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अखिल भारतीय आयुर्विज्ञान संस्थान, नई दिल्ली
All India Institute Of Medical Sciences, New Delhi

RPC-Unit-V

 

Oculoplasty, Ocular oncology, Strabismus & Neuro-ophthalmology  

FACULTY MEMBERS

S.No.

Name

Designation

1

Prof. M.S. Bajaj

Professor and Officer-In-Charge

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2

 Prof. Neelam Pushker

 

Professor of Ophthalmology

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3

Prof Rohit Saxena

Professor of Ophthalmology

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4

Dr. Rachna Meel

Additional Professor of Ophthalmology

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5

Dr. Amar Pujari

 

Assistant Professor of Ophthalmology

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Oculoplasty, Ocular oncology  

The Oculoplasty and Oncology Services of Unit 5 have pioneered several surgical techniques including ptosis correction via conjunctival route, novel eyelid reconstruction methods and socket reconstruction using cultivated amniotic membrane graft. The unit has also conducted noteworthy research activities including genetic studies on congenital eyelid anomalies, use of minimally invasive technique for canalicular obstruction, anti-metabolites in contracted socket and lacrimal drainage system, to name a few.  

The Unit provides state of art orbital, eyelid, lacrimal and ocular oncology care for cancers including orbital rhabdomyosarcoma, eyelid carcinomas, lacrimal gland adenoid cystic carcinomas, ocular surface malignancies, melanoma and retinoblastoma in coordination with paediatric, medical and radiation oncology teams of AIIMS. The unit is one of the few centres in the world to publish studies on sentinel lymph node biopsy in high-risk eyelid cancers which helps in better prognostication and treatment outcome. Both intramural and extramural research projects are ongoing in the field of clinical and molecular oncopathology. Tumour DNA sampling in retinoblastoma, molecular markers in retinoblastoma, ocular surface neoplasia, eyelid malignancies, lacrimal adenoid cystic carcinoma and ocular melanoma are some of basic research that is ongoing in close collaboration with ocular pathology team.  

The Unit provides Ophthalmic Plastic and Reconstructive Surgery for a wide variety of disorders including ptosis, congenital structural anomalies including use of expanders in congenital contracted socket, cosmetic blepharoplasty, eyelid retraction surgery, problems related to lacrimal drainage system, trauma-related orbital and periorbital deformities. Procedures such as orbital decompression surgeries, evisceration, enucleation, exenteration, placement of implant, botulinum toxin injections and scar revision surgeries etc are also routinely performed in the unit.  

During COVID-19 pandemic, the Oculoplasty Team was at the forefront in the management of cases with rhino-orbital mucormycosis during the epidemic of mucormycosis in the second wave of COVID-19 infection. We formed the AIIMS-RPC Guidelines for Early Detection and Prevention of Mucormycosis for the community and doctors which was also released by the press. In collaboration with Community Ophthalmology, we released the posters for awareness of patients and community mentioning the red flags for early detection and overall management and care of patients which included the follow-up advice also. Screening Guidelines were laid down by the Oculoplasty team and intensive screening for development of early signs of mucormycosis in indoor patients affected by COVID-19 infection on ventilator or any form of oxygen therapy with high-risk features was conducted by our team at various COVID wards in AIIMS for prompt treatment. Active participation of Faculty in Webinars on mucormycosis, including lectures, was conducted for teaching the residents on the early detection and treatment of mucormycosis. Studies related to impact of COVID-19 pandemic were initiated with the focus on the delayed presentations of mucormycosis and role of trans-cutaneous intra-orbital amphotericin B injections in early or recurrent cases of mucormycosis as a funded project. Psychosocial impact of destructive procedure, delayed presentations of cancer patients and change in pattern of orbital and periorbital infections during the COVID-19 pandemic are some of the ongoing studies. We have an active ongoing collaboration with the basic sciences on various projects related to mucormycosis.  

Over the past few years, in the field of Oculoplasty, there has been a paradigm shift from invasive surgery to non-surgical and minimally invasive therapeutic procedures with aesthetically pleasing and promising results. Some of the important ongoing studies in line with this concept are - nonsurgical management of peri-orbital veno-lymphatic malformation by intralesional sclerotherapy, role of oral sildenafil, topical medication for ptosis & pyogenic granuloma, abdominal fat transfer for the correction of cicatricial ectropion, use of botulinum toxin in thyroid eye disease and sutureless technique in skin grafting procedure. Some pioneering studies that are under publication are on single-stage surgery for eyelid reconstruction procedure, novel approach for protection of ocular surface in severe burn or trauma cases, ocular surface reconstruction using collagen matrix in patients with ocular surface chemical burns etc.  

More recently we have worked on role of biomarkers in fungal infection, use of fat graft in orbital volume augmentation, intralesional sclerotherapy in periocular and adnexal veno-lymphatic malformation, innovations in ptosis surgery, antimetabolites in contracted socket, intravitreal chemotherapy in retinoblastoma, orbital implants in enucleated socket, etc and published some of these studies in eminent journals.  

The unit has been at the forefront of ocular cancer research, including clinical trials into new and better treatments. Publications in indexed journals, constant teaching and participation of resident doctors in ongoing CME programs, workshops and conferences are part of the training program. The Unit Faculty published more than 20 research articles in the year 2021-22 and presented their work through several webinars and online conferences. Our resident doctors received 5 awards in National and Internationalconferences. The unit annually conducts the Oculoplasty and Ocular Oncology workshop, maintaining its tradition of the year round workshops in the challenging times of the pandemic. A comprehensive overview of diagnostic and management techniques in Oculoplasty and Oncology is showcased, and the event is attended by delegates from all over the country. There are special sessions on video based surgical skill transfer, approach to complex orbital and periorbital diseases, ocular pathology and insight into diagnostic and management of selected challenging cases. Recent advances at the centre are highlighted and delegates are given an opportunity for hands-on experience.he aim of the unit is to serve the patients in a compassionate and professional manner providing comprehensive care with a holistic team approach.

 

Strabismus and Neuro-ophthalmology  

The unit 5 also provides strabismus and neuro ophthalmology services. Patients with ocular misalignment, amblyopia, binocular visual problems and neuro-ophthalmic disorders are treated here. The unique protocols for clinical diagnosis, management, and advanced surgical facilities makes it one of the aspired places for strabismus care in India and abroad. In the field of amblyopia, the specialists now offer the novel dichoptic therapies for young children. In paediatric and in adult subjects, the basic as well as complex strabismic disorders are addressed in a systematic manner. The detailed preoperative orthoptic evaluation, centre specific treatment algorithm and the diverse expertise profile tries to provide the novel care here.  

Resident training is one of the major programs at our centre. To impart quality diagnostic and surgical skills to budding surgeons, the strabismus section conducts regular wet lab exercises, the common as well as complex case scenarios are simulated in wet lab, and under the direct guidance of an expert the skills are transferred with monitored hands on surgical training. The residents regularly participate in state level and national level conferences to present centres work and innovations in the field of strabismus. Recognizing which many awards and recognitions have been conferred in last few years. To address the existing lacunae in clinical as well as basic research areas, novel surgical techniques, randomised controlled trials and multicentric trials are conducted here. The effect of atropine eye drops in halting myopia progression, signs of vascular anomalies in amblyopic eyes (on optical coherence tomography angiography) and newer surgical techniques to provide better care are currently being explored here. To improve training patterns the animal modules are also being created here. To address surgical limitations, newer surgeries in unusual types of strabismus, modifications in existing technique, and newer concepts are also being explored.

 

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