WORK
“If you can’t do great things,do little things in a great way !”
Dealing with ocular pathologies is intricate,
intriguing and interesting. As Dr. Dhaivat exclaims,
“Medicine for me is not just a 9:00-5:00 job.
It’s a continuous life experience. To understand
What a patient feels in that particular gloomy condition
and to be able to share the experience along with the patient
is something that makes the worth of a doctor’s real value.
To share in happiness is important, but to share in distress
is always more crucial and highly valued. It’s the most beautiful
feeling in the world to see a person getting healed, and as a doctor,
I feel truly blessed to witness that firsthand in my patients!”
Here is an insight into some of the diseases and conditions Dr.
Dhaivat specializes in and is passionate about. All text, audio,
video, and pictures posted have been duly consented.
Catagories
Retinal Detachment
Trauma
Age related macular degenration
Diabetic Retinopathy
Macular Hole
Macular Membrane
Ocular Infection
Ocular prosthesis
Neuro ophthalmology
Secondary IOL
Uveitis
Vascular Occlusions
Ocular Oncology
Case-Study
What's the story here?
High myopic retinal detachment treated with buckle surgery! Spectacular results
Catagory : Retinal Detachment
What's the story here?
Sometimes, a try is worth it all!
Catagory : Retinal Detachment
What's the story here?
Precious eye, precious vision!
Catagory : Retinal Detachment
What's the story here?
Myopic patients are prone to retinal detachment. Hence, a routine yearly check-up is a must. In case of any symptoms of flashes or floaters, an immediate retinal consult is a MUST!
Catagory : Retinal Detachment
What's the story here?
Early surgery in cases of retinal detachment can restore significant vision!
Catagory : Retinal Detachment
What's the story here?
Having learnt this technique from the Master himself Dr Lingal Gopal, a world-pioneer in the management of Coloboma retinal detachment, I personally feel privileged to restore vision in such patients. Most of these patients are one-eyed and an ambulatory vision is unbelievably precious for them.
Catagory : Retinal Detachment
What's the story here?
A young 20 years old cricketer was referred to us with complaints of decreased vision in the left eye post trauma to the eye with a cricket ball on the ground while batting. When he met us, he told us that he tried to dodge the bouncer, but the ball hit his left eye. Post-injury, he gradually started losing vision in his left eye and started to feel heaviness around the eye and forehead. When we saw him, a large hemorrhagic choroidal detachment was noted in the left eye in the temporal area, which was confirmed on ultrasonography (B Scan). Since he was young and apprehensive, he wanted immediate evacuation of the blood. We counseled him to calm down and explained to him regarding the condition and started on medical treatment. Usually, most of these bleeds reduce over a period of time with medical therapy, just that it requires constant monitoring. He understood the pros and cons well and was under regular follow up. Three weeks later, his vision returned to 6/6 and the choroidal detachment settled well with no trace of blood underneath! One more feat achieved, one more eye saved!
Catagory : Trauma
What's the story here?
A young patient presented with an unbelievable penetrating traumatic injury while at work. On the radiological scan, a spring coil (metallic) was seen intraocularly. He traveled a distance to come to us after having multiple opinions including opinions to remove the entire eye. After thorough counseling and assurance, we operated him with a vitrectomy with a scleral tear repair and took the iron spring coil out of the eye. The surgery nearly took 2 hours and that was one of the most thrilling experiences of my life. His wife was in tears when we told them we had succeeded. One more eye saved, literally!
Catagory : Trauma
What's the story here?
A 22 year old otherwise healthy chap walked into the OPD with a sudden onset painless loss of vision is the right eye, with a visual acuity of 6/60. On further inquiring about>What happened, he told me about his habit of chewing the cover of his pen while nervously studying for his IAS exam. On that particular gloomy day, in the midst of a tense moment, he accidentally gulped it down his throat! Since the cover choked his throat really tight, he reflexively vomited it out. Unfortunately, that vomit reflex was so strong that the pressure in his eyes shot up and he landed up with a bleed inside his retina, something medically termed as “Valsalva Retinopathy”.
On examination, it was noted that the bleed was over the fovea, the most important part of the retina which is responsible for fine vision. On further testing with the OCT, it was confirmed that the bleed was under the Internal limiting membrane (ILM). Basically, our retina has 10 layers, and ILM is the first and inner most layer of the retina. Not a very common thing that happens!
