Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is the best course of treatment for limbal stem cell deficiency with a perforated corneal ulcer?
Tough situation! I would tend to favor stabilizing the eye with an emergent PKP, sutured AMT, and temporary tarsorrhaphy if a glue application is not successful or possible. Once the eye has epithelialized, an SLET can be performed if the other eye is normal.
How do you approach the management of bilateral non-infectious uveitis in the pediatric population?
Fortunately, it’s rare. Depending on the severity and symptoms, topical steroids work well. Interestingly, children can develop increased pressure quickly, so you have to be careful. The iCare IOP tool is great to get pressures without doing an EUA. A Rheumatologist can also help you. If symptoms ar...
What strategies have you found effective in overcoming socioeconomic and cultural barriers to amblyopia treatment adherence?
My approach is to assess the caregiver's knowledge and understanding of the treatment first. Then I provide an explanation for why I’m recommending the treatment, and why it is important to do it within a certain timeframe due to the critical period of visual development. I stress that LASIK or wear...
In a patient with active spondylarthritis and uveitis who cannot take TNF inhibitors, what is your next agent of choice?
Uveitis and typically acute anterior uveitis is commonly associated with Axial spondyloarthritides (SpA) but also other spondyloarthritides and is usually recurrent with exacerbation and resolution. The approach to the management of uveitis in my opinion is similar to patients without an underlying ...
When do you consider placing an amniotic membrane when performing PRK?
I would consider it in cases of previous herpetic keratitis in the setting of neurotrophic keratitis or the presence of some KNV. Also, you can consider using it post-PK in some patients with limbal deficiency, but to know that PRK can increase the risk of corneal transplant rejection. As for normal...
Does your decision to start or continue Ozempic therapy in patients with diabetic retinopathy depend on the severity of the retinopathy?
Yes. The concern for use of semaglutide in patients with DR is based on results of the SUSTAIN-6 trial where patients at risk for cardiovascular disease were given 1 mg of semaglutide or placebo. While semaglutide decreased the progression of renal disease in this cohort, retinal complications were ...
How do you approach the management of amblyopia in children with developmental delays or cognitive impairments?
I agree with Dr. @Dr. First Last! We never want to not offer the best therapies to children due to a perceived developmental delay or cognitive impairment. Many times, families and patients will surprise us and do wonderfully. That being said, trying to understand the emotions of the family can be ...
What is your surgical approach for optic disc pit retinal detachments if laser treatment is unsuccessful?
Vitrectomy with ILM peeling, creation of a pedunculated ILM flap that I attempt to insert into the pit to serve as a plug, peripapillary laser barricade, gas tamponade, and face-down positioning. If that fails, I will also consider using tissue glue to try to plug the pit further along with repeatin...
What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?
Post-surgical (exogenous) endophthalmitis is an uncommon complication. The incidence ranges from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endophthalmi...
How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?
Susac's is a rare disease characterized by an occlusive retinal vasculopathy, eighth nerve disease including hearing loss and balance issues, and CNS disease with a predilection for involvement of the corpus callosum. I am not aware of any randomized controlled data to guide treatment for Susac's, b...