Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When eyelid tissue loss is substantial, when is staged reconstruction preferred over primary closure?
Tissue is rarely actually missing, but more often rolled up or difficult to identify. If tissue is truly missing (most often from a dog bite more than any other type of trauma, in my experience), this question would need to be addressed on a case-by-case basis. There are a number of factors to consi...
How do you approach cases of zonular dehisence/weakness noticed intra-op?
For dehiscence of less than 90 degrees, placing CTR seems the safest and easiest way. Published studies suggest CTR use in zonular dialysis or weak zonules can improve postoperative visual or refractive outcomes in many cases. For 180 degrees of zonular loss, I try to preserve the anatomy if possibl...
Do you feel there is a role for capsulectomy for failed Ahmed implants and what is your preferred surgical approach?
There can be a role for capsulectomy after a failed Ahmed implant. In situations where a needling/5FU is insufficient, a capsulectomy provides a higher chance of success. Typically, I would dissect from the limbus backwards to the plate, excise as much capsule as possible, then close after ensuring ...
How do you determine the duration and taper of systemic corticosteroids when you add them alongside antibiotics for orbital cellulitis?
There is no 'standard of care' answer for this. My personal preference is the following: Pediatric patients -- 0.25 to 0.5 mg/kg dexamethasone daily (given in AM) for up to 3 days, starting the day after source control/cultures from surgery. Higher dose/longer duration if very inflamed, and lower d...
How has your use of SLT changed given the 6-year results of the LiGHT trial?
I offer primary SLT to almost all of my treatment-naive patients with OHTN or POAG, and most patients with mild-moderate disease who have never received SLT. I counsel patients that with primary SLT, they are less likely to show disease progression at 6 years and less likely to require incisional gl...
What is your approach to managing failed trabeculectomies with scarring but controlled IOP?
It's important to differentiate "controlled IOP" from the controlled rate of disease progression. If IOP is consistently 10-12 in the clinic and HVF and OCT are stable, close observation may be all that is needed. However if the IOP is "controlled" but the HVF shows evidence of progressive functiona...
If Acanthamoeba testing is unavailable locally, what immediate management is reasonable while arranging urgent referral?
It is always best to have a LOW threshold to initiate Acanthamoeba treatment. If you really suspect Acanthamoeba and have NO culture/PCR capability, I would recommend starting anti-Acanthamoeba therapy and getting the person to a cornea specialist who can confirm the diagnosis asap. Delay in treatme...
How do you decide timing of repair of a chronic macula threatening tractional retinal detachment?
There are many factors that are important in managing a chronic macula-threatening tractional retinal detachment. The general health of the patient affects surgical risk and candidacy, as well as the presence of other ophthalmic conditions like neovascular glaucoma and the status of the other eye. F...
How has your approach to dry eye management evolved with the advent of new prescription medications and nutraceuticals?
Dry eye disease is the most common reason for a patient visit to an eye care professional. Management of dry eye affects quality of life and quality of vision. In managing dry eye, the first step is making the diagnosis correctly and this can sometimes be difficult because of the varying symptoms as...
In cases of severe ocular trauma with NLP vision, under what circumstances do you consider proceeding with pars plana vitrectomy?
I don’t. Often, it is time to have a difficult discussion with the patient about the timing of eviseration or enucleation, if the eye presents as an open globe. The risk of endophthalmitis, worsening ptysis and pain, as well as the small risk of sympathetic ophthalmia, are sound reasons to consider ...