Although amniotic membrane transplantation (AMT) has long been used as an essential surgical technique for ocular surface reconstruction, its role continues to evolve and expand. In the management of numerous ocular surface disorders, ranging from inflammatory to infectious, traumatic to neoplastic, the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist. The purpose of this paper is to provide ophthalmologists with an updated, evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction, reviewing its common and even experimental applications known to date. The methods of amniotic membrane preservation, the available commercial amniotic membrane products to date, and future directions for amniotic membrane use, including amniotic membrane extract eye drops (AMEED), are also discussed. It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice,both in the operating room and in the clinic. By familiarizing the general ophthalmologist with its diverse applications, we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice, or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.

Background and Objective: Ocular surface disease (OSD) is a common yet often overlooked consideration in the management of patients with glaucoma. Although there have been several review articles summarizing the relationship between glaucoma medications and OSD, there is a relative absence of such articles on the effects of glaucoma surgical treatments. Here, we present a comprehensive review of the literature regarding the relationship of glaucoma management and OSD, with an emphasis on surgical considerations.

Methods: PubMed, Google Scholar, and Cochrane Review searches were performed using the following search terms: ocular surface, dry eye, minimally invasive glaucoma surgeries (MIGS), trabeculectomy,glaucoma medications. The titles and abstracts from those searches were screened for relevance to our review topics. Publications were included if the subjects included glaucoma patients, and if ocular surface outcomes were described. Non-English papers were excluded.
Key Content and Findings: Topical glaucoma medications frequently cause adverse effects on the ocular surface, both through direct action of the medications themselves as well as through toxicity from their associated preservatives. Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma, such as trabeculectomy, can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications. Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates, while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability. The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden. It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity. However, more research is needed to directly assess the extent of improvement seen after MIGS.

Conclusions: A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.

Background and Objective: Limbal stem cell deficiency (LSCD) describes the clinical condition when there is dysfunction of the corneal epithelial stem/progenitor cells and the inability to sustain the normal homeostasis of the corneal epithelium. The limbal stem cells are located in a specialized area of the eye called the palisades of Vogt (POV). There have been significant advances in the diagnosis and management of LSCD over the past decade and this review focuses on the pathophysiology of LSCD, its clinical manifestations, diagnosis, and causes.

Methods: Papers regarding LSCD were searched using PubMed to identify the current state of diagnosis and causes of LSCD published through to June 2022. 
Key Content and Findings: LSCD is clinically demonstrated by a whorl-epitheliopathy, loss of the POV, and conjunctivalization of the cornea. The diagnosis of this condition is based on clinical examination and aided by the use of impression cytology, in vivo confocal microscopy, and anterior segment optical coherence tomography (asOCT). There are many causes of LSCD, but those which are most common include chemical injuries, aniridia, contact lens wear, and Stevens-Johnson syndrome (SJS).

Conclusions: While this condition is most commonly encountered by corneal specialists, it is important that other ophthalmologists recognize the possibility of LSCD as it may arise in other co-morbid eye conditions.

Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease. Infectious keratitis, neurotrophic keratitis, nontraumatic corneal melts, descemetoceles, perforations, and corneal burns are all indications for this procedure. The flaps promote nutrition, metabolism, structure, and vascularity, as well as reduce pain, irritation, inflammation, and infection. Furthermore, patients avoid the emotional and psychological repercussions of enucleation or evisceration, while requiring fewer postoperative medications and office visits. Currently, fewer flaps are performed due to the emergence of additional therapeutic techniques, such as serum tears, bandage lenses, corneal grafting, Oxervate, amniotic membrane, and umbilical cord grafting. However, despite newer conservative medical methods, conjunctival flaps have been demonstrated to be useful and advantageous. Moreover, future technologies and approaches for globe preservation and sight restoration after prior conjunctival flaps are anticipated. Herein, we review the history, advantages, and disadvantages of various surgical techniques: Gundersen’s bipedicle flap, partial limbal advancement flap, selective pedunculated conjunctival flap with or without Tenon’s capsule, and Mekonnen’s modified inferior palpebral-bulbar conjunctival flap. The surgical pearls and recommendations offered by the innovators are also reviewed, including restrictions and potential complications. Procedures for visual rehabilitation in selective cases after conjunctival flap are reviewed as well.

Abstract: The goal of ophthalmology residency training is to produce competent ophthalmologists. Appropriate assessments must be employed to ensure this goal is met. Valid and reliable workplace-based assessments are designed to assess competence in the many domains required of a good ophthalmologist. These assessments increase standardization and objectivity as compared to simple observational feedback. When used appropriately, workplace based assessments not only provide measures of competence but also facilitate effective formative feedback and enhance learning.

Abstract: Angle closure glaucoma (ACG) is one of the major causes of blindness. Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris, which results in increased intraocular pressure (IOP) through impaired aqueous flow. Considering pupillary block by crystalline lens is the most frequent mechanism, lens extraction is regarded as an effective therapy. Recently, to validate the effect of lens extraction, the EAGLE study was reported. In this study, subjects were 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure (PAC) with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma (PACG), and were divided into clear-lens extraction group and standard care group (laser peripheral iridotomy and topical glaucoma medication). This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy. Initial clear lens extraction showed better clinical course and patient-reported outcomes. This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.