Exploring Maharashtra Market

Eyes are undoubtedly the windows to the world
OOOpppttthhhooo TTTiiimmmeeesss
Highlights of the
Issue
Optho Times | Vol. VI Nov 2016 – Jan 2017
www.opthoremedies.com
Serving Humanity Since 1973
OPTHO
R
O-Outstanding P-People serving T-Towards H-Humanity with O-Optimism
Rajesh Agarwal
From The Desk Of
Director - Operations
Dear Optho family
members,
It's a pleasure to interact
with our Optho stalwarts
at regular intervals, it
refreshes and rejuvenates
our heartily connections.
Half of the sales journey for
this fiscal year is over and
we need to re-evalulate and
calibrate ourselves for the
rest of the defined path. In
this course few have
excelled and some have
f a i l e d , d e s p i t e t h e i r
rigorous efforts, but not to dishearten the journey is
still remaining, all you need is to accelerate your
efforts in the right direction. Remember one can't
change the past, work on your present and change
the future .
Your destiny is in yours hands. So as the destiny of
the brand lies in the conviction that you have for it.
Much awaited product HY 5 is out, the welcome
response for HY 5 has been excellent. Now the key is
to maintain the energy level to build it as a brand
leader .
In the second year of Shri RK Agarwal Memorial
Award. Mr. SD Mishra & Mr. HL Tripathi have been
recognized for their continuous endeavour and
efforts towards the organization.
Team, I extend all my possible support to accelerate
the growth to realize the organizational goals. I
firmly believe that a battle is only won with team
efforts not individualism. Just remember “Together
we can & together we will make it happen.”
In the End I would like to quote few lines.
“When you focus on problems ,you 'll have more
problems
When you focus on possibilities, you will have
more opportunities.”
Rakesh Agarwal
FromTheDesk Of
Director-Sales
Dear Optho family
members,
Your continued trust,
e n c o u r a g e m e n t ,
s u p p o r t a n d f a i r
criticism based on data and
facts are what gives us
e n e r g y , e n t h u s i a s m ,
confidence and motivation to
strive for betterment.
In the universe of companies,
there are those that follow
the tried – and –tested path
towards acquiring scale,
growth and profitability. And
then there are some that have
dared to be different, taken
bets and stood by them, and created enormous
value in the process.
The pharmaceutical industry is moving towards
more adaptive selling methods for their sales
people. In a survey conducted on doctors to
understand their opinions about sales people to visit
them. Case studies, reveal that the adaptive selling
methods which is a combination of relational and
scripted aspects for the sales presentation. Doctors
found that the most successful sales calls were those
that were a good combination of relational aspects
as well as the education that is within the script of a
sales call. With a good combination, doctors found
that sales people stepped into an advisor role
opposed to just a sales role. This allowed the doctors
to have a stronger relationship and more trust
between those sales representatives that used their
time wisely and got their point across in the way that
each doctor preferred most.
Thus each one of us needs to adapt to the adaptive
selling model to achieve more results. Every one in
the loop needs to work on the same to get into
perfection and perfection comes out of regular
practice.
My message to you all is “Whenever you want to
achieve something, keep your eyes open,
concentrate and make sure you know exactly
what you want. No one can hit the target with
closed eyes”
Preven ng Darkness
Exploring Maharashtra
Re nopathy Of Prematurity
(Dr. Rohit Agarwal)
Intratunnel Phaco Fracture
(Dr. Sudhir Singh)
ARMD An Over View
(Dr. Arpit Airen)
Nasal Problem Not To Be
Taken Lightly (Dr. Ajay Shukla)
Self Analysis
Assessment
Aloe Vera Gel – A Promising
Therapy For Dry Eye
Pioneers in
Ophthalmology

Regards
Anushri R. Agarwal
CSP Execu ve and Editor In Chief
at OPTHO REMEDIES PVT. LTD
Dear,
Opthofamily members,
Gree ngs!!
As we concluded our recent annual sales mee ng in October 2016 this year, it was truly sales at
its finest where ideas bloomed in a congrega on of our dynamic managers. It was a fast track
two days of constantly moving between two extreme states of living the manager's life, from
idea ng to execu ng, from being on the top of the world to hi ng the bo om ground, from too much
calm to extreme chaos, but one thing that struck me was that while a manager may live lonely in this
world;buthecannotbeisolatedfromit.Atanypointof me,beingamanagerwilldemandyoutowear
the hat, which is perhaps exactly opposite of your state of mind at that point of me. More than
anything , managerial success is about being able to minding one's mind to deal with the situa on at hand and make best of it. More than being
the most intellectual person in the world, it calls for you to be most flexible. Most of all being a manager is like a sport where you may be
pushed to the extreme side of the court very o en, but you also know that in order to win you need to be heading to middle of the court as fast
aspossible.
Thewordcalledmarke ngisonesuchstrongwordwithhugedimensionsa achedtoit.Every businesshouseneedsgoodmarke ngstrategies
andmanagerpersonalstodothejobforthem.
Thus, development of meaningful and cohesive marke ng strategies in India is one of the ho est topics in the pharmaceu cal industry
today.Pharmaceu cal companies are increasingly looking towards India to drive sales growth. Marke ng is simultaneously recognized by the
industry as vital for product success and derided by the media as the main reason for high drug prices. Meanwhile regional and local market
strategiesareneededinanincreasinglycomplexandeverchangingmarketplacetoachieveresults.
India's market poten al has been widely discussed. Millions of people, coupled with economic growth, increasing affluence and a projected
increase in chronic diseases offer an opportunity to boost revenues at a me when blockbuster drugs are nearing the end of their product
lifecycleinthevariouspartsoftheworld.
India too has its share of various kinds of challenges. Different cultures, languages, socio-economic groups and regulatory/legal systems, mean
strategies can only be regionalised to a certain extent, a er which country-specific approaches are needed. Even dispari es of affluence and
educa on can be associated with different healthcare expecta ons. Success in India will depend upon the ability of marketers to navigate the
localenvironmentwithgloballydevelopedproducts.
Hence,marke ngac vi esareplannedbymanagement,
andtheirexecu onismonitoredthroughmanagerialfunc ons.
The Two M's :-Management & Marketing
The Essen als of a Corporate House
2

3
n es mated 19 million children are visually impaired. is an important cause for contribu ng to the burden of
A Childhood Blindness
blindness. The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic
development, and the availability of primary health care and eye care services. In high-income countries, lesions of the op c nerve
and higher visual pathways predominate as the cause of blindness, while corneal scarring from measles, vitamin A deﬁciency, the use of
harmfultradi onaleyeremedies,andophthalmianeonatorumarethemajorcausesinlow-incomecountries.Re nopathyofprematurityisan
important cause in middle-income countries. Other signiﬁcant causes in all countries are cataract, congenital abnormali es, and hereditary
re nal dystrophies. It is es mated that, in almost half of the children who are blind today, the underlying cause could have been prevented, or
the eye condi on treated to preserve vision or restore sight. The control of blindness in children is a priority within the World Health
Organiza on'sVISION2020programme. Opthoremedies believestosupporttheinterna onalcauseinallpossibleways,forthesameOptho
remedies keeps organizing camps and supports all such ac vi es. Re noblastoma (Eye Cancer ) though a rare eye disease but take a toll of
vision in 2000 kids every year. The disease most prominent in U ar Pradesh & Bihar. Optho is trying to spread massive awareness in these
areas and organizing camps. To reinforce the same, “Shri. RK Agarwal Memorial Founda on” has planned the LEAD campaign LETS
ERADICATE AWAY DARKNESS under which camps are organized to diagnose, treat & prevent eye diseases in children. Under the LEAD
campaign school going kids are screened for eye disease and educated about the deadly eye disease like RETINOBLASTOMA and inspiring
eyedona on.
“EYESIGHT SHOULD BE EVERYONE’S BIRTHRIGHT”
Preventing Darkness

Exploring Maharashtra
4
ptho Remedies started its opera on in Mumbai in 2012 . In a short span of 4 years Optho Remedies has created a niche in mindset of
Othe doctor fraternity. In the pharmaceu cal hub, of the country its diﬃcult to create a space for one self, but the determina on of
Optho Remedies has made itself to be counted among the top ophthalmic players of the area. With this objec ve we have ac vely
par cipated in the BOA & MOSCON conference. BOA Focus 2016’s objec ve is to cover the en re spectrum of ophthalmology from basics to
recent advances. BOA FOCUS 2016 promises to bring to you talks and discussions by acclaimed na onal, interna onal and local faculty. In the
conference almost 400 ophthalmologist visited our stall and interacted to exchange views . Our vast product range was a surprise treat for
ophthalmologists. MOSCON 2016 was yet another opportunity to be encashed and the same created a buzz among ophthalmologist. Optho's
new launch HY 5 “A third line therapy for TRED, management” has received encouraging and promising response from all delegates. The
response generated has given us the conﬁdence that soon Optho's vision of exploring Maharashtra’s market will turn into capturing
Maharashtra Market. We will be par cipa ng in the upcoming conference of Poona Ophthalmological Society 2016 (16th -18th Dec.) to
furtherenhanceourpresence inMaharashtra.Thispla ormwillhelpustostrengthenourbonds withophthalmicfraternity.Eagerlywai ngto
seeyouatPOS-2016.
* (C) Center (L) Left

5
Welcome on Board
Parveen Khurana
Asiv Khan
Shivam Anil Deore
Amit Kumar Upadhyay
Rahul Verma
HeadquarterDesigna onName
MR
MR
MR
MR
MR
MR
MR
MR
MR
AM
MR
Gurgaon
Haridwar
Pune
Ghaziabad
Lucknow
Nagpur
Kanpur
Gorakhpur
Aligarh
Kolkata
Aurangabad
MR
MR
MR
MR
MR
MR
MR
MR
MR
MR
MR
MR
Mumbai
Barasaat
Gorakhpur
Vishakhapatnam
Allahabad
Mumbai
Allahabad
Karnal
Salem
Lakhimpur
Guwaha
Chennai
Reserve your Slot
Ophthalmic Conference Calendar
BOSCON
Phaco Excel 2016
KOSCON 2016
Nayan Utsav 16-UPSOS Annual
Dhris 2016
VRSI 2016
AAPOS & SPOS
OSWB 2016
Punjab Oph. Society 2016
AIOS 2017
Poona Oph. Society 2016
th th
11 -13 Nov.
th th
12 -13 Nov.
th th
18 -20 Nov.
th th
18 -20 Nov.
th th
25 -27 Nov.
th th
25 -04 Dec.
nd th
2 -4 Dec.
th th
19 -20 Nov.
th th
10 -11 Dec.
th th
17 -19 Feb. 2017
th th
16 -18 Dec.
JLNM
Arvind Eye Hospital
Uva Meridian
Conven on
BRD Hospital & Raj Eye
Centre
Gokulam Park Hotel
Hotel Hya Regency
Hotel Marrio
Swabhumi
Jaipur Exhibi on and
Conven on Centre
Poona
Ludhiyana
VenueDate
Bhagalpur
Pondicherry
Uduchi
Gorakhpur
Kochi
Chandigarh
Jaipur
Kolka a
Ludhiyana
Jaipur
Hotel Marrio
CityTitle of Conference
ENT Conferences
VenueDateCityTitle of Conference
NMCH ENT DEPTT.AOICON- 2016 th th
25 -27 Nov.Patna
GurgaonWorld Phonocon 2017 th th
17 -19 Feb. 2017Gurgaon
Winner is Orissa Team
HY-5 FFNS-120
CCS-LC
Reserve Your Slot
With the launch of our new product we have started this new
sec on called “Reserve your Slot” to iden fy the performers of
par cular product in the given me frame. The same has been
started with CCS –LC. A new launch product for hyperosmolar dry
eye. Orissa team has stood with remarkable performance in the
veryﬁrstmonthandthe7menteamhasbooked2900unitsof
CCS-LC withYPMof414units forOrissaasastate.Swapnil Gajanan Pokale
Atul Mishra
Akshay Pandey
Pawan Yadav
Sanjay Kumar Singh
Dhangare Avinash Bhaskar
Majid Ahmad
Rupak Mukherjee
Ritesh Kumar
Yanda Latchum Naidu
Ankit Shukla
Rajesh R. Vishwakarma
Ramanand Saroj
Rajender Kumar
Ushen S
Vishakh Awasthi
Priyotom Mazumder
M Mahalingam

