Corneal stromal regeneration-keratoconus cell therapy: a review.

BACKGROUND: Keratoconus is a corneal ectatic disease caused by stromal thinning leading to astigmatism and progressive loss of vision. Loss of the keratocytes and excessive degradation of collagen fibres by matrix metalloproteinases are the molecular signatures of the disease. Despite several limitations, corneal collagen cross-linking and keratoplasty are the most widely used treatment options for keratoconus. In the pursuit of alternative treatment modalities, clinician scientists have explored cell therapy paradigms for treating the condition. METHODS: Articles pertaining to keratoconus cell therapy with relevant key words were used to search in PubMed, Researchgate, and Google Scholar. The articles were selected based on their relevance, reliability, publication year, published journal, and accessibility. RESULTS: Various cellular abnormalities have been reported in keratoconus. Diverse cell types such as mesenchymal stromal cells, dental pulp cells, bone marrow stem cells, haematopoietic stem cells, adipose-derived stem cells apart from embryonic and induced pluripotent stem cells can be used for keratoconus cell therapy. The results obtained show that there is a potential for these cells from various sources as a viable treatment option. CONCLUSION: There is a need for consensus with respect to the source of cells, mode of delivery, stage of disease, and duration of follow-up, to establish a standard operating protocol. This would eventually widen the cell therapy options for corneal ectatic diseases beyond keratoconus.

The relationship of diabetic retinopathy severity scales with frequency and surface area of diabetic retinopathy lesions.

PURPOSE: To assess the relationship between qualitative diabetic retinopathy (DR) scales with the precise numbers and surface area of DR lesions within the Early Treatment Diabetic Retinopathy Study (ETDRS) standard seven field (S7F) region on ultrawide-field (UWF) color fundus images. METHODS: In this study, we collected UWF images from adult patients with diabetes. Poor-quality images and eyes with any pathology precluding assessment of DR severity were excluded. The DR lesions were manually segmented. DR severity was graded according to the International Clinical Diabetic Retinopathy (ICDR) and AA protocol by two masked graders within the ETDRS S7F. These lesions' numbers and surface area were computed and correlated against the DR scores using the Kruskal-Wallis H test. Cohen's Kappa was performed to determine the agreement between two graders. RESULTS: One thousand five hundred and twenty eyes of 869 patients (294 females, 756 right eyes) with a mean age of 58.7 years were included. 47.4% were graded as no DR, 2.2% as mild non-proliferative DR (NPDR), 24.0% as moderate NPDR, 6.3% as severe NPDR, and 20.1% as proliferative DR (PDR). The area and number of DR lesions generally increased as the ICDR level increased up to severe NPDR, but decreased from severe NPDR to PDR. There was perfect intergrader agreement on the DR severity. CONCLUSION: A quantitative approach reveals that DR lesions' number and area generally correlate with ICDR-based categorical DR severity levels with an increasing trend in the number and area of DR lesions from mild to severe NPDR and a decrease from severe NPDR to PDR.

Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report.

BACKGROUND: Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis. CASE PRESENTATION: A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200. RESULTS: The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved. CONCLUSION: This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.

Diabetic Retinopathy and Diabetic Macular Edema in People With Early-Onset Diabetes.

This study examined the clinical profile, treatment profile, and vision outcomes of people ≤40 years of age with diabetes and diabetic macular edema (DME). Within this age-group, the prevalence of center-involving DME was 16%, with 74% of eyes showing cystoid edema, 37% showing spongiform edema, and 41% having neurosensory detachment. Longer diabetes duration (P = 0.001) and greater severity of diabetic retinopathy (P <0.001) were associated with DME prevalence. Thus, regular and more frequent follow-up, as well as early and aggressive treatment of diabetic eye disease, are required in people diagnosed early with diabetes.

Stem cell therapy in coronavirus disease 2019: current evidence and future potential.