The decision was taken to observe the bleed for a week and if it wouldn’t resolve by itself till then, we would opt for surgery to remove it. The vision over the week deteriorated and the color of the bleed began to change, indicating clotting tendency! Since we were planning to operate at the most sensitive area of the retina, we clearly explained him the pros and cons of surgery.
Today, the young chap, with a smile on his face, returned to the OPD with a vision of 6/6 N6, a box of mouth watering homemade pedas (yeah of course, COVID times!), and a result of his exam! Passed with distinction!
What a feeling!
Catagory : Trauma
What's the story here?
A 14 year old with a glass injury presenting with a corneoscleral tear repaired under general anaesthesia. Patient doing well!
Catagory : Trauma
What's the story here?
A violent sneeze can lead to Sub ILM hemorrhage which can lead to permanent vision loss if not treated. One such patient arrived and was operated at the right time, leading to achievement of nearly 100% of lost vision. Miraculous!
Catagory : Retinal Detachment
What's the story here?
A SUB ILM HEMORRHAGE due to severe vomiting! Vitrectomy + ILM peeling is the simple answer!
Catagory : Retinal Detachment
What's the story here?
A 60 year old patient presented with a sudden drop in vision and a large bleed over the macula in his right eye. With the help of clinical acumen and OCT, a diagnosis of polypoidal choroidal vasculopathy was established. Such a case usually responds very well to Anti VEGF injections. The patient was clearly explained that multiple injections would be needed at a regular interval, otherwise the chances of recurrence goes up. Unfortunately after taking the first injection, the patient had some family issues for which he could not come timely for the second injection. He came 3 months later with a re-bleed which was highly expected. I sat down with him, explained him the gravity of the situation and possible loss of complete vision if treatment was hindered with. He then went ahead with 3 more injections at an interval of 3 months.
Today, his vision has improved to 6/18 with a small area of scarring over the macula. Now he is on a regular follow up and makes sure he educates others too regarding the importance of timely treatment in retinal diseases!
Catagory : AGE RELATED MACULAR DEGENERATION
What's the story here?
A 56 year old myopic teacher walked into my OPD recently. He was highly stressed and softly mumbled that he had a sudden loss of vision in his left eye (CFCF) which was the only seeing eye. The vision loss happened before 2 days with apparantly no other positive history. On examining his retina, the right eye had a scar over the macula, which is the central point of vision in the eye; while the left eye showed large area of bleed covering nearly 80-90% of the central retina. With help of clinical acumen and an OCT scan, we diagnosed him to have a condition called Polypoidal choroidal vasculopathy (PCV) and soothingly explained him the entire problem.
Since the bleed was too large and was covering the central area of retina, the treatment was directed to achieve two main goals:
1. To displace the blood from the central area and clear the macula.
2. To dissolve the blood and solve the underlying problem.
We used 100% expansile C3F8 gas to reach Goal no 1 and injection Intravitreal Anti VEGF to reach Goal no 2. We advised him to stay in an upside down position (prone position) for a week, which would help in displacement of blood. Knowing the problem and solution so well now, he compliantly followed like literally his life depended on it!
And Voila! The trick worked!
1 month later, he turned up with a vision of 6/36 and resolving hemorrhage. Now he was extremely motivated to go ahead with further treatment. So we continued with Anti VEGF injections to solve the underlying problem. After 3 injections, the vision improved to 6/18, which was decent enough to make his living worth it and happily continue his teaching profession!
Someone has rightly said…It’s His will, His way, but Your faith! Blessed be the patient!
PCV is a dangerous retinal condition where a small blood vessel like structure called a polyp might rupture and cause bleeding or exudation over the retina. If not treated on time, it can cause permenent loss of vision. It is commonly found in smokers and hypertensives, and sometimes can also be found in myopics and elderly population. The treatment is mainly Intravitreal injections, but in certain tricky cases, gas displacement or lasers may help. If you happen to know people around who have such an issue, prompt them to take early treatment, otherwise permanent damage is bound to happen!
Catagory : AGE RELATED MACULAR DEGENERATION
What's the story here?
A 48 year old housewife noticed a small black spot in front of her eye. She tried to wash and rub her eye multiple times, but it just did not vanish. She hence consulted her local eye doctor, who said it is a retina a problem and you need to see a specialist as soon as possible. It was then she visited our OPD for consultation and we noticed her vision was down to 3/60. We noticed that there was a small bleed in the center of the retina, which on OCT scan was confirmed to be a membrane called Choroidal neovascular membrane (CNVM) or Membrane Neovasculare (MNV). The modern day treatment of such membranes is in form of Anti VEGF injections. The injection number can range from 3-4 to more than 10, depending on the severity of membrane and recurrence rate. Luckily, after 3 monthly injections, she had complete resolution of the membrane and bleed and the vision returned back to 6/9. The black spot also vanished completely and she is on regular three monthly follow up since then!
