Abstract: Diabetic retinopathy (DR) is the most common microvascular complication in patients with diabetes mellitus (DM), and remains the single greatest cause of blindness in working age adults around the world. In this article, we review the evolution of pharmacotherapies for both diabetic macular edema (DME) and DR such as anti-vascular endothelial growth factor inhibitors and various steroid formulations, as well as other emerging pharmacotherapies currently in late stage clinical testing for this disease.

Background: In recent years posterior corneal astigmatism and its effect on total corneal astigmatism has been studied, with research showing that this can impact total astigmatism. This study aims to ascertain if there is significant change in the posterior corneal astigmatism after cataract surgery and its impact on the total astigmatism.

Methods: Analysis of 76 eyes that underwent cataract surgery with monofocal intraocular lens implantation. Corneal topography was performed with Pentacam (OCULUS^?) pre- and post-operatively. Total corneal astigmatism was calculated with the algorithm of vergence tracing. We compared preoperative and postoperative changes in the magnitude and axis differences of anterior corneal curvature astigmatism, posterior corneal curvature astigmatism and the calculated total corneal astigmatism. We calculated the correlation between the total preoperative astigmatism and the difference between total corneal astigmatism and anterior corneal astigmatism.

Results: The mean preoperative and postoperative posterior astigmatism was 0.31±0.02 D, showing no significant differences before and after surgery (P=0.989). Statistically significant differences between the calculated total corneal astigmatism and anterior corneal astigmatism were registered preoperatively and postoperatively in the with-the-rule anterior (WTR) corneal astigmatism (P=0.004, P<0.0001); against-the-rule (ATR) anterior corneal astigmatism (P<0.0001, P<0.0001) and in the oblique (P=0.026, P=0.019) subgroups. The posterior corneal astigmatism and the total corneal astigmatism correlated positively with the differences between the total corneal and anterior corneal astigmatism (R=0.378, P=0.001).

Conclusions: There were statistically significant differences between the magnitude of the total astigmatism and anterior corneal astigmatism, underlining the impact of posterior corneal astigmatism. A positive correlation between the preoperative posterior astigmatism and the difference between the total corneal and the anterior corneal astigmatism suggests a specially relevant role of posterior corneal astigmatism when evaluating patients with higher degrees of astigmatism.

Abstract: This submission will briefly review the anatomy and physiology of the optic nerve, and highlight various ischemic optic neuropathies including anterior ischemic optic neuropathies (non-arteritis and arteritic), diabetic papillopathy, posterior ischemic optic neuropathies, and ischemic optic neuropathies in the setting of hemodynamic compromise.

Background: To present a surgical technique using a rigid intraocular lens as endocapsular supporting device in manual small incision cataract surgery (MSICS) for treating mild-moderate subluxated cataracts.

Methods: In our technique, a single-piece rigid polymethyl methacrylate (PMMA) lens was implanted in the bag following the nucleus removal, with its axis vertical to the zonular dialysis. This endocapsular-implanted IOL stretched the bag and provided sufficient stability and lens centration. This technique was performed in 19 eyes with subluxated cataracts, with zonulysis of ≤120 degree and nuclear sclerosis of grade ≤3. Mean follow-up time was 9.8 months.

Results: All eyes had endocapsular IOL implantation during surgery. Intraoperative extension of the dialysis did not occur in any eye. The IOL was placed in the bag in all but 1 case, in which dislocation of the IOL haptic into the vitreous occurred. Though the IOL was slightly decentered in 3 cases, it kept stable. All patients were asymptomatic.

Conclusions: This approach provides a simplified and practical strategy for surgically managing subluxation with mild-moderate zonular loss.

Background: To compare objective electrophysiological contrast sensitivity function (CSF) in patients implanted with either multifocal intraocular lenses (MIOLs) or monofocal intraocular lenses (IOLs) by pattern reversal visual evoked potentials (prVEP) measurements.

Methods: Fourty-five cataract patients were randomly allocated to receive bilaterally: apodized diffractive-refractive Alcon Acrysof MIOL (A), full diffractive AMO Tecnis MIOL (B) or monofocal Alcon Acrysof IOL (C). Primary outcomes: 1-year differences in objective binocular CSF measured by prVEP with sinusoid grating stimuli of 6 decreasing contrast levels at 6 spatial frequencies. Secondary outcomes: psychophysical CSF measured with VCTS-6500, photopic uncorrected distance (UDVA), and mesopic and photopic uncorrected near and intermediate visual acuities (UNVA and UIVA respectively).

Results: Electrophysiological CSF curve had an inverted U-shaped morphology in all groups, with a biphasic pattern in Group B. Group A showed a lower CSF than group B at 4 and 8 cpd, and a lower value than group C at 8 cpd. Psychophysical CSF in group A exhibited a lower value at 12 cpd than group B. Mean photopic and mesopic UNVA and UIVA were worse in monofocal group compared to the multifocal groups. Mesopic UNVA and UIVA were better in group B.

