Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is the role of topical aqueous suppressants as an adjunct to intravitreal anti-VEGF therapy in patients with persistent macular edema despite optimized injection frequency depending on etiology of ME?
Interesting question: It isn't stated what the cause of the macular edema is. In the only two indications for which there is evidence that anti-VEGF injections can have value (RVO and DME), there is little evidence of aqueous suppressants being of any value. So, in my opinion, non-intersecting sets....
What techniques do you use to minimize the risk of buckle extrusion or infection, especially in younger or highly myopic patients?
No different techniques. Make sure you soak the elements in saline with an antibiotic. Do not touch the buckle with your hands. Do not use instruments that can damage the silicone. Extrusions and infections are not common. Kids have a healthy Tenon that will keep buckles from extruding. Also, buckle...
How do you determine the duration and taper of systemic corticosteroids when you add them alongside antibiotics for orbital cellulitis?
There is no 'standard of care' answer for this. My personal preference is the following: Pediatric patients -- 0.25 to 0.5 mg/kg dexamethasone daily (given in AM) for up to 3 days, starting the day after source control/cultures from surgery. Higher dose/longer duration if very inflamed, and lower d...
What has been your experience incorporating the Port Delivery System (PDS) into clinical practice?
My initial exposure was as a study surgeon, and the first patient I saw in the study had had the port system placed 9 months before. When I saw her, the port injection surface had become exposed with breakdown of the surrounding conjunctiva and tenons. This required urgent surgery and a conjunctival...
What type of air/SF6 fill do you recommend following DSEAK in patients with scleral fixated IOLs? (i.e., only AC fill vs full eye fluid-gas exchange?)
For these patients, I do a suture pull-through technique with a Prolene suture to anchor the graft at the distal edge. To keep chamber stability and prevent the bubble from moving posteriorly, I suture all wounds, including the paracenteses. I use 18% SF6 or 6% C3F8 and do a full fill. C3F8 has beco...
Are there any important considerations when initiating orbital radiation therapy for TED in a patient with diabetic retinopathy?
Recent research would suggest that the risk of radiation retinopathy in patients with DM undergoing orbital radiation therapy for TED is low (Makhoul et al., PMID 41450582). However, my personal preference is to explore all other medical options (Tepezza, EUGOGO protocol, Actemra, etc.) prior to tre...
Are there any special considerations when approaching ptosis repair in a patient with a prior trabeculectomy?
I have two main concerns with trabeculectomy patients (or any glaucoma filtering procedure). The first is avoiding overcorrection of ptosis, which can expose the bleb and increase the risk of blebitis. The second is respecting the conjunctiva. I generally avoid posterior ptosis repair (MMCR or Fasan...
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...
When do you use GLP-1 receptor agonists for the management of patients with idiopathic intracranial hypertension (IIH)?
I would use GLP-1 agonists in all overweight IIH patients who did not have a contraindication if it wasn't for the cost. In the IIH treatment trial, 6% weight loss over 6 months lowered intracranial pressure by about 50 mm (acetazolamide also lowered ICP by about 50 mm, but of course, it did it much...
How do you approach treatment in patients with pachychoroid disease who show fluctuating subretinal fluid without visual decline?
What is described has often been called chronic CS(C)R. I do not believe there is any proven treatment better than observation for these patients at this time, so observation it is.