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To summarize available literature on physiologic and pathologic ocular changes during pregnancy. Narrative review of literature. Ocular changes occur commonly during pregnancy. Although most of these are benign physiologic responses to the metabolic, hormonal, and immunologic modifications to adopt the gestational product, there is some serious pathology that may develop, exacerbate, or even resolve over the course of pregnancy which requires prompt diagnosis and management. The pathological eye conditions can be classified into preexisting pathologies and emerging ocular diseases. Regardless of the different mechanisms by which these ocular changes occur, the key point is the establishment of an effective perinatal screening program to monitor the new development or successive progression of these ocular abnormalities. Irrespective of the visual health status of the pregnant women, regular perinatal eye examination should be scheduled in order to assure continuous surveillance of healthy eyes. Treatment of pathologic ocular conditions or functionally disturbing benign changes relies on an appropriate patient selection. Discriminating pathological eye disease from physiologic ocular changes is important in order to establish an individualized treatment or preventive plan and constitutes the mainstay of obstetric ophthalmology. This individualized approach should always weigh the ocular benefits of treatment to the mother against the potential harms to the fetus.

AimThe purpose of this study was to determine the association between prevalence of obstructive sleep apnoea (OSA) in patients with keratoconus (KC) and the severity of KC.MethodsSix-hundred and sixteen patients with KC and 616 patients without KC in the control group were enrolled in this prospective case–control study. Both groups were matched by age, gender, and body mass index (BMI). The Berlin Questionnaire was administered in both groups. Keratometric and topographic measurements of the KC eyes were recorded.ResultsSeventy-six (12.3%) and 40 (6.5%) patients were identified as high risk for developing OSA in KC and control groups, respectively (p<0.001). Family history of OSA and BMI were the risk factors for OSA in the KC group, while in the control group the only risk factor for OSA was the patient's gender. Patients with KC with a high risk of OSA had a significantly higher mean K, flat K, steep K (p<0.05), and a thinner corneal thickness (p<0.05). The severity of KC decreased in both OSA groups except for the grade 4 of high risk group which was the second most frequent group after grade 1 (p=0.005).ConclusionsOur study revealed that patients with KC are at increased risk of developing OSA, and patients with KC who are at higher risk of developing OSA may have more severe KC.

Purpose: Corneal collagen cross-linking (CXL) is a treatment strategy used in keratoconic eyes. Evaluation of long-term changes of higher-order aberrations (HOAs) after CXL is useful in understanding the efficacy of this procedure in improving optical, refractive, and visual acuity. This study aims to investigate the long-term effect of CXL on ocular HOA in patients with progressive keratoconus (KC). Methods: Using an OPD-Scan II aberrometer, ocular HOAs measurements of 56 eyes of 56 patients that underwent CXL was evaluated at the baseline, 1, 2, and 4 years after the procedure. All OPD-Scan measurements were decomposed into Zernike coefficients from 3rd to 6th order. Results: The results revealed that except for a few parameters, most of the aberration parameters continuously decreased during the study. In the 4-year postoperative period, a statistically significant improvement in all HOA parameters except 5th order Zernike polynomials (Z51, Z5−1, Z53, Z5−3, Z55, and Z5−5) was observed. All the values significantly decreased compared to the preoperative measurements (P < 0.05). The mean ± standard deviation (SD) root mean square of the 3rd, 4th, and the 5th order as well as coma, coma like, and total HOA parameters were significantly decreased compared to both preoperative and previous visits (P < 0.001). There were significant correlations between preoperative measurements of HOAs parameters with best-corrected visual acuity (BCVA) including Z31, Z3−1, Z40, Z51, and Z42. Moreover, all the HOAs parameters in 4 years after the CXL were significantly correlated with BCVA (P < 0.05). Conclusion: CXL is effective in improving HOA parameters in eyes with progressive KC during a long-term follow-up.

