Showing papers in "Current Ophthalmology Reports in 2020"
TL;DR: Global ophthalmology is a field dedicated to building sustainable eye care delivery systems to deliver high-quality care in minimal resource settings, with the aim of reducing blindness around the world.
Abstract: Our goal is to provide a review of the impact, global estimates, and projection of vision impairment as well as ongoing systems for eye care delivery. Many of the blinding diseases in developing countries are preventable or curable, but the lack of ophthalmologists, the lack of education, and the lack of access to any eye care are some of the major obstacles encountered. As our world becomes more interconnected through globalization, the interactions between different cultures and populations increase. Global ophthalmology is a field dedicated to building sustainable eye care delivery systems to deliver high-quality care in minimal resource settings, with the aim of reducing blindness around the world.
18 citations
TL;DR: Recent advances in strategies that aim to restore optic nerve function and vision in glaucoma through protective, reparative, and regenerative avenues are summarized.
Abstract: We summarize recent advances in strategies that aim to restore optic nerve function and vision in glaucoma through protective, reparative, and regenerative avenues. Neuroprotection relies on identification of early retinal ganglion cell dysfunction, which could prove challenging in the clinic. Cell replacement therapies show promise in restoring lost vision, but some hurdles remain in restoring visual circuitry in the retina and central connections in the brain. Identification and manipulation of intrinsic and extrinsic cellular mechanisms that promote axon regeneration in both resident and transplanted RGCs will drive future advances in vision restoration. Understanding the roles of multiple cell types in the retina that act in concert to promote RGC survival will aid efforts to promote neuronal health and restoration. Effective RGC transplantation, fine tuning axon guidance and growth, and synaptogenesis of transplanted and resident RGCs are still areas that require more research.
18 citations
TL;DR: In this systematic review, the prevalence of ocular symptoms and signs was low and conjunctivitis was a relatively rare occurrence, and further studies are needed to evaluate the viral tropism of SARS-CoV-2 and its role in the eyes.
Abstract: Studies have reported ocular involvement in the coronavirus disease 2019 (COVID-19), with SARS-CoV-2 having been detected in ocular swab samples. This has implicated the eye as a portal of transmission. The aim of this systemic review is to summarise and discuss the current literature regarding ocular involvement of SARS-CoV-2 in COVID-19. In this systematic review, the prevalence of ocular symptoms and signs was low (from 0 to 31.58%) and conjunctivitis was a relatively rare occurrence. The rate of detection of SARS-CoV-2 in the ocular swab samples was low as well and this ranged from 0 to 11.11%. The development of ocular symptoms and signs was not always accompanied by the detection of SARS-CoV-2 in the ocular swab samples. The opposite was described as well. This may reflect issues related to the characteristics of SARS-CoV-2 and of the study design. Nonetheless, the nature of research in a pandemic is that conclusions can change as more information is obtained. Whilst the eye is unlikely to be a main transmission route, we need to consider the possibilities of conjunctivitis as a presenting complaint and of the eye playing a role in the transmission of SARS-CoV-2. Furthermore, we need to take the appropriate precautions in our practice. Further studies are needed to evaluate the viral tropism of SARS-CoV-2 and its role in the eyes.
17 citations
TL;DR: This work critically appraises the recent literature about new surgical techniques for the management of large or recurrent macular holes and concludes that more data is needed to determine if one technique is superior to others.
Abstract: To review and critically appraise the recent literature about new surgical techniques for the management of large or recurrent macular holes. A variety of surgical approaches have recently been developed ranging from autologous retinal grafts to amniotic membrane transplant with varying levels of anatomical and visual success. More data is needed to determine if one technique is superior to others. However, with a variety of grafts, adhesives, and tamponades at their disposal, vitreoretinal surgeons have an extensive array of options to approach complex macular holes.
12 citations
TL;DR: An understanding and review of artificial intelligence in the subspecialty of retina and its potential applications within the specialty and a basic understanding of the technology is important for its effective implementation and growth.
