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: Red eye is common in our daily practice. It ranges from non-inflammatory to inflammatory causes. An extended course of disease should prompt suspicion and the possibility of diagnosis revision. A prolonged conjunctivitis mimicking nodular episcleritis can be presented as a manifestation of granulomatosis with polyangiitis (GPA). A 57-year-old woman complained of eye redness and tearing for two weeks which partially resolved with antibiotics. She was subsequently commenced on topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) and topical anti-allergic. However, in the following reviews she developed cornea thinning and her systemic examination revealed an injected uvula with absence of upper respiratory tract infection. She was investigated for connective tissue disease and found to have raised anti-inflammatory markers and her antinuclear antibody and C-ANCA tests were positive. She was diagnosed with GPA. Her conditions improved followed by the commencement of topical corticosteroid with high dose of systemic corticosteroid, which followed by a tapering regime with oral corticosteroid. Although red eye is common, it is associated with a variety of diseases. GPA manifestation can be as subtle as a red eye. Any prolonged partially treated red eye should prompt suspicion of a more sinister cause. Sensitive detection of other subtle systemic signs is very important.

Abstract: Animal models are crucial for the study of tumorigenesis and therapies in oncology research. Though rare, uveal melanoma (UM) is the most common intraocular tumor and remains one of the most lethal cancers. Given the limitations of studying human UM cells in vitro, animal models have emerged as excellent platforms to investigate disease onset, progression, and metastasis. Since Greene’s initial studies on hamster UM, researchers have dramatically improved the array of animal models. Animals with spontaneous tumors have largely been replaced by engrafted and genetically engineered models. Inoculation techniques continue to be refined and expanded. Newer methods for directed mutagenesis have formed transgenic models to reliably study primary tumorigenesis. Human UM cell lines have been used to generate rapidly growing xenografts. Most recently, patient-derived xenografts have emerged as models that closely mimic the behavior of human UM. Separate animal models to study metastatic UM have also been established. Despite the advancements, the prognosis has only recently improved for UM patients, especially in patients with metastases. There is a need to identify and evaluate new preclinical models. To accomplish this goal, it is important to understand the origin, methods, advantages, and disadvantages of current animal models. In this review, the authors present current and historic animal models for the experimental study of UM. The strengths and shortcomings of each model are discussed and potential future directions are explored.

Background: Sodium iodate (SI) is a chemical widely applied to induce retina degeneration in animal models. SI treatment caused formation of rosettes/folds in the outer nuclear layer (ONL) of the rat retina, but it was previously unclear whether SI also forms rosettes in mice. In addition, SI induced retina degeneration was never addressed in non-separate sclerochoroid/retina pigment epithelium/retina whole mount. Here we displayed features of retina degeneration including rosette formation in mice and developed a morphological analytic assessment using sclerochoroid/retina pigment epithelium/retina whole mounts.

Methods: SI was intraperitoneally injected in Sprague-Dawley (SD) rats and C57BL/6J mice using a single dose (50 mg/kg) or with a dose range (10 to 50 mg/kg) in BALB/C mice. Rat retinas were investigated up to 2-week post-injection by histology and whole mounts, and mouse retinas were investigated up to 3-week post-injection by histology, fluorescent staining of sections and/or sclerochoroid/retina pigment epithelium/retina whole mounts for the morphological evaluations of the SI-induced retina damage.

Results: SI-induced retina damage caused photoreceptor (PR) degeneration and rosettes/folds formation, as well as retina pigment epithelium degeneration and inward migration. It displayed mixed nuclei from choroid to PRs, due to layer disorganization, as shown by single horizontal images in the sclerochoroid/retina pigment epithelium/retina whole mounts. Measurement of the PR rosette area induced by SI provided a quantitative, morphological evaluation of retina degeneration.

Conclusions: The method of non-separate sclerochoroid/retina pigment epithelium/retina whole staining and mount allows us to observe the integral horizontal view of damage from sclera to PR layers, which cannot be addressed by using sectioned and separate whole mount methods. This method is applicable for morphological evaluation of retina damage, especially in the subretinal layer.

Background: Spontaneously resolved primary congenital glaucoma is rare and the mechanism remains unknown. Previous literature described the phenomenon of spontaneous resolution of primary congenital glaucoma, with no further reports on follow-up visits and visual development of patients. We report a case of unilateral spontaneously resolved primary congenital glaucoma at a 7-year follow-up visit and describe the differential development of axial length (AL) between affected eye and healthy eye.

Case Description: A 6-year-old boy firstly presented at Zhongshan Ophthalmic Center with expanded corneas and ruptures in Descemet’s membranes (Haab’s striae) and apparently thin retinal nerve fiber layer (RNFL) in the left eye (LE), but normal intraocular pressure (IOP) of both eyes without anti-glaucoma medications or surgeries. At 7-year follow-up, the IOPs of bilateral eyes were stable ranging from 8 to 11 mmHg. A cup to disc ratio and the RNFL was stable in the LE at the following visit. The AL increased almost 3 mm in the right eye (RE) but 1.5 mm in the LE. Without anti-glaucoma medications or surgeries, the primary congenital glaucoma was spontaneously resolved.

Conclusions: It may figure out the development and influence of the affected eye of the patient, including AL and refraction state with regular ophthalmic examination at periodic follow-up.

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: 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.

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.