Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Is there any role for topical corticosteroids in the treatment of photokeratitis?
Typically not, as this is not an inflammatory condition. The goal is to provide supportive care with aggressive lubrication and pain control with topical cycloplegics until epithelial regeneration occurs.
Do you stop netarsudil or brimonidine for patients with very injected conjunctiva prior to trabeculectomy, and what do you feel is the benefit?
I find Rhopressa helpful in lowering IOP pre-op surgery, but it can cause inflamed conjunctiva, so I stop 1 week prior to surgery and prefer brimonidine 0.15% (Alphagan P), and it may have neuroprotective value as well.
What are some special considerations for treatment of glaucoma and IOP lowering in patients with optic disc drusen?
Optic disc drusens (ODDs) in patients with glaucoma provide unique challenges for clinicians. ODDs on the surface of the optic disc are easy to spot; deeper (buried) DDs are difficult to diagnose. They require deeper B-scan cuts or require extended depth (ED) options. One must be cautious not to ove...
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 is your approach to intralesional steroid injection for chalazia (in terms of dosage, approach, timing)?
I offer the option of intralesional steroid to all patients with chalazia, particularly if there is significant inflammation present. I give up to 1 cc of a 10 mg/mL solution of dexamethasone. I have approached this by both transconjunctival as well as transcutaneous. I think transconjunctival hurts...
How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?
The optimal treatment approach for primary intraocular lymphoma is debated. This is a rare disease with only small retrospective series guiding therapy. There is no clear superior treatment approach in the literature. In clinical practice, younger patients are often treated initially with high-dose ...
How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?
Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!
In primary angle closure suspects without cataracts, how do you approach the discussion about LPIs, given the relatively low risk of an acute angle closure attack?
In primary angle closure suspects without cataracts, I will have a discussion about aqueous humor dynamics and outflow mechanisms of the eye, and how that relates to risk stratification in the patient's case. We are fortunate in glaucoma to have a fair bit of evidence to guide us in our clinical dec...
How do you approach IOL calculations and selection in patients with keratoconus based on disease severity?
Lens selection assuming stable KCN and no plan for a transplant: Symmetrical astigmatism and they don't want to wear CL after surgery? Can consider a toric lens. Symmetrical astigmatism and they are okay with continuing RGP/sclerals? Monofocal aberration-free lens. Asymmetrical astigmatism and want...
In what cases do you consider mannitol for cataract surgery?
I have found IV mannitol VERY helpful for dehydrating vitreous for short axial length, especially around 20.5 or less. Otherwise, in short eyes, there is less working space and a greater tendency for the iris to want to prolapse out, even in the absence of typical IFIS-type medications. I’ve typical...