Catagory : AGE RELATED MACULAR DEGENERATION
What's the story here?
Uncontrolled diabetes can be devastating and can lead to permanent blindness. One such patient came to our OPD with complains of decreased vision in the right eye since 6-8 months. Patient was aware of the problem but never addressed it since the other eye was okay. On presentation, his vision was highly compromised and he had a tractional retinal detachment involving the macula. We explained him that surgical intervention is the only option available and it would only work with a strict systemic control. We operated his eye after clearance from his physician. He underwent Vitrectomy with silicone oil.
6 months later, he improved to 3/60 vision, which is considered an ambulatory vision. The next step was to remove the silicone oil and cataract which had developed over a period of time. Also, he had developed a macular hole which was around 700 microns in size. He under a combined surgery for the same that is, a cataract and retina surgery in one sitting. 1 year after the surgery today, he has a stable vision of 6/36.
A very good metabolic condition is crucial in such cases, otherwise an improvement in ocular condition is seldom achieved!
Catagory : Diabetic Retinopathy
What's the story here?
Proliferative diabetic retinopathy is a dangerous condition which may lead to blindness. But if it is treated on time along with a good control of systemic condition, vision can be saved. Here is one case where the patient presented with multiple areas of neovascularization on the retina, with no evident macular edema. The patient was advised and treated with panretinal photocoagulation, that is laser treated of retina. One year later now, the patient’s vision is stable and is doing well!
Catagory : Diabetic Retinopathy
What's the story here?
A large base diameter (BD) macular hole sometimes might not close with the usual surgery. When the hole has BD of more than 1500 microns, I personally prefer to peel the ILM around the hole and tuck it inside the hole. A strict prone position post operatively for a period of one week is absolutely crucial. Over a period of time now, I have seen good closure rate with this technique, as in this case mentioned here.
Catagory : Retinal Detachment
What's the story here?
This is an interesting case of a 50 year male with a type A personality, who had seen 7 different retinal surgeons before he met me. All 7 had advised him to go ahead with surgery of macular hole. I was pretty sure he would go to a dozen other doctors due to his anxious nature. But to my surprise he turned up a week later and said was ready for surgery. By that time, the hole was already lifted up and there was evident subretinal fluid beneath. Also, the cataract became significantly dense to obscure the view. Hence, a combined surgery was performed. A month later, he turned up with an improved vision of 6/18.
A thorough counselling was>What brought him here. Sometimes, you just need to let the patient speak, and hear him out completely. Venting out relieves a lot of stress off the patients mind, which pushes them in their comfort zone. And thus, an improved compliance! No rocket science there
Catagory : Retinal Detachment
What's the story here?
Macular hole is a condition which requires early management. This lady came to us at a stage where the hole was already full thickness with a base diameter of 1200 microns. We advised her surgery and prone position post op for 1 week. Post op 1 month, she recovered quite well. We appreciated the pain taken by the lady to maintain a strict prone position, which is one of the key factors for hole closure.
Catagory : Retinal Detachment
What's the story here?
An untreated vein occlusion can lead to a vitreous hemorrhage and a secondary epiretinal membrane formation which eventually may lead to tractional retinal detachment. Such cases if not operated on time can lead to permanent structural changes in the retina, leading to a poor visual outcome.
Catagory : MACULAR MEMBRANE
What's the story here?
This is a case of a female who had a small membrane over the retina, which made her vision clarity compromised. She was a smart lady, and was well aware of the metamorphopsia caused due to the membrane. She was given the option of observation vs surgery, and she was quite eager to go ahead with surgery. The membrane was removed and a month later, her distortion was completely gone. One more contended patient to the list!
Catagory : MACULAR MEMBRANE
What's the story here?
A 60 year old gentleman with vitreoretinal traction treated with a simple vitrectomy. Safe and sound surgery for a significantly better vision!
Catagory : MACULAR MEMBRANE
What's the story here?
An epiretinal membrane is a thin layer that covers the central retina, obstructing light passage and leading to decreased vision and metamorphopsia. This patient exhibited symptoms attributed to such a membrane and underwent surgical removal, resulting in vision restoration and stability post-operation.
Catagory : MACULAR MEMBRANE
What's the story here?