Abstract: In the present article, we will provide an understanding and review of artificial intelligence in the subspecialty of retina and its potential applications within the specialty. Given the significant use of diagnostic imaging within retina, this subspecialty is a fitting area for the incorporation of artificial intelligence. Researchers have aimed at creating models to assist in the diagnosis and management of retinal disease as well as in the prediction of disease course and treatment response. Most of this work thus far has focused on diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity, although other retinal diseases have started to be explored as well. Artificial intelligence is well-suited to transform the practice of ophthalmology. A basic understanding of the technology is important for its effective implementation and growth.
9 citations
TL;DR: Doomed optoelectronic devices using external camera for images are unaffected by corneal or lens opacities but disconnect eye movements from image perception, while the opposite is true for implants directly detecting light.
Abstract: The goal is providing an update to the latest research surrounding optoelectronic devices, highlighting key studies and benefits and limitations of each device. The Argus II demonstrated long-term safety after a 5-year follow-up. Due to lack of tack fixation, subretinal implants appear to displace over time. PRIMA’s completed primate trial showed initial safety and potential for improved vision, resulting in ongoing clinical trials; Bionic Vision Australia developed a new 44-electrode suprachoroidal device currently in a clinical trial. Orion (cortical stimulation) is currently undergoing a clinical trial to demonstrate safety. Devices using external camera for images are unaffected by corneal or lens opacities but disconnect eye movements from image perception, while the opposite is true for implants directly detecting light. Visual acuity provided by devices is more complicated than implant electrode density, and new devices aim to target this with innovative approaches.
8 citations
TL;DR: Both transcriptomics and proteomics studies using genome-wide gene/protein expression profiling techniques have identified significant genes/proteins that may contribute to the pathogenesis of keratoconus and may be involved in functional categories related with extracellular matrix and TGFβ signaling.
Abstract: To summarize the recent advances in transcriptomics and proteomics studies of keratoconus using advanced genome-wide gene and protein expression profiling techniques. Second-generation sequencing including RNA sequencing has been widely used to characterize the genome-wide gene expression in corneal tissues or cells affected by keratoconus (KC). Due to variations in sample types, sequencing platforms, and analysis pipelines, different lists of genes have been identified to be differentially expressed in KC-affected samples. Gene ontology and pathway/network analyses have indicated the involvement of genes related with extracellular matrix, WNT signaling, TGFβ pathway, and NRF2-regulated network. High-throughput proteomics studies using mass spectrometry have uncovered many KC-related protein molecules in pathways related with cytoskeleton, cell matrix, TGFβ signaling, and extracellular matrix remodeling, consistent with gene expression profiling. Both transcriptomics and proteomics studies using genome-wide gene/protein expression profiling techniques have identified significant genes/proteins that may contribute to the pathogenesis of keratoconus. These molecules may be involved in functional categories related with extracellular matrix and TGFβ signaling. It is necessary to perform comprehensive gene/protein expression studies using larger sample size, same type of samples, and up-to-date platform and bioinformatics tools.
8 citations
TL;DR: An increasing evidence of real-world studies has supported utility of the FAc implant in DME patients, and it is effective in chronic DME with the added value of decreasing the treatment burden of multiple intravitreal injections.
Abstract: Fluocinolone acetonide is a synthetic fluorinated glucocorticoid. It has selective and potent agonist properties by binding to the cytosolic glucocorticoid receptor with high affinity; it is devoid of mineralocorticoid activity. Two extended-release (i.e., lasting up to 3 years) drug delivery systems containing fluocinolone acetonide (FAc) have been approved by the FDA for intravitreal use: Retisert® (BauschL however, intraocular pressure rises may be lower than the ones reported in trials. The implant has shown effectiveness in vitrectomized eyes. An increasing evidence of real-world studies has supported utility of the implant in DME patients. Its extended-release format for up to 3 years benefits the patient and carer as it means fewer injections and visits to the clinic.
