Abstract: Deep anterior lamellar keratoplasty (DALK) is preferred over conventional penetrating keratoplasty (PKP) for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection. However, DALK remains surgically challenging, largely due to challenges associated with achieving consistent pneumo-dissection of posterior stroma from the underlying pre-Descemet’s or Descemet’s membrane (DM). Air must be injected at sufficient depth in the corneal stroma in order to achieve successful pneumo-dissection, but advancing a needle too deep into the cornea can lead to perforation of DM. We describe here a novel technique using a handheld slit lamp (Eidolon model 510L, Eidolon Optical LLC, Natick, MA, USA) to assist in creation of the big-bubble in DALK surgery. Use of a handheld slit beam intraoperatively is a safe, relatively inexpensive, and effective technique for increasing the success of big-bubble formation in DALK procedures.

Abstract: Diabetic retinopathy (DR) is a complex multifactorial disease and one of the leading causes of visual impairment worldwide. DR pathogenesis is still not completely understood and, even if studies performed in the past focused on microvascular dysfunction as the main event, growing body of scientific evidence has demonstrated an important role of inflammation and neurodegeneration in the onset and progression of DR. This review summarizes current literature on the role of inflammation in the pathogenesis and progression of DR. In particular, it focuses on clinical inflammatory biomarkers detectable with non-invasive retinal imaging, suggestive of a local inflammatory condition. Current available treatments are applicable only at advanced stages of disease, therefore, there is the need to detect biomarkers of subclinical or early DR that can help in DR management before irreversible damage occurs. A better understanding of inflammatory pathways involved in DR may permit to implement more specific and personalized therapeutic strategies and clinical biomarkers may be a helpful tool in the everyday clinical practice to direct the patient to the most appropriate treatment option.

Abstract: Despite appropriate management of the systemic disease, patients with diabetes may develop severe forms of diabetic retinopathy that require surgery. Non-clearing vitreous haemorrhage (VH), traction retinal detachment involving the macula, combined traction and rhegmatogenous retinal detachment, progressive fibrovascular proliferation (PFP) and rubeosis with acute VH represent the main indications for surgery. Vitrectomy techniques and surgical tools have developed dramatically in the last decade in order to help the surgeon succeed in these challenging cases.

Abstract: Diabetic retinopathy (DR) is a leading cause of visual loss worldwide. Disease severity is graded from mild non-proliferative DR to proliferative DR. Optical coherence tomography angiography (OCTA) has become widely accepted as a useful noninvasive technique that provides detailed imaging of the ocular vessels. It is also becoming an increasingly essential tool for both qualitative and quantitative assessment of DR, especially with the advent of wider imaging capabilities. Various angiographic features of DR, such as microaneurysms, intraretinal microvascular abnormalities, neovascularization, and nonperfusion have been comprehensively studied and described using OCTA. Different quantitative OCTA metrics have been introduced, such as vessel density, foveal avascular zone (FAZ) area, and area of nonperfusion. Current research has been focusing on the application of quantitative OCTA for the diagnosis of DR and treatment monitoring. The primary purpose of this article is to review the use of OCTA, including its challenges, in the diagnosis and management of DR.

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.

Abstract: Acute retinal arterial ischemia, which includes transient monocular vision loss (TMVL), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and ophthalmic artery occlusion (OAO), is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery, heart or aortic arch, leading to partial or complete occlusion of the central retinal artery (CRA) or its branches. Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency. Patients with acute retinal arterial ischemia are at a high risk of having further vascular events, such as subsequent strokes and myocardial infarctions (MIs). Therefore, prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up (such as brain magnetic resonance imaging with diffusion weighted imaging, vascular imaging, and cardiac monitoring and imaging) and potential treatment of an urgent etiology (e.g., carotid dissection or critical carotid artery stenosis). Since there are no proven, effective treatments to improve visual outcome following permanent retinal arterial ischemia (central or branch retinal artery occlusion), treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.

Abstract: Optical coherence tomography (OCT) is an ocular imaging technique that can complement the neuro-ophthalmic assessment, and inform our understanding regarding functional consequences of neuroaxonal injury in the afferent visual pathway. Indeed, OCT has emerged as a surrogate end-point in the diagnosis and follow up of several demyelinating syndromes of the central nervous system (CNS), including optic neuritis (ON) associated with: multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies. Recent advancements in enhanced depth imaging (EDI) OCT have distinguished this technique as a new gold standard in the diagnosis of optic disc drusen (ODD). Moreover, OCT may enhance our ability to distinguish cases of papilledema from pseudopapilledema caused by ODD. In the setting of idiopathic intracranial hypertension (IIH), OCT has shown benefit in tracking responses to treatment, with respect to reduced retinal nerve fiber layer (RNFL) measures and morphological changes in the angling of Bruch’s membrane. Longitudinal follow up of OCT measured ganglion cell-inner plexiform layer thickness may be of particular value in managing IIH patients who have secondary optic atrophy. Causes of compressive optic neuropathies may be readily diagnosed with OCT, even in the absence of overt visual field defects. Furthermore, OCT values may offer some prognostic value in predicting post-operative outcomes in these patients. Finally, OCT can be indispensable in differentiating optic neuropathies from retinal diseases in patients presenting with vision loss, and an unrevealing fundus examination. In this review, our over-arching goal is to highlight the potential role of OCT, as an ancillary investigation, in the diagnosis and management of various optic nerve disorders.

Abstract: Between 2011 and 2013, two large-scale cohort epidemiology studies were launched in Shanghai: the SCALE study, which aimed to provide ocular public health services to cover the entire youth population in Shanghai, and the SCES, which was based on sample surveys and aimed to provide information on the prevalence and incidence of visual impairment and different types of refractive errors. A total of 910,245 children and adolescents were finally enrolled in the SCALE study; three possible methods for monitoring refractive error without mydriasis were tested, and the agreement between the refractive outcomes of three commonly used autorefractors were examined to ensure the accuracy of the results of the SCALE study. A total of 8,627 children were enrolled in the SCES, and the baseline prevalence of different refractive errors, different behaviors associated with 1 year myopic shifts, and the different patterns of 2-year myopia progression between internal migrant and local resident school children have been analyzed. In some subset samples of the SCALE study and the SCES, several refraction components such as choroidal thickness (ChT) and crystalline lens power were also measured, to further elucidate the relationships between the refraction components and myopia as well as the mechanism of myopia incidence and development. The three methods used in Shanghai to prevent and intervene with childhood myopia: increasing outdoor time, low concentration atropine, and use of orthokeratology lens are also addressed in this review.