Intravitreal Steroid Injection Research Articles

Incidence, Risk Factors, Treatment, and Outcome of Ocular Hypertension following Intravitreal Steroid Injections: A Comparative Study

Purpose: To compare the incidence, risk factors, treatment, and outcomes associated with intravitreal triamcinolone-acetonide (TA) and dexamethasone-implant (Dex)-induced ocular hypertension (OHT). Methods: This retrospective study reviewed 1,549 TA and Dex administrations in 1,075 eyes of 897 patients. Intraocular pressure (IOP) values were monitored for a period of 6 months following intravitreal injection(s) and patients were categorized as steroid-responders (SR): IOP≥21 mm Hg, and steroid non-responders (NR): IOP≤20 mm Hg. Glaucoma patients, glaucoma suspects, uveitis, trauma, and less than 1 month of IOP follow-up cases were excluded from the study. The incidence of IOP rise, time and magnitude of IOP rise, and its management procedures were studied. Ocular and systemic associations with OHT incidence were investigated. Statistical analysis was performed using SPSS.23 and p < 0.05 was considered significant. Result: Twenty-eight percent of TA and 17% of Dex administered eyes developed OHT. Male subjects and elderly people (greater than 40 years of age) are at higher risk for OHT following steroid treatment. A high percentage of IOP rise was observed on day 1 (41%) for TA-SR, and after 1 month (50%) for Dex-SR. IOP rise was found to be more severe (>30 mm Hg) for TA-SR compared to Dex-SR (p = 0.006). 6% TA-SR required trabeculectomy with medically uncontrollable IOP. Myopia is a risk factor for secondary OHT, whereas diabetes mellitus and hypercholesterolemia are protective of it. Conclusion: Twenty-eight percent of TA and 17% of Dex administrations developed OHT. Early and severe IOP rises were more common in TA than among Dex administrations. Myopia is a risk for Dex-OHT.

When to Perform a Treatment Switch in Diabetic Macular Edema in Patients with Inadequate Response to Anti-VEGF

Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. Multiple therapeutic options are currently available for these patients, including laser photocoagulation; intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs or steroids; or pars plana vitrectomy for tractional DME. The initial treatment for DME is well-defined and widely accepted, with anti-VEGF as first-line option. Nevertheless, between 30 and 40% of patients show partial response or no response whatsoever. There is no consensus on the number of injections needed in order to classify a patient as a non-responder or sub-optimal responder, nor on the definition of the latter. In this study, these concepts are analysed as well as the different therapeutic alternatives at hand, with special interest on the switch between different anti-VEGF and/or steroids. These analyses are performed from an anatomical and functional point of view as well as from an economic, cost-effectiveness perspective. Recent evidence suggests that an early switch to dexamethasone implant in eyes that did not respond adequately to anti-VEGF therapy after 3 injections provides better functional outcomes while alleviating the heavy economic burden of this disease.

Hyperbaric Oxygen Therapy for Recalcitrant Macular Edema Following Branch Retinal Vein Occlusion

Cystoid macular edema (CME) is the most common cause of reduced vision in branch retinal vein occlusion (BRVO). The treatment protocols for macular edema in BRVO have changed considerably in the previous decade because of the increased popularity of the wide use of optical coherence tomography (OCT) and intravitreal drugs. Intravitreal injection of anti-vascular endothelial growth factors (anti-VEGF) and steroids result in the reduction of CME. However, the effect is transient, and multiple injections may be required. On repeated use, few patients become non-responders to these drugs. Nonetheless, anti-VEGF drugs may have potentially life-threatening complications because of systemic absorption. Intravitreal steroids may lead to severe ocular side effects such as cataract and glaucoma. Chances of endophthalmitis, retinal tear, and inflammation can occur with any of the intravitreal injections. We present a case of BRVO with recalcitrant CME following focal laser, multiple intravitreal anti-VEGF, and steroid injections. However, he had cardiovascular risk factors, so repeated anti-VEGF injections were not given. He was planned for hyperbaric oxygen therapy and showed favorable response. His visual acuity improved and macular edema reduced to more than half from baseline values on OCT.

