Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your preferred regimen for treating recalcitrant and recurrent macula-threatening ocular toxoplasmosis?
Treatment options for ocular toxoplasmosis include: Trimethoprim/sulfamethoxazole (Bactrim) Azithromycin Pyrimethamine + sulfadiazine + folinic acid Atovaquone Oral clindamycin Intravitreal clindamycin I usually start with Bactrim DS PO BID. If a patient is sulfa allergic or pregnant, I start with a...
What alternative treatment strategies can be considered for pediatric patients with idiopathic choroidal neovascularization (CNVM) who require q4 week intravitreal anti-VEGF injections?
My experience in children with CNVM is that they do not need continuous injections. Always add an STK at the time of intravitreal injections. AND most importantly, many kids will let you inject them awake just like adults. Something that needs to be discussed with the patients themselves. If a kid s...
How do you manage checkpoint inhibitor-associated Vogt-Koyanagi-Harada (VKH) disease in patients who have poorly controlled diabetes?
Management of ocular inflammation secondary to immune checkpoint inhibitors (ICPIs) is a balance between managing ocular disease and not negatively impacting treatment of the underlying malignancy. If there is ICPI-associated VKH disease with serous retinal detachment, use of corticosteroids is unav...
What intra-op and post-op strategies maximize the longevity of a functional bleb in younger patients?
Great question, and one which I hope others will chime in on. Intraoperatively, I really want to ensure a broad dissection of Tenon's capsule from the underlying sclera to allow diffuse flow of aqueous into the subconjunctival space. I inject MMC (0.2mg/ml) rather than use sponges, so I like to ensu...
How would you approach the management of posterior uveitis caused by Toxoplasma gondii in immunocompromised patients, considering the potential for atypical presentations and treatment resistance?
There are no established studies to confirm the best medications and duration for the treatment of toxoplasmosis retinitis. The recommendations are based on experience and consensus. Further, I am not sure how you established resistance since one rarely has the organism to test, and there is no rout...
How do you monitor and manage visual development and amblyopia in children with glaucoma who require multiple surgeries during critical periods of visual maturation?
There is nothing special about managing visual development and amblyopia in children with glaucoma. They must be followed by a pediatric ophthalmologist and a cycloplegic refraction performed at least yearly (more frequent if a change is expected based on changes in vision or axial length) and glass...
How do you approach cases of transient monocular vision loss when initial carotid imaging and cardiac workup are unrevealing?
As you eluded, it is essential to rule out amaurosis fugax in a case of TMVL, and carotid Doppler and cardiac echo are two essential tests to evaluate the two potential sources of embolization in this setting. I would also recommend an MRI of the brain (to check for possible evidence of other ischem...
What is the role of bilateral same-day cataract surgery in your practice?
Like many things in medicine, sometimes there are mental hurdles to jump over that are more challenging than operational or evidence-based hurdles. We perform many invasive procedures, bilateral same day: laser vision correction, intravitreal injections, phakic IOLs, etc. Yet many of us, myself incl...
How would you approach the upfront management of a patient with acute unilateral vision loss with strong clinical risk factors for both cardioembolic stroke and GCA if an expedited MRI is not possible due to the presence of an AICD?
I'm definitely not an expert in this topic, but you have many clinical tools to increase/decrease your clinical suspicion for GCA vs. cardioembolic stroke. Some things I would ask: Is this patient currently in Afib? What's their CHADSVASC? Are they anticoagulated? Can we get a TTE to check for vege...
How do you determine the timing and necessity of surgical removal for retained subretinal perfluorocarbon?
Timing: Defer PFO removal until after you are convinced the retina is attached and will likely stay attached (e.g., after gas resolves or, if under oil, later than 8 weeks). Necessity: Plan for surgical removal if subretinal PFO is foveal or perifoveal. If not, then defer indefinitely unless PFO loc...