8 citations
TL;DR: Existing retinal tamponades, including perfluorocarbon heavy liquids, fluorinated gases, and silicone oil, have specific limitations that cause potentially avoidable morbidity, and potential novel developments that address those limitations are highlighted.
Abstract: In this article, the current use and limitations of existing retinal tamponades are discussed. Potential novel developments that address those limitations are subsequently highlighted, along with areas of future improvements. While retinal tamponades have existed for decades and improved the treatment of retinal detachments, many problems still exist with their use, including inadequate tamponade of the inferior retina, toxicity from retained heavy liquids, glaucoma, and keratopathy, among others. New advancements in the components of heavy liquids and vitreous substitutes aim to mitigate those issues. Existing retinal tamponades, including perfluorocarbon heavy liquids, fluorinated gases, and silicone oil, have specific limitations that cause potentially avoidable morbidity. New developments, such as heavy silicone oil, novel vitreous gels, and future avenues of approach, such as potentially reabsorbing heavy liquids may help increase our ability to treat retinal detachments with fewer complications.
6 citations
TL;DR: SD-OCT is the most established method for evaluating retinal anatomy and offers the benefits of a reduction in cases with missed macular pathology and fewer post-operative visual surprises.
Abstract: To review evidence on the utility of spectral domain optical coherence tomography (SD-OCT) in evaluating retinal structure prior cataract surgery and highlight new technologies that can assess retinal function perioperatively. SD-OCT detected clinically unsuspected macular pathology in 4.6–25% of individuals in the pre-operative cataract evaluation. The most common findings were epiretinal membrane and macular degeneration with frequencies that varied by population studied. These conditions have been associated with complication after surgery (e.g., macular edema, visual dissatisfaction). As such, findings on SD-OCT may impact the informed consent process, alter IOL selection, and provide realistic post-operative vision expectations. Other technologies that assess retinal function, such as microperimetry and multifocal ERG are beginning to be studied but their utility in the pre-operative cataract evaluation is not yet known. SD-OCT should be incorporated as a routine test prior to surgery to manage patient expectations and assist with optimal IOL selection, as even individuals with a seemingly normal clinical exam may have macular pathology. SD-OCT is the most established method for evaluating retinal anatomy and offers the benefits of a reduction in cases with missed macular pathology and fewer post-operative visual surprises.
6 citations
TL;DR: With the development of technology in detecting corneal nerves, this work can quantify the disease progression by which greatly benefits theDevelopment of corNEal regenerative treatment.
Abstract: We summarize recent developments in modern diagnostic tools for the corneal nerves, the diseased status reflected in corneal nerve changes, and the possible corneal nerve regenerative treatments. In vivo confocal microscopy (IVCM) and en face optical coherence tomography (EFOCT) are reliable tools for detecting the morphological changes of corneal nerves; while the esthesiometry is useful for studying the functional status of the corneal nerves. Corneal tortuosity increases in dry eye disease (DED) and neuropathic pain. Decreased of corneal nerve density in neurotrophic keratopathy (NK) is a marker of disease progression. Topical treatments of corneal nerve regeneration include substance P/insulin-like growth factor-1 combination and nerve growth factor. Blood-derived products rich in neurotrophic factors are also under investigation. For refractory NK, surgical corneal neurotization could be considered. With the development of technology in detecting corneal nerves, we can quantify the disease progression by which greatly benefits the development of corneal regenerative treatment.
TL;DR: The current market of intraocular lenses provides patients with the opportunity to experience spectacle independence following refractive cataract surgery, and current options include monovision with monofocal lenses, multifocal intraocular lens, extended depth of focus intraocular eyes, and pseudo-accomodative intraoculareyes.
