Advances in the treatment of diabetic retinopathy

Diabetic retinopathy, the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the standard care for diabetic retinopathy. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with diabetic macular edema and should be considered as the first-line therapeutic option. The current evidence suggests that intravitreal triamcinolone acetonide or anti-vascular endothelial growth factor agents result in a temporary improvement of visual acuity and a short-term reduction in central macular thickness in patients with refractory diabetic macular edema and are an effective adjunctive treatments to laser photocoagulation or vitrectomy. However, triamcinolone is associated with risks of elevated intraocular pressure and cataract. Vitrectomy with the removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic macular edema, particularly in eyes with associated vitreomacular traction. Emerging therapies include islet cell transplantation, fenofibrate, ruboxistaurin, pharmacologic vitreolysis, rennin-angiotensin system blockers, and peroxisome proliferator-activated receptor gamma agonists

Intraoperative flap complications in laser in situ keratomileusis with two types of microkeratomes

To determine the incidence and types of intraoperative flap complications in laser in situ keratomileusis [LASIK] encountered with the Hansatome microkeratome and the Moria microkeratome. In this retrospective case series, all patients with intraoperative flap complications who were treated between June 1999 and July 2008 at the Eye Consultants Center in Riyadh, Saudi Arabia, were identified and reviewed. Of the 4352 subjects who underwent bilateral primary LASIK procedure, intraoperative microkeratome complications were detected in 89 eyes of 83 patients. The overall incidence of flap complications was 89/8704 [1.00%]: incomplete flaps occurred in 53 eyes [0.60%], followed by buttonhole flaps in 17 eyes [0.19%], free complete flaps in 10 eyes [0.11%], free partial flaps in 6 eyes [0.07%], sluffed epithelium in 2 eyes [0.023%], and a splitted flap [vertical flap cut] in 1 eye [0.01%]. The incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were 1.21% [41/3378] and 0.90% [48/5326], respectively [P = 0.19]. There was a statistically significant difference between the two microkeratomes with regard to the incidence of buttonhole flaps: 0.33% [11/3378] for the Hansatome microkeratome versus 0.11% [6/5326] for the Moria microkeratome [P = 0.04]. Generally, the incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were similar. However, buttonhole flaps occurred more often with the Hansatome microkeratome [a type of microkeratome that produces larger flaps]. The commonest complication encountered was the incomplete flap, followed by the buttonhole flap and free flap

Outcomes of retreatment after aborted laser In Situ keratomileusis due to flap complications

To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis [LASIK] due to flap complications. This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment. Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes [66.7%], buttonhole flaps in 7 eyes [21.2%], free partial flaps in 3 eyes [9.1%], and a free complete flap in 1 eye [3.0%]. Twenty-two eyes [66.7%] were retreated with LASIK, and 11 eyes [33.3%] were retreated with surface ablation. The mean spherical equivalent [SE] was ?0.23 +/- 0.72 D, the mean astigmatism was ?0.65 +/- 0.89 D, and the mean loss of the best corrected visual acuity [BCVA] was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation [P=0.610]. There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation [P=0.756]. There were no intraoperative complications and no eyes required a second retreatment. Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable

Tuberculous uveitis

In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patient with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy

Propionibacterium acnes chronic pseudophakic endophthalmitis

Propionibacterium acnes [P. acnes] is a slow-growing, anaerobic, gram-positive bacillus. P. acnes is a well recognized cause of delayed-onset, chronic endophthalmitis. It should be considered in all pseudophakic patients with chronic intraocular inflammation. The diagnosis of P. acnes endophthalmitis requires a high index of suspicion. Cultures requiring an incubation period of 10 to 14 days are necessary for definitive diagnosis. Polymerase chain reaction [PCR] carries high sensitivity and specificity rates, and is more sensitive than aqueous or vitreous cultures. A long-term follow-up period is needed to evaluate the efficacy of treatment strategies of P. acnes endophthalmitis. Reasonable treatment choices include pars plana vitrectomy and intravitreal antibiotics with either partial or total capsulectomy and intraocular lens [IOL] exchange or removal. Total capsulectomy with IOL exchange or removal almost always leads to a cure

Corneal stromal melting after corneal tattooing with platinum chloride

To report a case of corneal stromal melting after corneal tattooing with platinum chloride. A 60-year-old patient underwent corneal tattooing with platinum chloride chemically reduced by hydrazine hydrate. Six weeks post-treatment, Biomicroscopic examination showed significant corneal stromal melting with an overlying epithelial defect and no evidence of infection. Corneal stromal melting can complicate corneal tattooing, probably due to the toxic effect of platinum chloride or hydrazine hydrate or both

Capsule contraction syndrome despite capsular tension ring

A 60-year-old man had phacoemulsification complicated by zonular dehiscence and implantation of capsular tension ring [CTR] and a three-piece foldable SENSARAE intraocular lens [IOL] in his right eye. Nine weeks postoperatively, sever anterior capsule fibrosis and contracture of capsulorhexis opening was noted. A neodymium: YAG [Nd:YAG] laser radial anterior capsulotomy was performed to prevent further zonular stress. This case shows that the use of CTR might not prevent the occurrence of capsule contraction syndrome