Recent Innovations in Medical and Surgical Retina.

Abstract

To summarize major innovations in retinal disease management during fiscal year 2014. Literature review. A subset of papers published in the peer-reviewed literature were selected. Major innovations in retina include: (1) advances in the treatment of diabetic macular edema, including the use of aflibercept and sustained delivery dexamethasone intravitreal implants as well as subthreshold micropulse diode laser therapy; (2) reduced progression of age-related macular degeneration (AMD) using zinc, vitamin C, vitamin E, lutein, and zeaxanthin supplements as reported in the Age-Related Eye Disease Study-2; (3) use of enhanced-depth imaging optical coherence tomography for choroidal imaging; (4) use of gene therapy to treat choroideremia; (5) use of combination pharmacotherapy (i.e., squalamine + ranibizumab) and gene therapy to treat the neovascular complications of AMD; and (6) use of stem cell-derived retinal pigment epithelium transplants to treat atrophic AMD and Stargardt macular dystrophy. In addition, we review the ocular and systemic risks associated with sustained intraocular steroid delivery and inhibition of vascular endothelial growth factor signaling pathways. We also review potential applications of gene- versus cell-based therapy for the treatment of retinal degenerative diseases. Several treatment approaches are effective in the treatment of diabetic macular edema. Prophylaxis against AMD progression with Age-Related Eye Disease Study-2 supplements seems to reduce the risk of developing neovascular but not atrophic complications of AMD. Enhanced-depth imaging optical coherence tomography data provide new information on the role of the choroid in a variety of conditions. Advances in gene- and cell-based therapy will revolutionize the development of regenerative medicine in ophthalmology.