Abstract: In this article, we review the latest research related to presbyopia management at the time of cataract surgery with attention focused on available options in the USA. With refractive cataract surgery, patient satisfaction is largely dependent on preoperative expectations with regard to spectacle independence and photic phenomena. Monovision with monofocal intraocular lenses have the highest rates of spectacle dependence but the lowest rate of photic phenomena. Extended depth of focus lenses provides excellent distance and intermediate vision, but patients often require glasses for near vision in addition to having mild glare and halos. Refractive multifocal lenses tend to have the highest rates of photic phenomena. Both diffractive and refractive multifocal lenses had excellent near and distance visual acuity but difficulty with intermediate vision. Trifocal lenses provided the most consistent vision at near, intermediate, and distance and only had moderate amounts of glare and halos with excellent patient satisfaction. The current market of intraocular lenses provides patients with the opportunity to experience spectacle independence following refractive cataract surgery. Current options include monovision with monofocal lenses, multifocal intraocular lenses, extended depth of focus intraocular lenses, and pseudo-accomodative intraocular lenses. Future technology is focusing on accommodation, pinhole apertures, and improved multifocality.
TL;DR: This review presents an updated evidence-based summary on the pathophysiology, classification, diagnosis, and how novel therapies have changed the management of Neurotrophic keratopathy.
Abstract: Neurotrophic keratopathy (NK) is a challenging ophthalmological disease. In this review, we present an updated evidence-based summary on the pathophysiology, classification, diagnosis, and how novel therapies have changed the management of NK. New specific medical and surgical modalities are emerging, such as Cenegermin (Oxervate®, Dompe) and neurotization procedures, which are changing the paradigm of the treatment of NK. In addition, more diagnostic resources are available, such as corneal confocal microscopy in vivo, non-contact esthesiometers, and common ocular surface points of care test, which have been validated in this condition. NK is a disease produced by an impairment of corneal innervation caused by a variety of local and systemic disorders, such as viral infection, medicamentosa, chronic contact lens use, surgical or iatrogenic, diabetes, multiple sclerosis, and more, that leads to a progressive chronic epitheliopathy with a variable degree of injury. Early diagnosis can be challenging due to low prevalence, clinical suspicion, and the need for complementary diagnostic methods to confirm. New medical and surgical treatment modalities have emerged that are specifically directed to the pathophysiology of NK with promising results.
TL;DR: There appears to be minimal association between intravitreal injections and RNFL thinning among non-glaucomatous eyes, but fewer studies have been published, and results have varied due to challenges in study design.
Abstract: To summarize the available literature on retinal imaging metrics in the context of intravitreal injections in glaucomatous and non-glaucomatous eyes. The retinal nerve fiber layer (RNFL) in injected non-glaucomatous eyes appears to thin at a similar rate to uninjected fellow eyes. A total of four studies evaluating RNFL thinning in injected glaucomatous eyes yielded mixed results, with more recent longitudinal investigations suggesting a potential association. The ganglion cell-inner plexiform layer is also being studied as a potential endpoint in both glaucomatous and non-glaucomatous eyes following intravitreal injections. There appears to be minimal association between intravitreal injections and RNFL thinning among non-glaucomatous eyes. However, in glaucomatous eyes, fewer studies have been published, and results have varied due to challenges in study design. Additional prospective studies with longer follow-up periods are warranted.
TL;DR: Surgical techniques for corneal neurotization (CN) and novel medical therapies for the treatment of NK are reviewed and cenegermin (Oxervate®, Dompé), a topical biologic medication, has emerged as an approved medical treatment for moderate to severe NK.
Abstract: Neurotrophic keratopathy (NK) is a degenerative corneal disease characterized by decreased corneal sensibility and impaired corneal healing. In this article, we review surgical techniques for corneal neurotization (CN) and novel medical therapies for the treatment of NK. In recent decades, there has been a paradigm shift in the treatment strategies for NK. New minimally invasive direct and indirect CN approaches have demonstrated efficacy at improving best-corrected visual acuity and central corneal sensation while decreasing surgical morbidity. In addition, several targeted medical therapies, such as recombinant human nerve growth factor (rhNGF), regenerating agents (RGTA), and nicergoline, have shown promise in improving corneal epithelial healing. Of these options, cenegermin (Oxervate®, Dompe), a topical biologic medication, has emerged as an approved medical treatment for moderate to severe NK. NK is a challenging condition caused by alterations in corneal nerves, leading to impairment in sensory and trophic function with subsequent breakdown of the cornea. Conventional therapy for NK depends on the severity of disease and focuses primarily on protecting the ocular surface. In recent years, numerous CN techniques and novel medical treatments have been developed that aim to restore proper corneal innervation and promote ocular surface healing. Further studies are needed to better understand the long-term efficacy of these treatment options, their target populations, and the potential synergistic efficacy of combined medical and surgical treatments.
