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  Most popular articles (Since June 06, 2017)

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Operation theaters and sterilization requirements — Design consideration and standards for infection control
T Nirmal Fredrick, Murugesan Kumaran
April-June 2018, 56(2):84-90
An operation theater (OT) complex is the “heart” of any hospital. An operating theater, operating room (OR), surgery suite, or a surgery center is a room within a hospital where surgical and other operations are carried out. The patient is the center point of a functioning OT complex. He/she is in isolation for varying times, away from his near and dear ones and is physically sick. Efforts should be directed to maintain vital functions, prevent infections/promote healing with safety, comfort, and economy. A “civil-mechanical-electrical-electronic-biomedical” combo effort driven and coordinated by the needs, preferences, and safety of the medical/surgical team forms the basis for starting and maintaining an OT. Hospitals should exercise great care in proper maintenance of the OR environment, heating ventilation and air-conditioning system (HVAC) system, and medical and nonmedical equipment inside the OR. Personnel involved in disinfection and sterilization process should follow aseptic protocols. Aseptic protocols mean following safe and disciplined procedures to minimize or eradicate the microbiological load in the environment and in the instrument brought into the sterile field during the surgery.
  20,058 1,468 -
Update on optical biometry and intraocular lens power calculation
Nazneen Nazm, Arup Chakrabarti
July-September 2017, 55(3):196-210
Intraocular lens (IOL) power calculation is the single most important determinant of functionally improved result of a technically precise cataract surgery. We have discussed recent advances in the field of optical biometry and IOL power calculation formulae as a means to achieve better postoperative visual outcome. The use of automated optical biometry device, the current 'gold standard' of IOL power calculation, dates back to 1999. We have highlighted the evolution of newer optical biometry devices and the technology they are based on, and their advantages and limitations. We have done technical comparison of contemporary biometers and have included contextual current review of literature. We have described newer generation IOL power formulae, IOL power calculation in high to extreme myopia, toric calculators and intraoperative aberrometry, and concluded our discussion with a note on future prospects of IOL power calculation.
  6,062 796 2
Orbital cellulitis- A review
Raghuraj Hegde, Gangadhara Sundar
July-September 2017, 55(3):211-219
Orbital cellulitis is an infection of the orbital soft tissues posterior to the orbital septum. It has the potential to be affect sight and function of the eye and extraocular tissues. Although it is commonly seen in the pediatric age group, adult orbital cellulitis is not uncommon. Infection usually originates from sinuses but sometimes the nidus of infection is in the eyelids, from retained vegetative foreign bodies, or very rarely from distant infection spreading to the orbit spread from blood. It is characterized by pain, proptosis, chemosis, diminution of vision, fever, periorbital erythema, and limitation of ocular motility. Historically orbital cellulitis was a sight and life-threatening condition. However, with the advent of high quality imaging, antibiotics and early surgical intervention to drain the orbital abscess when indicated, the chances of visual loss have reduced significantly. The purpose of this review is to describe current investigative and management paradigms in the treatment of orbital cellulitis and current recommendation in the management of complications resulting from it.
  5,623 534 -
Accommodative spasm: Case series
Anjali Kavthekar, N Shruti, M Nivean, M Nishanth
October-December 2017, 55(4):301-303
This study highlights importance of cycloplegic refraction to detect accommodative spasm(AS) patients and role of atropinisation for its management.This retrospective case series study was done at a tertiary care eye hospital in Chennai, India. Four patients, presented with complaints of sudden onset blurring of vision and asthenopic symptoms with history of aggravation of symptoms with prolonged near work and under stressful conditions.Refraction was initially showing myopic refractive error.After cycloplegia,there was hypermetropic shift and VA was 20/20 for distance in all patients with their hyperopic correction,and N6 with upto +3.00 dioptres for near.Diagnosis of AS was made.Bifocal glasses were prescribed and atropinisation(1%) with avoidance of aggravating factors was started . Patients were tapered gradually to prevent recurrence over three months and were observed for six months in which none had reccurence.Post cycloplegia,the condition resolved and asthenopic symptoms were improved.
