Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Have you experienced any significant refractive regression years after the final lock-in for light adjustable lenses?
But to be fair, the people who do these lenses have a vested interest in being positive about them. I would like to see a prospective double blind study.
How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?
Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!
Do you feel there is benefit to subconjunctival steroid or MMC injection at the time of valved tube placement?
In my opinion, there is a lack of compelling clinical evidence and studies to support the injection of subconjunctival MMC at the time of valved tube placement. I consider the injection of a subconjunctival steroid in patients with poorly controlled inflammation and those who I think may be less com...
What are the advantages of using plexitome for treating recurrent corneal erosions compared with traditional methods?
There is no evidence that any surgical technique is better than the others (PTK, burr, or puncturing) in terms of recurrence rate. The Plexitome has the same concept of puncturing. The advantages over needle puncturing are: controlled spike depth, which is very minimal in Plexitome minimal corneal ...
When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?
I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT,...
What strategies do you use to optimize cataract surgery outcomes in patients with anterior basement membrane dystrophy (ABMD)?
For the preoperative period, surface dryness should be well controlled; usually, artificial tears, punctal plugs, and Restasis are enough. Then, if the topography shows central irregular reading, I usually prefer to remove the epithelium and let it heal for a month before considering cataract surger...
Have you found a successful treatment option for fixed Descemet's folds following prolonged hypotony (after hypotony has been treated/resolved) or Descemet's striae from a surgical incision?
These are difficult situations. The best success I have had is doing DSEKs and suturing the graft in 4 quadrants with 10-0 nylon to prevent detachment. It takes longer to clear but prevents detachment, and the sutures can be removed once the edema is clear. The lifespan of these transplants is inher...
Are there any special considerations for cataract surgery in a patient with ICE syndrome (Chandler) with a relatively clear cornea?
It is important to try and get a cell count before surgery to manage patient expectations in case of increased risk of endothelial failure. The cataract surgery should be straightforward unless there is a correctopia needing a pupillary dilator. To note that MIGS are usually not successful when comb...
In a patient with prior cataract surgery in one eye with an unknown monofocal lens, how do you approach selection of a monofocal in the second eye?
The choice is completely dependent on the patient and the physician's discretion and discussion. No one choice for everyone.
What has been your experience using Dextenza for postoperative inflammation and pain control?
Dextenza has been an extremely useful tool for reducing the postoperative eyedrop burden in managing inflammation after cataract surgery. I typically reserve Dextenza for patients who may have difficulty adhering to a topical drop regimen. This may include those with limited dexterity, cognitive im...