TL;DR: Despite its systemic underlying etiology, organ-specific ocular GVHD is best treated through organ- specific topical management which allows reduction of symptoms and complications.
Abstract: This review offers an informed insight on the pathophysiology of ocular graft-versus-host disease in addition to up-to-date recommendations for monitoring and management. Ocular GVHD is estimated to affect tens of thousands of individuals in the USA. It is not known how many of these patients are aware of their condition or seek therapy for it. Diagnosis of ocular GVHD poses a difficult challenge due to the unspecific nature of the presentation. However, improvement in diagnostic criteria through available testing and updated guidelines can allow early identification promoting appropriate intervention. GVHD is a systemic disease that can involve any organ including the eye. Ocular GVHD is estimated to affect 40–60% of patients undergoing allogeneic hematopoietic stem cell transplant. The disease can result in significant morbidity and mortality and continues to pose a diagnostic challenge despite continuous revision of the available criteria. Multiple therapeutic options are available and have shown promise. Despite its systemic underlying etiology, organ-specific ocular GVHD is best treated through organ-specific topical management which allows reduction of symptoms and complications.
TL;DR: Considering etiological and anatomical differences, the adapted DMEK for Asian eyes is adapted and several technical modifications to improve clinical outcome are developed.
Abstract: Descemet membrane endothelial keratoplasty (DMEK) has become the treatment of choice for endothelial diseases such as Fuchs endothelial corneal dystrophy (FECD), especially in the United States and Europe. In this review, we give an overview of current knowledge about DMEK in Asian eyes and describe novel surgical modifications of this technique for these cases. Although many scientific reviews about DMEK in Caucasian eyes have already been published, there is still little knowledge about clinical outcomes of DMEK in Asian eyes. This is of particular importance, as there are substantial differences between DMEK in Asian and Caucasian eyes. Bullous keratopathy is the main indication for endothelial keratoplasty in Asia, whereas it is FECD in Caucasian countries. Considering etiological and anatomical differences, we have adapted DMEK for Asian eyes and have developed several technical modifications to improve clinical outcome. Our work might be helpful in performing successful DMEK in the Asian setting.
TL;DR: In this paper, photodynamic therapy with green light optical irradiation (RB-PDAT) was used to prevent the infection from progressing and strengthen the collagen of the cornea.
Abstract: Infectious keratitis is a sight-threatening microbial infection. The prevalence of antimicrobial resistance in cases of infectious keratitis has increased the demand for fortified compounded antimicrobial drops. Even with proper medical management, severe cases of infectious keratitis can further evolve into corneal perforation, requiring surgical intervention in the form of keratoplasty to control the infectious process. Due to the invasive nature of the procedure and the shortage of available donor tissue around the world, alternative treatments are needed for the management of progressive infectious keratitis. In ophthalmology, photodynamic therapy (PDT) has been used for numerous applications. PDT with Rose Bengal as a photosensitizer combined with green light optical irradiation (RB-PDAT) is a novel treatment with dual purpose: to arrest the infection from progressing and strengthen the collagen of the cornea. RB-PDAT may be considered as an adjunct therapy in severe cases of infectious keratitis to minimize the need for a therapeutic keratoplasty.
TL;DR: D diagnosis remains challenging and mainly depends on clinical suspicion with the aid of laboratory testing, and multiple treatment modalities have emerged for management mainly consisting of systemic immunosuppression for disease control in addition to adjunctive management for alleviating symptoms and preventing complications.
