Intravitreal Steroids Research Articles

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.

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.

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group.

The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.

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.

Current Approaches in Treatment of Diabetic Retinopathy and Future Perspectives.

Diabetes mellitus (DM) is a metabolic disease, which is the most common cause of low vision in developing countries and affects almost all systems of the body. In view of the increase in DM prevalence in the world, it would not be a surprise that diabetic retinopathy (DR) and other vascular complications related to diabetes become a serious public health problem. Currently, vascular endothelial growth factor, laser photocoagulation, and intravitreal steroids are the mainstays for DR treatment, but the efficacy of these treatment strategies remains insufficient. Therefore, new treatment modalities for DR have been developed, such as stem cell therapies, extracellular vesicular system, and nanodrug delivery systems. Although there have been several reviews in the literature on the treatment of DR, we have not confronted any review that has the titles of all these topics. With this review, we aim to present the pathophysiology of DR and to review the current and promising new treatment methods based on stem cells, extracellular vesicular system, and nanodrug delivery systems for the future of DR management.

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery-a Scottish Ophthalmological Surveillance Unit study.

PurposePost-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients.MethodsA Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation.ResultsFourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44–86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2–0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270–788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1–0.3) with average mean CRT of 327microns (245–488).ConclusionsWe identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.

Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone

BackgroundThe purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial.MethodsThis is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018.ResultsEighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye.ConclusionsThe use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.

Outcomes of Intravitreal Bevacizumab for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose: To determine the functional and anatomical outcome of intravitreal Bevacizumab in patients withmacular edema secondary to branch retinal vein occlusion.Study Design: Quasi Experimental study.Place and Duration of Study: Institute of Ophthalmology, Mayo hospital, Lahore, from February 2016 to December 2018.Material and Methods: Forty eyes of 40 patients with macular edema on OCT secondary to BRVO were included in the study. All the patients suffering from other types of macular edemacaused by diabetes, epi-retinal membrane (ERM), surgery involving posterior segment, vitreoretinal traction andhistory of intravitreal VEGF or steroids were excluded from the study. Intravitreal Bevacizumab was given whenmacular thickness was &gt; 300 μm or Visual acuity was &lt; 6/12. Follow-up was at 1st, 3rd, 6th and 12th month.Results: The mean age of the patients was 52.12 ± 5.63 years. Male to female ratio was 1.5:1. Infero-temporalvenous arcade was the most common site of BRVO (55%) followed by supero-temporal (35%) and macularBRVO (10%). Baseline visual acuity was 6/12 or better in 17.5% of the patients at presentation. This proportionincreased to 27.5%, 40%, 52.5% and 67.5% at 1, 3, 6 and 12 months respectively. Macular thickness measuredat presentation was 540 ± 120 μm. Macular thickness gradually reduced on follow-up. At one month meanmacular thickness was 430 ± 90 μm. It was less than 300 μm after 6 months.Conclusion: Intravitreal bevacizumab results in improved functional and anatomical outcomes in cases ofmacular edema secondary to BRVO.

Prospective study of morphologic and functional parameter changes post intravitreal therapy for macular edema.

Retinal sensitivity (RS) can be a valuable indicator of retinal function in response to intravitreal steroid or anti-VEGF treatment in the eyes with diabetic macular edema (DME), macular edema post retinal vein occlusion (RVO), or uveitis. This prospective longitudinal study included 68 patients (96 eyes) with macular edema (ME) secondary to diabetes mellitus (42 eyes), uveitis (36 eyes), or RVO (18 eyes). In addition to best corrected visual acuity (BCVA) and retinal thickness, Nidek MP1 microperimetry was used to quantify RS at baseline visit and to look at the mean difference (MD) at 3-6months and 1-2years post intravitreal therapy with corticosteroids or anti-VEGF. There was a significant negative correlation between the central RS and BCVA (r = - 0.47, p < 0.001), including DME (r = - 0.42, p = 0.006) and uveitis (r = - 0.60, p < 0.001), but not RVO (r = - 0.37, p = 0.12). At 2-year follow-up, the overall CST was reduced from baseline (MD - 147μm, 95% C.I - 192 to - 102, p < 0.001) with improved BCVA (MD - 0.12LogMAR, 95% C.I - 0.23 to - 0.01, p = 0.01), but no improvement in the RS in any of the disorders. Both anti-VEFG and steroid groups showed significant improvement in CST at 2 years from baseline (MD - 101μm, p = 0.001 and - 167μm, p < 0.001, respectively) with only improvement in BCVA among anti-VEGF group (MD - 0.16LogMAR, 95% C.I - 0.26 to - 0.07, p = 0.008). The long-term follow-up of ME cases did not show a significant improvement in RS following treatment even with reduced macular thickness at 2-year follow-up.

