Following the Fellows at Cleveland Clinic Cole Eye Institute: Dr. Paula Pecen

Paula E. Pecen, MD, is a second year Vitreoretinal Fellow at Cole Eye Institute, Cleveland Clinic, Cleveland, OH. Dr. Pecen shares her thoughts with RetinaLink as she completes her Fellowship. She plans to join the University of Colorado in Aurora, CO, in July.

Dr. Aleksandra Rachitskaya, who is one of Dr. Pecen’s Attendings’ said, “Dr. Paula Pecen is a superb viteroretinal fellow. If you ask her to do something, you often find that she has already thought of it and has done it five minutes ago. Her surgical skills and medical acumen are impressive. I look forward to seeing Paula begin her career in academic medicine and to her future contributions to our field.”

Where did you go to Medical school?
P. PECEN, MD: I attended Medical School at Duke University in Durham, North Carolina.

Why did you choose Retina versus another subspecialty?
P. PECEN, MD: Retina is a challenging subspecialty with a wide variety of pathology and the ability to treat and help not only retina problems, but also help other surgeons in other ophthalmology subspecialties (for example, draining hemorrhagic choroidals for our glaucoma friends, or removing retained lens fragments for our cataract surgeon colleagues).

What was the biggest surprise in your first year of Fellowship?
P. PECEN, MD: How different retina surgery was compared to all of the anterior segment surgery I had done as a resident.

What’s your favorite small gauge platform? And why?
P. PECEN, MD: 25-gauge vitrectomy seems to be the most versatile platform that lends itself to all diabetic cases, retinal detachments and macular cases – all of the instruments I prefer are available in 25-gauge and I don’t have any issues with too much flexibility like with 27-gauge instruments.

What is your favorite hand-held instrument and why?
P. PECEN, MD: I prefer using the 25-gauge Tano asymmetric forceps for peeling Epiretinal & Internal Limiting Membranes (ERM/ILM).

Is that different than what your Attending Physicians use during surgery?
P. PECEN, MD: Some of my attendings use Tano Asymmetric forceps, others use ILM or Eckardt forceps.

When treating a new patient with AMD, what is your preferred anti-VEGF treatment regimen?
P. PECEN, MD: I tend to start with bevacizumab (Avastin) monthly PRN, if the patient fails PRN treatment then I start monthly treatment until the patient is stable/plateaued or dry and then change to a treat-and-extend algorithm increasing by 1-2 weeks up to 12 weeks.

Do you change your anti-VEGF treatment regimen, if your patient is not responding to your first line of treatment?
P. PECEN, MD: Yes, if there is a poor or incomplete response to bevacizumab after 3 injections, I tend to change to aflibercept (Regeneron’s EYLEA); I consider ranibizumab (Genentech’s LUCENTIS) as a third line alternative.

What is your favorite place to vacation when you have a few days off?
P. PECEN, MD: Any type of mountain – I love hiking, running, biking and skiing.

What’s your advice for incoming Fellows in July?
P. PECEN, MD: Get ready to work hard and enjoy it! Hang out with your co-fellows and have fun! Try to get as much experience during fellowship, because this is the last step before you’re on your own.

Dr. Paula Pecen can be reached by e-mail at

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