6
However, managers are responsible for making sure that things are done properly, and while leaders may bring us vision, inspira on and
challenge,thesethingscountfornothingwithouttheefficientimplementa onbroughtaboutbygoodmanagement.
To be a great manager, you must have an extensive set of skills – from planning and delega on to communica on and mo va on. Because the
skill set is so wide, it's temp ng to build skills in the areas of management that you're already comfortable with. But, for your long-term
success,it'swisetoanalyzeyourskillsinallareasofmanagement–andthentochallengeyourselftoimproveinalloftheseareas.
This quiz helps you to quickly iden fy your areas of strength and weakness, so that you can capitalize on the former and manage the la er. We
thendirectyoutoresourcesthatyoucanusetodevelopyourskillsfurther.
Foreachstatement, ckintherelevantcolumnthatbestdescribesyou.Pleaseanswerques onsasyouactuallyare(ratherthanhowyouthink
youshouldbe).
In business, we o en seem to focus less on good management, and more on the glamorous and exci ng
work of leadership.
The Self Ananlysis Management Quiz
Score Comment
20-46
You need to improve your management skills urgently. If you want to be effec ve in a leadership role, you must learn how to
organizeandmonitoryourteam'swork.Nowisthe metostartdevelopingtheseskillstoincreaseyourteam'ssuccess!
47-73
74-100
You're on your way to become a good manager. You're doing some things really well, and these are likely the things you feel
comfortable with. Now it's me to work on the skills that you've been avoiding. Focus on the areas where your score is low,
andfigureoutwhatyoucandotomaketheimprovementsyouneed.
You're doing a great job managing your team. Now you should concentrate on improving your skills even further. In what
areas did you score a bit low? That's where you can develop improvement goals. Also, think about how you can take
advantageoftheseskillstoreachyourcareergoals.
Effec ve management requires a wide range of skills, and each of these skills complements the others. Your goal should be to develop and
maintaintheseskills,sothatyoucanhelpyourteamaccomplishitsobjec vesefficientlyandeffec vely.
1. When I have a problem, I try to solve it myself before
asking my boss what to do.
3. I make decisions following careful analysis, rather than
relying on gut ins nct.
4. I spend me talking with my team about what's going
well and what's needs be improving.
7. I brief my team members so that they know what's going
on around them in the organiza on.
6. When my team makes a significant mistake, I update my boss
on what has happened, and then I think of it as an important
lesson learned.
2. I follow up with team members whenever I see that their
behavior has a nega ve impact on customer service
5. When pu ng together a team, I consider the skills I need –
and then I seek people who best fit on my criteria.
8. I find myself comple ng tasks at the last minute, or asking
for extensions.
9. I use goal se ng to decide what tasks and ac vi es I
should work on.
10. I priori ze my To Do list or Ac on Program.
Ten Statements to Answer Not At All Some mes Rarely O en Very O en
*Ra ng:- NOT AT ALL=2, SOMETMES=4, RARELY=6, OFTEN=8, VERY OFTEN=10

7
Products of the Season
concentra on of DFBA at various levels, DFBA was found absent in
aqueous humor where as DFB was readily detected . this indicates
that the acetyl group was hydrolysed quickly but DFB
(Difluoroprednisolone Butyrate Acetate) remains in aqueous
humor within the first hour a er the drop ins lla on. This also
provesthathydrolysisofDFBdoesnotoccur.
POTENCYofDFB(DifluroprednisoloneButyrate)
1. Difluprednate emulsion is highly lipophillic in nature and
crossesthecorneatoreachaqueoushumor.
2. In aqueous humor , Difluprednate is deacetylated as thus is
converted into ac ve metabolite Difluroprednisolone butyrate (
DFB).
3. DFBactsasastrongcor costeroid.Itspotencycanbecompared
withanyofthestrongsteroids.
4. A er impar ng its An inflammatory ac on ,the endogenous
ssue esterases metabolites DFB in inert metabolite named
Hydroxyl Fluroprednisolone butyrate (HFB) with no toxic
effects.
SAFETYOFDIFLUPREDNATE:
Though being a strong cor costeroid, it does not possesses the
steroidal side effects unlike the exis ng steroids like prednisolone
acetate.Onthecontrary,it'sisverysafe.
Difluroprednate which is converted into DFB, the ac ve
metabolite whichcontroltheheavyinflamma ona erthesurgery.
Study have proved, DFB as a potent an -inflammatory metabolite
which is further metabolized into HFB an inert metabolite. But DFB
doesnotmetabolizeimmediately,itremains inaqueous humor for
thefirsthour a erthedropisins lled.
A er an hour DFB is metabolized in HFB which has no significant
ocularorsystemictoxici eswhichis characteris cofthesteroid.
Hence, this is established that even though, difluprednate is a
strongsteroid,butsafeatthesame me.
Flurocart doesnot contain BAK but here sorbic acid has been used
asapreserva ve.
CLINICAL PRACTICE:
1. Difluprednate, unlike the other exis ng steroids is the first
topical steroid totreatboth inflamma on&pain.
2. Flurocart has shown promising results in the treatment of
anterioruvei s
3. It'spotencyandlimitedsystema c absorp on makesita
be er op on whentrea ngchronic diseaselikeuvei s.
4. To treat the post surgical inflamma on pain & uvei s
difluprednateisthechoiceofdrug.
In short it can be said, that difluprednate 0.05% ophthalmic
emulsion is a potent new topical steroid that exhibi s
enhanced penetra on, be er bioavailability, rapid local
metabolism and strong efficacy with low incidence of adverse
effects.
Winter is fast approaching and just
a er the fes vi es of Dusherra &
Diwali there will be sudden influx of
surgery pa ents in all ins tu ons
and private ophthalmologists. The
d o c to rs h ave sta r te d t h e i r
prepara ons to meet the extra
pressure of surgery. Hence, all the
field staffs are adviced to prepare
themselves with the products
gradually used in the post opera ve
state. We have number of products
to be used like Moxifax –P / Moxifax-
Dx / Lotemox/ Flurocart / Moxifax
Nepacin / Flurgat / Bromifax & Tocin F etc . Each product has it's
own advantage for valid indica on and purpose . Our Flurocart is
onesuchprepara onwhichisusefulinpostopera vestate.
FlurocartEyeDrop
The medical fraternity is on the con nuous hunt for cor costeroid
which is strong enough to eliminate the post opera ve
inflamma onproperlyandsimultaneouslyshouldbesafealso.
Flurocart eye drops : This contains difluprednate in the
concentra on of 0.05% with preserva ve i.e. sorbic acid which is
considered tobesafeascomparedtoBAK.
Flurocart(Difluprednate isthefirstophthalmicsteroiddevelopedin
the past 35 years) with high potency , a favourable safety profile and
the ability to reduce the post opera ve pain. Difluprednate is a
diflurinated deriva ve of prednisolone and has a potent an
inflammatory ac vity. Difluprednate is a cor costeroid a synthe c
deriva ve of prednisolone fluorinated at C-6 & C-9 posi on .The
molecule derives its potency from fluorina on. Its an -
inflammatory ac vity further augmented (enhanced) by replacing
C-17 with butyrate, while its lipophilicity is enhanced by replacing
hydroxyl group at C-21 with acetate . Thus, difluprednate is
abbreviated as DFBA (Difluoroprednisolone Butyrate Acetate)
these modifica on have made difluprednate a strong ophthalmic
steroid.
Hence, diflupreduate score a dis nc on over prednisolone
acetate . The following features make it superior than prednisolone
acetate.
A er ins lla on of difluprednate emulsion, it quickly crosses the
cornea (being a lipophillic agent and reaches to the aqeous humor
.with contact of aqueous humor, it is decetylated to an ac ve
metabolite called as Difluroprednisolone Butyrate (DFB). This
possessestosimilarcor costeroidac vityprofile..
Thus, endogenous ssue esterases (cell and ssue of anterior and
posterior chamber) metabolizes DFB into inert metabolite called
Hydroxyfluroprednisolone Butyrate (HFB), this has no systemic
toxicity.This isforthefurtherprovedbyusing various
Difluroprednisolone Butyrate (DFB) | Difluoroprednisolone Butyrate Acetate ( Hydroxyfluroprednisolone ButyrateDFBA) | (HFB)

8
Of all the available intranasal cor costeroid Flu casone Fuorate is
the most promising intranasal cor costeroid for the treatment of
AllergicRhini s.
Flu casonePropionateV/SFFNS-120
vivomodelsincludedac va onoftheglucocor coidresponse
as NFkBelement, inhibi on of pro-inflammatory transcrip on
factors such and inhibi on of an gen-induced lung eosinophilia in
sensi zed rats. Flu casone is also found to increase airway
reten on of long-ac ng beta adrenergic agonist, thus poten a ng
itsbeneficialeffectsforthetreatmentofasthma.
FFNS-120
Allergic rhini s (AR) is one of the most prevalent chronic diseases
affec ng up to 20 to 30% of adults and up to 40% of children. The
increase in prevalence of allergic disorders in the country has been
more marked in the past two decades, with almost one in two
people exhibi ng an allergic response to some common
environmentalfactor.
Allergicrhini sisahighlyprevalent,allergen-induced,upper-airway
inflammatory disease, characterized by hyperreac ve airway
mucosa and episodes of symptom chronicity with periods of acute
exacerba on. It is linked to exacerba ons of other inflammatory
airway diseases, such as asthma and sinusi s, and thus has further
importanthealthimplica ons.
Allergic rhini s may be seasonal or perennial. Individuals with
seasonal allergic rhini s (SAR) have symptoms primarily in the
spring and fall, during the pollina ng season of the plants to which
they are sensi ve, such as grass, trees, or various weeds. Those with
perennial allergic rhini s (PAR) have symptoms year round to
allergens that have no seasonal varia on, such as house dust mites,
mold spores, or animal danders. Because of con nous exposure to
low concentra ons of allergens, symptoms of PAR are usually less
severethanthoseofSAR.
Usually thesymptomsofallergicrhini saretakenbythemasses as
common cold and indiscriminate use of over the counter medicine
to eradicate further worsen it. Usually to treat Allergic rhini s (AR)
nasal spray having intranasal cor costeroids are given. These
medicinestreatthecauseofthediseaseandbringbe errelief.They
are to be taken in the form of nasal sprays, which deliver the
medicine directly to the site of the problem (inside the nose).
Allergic rhini s (AR) is one of the most prevalent chronic diseases
affec ng up to 20 to 30% of adults and up to 40% of children.
Intranasal cor costeroids (INCS) are recommended as first-line
therapy for the treatment of persistent AR by the Allergic Rhini s
and its Impact on Asthma (ARIA) guidelines. Flu casone furoate
(FF) is a novel enhanced-affinity glucocor coid approved by the
Food and Drug Administra on (FDA) for the treatment of symptoms
of seasonal allergic rhini s (SAR) and perennial allergic rhini s (PAR)
inadultsandchildrentwoyearsofageandolder
We have one such prepara on named FFNS -120. Each spray of
FFNS-120 offers27.5mcgflu casonefurateinmetereddose.
Flu casone furoate Flu casone furoate. Is a synthe c trifluorinated
cor costeroid with potent an -inflammatory ac vity. The precise
mechanism through which flu casone furoate affects rhini s
symptomsisnotknown.
Cor costeroids have been shown to have a wide range of ac ons on
mul ple cell types (e.g., mast cells, eosinophils, neutrophils,
macrophages, lymphocytes) and mediators (e.g., histamine,
eicosanoids, leukotriees, cytokines) involved in inflamma on.
Specificeffectsofflu casonefuroatedemonstratedinvitroandin
Parameters Flu casone Propionate Flui casone Fuorate
Fluticasone propionate Momentasone Budesonide Ciclesonide Fluticasone furoate
FDA : Food and Drug Administration
Bioavailability (%)
Protein binding (%)
Excretion
Half life (hours)
[5]
Relative receptor afnity
Age of FDA approval (Years)
Onset/timer (hour)
Dose spray (ugm)
FDA approval (year
<2
91
Feces 95%; Urine 5%
7.8
1775
4
12
50
1994
Minimal
99
Feces 55%; Urine 45%
5.8
900
2
11
50
1997
34
85
Feces 34%; Urine 6%
2-3
855
6
4
32
1999
<1
99
Feces 66%: Urine 20%
6-7
120
6
1
50
2006
1.26
99
Feces 99%: Urine 1%
15.1
2989
2
6-8
27.5
2007
DOSE
Recommended
Glucocor coid Receptor
Affinity
Half Life
Onset
BD
4 years & above
Less
7-8 hours
12 hours
OD
2 years & above
More
15-16- hours
6-hours
Thus FFNS -120 offers the most advanced intranasal cor costeroid
i.e.Flu casoneFuorate.
Dose:-Children2to11yearsofage
The recommended star ng dosage in children is 55 mcg once daily
administered as one spray (27.5 mcg/spray) in each nostril. Children
not adequately responding to 55 mcg may use 110 mcg (two sprays
in each nostril) once daily. Once symptoms have been controlled,
the dosage may be decreased to 55 mcg once daily.
Adultsandadolescents12yearsofageandolder
The recommended star ng dosage is 110 mcg once daily
administered as two sprays (27.5 μg/spray) in each nostril, to be
trated to a minimum
effec ve dosage to
reduce the possibility of
side-effects. When the
maximum benefit has
been achieved and
symptoms have been
controlled, reducing the
dosage to 55 mcg (one
spray in each nostril)
once daily may be
effec ve in maintaining
controlofARsymptoms.
FFNS-120 should be
promoted to Chest
P h y s i c i a n / E N T
S p e c i a l i s t . / M D
Medicine.
Seasonal Allergic Rhini s (SAR) | Perennial Allergic Rhini s ( Allergic Rhini sPAR) | (AR)