Abstract: This review offers an informed insight on the pathophysiology of ocular cicatricial pemphigoid in addition to up-to-date recommendations for monitoring and management. Systemic immunosuppression is required for treatment of ocular cicatricial pemphigoid when there is high suspicion, even in the absence of diagnostic findings on biopsy. New therapeutic modalities continue to emerge and provide promising results. In addition, improved options for adjunctive care are also available. Ocular cicatricial pemphigoid is a systemic illness and a subset of mucous membrane pemphigoid that primarily affects the ocular surface. It involves a progressive and potentially blinding course of disease. Diagnosis remains challenging and mainly depends on clinical suspicion with the aid of laboratory testing. Multiple treatment modalities have emerged for management mainly consisting of systemic immunosuppression for disease control in addition to adjunctive management for alleviating symptoms and preventing complications.
TL;DR: This review summarizes the major factors currently implicated in the pathogenesis of tear film related ocular disorders, including dysfunctional adhesions, inflammatory factors, and insufficient lubrication by ocular surface mucins, and highlights the potential of in vitro models to propel more effective treatments into the clinic while improving fundamental understanding of ocularsurface biology.
Abstract: This review summarizes the major factors currently implicated in the pathogenesis of tear film related ocular disorders, including dysfunctional adhesions, inflammatory factors, and insufficient lubrication by ocular surface mucins, and highlights the potential of in vitro models to propel more effective treatments into the clinic while improving fundamental understanding of ocular surface biology. The cornea and conjunctiva form a continuous ocular surface that shields the visual system from environmental threats. Because of its precise composition and organization, the ocular surface also refracts and focuses light rays, enabling clear vision. In many ocular surface diseases such as dry eye, tear film homeostasis is disrupted, causing inflammation, dryness, and epithelial damage. These friction-driven phenomena result in negative feedback loops in the eye that cause significant discomfort and compromise visual acuity over time. Despite the prevalence of lubrication-related eye disorders, much remains unknown about disease initiation and progression, a knowledge gap reflected in the limited treatment options currently available. As novel therapeutics are developed to treat these conditions, scalable, cost-effective model systems that sufficiently recapitulate the complexities of the native ocular surface are needed to streamline drug screening and clinical translation.
TL;DR: Topical steroids have proven beneficial in conjunction with other anti-inflammatory medications such as topical calcineurin inhibitors, and as inflammation plays an important role in pathogenesis of DED, topical steroids may be considered for patients with refractory disease.
Abstract: To review current literature on the use of topical steroids for treatment of both aqueous-deficient and evaporative subtypes of dry eye disease (DED). Recent studies have shown that topical steroids are effective for the treatment of patients with moderate or severe DED who have failed to respond to more conservative measures. These medications are useful for patients with both aqueous-deficient and evaporative subtypes of DED. Although topical steroids are often used for a short period of time, patients with chronic ocular surface inflammation can benefit from long-term treatment. For this, low-potency steroids, such as loteprednol or fluorometholone, would be reasonable due to their reduced risk for increasing intraocular pressure. Topical steroids have proven beneficial in conjunction with other anti-inflammatory medications such as topical calcineurin inhibitors. As inflammation plays an important role in pathogenesis of DED, topical steroids may be considered for patients with refractory disease.
TL;DR: It can be anticipated that tissue engineering–based therapy toward corneal endothelial diseases will replace the current keratoplasty method as a promising treatment option in the near future.
Abstract: To summarize the recent advances of clinical and preclinical studies for corneal endothelial tissue bioengineering The challenges facing the generation of a clinical applicable corneal endothelial graft can be broadly classified into cell source selection, culture medium optimization, scaffold establishment, and the following three- and four-dimensional (4D) corneal construction Based on the current advances in primary human corneal endothelial cell (HCEC) culture and good manufacturing practice (GMP)–compliant medium development, the first clinical trial of bioengineered HCEC injection therapy has been conducted with encouraging results Other significant findings include the in vivo experiments of the stem cell–derived HCEC, the development of serum-, xeno-, and additive-free media, and the construction of 4D scaffold It can be anticipated that tissue engineering–based therapy toward corneal endothelial diseases will replace the current keratoplasty method as a promising treatment option in the near future
TL;DR: The various options available and specific considerations to take into account for myopia, hyperopia, astigmatism and presbyopia in turn are discussed, including laser refractive surgery and intraocular lens surgery.
