Intravitreal Sustained-release Dexamethasone Implant in Treatment for Chronic Macular Edema in Syphilis Infection: a Case Report.

Background: Macular edema results from many conditions, such as diabetic retinopathy, macular degeneration, inflammatory diseases, cataract operation, trauma, and tumors. Specifically, the capillary filtration rate should equal the speed of fluid removal from extracellular retinal tissue, such as the glial and retinal pigment epithelium cells layer (RPE). Once these forces are imbalanced, fluid accumulates in cystoid spaces within the inner layers of the retina. Objective: The main purpose of this case report is to show that macular edema caused by any inflammation, either bacteria, virus, or autoimmune origin, can be treated successfully, even if it is chronic. Case report: A 31-year-old man has been reported to our clinic with symptoms of blurry vision in the left eye, which occurred during the last year. Essential examinations included CDVA, IOP measurement, slit-lamp examination, indirect ophthalmoscopy, and OCT scan that showed significant macular edema (central foveal thickness of 353 microns). We initiated laboratory searches, such as blood, serology, and immunology testing for the next three months after his first visit, together with prescribed topical and periocular corticosteroid therapy. The test to VDRL (venereal disease research laboratory) for Syphilis and Toxocariasis came positive. We took the best decision and recommended further treatment with the intravitreal application of Dexamethasone Implant 0.7mg. One week after the intravitreal application of corticosteroids on the control exam, there were normal findings on the posterior segment with no macular edema (central foveal thickness of 269 microns). Conclusion: It is unexclusive that infection by Treponema pallidum (TP) causes isolated macular edema without any other symptoms on the anterior segment of the eye. It has indirect action on the macula, not just causing papilledema, retinal vasculitis, retinochoroiditis, and inflammatory disc edema, as expected. TP or the bacteria transmembrane protein (treponemal ligands) directly acting on vascular endothelial cells of the RPE cells, will be the key to the most certain mechanism of this condition. It is related to the possibility of the secretion of cytokines and the interactions between immune cells indirectly.

Vector Analysis of Visual Acuity and Refractive Outcomes of Astigmatic Corrections After T-PRK and Fs-LASIK.

INTRODUCTION: T Transepithelial photorefractive keratectomy (T-PRK) and femtosecond laser in situ keratomileusis (Fs-LASIK) are reftactive surgery methods for treating myopia and myopic astigmatism. Although T-PRK obtains similar results to Fs-LASIK with spherical myopia, it has differences in astigmatism correction. Vector analysis is a perfect tool to see the real difference between these two methods regarding astigmatic refraction and visual acuity. AIM: The aim of the study is to investigate changes in astigmatism and visual acuity following treatment of myopia and myopic astigmatism above -5.00DS and up to -2.00DC after either T-PRK or Fs-LASIK. METHODS: Patients (30 eyes per group) underwent unremarkable T-PRK (group I) or Fs-LASIK (group II) using Schwind Amaris 750S laser. Astigmatic data acquired by subjective refraction were subjected to vector analysis to determine the association between surgically (SIA) and target induced (TIA) astigmatic powers and differences in axes(θ). RESULTS: Key results at 6 months were: i) Mean astigmatism changed from -0.92 DC (sd ±0.49,95%CI-1.10to-0.75) to -0.38 DC (sd ±0.40,95% CI-0.52 to -0.24) in group I and -0.93DC (sd±0.55,95%CI -1.07 to -0.67) to -0.14DC (sd±0.31,95% CI-0.25 to -0.03) in group II (P=0.005 at 6 months). ii) Mean (±sd) θ was +9.7° (±19.0°) in group I and -2.2° (±15.5°) in group II (P=0.005). CONCLUSION: There was a greater mismatch between SIA and TIA powers and axes after T-PRK. T-PRK tends to induce more unwanted astigmatism. The predictability of the refractive and optical changes is better following Fs-LASIK.

Epidemiology of Diabetic Retinopathy at Eye Clinic Svjetlost Sarajevo: Two Years Retrospective Single Center Study.

INTRODUCTION: Diabetic retinopathy (DR) is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes. Disease severity was most often classified by the Early Treatment Diabetic Retinopathy Study (ETDRS) classification for DR severity. Patients are usually categorized based on the severity of DR as having mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative diabetic retinopathy (PDR). AIM: To evaluate DR status among patients at Eye Clinic Svjetlost Sarajevo , both, type 1 and type 2 DM patients who presented in our clinic at 2 years period - from June 2016 to June 2018. This is single center study. METHODS: Retrospective analysis of 753 diabetic patients that came for the first check up in our institution during those two years, 363 patients were male and 390 were female. Patients were divided in 3 groups (based on DR changes): a) No changes, b) Nonproliferative DR (with and without Diabetic macular edema-DME), c) Prolipherative DR (with and without DME + Advanced PDR). RESULTS: There were 35% of patients with no ocular changes, 41.2% had NPDR and 24% had PDR. Prevalence of DR in our study was 65.32%. Distribution of NPDR was 66.27%, and PDR was 33.73%. DME was present in 33.70% cases. In NPDR, DME was presented in 51% of the cases, while in PDR was presented in 49% of the cases. In state of advanced PDR, PDR was presented in 30.52% cases, tractional detachment and haemophtalmus in 50.20% of cases and neovascular glaucoma in 19.28%. Sixty-three patients ended up with vitroretinal surgery (8.4%) while in other studies that number is up to 3%. Out of that number 9 patients were patient with virgin eyes (14.28%). Neovascular glaucoma occurred in 19.28% of diabetics with proliferative retinopathy and 4.60% in all of diabetics. CONCLUSION: Diabetic retinopathy status of patients presenting at Eye clinic Svjetlost Sarajevo, Bosnia and Herzegovina is quite poor. There is a big need for early DR screening measures, good prevention and management of DR risk factors. Adequate and ON TIME management of DM and its vision threatening complications is of major importance.