Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your preferred surgical intervention for lagophthalmos secondary to a facial paralysis and signs of exposure keratopathy?
If temporary or early in the recovery, consider stick-on external eyelid weights. If it has been several months without any improvement, I like to do gold or platinum permanent weights sutured to the tarsus, in addition to a lower lid tightening as Dr. @Dr. First Last mentioned.
How has using a chandelier for scleral buckling impacted your teaching or surgical outcomes?
Chandelier buckles are valuable in teaching primary scleral buckle to fellows early in their training, but do not offer significant benefits beyond this application. The reason is that management of the chandelier itself (in the eye for marking breaks and cryo, out of the eye for placement of the ba...
How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?
The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam ev...
How do you approach the management of epithelial ingrowth in a patient who underwent LASIK 20 years ago and developed epithelial ingrowth following recent cataract surgery?
If it’s a small area in the periphery, not causing any issue, then it would be reasonable to monitor it as it may not progress. If it is progressing or starting to cause issues, you can either try YAG, which may take more than one round, or simply lift the flap and scrape both the bed and underside ...
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...
What factors guide your decision to perform subretinal fluid drainage during primary scleral buckle surgery for a rhegmatogenous retinal detachment?
Since external drainage of subretinal fluid is the step in scleral buckle surgery associated with the greatest risk of serious complications (i.e. subretinal hemorrhage, retinal perforation, retinal incarceration), I only drain if the subretinal fluid so bullous that drainage is necessary to insure ...
In patients with preexisting vitreous prolapse undergoing glaucoma drainage implant surgery, what is the optimal surgical timing for performing an anterior vitrectomy to minimize complications and ensure successful tube placement?
Prior to tube insertion.
How do you decide between a combined phacovitrectomy approach versus a staged procedure for patients with a retinal detachment and dense cataract?
A primary buckle might be a consideration here to avoid the issue of the cataract altogether. But if planning to add a buckle (with vitrectomy) during these cases, it is impossible to preoperatively perform lens measurements (i.e., axial length), which would be a relative contraindication to perform...
When do you decide to proceed with cataract or glaucoma surgery in patients with non-quiescent herpetic stromal keratitis?
Cataract surgery should wait until quiescent for at least 3 months. Glaucoma surgery, if emergent, may be unavoidable, but that has to be decided on a case-by-case basis.
In light of the voluntary recall of the Bausch & Lomb enVista IOL, what has been your experience regarding patient satisfaction and visual outcomes with other monofocal IOL options?
Excellent results with the PanOptic IOL and even better with the PanOptics Pro.