Karaciğer Apsesinin İlk ve Tek Bulgusu Olarak Klebsiella Endoftalmisi

This report aimed to present an endogenous endophthalmitis case occurred as an embolic complication of a liver abscess without any signs other than ocular symptoms. A 58-year-old man was admitted to ophthalmology clinic due to acute onset severe pain and loss of vision in the left eye. With no history of any ocular trauma or surgery, the patient underwent a thorough evaluation including blood sampling, cultures, and abdominal imaging as per the recommendations of the consultation to general surgery department. Computed tomography revealed a hepatic abscess, and an ultrasonography guided drainage was performed for treatment. The purulent drainage fluid culture was positive for Klebsiella pneumoniae. Ocular infection was managed by intravitreal antibiotic and steroid injections in addition to topical fortified and intravenous antibiotic therapy. After medical therapy, a vitrectomy was performed for the sequel such as fibrotic membranes but there was no improvement in the vision.

Treatment of cystoid macular oedema secondary to pentosan polysulfate maculopathy using anti-VEGF and intravitreal steroid injections.

Pentosan polysulfate-related maculopathy is a recently described clinical entity, related to dose and long term use of this medication, and may progress despite drug cessation. Cystoid macular oedema (CMO) has been reported in some cases, but there are few reports of treatment outcomes in the literature. We present the case of a 55 year old female, with CMO secondary to pentosan polysulfate maculopathy, that was responsive to treatment with both intravitreal anti-VEGF and steroid injections, stabilising vision over a four year follow up period. This is the first report, to our knowledge, of CMO related to pentosan polysulfate maculopathy responding to intravitreal steroid injections, broadening the therapeutic options for preserving vision in these patients.

Exophiala Endophthalmitis after Cataract Surgery

Purpose: To report a case of Exophiala endophthalmitis after cataract surgery, which has not been reported previously in Korea.Case summary: A 70-year-old woman visited the hospital 7 days after cataract surgery in her right eye with unilateral vision impairment. At the time of the visit, visual acuity of the right eye was hand motion, and the fundus was not clearly observed due to numerous inflammatory cells with hypopyon in the anterior chamber. With an initial diagnosis of suspected bacterial endophthalmitis, vitrectomy was performed immediately with intravitreal injection of antibiotics and steroid. On day 14 after vitrectomy, inflammation in the anterior chamber and vitreous opacity worsened, and complete vitrectomy, including of the vitreous base, and removal of the intraocular lens and capsule was performed. Exophiala was detected in the biopsy specimen on day 6 after the second surgery, and the patient was discharged with a prescription for voriconazole eye drops. On day 23 after the second surgery, the best-corrected visual acuity in the right eye had improved to 1.0, and there was no evidence of endophthalmitis recurrence and no observed additional abnormal findings of the fundus until 6 months after second surgery.Conclusions: In a case of fungal endophthalmitis that occurred after cataract surgery, good results were obtained by vitrectomy involving complete removal of the peripheral vitreous body, including the intraocular lens and lens capsule, which was the basis for growth of the fungus in the early stage of endophthalmitis.

The effect of posterior vitreous detachment induced by intravitreal injections on macular edema with retinal vein occlusion

Introduction: To evaluate whether posterior vitreous detachment (PVD) improves treatment outcomes.Methods:The medical records of treatment-naive patients followed up for a minimum of six months due to retinal vein occlusion between January 2007 and January 2016 were reviewed. Patients with initial PVD were excluded. Correlation analysis and binary logistic regression analysis were used to determine the relationship between categorical variables and treatment outcomes. A subgroup analysis (steroids vs anti-VEGFs) was also performed.Results: The study included 95 eyes of 95 patients with macular edema due to retinal vein occlusion. Patients in both groups [central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)] were similar in terms of demographic data and showed similar improvement during the study. The patients who underwent intravitreal steroid injection (IVD or IVTA) were 12.35 times (95% CI: 4.03-37.85) more likely to develop PVD. The patients in steroid group had a statistically significantly high correlation with visual and anatomic improvements, especially after 5 months of follow-up. The median time of PVD was 5 months (2-11).Conclusion: Commonly used drugs in intravitreal pharmacotherapy induce PVD, which plays an important role for the treatment of underlying macular edema.

