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The current evidence on whether annual diabetic retinopathy (DR) screening intervals can be extended was reviewed. A systematic review protocol was followed (PROSPERO ID: CRD42022359590). Original longitudinal articles that specifically assessed DR screening intervals were in English and collected data after 2000 were included. Two reviewers independently conducted the search and reviewed the articles for quality and relevant information. The heterogeneity of the data meant that a meta‐analysis was not appropriate. Twelve publications were included. Studies were of good quality and many used data from DR screening programs. Studies fit into three categories; those that assessed specific DR screening intervals, those that determined optimal DR screening intervals and those that developed/assessed DR screening risk equations. For those with type 2 diabetes, extending screening intervals to 3‐ to 4‐yearly in those with no baseline DR appeared safe. DR risk equations considered clinical factors and allocated those at lower risk of DR progression screening intervals of up to five years. Those with baseline DR or type 1 diabetes appeared to have a higher risk of progression to STDR and needed more frequent screening. DR screening intervals can be extended to 3–5 yearly in certain circumstances. These include patients with type 2 diabetes and no current DR, and those who have optimal management of other risk factors such as glucose and blood pressure. [ABSTRACT FROM AUTHOR]

Abstract Background The aim was to study aqueous humour inflammatory mediators’ levels in a cohort of Egyptian patients with diabetic macular oedema (DMO). Methods This was a case-control prospective study conducted on 2 groups: 25 eyes of 22 (11 females) patients seeking treatment for DMO as patients group, and 10 eyes of 10 (4 females) cataract patients as a control group. Aqueous humour was aspirated before intravitreal injection (patients’ group) or cataract surgery (control group). Inflammatory mediators in aqueous humour were measured using a multiplex bead immunoassay kit of 27 pre-mixed cytokines. Results Eotaxin, interferon gamma-induced protein 10 (IP-10), monocyte chemoattractant protein-1 (MCP-1/CCL2) and interleukin-8 (IL-8/CXCL8) were found significantly higher in patients’ group compared to control group (p = 0.043, 0.037, 0.001, 0.015 respectively). On the contrary, interferon-gamma (IFN-gamma) and granulocyte colony-stimulating factor (G-CSF) were found significantly higher in control group than patients’ group (p = 0.003, 0.019 respectively). Basic fibroblast growth factor (Basic-FGF/FGF-2) and interleukin-1 receptor antagonist (IL-1ra) were found higher (but not statistically significant) in controls (p = 0.100 and 0.070 respectively). Additionally, a negative and significant correlation was found between Eotaxin level in aqueous humour and central macular thickness. Conclusions Some mediators might be implicated in the pathogenesis of DMO either augmenting or suppressing role. Eotaxin, IP-10, MCP-1 and IL-8 might have a role in cases not responding to standard anti-vascular endothelial growth factor (VEGF) therapy. IL-1ra might have a protective role; therefore, the effectiveness of intravitreal injection of IL-1ra homologue needs to be studied in future clinical trials.

Background: The aim was to study aqueous humour inflammatory mediators' levels in a cohort of Egyptian patients with diabetic macular oedema (DMO). Methods: This was a case-control prospective study conducted on 2 groups: 25 eyes of 22 (11 females) patients seeking treatment for DMO as patients group, and 10 eyes of 10 (4 females) cataract patients as a control group. Aqueous humour was aspirated before intravitreal injection (patients' group) or cataract surgery (control group). Inflammatory mediators in aqueous humour were measured using a multiplex bead immunoassay kit of 27 pre-mixed cytokines. Results: Eotaxin, interferon gamma-induced protein 10 (IP-10), monocyte chemoattractant protein-1 (MCP-1/CCL2) and interleukin-8 (IL-8/CXCL8) were found significantly higher in patients' group compared to control group (p = 0.043, 0.037, 0.001, 0.015 respectively). On the contrary, interferon-gamma (IFN-gamma) and granulocyte colony-stimulating factor (G-CSF) were found significantly higher in control group than patients' group (p = 0.003, 0.019 respectively). Basic fibroblast growth factor (Basic-FGF/FGF-2) and interleukin-1 receptor antagonist (IL-1ra) were found higher (but not statistically significant) in controls (p = 0.100 and 0.070 respectively). Additionally, a negative and significant correlation was found between Eotaxin level in aqueous humour and central macular thickness. Conclusions: Some mediators might be implicated in the pathogenesis of DMO either augmenting or suppressing role. Eotaxin, IP-10, MCP-1 and IL-8 might have a role in cases not responding to standard anti-vascular endothelial growth factor (VEGF) therapy. IL-1ra might have a protective role; therefore, the effectiveness of intravitreal injection of IL-1ra homologue needs to be studied in future clinical trials. [ABSTRACT FROM AUTHOR]