The end of 2019 saw the beginning of the coronavirus disease 2019 (COVID-19) pandemic that soared in 2020, affecting 215 countries worldwide, with no signs of abating. In an effort to contain the spread of the disease and treat the infected, researchers are racing against several odds to find an effective solution. The unavailability of timely and affordable or definitive treatment has caused significant morbidity and mortality. Acute respiratory distress syndrome (ARDS) caused by an unregulated host inflammatory response toward the viral infection, followed by multi-organ dysfunction or failure, is one of the primary causes of death in severe cases of COVID-19 infection. Currently, empirical management of respiratory and hematological manifestations along with anti-viral agents is being used to treat the infection. The quest is on for both a vaccine and a more definitive management protocol to curtail the spread. Researchers and clinicians are also exploring the possibility of using cell therapy for severe cases of COVID-19 with ARDS. Mesenchymal stromal cells are known to have immunomodulatory properties and have previously been used to treat viral infections. This review explores the potential of mesenchymal stromal cells as cell therapy for ARDS.

Optical coherence tomography angiography in preterm-born children with retinopathy of prematurity.

PURPOSE: To describe the foveal avascular zone (FAZ) and vessel density (VD) in the superficial and deep capillary plexus in children with a history of prematurity on optical coherence tomography angiography (OCTA) and their correlation with gestational age (GA) and birth weight (BW). METHODS: We enrolled 81 preterm- and eight term-born children in this prospective observational study. The Optovue RTVue AVANTI (Optovue Inc., Fremont, CA) was used to procure the OCTA images. The 3 × 3 mm scan protocol centered on the fovea and the central 1 mm of the grid along with the FAZ of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was acquired. RESULTS: The mean SCP-VD was comparable between the preterms and term controls (p = 0.315) in the central fovea (1-mm grid). However, the SCP-VD of the 3-mm grid was lower in the preterms born without ROP, with type 1 ROP, and with type 2 ROP (47.61, 47.90, and 48.82 respectively) compared to that in the term group (51.38; p = 0.031). The FAZ in the SCP (p = 0.003) and DCP (p = 0.003) was significantly smaller in the preterms compared to that in the controls. Based on the GA sub-analysis, the FAZ was significantly smaller in the SCP and DCP of preterms born < 31 weeks and > 31 weeks GA (p < 0.000, p < 0.035, respectively). Based on the BW, the difference between the FAZ in the SCP (p = 0.002) and DCP (p = 0.003) was significant. There was no association between the visual acuity and FAZ. CONCLUSION: Optical coherence tomography angiography findings in this study show an altered foveal morphology and vascularity in preterms with and without ROP.

Solar retinopathy-correlation between adaptive optics and spectral domain optical coherence tomography with visual acuity.

BACKGROUND: To study the characteristics of photoreceptors on adaptive optics (AO) in patients of solar retinopathy and its correlation to changes in spectral domain optical coherence tomography (SDOCT) and visual acuity. METHODS AND MATERIAL: This is a cross-sectional observational study of six eyes of five patients with clinically diagnosed solar retinopathy. Five age-matched controls were included for comparison. A flood-illuminated adaptive optics retinal camera (AO; rtx1, Imagine Eyes, Orsay, France) was used to image the photoreceptors and a spectral domain optical coherence tomography (SDOCT; Spectralis™ Heidelberg Engineering, Germany) was used to study the retinal layers in these patients. The corrected distance visual acuity (CDVA) was assessed using Snellen's chart. RESULTS: Defects on the SDOCT were smaller (0.25 to 0.75°) at the fovea compared with AO (more than 1°). The cone mosaic was preserved beyond 1°. The cone count from the foveal center at 0.75, 1, 2, and 3° was decreased in all patients of solar retinopathy (mean value 5352) compared with age-matched controls (mean value 15693). A corresponding increase in spacing (mean value 19.13) compared with controls (mean value 9.34) was also observed. The CDVA ranged from 20/30 to 20/80. There was no statistically significant relationship between cone density, at any of the eccentricities measured, with CDVA or OCT defect (p > 0.05, for all). CONCLUSIONS: Adaptive optics is a sensitive and accurate tool to analyze photoreceptor damage in solar maculopathy. It can be used as an adjunct for better understanding of the pathology and to observe or predict changes in these patients.

Retinal pigment epithelium-secretome: A diabetic retinopathy perspective.