Delaying and preventing diabetic retinopathy

Abstract Diabetic retinopathy is a neurovascular complication of diabetes which is an avoidable cause of sight loss. Since the introduction of screening for diabetic retinopathy in the UK along with improving treatments for both diabetes and diabetic retinopathy it is no longer the leading cause of blindness in the UK. Screening detects diabetic retinopathy at an early stage when optimisation of blood glucose, blood pressure and cholesterol are effective in reducing the progression of diabetic retinopathy. Once proliferative diabetic retinopathy or diabetic macular oedema develops treatment includes laser photocoagulation, intravitreal vascular endothelial growth factor inhibitor injections, steroid injection and vitrectomy. With screening to detect diabetic retinopathy, improved therapies and technologies to help people manage diabetes and treatments for diabetic retinopathy sight loss is preventable for the majority of people. Copyright © 2021 John Wiley &amp; Sons.

Acute postoperative endophthalmitis after resurgery following primary cataract surgery: 9 years experience from a tertiary eyecare center.

To report the incidence, risk factors, and visual outcomes of acute postoperative endophthalmitis in patients undergoing resurgery after cataract surgery. Tertiary eye hospital in southern India. Retrospective, clinical registry. Medical records of patients were retrospectively reviewed from January 2010 to December 2018. Incidence, risk factors, causative organisms, management, and outcomes were studied. Patients who underwent resurgery within 6 weeks of primary cataract surgery and developed endophthalmitis within 6 weeks of resurgery were included. A total of 5705 patients (0.64%) underwent resurgery. Of 5705 resurgeries, 11 patients (0.19%) developed postoperative endophthalmitis. The incidence of endophthalmitis was higher in the eyes having a breach in the posterior capsule than the eyes with no breach in the posterior capsule (10/1277 [0.78%] vs 1/4428 [0.02%]). Among the 11 patients, secondary intraocular lens (IOL) implantation was the most common indication for resurgery (9/11 [82%]) after which endophthalmitis occurred. Three (27.3%) of the 11 patients were culture-positive. Nine (82%) of 11 patients were managed with a vitreous tap along with intravitreal antibiotics and steroid injections. After treatment, 80% of the patients achieved a visual acuity of 6/18 or greater (logMAR 0.5, P value < .05). None of the eyes developed phthisis bulbi. Eyes having a breach in the posterior capsule requiring vitrectomy and taken for resurgery as secondary IOL implantation were having an increased risk for endophthalmitis. The posttreatment visual outcomes were favorable.

89-OR: Cardiovascular and Mortality Risk with Intravitreal Anti-Vascular Endothelial Growth Factor (VEGF) Inhibitors in Patients with Diabetic Retinopathy (DR)