A case of vitreomacular traction (VMT) was successfully managed through pars plana vitrectomy (PPV) using a 25-gauge Alcon 20,000 cuts-per-minute vitrectomy system. The procedure included the peeling of the epiretinal membrane (ERM) and internal limiting membrane (ILM), followed by the placement of an air tamponade. The high-speed vitrectomy system provided precise tissue removal, and membrane peeling was carefully performed to relieve traction, promoting retinal reattachment and visual recovery.
This approach highlights the effectiveness of advanced vitreoretinal surgical techniques in managing complex macular pathologies like VMT.
Catagory : MACULAR MEMBRANE
What's the story here?
A very rare organism isolated in a case of post op endophthalmitis. Treated and saved on time!
Catagory : OCULAR INFECTION
What's the story here?
Customized ocular prosthesis given to the pt post evisecration surgery. Cosmetically pleasing!
Catagory : OCULAR PROSTHESIS
What's the story here?
This is a 55 year old male farmer who had a fungal ulcer in the left eye which he did not get treated for the past 3 months. Because of that, the infection had spread to the back of the eye (retina). When he visited our hospital, we noticed that the eye was perforated from the front (corneal perforation) and there was total vision loss with severe infection inside. Hence, we advised the patient to get the eye removed (evisceration surgery) to prevent the further spread of the infection. The operation went on well and he had been given medications for two months so that the socket heals well.
Two months later, when he visited our hospital for follow up, we assessed the socket and prepared a customized eye shell for the left eye. The implant on placement had good movements, and it looked very appealing cosmetically. The patient was extremely pleased and gifted us his priceless blessings!
Catagory : OCULAR PROSTHESIS
What's the story here?
A person with a painful blind eye underwent evisceration surgery, followed by the fitting of a customized ocular prosthesis. It was heartwarming to see his smile after receiving the prosthesis, and now he is also free of pain.
Catagory : OCULAR PROSTHESIS
What's the story here?
Optics neuritis diagnosed and treated on time, always gets you to a 6/6 or 6/9!
Catagory : Neuro ophthalmology
What's the story here?
This young chap came in with Post Covid Optic Neuritis. Since we diagnosed the condition early, prompt treatment was initiated right away. The patient regained near-total vision and is stable since then!
Catagory : Neuro ophthalmology
What's the story here?
A young patient with subluxated lens post trauma got operated by a cataract surgeon in his hometown. The surgeon was able to place the IOL in the bag with the help of CTR ring. Pt was doing well post op. One week later, unfortunately the IOL slipped down and decentered from the visual axis thus inciting ocular inflammation. The cataract surgeon called up for a consult. In cases like these, its better not to manipulate the IOL further, and that’s>What I explained the surgeon. I explained the patient that the primary surgeon had done a fantastic job with the surgery and it was unfortunate that the IOL slipped because of inadequate zonular support. The pt understood the situation well and was extremely compliant with treatment. I operated him for an IOL removal with Vitrectomy with a secondary SFIOL. One month post surgery, the new IOL looked absolutely stable and the eye was very quite. The vision improved drastically and pt was extremely contended with the management.
Catagory : SECONDARY IOL
What's the story here?
Paediatric SFIOL in an 8 year old! Spectacular cosmesis, spectacular result!
Catagory : SECONDARY IOL
What's the story here?
Marfan’s syndrome is a rare inherited disorder which affects the heart, eyes, blood vessels and bones. In the eyes, the most common occurrences are lens subluxation/dislocation and retinal detachment.
Operated this 6 year old champ recently who came in with iris hetrochromia, abnormally shaped pupil, posteriorly dislocated lens and multiple retinal lattices and holes. He underwent a Vitrectomy with endolaser with a scleral fixated IOL.
When I asked this bubbly kid to go for his refractive check up 1 month post surgery…he exclaimed,”Apun ko chasma nahi mangta, sab clear hai.”
Few moments in life when the sheer joy of that smile is above everything else! True pleasures 🙂
Catagory : SECONDARY IOL
What's the story here?
VKH treated, done and dusted! 6/60 to 6/6 in a month, maintaining stable vision thereafter.
Catagory : Uveitis
What's the story here?
A young girl treated for VKH with immunomodulators and steroid therapy. She is 6/6 N6 in both eyes now, off treatment, with no recurrences over past 2 years now. That’s the beauty of uveitis treatment taken at the right time!
Catagory : Uveitis
What's the story here?
A rare combo of CMV with HSV virus treated with Oral Medications and Vitrectomy! A victory in true sense.
