Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Which patients are good candidates for micropulse CPC?
Micropulse CPC is a suitable option for treating elevated IOP in a number of scenarios: advanced VF loss resulting in a small central or temporal island, intolerant to topical/oral glaucoma meds, poor general health limiting interventional surgery, no social support, and non-compliance.
Have you experienced any significant refractive regression years after the final lock-in for light adjustable lenses?
But to be fair, the people who do these lenses have a vested interest in being positive about them. I would like to see a prospective double blind study.
In eyes with chronic DME despite frequent anti-VEGF, what is your threshold to add or switch to intravitreal steroid therapy?
I’m quick to add steroids to anti-VEGF treatment. If there is little to no response to 3 anti-VEGF injections, adding a dexamethasone implant (Ozurdex) can help a lot. I will usually do that before switching in class. I usually switch to a different anti-VEGF if there is good but incomplete response...
How does a history of malignant glaucoma in one eye influence your surgical approach to the fellow eye, particularly regarding prophylactic/intra-operative measures (i.e., iridotomy, IZH)?
Although this is not a common occurrence, a history of malignant glaucoma in one eye will affect my surgical planning in the fellow eye. I have performed a prophylactic IZH in the fellow eye during cataract surgery. Additionally, I make sure that when appropriate, all fellow eyes have received a las...
What surgical strategies do you recommend for managing isolated skew deviation after stroke?
Skew deviation is a tough matter to diagnose and treat, but as a general fact the most cases of skew deviations occur along with an acute stroke or as a consequence of demyelinating disorders. Thankfully, most of them tend to disappear after a few weeks and rarely require treatment. Between the chro...
How important are retinal fluid fluctuations for long-term vision and how do you factor them in when making treatment decisions for conditions like nAMD and DME?
I think the question has been asked in a different form here. As I have commented on Mednet previously, it depends on a lot of factors, primarily: Are you treating the OCT or the patient? I'd also say the answer is very different for nARMD (or any CNVM) DME or edema from RVO. People: this is not a o...
In cases of failed endothelial keratoplasty with concurrent cataract, do you favor repeat keratoplasty plus lens extraction in the same setting or sequential surgeries?
I tend to favor combining the two into one surgery. If the view is not clear enough or the patient is interested in a more accurate refractive outcome, the surgery can, of course, be staged with the endothelial keratoplasty first, followed by cataract surgery about 3 months or so later. With the use...
How would you advise a younger patient with residual/recurrent optic nerve meningioma, proceeding with radiotherapy, about the risks of malignant transformation or induction of other brain malignancies because of radiation?
The risk of malignant transformation of an optic nerve sheath meningioma (ONSM) after RT appears to be remarkably low, much lower than the risk of blindness from an untreated, progressive ONSM. In a younger patient, I would lean toward RT for patients with imaging progression or early visual loss, ...
What is the best time frame to intervene surgically for the management of traumatic macular hole, and what techniques should one consider?
Traumatic macular holes differ from idiopathic holes as a moderate proportion may close spontaneously, particularly in younger patients and with smaller holes. Studies have quoted approximately 40+% spontaneous closure in traumatic macular holes compared to 5% for idiopathic macular holes. For this ...
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...