While intravenous anti-VEGF agents are known to contribute to arterial thromboembolic events, the cardiovascular (CV) safety of intravitreal anti-VEGF inhibitors remain unclear. Using Medicare and 2 U.S. commercial claims datasets (1/2009-12/2017), we identified 1:1 propensity score matched patients aged ≥18 years with DR initiating treatment with (1) intravitreal anti-VEGF injections or (2) laser procedure or intravitreal steroid injections (30,681 matched pairs). We assessed a composite CV outcome [myocardial infarction (MI) or stroke], its individual components, and mortality, using an intention-to-treat (ITT) scheme censoring at 180 days and 365 days of follow-up. We estimated pooled HRs and 95% CIs adjusting for 85 baseline covariates. Compared to laser or steroid treatment, intravitreal anti-VEGF injections were associated with a similar risk of the composite CV outcome [HR:0.91 (95% CI:078, 1.06)], MI [0.91 (0.74, 1.11)], stroke [0.92 (0.74, 1.15)], or risk of mortality [1.14 (0.87, 1.51)] at 6 months of follow up. Results were consistent in an ITT analysis censoring at 365 days (Table). Intravitreal anti-VEGF injections, compared to laser or steroid treatment, had similar risk of CV events and mortality in patients with DR. Disclosure M. Roh: None. H. Tesfaye: None. L. P. Aiello: Consultant; Self; KalVista Pharmaceuticals, Novo Nordisk, Regeneron Pharmaceuticals Inc., Stock/Shareholder; Self; KalVista Pharmaceuticals. S. C. Kim: Research Support; Self; AbbVie Inc., Bristol-Myers Squibb Company, Pfizer Inc., Roche Pharma. E. Patorno: Research Support; Self; Boehringer Ingelheim International GmbH, National Institutes of Health.

Racial Differences in Anti-VEGF Intravitreal Injections Among Commercially Insured Beneficiaries.

This study assessed racial and ethnic differences in receiving anti-vascular endothelial growth factor (VEGF) intravitreal injections among commercially insured patients. A retrospective cohort study of 104,430 patients diagnosed with wet age-related macular degeneration (AMD), diabetic retinopathy, central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO) in the Optum Research Database between 2011 and 2016. Main outcomes included receiving an intravitreal anti-VEGF treatment; the first type of treatment received, if any; and subsequent treatment with ranibizumab or aflibercept among patients who were first treated with bevacizumab. In a logistic regression model in all 104,430 patients, Asian patients were significantly less likely to receive an anti-VEGF treatment compared to white patients (odds ratio [OR] = 0.725; 95% confidence interval [CI], 0.667-0.789; P < .001), but Black and Hispanic patients were not. Overall, 19.9% (n = 20,753) of all included patients received treatment with intravitreal injections of anti-VEGF or steroids. In multinomial logistic models of treatment type among all patients who received intravitreal injections, Hispanic patients were less likely than white patients to initially be treated with ranibizumab (relative risk ratio [RRR] = 0.776; 95% CI, 0.647-0.929; P = .006) or aflibercept (RRR = 0.794; 95% CI, 0.654-0.964; P = .020). Black and Asian patients were not significantly more or less likely to receive different types of first-line injections compared to white patients. Among 17,092 patients who received bevacizumab as first-line therapy, Hispanic patients were less likely to subsequently transition to aflibercept than their white counterparts (RRR = 0.756; 95% CI, 0.634-0.903; P = .002). The authors found minimal racial and ethnic differences in receiving anti-VEGF treatment among commercially insured patients with wet AMD, diabetic retinopathy, CRVO, and BRVO. These results are limited by the fact that all of the patients included were commercially insured, and there are limited data on the socioeconomic status of the patients in their sample. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:208-217.].

Intracystic hyperreflective material in centre-involving diabetic macular oedema.

To report evolution and predictive value of intracystic hyperreflective material (ICHRM) on optical coherence tomography (OCT) in centre-involving diabetic macular oedema (CI-DME). Demographic and OCT features of patients with treatment-naïve CI-DME were analysed retrospectively. OCT parameters noted were macular oedema type, ICHRM presence, presence of hyperreflective spots, disorganised inner retinal layers and outer retinal layers integrity. Eyes were grouped into group 1 CI-DME without ICHRM and group 2 CI-DME with ICHRM. Univariate and multivariate linear regression analyses were done to study the correlation between various OCT features and final vision. In this study, 62 eyes of 50 patients were included in group 1 and 61 eyes of 51 patients in group 2. Mean presenting logMAR vision in groups 1 and 2 was 0.374 ± 0.346 and 0.523 ± 0.369 respectively. Poor final visual acuity was noted in CI-DME with ICHRM group (p = 0.015). On linear regression analysis, 3 OCT features, namely, ICHRM presence (p = 0.034), inner segment-outer segment layer disruption (p = 0.001) and ellipsoid zone defects (p = 0.003), were associated with poor final vision. More intravitreal anti-VEGF (2.98 vs 0.629) and steroid (1.51 vs 0.242) injections were required for macular oedema resolution in ICHRM group. This study is the first to assess the ICHRM on OCT as predictor for treatment outcome in DME eyes. We described its evolution during the DME management and its plausible influence on intravitreal therapy. We believe that this finding has the potential to become a novel biomarker for predicting the visual outcome in DME.

