Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is the best next surgical approach to manage severe inferior oblique overaction and superior oblique underaction after inferior oblique myectomy?
Persistent superior oblique (SO) muscle underaction after inferior oblique (IO) myectomy usually indicates an abnormal, loose, and floppy superior oblique tendon. At surgery, the first thing to do is traction testing of both oblique muscles to detect tightness or laxity. Videos of the "exaggerated t...
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...
What is the role of topical aqueous suppressants as an adjunct to intravitreal anti-VEGF therapy in patients with persistent macular edema despite optimized injection frequency depending on etiology of ME?
Interesting question: It isn't stated what the cause of the macular edema is. In the only two indications for which there is evidence that anti-VEGF injections can have value (RVO and DME), there is little evidence of aqueous suppressants being of any value. So, in my opinion, non-intersecting sets....
What techniques do you use to minimize the risk of buckle extrusion or infection, especially in younger or highly myopic patients?
No different techniques. Make sure you soak the elements in saline with an antibiotic. Do not touch the buckle with your hands. Do not use instruments that can damage the silicone. Extrusions and infections are not common. Kids have a healthy Tenon that will keep buckles from extruding. Also, buckle...
What has been your experience incorporating the Port Delivery System (PDS) into clinical practice?
My initial exposure was as a study surgeon, and the first patient I saw in the study had had the port system placed 9 months before. When I saw her, the port injection surface had become exposed with breakdown of the surrounding conjunctiva and tenons. This required urgent surgery and a conjunctival...
What type of air/SF6 fill do you recommend following DSEAK in patients with scleral fixated IOLs? (i.e., only AC fill vs full eye fluid-gas exchange?)
For these patients, I do a suture pull-through technique with a Prolene suture to anchor the graft at the distal edge. To keep chamber stability and prevent the bubble from moving posteriorly, I suture all wounds, including the paracenteses. I use 18% SF6 or 6% C3F8 and do a full fill. C3F8 has beco...
Are there any important considerations when initiating orbital radiation therapy for TED in a patient with diabetic retinopathy?
Recent research would suggest that the risk of radiation retinopathy in patients with DM undergoing orbital radiation therapy for TED is low (Makhoul et al., PMID 41450582). However, my personal preference is to explore all other medical options (Tepezza, EUGOGO protocol, Actemra, etc.) prior to tre...
How do you approach treatment in patients with pachychoroid disease who show fluctuating subretinal fluid without visual decline?
What is described has often been called chronic CS(C)R. I do not believe there is any proven treatment better than observation for these patients at this time, so observation it is.
What are the toxic effects of a small amount of intraocular perfluoron on the retina and cornea?
I have seen small amounts of PFO retained in the posterior pole and no inflammation was associated with it. But in some patients, particularly those with any subretinal PFO, retinal atrophy and chronic choroiditis can be seen. This will require surgical removal, especially if the PFO is trapped near...
What has been your experience with the travoprost intracameral implant (iDose)?
My experience has been positive, but I consider patient selection prior to surgical planning to be crucial. At this time, I am mostly targeting mild to moderate POAG patients who are on 1-3 glaucoma medications (at least one being a PGA). I usually perform the iDose along with cataract surgery and a...