Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In what clinical scenarios do you incorporate topical insulin drops to treat persistent epithelial defects?
I often use topical insulin drops in lieu of Oxervate for persistent epithelial defects and neurotrophic cornea. It works well and is much more affordable.
For very low cylinder that does not qualify for a toric lens and no access to femto, do you ever consider LRIs or slightly adjusting your main wound placement (if possible)?
I personally don't do manual LRIs as they can be somewhat unpredictable. Adjusting the main wound to the steep axis can treat 0.1 to 0.3 D due to SIA, so that might be the safest plan if femto is not available. B&L's Envista toric does treat as low as 1.25D, so that may also be an option.
In primary angle closure suspects without cataracts, how do you approach the discussion about LPIs, given the relatively low risk of an acute angle closure attack?
In primary angle closure suspects without cataracts, I will have a discussion about aqueous humor dynamics and outflow mechanisms of the eye, and how that relates to risk stratification in the patient's case. We are fortunate in glaucoma to have a fair bit of evidence to guide us in our clinical dec...
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 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.