Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Do you extrapolate from uveitis treatment pathways when managing other inflammatory eye conditions such as atypical serpiginous choroiditis?
I do tend to apply these principles. So these entities like serpiginous, relentless placoid, etc., I would consider posterior uveitis. While we definitely do not fully understand the full pathophysiology of all these diseases, there is good evidence of inflammatory activity, hence response to steroi...
What do you use to treat uveitis refractory to conventional synthetic DMARDs and TNF inhibitors?
I would add support to a trial of intravenous tocilizumab, particularly if macular edema is a feature of the uveitis. The STOP-Uveitis trial demonstrated reasonable efficacy in intermediate, posterior, and panuveitis (STOP-Uveitis) and I have used this within my own practice with success in patients...
Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?
The great majority of lymphoproliferative disorders of the orbit turn out to be NHL when subjected to sophisticated pathologic evaluation, but even those which are considered benign lymphoid hyperplasia (LH) are often and successfully treated with radiotherapy. The dose of RT for low-grade lymphoma ...
How long do you continue steroid-sparing agents such as tocilizumab for GCA once the disease is in remission off steroids?
This is an excellent question and one we confront regularly. This is another of what I call “happy problems” because it is a consequence of increasing options for effective therapy for our patients.Tocilizumab is clearly an effective agent for some patients with giant cell arteritis (GCA), and patie...
How do you manage MEK inhibitor induced ocular adverse events?
MEK inhibitor associated ocular adverse events may range from subretinal fluid, which does not typically require medication cessation to uveitis, which is treated according to the level of inflammation. In one report of optical coherence tomography scan evaluations to image retinal structures follow...
Are there any situations in which you would consider starting steroid-sparing agents at the outset for patients with scleritis without any evidence of systemic rheumatic disease?
Great question. I agree with Dr. @Dr. First Last that if the disease is very severe and we cannot risk flaring or continued activity I would consider it, or with contraindications to steroids. If this is not the case, I would try to treat acutely with NSAID or steroid, and if the disease keeps flari...
What are the benefits of sending HLA B27 genotype over HLA B27 antigen when evaluating for spondyloarthritis?
HLA-B27 is strongly associated with ankylosing spondylitis (AS) which is an inflammatory rheumatic disease that affects the spine, the sacroilliac joints, and peripheral joints. It is also associated with other diseases like acute anterior uveitis, inflammatory bowel disease, or psoriasis. HLA-B27 t...
How would you treat uveitis in a patient with a history of cutaneous T cell lymphoma?
In chronic uveitis patients where systemic therapy cannot be used, local steroid injections/implants can be useful. This question does not specify the type of uveitis, so it is difficult to answer. But in general, for anterior uveitis, sub tenon triamcinolone can be used which lasts 6 months. In oth...
How would you manage an active rheumatoid arthritis patient on suppressive antibiotic therapy for ocular HSV who has abnormal liver function tests?
As an ophthalmologist, I will answer this selectively. The choice of immunomodulation for RA in the setting of liver dysfunction, I would defer to rheumatology (I do know that there are plenty of appropriate options that minimize risk to the liver). As far as the ocular HSV, I have many patients wit...
How do you approach the management of patients with one clinical demyelinating event and MOG+ antibody status?
I do not always treat a MOG+ single event (isolated optic neuritis, isolated transverse myelitis, or ADEM-like presentation) as it is possible that it might be a one-time-only event (as might occur after a viral illness or vaccination). If there has been "dissemination in time", then I would conside...