9
The most commonly prac ced MSICS techniques are Blumenthal, visco-expression, irriga ng wire vec s and fish hook needle. These
techniques require a 7 to 9 mm large incision, which leads to more as gma sm. Intratunnel phaco fracture is a new technique
innovated by author, where the lens nucleus is broken inside the sub 6 mm sclerocorneal tunnel. We are going to demonstrate this
technique in this ar cle.
Intra tunnel phacofracture is a new nucleus management technique (ITPF) of the manual small incision cataract surgery, popularly known as
MSICS. In this technique maneuverings take place inside sclerocorneal tunnel. The lens nucleus is broken inside the sub 6 mm sclerocorneal
tunnel and removed. It's simple, inexpensive and reproducible technique. The 6 mm ITFP visual outcome is comparable with 3.2 mm clear
corneal phacoemulsifica on. By Intratunnel phacofracture technique all types of the cataracts can be successfully taken out through 4- 6 mm
wide tunnel. Other most commonly prac ced MSICS techniques are Blumenthal, visco-expression, irriga ng wire vec s and fish hook needle.
All these techniques require a 7 to 9 mm large incision, which leads to more as gma sm. In all these techniques maneuverings take place
insidetheanteriorchamber,soitposesrisktocornealendotheliumandotherstructures.
Keywords: MSICS, intratunnel, phacofracture
ABSTRACT
INTRATUNNEL PHACOFRACTURE: A NEW NUCLEUS MANAGEMENT TECHNIQUE OF MSICS
Intratunnel Phacofracture MSICS:
A New Cataract Refractive Surgery Technique
INTRODUCTION
Manual small incision cataract surgery (MSICS) and phacoemulsifica on are the most popular methods of cataract extrac on today. MSICS is
significantly faster, less expensive and less technology-dependent than phacoemulsifica on. MSICS has been extensively prac ced in
developing countries like India. Intratunnel phaco fracture is a new nucleus management technique, where the lens nucleus is broken inside
the sub 6 mm sclerocorneal tunnel and removed in contrast to other contemporary techniques. By incision size and site planning pre exis ng
as gma smisneutralizedhenceit'sacataractrefrac vesurgery.Allthetypesandsizesofthelensnucleusescanbetakenoutthistechnique.
IntratunnelPhacofractureTechnique
Intratunnel phaco fracture nucleus management technique was first described by the author1.Its a simple, inexpensive reproducible
technique.
Anesthesia
Manualsmallincisioncanbedoneperformedunderperibulbarortopicalanesthesia.
IncisionSiteandSizePlanning
Siteandsizeofincisionischosenaccordingkeratometryvalues(K1andK2).
A. If K1 and K2 are equal: External scleral incision width 4 mm and 1 mm away from the limbus in the supero
temporal or supero nasal quadrants. Logic behind this is that incision in the supero temporal and supero
nasalquadrantproducesamesurgicalinducedas gma sm(SIA)(Figure1).
Sudhir Singh,
MS Correspondence
Dr. Sudhir Singh
Senior Consultant & HOD
JW Global Hospital Research Centre
Mount Abu, India, 307501
drsudhirsingh@gmail.com

10
Superior Rectus Bridle Suture
A 4/0 silk superior rectus bridle
suture is placed beneath the
tendon of the superior rectus
muscle. It is helpful to posi oning
eye a er local anesthesia.
Superior rectus bridle suture is
not used when surgery is planned
under topical anesthesia.
Conjunc valFlap
A fornix based conjunc val flap at
the limbus with a chord length of
approximately 6.5 mm is made.
A er careful dissec on of the
Tenon's capsule, light cautery is
applied(Image8).
Sclera-cornealTunnel
A 6 mm scleral frown incision, 1.5
mm from the limbus is made with
a 15 number Bard Parker blade
(Image 9). A funnel shaped
sclerocorneal tunnel incision is
created with a steel crescent
knife. One side port is made 90
degreesapartoneithersideofthe
scleral tunnel with a 15 degree knife temporally in right eye and
nasally in le eye. With a 2.8 mm keratome, the anterior chamber is
entered 1.5 mm into the clear cornea. Anterior chamber is entered
with 1.5 mm in clear cornea with help of 3.2 mm keratotome (Figure
10).Thehydroxylpropylmethylcellulose2%(HPMC)viscoelsa csis
injectedintoanteriorchamber.
CentralCircularCapsulorhexis
The central circular capsulorhexis
is made with help of 26 gauze
needle capsulotome. If glow is
poor then capsule was stained
with trypan blue dye under the air
bubble. Then viscoelsa cs is
injected and capsulorhexis is
made. The size of capsulorhexis is
dependsonthesizeofthenucleus
.It may vary from 5.5 mm to 7.5 mm (Figure 11). If nucleus size is
an cipated large then two relaxing incisions are made at the
margins of the capsulorhexis. Capsulorhexis can also be made by
capsulorhexisforceps
Hydro-dissec onProcedure
The Hydrodissec on is made with
26 gauze cannula place on 2 CC
syringefilledirriga ngfluid.
Nucleus Prolapse in the Anterior
Chamber The internal incision of
the tunnel is enlarged sideways to
7mmthe5.1mmkeratome
D. If K1 and K2 difference is 1.5D:
External scleral incision width
6 mm and 1 mm away from
the limbus on the steeper axis
(Figure4).
E. If K1 and K2 difference is 2.0D:
7.0 mm and 1 mm away from
the limbus on the steeper axis
(Figure5).
F. If K1 and K2 difference is 2.5D:
7.5 mm and 1 mm away from
thelimbusonthesteeperaxis
(Figure6).
G. If K1 and K2 difference is 3.0D
or more: External scleral
incision width 7.5 mm and 1
mm away from the limbus on
thesteeperaxis(Figure6).
SURGICALSTEPS
Cleaninganddraping
The skin of the eyelids, lid margins
and around the eye is cleaned
with 10 percent solu on of
povidone-iodine solu on. Drape
is applied. Wire speculum is
placed. Cul de sac is thoroughly
washed with Ringer's lactate
solu onorbalancedsaltsolu on
B. If K1 and K2 difference is 0.5D:
External scleral incision width 4
mm and 1 mm away from the
limbus in the supero temporal or
superonasalquadrants(Figure2).
C. If K1 and K2 difference is 1.0D:
External scleral incision width 5
mm and 1 mm away from the
limbus in the supero temporal or
superonasalquadrants(Figure3).

11
(Image 12). Anterior chamber is formed again with viscoelsa cs and
the nucleus is rotated within the capsuleusing a Sinskey hook. The
nucleus is prolapsed into anterior chamber using a Sinsky hook
(Image 13). A Sinskey hook is used to retract the capsulorhexis to
engage the equator and lever out one pole of the nucleus outside
the capsular bag and the rest of the nucleus is rotated into the
anterior chamber. If the nucleus is too large then two or three
relaxing incision are made at the capsulorhexis margins at
equidistance.
NucleusManagement
Up to this step all above men oned steps are same as in other
manual small incision techniques. Intratunnel phacofracture
technique is different than other phacofracture techniques of
anterior chamber. Enough viscoelsa cs is placed between cornea
and superior surface of the nucleus to protect endothelium;
between nucleus and iris to keep away iris from nucleus. The
nucleusisrotatedwithinthecapsuleusingaSinskeyhook.Theglobe
is stabilized with tooth forceps and the small Lewis lens loop (AA
1915 from Appasamy Associate, India) is introduced through the
tunnelandposi onedbetweentheirisandthenucleus.Thenucleus
is engaged in the lens loop and slowly withdrawn from the anterior
chamberwhilethe posteriorlipof the tunnel is depressed.Once the
nucleus gets engaged in the tunnel, then the Lewis loop is pulled
posteriorlyand upwards. This causes breaking and removal of a part
of the nucleus and other part remains engaged in the tunnel. By
viscoelsa cstheengagedpartofthenucleusispushed backintothe
anterior chamber and rotated so its longitudinal axis is coincided
with longitudinal axis of the tunnel. Again viscoelsa cs is placed
between the cornea and superior surface of the nucleus and
between the nucleus and iris. The lens loop is introduced through
the tunnel and posi oned between the iris and the remaining part
of the nucleus. The remaining part of the nucleus is engaged in the
lens loop and slowly withdrawn from the anterior chamber while
the posterior lip of the tunnel is depressed. Most of the mes
remaining part of the nucleus comes out. If it s ll break down then
remaining part again pushed in the anterior chamber with help of
viscoelsa cs and previous steps are repeated ll it comes out
(Figure14).
Cor calMa erCleanUp
The remaining cor cal ma er
clean up is done with direct 23
gauge Simcoe irriga ng aspira ng
cannula. The anterior chamber is
formed with Viscoelsa cs (Image
15).
IntraocularLensImplanta on
A single piece PMMA intraocular
lens of 5.5-6.00 mm op c size and
12.5 mm total size is implanted
into the capsular bag. The anterior
c h a m b e r i s w a s h e d o u t
thoroughly by Simcoe irriga on
aspira on cannula using Ringer's
lactatesolu onorBSS(Image15).
Visual Acuity Pa ent Number (%)
Pa ent Cumula ve
Number (%)
6/6
6/9
6/12
6/18
6/24
6/36
7(5.14)
29(21.32)
32(23.52)
48(35.29)
16(11.76)
4(2.94)
7(5.14)
36(26.47)
68(50.00)
116(85.29)
132(97.05)
136(100)
Table 2. First postopera ve day uncorrected visual acuity (UCVA)
following 6 mm intratunnel phacofracture technique
(Source: US Ophthalmic Review, 2014; 7(1):26–30)
Visual Acuity Pa ent Number (%)
Pa ent Cumula ve
Number (%)
6/6
6/9
6/12
6/18
6/24
6/36
20(14.70)
56(41.17)
48(35.29)
9(6.61)
1(0.73)2
(1.47)
20(17.17)
76(55.88)
124(91.17)
133(97.79)
134(98.52)
136(100)
Table 3. First postopera ve day best corrected visual acuity
(BCVA) following 6 mm intratunnel phacofracture technique
(Source: US Ophthalmic Review, 2014; 7(1):26–30)
PublishedResult
First postopera ve day visual outcome of 6 mm intratunnel
phacofractureisgivenintable2and3.
15 degree blade
Crescent Blade
2.8 mm Keratotome
5.0 mm Keratotome
Drip Set
1.
2.
3.
4.
5.
0.5
0.5
0.5
0.5
0.5
1
1
1
1
1
0.5
0.5
0.5
0.5
1.0
Viscoelsa cs (HPMC )
Ringer Lactate Solu on
Trepan Blue
IOL
Medica on
Total
6.
7.
8.
9.
10.
1.0
0.5
0.5
3.0
2.5
1
1
1
1
1
1.0
1.0
1.0
2.5
2.0
10.0
Conjunc valFlapReposi on
Theconjunc valflapisrepositedbackandcauterizedattheedges.
Main Ports and Side ports Sealing Main port and side ports are sealed with
stromalhydra onusinga26gauzecannula.
Subconjuc valInjec on
A 0.5 cc subconjuc val gentamycin with dexamethasone injec on is given.
Eye is pad patched The mean uncorrected visual acuity and mean best
corrected visual acuity at first post opera ve day were 0.367 (Snellen
equivalent 20/46) and 0.226(Snellen equivalent 20/33) log MAR units
respec vely. No serious per and post opera ve complica on
encountered1.
ConsumableExpenditure
Per case consumable expenditure of cataract extrac on using this
techniqueisgivenintable1.

