Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In a patient with prior cataract surgery in one eye with an unknown monofocal lens, how do you approach selection of a monofocal in the second eye?
The choice is completely dependent on the patient and the physician's discretion and discussion. No one choice for everyone.
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The ongoing anti-VEGF injections are usually withdrawn when the clinical status of nAMD stabilizes with the absence of clinical activity for an extended period of time or, rarely, when the visual acuity improves to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...
In non-visually significant hypotony maculopathy after trabeculectomy, how do you approach timing and decision to revise the trab?
Hypotony after filtering surgery is not uncommon, with IOP less than 6 on 2 or more post op visits occurring in 28.6% of patients in a recent retrospective review by Khaliliyeh et al., PMID 41692420. However, most (79.9%) of these patients did not show any clinical sequelae. In this review, 10% of p...
In pediatric RRDs associated with high myopia or Stickler syndrome, how do you decide between scleral buckle alone versus combined vitrectomy and buckle?
Most of the time, a buckle works great. If there is posterior PVR that will not relax with a buckle or there is a GRT, then a vitrectomy will be necessary.
How do you approach the decision to escalate from conservative medical therapy to surgical intervention in a patient with EBMD-related recurrent corneal erosions who has not responded to several months of nighttime lubricating ointment?
In the case of recurrent erosion in the setting of EBMD, we first attempt to optimize the conditions for a pristine and smooth ocular surface. This includes non-preserved lubricants, hypertonic saline to avoid swelling and sloughing at night, and treatment of any dry eye and meibomian gland dysfunct...
What alternative treatments do you recommend trying for patients struggling with persistent, chronic ocular surface pain following refractive surgery unresponsive to traditional methods (i.e., lubrication, topical cyclosporine, punctal plugs)?
The first step is to identify the underlying cause of pain. If nociceptive: Target the visible source of pain. If peripheral neuropathic (e.g., due to corneal nerve abnormalities): Consider topical therapies that modulate nerve function, such as autologous blood-derived products (PRGF, AST, PRP) or...
What factors will most influence your decision to offer ENCELTO to patients with macular telangiectasia type 2?
Yet another (presumably very expensive) surgical treatment for a chronic macular disease was approved on the basis of OCT measurements without demonstrating visual benefit to the patient in a disease with a slow, variable course. Show me quality of life studies and visual benefit justifying surgical...
How should ectasia risk be triaged using RSB, PTA, and tomography?
Randleman ectasia risk score is very helpful in assessing the risks. It takes into consideration RSB PTA topography, CT, and age. Randleman Ectasia Risk Factor Score System
In cataract surgery following penetrating keratoplasty, do you think the use of scleral tunnel incisions versus clear corneal incisions meaningfully influence graft survival or astigmatic stability?
I generally prefer a clear corneal incision for most cataract surgeries following PK. Regarding endothelial safety, there are limited studies directly comparing endothelial cell loss or corneal edema between incision types. In my own experience over the past year, I have not encountered endothelial ...
How do you manage corneal ectasia after refractive surgery?
Corneal cross-linking should be the first step to halt progression. I would then typically encourage patients to try hard contacts, which help improve the vision in the most conservative way. There are a variety of surgical interventions that can be considered depending on how advanced the ectasia i...