laser delivery methods with pattern scanning and short pulse durations along with multi-modality treatment appear appealing. However, multi-centric, multiethnic, head-to-head comparisons of individual modalities alone or in combinations are still required to build an irrefutable body of evidence for management of diabetic retinopathy. The current article briefly reviews the emerging paradigms and current evidence available for understanding and dealing with pathological ocular angiogenesis in diabetes.

Purpose: To generate normative data for optical coherence tomography (OCT) estimated macular thickness in Indian eyes and to establish its determinants. Materials and Methods: In this cross-sectional, observational, hospital-based study, 189 healthy Indian individuals underwent a fast macula OCT scan. Macular thickness was measured in nine ETDRS (Early Treatment Diabetic Retinopathy Study) regions, and the effect of gender, age, laterality, diabetes, and hypertension status on it was determined. Results: Females had a significantly thinner fovea (176.71 ± 23.32 μm v/s. 193.24 ± 20.95 μm) and inner macula (p < 0.001) as compared to males. With advancing age, foveal thickness increases (p = 0.012) while the superior and inferior outer macula thins (p = 0.018-0.027). Diabetes in the absence of any clinical retinopathy did not affect macular thickness. Hypertensive individuals had a thinner macula in all regions except the fovea and nasal macula. Conclusions: The thinner macula in females and age-related thinning should be considered when interpreting OCT scans of the macula. Diabetics with good visual acuity and no evidence of clinical retinopathy had normal macular thickness. Sub-clinical attenuation of vessels might account for the thinner macula in individuals with hypertension.

Aim: To analyze various ocular diseases leading to permanent visual handicap in a district situated in central India based on visual handicap certification issued by the district ophthalmic surgeon after verification of the domicile of the person. Materials and Methods: Records of patients obtaining visual handicap certificate for complete blindness (visual acuity < 3/60 or central visual field less than 10 degree in the better eye) during 1 ^st January 2008 to 31 ^st December 2008 were identified. Information was retrieved and analyzed. Result: Two hundred and seventy nine people were blind (visual acuity <3/60 in the better eye) out of two thousand one hundred and ninety patients came for visual handicap certification. The causes of blindness were avoidable in 49.5% (diabetic retinopathy 12.9%, glaucoma 12.6%, corneal scar 14.0%, Steven Johnson syndrome 9.0%, retinopathy of prematurity 1.1%) and not preventable in 50.5% (retinitis pigmentosa 15.1%, congenital ocular malformations 13.6%, optic atrophy 12.5%, hereditary diseases 8.3%, and age-related macular degeneration 1.1%) patients. Conclusion: High prevalence of retinitis pigmentosa in the population warrants genetic counseling to be taken urgently. Early diagnosis and management is required to prevent blindness arising out of diabetic retinopathy and glaucoma. Newer challenges like congenital ocular malformations and retinopathy of pre-maturity were also seen. Screening for the retinopathy of prematurity should be made mandatory, as it is an increasing problem in countries with improving neonatal care services. Presence of bilateral corneal scar and Steven Johnson syndrome can be avoided by proper health education and inadvertent use of systemic medications.

We report the use of a novel technique "syndrome evaluation system" (Xcyton) as a rapid diagnostic tool in the diagnosis of a case of post-operative polymicrobial endophthalmitis. A patient with low-grade chronic endophthalmitis caused by Propionibacterium acnes and Candida species was diagnosed using this technology from aqueous sample and then treated with intravitreal antibiotics and antifungals.

We are reporting a case of acute necrotizing panophthalmitis associated with serologically proven Chikungunya infection. A young male with a history of fever and joint pain presented to our department with sudden painful proptosis of 6 hours. A detailed ocular examination and specialized serological, imaging, and histopathological tests were performed. Imaging studies revealed dislocated lens, suprachoroidal and vitreous hemorrhage, total retinal detachment and choroidal detachment and soft tissue edema of orbit. Although the Chikungunya virus was not isolated from vitreous tap, chorioretinal biopsy, and other eviscerated material,the serological studies were positive with high titer of recent Chikungunya infection. Histopathology of chorioretinal biopsy and uvea shows acute necrotizing inflammation. Acute necrotizing panophthalmitis (ANP) can be one of the ocular manifestations of Chikungunya infection and was devastating in the present case.

