February 16,17,18th 2001 

                             Venue : Hotel Clarks Amer , Jaipur

_______________________________________________________________________

February 16

13.00 Afternoon Special:

Jaipur Historic City tour and Evening Entertainment ,Dinner.

February 17

0645        -Hands on Program for PG Student

Lenses for Fundus Visualisation

in vitreous surgery                          Dr. Gopal Verma

      FundusSlit lamp Biomcroscopy        – Dr. Raj V Azad

        07.30                  -Old Governing Council Meeting

        08.15                  - Scientific Program Inauguration

        08.30                  -Symposium I

Dynamics in Vitreous Surgery

                       Chairman-S S Badrinath ,Madras

                       Convenor- B Patnaik , Delhi

                       Co-Convenor- Preetam Singh,Amritsar

The essentials                 -S Natarajan, Bombay

Epiretinal Surgery             -P N Nagpal,Ahmedabad

Vitreous Base Surgery      -Atul kumar,Delhi

P V R surgery                   -Tarun Sharma

Laser Vitreous Surgery     -Susanne Binder, Vienna

Diabetes Vitreous Surgery -NE. Kelly, San Francisco

                        Rumi Jahangir,Bombay

                        Pramod Bhende,Madras

                        Dinesh Sahu,Banglore

                        And All Speakers, Chairpersons and Convenors

10.30                - Coffee

11.00                - Nataraja Pillai Oration. N E Kelly, MD

                        "Genesis , Evolution & Revolution of Macular hole surgery"

11.30                 - FREE PAPERS

1. Scleral buckling with or without expansile gases a study of fifty cases. Ranajn Choudhary,-Calcutta
   

2. Scleral Buckling for stages 4 and 5 retionpathy of prematurity. Promad Bhende, Kaushal B. Bhavsar, Lingam Gopal , Nitin B Shetty,-Chennai
   

3. Risk factors for threshold retinopathy of prematurity. Anuradha Sharma, M.R.Dogra, Subina Narang, Saurav Dutta, Amod Gupta, Chandigarh

4. Efficacy of various laser wavelengths in the treatment of diabetic macular edema. Vishali Gupta ,Amod Gupta , Ravinder Kaur, Subina Narang M.R.Dogra, Chandigarh

5. Role of prophylactic inttravitreal antibiotics in open Globe injury. Amod Gupta Vishali Gupta, Subina Narang, Sayan Das, Chandigarh.

6. Visual outcome after successful diabetic vitrectomy. B. Maheswar, V R Saravana, V Raghuraman, N Sunil V Narendran, Coimbatore.

7. Redetachments after silicone oil removal-cause and managment.Raghuraman, N Sunil V Narendran, Coimbatore.

8. Juvenile X-linked retinoschisis (JXLR) clinical panorama and managment dilemmas. Shukla D, P S Aruna, P Namperumalsamy, Madurai.

9. Ultrasound in the diagnosis and management of posterior scleritis. Hement Murthy, N S Muralidhar - Banglore.

10. Threshold retinopathy of prematuratity in infants with birth weight more than 1200 gms. ,Amod Gupta , Subina Narang M.R.Dogra,Anuradha, Anil Narang- Chandigarh

11. Transpupillary thermotherapy as a modality of treatment for subfoveal neovascular membranes. Manish Nagpal, Shobhana Sharma – Ahmedabad.

12. Clinico microbiological profile and treatment outcome of endophthalmitis in a paediatric population – A retrospective study. Vedhamtham, Nazimul Hussain –Hyderabad.

                        Chairman:  T N Ursekar

                             Convenor: SPS Grewal, Chandigarh

                             Co –convenor: S Natarajan

Epidemiology of AMD in India            -V Narendran, Coimbatore

Understanding Macula & Advance  

In Imaging Pertaining to AMD           -Babu Rajendran,Madras

PDT & TTT in AMD                              -NE Kelly,SanFransisco

Tpa in submacular haemorrhage     - Susanne Binder, Vienna

RPE transplant in AMD                       -Susanne Binder, Vienna

Panel Discussion                                  -Indu Singh, Amritsar.

                                                              -Paritosh Kamdar, Bombay

                                                              -Alay Banker, Ahmedabad

                                                              -Ajay Dudani, Bombay.

16.30                              - Coffee

16.45                              -Special General body Meeting

17.30                              - Inauguration of VRS-I Annual Meeting.