Abstract: In this article, we review the current surgical options for refractive error and presbyopia, including laser refractive surgery and intraocular lens surgery A wide range of surgical treatments are available for treating refractive error Refractive surgeons today can correct higher levels of ametropia and presbyopia more safely and predictably Laser vision correction has been established as a safe and effective method for treating refractive error; however, the potential benefits of a wider range of procedures including refractive lens exchange and phakic intraocular implants are potentially useful in selected patients Refractive surgeons are able to provide patients with many options for the correction of refractive error Selecting the safest and most appropriate technique for each individual patient is critical This article discusses the various options available and specific considerations to take into account for myopia, hyperopia, astigmatism and presbyopia in turn
TL;DR: Topical non-steroidal anti-inflammatory (NSAIDs) and intensive topical steroid can effectively treat and prevent CME recurrences and the prophylactic use of NSAIDs and intensive steroid treatment may be a reasonable approach.
Abstract: In this review, we overview the incidence and management of cystoid macular edema following endothelial keratoplasty (EK) including Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Incidence of CME was 2.0–12.7% following DSAEK and 0.7–15.6% following DMEK. Glaucomatous eyes, in particular, with primary angle closure glaucoma and eyes with severe iris damage and eyes with combined EK with transscleral intraocular lens implantation experienced postoperative CME at a higher incidence. Topical non-steroidal anti-inflammatory (NSAIDs) and intensive topical steroid can effectively treat and prevent CME recurrences. CME is one of the major complications following EK and can be involved in the limitation of the recovery of postoperative visual acuity. Careful attention should be paid to patients with systemic and ocular conditions, as these might trigger postoperative CME. The prophylactic use of NSAIDs and intensive steroid treatment may be a reasonable approach.
TL;DR: The purpose is to inform ophthalmologists, eye bankers, and eye health professionals of technologies that could impact practice in the near future of corneal endothelial keratoplasty.
Abstract: Endothelial keratoplasty (EK) is increasingly used to treat corneal endothelial disease. However, issues remain with EK including a non-zero rejection rate, shortage of donor tissue, and technical challenges for Descemet’s membrane endothelial keratoplasty. Technologies that might solve these issues include small-molecule drugs, surgical innovations, cell therapy, tissue engineering, and gene therapy. Our purpose is to inform ophthalmologists, eye bankers, and eye health professionals of technologies that could impact practice in the near future. Recent advances are targeted at solving known issues with EK. Although none is yet routine, some are in clinical trials. Technologies that are closest to an ideal solution are those facing the highest regulatory and commercial hurdles. In the future, there will multiple options for the treatment of corneal endothelial cell failure. Which of these differing treatments will be used will depend on their efficacy as well as commercial, regulatory, and patient factors.
TL;DR: Pregnant women with glaucoma must be monitored closely, and their treatment should include collaboration with their obstetrician, and no predictions can be made regarding the course of their IOP or glAUcoma.
Abstract: This article is a review of studies relating to glaucoma in pregnancy. It also examines medical, laser, and surgical options specific to the particular needs of this population. In general, there is limited data on management of glaucoma in pregnancy, and no guidelines for treatment have been established. In one recent case series, pregnant women exposed to glaucoma medications were found to have no difference in pregnancy or fetal/neonatal outcomes compared with a control group. There are no available data for the use of the newer intraocular pressure (IOP) lowering agents (latanoprostene bunod, netarsudil) in pregnant women. Recent case reports describe various surgical interventions to treat glaucoma in pregnancy. Pregnant women with glaucoma must be monitored closely, and their treatment should include collaboration with their obstetrician. No predictions can be made regarding the course of their IOP or glaucoma. Management has to be determined on a case by case basis.