Diabetic retinopathy is a major complication of diabetes mellitus that can lead to retinal vascular abnormalities and visual impairment. While retinal endothelial pathology is well studied, retinal pigment epithelium (RPE) layer modifications and the patho-physiological regulations are not widely understood. The RPE is a highly specialized pigmented layer regulating not only physiological functions such as transport of nutrients, ions, absorption of light, phagocytosis of photoreceptor membranes, but also secretion of a number of cytokines, chemokines, angiogenic and anti-angiogenic factors. The RPE secretome, though crucial in health and disease, remains elusive in diabetic retinopathy. A knowledge of these secreted factors would help explain and correlate the clinical phase of the disease aiding in improved disease management. A comprehensive knowledge of the secreted factors of the RPE is a potential tool for understanding the differential treatment regime of early diabetic retinopathy, diabetic proliferative retinopathy and diabetic macular edema. In this review, we have delineated the importance of factors secreted by the retinal pigment epithelium and its regulation in the pathogenesis of diabetic retinopathy.

One for all: A standardized protocol for ex vivo culture of limbal, conjunctival and oral mucosal epithelial cells into corneal lineage.

BACKGROUND AIMS: Autologous transplantation of ex vivo cultured cells the treatment of choice for patients with limbal stem cell deficiency. The most commonly used cell sources for transplantation limbal, conjunctival or oral mucosal tissue. Protocols vary for culturing each tissue type, and there are no comparative studies on transplantation outcomes using these different culture techniques. To overcome this limitation, we devised a simple protocol that can uniformly promote growth and differentiation of cells from a limbal, conjunctival or oral mucosal biopsy into the corneal lineage. METHODS: Biopsies were cultured as explants on de-epithelialized human amniotic membrane in the presence of recombinant epidermal growth factor and insulin. Cultured cells were characterized using immunohistochemistry and quantitative reverse transcriptase polymerase chain reaction for stem/progenitor markers (ABCG2 and P63α) and differentiation markers (CK3, CK12, CK4, CK13, CK15 and CONNEXIN 43). Fluorescence-activated cell sorter analysis was performed for ABCG2. RESULTS: The results revealed that cells of all three biopsies differentiated into the corneal lineage. Positivity of CK3/12, CK4, CK12 and CONNEXIN 43 immunostaining and the relative mRNA expression of CK3, CK4, CK12, CK13, CK15 and CONNEXIN 43 could be detected in the cultured biopsies. CONCLUSIONS: Unlike tissue-specific protocols, our protocol can unequivocally promote differentiation of cells from a limbal, conjunctival or oral mucosal biopsy into the corneal lineage. This simple standardized protocol can be adapted for ocular surface reconstruction using stem cell transplantation.

Two novel missense substitutions in the VSX1 gene: clinical and genetic analysis of families with Keratoconus from India.

BACKGROUND: Visual system homeobox gene (VSX1) plays a major role in the early development of craniofacial and ocular tissues including cone opsin gene in the human retina. To date, few disease-causing mutations of VSX1 have been linked to familial and sporadic keratoconus (KC) in humans. In this study, we describe the clinical features and screening for VSX1 gene in families with KC from India. METHODS: Clinical data and genomic DNA were collected from patients with clinically diagnosed KC and their family members. The study was conducted on 20 subjects of eight families from India. The coding exons of VSX1 gene were amplified using PCR and amplicons were analyzed by direct sequencing. Predictive effect of the mutations was performed using Polyphen-2, SIFT and mutation assessor algorithms. Additionally, haplotypes of VSX1 gene were constructed for affected and unaffected individuals using SNPs. RESULTS: In the coding region of VSX1, one novel missense heterozygous change (p.Leu268His) was identified in five KC patients from two unrelated families. Another family of three members had a novel heterozygous change (p.Ser251Thr). These variants co-segregated with the disease phenotype in all affected individuals but not in the unaffected family members and 105 normal controls. In silico analysis suggested that p.Leu268His could have a deleterious effect on the protein coded by VSX1, while p.Ser251Thr has a neutral effect on the functional properties of VSX1. Haplotype examination revealed common SNPs around the missense change (p.Leu268His) in two unrelated KC families. CONCLUSIONS: In this study, we add p.Leu268His, a novel missense variation in the coding region of VSX1 to the existing repertoire of VSX1 coding variations observed in Indian patients with the characteristic phenotype of KC. The variant p.Ser251Thr might be a benign polymorphism, but further biophysical studies are necessary to evaluate its molecular mechanism. The shared haplotype by two families with the same variant suggests the possibility of a founder effect, which requires further elucidation. We suggest that p.Leu268His might be involved in the pathogenesis of KC, which may help in the genetic counselling of patients and their family.

