Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In patients with corneal edema and a glaucoma drainage tube placed in the AC, under what circumstances would you consider repositioning the tube in the sulcus first versus proceeding directly with endothelial keratoplasty alone?
I have a pretty low threshold to just move these tubes to the sulcus as soon as my cornea colleagues are contemplating an EK. I am not a cornea specialist, but my impression is that first grafts almost always do better than second grafts, so I want to give that first one the best chance of survival....
In what clinical scenarios do you incorporate topical insulin drops to treat persistent epithelial defects?
I often use topical insulin drops in lieu of Oxervate for persistent epithelial defects and neurotrophic cornea. It works well and is much more affordable.
How does LAL+ compare with other EDOF lenses?
The LAL+ combines an EDOF optical profile with the unique ability to fine-tune the refractive target postoperatively, offering a level of customization that goes beyond standard EDOF lenses. It provides a smoother range of vision with less anisometropia compared to traditional LAL monovision strateg...
What has been your experience using sutureless Müller’s Muscle-Conjunctival Resection (MMCR) for ptosis repair?
Personally, I get the desire to be less interventional, but if you are going to do this and it is 'less aggressive' than a levator resection, just put in a suture; it is not so hard.
How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?
Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessmen...
Which IOL do you prefer for patients with a history of hyperopic LASIK to minimize the risk of inducing spherical aberration?
I prefer an IOL without any induced spherical aberration, such as the enVista monofocal, in my post-hyperopic LASIK patients. Other standard monofocal lenses (such as clareon monofocal, J&J monofocal, etc.) have a built-in negative spherical aberration that is intended to offset the standard positiv...
How do you determine whether to switch to a different anti-VEGF agent or to Ozurdex after a patient with diabetic macular edema fails a series of Avastin?
For my practice, macular oedema (CSME) is based on three factors. Ischemia, inflammation, and traction: the three factors which lead to persistent oedema. IVFA will show the level of non-perfusion in the far periphery, which is a major producer of VEGF, and laser (PRP) is the treatment. IV anti-VEGF...
How do you approach perioperative steroids for a quiescent uveitis patient undergoing cataract surgery?
Preop: If the patient is using topical steroids chronically, I increased the dose of the drops to four times a day the week prior to surgery. If the patient is using chronic oral prednisone, I will increase the prednisone to 0.5 mg/kg, 3 days prior to surgery, followed by a quick taper every 3 days...
How would you approach the management of a patient presenting with bilateral central corneal perforations following treatment with Ipilimumab/Nivolumab?
I am aware of at least one case report describing this situation (Aschauer et al., PMID 36072439).Ideally, the offending medication is halted, but when dealing with life-threatening cancer, this may not be possible, especially if the treatment is working. In the acute setting, trying to stabilize th...
Is there a role for PDT in a young patient with PXE and bilateral CNVM who requires intravitreal anti-VEGF injections every 4 weeks and is beginning to develop atrophy?
I am not a fan of PDT for patients who are developing incipient atrophy. The question says anti-VEGF therapy is being given every 4 weeks, but it is not clear what agent is being used. I would try 2nd generation therapy such as faricimab, 8 mg aflibercept, or possibly brolucizumab (after discussion ...