Background and Objective: Subthreshold laser therapy has emerged as a therapeutic alternative to traditional laser photocoagulation for certain ophthalmic diseases including central serous chorioretinopathy (CSCR), diabetic macular edema (DME), macular edema secondary to branch retinal vein occlusion (BRVO), and age-related macular degeneration (AMD). The objective of this paper is to review and discuss the clinical applications of subthreshold laser and the mechanisms of different subthreshold laser techniques including subthreshold micropulse laser (SMPL), selective retina therapy (SRT), subthreshold nanosecond laser (SNL), endpoint management (EpM), and transpupillary thermotherapy (TTT).
Methods: A narrative review of English literature and publicly available information published before November 2021 from literature databases and computerized texts. We discuss the currently available subthreshold laser systems and the advancements made to perform different subthreshold laser techniques for various ophthalmic diseases. We highlight various clinical studies and therapeutic techniques that have been conducted to further understand the effectiveness of subthreshold laser in the clinical setting. We conclude the article by covering emerging subthreshold laser systems that are currently being developed for future clinical use. The PubMed database was utilized for peer-reviewed articles and pertinent information on subthreshold systems was cited from publicly available online websites covering specific systems.
Key Content and Findings: Various subthreshold laser systems have been developed to treat certain retinal diseases. Several systems are currently in development for future clinical applications.
Conclusions: While conventional laser photocoagulation has been effective in treating various retinal diseases, subthreshold laser systems aim to provide a therapeutic effect without visible signs of damage to the underlying tissue. This technology may be particularly effective in treating macular disorders. Further clinical studies are needed to evaluate their role in the management of retinal diseases.
Background and Objective: Vitreoretinal surgery requires fine micro-surgical training and handling of delicate tissue. To aid in the training of residents and fellows, unique educational modalities exist to help facilitate the development of these microsurgical skills. From virtual simulators to artificial eye models, simulation of the posterior segment has gained an increased focus in vitreoretinal surgical training programs. Development of surgical curricula for vitreoretinal training and attainment of surgical milestones has been a key component in integrating these educational training modalities. We will explore various simulators, eye models, and potential rubrics and discuss unique ways each may help and complement one another to train future vitreoretinal surgeons.
Methods: We conducted a systematic PubMed search of various review studies (from publications in English ranging from January 1978 to December 2020) discussing surgical simulators, eye models, and surgical rubrics for vitreoretinal surgery and their potential impacts upon training.
Key Contents and Findings: Our review assesses the benefits and applicability of various simulators, eye models, and surgical rubrics upon training.
Conclusions: Utilization of vitreoretinal surgical training tools may aid in complementing the hands-on surgical training experience for vitreoretinal surgical fellows. By using simulators and rubrics, we may better be able to standardize training for reaching vitreoretinal surgical milestones and providing adequate feedback to improve surgical competency and ultimately patient outcomes.
Background and Objective: Intraocular lymphoma (IOL) is a heterogenous category of rare malignancies that are often misdiagnosed and underrecognized. The rarity of IOL impedes clinical research and contributes to difficulty in standardizing its management. In this article we review the existing scientific literature to identify the current diagnostic tools and discuss comprehensive management of various categories of IOL. Our objective is to increase disease recognition of IOL as a whole and explore updated management options for each subtype.
Methods: PubMed and Embase were searched for publications using the terms ‘intraocular lymphoma’, ‘vitreoretinal lymphoma’, ‘uveal lymphoma’, ‘iris lymphoma’, ‘choroidal lymphoma’ and ‘ciliary body lymphoma’ published from 1990 to June 2021. Inclusion criteria were English language articles. Exclusion criteria were non-English language articles, case reports and animal studies.
Key Content and Findings: IOL often presents in middle-aged and older patients with symptoms of floaters and vision changes, but a broad array of clinical signs and symptoms are possible depending upon subtype. IOL can be subdivided by location of involvement into vitreoretinal and uveal lymphoma. These subtypes express key differences in their pathophysiology, clinical presentation, histology, prognosis, and treatment. Primary vitreoretinal lymphomas (PVRL) generally originate from B-lymphocytes and are associated with central nervous system (CNS) lymphoma. Ophthalmic findings include retinal pigment epithelium changes with yellow subretinal deposits known as “leopard spotting.” Primary uveal lymphomas generally originate from low-grade B-lymphocytes invading the choroid and carry an improved prognosis compared to vitreoretinal lymphomas. Funduscopic findings of primary uveal lymphoma include yellow to pink-yellow choroidal swelling with infiltrative subconjunctival “salmon-patch” lesions. Diagnosis for IOL is often delayed due to insidious onset, low prevalence, and tendency to mimic diseases such as uveitis. Diagnosis may be challenging, often relying on biopsy with specialized laboratory testing for confirmation of IOL. Optimal treatment regimens are currently debated among experts. Management of IOL is best coordinated in association with neuro-oncology clinicians due to the tendency for intracranial involvement.
