Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach perioperative steroids for a quiescent uveitis patient undergoing cataract surgery?
Preop: If the patient is using topical steroids chronically, I increased the dose of the drops to four times a day the week prior to surgery. If the patient is using chronic oral prednisone, I will increase the prednisone to 0.5 mg/kg, 3 days prior to surgery, followed by a quick taper every 3 days...
How would you approach the management of a patient presenting with bilateral central corneal perforations following treatment with Ipilimumab/Nivolumab?
I am aware of at least one case report describing this situation (Aschauer et al., PMID 36072439).Ideally, the offending medication is halted, but when dealing with life-threatening cancer, this may not be possible, especially if the treatment is working. In the acute setting, trying to stabilize th...
Is there a role for PDT in a young patient with PXE and bilateral CNVM who requires intravitreal anti-VEGF injections every 4 weeks and is beginning to develop atrophy?
I am not a fan of PDT for patients who are developing incipient atrophy. The question says anti-VEGF therapy is being given every 4 weeks, but it is not clear what agent is being used. I would try 2nd generation therapy such as faricimab, 8 mg aflibercept, or possibly brolucizumab (after discussion ...
How do you approach recommending ocular exams for asymptomatic candidemic patients considering the discordance between the IDSA and American Academy of Ophthalmology guidelines?
Endogenous endophthalmitis due to Candida sp. occurs in <1% of patients with candidemia. The IDSA 2016 guidelines for management of candidiasis outline evaluation and treatment of patients with endophthalmitis, with recommendations to perform a dilated ophthalmologic exam on all patients with candid...
What has been your experience both intra-op and post-op with different non-valved implants (Baerveldt vs. Clearpath)?
In general, all 3 non-valved implant styles available in the US (Baerveldt, Clearpath, and Molteno) work quite similarly, and utilize similar techniques regarding ligation, tube modifications to create early flow anterior to the capsule, and postoperative course. The Molteno implants are slightly na...
In what scenarios do you consider using an amniotic membrane graft for macular hole closure?
Given that the success rate of closing macular holes is excellent when the hole is worth closing, and that there are no studies demonstrating the benefit to the patient of amniotic membranes for (presumably) very large and chronic holes, I can't recommend this approach. Having said that, I have no e...
How do you decide between repeat surgical correction vs. botulinum toxin injections for recurrent intermittent exotropia after previous surgery?
If the lateral rectus muscle has been recessed, it would be very challenging to get Botox accurately administered. Bilateral medial rectus resection would be easier and is very effective.
What has been your experience incorporating the Port Delivery System (PDS) into clinical practice?
My initial exposure was as a study surgeon, and the first patient I saw in the study had had the port system placed 9 months before. When I saw her, the port injection surface had become exposed with breakdown of the surrounding conjunctiva and tenons. This required urgent surgery and a conjunctival...
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.
How do you balance medical management versus additional glaucoma surgery in patients with advanced glaucoma who develop IOP elevation after healing from a trabeculectomy revision for bleb leak complicated by prior suprachoroidal hemorrhage?
This is a very complicated case, and I will commend you for handling such a case. I would typically start with medical management, and if the glaucoma is sufficiently controlled, then that would be sufficient. However, given the progressive and complex nature of glaucoma, the pressures may not be ad...