Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your approach to incorporating IPL therapy for meibomian gland dysfunction?
We use a protocol that treats the whole upper and lower eyelid, and periocular area that includes the brow, crows feet and lower eyelid/cheek junction. We treat the nose as well. That said, I don’t believe a study exists to support IPL/BBL for MGD control, and IPL is questionable as a treatment for ...
How long should you wait after superficial keratectomy for accurate IOL measurements?
I wait at minimum of 4 weeks and reassess topography to see if stabilizes. If not stable, I will repeat every 4. weeks until stable (usually no more than 3 months needed).
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
How do you approach tube shunt placement in very high myopes with thin sclera?
Due to decreased scleral rigidity in highly myopic eyes, there is a higher risk of hypotony and hypotony maculopathy with filtering surgeries, including tube shunts. In choosing the type of tube shunts, I would favor a valved tube shunt in high myopes. For surgical technique, I take great care when ...
Are there any special considerations for cataract surgery in a patient with ICE syndrome (Chandler) with a relatively clear cornea?
It is important to try and get a cell count before surgery to manage patient expectations in case of increased risk of endothelial failure. The cataract surgery should be straightforward unless there is a correctopia needing a pupillary dilator. To note that MIGS are usually not successful when comb...
Have you found a successful treatment option for fixed Descemet's folds following prolonged hypotony (after hypotony has been treated/resolved) or Descemet's striae from a surgical incision?
These are difficult situations. The best success I have had is doing DSEKs and suturing the graft in 4 quadrants with 10-0 nylon to prevent detachment. It takes longer to clear but prevents detachment, and the sutures can be removed once the edema is clear. The lifespan of these transplants is inher...
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...
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.
Do you incorporate diurnal or nocturnal IOP measurements in your management of progression despite seemingly adequate daytime control?
The advent of home-based tonometry can make diurnal or nocturnal IOP measurements more convenient to obtain, though the cost of renting or buying these devices may be prohibitive for some patients. Glaucoma specialists sometimes use diurnal or nocturnal IOP measurements to identify whether there are...
In patients with end-stage glaucoma requiring surgery (cataract or incisional glaucoma surgery), how do you approach discussion of possible "snuff" and how does this factor in your decision to proceed with surgery?
I have operated on hundreds, if not thousands, of patients with end-stage glaucoma over my career. Many CAT IOL + bleb surgery or Cat IOL alone. I cannot remember a snuff directly related to surgery. Judicious use of ER acetazolamide immediately postoperatively goes a long way. If cat IOL alone and ...