Background and Objective: Corneal neurotization is a novel surgical technique used to restore corneal sensation in patients with neurotrophic keratopathy. Neurotrophic keratopathy is a disorder characterized by dysfunction of the ophthalmic division of the trigeminal nerve, which provides sensory innervation to the cornea. Without sensation, the cornea is at risk of infection, ulceration, perforation, and ultimately, vision loss. Corneal neurotization has emerged as an innovative technique to reinnervate anesthetized corneas by transferring a healthy donor nerve to the affected eye around the corneoscleral limbus. As the field of corneal neurotization rapidly grows, there is a need to synthesize the existing body of literature on corneal neurotization and identify important areas for further research. In this review, we will discuss neurotrophic keratopathy and its current management strategies, followed by an overview of corneal neurotization techniques, outcomes, surgical considerations, and future directions. Methods: PubMed and Google Scholar searches were conducted to retrieve and analyze relevant original papers and reviews on neurotrophic keratopathy and corneal neurotization up until April 2022.Key Content and Findings: Currently, numerous techniques for corneal neurotization exist, including direct nerve transfers, as well as indirect neurotization via interposition nerve grafts. So far, corneal neurotization has been shown to be highly successful in restoring corneal sensation, improving visual acuity,and improving corneal epithelial health. To date, there have been no significant differences in outcomes between direct versus indirect neurotization techniques, different donor nerves, or autologous versus allogeneic interposition grafts. However, there is some evidence that corneal neurotization procedures may be more successful in pediatric patients.Conclusions: Corneal neurotization shows great promise in treating neurotrophic corneas and represents the first management option to date that addresses the underlying pathophysiological mechanism of neurotrophic keratopathy by restoring corneal sensation. As the use of corneal neurotization continues to broaden, additional studies will become important to compare techniques in a systematic manner, with larger sample sizes, as well as standardized outcome measures and follow-up time.

The prevalence of diabetic retinopathy (DR) continues to increase in pregnant females; these individuals are also at a higher risk of disease progression. The lack of evidence regarding the safety and efficacy of current treatment options in pregnancy makes disease management particularly challenging.All pregnant women with diabetes should have a prenatal DR screening, as well as receive counseling regarding the progression and management of DR during pregnancy. Optimal blood glucose and blood pressure control should be encouraged. For patients with proliferative diabetic retinopathy (PDR) in the absence of visually significant diabetic macular edema (DME), panretinal photocoagulation (PRP) remains a safe and effective treatment option. Visually significant DME can be treated with focal laser if areas of focal leakage are identified in the macula on fluorescein angiogram, intravitreal steroids or anti-vascular endothelial growth factor (VEGF) agents, The theoretical risk of anti-VEGF agents to the fetus should be considered and the patients should be extensively counselled regarding the risks and benefits of initiating anti-VEGF therapy before initiating treatment. When the decision is made to treat with anti-VEGF agents, Ranibizumab should be the agent of choice. In conclusion, ophthalmologists should make treatment decisions in pregnant patients with DR on a case-by-case basis taking into consideration disease severity, risk of permanent threat to vision, gestational age, and patient preferences.

Contrast is the differential luminance between one object and another. Contrast sensitivity (CS) quantifies the ability to detect this difference: estimating contrast threshold provides information about the quality of vision and helps diagnose and monitor eye diseases. High contrast visual acuity assessment is traditionally performed in the eye care practice, whereas the estimate of the discrimination of low contrast targets, an important complementary task for the perception of details, is far less employed. An example is driving when the contrast between vehicles, obstacles, pedestrians, and the background is reduced by fog. Many conditions can selectively degrade CS, while visual acuity remains intact. In addition to spatial CS, “temporal” CS is defined as the ability to discriminate luminance differences in the temporal domain, i.e., to discriminate information that reaches the visual cortex as a function of time. Likewise, temporal sensitivity of the visual system can be investigated in terms of critical fusion frequency (CFF), an indicator of the integrity of the magnocellular system that is responsible for the perception of transient stimulations. As a matter of fact, temporal resolution can be abnormal in neuro-ophthalmological clinical conditions. This paper aims at considering CS and its application to the clinical practice.

Background: Femtosecond laser astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation have been studied individually for comparison to treat astigmatism at cataract surgery. We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty (LTK) in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery (FLACS). This is the first report of both procedures combined simultaneously, with or without history of LTK.

Case Description: A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004, with subsequent surgically induced high corneal astigmatism, and with age-related nuclear cataract of both eyes. IOL master demonstrated +7.71 diopters of astigmatism at 163 degree right eye and +3.29 diopters of astigmatism at 4 degree left eye. After extensive discussion of the risks and benefits, the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions (RIs) and toric IOL (Alcon SN6AT9) right eye; FLACS with toric IOL (Alcon SN6AT7) alone left eye. At 2-year follow-up, uncorrected visual acuity was 20/30 right eye, 20/25 left eye. His best corrected visual acuity was 20/25 (+0.25 +1.00 axis 21) right eye and 20/20 (plano +0.25 axis 90) left eye; his best corrected near visual acuity was J1+ with add +2.50 diopters right eye and left eye.

Conclusions: Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery. An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9, in our case, simultaneously, which can achieve an excellent long term visual outcome.

Abstract: Diabetic retinopathy (DR) remains a leading cause of irreversible vision loss in adult populations around the globe. Despite growing evidence of the effectiveness of routine assessments and early intervention, DR screening strategies are not widely implemented largely due to an inadequate availability of resources to cope with the growing burden of diabetes. Advances in technology in the field of DR screening are clearly warranted and the recent emergence of deep learning-based artificial intelligence (AI) grading of retinal pathology offers significant potential benefits including an increased efficiency, accessibility and affordability of screening programmes.

Abstract: The disease burden of diabetic retinopathy (DR) is tremendous around the world. While DR is correlated with hemoglobin A1c (HbA1c) and duration of diabetes, genetic differences likely account for variation in susceptibility to DR. DR is a polygenic disorder with demonstrated heritability. However, linkage and admixture analyses, candidate gene association studies, and genome-wide association studies (GWAS) have not identified many loci for DR that can be consistently replicated. Larger, collaborative, multi-ethnic GWAS are needed to identify common variants with small effects. Rigorous defining of controls groups as patients with a long duration of diabetes without DR, and case groups as patients with severe DR will also aid in finding genes associated with DR. Replication in independent cohorts will be key to establishing associated loci for DR. Investigations of mitochondrial DNA and epigenetics in DR are ongoing. Whole exome sequencing presents new opportunities to identify rare variants that might be implicated in DR development. Continued research in the genetic epidemiology of DR is needed, with the potential to elucidate pathogenesis and treatment of an important disease.