Ophthalmology   

Patient with a history of presumed benign ethnic neutropenia: PMN 1.5 prior to azathioprine and 1.2 after starting. The patient has an intolerance to ...

For LINAC radiosurgery systems, when would you neither offer hypofractionated SRS or SRS for benign perioptic lesions? Is there a distance from the op...

This question is part of a collaboration with RheumMadness and is specifically in reference to: Cost Effectiveness of HCQ Screening.

Is it necessary to do a taper afterward and what would be the recommended tapering schedule/duration? 

The patient has no extraocular features of a spondyloarthropathy and is on methotrexate. No active eye disease for past 1 year.

Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?

Are these toxicities expected to improve over time?

No active joint disease, patient on Hydroxychloroquine and Cimzia. Normal ESR/CRP.

For some patients, it may be overburdensome to make an extra trip to an ophthalmologist every other cycle. They may live far away from an ophthalmolog...

What would be your RT volumes and dose?

Patient previously trialed two anti-TNFi and Tocilizumab. Avoiding Rituximab due to positive JC virus testing. 

Can nodular scleritis be a presenting manifestation of GCA?

Is the diagnosis of Sjogren's mostly clinical in a patient with a consistent history and physical with positive serologies?

And have you ever seen it occur in isolation without any other manifestations of SLE? 

Is there a role for oral antiviral therapy alone (as opposed to induction with IV) and for what duration? And is there a role for ongoing suppressive ...

What is your approach to guiding ophthalmologists regarding our clinical suspicion for ocular syphilis and does the quantification of the titer help i...

Would the management change if there were complications with optic neuritis?

Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...

If so, when do you recommend timing for the cataract surgery? 

Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.

Female patient in her 20's with RA/SLE has been on steroids and methotrexate, currently on HCQ and Orencia. Failing Orencia with active disease. Want ...

Other manifestations improved (renal function has stabilized, fatigue, arthritis, and LCV have resolved). Ophthalmologist has controlled the uveitis u...

Patient with history of toxoplasma chorioretinitis, currently on oral and topical prednisone. 

Patient has failed methotrexate and adalimumab. 

Patient failed topical ocular therapies, methotrexate, azathioprine.

Is the approach different from uveitis immunosuppression?

Do you refer them to Ophthalmology? Have you had to switch patients off of Dupixent due to their ocular side effects?

Would increased risks from concurrent intravitreal avastin preclude treatment? Would you recommend a waiting period in between the treatments?

If patients are asymptomatic, what work up do you typically proceed with?

Do you wait for a second clinical event or start immunomodulatory therapy right away?

Specifically, what do you do if there is minimal improvement with IV steroids and/or IVIG?

What immunosuppression and dosing do you typically use?

If so, what dose and fractionation would you recommend?

Ex. optical coherence tomography, visual-evoked potentials

Are there specific features that suggest drug-induced uveitis versus de novo uveitis?

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

Are IL-17 or IL-23 inhibitors helpful?

Patient was previously well controlled on methotrexate, which was discontinued during cancer treatment.

In this scenario, is systemic treatment better given bilateral involvement? In a patient who has already had cataract surgery and is not at risk for c...

Would you recommend screening MRIs for children who have RB1 mutations but have not yet developed retinoblastoma?

Are there exclusion criteria?

Would you suspect progressive disease v. radiation necrosis vs optic neuritis due to immunotherapy. Eyes were within radiation field 8 months ago.&nbs...

Do you prescribe to 5mm/apex or use a margin? Do you add time for tumor growth or allow less than the prescription dose to the apex?

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possib...