Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach the management of indeterminate orbital lesions in asymptomatic patients with inconclusive imaging findings?
I feel like there is a specific case here. If so, I’d love to hear the details. That said, I’d return to the differential diagnosis of orbital masses/issues with the popular VEIN mnemonic - vascular, endocrine (thyroid), inflammatory, and neoplastic. While inflammatory lesions are commonly painful, ...
How do you approach the timing of vitrectomy in non-clearing vitreous hemorrhage secondary to proliferative diabetic retinopathy?
In patients with regressed PDR following complete PRP, the timing of vitrectomy for non-clearing vitreous hemorrhage depends on the patient's overall visual needs, fellow eye status, etc. In such patients, assuming the ultrasound shows the retina to be attached, I consider the vitrectomy to be a non...
How do you manage cystoid macular edema (CME) unresponsive to topical treatments in steroid responders?
Management depends on the underlying etiology of the CME. If the cause is primarily vascular, anti-VEGF therapy is typically the first-line treatment. If the CME is inflammatory in nature and continued steroid therapy is desired, I collaborate closely with a glaucoma specialist to determine if IOP c...
How do you decide on a steroid sparing agent for idiopathic orbital inflammation partially responsive to steroids?
Idiopathic orbital inflammation is a diagnosis of exclusion which is usually supported by orbital imaging and/or biopsy. It is important to exclude other causes of orbital inflammation which include thyroid eye disease, ANCA-associated vasculitis, sarcoidosis, histiocytosis, infection, or metastatic...
How do you manage periocular reconstructive surgery in patients with advanced orbital fractures and concurrent soft tissue injuries?
Assuming the patient is neurologically and hemodynamically stable, soft tissue injuries of the globe must be addressed first. Removal of orbital and intraocular foreign bodies, profuse irrigation, and globe repair, always precedes repair of the orbital fractures. When the fractures warrant repair, i...
Do you combine anti-VEGF with PDT for polypoidal choroidal vasculopathy upfront or reserve PDT for refractory cases?
Having considered EVEREST, EVEREST II, and PLANET, I tend to start with monthly aflibercept, with a low threshold for applying PDT during the first 3 months, before the vessel complex is too established to undergo regression.In practice, I only uncommonly encounter PCV early in its clinical course; ...
When should delayed removal of an intraocular foreign body be considered?
If you are deciding whether to close the globe first and then remove the IOFB with a later surgery, then first consider the type of IOFB and its potential to incite infection or inflammation. No matter what type of IOFB it is, the team repairing the ruptured globe should inject intravitreal broad-sp...
How do you decide whether or not to excise a pterygium prior to cataract surgery?
I'll remove a pterygium prior to cataract surgery if I suspect the pterygium will need removal at some point in the future. This could mean: 1.) I have seen evidence of pterygium progression in the recent past (either physical growth onto the cornea as compared to historical measurements/photos, or ...
How do you counsel patients interested in LAL monovision about the possibility of reduced glasses dependence?
One of the main advantages of the LAL is the ability to fine-tune monovision after surgery, allowing patients to experience and adjust their visual balance between distance and near before final lock-in. I explain that this flexibility greatly increases satisfaction and can significantly reduce glas...
In extremely premature infants born at <25 weeks gestational age, how do you individualize the timing and frequency of ROP screening?
Those extremely premature infants with an unstable clinical course or where the accuracy of GA was uncertain may need to be screened prior to 31 weeks PMA (post-menstrual age).Please see our paper: Souverein et al., PMID 38878959.In this study, among infants <=24 weeks gestational age at birth, we f...