12
DISCUSSION
Intratunnel phaco fracture (ITPF) is a new technique innovated by
Sudhir Singh, where the lens nucleus is broken inside the sub 6 mm
sclerocorneal tunnel and removed. As nucleotomy maneuvering
taken place inside the corneo-scleral in contrast to other nucleotomy
techniques where maneuverings take place inside the anterior
chamber. By Intratunnel phacofracture technique all types of the
cataractsweresuccessfullytakenoutthrough4to6mmwidetunnel.
The incision size is planned according amount of the preexis ng
as gma sm with an aim to neutralize it. So it also work as refrac ve
surgery and eliminate the need of the expensive toric IOLs by
neutralizing preexis ng as gma sm by surgical induced as gma sm
(SIA).
When there is a very large nucleus and compromised endothelium
then liberal incision is planned. So if nucleus is managed to remove
though a sub 6mm incision at appropriate site would result
approximately same as gma sm as 3.2 mm phacoemulsifica on 2-
5.
Other most commonly prac ced MSICS techniques are Blumenthal,
visco-expression, irriga ng wire vec s and fish hook needle. These
techniques require a 7 to 9 mm large incision, which leads to more
as gma sm
First postopera ve day mean uncorrected visual acuity and mean
best corrected visual acuity at first post opera ve day of 6mm ITPF
were 0.367 (Snellen equivalent 20/46) and 0.226(Snellen equivalent
20/33) log MAR units respec vely1. No serious per and post
opera vecomplica onencounter.
Conclusion:
Intratunnel phaco fracture (ITPF) manual small incision cataract
surgery is safe, effec ve, refrac ve, reproducible, and economical
technique.Itisanalterna vetoexpensivephacoandtoricIOLs
SurgicalVideo
h ps://www.youtube.com/watch?v=_nYIR3n_o&feature=youtu.be
&list=PLO6iZMCr0FmxCYmg7Pxq_lf07K9Ki8CTA
FINANCIAL DISCLOSURE
Theauthorhasnofinancialinterestinanyproductmen oned.
References
1. Sudhir Singh. First Postopera ve Day Visual Outcome Following
6 mm Manual Small Incision Cataract Surgery Using Intratunnel
Phacofracture Technique. US Ophthalmic Review,
2014;7(1):26–30
2. OshikaT,NagaharaK,YaguchiS,EmiK,TakenakaH,TsuboiS,et
al . Three year prospec ve randomized evalua on of intraocular
lens implanta on through 3.2 and 5.5 mm incisions. J Cataract
RefractSurg1998;24:509-14
3. Gokhale NS, Sawhney S. Reduc on in as gma sm in manual
MSICS through change in as gma sm site. Indian J Ophthalmol
2005;53:201-3
4. George R, Rapauliha P, Sripriya AV, Rajesh PS, Vahan PV, Praveen
S. Comparision of endothelial cell loss and surgically induced
as gma sm following conven onal extracapsular cataract
surgery, manual small incision surgery and phacoemulsifica on.
OphthalEpidemiol2005;12:293-7.
5. Gogate PM, Kulkarni SR, Krishnaiah S, Deshpande RD, Joshi SA,
Palimkar A, et al . Safety and efficacy of phacoemulsifica on
compared with manual small incision cataract surgery by a
randomized controlled clinical trial: Six weeks results.
Ophthalmology2005;112:869-7411.
6. G o gate P, D e s h p a n d e M , N i r m a l a n P K . W hy d o
phacoemulsifica on? Manual small-incision cataract surgery is
almost as effec ve, but less expensive. Ophthalmology
2007;114:965–8.
7. Gogate PM, Kulkarni SR, Krishnaiah S, et al. Safety and efficacy of
phacoemulsifica on compared with manual small-incision
cataractsurgery by a randomized controlled clinical trial: six-
weekresults.Ophthalmology2005;112:869–74.
8. Ruit S, Tabin G, Chang D, et al. A prospec ve randomized clinical
trial of phacoemulsifica on vs manual sutureless small-incision
extracapsular cataract surgery in Nepal. Am J Ophthalmol
2007;143:32–8.

13
RETINOPATHYOFPREMATURITY
Re nopathy of Prematurity (ROP) is a
fibrovascular prolifera ve disorder,
which affects the developing peripheral
re nal vasculature of premature infants.
Re nopathy of prematurity (ROP) is one
of the leading causes of blindness among
neonates in the world. With the
increased survival of extremely
immature neonates, more infants are at
risk of developing ROP.ROP is a
preventablecauseofblindnessand
remainsoneoftheleadingcausesof
visuallossinchildren.
With this rising rate of prematurity and improvingsurvival, the need
for ongoing ROP screening, treatment op ons, and long-term
follow-up is greater than ever. Recent advances in treatment for
ROP offer the promise of improved outcomes and preven on of
lifelongvisionloss.
RiskFactors
AmongthecrucialriskfactorsofROPare
Birthweight
Gesta onalage
Numberofdaysoxygenadministered
Otherriskfactorsinclude
Mul plebirths
Bloodtransfusions
RespiratoryDistressSyndrome(RDS)
Sepsis
IntraVentricularHaemorrhage(IVH)
IntraUterineGrowthRetarda on(IUGR)
VitaminEdeficiency
Anaemia
Seizures
Pathogenesis
Normally, re nal vascular development occurs in two phases
wherein phase 1 is independent of vascular endothelial growth
factor (VEGF) and occurs from 8-21 weeks of fetal development.
Spindle cells (mesenchymal precursor cells) appear around op c
disc region and then cords of spindle cells advance towards
oraserrata, which differen ate into capillaries, which subsequently
develop into arterioles and venules. Later, phase 2 dependent on
VEGFoccursfrom22to40weeksofdevelopmentinwhich
prolifera ng endothelial cells migrate from exis ng blood vessels to
formnewcapillaries.
ROP also occurs in premature babies exposed to high oxygen a er
birth, which leads to vaso-oblitera on and cessa on of vessel
growth due to down regula on of VEGF. When oxygen exposure is
reduced there is a pathological release of VEGF from avascular
re nathatleadstoneovasculariza on.
Classifica on
Interna onal Classifica on of Re nopathy of Prematurity (ICROP)
wasdevelopedin1984andlatermodifiedin1987and2005.
Thisclassifica onisbasedonthreeclinicalparameters:
Loca on of disease: 3 zones of re nal involvement are recognized,
eachofwhichiscenteredatthedisc(Figure1).
a. Zone 1: With disc as center and twice the distance from disc to
fovea, the circle formed is zone 1. It subtends an arc of about
600
b. Zone 2: extends from the peripheral border of zone 1 to nasal
oraserrataandcorrespondingareatemporally.
c. Zone 3: is the remaining temporal crescent of re na anterior to
zone2.
Extentofdisease:numberofclockhoursinvolvement(Figure1).
Stagingofdisease:definedaccordingtodegreeofvascularchanges
along with loca on in zone & extent in clock hours for
documenta on.
a) Stage 1 - Demarca on line: Is a thin, rela vely flat, white and
lies within the plane of the re na but is a definite structure
that separates the avascular re na anteriorly from the }
vascularizedre naposteriorly.(Figure2).
b) Stage 2 – Ridge: Is a hallmark of stage 2 ROP, arises in the region
of the demarca on line, has height and width and extends
abovetheplaneofthere na(Figure3).
c) Stage3–Extrare nalfibrovascularprolifera on(EPF):Itextends
from the ridge into the vitreous and is con nuous with the
posterioraspectoftheridge (Figure4).Itisfurthersubdivided
into mild, moderate or severe depending on the extent of
EPFinfiltra ngthevitreous.
d) Stage 4 – Par al re nal detachment: Stage 4 is divided into
par alre nal detachmentnotinvolvingfovea,stage4A(Figure
5) and involving fovea, stage 4B (Figure 6). Visual
prognosisofstage4Bispoorerthan4A.
e) Stage 5 – Total re nal detachment: These are generally
trac onal and may occasionally be exuda ve. (Figure 7) Visual
prognosisistheworstforstage5 ROP.
f) Aggressive posterior ROP (AP-ROP): An uncommon, rapidly
progressing, severe form of ROP. If untreated, it usually
progresses to stage 5 ROP. The characteris c features of AP-
ROP are its posterior loca on,
prominence of plus disease and
the ill-defined nature of the
re nopathy (Figure 8). It is
observed most commonly
in zone I, but may also occur in
posteriorzoneII.
Dr. Rohit Agarwal
(MBBS DOMS) Oculoplasty
Deen Bandhu Eye Hospital
Ayodhya
Doctor’s Speak

