Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors influence the decision to initiate anti-VEGF injections to prevent radiation retinopathy after plaque brachytherapy?
A great and timely question! There is increasing evidence, based on several retrospective series, that prophylactic use of anti-VEGF agents (particularly bevacizumab) may provide better visual and structural (avoiding neovascular complications) in post-plaque melanoma patients. This is with injectio...
How often do you monitor asymptomatic atrophic holes and lattice in pediatric patients?
I do it annually unless there’s traction on the hole, in which case I would laser it. When young people have formed vitreous, it’s very, very uncommon for them to detach from an asymptomatic hole. That’s why we see adult patients with scarred holes who never had a laser. The body eventually figures ...
How do you decide on treatment modality for ocular surface squamous neoplasia?
For primary OSSN, my initial treatment modality will either be wide surgical excision with cryotherapy and amniotic membrane graft or medical treatment with 5-Fluorouracil drops QID x7 days, followed by a 3-week drop holiday. I find that there is little to no downside to trying 5-FU first, given tha...
What should be the first line treatment for metastatic uveal melanoma?
There is no consensus for frontline treatment of metastatic uveal melanoma. A clinical trial would be recommended for all patients if possible. If the disease is only within the liver, consideration of liver directed therapy would be reasonable. For metastatic disease beyond the liver checkpoint imm...
What is your preferred surgical intervention for lagophthalmos secondary to a facial paralysis and signs of exposure keratopathy?
If temporary or early in the recovery, consider stick-on external eyelid weights. If it has been several months without any improvement, I like to do gold or platinum permanent weights sutured to the tarsus, in addition to a lower lid tightening as Dr. @Dr. First Last mentioned.
How has using a chandelier for scleral buckling impacted your teaching or surgical outcomes?
Chandelier buckles are valuable in teaching primary scleral buckle to fellows early in their training, but do not offer significant benefits beyond this application. The reason is that management of the chandelier itself (in the eye for marking breaks and cryo, out of the eye for placement of the ba...
How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?
The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam ev...
How do you approach the management of epithelial ingrowth in a patient who underwent LASIK 20 years ago and developed epithelial ingrowth following recent cataract surgery?
If it’s a small area in the periphery, not causing any issue, then it would be reasonable to monitor it as it may not progress. If it is progressing or starting to cause issues, you can either try YAG, which may take more than one round, or simply lift the flap and scrape both the bed and underside ...
What strategies do you use to optimize cataract surgery outcomes in patients with anterior basement membrane dystrophy (ABMD)?
For the preoperative period, surface dryness should be well controlled; usually, artificial tears, punctal plugs, and Restasis are enough. Then, if the topography shows central irregular reading, I usually prefer to remove the epithelium and let it heal for a month before considering cataract surger...
What factors guide your decision to perform subretinal fluid drainage during primary scleral buckle surgery for a rhegmatogenous retinal detachment?
Since external drainage of subretinal fluid is the step in scleral buckle surgery associated with the greatest risk of serious complications (i.e. subretinal hemorrhage, retinal perforation, retinal incarceration), I only drain if the subretinal fluid so bullous that drainage is necessary to insure ...