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 the most appropriate next step for a patient experiencing prolonged hypotony following Ahmed glaucoma valve implantation and unsuccessful medical management?
To reduce aqueous flow through the tube, a less invasive approach involves occluding the tube lumen using a 2-0 or 3-0 Prolene suture via an ab interno technique. For complete occlusion, a Supramid suture may be used instead of Prolene. The ab interno approach minimizes conjunctival disruption. Alte...
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...
What has been your experience with Durysta (bimatoprost implant) for glaucoma management?
Excellent option for glaucoma patients. I have been offering routinely for about a year now. Topicals are also an option, but compliance, insurance coverage, side effects (ocular surface), and monthly cost all affect quality of life and efficacy of treatment. I prefer SLT + Durysta over topical trea...
What is the appropriate interval before safely performing cataract surgery after plaque radiation therapy for iris melanoma?
Great question, but one that requires a nuanced answer. Often, patients with iris melanomas have some degree of lens opacity, and following brachytherapy, the cataract will surely progress. I recommend carefully following up on the iris melanoma after radiation to ensure the lesion is regressing pro...
What is your approach to patients with biopsy proven giant cell arteritis that continue to have symptoms after initiation of high dose glucocorticoid therapy?
First, let's define and discuss “high-dose” steroids. Oral therapy is typically 60-100 mg of prednisone daily, and IV is 500-1000 mg of methylprednisolone daily for three days, followed by oral prednisone. There has been no difference in long-term outcomes for vision loss or diplopia. The complicati...
What factors influence your decision to pursue surgical management in cases of infectious keratitis caused by multidrug-resistant pathogens?
I would consider operating sooner rather than later for a keratitis that’s headed in the wrong direction. It’s important to intervene prior to the development of extensive CNV or limbal involvement or corneal perforation for a more controlled, straightforward operation. The exception may be fungal k...
How do you manage corneal ectasia after refractive surgery?
Corneal cross-linking should be the first step to halt progression. I would then typically encourage patients to try hard contacts, which help improve the vision in the most conservative way. There are a variety of surgical interventions that can be considered depending on how advanced the ectasia i...
In cases of congenital ptosis with poor levator function, how do outcomes of frontalis flap suspension compare to silicone rod frontalis sling?
A frontalis flap procedure offers superior cosmesis in that only a lid crease incision is made, and no incisions are made above the brow. However, it does take significant additional operative time to dissect the flap from a single inferior incision. There is the thought that it might be less adjust...
How do you decide to use MIGS versus traditional surgical options like trabeculectomy or tube shunt placement in the management of glaucoma?
Current IOP and your IOP goal are key. Angle MIGS will typically reduce IOP from the low to mid-20s to the mid to upper teens. I consider Xen a MIBS procedure. I’ve been able to use Xen as my bleb surgery of choice, even in patients who have had multiple prior ocular surgeries, including PPV, tube s...