Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors affect/correlate with viral PCR yield in aqueous in a patient with recurrent episodes of uveitis associated with high IOP?
Regarding viral PCR testing of aqueous for patients with recurrent episodes of hypertensive uveitis, I have the following thoughts: For herpetic uveitis specifically, HSV (1 and 2), VZV, and CMV, sampling the aqueous for viral PCR is highly sensitive (upwards of +90%) and comparable to that of vitre...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
Have you experienced any significant refractive regression years after the final lock-in for light adjustable lenses?
But to be fair, the people who do these lenses have a vested interest in being positive about them. I would like to see a prospective double blind study.
What are the advantages of using plexitome for treating recurrent corneal erosions compared with traditional methods?
There is no evidence that any surgical technique is better than the others (PTK, burr, or puncturing) in terms of recurrence rate. The Plexitome has the same concept of puncturing. The advantages over needle puncturing are: controlled spike depth, which is very minimal in Plexitome minimal corneal ...
What strategies do you use to optimize cataract surgery outcomes in patients with anterior basement membrane dystrophy (ABMD)?
For the preoperative period, surface dryness should be well controlled; usually, artificial tears, punctal plugs, and Restasis are enough. Then, if the topography shows central irregular reading, I usually prefer to remove the epithelium and let it heal for a month before considering cataract surger...
Have you found a successful treatment option for fixed Descemet's folds following prolonged hypotony (after hypotony has been treated/resolved) or Descemet's striae from a surgical incision?
These are difficult situations. The best success I have had is doing DSEKs and suturing the graft in 4 quadrants with 10-0 nylon to prevent detachment. It takes longer to clear but prevents detachment, and the sutures can be removed once the edema is clear. The lifespan of these transplants is inher...
What has been your experience using Dextenza for postoperative inflammation and pain control?
Dextenza has been an extremely useful tool for reducing the postoperative eyedrop burden in managing inflammation after cataract surgery. I typically reserve Dextenza for patients who may have difficulty adhering to a topical drop regimen. This may include those with limited dexterity, cognitive im...
In your experience, what factors prompt you to switch a patient with diabetic macular edema to Eylea HD?
In my practice, it isn’t switching to longer acting anti-VEGF, it is the treatment of the peripheral retinal ischemia. I often initially treat CSME with Avastin, but I use an IVFA to evaluate and treat the non-perfused retina with laser. It is the PRP that treats the VEGF production driving the diab...
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
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...