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...
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.
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.
What factors influence your decision to use femtosecond laser-assisted cataract surgery in complex cases?
For complex cataracts with patients having shallow anterior chambers, weak zonules (pseudoX), and dense cataract, Femtosecond may be more beneficial than the standard technique in reducing energy and AC manipulation for these cases. However, it would be risky to perform the laser under these complex...
Under what circumstances would CPC be considered the primary intervention for severe glaucoma with preserved central vision?
I would consider CPC as a primary intervention in the following circumstances: old age (>80), no social support, inability to keep appointments, unable to instill glaucoma drops, or intolerance to systemic CAIs. Karanjit
How do you approach the timing of surgical intervention in intermittent exotropia?
If the child alternates fairly well and there is no amblyopia, I monitor the strabismus every six months. There is no urgency to operate in these cases, and multiple measurements of the angle over time are beneficial. The frequency helps with the decision. If the eyes are exotropic more than 40% of ...
How do you decide between performing an ECP versus a MIGS procedure in a patient undergoing cataract surgery?
If a patient would benefit from a concurrent IOP-lowering procedure at the time of cataract surgery, there are many options. Some glaucoma specialists will choose ECP in the setting of angle closure, with the thought that ECP will shrink the ciliary processes and allow more opening of the angle. ECP...