Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
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 ...
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 ...
In patients with myopic traction maculopathy, what clinical and imaging thresholds prompt you to intervene surgically rather than continue observation?
Given the risk of surgery, I typically follow patients conservatively as long as they feel the involved eye (when the other eye is covered) has visual function sufficient for important daily visual tasks such as reading, driving, working, etc. Many eyes continue to have functional vision even with v...
What is your approach to antiviral treatment of HSV acute retinal necrosis?
Acute Retinal Necrosis (ARN) is a rapidly progressive syndrome usually caused by varicella-zoster virus (VZV)and herpes simplex virus 1 or 2 (HSV). The syndrome is rapidly progressive in the absence of antiviral treatment. PCR performed on aqueous or vitreous sampling is highly sensitive and strongl...