                                           (includes installation of New President)

18.30                              -Annual General Body Meeting

20.15                              -Dinner & Entertainment.

NB: Election for different post will be held between 18.30 and 1930 hrs. Counting of votes will be completed by 1945 hrs and the results will be announced immediately.

10.30         - Coffee

Film Festival

11.30                  Chairman: P Namperumalsamy, Madurai

                          Convenor : Taraprasad Das, Hyderabad

                          Co-Convenor: Amod Gupta

Presentation: 5 min

Discussion : 5 min Total: 10 min

1. Indocyanine Green-assisted peeling of the internal limiting memberane during vitrectomy for macular hole repair. Atul Kumar, New Delhi

2. Phacoemulsification with intraocular lens combined with silicone oil removal through posterior capsularhexis: Another triple procedure. Vinay kumar Gardodia, Vijay K. Dada,Dinesh Talwar,Namrata Sharma- New Delhi.

3. Newr eaiser technique of vitrectomy in PDR. Ajay Dudani- Mumbai

4. Laser Vitrectomy . Indu Singh –Amritsar

5. Indocynanine assisted ILM removal. Indu Singh -Amritsar

6. Management of GRT. Meena Chakrabarti- Kochullor.

7. Importance of Vitreous base surgery in vitro retinal cases. Nabin Paynaik – New Delhi

8. Nucleus drop management our experience. Mohan Rajan , Sujata Mohan – Chennai

9. Newr instruments for vitreo retinal surgery. Alay Banker- Ahmedabad

10. Vitrectomy a treatment modality of subretinal cysticircosis.Harsha Bhattacharjee -Beltola

11. Ultrasound biomicroscopy in silicon oil filled eyes.Li Wenhua, Tara Prasad Das, Subhadra Jalali-Hyderabad

12. Trans-Scleral Diode in SRNV in ARMD.Hem K Tewari, Pradeep V, Lalit Verma-New Delhi.

13.20         - Valedictory

From The Desk of Dr. B. Patnaik (outgoing President`s Lecture)

Dr Bijayananda Patnaik, MD, MS

Retina Associates, New Delhi

WWW. patnaikb.com

Often an accident of Fate changes the course of a life. Mine did, when I was a second year medical student. It was 1956. My carrier option was filled up for a retina surgeon. I lost vision, weeks after I noticed a field defect. But no one knew why. My Professor of Ophthalmology, after prolonged fundus examination with a direct ophthalmoscope, under full mydriasis thought the visual loss to be functional. I was fobbed off with a pair of new glasses. Five months later a House Surgeon at Calcutta diagnosed a total retinal detachment. A good example of the adage: what the mind does not know the eye does not see. However, innumerable pain taking search for a retinal break, again with a direct ophthalmoscope, during a 4 months of hospitalized complete bed rest, failed to reveal one. Some luck, as it would turn out, some good guess and few spots of surface diathermy held the retina in place, which had settled on rest. I had 4 months to make up my mind what to do with my life. I promised to myself, I would do my best not let the same fate visits some one else, if I can help.

By the time I was a House Surgeon in ophthalmology myself in 1962, the technique of surgery for retinal detachment was basically same as it was at Calcutta in 1956 and as it was described by Pischell, 1952. That is, surface diathermy of the holes detected by direct ophthalmoscopy; and draining the subretinal fluid by penetrating diathermy. Additional step of scleral resection was considered bold . Since it was attempted in difficult or complicated cases and was not often adequate, the results and therefore, the reputation of the procedure was not too good. I remember, I used to spend hours with the direct ophthalmoscope to locate and plot the retinal breaks in preparation for surgery. The reattachment rate was rather low, probably around 30%.

During this period, my Guru, Prof L.P.Agarwal used to encourage us to use the only Indirect Ophthalmoscope we had. Yet since no one had ever used it and those who had attempted probably half heartedly, had found it frustrating, the matter had rested with status quo. My private obsession probably helped me to break the mental barrier. Soon I became the department's expert in Indirect Ophthalmoscope. I could locate retinal breaks on the table for my consultant, who would insist of placing the diathermy once I have located the retinal breaks. Success in draining the subretinal fluid was a 'big deal' those days. With Indirect Ophthalmoscope to guide us we could drain fluid more efficiently. The success rate soared. Yet, relatively complicated cases with PVR did not do too well.