Elaborar recomendaciones basadas en la evidencia disponible y el consenso de expertos para el manejo terapéutico de los pacientes con uveítis no infecciosas, no neoplásicas y no asociadas a enfermedad desmielinizante. Se identificaron preguntas clínicas de investigación relevantes para el objetivo del documento, reformuladas en formato PICO (paciente, intervención, comparación, outcome o desenlace) por un panel de expertos seleccionados en base a su experiencia en el área. Se realizó una revisión sistemática de la evidencia, graduándose de acuerdo a los criterios Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Subsecuentemente, se formularon las recomendaciones. Se seleccionaron tres preguntas PICO, referentes a uveítis anteriores, no anteriores y complicadas con edema macular. Se formularon un total de 19 recomendaciones con base en la evidencia encontrada y/o en el consenso de expertos. Se presenta el primer documento oficial de la Sociedad Española de Reumatología de recomendaciones para el tratamiento de las uveítis. Pueden aplicarse directamente al sistema sanitario español como herramienta de ayuda y homogenización terapéutica. To develop evidence-based expert-consensus recommendations for the management of non-infectious, non-neoplastic, non-demyelinating disease associated uveitis. Clinical research questions relevant to the objective of the document were identified, and reformulated into PICO format (patient, intervention, comparison, outcome) by a panel of experts selected based on their experience in the field. A systematic review of the available evidence was conducted, and evidence was graded according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Subsequently, recommendations were developed. Three PICO questions were constructed referring to uveitis anterior, non-anterior and complicated with macular edema. A total of 19 recommendations were formulated, based on the evidence found and/or expert consensus. Here we present the first official recommendations of the Spanish Society of Rheumatology for the treatment of non-infectious and non-demyelinating disease associated uveitis. They can be directly applied to the Spanish healthcare system as a tool for assistance and therapeutic homogenisation. [ABSTRACT FROM AUTHOR]

Background: Retinal vein occlusion is the second most common retinal vascular disease after diabetic retinopathy. Branch retinal venous occlusion (BRVO) occurs the occlusion of one of the branches of the retinal vein. The occlusion occurs mostly at arteriovenous crossing and more frequent in upper temporal retinal veins. Patients and Methods: In the current study, randomized control study was conducted on 2 groups divided into 27 eyes (Ranibizumab alone), 27 eyes (Ranibizumab and Targeted retinal laser). Results: The BRVO is investigated by FFA and OCT-Macula and macular edema is measured by OCT-Macula. And the current result shows highly statistically significant improvement in visual acuity and reducing macular edema (decrease foveal thickness)with P value