14
Plus disease: It is an addi onal sign indica ng the severity of ac ve
ROP. This includes increased venous dilata on and arteriolar
tortuosity of the posterior re nal vessels (Figure 9) and may later
increase in severity to include iris vascular engorgement, poor
pupillarydilata on(rigidpupil)andvitreoushaze.
Pre-plus disease: It is defined as vascular abnormali es of the
posterior pole that is insufficient for the diagnosis of plus disease
but demonstrates more arterial tortuosity and more venous
dilata onthannormal(Figure10).
Screeningstrategies
Whentoscreen?
The development of ROP correlates according to the infant's
postmestrual age (gesta onal age + post natal age) rather than the
mesincebirth(chronologicalage).
As per recommenda ons by American Academy of Ophthalmology
and Pediatrics and Associa on of Pediatric Ophthalmology and
Strabismus in 2006, ini al eye examina on is to be done by 31
weeks postmenstrual age or 4 weeks of chronological age which
ever is later. However, an easier way to remember is that first re nal
examina onshouldbedonebyfirstmonthoflife.
Whomtoscreen?
Recentrecommenda onsbyAmericanAcademyofOphthalmology
and Pediatrics and Associa on of Pediatric Ophthalmology and
Strabismus in 200610 suggest fundus examina on for all infants
with birth weight (BW) = 1500g or with gesta onal age (GA) = 30
weeks and also for any premature infant weighing between 1500 –
2000 gms or GA > 30 weeks with an unstable clinical course believed
to be at risk by the a ending pediatrician. UK guidelines state that
babies with gesta onal age = 31 weeks or birth weight = 1500g
shouldbescreenedforROP.
ScreeningcriteriaformulatedaccordingtoIndianscenario:
· AllinfantswithBW=1800gorGA=34weeks.
· All infants requiring supplemental oxygen or with unstable
neonatal course felt as high risk by the a ending neonatalogist,
irrespec ve of GA or BW, should also bescreened. This is called
“sicknesscriteria”.
Howtoscreen?
Screening is done in a temperature controlled room / nursery in the
presence of a neonatologist, since such babies are suscep ble to
hypothermia, bradycardia, apneic episodes and fall in oxygen
satura on. A re na specialist or an ophthalmologist does screening
with the help of indirect ophthalmoscope, +28/+20 D lens, scleral
depressor (wire vec s) and alphonso speculum along with 0.5%
proparacaine drops for topical anesthesia and half strength
tropicamide plus (0.4% tropicamide with 2.5% phenylephrine) for
pupillarydilata on
ManagementpearlsofROP
Whentotreat?
Threshold disease: As per CRYO-ROP study is defined as Stage 3 in
zone I or II involving > 5 con guous or 8 cumula ve clock hours with
plusdisease.Thiswastheprevious“cutoff”stagefortreatment.
Prethreshold Disease: Early Treatment ROP (ETROP) study has
revised the treatment guidelines. This study proved that earlier
treatment(PreThresholdstage)hasabe eroutcome.
TheydivideprethresholdROPinto
a) Type 1 ROP or High Risk Prethreshold: This is the new “cut off”
fortreatmentandis supposedtobetreatedimmediately.
i. Zone1anystagewithplusdiseaseor
ii. Zone1stage3withoutplusdiseaseor
iii. Zone2stage2or3withplusdisease.
b) Type 2 ROP or Low Risk Prethreshold Disease: These should be
considered for treatment only if they progress to type 1
orthresholdROP.
i. Zone1stage1or2withoutplusdiseaseor
ii. Zone2stage3withoutplusdisease.
Howtotreat?
Principle is abla on of the ischemic
peripheral re na stops the release of
angiogenic factors. Two op ons are
available:
Cryotherapy: Mul ple applica ons
are made to treat en re avascular
re na anterior to the ridge (Figure 11). However cryotherapy
requires general anesthesia, has more local complica ons like
severe lid edema and for zone I cases, the cryo probe cannot reach
posteriorly because of the restric on caused by the conjunc val
fornix.
Laser Photocoagula on: It is a prac cal alterna ve a er the advent
ofindirectlaserdeliverysystem.Themainadvantagesarethatitcan
be performed under topical anesthesia, systemic and local
complica ons are much less compared to cryotherapy, and it can be
done as out pa ent procedure (with anesthe st or neonatologist
standby) and posterior re na in zone I
casescanbetreatedeasily(Figure12).
Laser or cryotherapy can only be done
llstage3ROP.Managementofstages
4 and 5 is surgical and final outcome is
verypoorforthesestages.

15
Doctor’s Speak
Dr. Arpit Airen (M.S.)
Airen Hospital (Ujjain)
DryAMD
Dry AMD occurs when the light sensi ve cell in the macula slowly
breakdown, gradually blurring central vision in the affected eye . As
Dry AMD get worse, one may see a blurred spot in the vision field.
Over the me as less of the macula func ons, central vision is
gradually lost in the affected eye. The most common symptom of
dry AMD is slightly blurred vision. One may have difficulty
recognising faces or one may need more light for reading and other
tasks.Dry AMDgenerallyaffectsbotheyesbutat mesvisioncanbe
lostinoneeyewhiletheothereyeseemsunaffected.
Drusen
One ofthemostcommonearlysignsofdryAMDisdrusen.
Drusenareyellowdepositsunderthere na.Theyo enarefoundin
people over 60 years of age. Dry AMD has three stages, all of which
mayoccurinoneorbotheyes.
EarlyAMD
People with early AMD have either several small drusen or a few
medium sized drusen, at this stage are no symptoms and no vision
loss.
IntermediateAMD
People with intermediate AMD have either many medium sized
drusen or more large drusen. Since people see a blurred spot in the
centre of their vision, more light may be needed for reading and
othertasks.
AdvancedDryAMD
In addi on to drusen people with advanced dry AMD have a
breakdown of light sensi ve cells and suppor ng of light sensi ve
cells and suppor ng ssue in the cental re nal area. This
breakdown can cause a blurred spot in the centre of your vision.
Over me the blurred spot may get bigger and darker taking away
moreofthecentralvision.
CausesAndRiskFactorsForAMD
The greatest risk factor is age, although AMD may occur during
middleage.
OtherRiskFactors
· Smoking:SmokingmayincreasetheriskofAMD.
· Obesity :studies suggest a link between obesity and the
progressionofearlyandintermediateAMDtoadvancedAMD.
· Family History: Those with immediate family members, who
haveAMDareatahigherriskofdevelopingthedisease.
· Gender:Womenappeartobeatgreaterriskthanman.
Detec onAndDiagnosis
Evalua onofARMDpa entincludes:-
· VisionTes ng(SnellenandETDRS).
· Amslergridtest(ScotomaScore).
· FundusFluiresceinAngiography(FFA).
· Indocyaninegreen(ICG)angiography
· ContrastSensi vity.
· Readingspeed.
· Op calCoherenceTomography(OCT)
AGE RELATED MACULAR
DEGENERATION – AN OVER
VIEW
Abstract:- Age related macular
degenera on (AMD) is one of the
leading cause of bilateral irreversible
sever visual loss in individual over 50
years of age. That gradually destroys ,
sharp central vision. AMD occur in two
forms Dry (Non exuda ve) type & Wet
(exuda ve / Neovascular) type. The
important risk factor for AMD is age. People over age 50 are clearly
at greater risk. Other risk factors are smoking, obesity, family
history. Fundus, fluorescein angiography, indocyanine green
angiography & op cal coherence tomogram are very important
diagnos ctool.
Laser photocoagula on is effec ve in treatment of extrafoveal
choroidal Neovascularisa on secondary to AMD Intravitreal An
VEGFS, now a day it has been found to show improvement or slow
downvisionlossfromAMD.
Introduc on:-AMD isoneof leadingcauseof bilateralvisuallossin
individuals above 50 year of age. AMD is caused by hardening of the
arteries that nourish the Re na. This deprives the sensi ve re nal
ssueofoxygenandnutrientthatit needstofunc onandthrive.
Maculardegenera onvarieswidely inseverityintheworstcases.It
cause a complete losse of central vision, making reading or driving
impossible while in other it may cause slight distor on. Fortunately
macular degenera on does not cause total blindness as it does not
effecttheperipheralvision.
Early AMD includes discrete yellow spots at the macula (drusen),
hyper pigmenta on of the RPE or sharply demarcated area of RPE
depigmenta on . Late AMD includes geographic atrophy of the RPE
with visible under laying choroidal vessels ,PED with or without
neurosensory detachment, subre nal or sub- RPE
Neovascularisa on or fibroglial scar ssue, haemorrhage and
exudates
WETAMD
Wet AMD occurs when abnormal blood vessels behind the re na
start to grow under the macula these new blood vessels tend to be
very fragile and o en leak blood and fluid. The blood and fluid raise
the macula from its natural place at the back of eye and damage to
the macula occurs rapidly. With wet AMD loss of central vision can
occure quickly , wet AMD is also known as advance AMD. Early
symptoms of wet AMD is that straight line appear wavy, over all 10
% of AMD pa ent have wet form of AMD. Visual loss in wet or
exuda ve ARMDisaconsequenceof:
· Presenceofexuda onunderthe re na.
· Presence of membrane with or without development of scare
ssuecausing distor on anddamageofthephotoreceptors.
· Presence of sub re nal blood, which again causes direct
damagetophotoreceptors.
90%ofvisuallossincasesofAMDisbecauseofwetformofdisease.

16
A drug called verteporfin is injected into the arm and it travels
throughout the body,including the new blood vessels in the eye.
Thedrugtendsto“S ck”tothesurfaceofnewbloodvessels.Next,a
light is shined into the eye for about 90 seconds. The light ac vates
the drug.The ac vated drug destroys the new blood vessals and
leadstoaslowerratrofvisiondecline.
Unlike laser surgery ,this drug dose not destroy surrounding healthy
ssue. Because the drug is ac vated bylight, it is necessary to avoid
exposing the skin or eye to direct sun light or bright indoor light for
five days a er treatment. Photodynamic therapy is rela vely
painless. It takes about 20 minutes. PDT slows the rate of vision loss.
It does not stop vision loss or restore vision in eye already damaged
by advanced AMD . treatment result o en are temporary . Pa ent
mayneedtobetreatedagain.
Transpupillary Thermotherapy (TTT)
It is a technique by which heat is delivered to the choriid and Re na
pigment epithelium using a diode laser at 810nm. The goal in using
technique for treatment of choroidal neovascularisa on is to
achieve occlusion of the neovascularisa on without damage to
other cells. Heat penetra on is op mised by exposure me, beam
diameterandwavelength.
SubmacularSurgery
A er complete pars plana Vitrectomy CNVM is removed form
subre nal space by making re notomy temporal to fovea (usually)
and inducing localised re nal detachment. Fluid air exchange is
performed at the end of surgery and gas tamponade is given. Sub
re nal trials concluded that there is no reason to prefer submacular
surgerytolasephotocoagula on.
MacularTransloca onSurgery
Itisusedinthemanagementofpa entswithsubfovealCNV.Theaim
of surgery is to relocate the central neurosensory re na
(Fovea)away form CNV,to an area of healthier RPE, Bruch's
membrane and choroid. This is s ll an experimental method of
treatment.β
An oxidantsAndTraceMinerals
Age related eye disease study (AREDS 2) concludes that persons
more than 55 years with extensive intermediate size drusens, at
least one large drusen, non central geographical atrophy in one or
both eyes or advanced AMD or loss of vision due to AMD in oneyear
shouldbeconsideredforsupplementa on.
The study recommends vit. C-500mg, Vit E-400 IU, Leu n 10mg,
Zeaxanthin2mg,ZincOxide25mg,Cupric Oxide-2mg.
An vascularEndotheliumGrowthFactor(An VEGF)
Wet AMD can now be treated with new drugs that are injected into
theeye(an VEGFtherapy).
Abnormallyhightlevelsofaspecificgrowthfactoroccurineyeswith
wet AMD and promote the growth of abnormal new blood vessels.
Thisdrugtreatmentblockstheeffectsofthegrowthfactor.
One will need mul ple injec ons that may be given as o en as
monthly. The eye is numbed before each injec on. A er the
injec on the eye will be monitored. This drug treatment can help
slowdownvisionlossformAMDandinsomecasesimprovesight.
During an eye examina on one may be asked to look at Amsler grid.
The pa ern of the grid resembles a checkerboard.The person being
examined will cover one eye and stare at a black dot in the centre of
the grid. While staring at the dot one may no ce that the straight
lines in the pa ern appear wavy or one may no ce that some of the
linesaremissing–thesemaybesignsofAMD.
In case of wet AMD fundus fluorescein angiography is must. Classic
CNVM presents as discrete,early hyperfluorescence with leakage of
dye in the overlying neurosensory re nal detachment. A lacy
pa ern within the CNVM is most o en not observed in exuda ve
AMD.
OccltCNVMare,categorisedinto2
Basic forms,late leakage of undetermined source and fibrovascular
PEDs.
Indocyaninegreenangiography(ICG)
ICG facilitates the study of the choroidal circula on by be er
delinea on of the choroidal circula on than fluoresce in
angiography.Unlike fluorescein, ICG is stongly bound to plasma
proteins,which prevents diffusion of the compound through the
fenestrated choroidal capillaries and permits be er delinea on of
choroidal details. ICG can facilitate visualisa on of choroidal
vasculatureandCNVMthroughhaemorrhage.
ICG angiogram can show CNVM as localised hot spots or as diffuse
hyperfluorescent plaques.ICG could be er reveal the occult CNVM
withICGangiography.
Op calCoherenceTomogram(OCT)
Precise anatomical loca on of the CNVM is possible with OCT. It is
possible to localise whether it is sub RPE (type-1)or
subneurosensoryre na(type-2)
Drusen may appear as areas of focal eleva ons of RPE with shallow
borders and no op cal shadowing,underneath subre nal
haemorrhage when present,appear as hyperreflec ve with ill
definedborders.
TreatmentOp onsForArmd
· ArgonKryptonLaserPhoto-coagula on.
· Photodynamictherapy(PDT)
· Transpupillary Thermotherapy(TTT)
· SubmacularSurgery.
· MacularTransloca onSurgery.
· An oxidants&TraceMinerals.
· An angiogenicTherapy
· OralThalidomideandinterferonalpha.genetherapy
· Useofelectronicchipimplants.
LaserPhotocoagula on
This procedure uses a laser to destroy the fragile,leaky blood
vessels. A high energy beam of light is aimed directy onto the new
bloodvesselsanddestroysthem,preven ngfurtherlossofvision
The risk of blood vessels developing a er laster treatment is
high.Repeated treatments maybe necessary. In some cases vision
lossmayprogressdepiterepeated treatments.
PhotodynamicTherapy(PDT)
Pa ents with classic subfoveal or juxtafoveal CNVM should be
treatedwithPDTasarule.