Though we were pretty well informed about the newer techniques being tried, mostly in USA, our capacity for adopting or even trying out newer techniques was being severely restricted because of difficulty in importing instruments and materials. Limitations in foreign travel, paucity in fellowships meant that we had to try newer techniques after reading journals only.

My one year fellowship with Professor Hans Goldmann in Switzerland soon after my post graduation in 1966-67, gave me some opportunity to see retinal detachment surgery as it was being practiced in Europe. They were not as progressive as people were in USA. I was inducted to the use of Goldmann's 3 mirror contact lens. They were using a mono ocular hand held indirect ophthalmoscope ( the Bonoscope) during surgery. I thought our routine use of Fison's headband mounted binocular indirect ophthalmoscope was a superior system. And so it is.

On my return in 1967, as a Senior Resident, I was to try out several buckling procedures using preserved human sclera. Partial thickness scleral resection with or without using the resected sclera for imbrication. We used Arruga's encircling procedure using various thick sutures. The simplistic belief was that if one can keep the tears anterior to the encircling tread and drain the fluid, the retina posterior to the string would remain flat. However soon we noticed, that was not true. By this time we were training more residents in the use of Indirect Ophthalmoscope, some of them are among the top Retinal Surgeons today. I was to organize the first Retina Workshop at the AIIMS.

Once I joined the faculty at the Maulana Azad Medical College, with Dr SRK Malik as the HOD, who was very effective with the officialdom, we had greater access to imported equipments and materials. I set up a proper Retina Service. We used silicon sponge rods a lot, for that was cheap and was available in meter lengths. They were used as local buckles both circumferential and radial; intrascleral and episcleral. Soon I realized that these buckles held by sutures are by no means permanent. The buckles are steadily flattened under positive IOP with the buckling material being ejected out of the sclera. I do believe, in most cases the vitreous traction is persistent and need a permanent neutralization. The answer is a Permanent buckle. The only practical way one can maintain a permanent buckle is to place it under an encircling element. The only such element available those days were thick sutures- silk, supramid etc. I had been using radial sponge rods under the encircling threads extensively. That gave us very encouraging results. Percentage of success was comparable to those in USA at that time. We reported a small series of 100 consecutive cases of retinal detachment in 1974. Our results were better than the expected percentage of success in each 'class' of Retinal Detachment as computed by Jesberg in, 1968 in a paper " Prognostic Classification of Retinal Detachments". Unfortunately, by that time I had been seeing some of my old cases with Arruga's encircling threads coming back with the treads cutting through the sclera ' string syndrome'. For a period I had used long strips of preserved sclera as encircling elements. I have used fascia lata for the same purpose.

Though solid silicon buckling material were described by Schepens et al as early as 1960, it was not before 1972 that we could procure these on a regular basis. For 5 years we did exclusively intro sclera buckling with or without encircling bands for that was the most modern technique advocated by no less a person than Charles Schepens. Besides, the results had not been better. However, there were problems. It was time consuming, I thought pretty mutilating. The inevitable encounter with the vortex veins always would be a cause for unease. The not infrequent rise of IOP with diathermy leading to corneal pacification on the table used to bother us. In the classical technique used by Dr Stephen's Boston group, the bed of the resected sclera was being treated with diathermy. However, we thought this involved too much of indiscriminate diathermy and settled for diathermy only to cover retinal breaks. Yet, we were never entirely comfortable about the procedure.

During this period ( 1973) a Amoils Cryo unit was acquired for intracapsular cataract extraction. Lincoff has been using cryo extensively in the episcleral buckling procedures since early 1960's. Before him Bietti had used cryo for retinopexy as early as 1933. We realized that the cataract cryo probe was eminently suited for retinopexy also . We could now do the retinopexy under indirect ophthalmoscopic control. There was no problem with rise of IOP. We had complete freedom to choose any type of buckle, including the silicon tires and the encircling bands to be used on the scleral surface without the time consuming, mutilating scleral resection. We could now finish a case in less than an hour under local anaesthetia instead of 2 to 3 hours under general. I thought, at last the technique of scleral buckling procedure was then standard. Yet, some of my contemporaries in this country did not like using cryo for retinopexy for several years, for some very influential group in USA claimed that the cryo scars were not as strong as the diathermy scars. Today, cryo is being used for retinopexy in retinal detachment surgery all over the world, some die hard hold outs notwithstanding.