Successful management of intralenticular Ozurdex injection causing cataract and intractable glaucoma

A 50-year-old female presented with profound vision loss and was previously advised injection Ozurdex in the left eye. In the left eye, the anterior chamber was quiet, intraocular pressure (IOP) was 58 mmHg and cataractous changes were noted with Ozurdex implant inside the lens substance. The left eye had glaucomatous cupping (0.9:1 CDR), bipolar rim thinning, inferior notch and healed choroiditis. The patient underwent phacoemulsification, trabeculectomy and mitomycin-C in the left eye. Visual acuity improved and IOP was under control. Although Ozurdex is effective, there are reports of complications related to the drug and implantation procedure. This case highlights an uncommon complication of an uncontrolled, persistent steroid response leading to glaucomatous optic atrophy and profound vision loss due to an accidental intralenticular implantation of Ozurdex. Our case reinforces the need for caution about the decision regarding the judicious use of intravitreal steroids and employment of appropriate technique.

Diabetes und Augenerkrankungen

AbstractThe frequency of diabetic retinopathy increases and is a leading cause of blindness in the working population. Recommended exams are testing of the visual acuity, ophthalmoscopy with dilated pupils, fundus fluorescein angiography and optical coherence tomography (OCT). By OCT the diagnosis and monitoring of diabetic macular edema has vastly improved. By intravitreal medications such as intravitreal anti-VEGF or intravitreal steroids macular edema can be treated successfully. Panretinal laser photocoagulation is the gold-standard in the therapy of proliferative diabetic retinopathy. Patients benefit from good co-working of general practitioner and ophthalmologist concerning screening and treatment.

Chronic Unilateral Uveitis as a Manifestation of Leprosy: A Case Report and Literature Review

ABSTRACT Purpose: To describe a case of leprosy presenting chronic anterior uveitis associated with other systemic lesions. Methods: Case report and systematic literature review. Results: We describe the case of a 65-year-old patient presenting clinical features of chronic uveitis and poor response to topical and intravitreal steroid treatment. Upon ocular examination, diffuse iris atrophy and macular edema were observed and laboratory tests for autoimmune and infectious diseases were within normal range. Physical examination revealed the presence of skin lesions on trunk and extremities, which were biopsied and identified as positive for leprosy. Conclusion: The case reported herein presented atypical characteristics of uveitis due to the involvement of the posterior segment of the eye. Leprosy diagnosis could be a challenge, a systematic approach is mandatory to achieve adequate treatment.

A Cross-Sectional Online Survey Identifies Subspecialty Differences in the Management of Pediatric Cataracts Associated with Uveitis.

IntroductionTo determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of intraocular lenses.MethodsUveitis ophthalmologists and pediatric ophthalmologists were surveyed via an online poll regarding their therapeutic management of pediatric uveitic cataract and intraocular lens (IOL) placement.ResultsSixty-two responses from uveitis ophthalmologists and 47 responses from pediatric ophthalmologists were recorded. According to 79% of all responses, uveitis was not a contraindication for primary IOL implantation in patients with controlled intraocular inflammation. Pediatric ophthalmologists were more likely to respond that the presence of chronic juvenile idiopathic arthritis-associated iridocyclitis, pars planitis, or recurrent acute anterior uveitis is a contraindication for primary IOL implantation in pediatric cases with full control of intraocular inflammation. There was no consensus within either specialty with regard to the preferred IOL material for lens implantation. Uveitis ophthalmologists were more likely to report the use of intravenous and intravitreal steroids for perioperative treatment. In cataract surgery for a child with recurrent acute anterior uveitis, a higher percentage of uveitis ophthalmologists (71%) than pediatric ophthalmologists (50%) responded that the posterior capsule should be primarily opened. A higher percentage of uveitis ophthalmologists also stated that anterior vitrectomy should be performed at the time of cataract surgery in all three uveitis types.ConclusionsPediatric ophthalmologists and uveitis ophthalmologists have similar approaches to the management of pediatric uveitic cataract removal and IOL insertion, but several differences remain between these subspecialties. Continued collaboration between the subspecialties would be helpful to better develop consistent criteria to improve patient care.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00245-x) contains supplementary material, which is available to authorized users.