Conclusions: Electrophysiological CSF behaves differently depending on the types of multifocal or monofocal IOLs. This may be related to the visual acuity under certain conditions or to IOL characteristics. This objective method might be a potential new tool to investigate on MIOL differences and on subjective device-related quality of vision.

Background: Understanding factors that contribute to posterior capsular opacification (PCO) development is a significant public concern as treatment can lead to complications. In order to prevent PCO, a better understanding of intraocular lens (IOL) characteristics, including design and material, and patient interaction is required. Herein, we performed a retrospective multivariable analysis to determine which factors (IOL and patient based) were least likely to result in PCO.

Methods: One hundred eighty post-mortem eyes with implanted IOLs were collected from the Minnesota Eye Bank, along with clinical history, including date of cataract surgery and IOL model number. The capsular bag (CB) with the IOL implant was removed from all eyes to obtain digital images. PCO outcome was quantified on CB images using an objective, automated custom image analyzer (Medical Parachute Automated Detector Opacification Software). The software measured intensity and area of the opacification within the IOL optic edge, intra-optic edge (IOE = intensity/area), and in Soemmering’s ring (SR = intensity/area). Epidemiologic analysis assessed which IOL characteristics and patient-related factors correlated with PCO. IOL factors included material, edge design, lens filter, company, IOL model, decentration and time from cataract surgery to death. Patient factors included sex, age and diabetes, among others.

Results: Multivariate analyses showed non-diabetic patients had less PCO (P=0.05). Individuals 50–80 years old compared to 80+ had lower SR PCO (P=0.04). Non-blue light filter IOLs had lower SR and IOE PCO compared to filter IOLs (P=0.03, 0.001). Square and frosted optic edge design had lower SR and IOE PCO rates compared to OptiEdge and round optic edge design (P=0.002, 0.02). The IOL model that had the least PCO was the ZA9003 model, but this was only significant for SR and not IOE PCO (P=0.04). Adjusting for patient-factors, IOL lens model was no longer a confounding factor for PCO. Patients with an IOL implanted for <7 years had lower SR PCO, whereas lower IOE PCO was only seen in implants <4 years old (P=0.0001, 0.04).

Conclusions: In order to generate a lens that does not develop PCO, it is critical to understand the IOL- and patient-related factors that lead to PCO development. Based on our data, the most susceptible patients are elderly and diabetic, and it may be preferable to implant a square and frosted edge lens without blue-light filtering in this cohort.

Background: Epidermolysis bullosa (EB) is a heterogynous group of skin disorders characterized by formation of blisters and erosions of the skin in response to minor trauma. Subtypes include EB simplex (EBS), junctional EB (JEB), dystrophic form of EB (DEB) and finally Kindler syndrome (KS). In addition to dermal manifestation, patients can present with various ophthalmic pathologies.

Methods: We reviewed the pathobiology, epidemiology and management of ocular manifestations as well as current and future innovative therapies for EB.

Results: The severity and incidence of ocular involvement were the highest in the recessive DEB-generalized severe and JEB-generalized severe subtypes. Recurrent corneal erosions and blisters were the most common finding and seem to correlate with skin disease. Other manifestations include corneal scaring, blepharitis, ectropion, symblepharon, infantile cataracts, lacrimal duct obstruction as well as meibomian gland deficiency.

Conclusions: Ophthalmology consult as well as regular follow-up are essential in the multi-disciplinary approach of this disease. Indeed, parents’ and patients’ education as well as early diagnosis and treatment are crucial to prevent permanent and long-term visual disabilities.

Abstract: Complications of myopia have become an important public health issue with serious socio-economic burdens. Prevention and treatment are both important. The Taiwan Student Vision Care Program (TSVCP) promoted by Ministry of Education (MOE) has been carried out for 3 decades in Taiwan. The myopia prevalence has increased rapidly to a high level and therefore myopia prevention has continued to be the most important item in the program. Therefore, TSVCP aims to decrease the prevalence of myopia, in order to decrease the high myopia related blindness in the future. Recently, outdoor activity has been found to be an important protective factor for myopia and was implemented in TSVCP since 2010. Afterwards, the nationwide vision impairment rate (uncorrected vision 20/25 or less) of elementary school students declined unprecedentedly and continuously in recent years. Evidence-based protective and risk factors for myopia are now clearer. Widespread acknowledgement of myopic disease, preventing the onset of myopia, prompt diagnosis, and early treatment to control progression are all important.

Abstract: Successful management of a case of aggressive posterior retinopathy of prematurity (APROP) poorly responsive to laser therapy with intravitreal bevacizumab (IVB) is discussed. IVB is useful as rescue therapy in such cases, if given within the correct window period post laser therapy.