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.
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.
Background: To assess the safety and efficacy of supracapsular implantation with optic capture of the posterior chamber intraocular lens in Chinese children with aphakic after traumatic cataract.
Methods: It was a retrospective case series study. Fifteen cases (15 eyes) Chinese children received supracapsular implantation with optic capture of the posterior chamber intraocular lens. Pre- and post-operative visual acuities were recorded. Intra- and post-operative complications were observed. The follow-up period ranged from 7 to 43 (28.7±7.2) months.
Results: Implantation of optic capture of the posterior chamber intraocular lens was successfully performed in 15 eyes. The best corrected visual acuity (BCVA) ranged from 0.3 to 1.0 (0.61±0.19). No optic axis opaque was found in 15 eyes with optic capture. The major complications of optic capture were iris posterior synechia and intraocular lens (IOL) precipitates. Intraocular dislocation was found in one case three weeks after the operation.
Conclusions: Supracapsular implantation with optic capture of the posterior chamber intraocular lens is safe and effective for the treatment of traumatic cataract in Chinese children.
Abstract: Diabetic retinopathy (DR) remains a leading cause of irreversible vision loss in adult populations around the globe. Despite growing evidence of the effectiveness of routine assessments and early intervention, DR screening strategies are not widely implemented largely due to an inadequate availability of resources to cope with the growing burden of diabetes. Advances in technology in the field of DR screening are clearly warranted and the recent emergence of deep learning-based artificial intelligence (AI) grading of retinal pathology offers significant potential benefits including an increased efficiency, accessibility and affordability of screening programmes.
Abstract: Four challenging and unusual retinal cases: (I) 11-year follow-up for retinal hemangioblastoma with von Hippel-Lindau (VHL) disease; (II) treatment for central serous chorioretinopathy (CSC)—observation, half does photodynamic therapy (PDT) or micropulse laser photocoagulation; (III) diagnosis and treatment for a child with optic nerve defect; (IV) the optional treatment for retinal detachment (RD) with iridolenticular choroidal coloboma, were presented and discussed by three international retinal specialists at a retinal clinical round in Fundus Diseases Center of Zhongshan Ophthalmic Center (ZOC). The discussion helps us a better understanding of the pathogenesis and managements of these four retinal diseases and their association with systemic conditions.
Abstract: Retinopathy of prematurity (ROP) is a proliferative disorder of the developing retina in premature and low birth weight infants. Recently, the role of vascular endothelial growth factor (VEGF) in the pathophysiology of ROP has been well studied and anti-VEGF drugs have been used in phase 2 to treat ROP patients in many ways. At first, ophthalmologists began to give intravitreal bevacizumab (IVB) or ranibizumab off-label to treat ROP as a salvage treatment after failure in laser photocoagulation or in combination with laser as an adjuvant treatment for patients had media opacity or rigid pupil. Now anti-VEGF drugs are also used as monotherapy in type I ROP or perioperative use in stage 4/5 ROP. Questions remain regarding long-term safety, dose, timing, visual outcomes and long-term effects, including systemically.