17
Surgical treatment: Surgery is advocated if laser or cryotherapy is
unsuccessful in preven ng progression to stage 4 or 5. Surgical
op onsavailableare
Forstage4Aor4B
a. Scleralbuckling
b. Lenssparingvitrectomy
(Note: Vascularly inac ve and stable 4A ROP can only be
observed)
Forstage5:
c. Lensectomy+vitrectomy
d. Openskyvitrectomy
ROP management doesn't end with laser or surgery. Once treated,
lifelong follow up (yearly) is mandatory. All other premature infants
irrespec ve of having ROP yearly follow up ll the age of 5 years is
advisable to rule out refrac ve errors (most common), squint and
amblyopia(lazyeye).
Roleofan -vascularendothelialgrowthfactor(VEGF)injec onsin
ROP:
It is very controversial, as VEGF is also needed for normal
vasculariza on of the re na to be completed. Thus an VEGF
injec ons may stop growth of not only abnormal new vessels but
also of the normal ones. Systemic absorp on of these drugs may
cause vascular development delay in other developing organs. Thus
currently an -VEGF injec ons are used in ROP only when the
standard treatment (which is laser) fails and the disease progresses.
Itisnotrecommendedasthefirstlineoftreatment.
Development of polyp in the nose is a
common problem. Polyps are developed
due to infec on of the mucous membrane
of nose .These polyps can be of yellow or
browncolor.
CAUSE :- Polyps in the nose can develop
due to different reasons .Polyps can
develop due to infec on, due to sinus
problem,asthma,allergiesduetofungusor
pollens, cys c fibrosis and gene c reasons.
Polyps can also develop due to analgesic
drugslikeaspirinandibuprofen.
SYMPTOMS:-Thesearethefollowingsymptomsofnosepolyps.
1) Sensa onthatyournoseisblocked.
2) Runnynose.
3) Nasalconges on.
4) Reducedsenseofsmell.
5) Afeelingofpressureinyourforeheadorface.
6) Nasalstuffiness.
7) Breathingthroughmouth.
8) Usingofpusorbloodinsideoroutside.
TREATMENT:-Thesearethefollowingtreatmentofnosepolyps.
1)SURGERY:- Surgeryisdonebyendoscopy.
Endoscopy leads to less bleeding,pain and be er pa ent recovery
ascomparedtoconven onalsurgery.
2) MODERN TREATMENT :- With laser or micro-debrider surgery is
more precise. In problem related to fungal infec on, polyps can
developagainevena ersuccessfulsurgery.
3) IMMUNOTHERAPY :- By diagnosing allergies and vaccina ng
against it. Vaccina on can be given through oral route also. In few
cases, this problem can be life threatening, therefore ENT doctor
shouldbeconsultedimmediately.
In normal condi on there is no bleeding through nose but if there is
bleedingthroughnose,itcanbecancer.
Tumours of nose like papillama, nasopharyngeal fibroma looks like
polyps in children and adults. These can be life threatening .The
maintreatmentofpolypissteroidswhichcanbegiventhroughnose
or mouth.To control infec on an bio cs are given. On basis of
symptomsan -histaminicdrugsalsoused.
Dr. Ajay Shukla
MS ENT
TB Sapru Hospital
Allahabad
A Clinically proven formula for
ARMD & Diabe c Re nopathy
Do Not Take The Problem of Nose Lightly

18
Remedies from Granny’s Kitchen
Note: Mail the correct answers at optho mes@opthoremedies.com / pmt@opthoremedies.com
Winners will be rewarded in the next issue.
CROSSWORD
Volume 6 Quiz:
Ram Asray Yadav
MR (Varanasi)
Volume 5 Quiz Winners Optho Times Vol. 5 Quiz Answers:
Quiz
Q-1. Name the receptor involved in corneal
re-epiltheliza on.
Q-2. Name the process of sodium hyaluronate synthesis
used in the produc on of HY-5.
Q-3. _____Is indicated for SAR/PAR.
Q-4. What is the Osmolarity of HY-5 Eye drop.
Q-5. Normal osmolarity of tear film should be less_____ than.
Q-6. Flurocart is deacetylated to convert it into ac ve form
cold_____.
Q-7. Offers________ mes higher concentra on than
Acyclovir.
Q-8. Omega 3 fa y acid is recommended over which level
in dry eye condi on.
Q-9. How many mes of hydra on is offered by sodium
hyaluronate.
Q-10. DFB (Difluroprednisolone Butyrate) is converted into
inac ve form.
*Search for the suitable answers from the given grid of cross word puzzle,
Horizontally & Ver cally.
D
B
G
H
T
I
F
A
X
B
H
V
D
O
Z
J
B
O
A
M
T
U
D
G
F
P
I
N
I
E
Y
E
8
C
C
S
M
4
D
C
C
F
G
E
L
R
F
A
X
A
M
1
D
V
Z
T
4
E
E
A
B
Y
F
N
N
F
C
H
M
I
0
E
G
3
E
D
I
U
C
O
N
N
U
C
T
L
V
I
T
I
S
F
E
O
M
N
1
O
C
I
S
T
J
G
U
T
I
L
B
L
H
E
X
B
R
4
M
O
T
1
M
R
H
S
X
D
L
B
E
F
H
I
U
H
9
A
C
O
2
N
E
A
L
E
F
E
M
V
S
C
6
O
C
U
L
A
R
0
Y
P
E
R
T
B
N
T
E
O
N
0
G
K
F
S
B
6
V
V
Z
3
V
N
V
R
A
L
V
D
0
H
F
S
H
L
E
H
V
M
1
C
C
K
T
6
2
H
V
3
O
F
A
X
A
J
N
A
C
2
6
A
H
3
X
V
Z
V
6
C
A
B
D
C
D
R
Y
E
Y
E
R
J
D
5
J
V
X
L
We Value Your Feedback
Ravi Pharmaceu cals
Distributor
(Ludhiana)
1. Hyperosmolarity
2. Re-Epitheliza on
3. High
4. Osmoprotectant
5. L Carni ne & Erythritol
6. Lubrica on
Marvellous
Commendable
Outstanding
We have only three words to say
In Short it
xkxj esa lkxj

19
Doctor’s Birthday & Marriage Anniversary Celebration
Across the Nation

20
Pioneers In Ophthalmology
Georg Bar sch (1535–1607) was a German physician, was born in 1535 in Königsbrück, a village near Dresden,
Germany. At the age of thirteen he began his medical career as an appren ce to a barber surgeon, and for a
considerable por on of his life Bar sch was an i nerant surgeon who plied his trade throughout Saxony, Silesia,
and Bohemia. He eventually se led down in Dresden, and in 1588 became court oculist to Duke Augustus I of
Saxony.
Although Bar sch was not academically trained, he was considered a highly skilled prac oner of ocular medicine
and surgery. He is credited for producing the first Renaissance manuscript on ophthalmic disorders and eye
surgery,"OphthalmodouleiaDasistAugendienst".Itwaspublishedin1583,anddiscussedoculardiseases,surgical
techniques and instruments, and contained an ophthalmic atlas of 92 woodcuts depic ng diseases of the eye.
Bar sch is called as the father of Ophthalmology for his contribu on. Despite his skill as a surgeon, Bar sch was a
supers ousindividual,ashebelievedthatmagic,astrologyandwitchcra playedasignificantpartinmedicine.
Father of Ophthalmology
Jacques Daviel 11 August 1696 – 30 September 1762 was a French ophthalmologist credited with origina ng the
first significant advance in cataract surgery since couching was invented in ancient India. Daviel performed the first
extracapsularcataractextrac ononApril8,1747.
Daviel earned his medical degree from the Medical School of Rouen, prac ced in Marseille where he was affiliated
with the medical school there, then restricted his prac ce to ophthalmology in 1728. He was on the staff of
Hospitald'InvalidesandbecameoculisttoLouisXV.
In March 1756 he was elected a Fellow of the Royal Society In 1759, He was elected a foreign member of the Royal
SwedishAcademyofSciences.
Davieldiedofapoplexyin1762whileonatriptoGeneva,Switzerland.
Father Of Modern Cataract
Surgery
Diwali Celebration at Head Ofce

21
Interna onal Journal of Pharmaceu cal and Medicinal Research
Original Research Ar cle
To evaluate the efficacy of Gritakumari (Aloe Vera Gel) in the management of Shushkakshipaka (Dry Eye Syndrome)
Sakshi Kanaujia1*, Vishwanath2, Shamsa Fiaz1
1
Post Graduate, Department of Shalakya Tantra, Na onal Ins tute of Ayurveda, Jaipur, India
2
Post Graduate,, P.G Department of Shalakya Tantra, Rishikul Government Ayurvedic College, Haridwar, India
ABSTRACT
Background: The tear film is fundamental of the maintenance of the ocular surface. Deficiency in tear quan ty or quality, which can be caused
by low tear produc on or excessive tear evapora on, results in an unstable tear film and dry eye syndrome (DES). Dry eye syndrome is
characterized by symptoms of ocular dryness and discomfort. It is a disease of deficient or deranged tears and ocular surface disorder
producing symptoms of discomfort, visual disturbance and tear film instability. Shushkakshipaka, an etymologically and clinically similar en ty
to DES, is defined in Ayurveda as the disease affec ng all parts of the eye characterized by Paka (inflamma on) due to Shuskatva (dryness)
caused by altered coherence of Ashru(tears) with ocular surface or due to lack of Ashru. Objec ve: To compare the effect of Gritakumari
(Aloevera gel) and ar ficial tear drops Carboxy methyl cellulose [CMC 0.5%] in the management of Shushkakshipaka (dry eye syndrome).
Design: Randomized prospec ve clinical control trial. Material and methods: Pa ents were divided into two groups 18 in group A (trial group)
and !7 in group B (control group).Group A was treated with Aloevera gel and group B treated with ar ficial tear drops 4 mes a day for one
month.Results:TheeffectofAloeveragelwasfoundtobeequivalenttoCMC1%.Conclusion:Gritakumari(Aloeveragel)canbeusedaspotent,
safeandcosteffec vetreatmenttoamelioratethesymptomsofDES.
1.Introduc on
Dry eye is one of the most frequently encountered ocularb
morbidi es, a growing public health problem and one of the most
common condi ons seen by eye care prac oners[1]. In the light of
new knowledge about the role of ocular surface inflamma on and
tear hyperosmolarity in dry eye and the effects of dry eye on visual
func on, the Interna onal Dry Eye Workshop (DEWS) defined dry
eye as a “Mul factorial disease of the tears and ocular surface that
results in symptoms of discomfort, visual disturbance, and tear film
instability with poten al damage to the ocular surface. It is
accompanied by increased osmolarity of the tear film and
inflamma onoftheocularsurface”[2].
Dry eye can be classified into two types, evapora ve (tear
sufficient), and tear deficient. In tear deficient dry eyes, there is
disorder of lacrimal gland to secrete or transfer fluid to the
conjunc val sac. In tear sufficient (evapora ve) dry eyes, there is
increasedevapora onoftearfluidfromtheocularsurface.Indry
eye syndrome, pa ent complaints various type of symptoms like
dryness, soreness, burning sensa on, foreign body sensa on,
itching and there may be intermi ent blurring vision[2]. Evalua on
of dry eye is determined with various symptoms ques onnaires and
clinical test[3,4]. The conven onal approach to the treatment of dry
eye is to provide lubrica ng eye drops or tear subs tute. Topical
an inflammatory as well as immunosuppressant cor costeroids
and cyclosporine A, may be useful in dry eye associated with
inflammatory ocular surface disease such as keratoconjunc vi s
sicca, Sjogren’s syndrome. Despite a number of researches being
carried out, no cura ve treatment for DES has been achieved. Only
pallia ve measures in the form of tear replacement therapy with a
variety of ar ficial tear solu ons are available which are to be used
for lifelong by the pa ents, further burdening them financially.
Pallia ve measures also fail to alleviate the symptoms later on due
to preserva ve induced damage to the epithelial lining and basic
secretors.
Corresponding Author: Sakshi Kanaujia, Post Graduate, Department of Shalakya Tantra, Na onal Ins tute of Ayurveda, Jaipur, India; Email:
sakshi.kanaujia@gmail.com
Aloe Vera Gel – A Promising Therapy For Dry Eye
Current available treatments for the dry eye are not fully effec ve because they do not induce re-epitheliza on of the cornea and repairing of
the physiology of the eye. In this cases is common the use of cor costeroids to decrease inflamma on, thus impairing local immunity. This
situa on facilitates the onset of opportunis c and chronic infec ons. The persistent irrita on caused because the fail in lubrica on between
theeyes'lidandtheeyesurfacemayalsotriggerHerpesvirus(HSV)recurrence.
The Aloe Vera gel has proved effec ve in the treatment on internal and external wounds because of its following proper es: analgesic, an -
inflammatory, aids in cell penetra on of source compounds, s mulates fibroblasts to produce collagen and proteoglycanes as to build new
ssueintheaffectedarea,regeneratesepithelium,increasesimmunity,causesnocollateraleffectsandisnontoxic.
The above men oned proper es of the Aloe Vera gel are very valuable in ophthalmology because of the lack of an effec ve treatment for the
following different pathologies: dry eye, viral keratoconjun vi es, corneal ulcers, kera s, alkaline or acid burns, recurrent corneal ulcers.
Aloe Vera gel eye drops is recommended in all this pathologies, because of the repairing proper es of the Aloe Vera, the rapid response of the
pa ent (decrease pain and inflamma on), because it has no collateral effects, it is easy to administer, it is inexpensive, and the treatment
involveslessfrequentapplica onsthanothertherapies.