Purpose To compare the ophthalmic parameters and the severity of keratoconus (KC) in pediatrics and adults at the time of initial diagnosis in an Iranian population. Methods KC was diagnosed via slit-lamp examination and Pentacam imaging. In a retrospective observational study, consecutive patients were divided into two groups of pediatrics (<18 years old) and adults (>18 years old). Topographic, keratometric, and tomographic parameters, and severity of KC at the time of diagnosis were compared in both groups. Severity of KC was classified according to Amsler–Krumeich classification. Results One hundred fifty-eight eyes of 158 pediatric patients and 343 eyes of 343 adults with KC were studied. The mean ages of the pediatric and adult patients were 15 ± 1.9 and 22 ± 1.9 years, respectively ( p < 0.001). The results revealed that pediatric patients had significantly higher values of anterior and posterior mean, flat and steep keratometry, astigmatism, and maximum elevation and significantly lower central and thinnest corneal thickness ( p  < 0.05). No significant difference was found regarding sphere, cylinder, manifest refraction spherical equivalent, and uncorrected and best-spectacle corrected visual acuity between the groups ( p  > 0.05). Pediatric patients had a significantly more severe KC than adult patients according to Amsler–Krumeich classification ( p  = 0.001). Conclusion Our findings suggest that KC is more severe in pediatrics, hence the fact that they should be closely monitored and intensively treated.

Keratoconus as the most common cause of ectasia is one of the leading cause of corneal transplants worldwide. The current available therapies do not modify the underlying pathogenesis of the disease, and none of the available approaches but corneal transplant hinder the ongoing ectasia. Several studies document Crosslink defect between collagen fibrils in the pathogenesis of keratoconus. Collagen cross link is a relatively new approach that with the application of the riboflavin and ultraviolet A, new covalent bands reform. Subjective and objective results following this method seem to be promising. Endothelial damage besides other deep structural injury, which is the major concern of this technique have not yet been reported, when applying the standard method.

A 31‐year‐old Caucasian male developed reinfection with SARS‐CoV‐2, 2 ½ months after an initial episode of ICU admission for respiratory support due to COVID‐19. The second episode was in the form of malaise, aphthous gingival ulcer, and desquamating palmar lesion. A 31‐year‐old Caucasian male patient developed reinfection with SARS‐CoV‐2, 2 ½ months after an initial episode of ICU admission for respiratory support due to COVID‐19. The second episode was in the form of malaise, aphthous gingival ulcer, and desquamating palmar lesion.

BackgroundTo investigate the effect of pregnancy on anterior, posterior and biomechanical corneal parameters of healthy eyes.MethodIn this prospective cohort study, 70 pregnant participants with clinically healthy eyes underwent corneal topographic imaging evaluation by Pentacam and biomechanical assessment by Ocular Response Analyzer (ORA) before pregnancy, at the third trimester of pregnancy (34th week of pregnancy) and 12 months after delivery. The same number of age-matched non-pregnant females was evaluated at the corresponding appointments as the control group.ResultsAssessment of the tomographic, topographic and ORA measurements before pregnancy, at the third trimester of pregnancy and 12 months post partum revealed no statistically significant changes in anterior and posterior corneal flat, steep and mean keratometry, anterior and posterior elevation measurements, central and thinnest corneal thickness, corneal hysteresis, corneal resistance factor and intraocular pressure measurements (p>0.05, repeated measures analysis of variance (ANOVA)). All of the study parameters returned to their baseline levels 1 year after delivery. The ophthalmic parameters of the non-pregnant group remained significantly unchanged during the study period (p>0.05, all comparisons, repeated measures ANOVA). Moreover, no statistically significant differences were found between pregnant and non-pregnant groups in the second (34th week of pregnancy) and third (post partum) appointments (p>0.05, all comparisons, one-way ANOVA).ConclusionOur findings may suggest a physiological nature for ocular changes during pregnancy that these changes return to baseline values after delivery. The differences between tomographic, topographic and biomechanical corneal parameters before pregnancy, during pregnancy and post partum were not statistically or clinically significant.