Introduction: Post Fever Retinitis (PFR) is an infectious or parainfectious uveitis presenting with visual impairment after a fever episode. The condition can cause potential visual impairment in these patients. There is no national guideline for treatment of PFR. Hence, there is a need to study the clinical features and visual outcomes with the use of corticosteroid therapy. Aim: To describe the clinical features of patients presenting with PFR and visual outcome with the oral corticosteroid therapy. Materials and Methods: This retrospective study conducted in the Outpatient Department (OPD) of Ophthalmology at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The duration of the study was 35 months, from January 2019 to December 2021. A total of 23 eyes of 13 patients treated with oral corticosteroids were included. Data collected included patients' demographic details including name, age, sex, hospital identification number, duration of vision loss, detailed ophthalmic examination findings, including visual acuity testing with Snellen's chart, slit lamp examination findings and fundus examination findings including detailed fundus drawings, Optical Coherence Tomogram (OCT) and fundus photographs. Visual Acuity (VA) at the time of presentation and after steroid therapy were recorded. Data was entered in microsoft excel spreadsheet and descriptive analysis was done. Results: Age of the study participants ranged from 15 years to 52 years with an average of 29.6 years. A total of 23 eyes of 13 patients were included in the present study. At the time of presentation, two eyes had visual acuity better than 6/12 on Snellen's chart. Five eyes had mild vision impairment, five eyes had moderate vision impairment and eleven eyes had vision <3/60, according to the visual impairment classification of World Health Organisation (WHO). Macular oedema was the other most common finding seen in 12 (52.17%) eyes. All the patients showed beginning of resolution of retinitis by 2-3 weeks after starting oral corticosteroids. A total of 23 eyes, 8 (34.7%) eyes recovered vision >6/12, out of which 6 eyes (26.08%) recovered with 6/6 vision. Conclusion: PFR affects predominantly young immunocompetent individuals. Treatment outcomes with oral steroids is found to be satisfactory. [ABSTRACT FROM AUTHOR]

To suggest a unique missense variant candidate based on long‐term ophthalmological changes and associated systemic signs described in five patients from two unrelated families affected by an autosomal dominant multi‐systemic disorder including Retinal dystrophy, Optic nerve oedema, Splenomegaly, Anhidrosis and migraine Headaches, called ROSAH syndrome, related to a unique missense variant in ALPK1 gene. Observational longitudinal follow‐up study of unrelated families. Clinical analysis of ophthalmological and systemic examinations was performed, followed by genetic analysis, including targeted Next Generation Sequencing (NGS) and Whole‐Genome Sequencing (WGS). The ophthalmological phenotype showed extensive optic nerve swelling associated with early macular oedema and vascular leakage. The main associated systemic manifestations were recurrent fever, splenomegaly, anhidrosis, mild cytopenia, anicocytosis and hypersegmented polynuclear cells. WGS, shortened in the second family by the gene candidate suggestion, revealed in all patients the heterozygous missense variant c.710C>T; p.(Thr237Met) in ALPK1. The primary morbidity in ROSAH syndrome in this cohort appeared ophthalmological. Comprehensive, detailed phenotype changes aided by the advancement in genetic testing could allow an early genetic diagnosis of ROSAH syndrome and targeted treatment. The unique missense variant may be suggested as a target of gene correction therapy. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) have been taking a leading position among retinal disorders, causing a persistent and significant decrease in visual functions. The base of the disease is a retinal vascular microangiopathy, which induces a tissue ischemia and excessive production of vascular endothelial growth factors. The main method of treatment for this pathology is a laser photocoagulation. However, it is not always possible to perform appropriate laser photocoagulation, by that limiting its efficacy (cases of hard cataract and hemophthalmos). In addition, this type of treatment might have a number of serious complications, such as macular oedema, recurrent vitreous hemorrhages, the occurrence of fibrosis, atrophic changes in the retina, which leads to a decline in visual acuity and contrast sensitivity, worsening the visual field. Over the past 10 years, vascular endothelial growth factor inhibitors have been introduced into clinical practice, and showed their benefits in the treatment of disorders leading to a pathological angiogenesis. But due to the limited number of systematic observations, assessing the impact of these drugs, is necessary to investigate their efficacy and safety in patients with proliferative DR, in order to develop indications for their use. The purpose of the review is evaluation of the effect of vascular endothelial growth factor inhibitors on active neovascularization in patients with proliferative diabetic retinopathy. There is a literature of international clinical guidelines, randomized clinical trials with a varying level of evidence, articles and publications by groups of authors in the article.

