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For decades, macular laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). With the relatively recent advent of anti-vascular endothelial growth factor (VEGF) agents, DME treatment has entered a new era. VEGF is a well-known pro-angiogenic and pro-permeability factor involved in the pathogenesis of DME. VEGF blockade has proven remarkably effective at reducing DME and improving visual acuity (VA) in eyes with center involved DME causing VA loss in several randomized controlled trials (RCTs). Intravitreal aflibercept, ranibizumab, and bevacizumab (the latter used off-label) are 3 anti-VEGF molecules currently available for DME treatment. Aflibercerpt is a 115-kDA recombinant fusion protein consisting of VEGF binding domains of human VEGF receptors-1 and -2 fused to the Fc domain of human immunoglobulin-G1. The ability to bind placental growth factors 1 and 2 (which is another pro-permeability mediator) and a theoretically long half-life are potential advantages of aflibercept over other anti-VEGF agents. The use of intravitreal aflibercept in DME treatment has been investigated in several RCTs. The aim of this chapter is to briefly report on the current evidence for treating DME with intravitreal aflibercept., (© 2017 S. Karger AG, Basel.)

Purpose: The aim of this study was to investigate the short-term retinal sensitivity and metamorphopsia changes after half-fluence photodynamic therapy (PDT) in patients with central serous chorioretinopathy (CSC)., Methods: Patients with acute CSC and evidence of angiographic leakage and subretinal fluid on optical coherence tomography (OCT) were enrolled. Before, and 1 week (W-1) and 2 months (M-2) after PDT, all patients underwent best-corrected visual acuity, enhanced depth imaging OCT, microperimetry (MP) and preferential hyperacuity perimetry (PHP). We considered 'affected' the Early Treatment of Diabetic Retinopathy Study (ETDRS) sectors showing a mean retinal thickness greater than 350 μm on the baseline OCT thickness map. MP retinal sensitivity, PHP 'score' and retinal thickness were measured in each ETDRS 'affected sector'. Functional correlation between MP and PHP was also investigated., Results: Twelve eyes of 12 patients were included. MP and PHP correlated with each other at baseline (p = 0.04) but not at W-1 (p = 0.12) and M-2 (p = 0.05). Mean MP retinal sensitivity slightly improved from 12.9 ± 5.0 dB at baseline to 14.5 ± 4.7 dB at M-2 (p = 0.2). The PHP score changed from 0.33 at baseline to 0.32 at M-2 (p = 0.3). In the ETDRS 'affected sectors', MP retinal sensitivity improved significantly from 12.9 ± 5.0 dB at baseline to 14.5 ± 4.7 dB at M-2 (p = 0.03), whereas the PHP score did not show significant changes over time., Conclusion: Half-fluence PDT achieved short-term improvement in the sensitivity of the retinal 'affected sectors' but did not influence metamorphopsia as measured on PHP in patients with acute CSC., (© 2016 S. Karger AG, Basel.)

Purpose: To evaluate low-voltage X-ray stereotactic radiotherapy (SRT) delivered in conjunction with intravitreal ranibizumab for the treatment of active macular polypoidal choroidal vasculopathy (PCV)., Methods: At baseline, all eyes received an intravitreal injection of ranibizumab, followed by 16-Gy X-ray SRT to the macula. Further ranibizumab injections were given pro re nata. The primary outcome measure was regression of the polyps assessed by indocyanine green angiography. Secondary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) changes on optical coherence tomography. Local or systemic adverse events were evaluated as well., Results: We examined 12 eyes of 12 patients with PCV. At month 12, an angiographic regression of the polyps was observed in 10 of the 12 eyes. The mean BCVA improved by 7.6 letters: from 65.08 ± 11.4 to 72.7 ± 14.75 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The mean CFT decreased from 372.3 ± 79.6 to 215.9 ± 57.9 µm (p < 0.01). No local or systemic adverse events were reported., Conclusions: The preliminary data support the safety of low-voltage X-ray SRT for the treatment of macular PCV and show polyp closure, reduction in CFT and improvement in the mean BCVA. Additional research is warranted to confirm the efficacy and longer-term safety of this therapy in this population., (© 2014 S. Karger AG, Basel.)

Diabetic macular edema (DME) is a highly prevalent cause of vision loss and has a remarkable impact on public health, and on the quality of life of diabetic patients. Even though laser photocoagulation has been the standard of care for decades, a substantial group of patients are unresponsive and fail to improve after laser treatment. Recently, new pharmacological approaches based on the use of intravitreal drugs, such as corticosteroids and anti-vascular endothelial growth factor, have revolutionized the treatment of DME. The use of intravitreal drugs is supported by the improvement in visual acuity reported by several clinical trials and can limit the potentially destructive effects of the laser treatment. Encouraging results also emerged from studies evaluating the use of a combination therapy, or the association of intravitreal drugs and laser treatment. This review aims at providing a brief synopsis of the main investigations regarding the current pharmacological approach to DME.

Retinal vascular occlusive disorders constitute one of the major causes of blindness and impaired vision. There is marked controversy on their pathogeneses, clinical features and particularly their management. Recently, advances in clinical research added antivascular endothelial growth factor, corticosteroids and sustained-release implants to our armamentarium in the management of retinal vein occlusions. The purpose of our paper is to provide an update and a brief review on the current treatment options of retinal vein occlusions., (Copyright © 2013 S. Karger AG, Basel.)