TL;DR: There is evidence for parity with FS-LASIK in visual outcomes, as well as advantages to SMILE in post-operative dry eye, spherical aberration induction, and biomechanical stability.
Abstract: In this article, we review the early experience with small incision lenticule extraction (SMILE) in the USA as well as recent international data We address long-term experience, new techniques, optimization of settings, corneal biomechanics, and comparison with other refractive surgical procedures Despite promising early experience, US refractive surgeons have adopted the SMILE procedure slowly, owing in part to limitations on energy settings that have impacted early visual recovery Outside of the USA, advances in parameters and techniques have driven improved early and long-term outcomes, with the result of increasing adoption Although there remains debate, there is evidence for parity with FS-LASIK in visual outcomes, as well as advantages to SMILE in post-operative dry eye, spherical aberration induction, and biomechanical stability SMILE is a safe and effective procedure with promising advantages over other techniques and increasing usership worldwide Continued improvements in energy optimization, nomogram development, and surgical technique allow for improved outcomes over early iterations of SMILE
TL;DR: ISBCS appears to be a more efficient and cost-saving procedure that remains safe and effective for improving visual functioning in patients with bilateral visually significant cataracts.
Abstract: Immediately sequential bilateral cataract surgery (ISBCS) has been gaining attention over the past decade as a more efficient way to address the growing need for cataract removal in an aging population, and yet delayed sequential bilateral cataract surgery (DSBCS) remains the standard of care in many ophthalmologic communities. This review discusses some of the reasons surgeons have been hesitant to adopt ISBCS and hopes to address both the pros and cons of the procedure in the current medical environment. Many of the current arguments against the practice of ISBCS involve potential bilateral surgical complications and worse refractive outcomes; however, the literature to date does not support these arguments. The risk of unilateral vision threatening complications appears similar to DSBCL, and no cases of bilateral complications have been reported when the currently recommended protocols have been obeyed. Additionally, refractive targets have been similar to DSBCS in current published studies. ISBCS appears to be a more efficient and cost-saving procedure that remains safe and effective for improving visual functioning in patients with bilateral visually significant cataracts.
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TL;DR: How patients with glaucoma may be assessed for their driving safety and how the authors treat and evaluate these patients in their own practices are discussed.
Abstract: Loss of the ability to drive is highly associated with depressive symptoms in older persons. There are many reasons why an individual may give up driving, poor vision being an important one. Given the high prevalence of glaucoma in this population and the critical role that vision plays in the ability to drive, it is therefore important to consider how glaucomatous vision loss plays into the ability to drive safely. In this review article, we will summarize the literature on the topic of glaucoma and driving and the studies that have been done to evaluate this topic. Studies of both the self-perceived impact of glaucomatous visual field loss on driving as well as studies that include on-road and simulated driving experiments will be reviewed. We will discuss how patients with glaucoma may be assessed for their driving safety and review how we treat and evaluate these patients in our own practices.
TL;DR: GDD implantation certainly carries risk of endothelial injury and keratoplasty viability, but newer ker atoplasty techniques may improve visual outcomes, and attention to placement and location of the GDD may affect the risk of progressive corneal injury.
Abstract: To discuss the relevant clinical associations between glaucoma drainage device (GDD) implantation and health of the cornea, focusing on corneal endothelial disease and success of viability of keratoplasty Corneal endothelial injury and risk of graft failure continues to demonstrate association with GDD placement; however, newer studies demonstrate improved outcomes associated with Descemet membrane endothelial keratoplasty Additionally, newer adverse effects associated with GDD placement have been described GDD implantation certainly carries risk of endothelial injury and keratoplasty viability, but newer keratoplasty techniques may improve visual outcomes Furthermore, attention to placement and location of the GDD may affect the risk of progressive corneal injury