Introduction: Post Fever Retinitis (PFR) is an infectious or parainfectious uveitis presenting with visual impairment after a fever episode. The condition can cause potential visual impairment in these patients. There is no national guideline for treatment of PFR. Hence, there is a need to study the clinical features and visual outcomes with the use of corticosteroid therapy. Aim: To describe the clinical features of patients presenting with PFR and visual outcome with the oral corticosteroid therapy. Materials and Methods: This retrospective study conducted in the Outpatient Department (OPD) of Ophthalmology at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The duration of the study was 35 months, from January 2019 to December 2021. A total of 23 eyes of 13 patients treated with oral corticosteroids were included. Data collected included patients’ demographic details including name, age, sex, hospital identification number, duration of vision loss, detailed ophthalmic examination findings, including visual acuity testing with Snellen’s chart, slit lamp examination findings and fundus examination findings including detailed fundus drawings, Optical Coherence Tomogram (OCT) and fundus photographs. Visual Acuity (VA) at the time of presentation and after steroid therapy were recorded. Data was entered in microsoft excel spreadsheet and descriptive analysis was done. Results: Age of the study participants ranged from 15 years to 52 years with an average of 29.6 years. A total of 23 eyes of 13 patients were included in the present study. At the time of presentation, two eyes had visual acuity better than 6/12 on Snellen’s chart. Five eyes had mild vision impairment, five eyes had moderate vision impairment and eleven eyes had vision 6/12, out of which 6 eyes (26.08%) recovered with 6/6 vision. Conclusion: PFR affects predominantly young immunocomp-etent individuals. Treatment outcomes with oral steroids is found to be satisfactory.

Systemic administration of agents that inhibit vascular endothelial growth factor (VEGF) and therefore vascular proliferation is often used to treat various cancers. However, these agents are associated with a number of side effects, including proteinuria and renal injury. Intravitreal injection of anti‐VEGF agents has become the cornerstone of macular disease treatment. Since these agents cross the blood‐retina barrier and enter the circulation, systemic side effects have been reported. We report the novel case of a 57‐year‐old patient who presented with macular oedema secondary to central retinal vein occlusion, underwent three monthly loading‐dose injections with the anti‐VEGF agent ranibizumab, and 2 weeks after the second injection presented with biopsy‐verified membranoproliferative glomerulonephritis. Twelve weeks after presenting with renal failure and 10 weeks after his last anti‐VEGF injection, the patient demonstrated spontaneous recovery of his kidney function. The patient had a history that promoted renal fragility, including hypertension, liver transplantation 6 years earlier for alcohol‐related cirrhosis and new‐onset diabetes mellitus after transplant. Our literature review and case suggest that although adverse renal events after intravitreal anti‐VEGF injections are very rare, ophthalmologists and nephrologists should be aware of this risk. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate treatment efficacy in diabetic macular oedema (DME) comparing a study population receiving combined intravitreal vascular endothelial growth factor (VEGF) inhibition and focal/grid photocoagulation with a matched, real‐world population receiving standard of care treatment. Methods: In an exploratory study, we included 43 eyes from 32 patients from a previously published study as well as 46 eyes from 38 standard‐of‐care patients. The study population had received a loading dose of three monthly aflibercept injections followed by focal/grid photocoagulation and additional aflibercept pro re nata. Principal measurements at 12 months were numbers of intravitreal injections, best corrected visual acuity (BCVA) and central retinal thickness (CRT). Results: At baseline, there were no differences between groups regarding age, sex, body mass index, haemoglobin A1C, systolic pressure or type of diabetes, but the study population had a higher diastolic pressure (81.6 versus 72.1 mmHg, p = 0.03) and a lower duration of diabetes (12.3 versus 23.2 years, p = 0.03). At month 12, patients in the study group had a higher visual acuity (79.6 versus 74.3 ETDRS letters, p = 0.03), despite having received fewer aflibercept injections (4.4 versus 5.9, p < 0.01) with a higher likelihood of having only received the three mandatory injections in the loading phase (39.5% versus 13.0%, p = 0.01). Conclusion: In comparison to a matched, real‐world DME‐population, patients in combined treatment with intravitreal aflibercept and postloading focal/grid photocoagulation obtained a better functional outcome despite having received fewer intravitreal injections. Future randomized studies are needed to evaluate the long‐term efficacy of this combined treatment regimen. [ABSTRACT FROM AUTHOR]

