The Common Antidiabetic Drug Metformin Reduces Odds of Developing Age-Related Macular Degeneration.

Purpose: AMD is the leading cause of irreversible blindness in older individuals in the Western world, and there are currently no therapies to halt disease progression. Studies suggest that the commonly prescribed antidiabetic drug, metformin, is associated with decreased risk of several ocular diseases, but no work has investigated the effect of metformin use on development of AMD. Thus, we aim to investigate whether metformin use is associated with decreased risk of developing AMD. Methods: In this retrospective case-control study, we used medical records from patients older than 55 who have visited a University of Florida health clinic. Three controls were matched for every AMD case, defined by International Classification of Diseases, Ninth Revision code, based on the Charlson Comorbidity Index to ensure comparable baseline overall health status. Univariate and conditional multivariable logistic regressions were used to determine the association between a variety of covariates, including metformin use, and AMD diagnosis. Results: Metformin use was associated with decreased odds of developing AMD, independently of the other covariates investigated, with an odds ratio of 0.58 and a 95% confidence interval of 0.43 to 0.79. Other medications assessed were not associated with decreased odds of developing AMD. Conclusions: Patients who had taken metformin had decreased odds of developing AMD, suggesting that metformin may have a therapeutic role in AMD development or progression in those who are at risk. Further work should include clinical trials to investigate prospectively whether metformin has a protective effect in those at risk for developing AMD.

Transvitreal endoresection of refractory retinal capillary hemangioblastoma after feeder vessel ligation.

BACKGROUND AND OBJECTIVE: Retinal capillary hemangioma (RCH) is a developmental vascular tumor occurring sporadically or associated with Von Hippel-Lindau syndrome. Treatment for large solitary RCH is challenging. Laser, cryotherapy, radiotherapy, photodynamic therapy, and en bloc resection for advanced cases have been described in the literature without consensus on standard management. MATERIALS AND METHODS: A novel technique of 20-gauge transvitreal endoresection of solitary peripheral RCH after ligating the feeder vessels is described. RESULTS: Tumors were successfully resected after ligating the feeder vessels bimanually in a closed and more controlled ocular environment. Feeder vessel ligation is intended to compensate for the involution time of the caliber of feeder vessels, when postoperative hemorrhage is more likely to occur. Another advantage of ligating the blood vessels is to secure hemostasis without using heavy endocautery. Postoperatively, proliferative vitreoretinopathy remains a concern. CONCLUSION: Pending a larger randomized trial, performing endoresection in RCH that is large and unresponsive to conventional treatment is an acceptable option.

Revisiting autologous platelets as an adjuvant in macular hole repair: chronic macular holes without prone positioning.

BACKGROUND AND OBJECTIVE: Chronic macular hole and inability to maintain prone positioning remain poor prognostic markers for successful macular hole closure. The authors revisited the role of autologous platelets as an adjunct to internal limiting membrane (ILM) peeling of chronic macular holes in patients unable to maintain prone positioning. PATIENTS AND METHODS: A retrospective case study was conducted on 13 eyes of 13 patients with full-thickness chronic macular hole (> 24 months). Each patient was unable to maintain prone positioning due to medical and physical comorbidities. Each eye was treated with pars plana vitrectomy, ILM peeling, autologous platelets, and C(3)F(8) gas tamponade. No positioning was advised postoperatively. All patients had complete ophthalmic examinations preoperatively and 1 day and 1, 3, and 6 months postoperatively with optical coherence tomography. Outcome measures were anatomic closure based on Tornambe classification, final best-corrected visual acuity, and improvement of quality of vision. RESULTS: All 13 patients completed 6 months' follow-up. Macular hole duration ranged from 2 to 5 years. There was a 100% macular hole closure rate at 1 and 6 months postoperatively. All patients reported subjective improvement in visual acuity as an improvement of an absolute central scotoma. At 6 months postoperatively, 38% of patients reported improved best-corrected visual acuity. There were no recurrences. CONCLUSION: Autologous platelets and ILM peeling may function synergistically to enhance chronic macular hole closure in patients unable to maintain prone positioning.

Endophthalmitis secondary to corneal sutures: series of delayed-onset keratitis requiring intravitreal antibiotics.

PURPOSE: To describe 5 cases of endophthalmitis secondary to corneal sutures. SETTING: Department of Ophthalmology, University College Hospital, Galway, Ireland. METHODS: A retrospective review was done of 5 patients who presented over a period of 19 months with suture-related bacterial keratitis that progressed to endophthalmitis. Intravitreal antibiotics were used to control the infection. RESULTS: Despite intensive topical broad-spectrum antibiotic treatment for suture-related infective keratitis, the infection progressed to endophthalmitis in all 5 patients. Intravitreal antibiotics resolved the infection. CONCLUSIONS: Corneal sutures are a risk factor for infective keratitis irrespective of their site. Suture-related keratitis may progress rapidly to endophthalmitis despite intensive topical antibiotics. Intravitreal antibiotics are indicated when endophthalmitis is present.