Radiation retinopathy masquerading diabetic retinopathy

Background: Radiation retinopathy (RR) can occur years after irradiation as a chronic and progressive retinal micro-angiopathy. The presentations of RR are similar to other retinal vaso-occlusive disorders like diabetic retinopathy, hypertensive retinopathy. The patient was referred to us as a case of diabetic retinopathy who had received intravitreal injections for macular edema without any improvement. A thorough evaluation revealed it to be a case of Radiation retinopathy. RR treatment includes laser photocoagulation, intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, intravitreal steroid injections, and surgery. Case presentation: We report a case of a 47-year-old diabetic male patient in whom RR developed following 30Gy of radiation therapy for Ethmoidal sinus carcinoma masquerading as Diabetic retinopathy. FFA was showing extensive ischemia of the retina, and OCT showing Macular edema. He received Pan retinal photocoagulation in both eyes followed by multiple intravitreal Anti-VEGF injections on a PRN basis and underwent Pars plana vitrectomy in the right eye for non-resolving vitreous hemorrhage. Conclusion: The patient's vision improved only after treating the retinal ischemia with photocoagulation and later treating the macular edema. This report emphasizes the importance of differentiating this disease entity from other vaso-occlusive retinopathy by eliciting a detailed patient history and planning further management accordingly.

Endophtalmitis associated with flange exposure after a 4-flanged canabrava fixation techique

A 101-year-old woman who underwent 4-flanged intrascleral fixation intraocular lens (ISF IOL) technique surgery in her left eye (elsewhere) 6 months prior to her presentation, was referred to our department due to pain and loss of vision for the previous 4 days. The patient presented with left eye visual acuity of hand motion, conjunctival hyperemia, hypopyon, vitritis, and 2 polypropylene flanges exposed throughout the conjunctiva. Endophthalmitis was diagnosed followed by urgent treatment with vitreous and anterior chamber tap, and intravitreal injections of antibiotics and steroids. Cultures revealed Streptococci viridans infection. No further surgical intervention was performed due to patient opposition. The infection resolved within a few weeks; however, phthisis bulbi developed subsequently. ISF IOL with 4 polypropylene flanges has gained popularity. A rare complication of flange extrusion might lead to endophthalmitis. Studies evaluating short- and long-term complications of this technique are warranted.