Purpose: Angiostatic agents have proven effective in the treatment of macular oedema in patients with branch retinal vein occlusion (BRVO). However, treatment is inconvenient and expensive, and novel treatment regimens are warranted. We aimed to evaluate if combination treatment of navigated central retinal laser and aflibercept lowered the treatment burden in these patients. Methods: Treatment‐naïve patients with BRVO and macular oedema were included at two centres and randomized 1:1 to three monthly injections of 2.0 mg aflibercept with (Group A) or without (Group B) navigated central laser, followed by aflibercept as needed from month 4 through 12. Re‐treatment need was evaluated, and secondary endpoints included functional and anatomical outcomes and safety evaluated by retinal microperimetry. Results: We evaluated 41 eyes of 41 patients with a mean age of 69.6 years. Baseline median best‐corrected visual acuity (BCVA) was 70.0 letters, and median central retinal thickness (CRT) was 502 μm with no difference between Groups A (n = 21) and B (n = 20). Percentage of patients needing re‐treatment after month three was 71% and 80% (p = 0.72). At month 12, groups did not differ in number of injections after loading (1 versus 2, p = 0.43), change in BCVA (+12.8 versus +15.1 letters, p = 0.48), CRT (−195 versus −181 μm, p = 0.82), or retinal sensitivity (+3.3 versus +4.1 dB, p = 0.67). Conclusion: In treatment‐naïve BRVO patients, addition of navigated central laser to aflibercept did not lower treatment burden or affect functional or anatomical outcomes. A low number of intravitreal injections were needed for successful outcome in both treatment arms. [ABSTRACT FROM AUTHOR]

Peroxisomal biogenesis disorders (PBDs) are a heterogeneous group of genetic diseases. Multiple peroxisomal pathways are impaired, and very long chain fatty acids (VLCFA) are the first line biomarkers for the diagnosis. The clinical presentation of PBDs may range from severe, lethal multisystemic disorders to milder, late-onset disease. The vast majority of PBDs belong to Zellweger Spectrum Disordes (ZSDs) and represents a continuum of overlapping clinical symptoms, with Zellweger syndrome being the most severe and Heimler syndrome the less severe disease. Mild clinical conditions frequently present normal or slight biochemical alterations, making the diagnosis of these patients challenging. In the present study we used a combined WES and RNA-seq strategy to diagnose a patient presenting with retinal dystrophy as the main clinical symptom. Results showed the patient was compound heterozygous for mutations in PEX1. VLCFA were normal, but retrospective analysis of lysosphosphatidylcholines (LPC) containing C22:0–C26:0 species was altered. This simple test could avoid the diagnostic odyssey of patients with mild phenotype, such as the individual described here, who was diagnosed very late in adult life. We provide functional data in cell line models that may explain the mild phenotype of the patient by demonstrating the hypomorphic nature of a deep intronic variant altering PEX1 mRNA processing. [ABSTRACT FROM AUTHOR]

Faricimab is a new drug approved for the treatment of neovascular age-related macular degeneration (AMD) and diabetic macular edema. It is the first bispecific monoclonal antibody for intraocular use. Faricimab inhibits pathological angiogenesis and reduces vascular permeability and inflammation in the eye. Clinical trials have shown that faricimab is noninferior to aflibercept, another VEGF inhibitor, in improving visual acuity in patients with AMD and diabetic macular edema. The drug has a similar safety profile to aflibercept, with mild to moderate ocular adverse events being the most commonly reported. Faricimab has the potential to extend treatment intervals, reducing the burden on patients. [Extracted from the article]

