Microsoft Word - Editorial


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Editorial 

 
Reminders and Regrets 

 
 
Despite repeated editorials, communications, 
highlights, tips, pearls, lectures, seminars in the past I 
regret to say that still a considerable lot of ophthal-
mologists ignore the valuable recommendations of 
their learned colleagues in their clinical practice 
resulting in unsatisfactory at times catastrophic 
outcomes for their patients both in public and private 
setups. 

In my farewell editorial I would like to remind 
once again these golden rules of the game. 
1. The most important investigation in glaucoma is 

Gonioscopy to determine the type of glaucoma for 
appropriate management. 
In angle closure glaucoma miotics (like 
pilocarpine) are the only logical treatment while 
Iridotomy (laser) or Iridectomy (surgical) are the 
ultimo. Extensively advertised, glamorous and 
costly drugs like beta blockers, alpha adrenergic 
agonists, topical CAI and prostaglandin analogues 
are meant for management of open angle type of 
glaucomas and have insignificant role in angle 
closure glaucomas. 
When filtration is indicated use mitomycin like 
drugs with great caution due to post operative 
hypotony and later thin blebs getting infected. Try 
alternative measures like releasable sutures, 
suture lysis and various other bleb management 
techniques. 

2. Prevention is better than cure. 
In addition to ensuring the cleanliness and sterility 
of the operative field, lid margins and eye lashes, 
instil a few drops of povidine–iodine solution in 
the conjunctival sac for a few minutes before 
surgery. 
Despite controversies preop prophylactic 
antibiotic drops; intra cameral antibiotics preop or 
at the end of surgery sub conjuctival injection of 
antibiotic-steroid are still recommended. Your 
surgical maneuvers should be gentle, least 
traumatic and purposeful. 

3. Diabetic blindness is assuming empidemic 
proportions especially in our country. Patients 
need proper advice regarding tight glycemic, 
hypertension and lipidemic control, dietary 
regulation and exercise. Laser treatment is still the 
mainstay for proliferative and maculopathy cases. 
In certain situations intra vitreal steroids or anti-
vegf injections like avastin are indicated but 
injudicious use is causing serious complications. 

4. Uniocular congenital cataract surgery should be 
done with a lot of reservations. Prevention of 
amblyopia is not a convincing outcome in our set 
ups and the rate of complication are significant. 
Avoid insertion of IOL after cataract surgery in 
juvenile Uveitis. 

5. Treatment of accommodative esotropia is not 
surgery because the parents dislike glasses. 
Surgery in such cases will have adverse effects in 
passing years. 

6. Despite continuous better and safer techniques of 
cataract extraction, the dilemmas of post operative 
complications are still no less grave at times. 
Hence the basic indication of cataract surgery still 
remains when it interferes with normal routines of 
the patient. 
Drugs claiming to stop cataract formation and 
progression are not substantiated by any authentic 
study and are an economic strain in a poor 
country. 
In dropped nucleus during cataract surgery do not 
fish for it in the vitreous cavity if you are not a 
trained vitreo retinal surgeon. To avoid serious 
complications refer to proper facility. 

7. In bacterial infective keratitis, the instillation of 
appropriate antibiotic drops should be intensive 
and to be continued even during sleep by 
attendants. 

8. Refractive surgery should never be done without 
proper topographic evaluation (Like Orbscan & 



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pupillometery). Post operative ectasia is a serious 
complication if excessive tissue is removed. 

9. Pars plana Uveitis like cases should be treated 
with steroids only if the vision is effected. To 
avoid systemic steroid side effects, try deep sub 
tenon steroid injection or consider anti metabolites 
as such or in combination with steroids. 

10. Imaging investigations are expensive and not 
without risks. These should be ordered to facilitate 
clinical localization and expectations of particular 
findings to reach proper diagnosis, plan 
appropriate management and provide more 
accurate prognosis of the history of the disease 
and these should be ordered only if the 
information is not available by simpler safer and 
less expensive means. 

11. If a patient comes to you for second opinion after 
an unsatisfactory outcome of previous procedure 
else where be very kind, courteous, helpful and 
reassuring in a positive way to relieve the patients 
anxiety, grief, agony, anger and disappointment. 

12. Write comprehensive, legible, detailed account of 
treatment given to patients especially the surgical 
procedures. Note down any complication or 
untoward happenings and their management. 
Such information in future will guide for 
understanding the status of the structures, tissues 
and their response to further manipulations for 
providing better care to patient by you or someone 
else. 

13. Use of antioxidants is a fab without any significant 
proof of real benefit in degenerative conditions of 
the eye. A carrot, radish, cucumber, orange , apple 
or guava etc are a lot more cheaper, affordable, 
palatable and nourishing compared to costly anti 
oxidant pills for poor populations in particular. 

14. Be and always remain with it by acquiring the 
latest through all possible means. 
With best wishes 
 

Prof. M Lateef Chaudhry 
Editor in chief