  4,956 377 -
Newer drugs in glaucoma management
Sujatha V Kadambi, Ronnie George
April-June 2017, 55(2):134-139
Glaucoma, a chronic progressive neurodegenerative disease, has both intraocular pressure dependent and independent pathogenetic mechanisms. Medical therapy is the first line of treatment in glaucoma management. Patient adherence and persistence to pharmacotherapy is a great barrier to its success. This review highlights the recent advances in medical management and discusses newer pharmacotherapy including new molecules with novel mechanisms of action, novel target molecules/genes/tissues, and newer drug delivery systems, many of which are still in clinical trial phase.
  4,100 603 -
Clinical profile of nonstrabismic binocular vision anomalies in patients with asthenopia in North-East India
Damaris Magdalene, Pritam Dutta, Mitalee Choudhury, Saurabh Deshmukh, Krati Gupta
July-September 2017, 55(3):182-186
Aim: To report the clinical profile of non-strabismic binocular vision anomalies (NSBVA) in patients with asthenopia in North-East India. Materials and methods: A hospital based study was conducted on 131 patients from age group 10-40 years attending the vision therapy clinic. Patients were divided into the age groups 10-20 years, 21-30 years and 31-40 years. A detailed orthoptic evaluation was carried out including sensory and motor testing and a diagnosis was made comparing various orthoptic parameters of the particular patients. Results: Of the 131 patients, 81 were female and 50 were male. The number of patients was 62 in the 10-20 years age group, 49 in 21-30 years age group and 20 in 31-40 years age group. The prevalence of NSBVA in age group 10-20 years was 69.35%, 21-30 years was 67.35% and 31-40 years was 50.00%. It was observed that the most common NSBVA was convergence insufficiency across all age groups followed by accommodative insufficiency and convergence excess. Conclusion: Early detection of NSBVA is important because these deviations may decompensate without treatment and become strabismic resulting in loss of stereopsis and development of suppression. Early detection and treatment provides best opportunity for academic success in school going age groups.
  2,591 248 -
Generic drugs in ophthalmic practice: Boon or bane?
Murali Ariga, M Rajalakshmi, C Praveena
July-September 2017, 55(3):220-222
Generic pharma products are inexpensive as compared to the original innovator branded drugs. True generics are not freely available in India. There have been concerns about efficacy and quality of generics that are available. This review outlines these issues and the legislation regarding the availability and use of generics in our practice.
  2,660 166 -
Approach to headache in ophthalmic practice
R Vasumathi
April-June 2018, 56(2):91-97
Headache is one of the most commonly experienced of all the physical discomforts. About half of the adults have a headache in a given year. Headaches can occur as a result of many conditions. Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. The evidence in the literature for a strong association between oculovisual problems and headache is weak. Still, patients who believe that appropriate ocular examination and treatment help to lessen their headache visit ophthalmologists very frequently. Although ophthalmic causes are sometimes diagnosed, eye pain and visual disturbances are often neurologic in origin. Many primary headache disorders have ophthalmic features, and secondary causes of headache frequently involve the visual system. Both afferent and efferent symptoms and signs are associated with headache disorders. Moreover, the frontal or retroorbital pain of some primary ophthalmic conditions may be mistaken for a headache disorder, particularly if the ophthalmologic examination is normal. This review summarizes the common causes of headache encountered in ophthalmic practice and the red flag signs which need referral to other specialists.
  2,554 233 -
Posterior staphyloma
Baskararajan Gopalakrishnan, Bhuvanasundari Baskarajajan
April-June 2018, 56(2):76-83
Introduction: Very high myopia is usually associated with posterior staphyloma. The pathology, management and our experience reported in the article. Methods: We studied a total of 3737 student population in schools and colleges in the year 2001 — 2002 with the help of the Principals and teachers. High myopic patients treated in our hospital (242 patients) who underwent B—Scan and surgical management in two stages, posterior scleral support operation followed by low power intraocular lens implantation, have been included in the study(14). Discussion: High myopia and keratoconus have opposite effect in the anatomy of eye ball. In high myopia, the anterior segment of the eye is usually normal or there may be slight variation in the depth of anterior chamber whereas in keratoconus the posterior segment is normal. Staphyloma, usually occurs in the posterior pole of the eye ball involving the macular region can also expand anteriorly leading to thinning of sclera to be observed as bluish bulging. As the posterior staphyloma progresses, the retina undergoes degenerative changes due to stretching in the macular region, around the ora-serrata and around the optic disc also. In the posterior pole, the thinning of sclera and retina leads to a decrease in the functional efficiency of the retina which is often misconstrued as amblyopia especially in uni-ocular high myopes. In majority of such cases, surgical compression of the posterior pole by preserved donor sclera from behind reverses the damage and restores full vision when followed by low power intra ocular lens implantation. Results and Conclusion: 242 high myopes, among which 212 patients with Bilateral and 30 patients with unilateral involvement were included in this report and final visual outcome analyzed. In the surgical management of very high myopes, it is mandatory to manage the posterior staphyloma to get good visual outcome. To arrest the myopic progression, P.S.S.O. should be performed in young age itself.
  2,504 174 -
Kayser fleischer ring: A strong clinical indicator of neuro-wilson's
Rajalakshmi Selvaraj, Subashini Kaliaperumal, Pooja Kumari
October-December 2017, 55(4):307-309
A female child presenting with features of lupus nephritis was referred for ophthalmic evaluation related to autoimmune diseases. It turned out to be a dense yellow-brown deposit of Kayser Fleischer (KF) Ring and sunflower cataract following which diagnostic tests for Wilson disease (WD) were carried out and treated for the same. However, the child died in a month due to hepatic encephalopathy and sepsis. The dense KF ring conveys that it has been long-standing and a definite indicator of Neuro WD. In this brief report, the authors would like to insist on the significance of early identification of KF ring and its neurological relevance.
  2,512 161 -
Pediatric intraocular lens power calculation
Sandra Chandramouli Ganesh, Shilpa G Rao, Farhadul Alam
October-December 2018, 56(4):232-236
Pediatric cataracts pose multiple challenges in terms of management and postoperative rehabilitation. Difficulties in obtaining accurate measurements for axial length and keratometry are encountered due to poor cooperation in children and instrumentation errors. There exist multiple formulae for intraocular lens (IOL) power calculation, which are based on various factors and have varying degrees of accuracy. Children exhibit a tendency for myopic shift due to the anatomical differences from adult eyes and due to the growth of eyeball, as a result of which they require undercorrection, when IOL implantation is planned.
  2,185 235 -
Quality healthcare and clinical processes: An amalgamation needed to achieve clinical excellence
Suneeta Dubey, Deepika Verma, AK Arora
July-September 2017, 55(3):187-191
Quality improvement is an essential component of 21st-century medicine. Dr. Shroff's Charity Eye Hospital is National Accreditation Board for Hospitals and Healthcare Providers-accredited organization which firmly believes in amalgamating quality measures with clinical processes and bringing out the most effective clinical environment for best patient care, one of the values of the organization. Clinical excellence is achieved through a stepwise approach.
  2,221 151 -
Profile of brain tumors having ocular manifestations in a Tertiary Eye Care Institute: A retrospective study
Saurabh Deshmukh, Dipankar Das, Harsha Bhattacharjee, Ganesh Ch Kuri, Damaris Magdalene, Krati Gupta, Prabhjot Kaur Multani, Vivek Paulbuddhe, Shriya Dhar
April-June 2018, 56(2):71-75
Aim: To form a profile of brain tumors having ocular manifestations presenting to a tertiary eye care institute. Materials and Methods: The medical records of patients diagnosed with primary brain tumors between January 2012 and December 2017 were reviewed. Patients underwent a detailed ocular examination and neuroimaging to confirm the diagnosis. Results: Out of the 17 patients, 11 (65%) were female and 6 (35%) were male. The mean age was found to be 43.17 ± 11.04 years and the majority of the patients belonged to the age group 21—40 years (47.06%). The most common presenting symptom was found to be diminution of vision (100%), followed by headache (41.14%) and vertigo (23.52%). The most common sign was optic disc changes, namely optic atrophy (47.05%), followed by disc pallor (29.41%) and papilledema (11.76%). Meningioma (41%) was the most common tumor followed by pituitary macroadenomas (29%). At the time of presentation, two patients had the restriction of extraocular movements, seven patients had a positive relative afferent pupillary defect, and four had defective color vision. Conclusions: Ophthalmic signs and symptoms form a major part of the presentation in patients with intracranial tumors. Majority of the patients diagnosed by ophthalmologists with brain tumors presented with optic disc pallor or edema resulting in diminution of vision. By careful neuro-ophthalmic evaluation, early diagnosis of intracranial space occupying lesions can be made and prompt referral to neurosurgeon can reduce the morbidity and mortality.
  2,143 220 -
Scleral-fixated intraocular lenses
VG Madanagopalan, Parveen Sen, Prabu Baskaran
October-December 2018, 56(4):237-243
Scleral-fixated intraocular lenses (SFIOLs) are important tools for an ophthalmologist when dealing with the eyes that have inadequate capsular support. Since the time of its introduction, SFIOLs and techniques for their implantation have seen many innovations. Initially, sutured SFIOLs were widely performed. In the last two decades, sutureless SFIOLs are gaining popularity. Both these methods and the different surgical techniques to perform them offer unique advantages to the surgeon. Therefore, careful consideration is to be given to the choice of technique and steps to be employed for a particular eye. In this article, we aim to provide an overview of the commonly used techniques in SFIOL surgery and provide certain surgical tips that may help the surgeon in the operating room.
  1,877 243 -
Scleral buckling: Principles, utility, and relevance today
VG Madanagopalan
October-December 2017, 55(4):286-292
With time, any surgical specialty or procedure invariably undergoes change. New techniques and technologies become available and the next generations of surgeons innovate to modify established methods. The surgical management of retinal detachment has come a long way from the days of Custodis and Schepens. Scleral buckling (SB), which was once the “gold standard” when reattachment of the retina was desired, no longer enjoys the coveted standing of yore. Despite being in use for more than six decades, the many “modifications” of this surgical procedure are rather superficial - although some may argue that the procedure itself is superficial - and the original surgical principles described have remained constant. In this article, we focus on the utility of buckling, the dynamic physical forces at work when a buckle attempts to reattach the retina and the role of SB in this era of microincision surgeries.
  1,870 233 -
Posterior iris-claw intraocular lens implantation as an effective option in aphakia
M Periyanayagi, Nithiya Selvaraj, M Sivakami
October-December 2017, 55(4):282-285
Aim: This study aims to evaluate the safety, effectiveness, and complications of posterior iris-claw intraocular lens (IOL) in aphakic patients with inadequate capsular support. Patients and Methods: This prospective interventional study was conducted in 100 eyes of 99 patients between July 2013 and June 2017. Surgical aphakia with inadequate capsular support, large zonular dialysis, subluxated lens, dislocated lens, dislocated IOL, and aphakia following congenital cataract surgery were included. Preoperative and postoperative best-corrected visual acuity (BCVA) and the occurrence of various vision-threatening complications such as iridocyclitis, decentration, vitritis, cystoid macular edema, and retinal detachment were considered during the follow-up period. Results: One hundred eyes of 99 patients who fulfilled the criteria were included. The mean follow-up period was 13.5 months (4–24 months). About 90% of patients had improvement in vision with postoperative BCVA of 6/12–6/6, 7% had visual improvement with postoperative BCVA of 6/18–6/36, and 3% had a drop in visual acuity with BCVA < 6/60. About 15% developed iridocyclitis in the immediate postoperative period and responded well to topical steroids. Nearly 2% developed vitritis during the follow-up period and 1% developed rhegmatogenous retinal detachment. None had decentration or cystoid macular edema during the follow-up period. Conclusion: Posterior iris-claw IOL implantation is a safe, effective, and timely procedure in aphakia with inadequate capsular support in the hands of a skilled experienced surgeon.
  1,817 172 -
Zepto cataract surgery: The way forward
Nishanth Madhivanan, Shruti Nishanth, Nivean Madhivanan, Madhivanan Natarajan
April-June 2018, 56(2):98-101
Continuous curvilinear capsulotomy (CCC) is one of the most crucial steps of cataract surgery because of numerous surgical and anatomic advantages. The introduction of cataract surgery assisted by femtosecond laser has improved the repeatability and the accuracy of a perfectly rounded capsulotomy, as compared to the manual CCC. However, multiple surgical steps and the relatively high cost-per case have rendered this technology useful only to the affordable. This article describes a cost-effective and convenient new technique of perfecting the circular capsulotomy using a device called precision pulse capsulotomy or Zepto.
  1,795 152 -
Juvenile X-Linked retinoschisis: Response to topical dorzolamide therapy
Krati Gupta, Dipankar Das, Harsha Bhattacharjee, Hemalata Deka, Damaris Magdalene, Saurabh Deshmukh
January-March 2018, 56(1):35-37
We report clinical course of a 22-year-old Indian male patient presenting with bilateral Juvenile X-linked retinoschisis (JXLRS) in response to topical 2% dorzolamide hydrochloride treatment. He presented with progressive diminution of vision in both eyes (OU) for the past 16 years. A “cartwheel” macular pattern was observed in his retina OU. Multimodal imaging including fundus photography, fluorescein fundus angiography, optical coherence tomography (OCT), and electroretinogram was performed. Following treatment with topical dorzolamide, there was a significant regression of the macular cyst on OCT and significant improvement in the visual acuity. This case report emphasizes on the response of macular cysts to topical dorzolamide. Thus, it may be a promising treatment option in terms of visual as well as anatomical recovery in JXLRS.
  1,766 111 -
Botulinum toxins and fillers for treatment of the aging face
Bhupendra C. K. Patel
April-June 2017, 55(2):113-119
We present a comprehensive review of how to best use neuro-toxins and fillers to rejuvenate the aging face. With modern neuro-toxins and fillers, it is now possible to achieve an improvement in the aging changes of young, middle-aged, and older patients. Furthermore, with the appropriate application of these materials, surgical results can be kept looking good without the need for repeated surgical intervention. As it is important to understand the relationship of the different parts of the face when assessing the aging face, we review the best practices as applied to the whole face.
  1,677 172 -
Traumatic luxation of the globe: A novel simple treatment
Viji Rangarajan, Yazhini Tamilmani
April-June 2017, 55(2):145-147
Luxation of the eyeball is a rare clinical entity that may present spontaneously or more commonly following trauma, but it carries a risk of threat to permanent vision loss. Appropriate intervention should be undertaken instantly. Prompt reduction results in restoration of full anatomical, functional, and visual recovery in otherwise healthy eyes. We report a case of globe luxation following trauma by the brake handle of a two-wheeler in a 12-year-old female, who recovered completely after reposition of the globe using Desmarres Lid Retractors.
  1,663 126 -
Bilateral endogenous endophthalmitis in disseminated histoplasmosis secondary to immunosuppression: A rare case report
Surpriya Hawaibam, Dipankar Das, Ronel Soibam, Harsha Bhattacharjee, Saurabh Deshmukh, Richa Shrivastava, Krati Gupta
April-June 2018, 56(2):108-110
We report the clinical course of a 47-year-old diabetic and hypertensive male who presented to us with diminution of vision in both eyes (OU) for 4 months. He was diagnosed with granulomatosis with polyangiitis and was treated with cyclophosphamide and steroids elsewhere. Before this, he was on steroids and methotrexate for probable sarcoidosis based on cavitary lesions in the lungs. During tapering of the steroids and so in relatively immunosuppressed status, he developed fever and maculopapulo-nodular skin lesions. Skin lesion biopsy confirmed Histoplasma capsulatum and he was started on systemic antifungals. Later, he developed bilateral endogenous endophthalmitis and was managed with intravitreal medications followed by vitrectomy with lensectomy OU. The patient regained vision and is maintaining the same until 1 year of follow-up. Thus, in spite of its rare occurrence, H. capsulatum should be considered as a cause of endogenous endophthalmitis in an immunosuppressed host with systemic histoplasmosis.
  1,654 106 -
Perspective about blindness and vision 2020-national program for control of blindness among students of different disciplines and general population
Annamalai Sowmiya, Sankar Muthuramalingam, Krishnamoorthy Ilango
October-December 2018, 56(4):222-225
Objectives: To study the awareness about causes of blindness, Eye donation, NPCB and Vision 2020 among students of Medical, Paramedical, Engineering College and General Public in a semi-urban centre. Materials and Methods: A cross sectional descriptive study was conducted at the Velammal Medical College Hospital in 4 months duration, which recruited around 2000 individuals from general public, students from various disciplines. A semi structured Questionnaire was presented and responses were recorded. They were analysed statistically. Results: Almost half of the respondents were not aware about existence of NPCB programme and awareness about existence of programme is high among Nursing Students (96.92%). Awareness about causes of blindness is significantly higher among Medical students (99.23%).Awareness about eye donation is only about 74.5%. Awareness about various aspects of Childhood eye diseases is about 70-80%. Conclusion: There is an improper utilisation of NPCB programme services due to lack of awareness about the same. Some of the strategies that the students were willing to participate were widespread awareness programmes in media and outreach programmes at gross root level. So we should utilise the resources and potential of student community in educating the public.
  1,605 146 -
Clinical profile and visual outcomes of traumatic optic neuropathy
Priya Sivakumar, Nirmala Devy, Rajesh Vedachalam
January-March 2018, 56(1):3-7
Background: Road traffic accidents (RTA) are the leading cause of disabilities among people aged 15-30 years. Traumatic optic neuropathy (TON) occurs in upto 5% of closed head traumas. It is an ophthalmic emergency for which there is no standardized treatment protocol. Purpose: To evaluate clinical presentations and visual outcome of TON. Methods: Retrospective analysis of 56 TON patients treated in a tertiary eye care facility over three years. Clinical profile, ocular and cranial injuries were recorded. Visual outcomes of treated (1gm/day intravenous methylprednisolone for three days followed by oral prednisolone 1 mg/kg over 2 weeks) and untreated patients were analysed.Best corrected visual acuity at one month follow up was taken as the primary outcome measure. Statistical analysis was done using Mann-Whitney U test and Wilcoxon sign rank test. Results: Of 56, nine patients had presenting vision >6/60 and 47 had ≤6/60. Forty four out of 56 patients received intravenous and oral steroids, of them, >2 line improvement was seen in 25 patients. Final vision of >6/60 was recorded in 32 patients (31 treated,1untreated). 24 patients had a final vision ≤6/60 (13 treated, 11 untreated). Significant difference between baseline visual acuity and post treatment visual acuity at one month review was noted in patients who received steroids (P = 0.001). Of the 12 Patients managed conservatively no significant improvement was seen. Conclusion: Patients with baseline vision >= 6/60 improved after high dose IV methylprednisolone but those with very poor baseline vision on and those managed conservatively did not significant improvement. No major side effects were encountered with the above stated steroid regimen.
  1,541 196 -
Comparison of peribulbar anesthesia with sub-tenon's in manual small incision cataract surgery
Abhinay Ashok, Srikanth Krishnagopal, Kirti Nath Jha
April-June 2018, 56(2):67-70
Aim: Comparison of peribulbar anaesthesia with sub-Tenon's anaesthesia in manual small incision cataract surgery in relation to time of onset of akinesia of extra ocular movements, pain at the time of administration, end of surgery and 1 hour after surgery and complications. Methodology: A randomized comparative study of 113 patients of which 57 patients received peribulbar anaesthesia and 56 patients received Sub-Tenon's anaesthesia. Results: The average time of onset of akinesia with sub-Tenon's anaesthesia was 2.78 ± 0.958minutes and peribulbar anaesthesia was 9.96 ± 2.141minutes. The difference was statistically significant (p = 0.00).Extraocular movements and ease of procedure between the two groups was almost the same and not statistically significant. Incidence of minor complications like chemosis and sub conjunctival haemorrhage were more in sub-Tenon's technique. Peribulbar anaesthesia ranked higher on pain score (5.12 ± 1.255) at the time of administration compared to Sub Tenon's anaesthesia (3.77 ± 1.716), the difference being statistically significant (p = 0.00). Conclusion: Sub-Tenon's anaesthesia is a safe and effective substitute for preibulbar anaesthesia in intraocular surgeries.
  1,505 180 -
Optical coherence tomography angiography: A general view
Arulmozhi Varman, Ramya Muralidharan, Dinesh Balakumar
April-June 2017, 55(2):107-112
Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates angiography images in a matter of seconds. Since it detects vascular compromise even before clinical picture sets in , it is a very useful tool in the diagnosis of retinal vascular pathology.In this review we introduce the technology and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases..Its current limitations include a relatively small field of view, inability to show leakage & motion artefacts.Published studies hint at OCTA's potential efficacy in the evaluation of common ophthalmologic diseases such as age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma.
  1,491 180 -