(1) Background: we aimed to evaluate choroidal vascularity change in eyes with central and branch retinal vein occlusion (RVO). (2) Methods: in this retrospective cross-sectional study, we reviewed the records of 47 patients with recent-onset, naïve, unilateral retinal vein occlusion. Enhanced-depth imaging optical coherence tomography scans were binarized using the ImageJ software; luminal area (LA) and total choroidal area (TCA) were measured. The choroidal vascularity index (CVI) was calculated as the proportion of LA to TCA. Depending on the pattern of macular oedema, eyes were classified as having no macular oedema (nME), cystoid macular oedema (CME), cystoid macular oedema with serous retinal detachment (mixed). (3) Results: CVI, TCA and LA were greater in eyes with RVO than in fellow, unaffected eyes. No difference was found between central and branch RVO except for central macular thickness (CMT). When compared with controls, eyes with CME presented a significant increase in subfoveal choroidal thickness, CMT, TCA, LA and CVI; eyes with mixed macular oedema had greater CMT and CVI than contralateral eyes; no significant differences in any of the considered parameters were observed in eyes with nME. (4) Conclusions: The results suggest that RVO alters the vascularity of the choroid that varies according to the type of macular oedema. [ABSTRACT FROM AUTHOR]

Background: Recent development of cataract surgery has led to the improvement of visual outcomes. However, pseudophakic cystoid macular oedema (CME), which is also known as Irvine–Gass syndrome, remains a usual cause of unexpected visual disturbance after both complicated and uncomplicated cataract surgeries. Optical coherence tomography is an important method in detecting changes prior to clinical presentation. Aim: To assess macular thickness changes after uncomplicated phacoemulsification using spectral domain optical coherence tomography (SD-OCT). Setting: The study assessed healthy patients who had uneventful phacoemulsification and changes in macular thickness in Ibn Al Haitham Teaching Eye Hospital (tertiary eye center), Baghdad, Iraq. Methods: Macular thickness of 86 eyes with uncomplicated phacoemulsification were measured by using four OCT examinations: one preoperatively, which was used as a control, and three in the first week and first and second months. Incidence of macular thickness changes was evaluated in the central and para and perifoveal areas to detect which areas of the macular map will be affected more. Significance was tested by using paired t-test and p 0.05 was considered significant. Results: Significant increase in macular thickness postoperatively during the 2-month period reaching the maximum level in the second month; early significant changes were noticed in paracentral area in the first week whilst significant increase in the central and pericentral area was recorded in the first month. Cystoid macular oedema (CME) was detected in six eyes (7%) in the second month. Conclusion: Significant variation in macular thickness can occur after uneventful phacoemulsification surgery in healthy patients. Cystoid macular oedema was detected in 7% of our patients using SD-OCT. It is rare after uncomplicated phacoemulsification in healthy individuals but should be kept in mind in the follow-up period. A detailed fundus examination with OCT imaging is thus recommended in the first or second month postoperatively for the early detection and treatment of CME.

Purpose: To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post‐operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best‐corrected visual acuity (BCVA). Methods: Design: Prospective randomized clinical trial Setting: Multi‐centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post‐operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best‐corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post‐operation. Results: Although all three groups showed reduction in macular thickness post‐operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post‐operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1‐month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post‐operation (2.72 and 1.58 mmHg, respectively). Conclusion: Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post‐vitrectomy ERM surgery. [ABSTRACT FROM AUTHOR]

