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Aims: To evaluate treatment outcomes of pro re nata dosing of intravitreal dexamethasone implant in eyes with refractory diabetic macular edema (DME) amongst Indian subjects. Methods and material: Retrospective, interventional case series. Medical records of 28 eyes of 23 patients with refractory DME who underwent intravitreal dexamethasone (700 µ) implant were reviewed. Paired t-test was carried out to measure mean change in the parameters evaluated. Mann-Whitney U test and Fisher's exact t-test were done to explore differences between groups receiving single or multiple injections. Results: Best corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline were 0.85 (±0.44) and 612 µm (±123), respectively. Mean CMT over 6 months (measured monthly) following injection was 340±119 µm (p=0.001), 346±150 µm (p=0.02), 368±169 µm (p=0.02), 304±174 µm (p=0.001), 525±216 µm (p=0.94) and 532±201 µm (p=0.46), respectively. Mean BCVA at each month following injection was 0.68±0.36 (p=0.02), 0.75±0.45 (p=0.42), 0.55±0.40 (p=0.11), 0.63±0.40 (p=0.12), 0.78±0.30 (p=0.90) and 0.60±0.47 (p=0.92), respectively. Mean follow-up was 12 months (range: 6-33 months). Mean BCVA and CMT at mean 12 months were 0.72±0.46 (p=0.10) and 358 µm±189 (p=0.0001), respectively. Seven eyes had raised IOP; five eyes required cataract extraction. Conclusions: Intravitreal dexamethasone implant is effective in treatment of refractory DME. However, its therapeutic effect lasts for about 4 months., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Rishi et al.)

Purpose: To assess the choroidal thickness in differently pigmented areas of the fundus in a 46-year-old female with Waardenburg syndrome. Methods: Retrospective, case review. Choroidal thickness was measured using swept-source optical coherence tomography (SS-OCT, Topcon DRI OCT-1 Atlantis) and compared between the pigmented and hypopigmented areas within the same eye and between the two eyes. Results: Best corrected visual acuity (BCVA) was 20/20 in both eyes. The right fundus had a variegated appearance without choroidal hypopigmentation. The left fundus had choroidal hypopigmentation beyond the superotemporal arcade up to the periphery. Subfoveal choroidal thickness was 455 µ in the right eye and 569 µ in the left eye. In the left eye, the comparison of two equidistant points from the foveola along a radial scan passing through the superotemporal hypopigmented area revealed a thinner choroidal thickness (457 µ) compared to the corresponding point in the pigmented inferonasal quadrant (591 µ). Conclusion: Choroidal thickness is decreased in the hypopigmented area of the fundus compared to the pigmented area in subjects with Waardenburg syndrome. The overall thickness of the choroid in such eyes could still be more than the mean value in the normal population., Competing Interests: The authors declare that they have no competing interests.

A 31-year-old male presented with central scotoma of 9 months duration in the right eye and a similar complaint in the left eye, since a week. Best corrected visual acuity (BCVA) was 20/60 in the right eye and 20/30 in the left eye. Clinical features and supportive investigations were consistent with the diagnosis of acute zonal occult outer retinopathy (AZOOR). The patient was treated with systemic steroids. At 3-month follow-up visit, BCVA improved to 20/40 in the right eye and remained at 20/30 in the left eye. Humphrey's visual field showed a slight reduction of scotoma in both eyes., Competing Interests: The authors declare that they have no competing interests.

An unusual case of choroidal neovascularization in a young female with factor VIII deficiency is presented. The treatment course lasted 23 months. A favourable treatment outcome with restoration of the original visual acuity was achieved. The eye remained stable until the last follow-up, 10 years following therapy., Competing Interests: The authors declare that they have no competing interests.

A19-year-old man presented with decreased vision in the right eye following a bee sting injury, ten days back. Examination revealed conjunctival hyperemia at the site of the sting, anterior uveitis, vitritis, mild disc hyperemia, ocular hypotony, and striae at macula. Treatment was initiated elsewhere with topical antibiotics, steroid, and cycloplegic. Systemic steroids were added. Three weeks later, vitiritis resolved, intraocular pressure became normal and the vision improved from 20/60 to 20/20. However, a chorioretinal atrophy in the vicinity of the sting site was noted. Global electroretinogram (ERG) revealed reduced scotopic responses and depressed oscillatory potentials; even though the photopic response was normal. Multifocal ERG and microperimetry were normal. Two months later, after discontinuation of medication, a traumatic mydriasis with a sluggish pupillary reaction was noted. Sixteen months later, the fundus remained stable. This is a rare case report of a bee sting injury leading to anterior uveitis, vitritis, and cilio-choroidal detachment, mimicking endophthalmitis. Timely recognition of the cause of the intraocular inflammation and appropriate treatment led to optimal recovery., Competing Interests: The authors declare that they have no competing interests.