Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors should be considered when deciding the best timing for choroidal drainage in a monocular patient with a suprachoroidal hemorrhage and a concurrent retinal detachment?
Reason for the suprachoroidal hemorrhage, size, duration, nature of the retinal detachment, and other coexisting conditions are some factors to consider. A therapeutic level of coumadin, use of antiplatelet medications are fine; clearly a greatly elevated INR is a contraindication. Some surgeons mig...
What’s your approach to managing postoperative inflammation and CME in high-risk patients after cataract surgery?
As a retinal specialist, I often receive referrals from my cataract surgery colleagues for patients with cystoid macular edema (CME) post-cataract surgery. My initial approach involves topical steroids combined with a topical NSAID. I re-evaluate these patients in two to four weeks to assess for ana...
How do you manage a patient with giant cell arteritis treated with weekly tocilizumab and low dose glucocorticoid who develops sudden vision loss?
Fortunately, this scenario is a rare event, as most patients treated with ongoing tocilizumab (TCZ) and prednisone are at a far lower risk for developing new visual loss due to giant cell arteritis (GCA). A recent paper by Amsler et al., PMID 33752737 reviewing the risk for visual loss in patients b...
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...