Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Who is your ideal candidate for a XEN over other filtering procedures such as trabs or tubes?
I typically reserve the Xen Gel Stent for elderly, Caucasian patients, especially women, with moderate open-angle glaucoma who need better pressure control but don’t require single-digit IOPs. These patients tend to have thinner, less fibrotic Tenon’s capsules and a lower risk of scarring, which all...
What is your preferred surgical approach for revision of an over-filtering bleb?
Hypotony after trabeculectomy is not uncommon, and I generally inform my patients prior to surgery that the risk of hypotony is roughly 10-20%. But, as is well known, not all patients develop hypotony maculopathy or detrimental effects from low IOP, and some patients can do well with IOP in the hypo...
For patients with neovascular glaucoma and uncontrolled IOP, do you ever consider a glaucoma drainage device (GDD) combined with ECP as opposed to just a standalone GDD?
I've never performed those two surgeries together, and I don't know of any papers that looked at that. Many NVG patients who get tubes in my practice are phakic, which makes ECP a non-starter. For the pseudophakic ones, I usually do a tube alone, combined with anti-VEGF and PRP. I would consider ECP...
How long should you wait after superficial keratectomy for accurate IOL measurements?
I wait at a minimum of 4 weeks and reassess the topography to see if it stabilizes. If not stable, I will repeat every 4 weeks until stable (usually no more than 3 months needed).
What is your approach to incorporating IPL therapy for meibomian gland dysfunction?
We use a protocol that treats the whole upper and lower eyelid, and periocular area that includes the brow, crows feet and lower eyelid/cheek junction. We treat the nose as well. That said, I don’t believe a study exists to support IPL/BBL for MGD control, and IPL is questionable as a treatment for ...
How do you approach surgical repair of a 6-clock-hour retinal dialysis with posteriorly folded retina, and what strategies do you use to minimize retinal slippage?
First of all, make sure it’s a dialysis and not a GRT. For dialysis, I would definitely start with a buckle.
Do you incorporate diurnal or nocturnal IOP measurements in your management of progression despite seemingly adequate daytime control?
The advent of home-based tonometry can make diurnal or nocturnal IOP measurements more convenient to obtain, though the cost of renting or buying these devices may be prohibitive for some patients. Glaucoma specialists sometimes use diurnal or nocturnal IOP measurements to identify whether there are...
What is your approach to antiviral treatment of HSV acute retinal necrosis?
Acute Retinal Necrosis (ARN) is a rapidly progressive syndrome usually caused by varicella-zoster virus (VZV)and herpes simplex virus 1 or 2 (HSV). The syndrome is rapidly progressive in the absence of antiviral treatment. PCR performed on aqueous or vitreous sampling is highly sensitive and strongl...
Do you routinely recommend IV systemic antibiotic therapy in additional to intravitreal antibiotic therapy for exogenous bacterial endophthalmitis?
Post-surgical (exogenous) endophthalmitis is an uncommon complication with the incidence ranging from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endopht...
What treatment strategies do you use to reduce the risk of post-herpetic neuralgia after herpes zoster ophthalmicus?
For prevention, our best tool is the VZV vaccine (Shingrix). I recommend that all patients over age 50 consider receiving it. However, if an individual develops VZO and has persistent pain, I begin with antiviral therapy to assess whether subclinical viral activation is contributing to the pain (dur...