FLOURESCEIN FUNDUS ANGIOGRAPHY VERSUS OPTICAL COHERENCE TOMOGRAPHY IN DIABETIC MACULAR EDEMA

Background: Diabetic maculopathy is the leading cause of visual loss in diabetic patients. The pathogenesis is not fully understood and a satisfactory therapy is currently not available. The most common tools to diagnose diabetic retinopathy and diabetic macular edema are flourscien fundus angiography (FA) and optical coherene tomography (OCT). Objective: To compare between the assessment of diabetic macular edema by Fluorescein fundus angiography and by Optical coherence tomography in the same patients. Patients and Methods: Forty eyes were included in the study with non-proliferative diabetic retinopathy with maculopathy those met the inclusion criteria. Patients were fully evaluated including history, examination and investigations. Investigations used Optical Coherence Tomography and Flouresien Fundus Angiography. Study setting at Memorial Institute of Ophthalmic Research (MIOR) and Al-Azhar University Hospitals from March 2019 to October 2019. Results: The distribution of FA patterns showed diffuse leakage at macula as the most common pattern seen in 60% of eyes followed by focal leakage at macula seen in 27.5% of eyes, and combined (focal and diffuse leakage at macula) was seen in 12.5% of eyes. Eyes with focal leakage were more likely to have CME, whereas eyes with diffuse leakage were more likely to have serous foveal detachment and combined pattern on OCT show cystoid macular edema with serous foveal detachment. Conclusion: FA is known to be a sensitive method for qualitative assessment of fluid leakage in diabetic macular edema; however, actual macular thickening assessed by OCT is better correlated with the loss of visual acuity. Furthermore, FA is an invasive procedure with side effects ranging from nausea to its rare complication of anaphylaxis and death. OCT is noninvasive, comfortable, safe, fast and can be repeated as often as required and offers an alternative to FA in the follow up of changes in retinal thickness after laser photocoagulation and intra-vitreal steroid injection. However, FA is still essential for the assessment of the foveal perfusion state, which cannot be demonstrated by the OCT.

Current role of intravitreal injections in Irvine Gass syndrome-CRIIG study.

To analyze the role of intravitreal anti-vascular endothelial growth factor (anti-VEGF) or steroid injection for the management of Irvine Gass syndrome. It is an interventional, retrospective, multicenter study. One hundred and thirty-two injections were given in 79 eyes of 72 patients with Irvine Gass syndrome. Patients were treated with at least one intravitreal injection of either anti-VEGF or steroid. Outcomes were measured at 12 months (± 1 week). [Ranibizumab (Lucentis; Genentech, South San Francisco, CA) (Razumab; Intas Pharmaceutical Ltd, Ahmedabad, India) Bevacizumab (Avastin; Genentech, South San Francisco, CA) or Aflibercept (Eylea; Regeneron, Tarrytown, NY)] or steroids [Dexamethasone implant (Ozurdex, Allergan Inc, Irvine, CA) or intravitreal triamcinolone)]. Intravitreal injections were initiated in (67.6%) of eyes within 14 weeks of diagnosis. Intravitreal dexamethasone implant was used as the initial intravitreal therapy in (73.4%) of eyes. More than fifty percent (54.5%) of the patients were switched from anti-VEGF to Intravitreal dexamethasone implant. Reduction in the mean CMT was 336.7 ± 191.7 and 160.1 ± 153.1 microns in eyes treated within four weeks and more than 14 weeks from diagnosis (p = 0.005). Mean ETDRS letter gain was 16.7 ± 12.9 and 5.2 ± 9.2 in eyes treated within 4 weeks and more than 14 weeks from diagnosis (p = 0.004). Three eyes injected with intravitreal dexamethasone implant reported an intraocular pressure spike of > 25 mmHg which was controlled with topical medications. No other ocular or systemic adverse events were observed. Study results suggest that physicians tend to introduce intravitreal therapy within 14 weeks of diagnosis. The most common therapy at initiation and for the switch is intravitreal dexamethasone implant. Patients treated early (within 4 weeks) respond better in terms of structure and function.

Uveitis Induced by Biological Agents Used in Cancer Therapy

ABSTRACT Purpose: To report cases of uveitis induced by biological therapy given for cancer. Methods: Retrospective review of medical charts of patients. Results: Included were six patients aged 14–81 years. Three were treated with vemurafenib and one each with nivolumab, ipilimumab, and osimertinib. The oncological diagnoses were metastatic thyroid carcinoma, pleomorphic xanthoastrocytoma, metastatic melanoma, adenocarcinoma of the lung, and metastatic breast cancer. Ocular manifestations appeared 4–82 weeks after the biological treatment was initiated. The most common ocular presentation was anterior uveitis. Onset was sudden in all cases. The median duration of uveitis was 70 weeks. Treatment included topical or systemic corticosteroids; one patient received a single intravitreal steroid injection in one eye. Conclusions: Uveitis may rarely be induced by treatment with biological agents for cancer. Both oncologists and ophthalmologists should be aware of this potential side effect. Early detection and management can prevent permanent complications and save the patient’s vision.