A 69-year-old diabetic man, treated intermittently with oral and periocular corticosteroids for suspected left eye choroiditis for past one year, presented with decreased vision in left eye. We noted best-corrected visual acuity (BCVA) of 20/35 and 20/30 in right and left eyes, respectively. Right lens was cataractous and left pseudophakic. Right fundus was normal while left showed shallow serous detachment around optic disc with underlying focal choroidal lesions. Blood investigations revealed markedly raised leukocyte count with marked lymphocytosis. Bone marrow cytology confirmed B-cell chronic lymphocytic leukemia. The patient's ocular and systemic condition resolved with rituximab and bendamustine chemotherapy.

The aim of this study was to evaluate the effect of single intravitreal ranibizumab injection in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION). The study includes a retrospective analysis of six eyes of six patients diagnosed with NAION. Mean time between visual loss and the intravitreal injection was 7.8 days (range 2– 15 days). The mean age of patients was 58.2 years (range 45– 63 years). Mean visual acuity gain was two Snellen's lines at the six-month follow-up. The mean optic nerve head peri-papillary thickness measured with spectral domain optical coherence tomography after one month decreased by an average of 230 microns. No complication related to the injection was observed during six months' follow-up. Our case series, the fi rst of its type from the Indian subcontinent, shows that patients with acute NAION may benefi t from intravitreal ranibizumab injection.

Magnetic resonance imaging (MRI) has become an indispensable diagnostic tool in the field of radiology. Due to better soft tissue contrast resolution and no ionizing radiation, it has become the modality of choice in most cases of orbital / ocular pathologies. Ophthalmologists tend to neglect interpreting orbital MRI, and rely mainly on the reports provided by the radiologists. This article deals with the basics of MRI and the appearance of normal orbital structures on MRI. This knowledge will help ophthalmologists interpret the MRI orbital pathologies which will be published in the subsequent issue.

Importance of thorough history-taking, meticulous examination and tailored investigations cannot be underestimated in any branch in medicine, and the same goes for neuro-ophthalmology too. In patients presenting with visual loss, ocular motility disturbances, or simply headache, the ophthalmologist may be the first one to diagnose life-threatening conditions. Thus, before referring the patient to other services, it is essential to arrive systematically and rationally at a conclusive, problem-oriented diagnosis. This article gives a stepwise approach to work up patients with a potential neuro-ophthalmic condition. It gives a brief and helpful overview about history-taking in these patients and clears most ambiguities regarding examination techniques and the choice and timing of investigations. It may especially prove to be very useful and of special interest for training ophthalmologists.

The article deals with the basic understanding of electrophysiological tests in clinical practice. Electrophysiological tests involves assessing the function of the rod-cone system and proximal visual pathway. Visual evoked potential (VEP) is performed to assess the function of the proximal optic nerve. Electro-oculogram (EOG) is used to study the photoreceptor-RPE junction. Electroretinogram (ERG) is used to assess the function of photoreceptor (a-wave) and the inner retina (b-wave). Pattern ERG is helpful to study the macular cone function and ganglion cell function. The a-wave in ERG is diagnostic of rod-cone or cone-rod dystrophy. The amplitude of b-wave in ERG helps us to distinguish inner retinal dysfunction from photoreceptor dysfunction. Hence ERG is not only helpful in making a diagnosis but is also helpful in studying the prognosis of the disease which eventually helps in counseling the patient. Pattern ERG when used in conjunction with pattern VEP helps to pinpoint the cause of an unexplained loss of vision. Multifocal ERG studies the focal responses at the posterior pole within the arcades. The most important use of a multifocal ERG is in the early detection of hydroxychlroquine toxicity. Visual acuity assessments with sweep VEP, focal ERG and multifocal VEP are the newer developments in electrophysiology.

Dyes are used in ophthalmology, both as diagnostic and therapeutic aid. The use of diagnostic dyes represents one of the most efficient, objective, non-invasive, and directly visible means we have of identifying and tracking ocular structures at the cellular level. They particularly are useful as both diagnostic modalities and as therapeutic adjutants in both anterior and posterior segment disorders.

The article provides practical tips to ophthalmic post-graduates who are appearing for their exit examination. The theory answer paper should be not just knowledgeable but also appropriate, succinct, and presentable. The article suggests ways to approach a question regarding disease, clinical entity or a surgical technique. It has ways to make the theory answer sheet more readable and presentable for the examiner. The practical and viva voce assessment requires the candidate to be suitably groomed, caring to the patient and demonstrate his /her clinical skills aptly.

Amniotic membrane (AM) was first used as a biomaterial in ophthalmic surgery in 1938. It was applied as a conjunctival replacement following symblepharon release. The durability, pliability and versatility of AM make it a useful adjunctive treatment in various ophthalmic procedures. This review aims to highlight the new developments, mechanisms of action, and established indications of amniotic membrane transplantation (AMT) that have been published in the last few years.