Effects of Smoking on Outcomes of Anti-Vascular Endothelial Growth Factor Therapy in Patients with Diabetic Macular Edema: A Retrospective Case-Control Study.

PURPOSE: To determine the effect of smoking on the response to anti-vascular endothelial growth factor (anti-VEGF) therapy treatment in patients with diabetic macular edema (DME). METHODS: This is a retrospective case - control study that included 60 eyes with DME. Smoking habits were obtained from hospital records and patient recall. Patients were divided into two groups: the ever-smoker group and the never-smoker group. All patients received Intravitreal ranibizumab with three loading doses followed by PRN protocol and all were followed up for at least 1 year. Outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, and number of visits. RESULTS: Smoking was not associated with worse posttreatment visual acuity and was not found to influence the change in ocular coherence tomography measurement of central macular thickness and the change in BCVA (posttreatment minus pretreatment). There were no statistically significant differences in the duration of treatment or number of visits between two groups of patients the ever-smoker group and the never-smoker group (P > 0.05). CONCLUSION: In this study, smoking status did not influence the treatment outcome of anti-VEGFs; however, smoking should be encouraged due to its well-known other systemic unwanted effects.

Mucormycosis with extensive cranial nerve involvement as the first presentation of diabetes mellitus: A case report.

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.

Relationship Between Central Corneal Thickness and Ganglionic-Inner Plexiform Cell Layer and Retinal Nerve Fibre Layer Thickness in Normal Subjects.

PURPOSE: To determine the relationship between central corneal thickness (CCT), ganglionic cell-inner plexiform layer thickness and macular nerve fibre layer (RNFL) thickness as measured by optical coherence tomography in a cohort of healthy subjects. METHODS: Sixty healthy eyes from 60 subjects were included in this study. All subjects had a standard slit-lamp examination and optical coherence tomography. Central corneal thickness was measured using the Optopol spectral domain optical coherence tomography (SD OCT) machine (version 7.2.0). A linear mixed effects model was used to assess the relationship between central corneal thickness (CCT) and ganglionic cell-inner plexiform layer thickness and macular retinal nerve fibre layer thickness (RNFL). RESULTS: Sixty healthy eyes from 60 subjects were included in this study. The average age was 41.8 years (±20.6 years). There were 22 males (37%) and 38 females (63%). The average central corneal thickness was 525.2 ± 35.1 µm (451-601) µm. The average macular retinal nerve fiber layer thickness was 28.9 ± 2.5 µm (23-38µm), and the average ganglionic cell-inner plexiform layer thickness was 88.6 ± 6.3 µm (75-110 µm). We found no statistically significant relationship between central corneal thickness and ganglionic cell-inner plexiform layer thickness (p=0.983) nor with macular RNFL (p =0.285). CONCLUSION: In this cohort of healthy subjects, there was no statistically significant relationship between central corneal thickness and ganglionic cell-inner plexiform layer thickness or with macular retinal nerve fibre layer thickness.