COMPARING THE OUTCOME OF SINGLE VERSUS MULTIPLE SESSION LASER PHOTOABLATION OF FLAT NEOVASCULARIZATION IN ZONE 1 AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY: A Prospective Randomized Study.

PURPOSE: To compare single versus 2-session laser photoablation for flat neovascularization in cases with Zone 1 aggressive posterior retinopathy of prematurity. METHODS: Twenty-nine Asian Indian infants with aggressive posterior retinopathy of prematurity were randomized; each eye received 1 of 2 methods (29 each in Group A or B) proposed by the PHOTO-ROP group. Group A underwent single session laser to the avascular retina underlying the flat neovascularization by direct laser over the fronds. Group B underwent laser in 2 sessions; first, laser was delivered to the avascular periphery up to the flat neovascularization and 7 days later to the avascular bed exposed by the retraction of the fronds. Outcome and complications between the two groups were compared. RESULTS: Mean birthweight and gestational ages were 1,276 g and 30.1 weeks, respectively. All eyes showed favorable outcome at a minimum 12-month follow-up. Hemorrhages after laser (41.4% vs. 17.2%, P < 0.001) were more common in the single laser group. Large hemorrhages (>1 disk diameter) seen in Group A took longer than 8 weeks to resolve and developed focal fibrosis. CONCLUSION: This study demonstrates that the two-staged laser procedure produces fewer and smaller hemorrhages and no fibrosis compared with a single session. Both methods have comparable favorable outcomes in Asian Indian infants.

Human immunodeficiency virus retinopathy with presumed cytomegalovirus retinitis with macular oedema in a diabetic.

A man in his early 50s on regular follow-up for a stable non-proliferative diabetic retinopathy (NPDR) presented with decreased vision, worsening of retinal pathology and macular oedema in both eyes. His corrected distance visual acuity (CDVA) was 6/9 in the right eye and 6/15 in the left eye and fundus examination showed multiple intraretinal haemorrhages in all quadrants. His systemic workup revealed a severe thrombocytopaenia, which prompted a further detailed systemic evaluation revealing him to be positive for HIV with retinopathy complicating the pre-existing NPDR. Given the significant inflammation and macular oedema, a cocktail of intravitreal bevacizumab, ganciclovir and dexamethasone was administered. The retinopathy and macular oedema resolved and the CDVA improved to 6/6 in both eyes over a 6-month follow-up period. Any sudden worsening of fundus findings in a patient with diabetes necessitates immediate and detailed ocular and systemic evaluation, especially when the immune status is unknown.

Determinants for Anemic Retinopathy.

Objectives: To study the prevalence of fundus lesions in anaemics and define the hematological risk factors for retinopathy using the receiver operating characteristic curve analysis. Methods: For this retrospective study, patients ≥18 years and diagnosed with anemia with dilated fundus examination by a retina specialist from May 2019-April 2020 were included. Anemic retinopathy (AR) was present if hemorrhages in different layers of the retina, Roth's spots, exudates, cotton wool spots, retinal edema, and optic disc changes were noted. Patients with secondary anemia were excluded. Two groups were identified: Group 1: Patients with AR; Group 2: Patients with no AR with normal fundus. Demographic features, fundus findings, and hematological parameters were noted. Results: 38 (30%) eyes of 23 patients had AR; 90 (70%) eyes of 47 patients had no AR. The mean age in Group 1 and Group 2 was 54.7±18.9 and 58.6±15.3 years, respectively. Low hemoglobin (Hb) [mean = 7.82±1.64 gm/dl, p=<0.001] and hematocrit [mean = 26.93±5.22 %, p=0.002] values were noted in the AR group. AUC values for Hb (0.737) and hematocrit (0.719) were higher for the AR group. Hb < 8.95g/dl could predict AR with 85.8% sensitivity and 68.9% specificity, and hematocrit < 30.5% could predict AR with 80% sensitivity and 53.2% specificity. On regression analysis, Hb (p<0.001) and hematocrit (p=0.000) were associated with AR. Conclusion: Retinopathy is frequently seen in severe anemic patients. It is recommended that patients having low anemia should undergo a retinal examination.