During mid seventies, three of my distinguished contemporaries took to serious exclusive retina service on different part of the country. Dr Namperumalsamy of Arvind Eye Hospital , Madurai started Vitreous surgery under the encouragement and guidance of Dr Golam Peyman and took formal training in the surgical management of retinal detachments at Boston with Dr Schepens later. He is heading a thriving Retina Care center of excellence since. Their residency and fellowship programs one of the best in the country. One of his old residents, Dr T.P.Das is heading the Department of Retina Service, at now famous L.V.Prasad Eye Institute at Hyderabad . Dr S.S. Badrinath came back after completing a full Residency Program under the Dr Charles Schepens, the father of modern Retinal Surgery at Boston. A true student of Dr Schepens, he introduced an element of absolute discipline and consistently high quality in providing not only Retina but Ophthalmic services, not common in India till then. His Retina Fellows are distinguishing themselves all over the country. Dr P.N.Nagpal, trained in Germany, before setting up by now well known, Retina Foundation at Ahmedabad. A natural teacher, his contribution to Ophthalmic and specially Retina training in India is unmatched. Since he organized the first ever Retina Symposium in the country, his Symposia and Seminars are legend, where he manages to assemble an impressive National and International Faculty, year after year for all these years. In North India, the Department of Ophthalmology at the AIIMS, which grew in to Dr Rejendra Prasad Center for Ophthalmic Sciences, boasts the most robust Faculty for Retina Care in the country. The post graduate training program and the residency program is unique in the country. Thanks to the products of these world class institutions, we have now well trained and competent retina specialist all over the country. At several centers, the quality and extent of Retina Care is as good as the best in the world.

I have been a great follower of Radial Buckles, in difficult cases, with large tears and PVR. When one uses an encircling element to produce a prominent and permanent buckle, one inadvertently helps to produce radial folds, one of the commonest cause of failure of retinal detachment surgery. Some times we had to place multiple radial buckles to take care of large tears. In the process we produce disturbing distortion of the globe often with gross astigmatism. Besides, the classical complicated cases : retinal detachment with giant retinal tears, retinal detachments in coloboma choroid, RD in macular holes, RD with significant PVR, RD following open globe injury, with or with out intraocular foreign bodies or RD in proliferative retinopathies, are not amenable to be treated by scleral buckling procedures. The vitreous surgery seemed to be the right answer.

Pars plana vitreous surgery has been making waves, specially in USA. Resigning my teaching position in 1980, so that I can go round the world and see for myself these momentous developments, , I watched most of the top vitreous surgeons of the world in two continents. Now in private practice, self employed, I had more resources and more focussed resource utilization. Yet, it took me 5 years to put together an infrastructure for serious and modern vitreous surgery. In this field one needs constant updating . I make it a point to travel at least once a year to watch out-standing vitreous surgeons operating in any part of the globe. The most cost effective way to remain duly informed. Today over 90% of my surgical work in vitreo retinal surgery. With the significant increase in number of cataract surgery with IOL implantation, the number of cases of pseudophakic retinal detachment is on the increase. With the poor visibility of the fundus because of the thickened capsule, opaque lens matter or fixed pupil and the frequent involvement of the anterior vitreous in the post operative inflammation of ECCE, primary vitreous surgery has become, in my opinion a better and surer option.

It is not only in the field of Surgical Retina that we have made significant progress , but also in several other areas of Medical Retina too. I had the historic good fortune to take the first Fluorescent Fundus Photograph in India in June 1969, modifying a fairly elementary Fundus Camera. We presented our first few months work on Fluorescein Angiography at the Annual Conference of the AIOS at Patna, 1970. That gave us a head start in studying and understanding for the first time such misunderstood conditions as CSR ( used to be mistaken for macular edema, when it is a condition of serous macular detachment) or ill-understood conditions as CNV membrane ( used to be mistaken to be hemorrhagic central choroiditis).Even today some of our colleagues who have not realized the usefulness of F.A or out of old habit still call CSR, macular edema. We still find diagnosis of hemorrhagic choroiditis is being returned for choroidal neovascular membranes and treated with steroids and losing valuable time in the process. We have classified CSR in to type-I and type-II on the basis of FA. We consider type-II CSR are to be due to choroiditis. These deteriorate with heavy dosage of oral steroids. Most of these heal on drugs for tuberculosis. The diagnosis of tubercular choroiditis is made on the therapeutic response, not the type of evidence to convince the habitual Indian skeptics. PCR for tuberculosis on aqueous samples may give the answer.