Ocular Hypertension Following Intravitreal Injection of 0.7mg Dexamethasone Implant versus 2mg Triamcinolone

ABSTRACTBackground: To compare the incidence and outcomes of ocular hypertension (OHT) after intravitreal injection of 0.7 mg dexamethasone (DEX) and 2 mg triamcinolone acetonide (IVT).Methods: In a single-center, retrospective comparative case series, all patients with at least 3 months follow-up receiving 2 mg IVT 3/1/2012 – 3/1/2017 or 0.7 mg dexamethasone 10/1/2014 – 3/1/2017 were included. Ocular hypertension was defined as an intraocular pressure (IOP) ≥ 25 mmHg. Patients with a minimum of 3 months follow-up were included. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded.Results: 106 eyes in 100 patients receiving IVT and 114 eyes in 102 patients receiving DEX were included. The mean number of injections was 2.9 for patients receiving IVT and 2.4 for patients receiving DEX (p = .11). Fourteen eyes (13.2%) in 14 patients receiving IVT developed OHT compared to 17 eyes (15.1%) in 15 patients receiving DEX (p = .85). All cases of OHT were managed with IOP lowering drops or observation alone.Conclusions: Rates of ocular hypertension following 2 mg IVT and DEX are similar. All patients developing OHT were successfully managed without surgical intervention.

Scleral Fixation of the Fluocinolone Acetonide Implant in Eyes with Severe Iris-Lens Diaphragm Disruption and Recalcitrant CME: The Fluocinolone-Loop-Anchoring Technique (FLAT).

IntroductionWhile proven to be an effective treatment for cystoid macular edema (CME) and diabetic macular edema, intravitreal steroid implants (IVSI) may cause undesirable side effects, including steroid-related glaucoma or migration into the anterior chamber in the case of iris–lens diaphragm disruption. Here we present a new surgical technique that allows for the easy implantation and subsequent fixation of the fluocinolone acetonide intravitreal implant without the risk of migration as a feasible and possibly reversible approach in the treatment of persistent CME in severely damaged eyes.MethodsIn this single-center, prospective off-label, proof of principle, scleral fixation of the fluocinolone implant was performed in two eyes with disrupted anterior–posterior segment border and persistent CME. Both eyes were then followed monthly in accordance to a detailed protocol.ResultsThe procedure was overall well tolerated without severe side effects. There was no migration of the implant in the anterior chamber in either eye.ConclusionScleral fixation of the fluocinolone implant proved to be a safe and feasible approach in eyes with persistent CME and disrupted anterior–posterior segment border. This new technique also allows for the possible removal of the implant and may therefore be suitable even for eyes at higher risk for side effects, such as glaucoma.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00232-2) contains supplementary material, which is available to authorized users.

Fluocinolone acetonide for the treatment of chronic diabetic macular edema: an Italian real‐world experience

AbstractPurposeThis is a retrospective real‐world study on the use of Fluocinolone acetonide (FAc) intravitreal implant (Iluvien®) for the treatment of chronic diabetic macular edema (DME) insufficiently responsive to available therapies. Its aim is to give a further contribution in assessment of efficacy and safety of this drug delivery system.MethodsPatients included were collected from July 2017 to May 2019. 53 pseudophakic chronic DME patients (69 eyes) were enrolled to evaluate anatomo‐functional outcomes; namely, best corrected visual acuity (BCVA), central macular thickness (CMT) and complications (i.e. rise in intraocular pressure (IOP) and need for IOP lowering medications, hemovitreous, endophtalmitis) of Iluvien® implants. The study partecipants were all previously unsuccessfully treated with first‐line therapies (anti‐VEGF and laser) and intravitreal dexamethasone (Ozurdex®). Patients were considered eligible only in presence of response to the latter drug without significant intra‐ocular pressure increase. Information about further need for DME additional therapies post‐FAc were also recorded. The data of 18 eyes with at least 12 months follow‐up are reported.ResultsAt baseline the mean overall BCVA was 58.3±17.5 ETDRS scale letters. Post‐FAc implant, mean BCVA rised to 63.9 ± 15.2, 60.8 ± 18.3, 61.3 ± 16.9 and 64.5 ± 13.9 ETDRS letters at 2, 4, 6 and 12 months respectively. The percentage of eyes achieving 15 or more ETDRS letters improvement within 12 months was 33.3%. CMT values, from a baseline mean of 517.4 ± 204.0 µm, decreased to 364.9 ± 138.4 µm, 410.8 ± 192.4 µm, 339.0 ± 126.8 µm and 339.9 ± 82.0 at 2, 4, 6 and 12 months, respectively. In this period of observation a dry macula (&lt;300 µm) was obtained in 33.3% of eyes. Recorded complications included increase in IOP with need for IOP lowering medications in 18.9% of study population. Only 8.7% patients needed to perform additional DME therapies for poor response to FAc.ConclusionsThe preliminary results of our study support the use of FAc for the treatment of chronic DME. Efficacy and safety profiles seem to be comparable with the ones of the FAME pivotal study but with less IOP concerns. Selecting patients previously treated with intravitreal steroids and without increase in IOP can further minimize risks. Mean increase of IOP over time can be safely managed with topical therapy in the large majority of cases.