Resveratrol for dry eye disease - Hope or Hype?

Dry eye disease (DED) is a multifactorial and common ophthalmic disease that has a tremendous effect on the quality of life. It is now becoming a public health concern because of our changing lifestyle and environment. The current treatment modalities, artificial tear substitutes, and anti-inflammatory therapy are directed at dry eye symptoms. One of the major drivers for DED is oxidative stress, and the polyphenol group of natural compounds has the potential to reduce the same. Resveratrol, widely found in the skin of grapes and nuts, has antioxidative and anti-inflammatory properties. It has been shown to have beneficial effects in glaucoma, age-related macular degeneration, retinopathy of prematurity, uveitis, and diabetic retinopathy. Studies have also explored the beneficial effects of resveratrol in DED, making it as a promising therapeutic molecule. Resveratrol has not yet reached clinical application because of difficulty in deliverability and low bioavailability. In this review, we explore the potential of resveratrol in DED treatment based on various in vitro and in vivo studies.

Bacillary Layer Detachment in Unilateral Acute Idiopathic Maculopathy: A Report of 2 Cases.

AIM: To report the presence of bacillary layer detachment (BLD) in unilateral acute idiopathic maculopathy (UAIM). CASE DESCRIPTION: Two patients diagnosed with UAIM based on the clinical and imaging features showed the characteristic splitting of the ellipsoid layer on spectral domain optical coherence tomography (SDOCT). This has been termed as bacillary layer detachment. RESULTS: No treatment was given. In both cases, there was a complete spontaneous resolution of the SDOCT findings 14-days post-presentation in Case 1 and 5-days post-presentation in Case 2 with improvement in visual acuity to 20/20, N6 in both cases. CONCLUSION: BLD in UAIM is not a commonly reported SDOCT finding and can serve as an imaging biomarker.

DIRECT LASER PHOTOCOAGULATION TO THE DILATED RIGHT-ANGLED VESSEL IN THE MANAGEMENT OF PROLIFERATIVE TYPE 2 MACULAR TELANGIECTASIA.

PURPOSE: To report a case of proliferative Type 2 macular telangiectasia treated successfully with direct laser photocoagulation to the right-angled vessel. METHODS: Descriptive case report. CASE DESCRIPTION: A 61-year-old man, with no past medical history, was diagnosed and treated previously elsewhere for bilateral proliferative Type 2 macular telangiectasia. He complained of recent onset decrease in vision in his right eye for last 2 months. Right eye visual acuity was counting fingers at 3 m and left eye was 6/18. Fundus examination showed proliferative Type 2 macular telangiectasia in both eyes with active neovascular complex in the right eye. Direct thermal laser photocoagulation to the tips of the right-angled vessels with single-spot PASCAL Synthesis (Topcon Medical Laser System) at 532 nm wavelength was done. After laser, reduction in the hyporeflective space height was noted on optical coherence tomography. No additional intravitreal anti-vascular endothelial growth factor injections were required. At the last 6-months follow-up visit, visual acuity improved to 6/36, N18 in the right eye. CONCLUSION: Direct laser photocoagulation to the right-angled vessel can be considered as possible treatment option for proliferative Type 2 macular telangiectasia, especially in patients nonresponsive to anti-vascular endothelial growth factor therapy. However, long-term follow-ups are required to see whether it is possible to maintain the efficacy.