22
Int. J. Pharm. Med. Res. 2015; 3(6):276-280
Chart No.1: Demographic detail has shown by graph Chart No. 2: Demographic detail has shown by graph
Shushkakshipaka, an etymologically similar en ty, has been
described in Ayurvedic texts whose e o-pathogenesis and clinical
features of dryness and inflamma on of the ocular surface
remarkably correlates with that of DES. Shushkakshipaka is a
SarvagataRoga,thatis,diseaseaffec ngallpartsoftheeye;aVataja
or Vata-Pi aja/Vata-Raktaja curable disease[5]. While
thedescrip on in Sushruta demarcates the early stage, Vagbha a
gives details of a fully-fledged picture including Paka (inflammatory)
stage of the disease[6-8]. Ayurvedic texts enlist a number of
treatment modali es for treatment of the disease, including both
localized and systemic measures. In view of the magnitude of the
problem,thiscasestudywas
undertaken to achieve cost-effec ve treatment modali es of
Ayurvedaintrea ngthischronicailment.
In the present clinical study, an a empt was made to observe the
role of Ghritakimari (Aloe Vera gel) in dry eye syndrome. Aloe vera
has wide spectrum of therapeu c and medicinal proper es. The gel
has lubrica ng[9], wound healing[10] and an -inflammatory
proper es[11], as researched in previous studies, this clinical study
was planned to evaluate the effect of Ghritakumari gel (Aloe vera
gel)ascomparedtotheCMC1%inclinicalparametersofdryeye.
2.MaterialsandMethods
Design:Randomizedprospec veclinicalcontroltrial.
Selec onofpa ents
Pa entswereselectedfromtheShalakyaTantra(Netraroga)
OutPa entDepartmentoftheNa onalIns tuteofAyurveda,
Jaipur.
Inclusioncriteria
•Pa entsbetweentheagegroupof30to70years.
•Pa entshavingclinicalfeatureswithdryeyeand
thosemen onedShushkakshipakawillbeincluded.
ExclusionCriteria
Pa entswithhistoryofoculartrauma.
·Pa entswithocularsurgerypriortothree
monthofstudy.
·Pa entswithvisualmediadisorderorany
otherdegenera vedisorderofeye.
·Pa entssufferingfromany
systemic/metabolicdisorder.
GroupingandDosing
GroupA
In Trial group 18 pa ents was treated with drops of Aloe vera gel
topically4 mesperdayfor28days.
GroupB
In Control group 17 pa ents was treated with 1% ophthalmic
solu on of Carboxy methyl cellulose topically 4 mes per day for 28
days.
Prepara onoffreshGhritakumarigel
Fresh gel of Ghrita kumari was extracted from Ghrita kumari leaf
before applica on in the eye. Leaf was washed, dried well and gel
was collected by giving an incision on leaf surface. Deep seated pulp
wasdirectlyappliedtotheeyeaseyedrops.
Assessmentcriteria
Subjec vecriteria
Rukshata( dryness), Kunita (shrunken), Darunata (hardness) , Aavila
darshan (blurring of vision), Karacho unmilna (difficulty in opening
andclosingofeye),Gharsha(foreignbodysensa on),Toda(s nging
pain),Bheda(tearingpain)andUpdeha(s ckingofeye).
Objec vecriteria
Schirmer’s-Itest
Tearfilmbreakup me
Assessmentcriteria
Grading and scoring system was adopted for assessing each clinical
feature before the commencement of trial and a er the comple on
ofthetrial.
Observa on

23
Results
Group A Group B
55.52%
50.00%
33.33%
28.57%
38.53%
29.22%
45%
42.10%
50%
41.67%
54.00%
42.30%
38.34%
33.33%
rukshta kunita daruna aavila
darshan
garsha updehakaracho
unmilna
Group A Group B
61.25% 65.00%
33.33%
38.57%
TFBUTschirmer's
tear test
Chart No. 3: Effect of Aloe vera gel (Group A) and ar ficial
tear drop (Group B) in subjec ve parameter
Chart No.4: Effect of Aloe vera gel (Group A) and ar ficial
tear drop (Group B) in objec ve parameter
Table No. 1: Compara ve effect of both groups on clinical symptoms
Symptom Group N Mean score %
BT-AT=D Relief
SD ± SE ± ‘t’ ‘p’ M.W ‘P’
RUKSHTA
KUNITA
DARUNA
AAVILA DARSHAN
KARACHO UNMILNA
GARSHA
TODA
UPDEHA
A
B
A
B
A
B
A
B
A
B
A
B
16
16
4
5
4
4
16
13
11
09
17
16
3
0
8
11
1.05
0.470
0.5
0.4
1.25
0.75
1
0.615
0.9
0.55
1.11
0.65
0.65
O.00
0.875
0.454
65.52
50
33.33
28.57
58.53
29.22
63.62
42.10
69.24
41.67
74.07
42.30
33.33
00
58.34
33.33
0.539
0.514
0.577
0.54
0.5
0.5
0.554
0.615
0.31
0.52
0.68
0.49
0.58
0.77
0.353
0.522
0.127
0.124
0.288
0.244
0.56
0.25
0.148
0.140
0.1
0.17
0.15
0.11
0.33
0.34
0.125
0.157
3.8
0.26
1.4
2.012
1.88
2.33
0.70
1.96
0.0006
0.7980
0.2070
0.0543
0.0756
0.0271
0.5185
0.0659
53.5
9
4.5
69
32
86
3
25
<0.001
>0.05
>0.05
>0.05
>0.05
<0.05
>0.05
>0.05
Table No. 2: Compara ve effect of both groups on objec ve parameters
Symptom Group Eye N Mean score %
BT-AT=D Relief
SD ± SE ± ‘t’ ‘p’ M.W ‘P’
Schimer’s Tear Test
TFBUT
RE
LE
RE
LE
A
B
A
B
A
B
A
B
11
13
11
12
14
13
11
12
0.81
0.69
0.90
0.384
0.857
0.76
0.50
0.53
50
50
55.55
27.78
66.7
73.72
38.89
35
0.40
0.048
0.539
0.50
0.66
0.66
0.513
0.518
0.127
0.133
0.162
0.140
0.177
0.201
0.138
0.143
0.45
1.385
1.649
2.083
0.6595
0.1794
0.1127
0.0486
56
56
52
48
>0.05
>0.05
>0.05
>0.05
3.Discussion
There is ample descrip on of Sushkakshipaka in Ayurvedic
literature. It has been described as a Vata or Vata-Pi aja eye
disorder affec ng all parts of the eye which is curable by
medical means. It is clear from the etymological deriva on of
the Sushkakhipaka that the disease can occur in two ways,
viz., either by absent or decreased secre on of tears or their
altered coherence with the ocular surface resul ng in paka
(inflamma on) of the Netra. Similar classifica on of dry eye in two
broad categories of tear deficient and tear sufficient dry eye is in
vogueinmodernophthalmologicalliterature.
Whereas the abstrac on of tear is described vividly in modern,
literature,itisnotsointextsofAyurveda.ToascertaintheAyurvedic
concept of fluids which bathe the ocular surface, a thorough search
was done which yielded that though no structure was linked with
the forma on of Ashru in Ayurveda, the ancient sages knew the
importance of tear fluid very well and drainage pathway of lacrimal
system was known to them. It was concluded from the evidences
sca ered in Ayurvedic literature that Ashru is derived from the Rasa
Dhatu,anditsfunc onsinthe

