Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In clinical practice, how can AMD imaging biomarkers guide risk stratification and shape discussions with patients regarding prognosis and monitoring?
When I see a patient with intermediate AMD, if I see biomarkers on OCT such as hyperreflective foci (HRF), drusen that have hyporeflective cores, lots of drusenoid deposits, acquired vitelliform lesions, or areas of thick basal laminar deposit, I realize that patient is at higher risk for progressio...
What is your preferred regimen for treating recalcitrant and recurrent macula-threatening ocular toxoplasmosis?
Treatment options for ocular toxoplasmosis include: Trimethoprim/sulfamethoxazole (Bactrim) Azithromycin Pyrimethamine + sulfadiazine + folinic acid Atovaquone Oral clindamycin Intravitreal clindamycin I usually start with Bactrim DS PO BID. If a patient is sulfa allergic or pregnant, I start with a...
What alternative treatment strategies can be considered for pediatric patients with idiopathic choroidal neovascularization (CNVM) who require q4 week intravitreal anti-VEGF injections?
My experience in children with CNVM is that they do not need continuous injections. Always add an STK at the time of intravitreal injections. AND most importantly, many kids will let you inject them awake just like adults. Something that needs to be discussed with the patients themselves. If a kid s...
How do you manage checkpoint inhibitor-associated Vogt-Koyanagi-Harada (VKH) disease in patients who have poorly controlled diabetes?
Management of ocular inflammation secondary to immune checkpoint inhibitors (ICPIs) is a balance between managing ocular disease and not negatively impacting treatment of the underlying malignancy. If there is ICPI-associated VKH disease with serous retinal detachment, use of corticosteroids is unav...
What intra-op and post-op strategies maximize the longevity of a functional bleb in younger patients?
Great question, and one which I hope others will chime in on. Intraoperatively, I really want to ensure a broad dissection of Tenon's capsule from the underlying sclera to allow diffuse flow of aqueous into the subconjunctival space. I inject MMC (0.2mg/ml) rather than use sponges, so I like to ensu...
How would you approach the management of posterior uveitis caused by Toxoplasma gondii in immunocompromised patients, considering the potential for atypical presentations and treatment resistance?
There are no established studies to confirm the best medications and duration for the treatment of toxoplasmosis retinitis. The recommendations are based on experience and consensus. Further, I am not sure how you established resistance since one rarely has the organism to test, and there is no rout...
How do you typically manage the use of intravitreal antibiotics during globe repair?
At the end of the case, if no allergies, I will inject vancomycin and ceftazidime intravitreal. If there was vegetable matter involved in the injury (tree branch), I would include an antifungal like voriconazole.
How has intraoperative OCT influenced your surgical decision-making during complex macular cases?
I use iOCT very frequently because I am sent a lot of patients who failed surgery elsewhere. The most common situation is failure of macular hole closure. Sometimes it’s not clear what areas have been peeled, even with staining with ICG or Brilliant Blue G (BBG). Having the iOCT makes it easier to s...
In patients with retinitis pigmentosa–associated cystoid macular edema that is refractory to medical management, does pars plana vitrectomy have a therapeutic role?
Patients with RP have an increased incidence of macular edema (CME) and epiretinal membranes (ERM). If CME is associated with ERM, then there may be a role of PPV with membrane peel, but if CME is isolated, oral or topical carbonic anhydrase inhibitors would be considered the treatment of choice.
What clinical or OCT-based parameters guide your decision to perform an ERM peel in patients with DME and concurrent ERM?
The presence of an ERM in a patient with DME negatively impacts the response to anti-VEGF injections and reduces the efficacy of the injections. The ERM acts as a physical barrier, reducing drug penetration, and can also contribute to the progression and persistence of DME through the production of ...