Combined therapy for diabetic macular edema

Diabetic macular edema [DME] is the main cause of visual impairment in diabetic patients. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. The management of DME is complex and often multiple treatment approaches are needed. This review demonstrates the benefits of intravitreal triamcinolone, bevacizumab and ranibizumab as adjunctive therapy to macular laser treatment in DME. The published results indicate that intravitreal injections of these agents may have a beneficial effect on macular thickness and visual acuity, independent of the type of macular edema that is present. Therefore, pharmacotherapy could complement focal/grid laser photocoagulation in the management of DME. For this review, we performed a literature search and summarized recent findings regarding combined therapy for DME

Acute bacterial endophthalmitis after intravitreal bevacizumab injection: case report and literature review

A case report of a 52 year old male who received intravitreal bevacizumab and developed culture positive endophthalmitis. Vitreous culture indicated that endophthalmitis was caused by Staphylococcus epidermidis. The patient was initially managed with intravitreal injection of ceftazidime and vancomycin, followed by pars plana lensectomy, pars plana vitrectomy with intravitreal injection of 1 mg/0.1 ml vancomycin, 2.25 mg/0.1 ml ceftazidime, 5 mg/0.1 ml fortified amphotericin-B and 4 mg/0.1 ml dexamethasone. Postoperatively the patient improved significantly. However, vision improved from hand motion to counting fingers secondary to severe retinal ischemia. Acute endophthalmitis can develop after intravitreal bevacizumab injections and cause profound visual loss. A review of literature was also performed for similar cases

Acute retinal necrosis after Boston type I keratoprosthesis

A case report of a 68-year-old male who developed acute retinal necrosis [ARN] after Boston type I keratoprosthesis is presented. The procedure was performed for multiple graft failure secondary to herpetic keratitis. Clinical data including visual acuity, color fundus photography, fluorescein angiography, laboratory tests findings, and management are presented. After exclusion of other causes by laboratory workup, the patient was diagnosed with ARN most likely secondary to herpetic infection. Intravenous acyclovir and oral prednisolone were administered to the patient resulting in marked improvement in visual acuity and regression in the size of the retinitis. The patient eventually developed a soft eye and choroidal detachment with light perception vision. In patients with a history of herpetic keratitis or keratouveitis, it is highly advisable to maintain prophylactic systemic antiviral treatment before and after any ocular procedure such as the Boston keratoprosthesis

Retinal detachment after laser In Situ keratomileusis

To report characteristics and outcome of rhegmatogenous retinal detachment [RRD] after laser in situ keratomileusis [LASIK] for myopia. A retrospective chart review of patients who presented with RRD after myopic LASIK over a 10-year period. Fourteen eyes were identified with RRD. Of these, two of 6112 LASIK procedures were from our center. The mean age of patients with RRD was 35.43 years. The mean interval of RRD after LASIK was 37.71 months [range, 4 months to 10 years]. The macula was involved in eight eyes and spared in six eyes. Retinal breaks included a macular hole in two eyes, and giant tear in two eyes. Multiple breaks [>2 breaks] occurred in 6 cases. Pars plana vitrectomy [PPV] was performed in 3 [21.4%] eyes, a scleral buckle [SB] was performed in 4 [28.5%] eyes and 7 [50%] eyes underwent combined PPV and SB. Mean follow-up was 15.18 months [range, 1 month to 7 years]. The retina was successfully attached in all cases. The final visual acuity was 20/40 or better in 7 [50%] eyes, 20/40 to 20/60 in 4 [28.5%] eyes, and 20/200 or less in 3 [21.4%] eyes. Poor visual outcome was secondary to proliferative vitreoretinopathy, epiretinal membrane, macular scar and amblyopia. The prevalence of RRD after LASIK was low at our institute. Anatomical and visual outcomes were acceptable in eyes that were managed promptly. Although there is no cause-effect relationship between LASIK and RRD, a dilated fundus examination is highly recommended before and after LASIK for myopia

Characteristics of optic disc melanocytomas presenting with visual dysfunction

A retrospective review study was designed to describe five cases of optic disc melanocytomas with tumor-related visual impairment. Five patients with optic disc melanocytoma presented with visual complaints to a tertiary eye hospital in Saudi Arabia. Demographic and clinical data were analyzed, including the results of ocular examination, lesion laterality, best-corrected Snellen visual acuity, papillary reflex, visual field testing, color fundus photography, fundus fluorescein angiography, and ophthalmic ultrasound. Visual dysfunction secondary to optic disc melanocytoma was identified. Case 1 had macular star edema with mild tumor enlargement, Case 2 had optic atrophy, Case 3 had juxtapapillary choroidal neovascular membrane with macular involvement, Case 4 had optic disc swelling with an enlarged blind spot, and Case 5 had a large altitudinal visual field defect. Although melanocytomas of the optic disc tend to have a benign behavior with slow evolution and stable vision, they may adversely affect visual function through a variety of mechanisms