24
eye is similar to that of Rasa Dhatu in the body. It restores the wear
and tear and provides nutri on to the outer tunics. It lubricates the
eye and keeps the eye wet[12]. A number of treatment
modali eshavebeendescribedinAyurvedaforthemanagementof
Sushkakshipaka. It not only includes localized measures, but also
systemic use of drugs has also been indicated. This variety of
treatment modali es points toward the diverse pathology of the
disease.
Clinicalprofile
Majority of the pa ents were in the age group of 51–60 years which
indicates decrease in tear produc on with age. Majority of pa ents
were female of postmenopausal age reflec ng toward the role of
hormonal changes in the causa on of DES. Most of the pa ents
registered in this study were Hindu of urban habitat signifying
predominance of this community in the area where the trial was
conducted. Most of the pa ents were having Vata-Pi aja Prakri
and as the disease is Vata-Pi a domina ng, the person with similar
Prakri is more prone to develop this disease. Thus, the disease was
achallengetotreatduetothesimilarityinKala(agegroupaffected),
Prakri (Vata-Pi aja Prakri of the pa ents) and Dosha (Vata-Pi aja
disease)besidesbeingofDvidoshajanature[13].Maximumnumber
of pa ents had Madhyam Dehabala. It can be ascribed to the age
(middle age) group affected by this disease in which Pi a and Vata
showtheirpredominancerespec vely.
Probableac onofdrug(aloeveragel)
Aloe vera has a wide spectrum of therapeu c and medicinal
proper es. The therapeu c uses of Aloe vera have been men oned
in ancient texts like Bhavprakash Nigantu[14] Kaiydeva Nigantu[15],
Sharangadhar Samita[16]. The herb ( Aloe vera) proposed in the
clinical study has been used for various disease like Vrana, Kustha,
Gulma, Pliharoga, Yakritvridhi, Kaphaja jwara, Granthi, Agnidagdha,
Vishaphota,Pita- rakta vikar, Chuddraroga etc. Various experimental
as well as clinical studies suggest the role of Aloe vera in the
management of Dry eye[09], inflamma on[17] and skin
disorder[18] etc. considering these factors this drug had been
selectedforassessingitssymptomsfordryeye.
Group A (Trial group) has shown significantly be er results in the
chief complaints like Ruksta, karachounmilna, Garsha and in tear
quan ty tests (Schirmer tear test ), Tear film stability test(Tear film
break up me) than group B(control group). In rest of signs and
symptomstrialdrugwasalmostequallyeffec vetocontrolgroup.
4.Conclusion
The effect of Ayurvedic treatment was found to be equivalent
to standard therapy of tear supplementa on (CMC eye
drops), although Aloe vera gel provided more relief in certain
symptoms like, rukshata and krachounmilna etc., ThisAyurvedic
management can be used as a potent, safe and cost-effec ve
treatment to ameliorate the symptoms of DES. This is a very small
sampleand shortdura on study,soitissuggestedthatlargesample
and long dura on studies should be conducted, with Aloe vera gel.
This study is an eye opener for future research scholars to study the
efficacy of Aloe vera gel in the management of disease
S h u s h k a k s h i p a k a - D r y e y e o n l a r g e s c a l e .
References
[1]. O’Brien PD., Collum LM. Dry eye: Diagnosis and current
treatment strategies, Current Allergy and Asthma Reports
2004;4:314–9.
[2]. Michael AL., Christophe B., Jules B, Murat D., Gary NF., Shigeru
Ket al., The defini on and classifica on of dry eye, Report of
the Defini on and Classifica on Subcommi ee of the
Interna onalDryEyeWorkShop2007;5(2):75-92.
[3]. Schein OD., Teilsch IM., Rela on between signs and symptoms
of dry eye in elderly, American Journal of Ophthalmology
1997;104:1395-1401.
[4]. Mc Monnies CW., Pa ent history in screening for dry eye
condi ons, Journal of the American Optometric Associa on,
1987;58:296.
[5]. Vaidya JTA.: Sushruta Samhita U ar Tantra; Sarvagataroga
Vijananiyopakrama Adhyaya: Varanasi: Chaukhambha
Orientalia,9thed.,Chapter6verse26,2007;605.
[6]. Shivprasad Sharma. Ashtanga Samgraha of Vriddha Vagbhata
U ar Sthana; Sarvaakshiroga Vijnaniya Adhyaya: 1st ed.,
Chapter 18, verse 16-17, Varanasi: Chowkhamba Sanskrit
SeriesOffice,2006;718.
[7]. Pandit HP.: Ashtanga Hridaya of Vagbhata U ar Sthan;
Sarvaakshiroga Vijnaniya Adhyaya; Varanasi: 1st ed., Chapter
15,verse16-17,ChaukhambaKrishnadasAcademy,2006;829.
[8]. Vaidya JTA.: Sushruta Samhita U ar Tantra; Vata - Abhishyanda
Pra shedhopakrama Adhyaya: 9th ed., Chapter 9, verse 22,
Varanasi:ChaukhambhaOrientalia,2007;612.
[9]. Nuria EAC., de de la Pena., Patent on use of Aloe vera
ophthalmic solu on for treatment of the dry eye syndrome,
inflamma ons, ulcera ons, alkaline or acid burns, infec ons,
andcataracts,Patentno.US6013259A,11Jan2000.
[10]. Tizard I., Busbee D., Maxwell B., K. Mc., Effect of Acemannan, a
complex carbohydrate, on wound healing in young and aged
rats,Wounds1994;6:201-209.
[11]. Klein A. et.al., Aloe Vera, Journal of the American Academy of
Dermatology1998;18:714-720.
[12]. Vaidya JT.: Sushruta Samhita, Sootra Sthana; Dosha- Dhatu-
MalaKshaya-VriddhiVijnaniyaAdhyaya:9thed., Chapter15,
V e r s e 1 , V a r a n a s i : C h a u k h a m b h a O r i e n t a l i a ,
2007;67.
[13]. Va i d ya J T. : C h a ra ka S a m h i ta o f A g n i ve s h a , C h a ra ka ,
Dridhabala, Sutra Sthana, Mahachatushpada Adhyaya: 9th
e d . , C h a p t e r 1 0 , Ve r s e 1 4 - 1 6 ,Va r a n a s i : C h a u k h a m b a
Orientalia,2011;66.
[14]. BhavaPN.:Guduchiyadivarg,
Edi on-2005, Shl.No.229-230,
ChaukhambaBhar Academy,
pageno-419,,
[15]. Kaiyadev N.: Oshadhi varg, 2th
e d . , S h l . N o . 1 6 3 8 - 1 6 4 0 ,
V a r a n a s i : C h a u k h a m b a
Orientalia,2006;648.
[16]. Sharangdhar Samhita, Madhyam
Khand, Chapter- 62 verse
42-48, Varanasi: Chaukhamba
Vidyabhavan,2002.
[17]. Udupa SI., Udupa AL., Kulkarni DR.,
A n i n fl a m m a t o r y a n d
wound healing proper es of Aloe
v e r a , F i t o t e r a p i a 1 9 9 4 ,
65:141145.
[18]. Feily A., Namazi MR., Aloe vera in
d e r m a t o l o g y : A b r i e f
r e v i e w, G i o r n a l e I t a l i a n o
Dermatologia Venereologia
2009;144:85–91.

Accelerating Growth Meet 2016 at Head Ofce
Mee ngs are a part of pharma marke ng industry. We have recently concluded the half yearly sales review mee ng. But in todays scenario
sales mee ngs are becoming a rou ne thing and losing the importance and value it used to enjoy a decade back. The ques on that arises here
is,mee ngshasjustbecomearepe onofthe samewhatisknowntothesalesstaff.90%ofthemee ngfailtoconcludewithconclusion that
gives confidence to the sales personnel to reform the and cover the shortcoming. Mee ngs have just taken the shape of Q & A round over
sales figure . The best outcome of sales mee ng can only be achieved if it leads with self realiza on and mo va on. Recently concluded
mee ng “Accelera ngGrowth”wascentralizedontheveryaspect,coreofsalesliesinthepassionthatresidesintheheartofsalespersonnel.
Accelera ng growth meet was focused to release its plan to accelerate its growth for futuris c goals in realis c approach. Under Shri RK
Agarwal Memorial Award our employee assets Mr. SD Mishra & Mr. HL Tripathi have been honored for their outstanding contribu on which
makesthemtheemployeeassets.
S. D. Mishra Ji
Our Employees- “The Most Valuable Assets”
Mr.S.D.MishraJiisoneofourmostsenioremployeeatOpthoRemediesPvt.Ltd.Hehasseentheeraofmantomachinein
thecompanyandhasalsoseencompanyexpandingfrom3-4headquarterstoitsPanIndiapresence.
HeisinOpthoFamilysincelast21yearsi.e.fromFebruary'1995.Hetrulybelievesthat“Ifyouthinkyouaretoobigforsmall
jobs then maybe you're too small for big jobs”, this is the secret of his success. He started his journey as office assistant as
anofficeassistantandgotpromotedasmanagerclaims.HeisnowoneofthepreciousratnasofOpthoRemedies.
WhilesharinghismemorieswithusheexpressedthathefeelsreallyblessedbeingthepartofIndiancompanywhereeven
in this era we do holy rituals and he is an ac ve par cipate in all religions func ons . This is how the roots are nourished by
thefoundersofthecompany,sothatthestormcan'tdefeatourFamilytreeandisthereasonwhywereferourcompanyas
ourfamily.
25
Interviewed by
Jagrity (HR Manager)

26
Mr. Amit Kothari
Abhinandan Medical Agencies (Indore)
Mr. Pradeep Rastogi
Amar Pharmaceu cal (Kashipur)
An Interactive Session with
Associates
Q.1:Howdidyourjourneyasadistributorstart?
I started my Pharma business in late 1998.This was the year when
IgotassociatedwithOpthoRemediesPvt.Ltd.
Q.2:Sharewithussomeexperiencefromyourgrowingyears?
Our associa on with Optho Remedies since beginning is build on
core values like trust, respect and adherence to best standards of
professional ethics. Optho Remedies has grown from a small
companytoamajorplayerinophthalmicsegment.
Q.3:HowdidyourjourneywithOpthostart?
We started our journey with Optho Remedies in late 1998 and
since then Optho Remedies has been our valuable partner in
providing world-class medicine at very economical rates to the
public.
Q.4:Howisyourrela onshipwithcompany'sDirector/NSM?
We share a good rela onship with Mr. Rajesh Agarwal and Mr.
RakeshAgarwal.
Q.5:NameourmanagerwhointroducedyoutoOptho?
It's a long associa on, so not very sure about the person who
introducedustoOpthoRemedies.
Q. 6: Any special memory a ached with Optho you wish to
share?
In such a long tenure of rela onship, we have shared many good
moments. Especially results of 2 products are very good i.e. CCS
range and ZOLINE, even I personally use ZOLINE and my father is
usingCCS.
Q. 7: What does Optho do for its dealers that no other brand
does?
Optho Remedies provides a wide range of ophthalmic and ENT
products,withworld-classqualityataveryeconomicalrates.text
Lot of changes have taken place in the company in last 3 years
either its Claims/HR/Accounts or Store department interac on
become more frequent and easy which helps us to discuss solve
issuesinverylimited me.
Ques on 8: Is your family also involved in the business with
you?Ifyes,howdoestheyounggenera ontaketheassocia on
withOptho?
No,IamtheonlypersoninvolvedinthePharmabusiness.
Q.1:Howdidyourjourneyasadistributorstart?
Amarpharmaceu calwasstartedbymyfatherin1968.
Q.2:Sharewithussomeexperiencefromyourgrowingyears?
Our experience with Optho Remedies has been very good from
the beginning, our rela onship with company has evolved
through me and developed into a bond of mutual respect and
trustforeachother.
Q.3:HowdidyourjourneywithOpthostart?
We started our journey with Optho Remedies as a stockiest in
1980.With con nued support and good will in market both the
firms benefited and took a step further .We are associated with
the firm since 2003 as a distributor .We look forward for
con nuedassocia onandstrongerbondwiththefirm.
Q.4:Howisyourrela onshipwithcompany'sDirector/NSM?
Amicable, we share a good rela onship with Mr. Rajesh Agarwal,
Mr.RakeshAgarwal.
Q.5:NameourmanagerwhointroducedyoutoOptho?
I have been associated with Optho Remedies for long me, it
would be very difficult for me to tell the name of person, who
introduced me to the company as of now we are in touch with
greatteamleadbyMr.Dheeraj&Mr.RidimAgarwal.
Q. 6: Any special memory a ached with Optho you wish to
share?
In such long tenure of rela onship, we have shared many
wonderful moments together. There are many such memories
andtochooseoneisverydifficult.
Q. 7: What does Optho do for its dealers that no other brand
does?
Hassle free and great management in terms of addressing to the
problemsofdistributor.
Ques on 8: Is your family also involved in the business with
you?Ifyes,howdoestheyounggenera ontaketheassocia on
withOptho?
rd
Yes, we take proud sta ng that it's our 3 genera on is in
associa onwithOpthoRemedies.
Interviewed by
Mr. Ashish Upadhyay

Patron
Mr. Rajesh Agarwal & Mr. Rakesh Agarwal
Editor in Chief
Mrs. Anushri R. Agarwal
Team
Mr. D. K. Srivastava, Mr. Satyendra Verma
Mr. Ashish Upadhyay
Special Thanks to
Dr. Sudhir Singh / Dr. Rohit Agarwal / Dr. Arpit Airen/
Dr. Ajay Shukla
Our Team Spectrum
OPTHO REMEDIES P. LTD.
Head Oﬃce : 28, MNNIT, Industrial Estate, Teliarganj, Allahabad - 211004 Tel : +91-532-2545669
nd
Branch Oﬃce : 8A/37, 2 Floor, Channa Market, Karol Bagh, New Delhi - 110005
h ps://www.linkedin.com/company/optho-remedies-p-ltd| Log on : www.opthoremedies.com
We Care For Your Vision
Serving Humanity Since 1973
OPTHO
R
eAugentus Pharma
A Division of Optho Remedies (P) Ltd.
www.pharmaprints.com
Share your articles / views on
optho mes@opthoremedies.com
O-Outstanding P-People serving T-Towards H-Humanity with O-Optimism.
A Division of Optho Remedies (P) Ltd.

Exploring Maharashtra Market

Recommended

Recommended

More Related Content

What's hot

What's hot (9)

Viewers also liked

Viewers also liked (20)

Similar to Exploring Maharashtra Market

Similar to Exploring Maharashtra Market (20)

Exploring Maharashtra Market