Conclusions: IOL represents a group of multiple malignancies with distinct clinicopathologic features. Future outlook for treatment and prognosis of IOL is likely to improve with less invasive molecular diagnostic techniques and increased awareness. Clinicians should be circumspect in all patients with possible IOL and promptly refer to oncologic specialists for rapid evaluation and treatment.
Background: Bacillary layer detachment (BALAD) is a phenomenon characterized by fluid accumulation at the myoid region of the inner photoreceptor segments identifiable on optical coherence tomography (OCT) imaging. This finding has been recently described in patients with diverse primary diagnoses which share the common feature of serous exudation in the posterior pole. However, thus far there have been very few reports in the literature of BALAD in patients with posterior scleritis.
Case Description: A 16-year-old male presented with unilateral vision changes that acutely worsened overnight to significant unilateral vision loss. He was eventually diagnosed with idiopathic posterior scleritis with associated BALAD on OCT. Similar to other reported cases of BALAD, he experienced anatomic restoration of the outer retina followed by good visual recovery after treatment with high dose steroid, ultimately with complete recovery of both retinal anatomy and vision within 4 months.
Conclusions: This case provides further evidence that posterior scleritis can be a cause of BALAD. The rapid presentation and excellent visual and anatomical outcome of this case is entirely consistent with known descriptions of BALAD in a variety of other conditions, further supporting the categorization of BALAD as an entity which retinal specialists should be able to recognize as distinct from other forms of intraretinal fluid, retinal detachment, and retinoschisis.
Background: Surgically induced astigmatism (SIA) and corneal high-order aberrations (HOAs) are the two main causes of poor visual quality after cataract surgery. Changes in the parameters of corneal HOAs after cataract surgery and their effects on and relationships with changes in corneal curvature have not yet been reported. This study aimed to explore changes in anterior, posterior and total corneal curvature, astigmatism and HOAs after microincision cataract surgery.
Methods: Sixty-one age-related cataract patients (61 eyes) were included in this prospective study. The total, anterior and posterior corneal astigmatism and corneal HOAs were analyzed by anterior segment optical coherence tomography (AS-OCT) and iTrace before, one day, one week and three months after 2.2 mm temporal microincision coaxial phacoemulsification to evaluate the changes in anterior, posterior and total corneal curvature, astigmatism and corneal HOAs.
Results: The mean J0 and J45 values of anterior, posterior and total corneal curvature obtained by AS-OCT showed no statistically significant difference between preoperatively and any postoperative follow-up. SIA occurred on the anterior, posterior and total corneal surfaces and showed no statistically significant difference at any postoperative follow-up. No significant changes in 3rd-order oblique trefoil, vertical coma or 4th-order spherical aberrations were observed after surgery except for a significant increase in horizontal coma at postoperative day 1 (POD1).
Conclusions: There were no significant changes in corneal curvature after 2.2 mm temporal microincision coaxial phacoemulsification, and the corneal HOAs were not changed significantly except for the increase in horizontal coma at POD1, which may be one of the main reasons of poor visual quality at POD1 in some cataract patients who have good uncorrected or corrected distance vision.
Background: To investigate the outcome of cataract surgery in patients with legal blindness defined as best-corrected visual acuity (BCVA) of 20/1,000 or lower and to determine factors influencing the visual outcome in these patients.
Methods: Medical records of 68 eyes of 62 patients diagnosed with legal blindness and underwent cataract surgery were reviewed. The study population was divided into 3 groups based on types of cataracts (Group A: posterior subcapsular cataract, Group B: mature or brunescent cataract, and Group C: cataract combined with other ocular diseases). Data including demographics, predisposing factors, BCVA before and 6 months after surgery and post-operative complications were collected and analyzed.
Results: Mean preoperative logMAR BCVA was 1.88±0.24, 2.24±0.26 and 1.96±0.31 in Groups A, B and C, respectively (P=0.003). The postoperative BCVA was 0.49±0.35, 0.51±0.47 and 0.90±0.53 in Groups A, B and C, respectively (p=0.003). Significant improvement in BCVA was shown in all 3 groups (P<0.001 in Groups A and B and, P=0.001 in Group C). There was significant difference in the amount of visual improvement among the 3 groups, P<0.001). Although there was no significant difference in the amount of visual improvement between group A and C (P=0.379), significantly higher visual improvement was achieved in group B compared with group A (P=0.012) and C (P=0.001).
Conclusions: Cataract surgery should be encouraged for patients with legal blindness, even in the presence of other ocular disease. Significant visual recovery was observed in all the groups, particularly in those with mature or brunescent cataract.