Fluorescein Angiography gave us the opportunity to study and understand Eales Disease( 1973 & 1979). We have shown that Eales Disease is the manifestation of multiple inflammatory branch vein occlusion (BRVO). What ever is the etiology, the basic Pathology is Retinal Phlebitis (1998). Similarly, we demonstrated the immediate cause of Proliferative Retinopathy, be it Eales Disease or Diabetic Retinopathy..

Though photocoagulators had been acquired several years earlier by a couple of Institution in the country, we were unaware of their use. We were among the early users of the photocoagulators in a systematic and regular fashion. Thus we were pretty active in treating Proliferative Diabetic Retinopathy since 1969, at a time when its utility was not universally established. The understanding of the pathophysiology of Eales disease helped us immensely in its rational management. During the phase of active phlebitis we used oral steroids with or with out drugs for tuberculosis. Our observation that some cases of phlebitis with certain clinical features are due to tuberculosis has received valuable support from recent PCR study of vitreous and aqueous samples. The vascular proliferation due to capillary closures, demonstrated by our fluorescein studies were treated by selective retinal ablation by photocoagulation of the 'identified ischaemic retina' ( identified by FA). We were the first to treat resistant cases of CSR by pin point photocoagulation of the leaking site, in early 1973. We published a series of 15 cases of CSR treated by photocoagualtion in the IJO, 1974. In type -I CSR with a single point leakage, we have described a very mild spot of photocoagulation, which even does not whiten the retina above, and we have described the procedure as 'photofomentation'. I have been treating cases of sub retinal CNV membranes, including the subfoveal membranes by photocoagulation since early 1970s.

We deliberately and successfully treated a resistant case of disc neovascularisation (NVD) in a case of Eales disease, not regressing after repeated xenon photocoagulation, by peripheral transconjuctival cryopexy in November 1978 (paper presented at the AIOS conference at Manipal,1980). The first ever observation of extensive cryopexy for retinal degeneration resulting in regression of disc neovascularisation was reported by Lempert (1979) We had then used peripheral cryo as a supplement to xenon photocoagulation in some difficult cases of Proliferative Diabetic Retinopathies.

I have been actively promoting and participating in education and training in Retina all along. While I was a Registrar, I had organized the first ever Workshop on Retina at AIIMS. Again I had organized the first ever Instruction Course on 'Retinal Examination Techniques' of the All India Ophthalmological Society at Puna. I have organized or participated in most retina CME programs since 1970s. I have written popular science articles to educate the target group of patients about their retinal problems and solutions. I might have made some small contribution to the fact that we have now several hundred ophthalmologist who are well versed with Indirect Ophthalmoscopy and Retina Care.

Thus, during my professional life time, I have travelled from the elementary Diathermy and Drainage to the futuristic Primary Vitreous Surgery for treating Retinal Detachments. It has been a Great Experience. I have enjoyed the challenge and may have redeemed to some extent the pledge I had made to myself. The management of retinal detachment in India is world class today. We have made remarkable progress in all aspect of retina Care, besides. I am happy that I was associated with this historic development of the Retina Care in the country.

Schepens,C.L.,Okamura,I.D., et al. Arch. Ophthalmol. 64:868,1960

Lincoff,H.A.et al Trans. Am. Acad. Ophthalmol.Otolaryngo. 68:412,1964

Amoils, S.P. Am.J.Ophthalmol.60:846,1965

Malik,SRK, Patnaik. B. Ind. J. Ophthalmol.21:5, 1973

Patnaik, B., Kalsi, R. Ind. J. Ophthalmol. 22,I,1, 1974.

Patnaik, B., Kalsi, R. Ind. J. Ophthalmol. 22,I,1, 1974.

Patnaik, B. Kalsi, R. & Malik,SRK. Ind J. Ophthalmol. 22,II,6. 1974

Kalsi,R. Patnaik,B. Ind. J. Ophthalmol. 27:87, 1979

Patnaik, B. et al, Ophthalmology Clinics of North America. 11: IV, 601, 1998

Sponser Page