Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How would you approach the management of posterior uveitis caused by Toxoplasma gondii in immunocompromised patients, considering the potential for atypical presentations and treatment resistance?
There are no established studies to confirm the best medications and duration for the treatment of toxoplasmosis retinitis. The recommendations are based on experience and consensus. Further, I am not sure how you established resistance since one rarely has the organism to test, and there is no rout...
What is the role of bilateral same-day cataract surgery in your practice?
Like many things in medicine, sometimes there are mental hurdles to jump over that are more challenging than operational or evidence-based hurdles. We perform many invasive procedures, bilateral same day: laser vision correction, intravitreal injections, phakic IOLs, etc. Yet many of us, myself incl...
How do you determine the timing and necessity of surgical removal for retained subretinal perfluorocarbon?
Timing: Defer PFO removal until after you are convinced the retina is attached and will likely stay attached (e.g., after gas resolves or, if under oil, later than 8 weeks). Necessity: Plan for surgical removal if subretinal PFO is foveal or perifoveal. If not, then defer indefinitely unless PFO loc...
What alternative treatments do you recommend trying for patients struggling with persistent, chronic ocular surface pain following refractive surgery unresponsive to traditional methods (i.e., lubrication, topical cyclosporine, punctal plugs)?
The first step is to identify the underlying cause of pain. If nociceptive: Target the visible source of pain. If peripheral neuropathic (e.g., due to corneal nerve abnormalities): Consider topical therapies that modulate nerve function, such as autologous blood-derived products (PRGF, AST, PRP) or...
How do you typically manage the use of intravitreal antibiotics during globe repair?
At the end of the case, if no allergies, I will inject vancomycin and ceftazidime intravitreal. If there was vegetable matter involved in the injury (tree branch), I would include an antifungal like voriconazole.
How has intraoperative OCT influenced your surgical decision-making during complex macular cases?
I use iOCT very frequently because I am sent a lot of patients who failed surgery elsewhere. The most common situation is failure of macular hole closure. Sometimes it’s not clear what areas have been peeled, even with staining with ICG or Brilliant Blue G (BBG). Having the iOCT makes it easier to s...
What has been your impression of the clinical outcomes for photobiomodulation for dry AMD?
I’m not impressed by a 2.4-letter improvement over placebo after 27 treatments. It sounds like noise and can be compared to a drop of preservative-free artificial tears. It’s not like we have tons of clinic availability to spend our time on such trivial improvements. We need a better assay to find t...
In patients with retinitis pigmentosa–associated cystoid macular edema that is refractory to medical management, does pars plana vitrectomy have a therapeutic role?
Patients with RP have an increased incidence of macular edema (CME) and epiretinal membranes (ERM). If CME is associated with ERM, then there may be a role of PPV with membrane peel, but if CME is isolated, oral or topical carbonic anhydrase inhibitors would be considered the treatment of choice.
What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?
In a study by Bidot et al., PMID 26457687, transverse venous sinus stenosis (TVSS) was the most useful sign of IIH because of its high pooled sensitivity (97%) and specificity(93%). Orbital findings, such as optic nerve head protrusion, posterior scleral flattening, optic nerve tortuosity, and diste...
What clinical or OCT-based parameters guide your decision to perform an ERM peel in patients with DME and concurrent ERM?
The presence of an ERM in a patient with DME negatively impacts the response to anti-VEGF injections and reduces the efficacy of the injections. The ERM acts as a physical barrier, reducing drug penetration, and can also contribute to the progression and persistence of DME through the production of ...