The role of vitrectomy in uveitis

AbstractIn uveitis patients therapy usually depends on the aetiology of the disease and a correct diagnosis is therefore important. A diagnostic vitrectomy with laboratory workup of vitreous specimens can improve the likelyhood of diagnosis. In therapeutiv vitrectomy, removing infiltrated vitreous helps in diagnosis by restoring fundus view and removes potentially harmful inflammatory and infectious material from the eye. Visual acuity has been reported to improve in 70%‐90% of cases depending on aetiology. Secondary retinal problems such as Epiretinal membranes with macular traction, macular holes or retinal breaks and detachment can be successfully treated. Additional treatment with intravitreal steroids can be considered.Combining modern microincisional vitrectomy surgery with phacoemulsification is a safe option.

POTENSI 6-AZA-INDAZOLE SEBAGAI TERAPI YANG DAPAT DIPERBAIKI UNTUK PERAWATAN RETINOPATI DIABETIK MELALUI INHIBISI FAKTOR D PENYELESAIAN

Diabetes mellitus is a chronic disease that has a high prevalence in Indonesia. One of diabetes’ complications is Diabetic Retinopathy (DR). DR is one of the highest cause of preventable blindness in the world. The treatment for DR up till then uses intravitreal anti-VEGF injection, intravitreal steroid antiinflammation injection. Intravitreal administration can cause some side effects such as increased intraocular pressure and endophthalmitis. Furthermore, patient’s convenience is also disturbed, for always having to see a medical personnel frequently. One pathogenesis of DR is the activation of the complement system which causes lysis of endothelial cells and results in ischemic damage to the retina. This ischemic effect will stimulate VEGF secretion that manifests in the phase of Proliferative Diabetic Retinopathy (PDR). Inhibitor of D factor, 6-aza indazole is a small size protein, less than 300 Da which has the potential to inhibit progress of DR by interfering with the activation of alternative pathway (AP) of the complement system. This is supported by the in-vivo test result, where there is a significant inhibition of intraocular AP activation continuously for 8 hours after an oral administration of this agent at a dose of 30 mg/kg. But this study is still in a pre-clinical phase that uses mice as the subject. Therefore, there must be a further study and clinical trial to find out the dosage and safety of this agent to be applied to humans. Keywords: 6-aza indazole, alternative pathway, complement factor D inhibitor, diabetic retinopathy

Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era.

This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era. A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed. A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively. In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings.

The eye in dengue fever, a rarely appreciated aspect of dengue expanded syndrome: a case report

BackgroundDengue fever is a mosquito-borne illness prevalent mainly in the tropics. It is feared for causing the dengue hemorrhagic spectrum of the disease leading to significant morbidity and mortality. Its rarer manifestations are categorized as the expanded dengue syndrome, and though being recognized, they are not fully appreciated and understood. The involvement of the eye in dengue fever is one such phenomenon.Case presentationA 27-year-old South-Asian woman presented on day 2 of dengue fever, without capillary leakage, for further management. Despite developing hepatitis, she had an otherwise uncomplicated progression of the illness because she did not develop capillary leakage. On day 8 of the illness, she had the lowest platelet count and developed bilateral blurred vision. Examination revealed that only gross movements were detected in the left eye, and the right eye had a visual acuity of 6/9. She was diagnosed with foveolitis in the right eye and central serous chorioretinopathy in the left eye, along with hemorrhages in both eyes. These were confirmed by funduscopy, fluorescein angiography, optical coherence tomography, and macular scans. She received systemic and intravitreal steroids and was assessed regularly. After 6 months of observation, her visual acuity was 6/6 in the right eye and 6/9 in the left eye, which remained the same thereafter.DiscussionThe exact mechanism of eye involvement in dengue viral infection is poorly understood. Multiple causes have been suspected and include viral factors, immune mediation, capillary leakage, stress, and hemorrhage. Eye involvement is classically seen at the lowest platelet count and when the count begins to rise. Though symptoms are nonpathognomonic, blurring of vision is the commonest complaint, but the range of presentation is extensive and variable. Ophthalmological assessment and funduscopy are very useful in addition to advanced assessments. There is no clear consensus on management; suggestions range from conservative care to aggressive steroid therapy with immune modulation and even ophthalmological intervention. Recovery can be full or partial with a variable time scale.ConclusionThe extensive spectrum of possible visual symptoms should prompt the clinician to suspect any visual complaint as potential dengue eye involvement. Guided studies and screening are needed to better understand the true incidence of eye involvement in dengue fever.