A matched case–control study of the clinical, economic, and patient-reported outcomes of cystoid macular edema complicating phacoemulsification surgery

To assess the visual outcomes of pseudophakic cystoid macular edema (CME) as compared with age- and copathology-matched control subjects, the costs of treatment and follow-up, and the patient-reported outcomes using the new Cat-patient-reported outcome measures (PROM) 5 questionnaire. West Suffolk Hospital NHS Foundation Trust, United Kingdom. Matched case-control study. Fifty-two eyes of 49 patients developed CME over an 18-month period. Age- and copathology-matched patients were identified from clinical records over the same time period in a 2:1 ratio (90 eyes). Postoperative clinical outcomes were recorded including treatments received, costs of treatments, and patient-reported outcome measures using the Cat-PROM5. Patients with CME reported a significantly worse outcome from surgery than control subjects. Furthermore, patients with CME had significantly worse visual acuity postoperatively than control subjects (CME: logarithm of the minimum angle of resolution 0.40 ± 0.33, n = 37; control subjects: 0.30 ± 0.33; P < .05) despite there being no difference in preoperative visual acuity. In patients with epiretinal membrane (ERM), notably those with CME had worse patient-reported outcomes than control subjects with ERM, and only 18% received prophylactic corticosteroid injection at surgery compared with 63.6% of control subjects. CME resulted in an excess of 266 outpatient appointments, with 388 weeks of topical therapy, 18 orbital floor injections, 6 intravitreal steroid injections, 5 intravitreal antivascular endothelial growth factor injections, and 1 intravitreal dexamethasone implant with an excess expenditure of £216.81 per case. Patients developing CME after cataract surgery had reduced visual acuity at 4 to 6 weeks, patient-reported visual outcomes, and increased number of hospital appointments, treatments, and costs.

Dexamethasone implant – An update

Uveitic entities may be infectious or noninfectious in etiology. Corticosteroids remain the first-line treatment for noninfectious posterior uveitis. Intravitreal injections of steroids have been useful in targeted therapy of the posterior segment. However, a host of systemic and local adverse effects limits the usefulness of steroids. Intravitreal implants of dexamethasone with sustained release of the drug over months are a more effective and safer option. Various formulations with varying dosage and lifespan such as retisert, ozurdex, and yutiq are available. Ozurdex has a very successful track record over numerous studies in treating posterior uveitis in adults and children. It is important to rule out infectious causes of uveitis before administering ozurdex. We can achieve optimal control of ocular inflammation with minimal systemic side effects when used judiciously.

Role of Inflammation in Classification of Diabetic Macular Edema by Optical Coherence Tomography.

Diabetic macular edema (DME) is the abnormal accumulation of fluid in the subretinal or intraretinal spaces in the macula in patients with diabetic retinopathy and leads to severely impaired central vision. Technical developments in retinal imaging systems have led to many advances in the study of DME. In particular, optical coherence tomography (OCT) can provide longitudinal and microstructural analysis of the macula. A comprehensive review was provided regarding the role of inflammation using OCT-based classification of DME and current and ongoing therapeutic approaches. In this review, we first describe the pathogenesis of DME, then discuss the classification of DME based on OCT findings and the association of different types of DME with inflammation, and finally describe current and ongoing therapeutic approaches using OCT-based classification of DME. Inflammation has an important role in the pathogenesis of DME, but its role appears to differ among the DME phenotypes, as determined by OCT. It is important to determine how the different DME subtypes respond to intravitreal injections of steroids, antivascular endothelial growth factor agents, and other drugs to improve prognosis and responsiveness to treatment.