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.

Background and Objective: Nearly 30 years have passed since limbal stem cell deficiency (LSCD) was first identified by pioneers and given clinical attention. LSCD remains a difficult disease to treat. It can potentially lead to blinding. At present, understanding of limbal stem cells (LSCs) has deepened and various treatment options for LSCD have been devised. The objective of this review is to summarize basic knowledge of LSCD and current treatment strategies.

Methods: PubMed search was performed to find studies published in English on LSCs and LSCD including original reports and reviews. Literatures published from 1989 to 2022 were reviewed.
Key Content and Findings: LSCs are enigmatic stem cells for which no specific marker has been discovered yet. Although LSCD is not difficult to diagnose, it is still challenging to treat. An important advancement in the treatment of LSCD is the provision of guidelines for selecting systematic surgical treatment according to the patient’s condition. It is also encouraging that stem cell technologies are being actively investigated for their potential usefulness in the treatment of LSCD.

Conclusions: Although various treatment options for LSCD have been developed, it should be kept in mind that the best chance of treatment for LSCD is in the early stage of the disease. Every effort should be made to preserve as many LSCs as possible in the early treatment of LSCD.

Backgrounds: To assess changes in anterior segment biometry during accommodation using a swept source anterior segment optical coherence tomography (SS-OCT).

Methods: One hundred-forty participants were consecutively recruited in the current study. Each participant underwent SS-OCT scanning at 0 and ?3 diopter (D) accommodative stress after refractive compensation, and ocular parameters including anterior chamber depth (ACD), anterior and posterior lens curvature, lens thickness (LT) and lens diameter were recorded. Anterior segment length (ASL) was defined as ACD plus LT. Lens central point (LCP) was defined as ACD plus half of the LT. The accommodative response was calculated as changes in total optical power during accommodation.

Results: Compared to non-accommodative status, ACD (2.952±0.402 vs. 2.904±0.382 mm, P<0.001), anterior (10.771±1.801 vs. 10.086±1.571 mm, P<0.001) and posterior lens curvature (5.894±0.435 vs. 5.767±0.420 mm, P<0.001), lens diameter (9.829±0.338 vs. 9.695±0.358 mm, P<0.001) and LCP (4.925±0.274 vs. 4.900±0.259 mm, P=0.010) tended to decreased and LT thickened (9.829±0.338 vs. 9.695±0.358 mm, P<0.001), while ASL (6.903±0.279 vs. 6.898±0.268 mm, P=0.568) did not change significantly during accommodation. Younger age (β=0.029, 95% CI: 0.020 to 0.038, P<0.001) and larger anterior lens curvature (β=?0.071, 95% CI: ?0.138 to ?0.003, P=0.040) were associated with accommodation induced greater steeping amplitude of anterior lens curvature. The optical eye power at 0 and ?3 D accommodative stress was 62.486±2.284 and 63.274±2.290 D, respectively (P<0.001). Age was an independent factor of accommodative response (β=?0.027, 95% CI: ?0.038 to ?0.016, P<0.001).

Conclusions: During ?3 D accommodative stress, the anterior and posterior lens curvature steepened, followed by thickened LT, fronted LCP and shallowed ACD. The accommodative response of ?3 D stimulus is age-dependent.

Background: Dyop® is a dynamic optotype with a rotating and segmented visual stimulus. It can be used for visual acuity and refractive error measurement. The objective of the study was to compare refractive error measurement using the Dyop® acuity and LogMAR E charts.

Methods: Fifty subjects aged 18 or above with aided visual acuity better than 6/12 were recruited. Refractive error was measured by subjective refraction methods using the Dyop® acuity chart and LogMAR E charts and the duration of measurement compared. Thibo’s notation was used to represent the refractive error obtained for analysis.

Results: There was no significant difference in terms of spherical equivalent (M) (P=0.96) or J0 (P=0.78) and J45 (P=0.51) components measured using the Dyop® acuity and LogMAR E charts. However, subjective refraction measurement was significantly faster using the Dyop® acuity chart (t=4.46, P<0.05), with an average measurement time of 419.90±91.17 versus 452.04±74.71 seconds using the LogMAR E chart.

Conclusions: Accuracy of refractive error measurement using a Dyop® chart was comparable with use of a LogMAR E chart. The dynamic optotype Dyop® could be considered as an alternative fixation target to be used in subjective refraction.

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.

Perception is the ability to see, hear, or become aware of external stimuli through the senses. Visual stimuli are electromagnetic waves that interact with the eye and elicit a sensation. Sensations, indeed, imply the detection, resolution, and recognition of objects and images, and their accuracy depends on the integrity of the visual system. In clinical practice, evaluating the integrity of the visual system relies greatly on the assessment of visual acuity, that is to say on the capacity to identify a signal. Visual acuity, indeed, is of utmost importance for diagnosing and monitoring ophthalmological diseases. Visual acuity is a function that detects the presence of a stimulation (a signal) and resolves its detail(s). This is the case of a symbol like “E”: the stimulus is detected, then it is resolved as three horizontal bars and a vertical bar. In fact, within the clinical setting visual acuity is usually measured with alphanumeric symbols and is a three-step process that involves not only detection and resolution, but, due to the semantic content of letters and numbers, their recognition. Along with subjective (psychophysical) procedures, objective methods that do not require the active participation of the observer have been proposed to estimate visual acuity in non-collaborating subjects, malingerers, or toddlers. This paper aims to explain the psychophysical rationale underlying the measurement of visual acuity and revise the most common procedures used for its assessment.

Background: Pterygium is a sun-related ocular surface disease secondary to ultraviolet (UV) radiation exposure. Outdoor occupational UV exposure is known to occur secondary to sun exposure. We present a unique case of pterygium associated with indoor occupational light-emitting diode (LED) exposure not previously described in the literature.

Case Description: A mobile phone repairer presented with blurred vision and a superotemporal pterygium of his dominant left eye associated with a magnifying glass LED work lamp was diagnosed. This was excised routinely with conjunctival autografting to the defect. Histopathology confirmed benign pterygium and recovery was uncomplicated with resolution of blur.

Conclusions: The development of pterygium in our patient may have arisen due to the LED lamp’s wavelengths possibly falling within the UV as well as the upper end of the visible light radiation spectrum. Given the increasing reliance on LED light sources in modern life, ocular conditions arising from exposure to these radiation sources may now need to be listed in the differential diagnoses of patients with pterygium. Appropriate UV protection counselling for these types of lights may also now need to be considered.

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.

A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease. We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects. Technique description and retrospective interventional case series. The reconstruction technique was used by an experienced oculoplastics surgeon (ASL) in 3 adults with malignant lesions involving the lateral upper eyelid margin, resulting in a post-excision 50% full-thickness defect between November 2017 and June 2020. The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap. The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle. Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases. One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants. In all patients, the final eyelid contour and symmetry were adequate, with only minimal scarring, evident already 3 to 4 months postoperative. There were no major complications or need for revisions. The technique described herein highlights the utility of the blepharoplasty flap for lateral, full-thickness upper eyelid defects. This logical variation enables the reconstruction of significant defects using only local tissue, obeying the “like with like” principle, and helps avoid the need for a bridging flap. We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour, together with a fast recovery of appropriate eyelid function.