Evaluation of outer retinal layers changes before and after intervention in diabetic macular edema

Aim of the work: this study aimed to evaluate changes in photoreceptors, inner segment/outer segment [IS/OS] junction and external limiting membrane [ELM] following grid argon laser versus intravitreal injection of antivgef [ Ranibizumab ] in diabetic type2 patients affected by clinically significant macular edema

Methods: forty eyes of diabetic type 2 patients who were affected by clinically significant macular edema were randomly categorized into two groups[ Group treated by argon grid laser and group treated by intravitreal injection of antivgef for the first time] both groups were investigated for best corrected visual acuity [BCVA] and the integrity of the photoreceptors, IS/OS and ELM as being [Continuous[+], interrupted[ +/- ] or Absent [-] ] by spectral-domain optical coherence tomography [SD-OCT][ CIRRUS HD-OCT] before treatment , 1month, 2months and 3months after treatment . Other variables, included central macular thickness [CMT] and central macular volume [CMV] were evaluated

Results: significant difference was found between [photoreceptor, is/os] [+], photorecptor, is/os [+,-] and photoreceptor, is/os [-] groups in BCVA at baseline; it was 0.61,0.73,and 1 and after 6 months it was 0.48,0.73 and 1 . Results were similar for ELM groups. Signiant difference was found between ELM [+], ELM [+,-] and ELM [-] groups in BCVA at baseline it was 0.59,0.72,and 1 and after 6 months it was 0.46,0.68 and 1 in lucentis group and signiant difference was found between photoreceptor, is/os [+] and photorecptor ,is/os [+,-] groups in BCVA at baseline was[0.32and 0.3 and after 6 months it was 0.27and 0.3 . Results were similar for ELM groups. Signiant difference was found between ELM [+] and ELM [+,-] groups in BCVA at baseline it was 0.29 and 0.5 and after 6 months it was 0.25 and 0.4 in argon laser group

Conclusion: the more damage of outer retinal layers at the time of DME the lower visual acuity following DME resolution and the presence of intact of these layers is an important factor in determining final visual acuity

Mitomycin-C needle bleb revision in congenital glaucoma

This study was designed to evaluate the efficacy and safety of mitomycin-C [MMC] augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital. A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 +/- 3.4 years [range, 1-12 years]. Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC [0.04 mg/mL] and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous out flow. Follow-up ranged from 6 to 20 months [mean, 9.23 +/- 5.25 months]. One needling revision was performed in 22 eyes [73.3%] and eight eyes [26.7%] received two needle revisions. The mean intraocular pressure [IOP] decreased from 26.9 +/- 2.85 mmHg [range, 21-34 mmHg] before surgery to 15.63 +/- 3.15 mmHg [range, 10-24 mmHg] at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye. MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery