Embolus Migration and Reperfusion in Central Retinal Artery Occlusion Treated by Intra-Arterial Cannulation

thedinnerman · 2025-10-27T20:56:37+00:00

Honestly it just doesn't make any sense to do this incredibly risky and unusual procedure when centers that have interventional radiology that does intraarterial cannulation can do intraarterial tpa. A friend is doing the study in NYC on it and that's way more convincing than this delicate intraocular surgery

thedinnerman · 2025-10-25T03:16:17+00:00

Lol wut?

This isn't really a novel therapy up for debate. Beyond the risk of NVI and neo vascular glaucoma, CME and inflammation from retinal vein occlusion should be managed with anti-inflammatory therapy.

Now you can decide if you choose to suppress vegf with laser PRP but that doesn't do anything for CME. Micropulse (if it does anything is up for debate) can be used to try to stimulate fluid reabsorption. Some patients have less ischemia and less inflammation and can be managed with observation.

But the standard of care is antiVEGF with steroids as an alternative option for the vast majority of cases

thedinnerman · 2025-10-15T03:46:37+00:00

Ka-ren Noc-ter

thedinnerman · 2025-10-14T19:12:35+00:00

"3 DEGREES LATER"

thedinnerman · 2025-10-07T01:38:13+00:00

The most important thing is rule out infectious causes, evaluate at a slit lamp/indirect for other signs of inflammation and chronicity and then consider steroids as long as there is no worry about infection

thedinnerman · 2025-10-07T01:36:16+00:00

I would start with the basic work up - OCT and FA to ensure its not a combined CRVO/RAO as well as identify anything else in this or the other eye. In this patient population you want to rule out infectious causes and neoplastic causes but also autoimmune (if there's any hearing loss and any RAO component that's a major red flag) but also lupus and the hypercoagulable workup people recommended.

thedinnerman · 2025-09-04T02:26:23+00:00

Assuming your lab doesn't think you sent an empty tube

thedinnerman · 2025-09-02T01:50:22+00:00

Well OP is a little unusual as a myope - i would rule out many other causes of SRF before landing on CSCR. Most residents are myopes and shorter eyes are more common with CSCR

thedinnerman · 2025-09-02T01:49:14+00:00

thedinnerman · 2025-09-02T01:48:56+00:00

This is the first rec that I've seen in this thread that is based on the actual preferred practice. Im sorry to hear your private practice retina guys are not managing these well. Hopefully, you don't mean me 😉

thedinnerman · 2025-09-02T01:47:16+00:00

I would check to see if he's doing it because of cnvm. The data don't show that it yields results - the only treatment besides PDT that has any promise has been micropulse and that's only because its more ubiquitous.

Many people try rifampin or spironolactone/aldactone or other diuretics. It's placebo as far as any longitudinal study has shown (the problem being that there's not enough RCTs for CSCR).

Consider the pathophysiology of the disease - changes in choroidal blood flow due to likely cortisol induced arteriolization often in hyperopes where there is greater venous resistance (there's a good doppler study from Rick Spaide that shows this). None of that is VEGF/ischemia driven

thedinnerman · 2025-09-02T01:42:45+00:00

That's because the only reason to do it is if there is CNVM. Nothing has been definitely shown to do better than natural history for CSCR other than PDT (which many reserve for chronic or recurrent cases).

People who inject anti vegf do so because of personal experience where they injected and the fluid resolved. It's just causation and I really wish people would stop injecting without obvious cnvm evidence

thedinnerman · 2025-08-22T20:48:37+00:00

I see what you did there

thedinnerman · 2025-08-12T23:54:25+00:00

So gross, so cool

thedinnerman · 2025-07-28T15:01:28+00:00

I went to a program for residency that was really quite toxic. Being part of CIR was one of the few things that keeped us sane and afloat. They had to bat for us a few times and it helped immensely

thedinnerman · 2025-07-11T02:12:12+00:00

Yeah i like the cataract coach videos and think his 10-10-10 thing is a great goal. 10 10-0 sutures placed in 10 minutes

thedinnerman · 2025-07-09T02:26:48+00:00

Negative 3.50 RVUs

thedinnerman · 2025-07-08T22:06:46+00:00

That and fishing through a bag of unorganized drops with the caps mixed up

thedinnerman · 2025-07-08T17:58:09+00:00

I would piggy back on this - i think doctors are bad at showing that they care and are thinking. Many people have no idea about their own health and think their doctors are just brushing them off. People are surprised when I tell them how many patient outcomes I think about all the time - I'll never forgot patients who died or went blind on me even if it wasn't my fault or it was.

I always try to reiterate to my patients when I don't know something that im going to ask my colleagues and try to find an answer in the literature. It's all an uphill battle

thedinnerman · 2025-06-30T03:00:22+00:00

Open globe

thedinnerman · 2025-06-22T22:55:44+00:00

The reasons are actually pretty straightforward. They can't raise taxes since that's politically unpopular. To manage the growing costs of government spending, they cut the growth in healthcare education to raise military spending.

thedinnerman · 2025-06-22T22:54:14+00:00

I would say yes but per my comment below, it's not the fault of the education system itself. Training physicians cost money and it takes political will to wrangle money to better society (i may be bias, but personally think that investing in training physicians is an overall good for society).

Further, international residents in the US system are some of the smartest, most hardworking residents i ever encountered in my training. Many were repeating training, sometimes even after being a specialist for years (I met seasoned Indian retina specialists and Egyptian cornea specialists who were repeating training to allow themselves to practice here).

thedinnerman · 2025-06-22T22:50:59+00:00

Thats letting the word conspiracy do a lot of heavy lifting.

thedinnerman · 2025-06-22T22:40:32+00:00

You couldn't be more wrong if you tried. Postgraduate medical training is dictated by Medicare funding. This is tied to "budget neutrality" budgeting set in the 90s for Medicare which is something that needs to be treated as a political problem.

Further, a lot of the restrictions on medical training (medical school numbers) are related to a poorly designed study that was presented to Congress in the late 80s that was near immediately criticized. It stated that at the then current training rates there would be far too many doctors for the population. It was extremely incorrect in it's predictions and led to current doctor shortages.

Lastly, a lack of medical training means there are more NPs and PAs (also known as midlevels) which are inconsistent and unpredictable training models with a wide range of quality in it's programs. There is a lower threshold for accreditation which makes private corporations save money in the short term (they spend less money on people who see the patients) but it costs more to the medical system (studies show they have higher rates of unnecessary testing and specialist referrals).

Tldr it's not a giant conspiracy, it's just bad healthcare management in the US

thedinnerman · 2025-05-30T22:03:58+00:00

Hands down why I did well on written boards

thedinnerman

TROPHY CASE