Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?
In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...
What has been your experience with CP250 vs. CP350 in terms of ease of implantation, post-operative course, and efficacy in IOP lowering?
We did look at this in our study from Wills (Shalaby et al., PMID 38158079) and did not find a difference in IOP control or medication use between CP250 or CP350. However, the CP350 cohort was small and this was a retrospective study. Similar findings have been published earlier regarding the BGI 25...
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
How do you determine the appropriate toric IOL when there is a discrepancy in axis or cylinder power between optical biometry and corneal tomography during preoperative evaluation?
Always difficult. Always re-measure when discrepancies occur. For axis discrepancies, Auto Ks, topography, biometry, and past refraction. Past refraction is where the patient lived their entire life before their cataract surgery. Which of these tests aligns the most? Past refraction, especially pre-...
What is your approach to treatment for recalcitrant MGD?
Recalcitrant MGD is a frequently seen clinical problem, especially in older patients. Standard treatment encompasses warm compresses and lid hygiene. The latter can be performed with over-the-counter lid wipes or simply with baby shampoo. Tropical antibiotics such as Polytrim drops and bacitracin/po...
How do you approach surgical repair of a 6-clock-hour retinal dialysis with posteriorly folded retina, and what strategies do you use to minimize retinal slippage?
First of all, make sure it’s a dialysis and not a GRT. For dialysis, I would definitely start with a buckle.
How do you differentiate between macular schisis vs. macular edema vs. optically empty spaces (from macular telangiectasia) on OCT?
When trying to differentiate between these identities, I begin by looking at the morphology of the intraretinal fluid-filled spaces on OCT imaging. The cystoid spaces in macular edema caused by vascular leakage or medications (e.g., niacin) are typically round in shape and increase in size toward th...
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...
How do you counsel patients when discussing risks/benefits of ECP vs. CPC?
I don't regularly use ECP, but I have a lot of experience with micropulse CPC (referred to as MP-TLT or MPCPC) and traditional CPC. Firstly, although MPCPC involves less energy compared to traditional CPC, that does not mean that the procedure is without risk. Because of these risks, MPCPC should no...
In a patient with recurrent episodes of GCA that flare shortly after steroid tapering, how do you differentiate between steroid-dependent inflammatory relapse, an alternative autoimmune vasculitic process, and a paraneoplastic phenomenon?
This could certainly be worrisome for a paraneoplastic phenomenon. GCA is associated disproportionately with myeloid lineage mutations (CHIP - clonal hematopoiesis of indeterminate significance). TET2 is think is the best-studied mutation, but in my experience, any other CHIP mutations such as ASXL1...