Reducing the Impact of the COVID-19 Pandemic on Retinopathy of Prematurity Screening: Successful Strategies Learnt from a Multi-Center Tele-Medicine Program in India.

PURPOSE: Control of blindness due to retinopathy of prematurity (ROP) requires timely screening and treatment within 48-72 h. Anticipating that the coronavirus disease 2019 (COVID-19) pandemic would disrupt ROP services, we devised strategies ''on-the''-go"" to ameliorate this possiblity. We describe the successful outcomes of this approach in preventing infant blindness during the pandemic. METHODS: Data on the number of preemies recruited, screened and treated in the Karnataka Internet-assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program were collected in a retrospective (2019, interval 1) - prospective (2020, interval 2) manner. We summarize 10 key strategies that were developed as we faced logistic, operational and implementation challenges. These included pragmatic methods of enhancing enrolment, transporting for screening and ensuring timely treatment in the outreach. RESULTS: The total number of ROP screening sessions was 20,598 (7,197 new) and 14,371 (5,773 new) during interval 1 and 2 respectively. Of these, 166 (2.3%) and 157 (2.7%) infants required treatment during interval 1 and 2 respectively. All infants needing treatment during the COVID period, were treated on time which was possible due to successful implementation of the 'on-the-go' strategies throughout the state of Karnataka. The fiscal equivalent of the blindness prevented during this period is USD 15.6 million. CONCLUSION: The greater decline in the number of ROP screening episodes in neonatal units in government hospitals was because several were converted to 'COVID only" hospitals. KIDROP's multi-zonal, decentralized strategy, which uses non-physician-based imaging in a telemedicine network, ensured that essential ROP services continued even during the lockdown.

What do retina fellows-in-training think about the vitreoretinal surgical simulator: A multicenter survey.

Purpose: To profile vitreoretinal (VR) fellows-in-training from India exposed to the Eyesi surgical simulator, to identify potential barriers to voluntary use, and enumerate the most preferred tools and tasks before incorporating them into a formal skill-transfer curriculum. Methods: A questionnaire consisting of 22 questions was designed and circulated through an online portal (surveymonkey.com) to four different institutes of India having a VR surgical fellowship program and using a functional Eyesi (Haag-Streit) simulator. All fellows and trainees who were exposed to the simulator were eligible to participate, irrespective of time spent on the simulator and exposure to training steps on real patients. The responses collected were private and anonymous. Results: Of the 37 respondents, most (n = 25, 68%) considered surgical simulators to be the best training tool before operating on the human eye. A majority (n = 35, 94.5%) of participants spent <3 h per week on the simulator, which, most (n = 30, 81%) felt was not enough time. The main reasons for this underutilization were work-hour limitations (54.8%), lack of a structured training program (19.3%), or a dedicated supervisor (16.1%). Again, the majority (n = 33, 89%) of participants responded that VR surgical skills acquired during simulator training were transferrable to the operating room, which was reflected by their response (n = 31, 83.7%) that simulator-based training should be made mandatory before operating room exposure. Conclusion: This study gives an insight into the overall practice patterns and preferences in simulation training of surgical VR fellows-in-training across India. It indicates that the simulator is extremely helpful to fellows and if adopted, VR surgical simulators with organized, directed, and supervised sessions will considerably improve the surgical training experience.

Ocular surface changes following vitreoretinal procedures.

Dry eye disease (DED) can lead to ocular discomfort as well as visual disturbances. Older adults are more likely to develop DED. They are also more likely to develop retinal diseases such as diabetic retinopathy and age-related macular degeneration, which may require vitreoretinal surgeries, lasers, and intravitreal injections. Posterior segment surgery may cause or worsen existing dry eye symptoms, albeit temporarily. Despite good anatomic and functional outcomes, ocular surface dysfunction can have a significant impact on the quality of life, lowering a patient's satisfaction with the retinal treatment. Preexisting DED, intraoperative tissue handling, and postoperative treatment may all contribute to the severity of ocular surface dysfunction. In this article, we have reviewed all relevant studies on the development of ocular surface changes and DED, as well as the impact of vitreoretinal surgeries and procedures on the ocular surface.