Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In cases of failed endothelial keratoplasty with concurrent cataract, do you favor repeat keratoplasty plus lens extraction in the same setting or sequential surgeries?
I tend to favor combining the two into one surgery. If the view is not clear enough or the patient is interested in a more accurate refractive outcome, the surgery can, of course, be staged with the endothelial keratoplasty first, followed by cataract surgery about 3 months or so later. With the use...
For patients with evidence of prior bilateral uveitis (PS, pupillary membranes, inactive KP, no view posteriorly) who reports no prior symptoms and who has had negative lab work-up, when do you consider repeat work-up and which labs would you repeat?
This is a difficult question to answer succinctly, as so much information is missing to provide a complete response. However, it does raise some important points that are worth mentioning:There is a prevailing tenet, which I was taught as a resident and hear often from residents today, that 1st epis...
How would you advise a younger patient with residual/recurrent optic nerve meningioma, proceeding with radiotherapy, about the risks of malignant transformation or induction of other brain malignancies because of radiation?
The risk of malignant transformation of an optic nerve sheath meningioma (ONSM) after RT appears to be remarkably low, much lower than the risk of blindness from an untreated, progressive ONSM. In a younger patient, I would lean toward RT for patients with imaging progression or early visual loss, ...
What is the best time frame to intervene surgically for the management of traumatic macular hole, and what techniques should one consider?
Traumatic macular holes differ from idiopathic holes as a moderate proportion may close spontaneously, particularly in younger patients and with smaller holes. Studies have quoted approximately 40+% spontaneous closure in traumatic macular holes compared to 5% for idiopathic macular holes. For this ...
What clinical and diagnostic factors best predict who will benefit from intervention versus observation for patients with visually significant floaters?
There are no clinical or diagnostic factors that predict who will benefit from an intervention for vitreous floaters. Symptomatology from vitreous floaters is subjective. Patient-reported outcome measures after floaterectomy are also subjective. The improvement in symptoms following vitrectomy (I do...
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
In phacomorphic glaucoma with limited view, how do you approach surgical management (i.e., staged or combined surgery, temporize with LPI)?
In true phacomorphic glaucoma, the definitive treatment is cataract extraction. I first focus on medically lowering the IOP, and if the cornea is hazy, I do everything possible to clear it to obtain a safe surgical view. If the view remains limited, I’m comfortable using the biometry from the fellow...
How do you decide when to stop anti-VEGF injections for patients with exudative AMD?
The ongoing anti-VEGF injections are usually withdrawn when the clinical status of nAMD stabilizes with the absence of clinical activity for an extended period of time or, rarely, when the visual acuity improves to 20/20. I usually use the treat and extend protocol for the treatment of exudative AMD...
How do you balance empiric therapy and diagnostic testing in severe pediatric conjunctivitis presentations?
It depends on the meaning of "severe pediatric conjunctivitis." There are 3 main types of pediatric conjunctivitis that being bacterial, viral, and allergic. Viral needs to be broken down into viral and herpes viral, in the way they are treated. For routine pediatric conjunctivitis, which does not i...