Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When do you consider placing an amniotic membrane when performing PRK?
I would consider it in cases of previous herpetic keratitis in the setting of neurotrophic keratitis or the presence of some KNV. Also, you can consider using it post-PK in some patients with limbal deficiency, but to know that PRK can increase the risk of corneal transplant rejection. As for normal...
Does your decision to start or continue Ozempic therapy in patients with diabetic retinopathy depend on the severity of the retinopathy?
Yes. The concern for use of semaglutide in patients with DR is based on results of the SUSTAIN-6 trial where patients at risk for cardiovascular disease were given 1 mg of semaglutide or placebo. While semaglutide decreased the progression of renal disease in this cohort, retinal complications were ...
How do you approach the management of amblyopia in children with developmental delays or cognitive impairments?
I agree with Dr. @Dr. First Last! We never want to not offer the best therapies to children due to a perceived developmental delay or cognitive impairment. Many times, families and patients will surprise us and do wonderfully. That being said, trying to understand the emotions of the family can be ...
What is your surgical approach for optic disc pit retinal detachments if laser treatment is unsuccessful?
Vitrectomy with ILM peeling, creation of a pedunculated ILM flap that I attempt to insert into the pit to serve as a plug, peripapillary laser barricade, gas tamponade, and face-down positioning. If that fails, I will also consider using tissue glue to try to plug the pit further along with repeatin...
What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?
Post-surgical (exogenous) endophthalmitis is an uncommon complication. The incidence ranges from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endophthalmi...
How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?
Susac's is a rare disease characterized by an occlusive retinal vasculopathy, eighth nerve disease including hearing loss and balance issues, and CNS disease with a predilection for involvement of the corpus callosum. I am not aware of any randomized controlled data to guide treatment for Susac's, b...
How would you approach management of nodular scleritis in the setting of suspected GCA?
Scleritis is probably a rare but real association with GCA. The rarity is such that I would not ignore alternative causes of scleritis. For example, ANCA-associated vasculitis could mimic GCA and syphilis has also been reported as a masquerade. Scleritis is usually divided into 5 forms: nodular, dif...
Can giant cell arteritis present with a partial cranial neuropathy?
Giant cell arteritis (although giant cells on temporal artery biopsy are not a sine qua non) most typically presents to the neuro-ophthalmologist with ischemic optic neuropathy (usually anterior and sometimes posterior).Ophthalmoplegia is uncommon in GCA but has been attributed to oculomotor and abd...
What is your approach to the treatment of visual snow syndrome?
Visual snow is not a syndrome. It's a symptom that consists of static vision. I opine that it's origin is retinal (not brain) and that it relates to ongoing activity. In the past I have referred to it as retinal repolarization disorder. It should not be confused with migraine aura status, which is a...
How do you approach re-operations for vertical strabismus in cases where prior horizontal muscle surgery has affected vertical alignment?
First, you need to know what was done in the previous surgery. Vertical strabismus often accompanies horizontal deviations even after routine surgery. DVD and superior or inferior oblique muscle overaction and the most common deviations. Once you have all of your information, you can plan appropriat...