Catagory : Uveitis
What's the story here?
A young 36-year-old individual sought medical attention for decreased vision because of subretinal fluid caused by a choroidal hemangioma in the superonasal quadrant. We administered anti-VEGF injections alongside transpupillary thermotherapy laser treatment, resulting in significant vision improvement within one month post-treatment. Accurate diagnosis proved pivotal in achieving such successful outcomes in similar cases.
Catagory : Uveitis
What's the story here?
Branch retinal vein occlusion (BRVO) is a retinal condition in which one or more of the veins gets blocked due to underlying diseases like hypertension, diabetes, coagulation disorders etc. It is a kind of stroke inside the eye. The mainstay of treatment in today’s era is in form of intravitreal injection (Anti VEGF, Steroids). But in some cases and circumstances, laser photocoagulation remains must to prevent recurrence of the disease.
This is one such case of a 60-year-old male, a retired teacher, who presented with decreased vision in the left eye for 1 month. The patient was on irregular medications and used to pop blood thinners on and off. He was diagnosed to have Branch retinal vein occlusion with macular edema and was advised monthly doses of injection Anti VEGF. He was showing great improvement with the treatment. Unfortunately after two injections, the patient had a family issue and a financial crunch, and he said that he had no funds or time for further treatment. In this scenario, we performed sectoral laser photocoagulation to the susceptible area diagnosed on the fundus fluorescein angiogram, so that recurrence of this condition can be prevented. A year later, the patient turned up for a routine checkup. On recollecting the old data, we found that the patient’s vision has improved to nearly 100%. We were pleased to note that in spite of all the personal troubles, the patient maintained a strict diet chart and was regular on systemic medications. It’s always a pleasure to see such a great commitment from the patient’s end!
Catagory : Vascular Occlusions
What's the story here?
A very well educated 50 year old businessman turned up in the OPD one fine day with complains of sudden onset decreased vision in the right eye. He exclaimed that he had met a doctor for the same who asked him to refer a retina specialist. On examining his right eye, an inferior hemi central retinal vein occlusion was noted with a large macular edema. He was explained regarding the importance of early anti VEGF therapy and a good systemic control. I was amazed to see the change within 3 months, not only in his eye but in his lifestyle. With a strict diet control along with regular anti hypertensive medications, he really surprised me! He eventuality improved to a vision of 6/9 after a course of 3 injections.
Catagory : Vascular Occlusions
What's the story here?
Branch retinal vein occlusion (BRVO) is a retinal condition in which one or more of the veins gets blocked due to underlying diseases like hypertension, diabetes, coagulation disorders etc. It can lead to a massive hemorrhage inside the eye and accumulation of fluid at the center of the retina (macular edema). This is one of the eye conditions that need immediate care.
This case is of a 50 year old female, a lawyer, whose blood pressure shot up to 200/100 because of missing her regular dosage of medication for a week. The patient had a Branch retinal vein occlusion with macular edema (as seen on the OCT scan) and thus, the vision dropped drastically. Luckily, she came to us for early treatment. She was treated with monthly Anti VEGF injections after explaining the pros and cons of the condition. Post 3 injections (one each month), her vision improved to 6/9 with significant reduction in the fluid over the macula. No further treatment was needed, and she is now on regular 3 monthly follow up with us. Because of this incident, she is now extremely vigilant about taking her medications at the right time!
Catagory : Vascular Occlusions
What's the story here?
I am delighted to share that we at Choithram Netralaya successfully operated on a 2-year-old girl diagnosed with retinoblastoma, a rapidly progressing eye cancer that can be life-threatening if untreated.
This young girl had right eye grade E retinoblastoma with transscleral and retroorbital extension, a severe form of the disease, which necessitated urgent enucleation surgery under general anesthesia combined with adjuvant chemotherapy.
I would like to extend my heartfelt gratitude to Dr. Aman Vaishya (Oculoplasty Consultant), Dr. Amit Neema (Anesthesiologist), Dr Rajesh Patidar (Oncologist) and our dedicated oncology team for their invaluable contributions in making this life-saving ocular oncology surgery possible.
The child is now recovering well, and we will be planning for her ocular cosmetic reconstruction soon.
Catagory : Ocular Oncology
BLOG
“Better to fail in originality than to succeed in imitation!”
Thoughts, ideas and expressions reflect how a person perceives things. Dr. Dhaivat is an avid writer and keeps on writing on various medical and non-medical subjects. Some of these articles are posted here, have a read!