Background: Post fever uveoretinal sequelae (PFURS) are the various uveoretinal manifestations seen after a systemic febrile illness in an immunocompetent individual caused by bacteria, viruses, and protozoa. These may be the result of a direct invasion by the pathogen or by indirect mechanism mediated through immune mechanisms. Method: The authors aim to review the ocular manifestations, utility of relevant diagnostic tests, management, and prognosis of PFURS. A comprehensive literature search was conducted on PubMed and Google Scholar databases with the search words “retinitis”, “choroiditis”, “neuroretinitis”, “macular edema”, “maculopathy”, “multifocal retinitis”, “chikungunya”, “dengue”, “West Nile”, “typhoid”, and “rickettsiosis”. Only articles published or translated into English language were considered. The key data were extracted, evaluated, and combined. Results: The authors search yielded 95 articles for the period between 1986 and May 2020. Painless blurring of vision was the most common symptom. Patients can have varied posterior segment manifestations, including vitritis, focal and multifocal patches of retinitis which could be unilateral or bilateral, optic nerve involvement, serous detachment at the macula, macular oedema, and localised involvement of the retinal vessels in the form of beading of the vessel wall, tortuosity, and perivascular sheathing. Conclusion: PFURS presents with a similar morphological pattern irrespective of the aetiology and follows a preset natural course before resolution. Treatment may or may not be required. Treating physicians need to be aware of this important ophthalmic condition even after complete resolution of fever.

Abstract Background Whether they are injected peri- or intraocularly, corticosteroids are still essential tools in the therapeutic arsenal for treating inflammatory macular oedema. A few years ago, however, only triamcinolone acetonide was available to ophthalmologists. While this compound was initially developed for rheumatological or dermatological use, it has been increasingly deployed in ophthalmology, despite still being off-label. In 2011, the system for delivery of dexamethasone from a biodegradable, injectable implant into the vitreous cavity obtained approval for use in inflammatory macular oedema. While the efficacy and safety of triamcinolone in macular oedema, including inflammatory oedema, have already been studied, there are currently no publications on subconjunctival triamcinolone injections, which are simple, effective and well tolerated. To date, the dexamethasone 700 μg implant has been authorized for the treatment of noninfectious intermediate and posterior uveitis, but there have been no studies to evaluate the efficacy and safety of the different peri- and intraocular strategies, including the treatment of inflammatory macular oedema. Methods This protocol is therefore designed to compare the efficacy and safety of peri- and intraocular corticosteroid injections in the treatment of inflammatory macular oedema. In this ongoing study, 142 patients will be included, and the oedematous eye will be randomised to treatment with either subconjunctival triamcinolone injection or an intravitreal implant containing 700 μg dexamethasone. Follow-up is planned for 6 months with monthly visits. Each visit will include visual acuity measurement, a slit lamp examination, fundoscopy, intraocular pressure measurement, laser flare measurement (if available) and spectral domain optical coherence tomography. Discussion The results of this trial will have a real impact on public health if it is shown that a Kenacort retard® (i.e. triamcinolone) injection costing just €2.84 and performed in the physician’s office (with no additional overhead costs) is at least as effective as the dexamethasone 700 μg implant (Ozurdex®; costing approximately €960 with the injection performed in a dedicated room), with no increased side effects. Trial registration ClinicalTrials.gov, NCT02556424. Registered on 22 September 2015.

Purpose: To assess the prevalence of vitreomacular adhesion (VMA) in consecutive naïve eyes diagnosed with macular oedema (ME) secondary to retinal vein occlusion (RVO) and to longitudinally evaluate the incidence of vitreomacular interface changes over time and the influence on response to treatment. Design: Retrospective cross‐sectional analysis and longitudinal cohort study conducted at two Italian tertiary referral centres. Methods: A total of 295 eyes, treated with intravitreal ranibizumab and/or dexamethasone for ME secondary to RVO between June 2008 and May 2018, were enrolled in the study. 280 fellow eyes met the inclusion criteria and were included as control group. The vitreomacular interface status was evaluated by spectral domain optical coherence tomography (OCT) and graded according to the OCT‐based International Classification System developed by the International Vitreomacular Traction Study (IVTS) group. Results: At baseline, VMA was present in 130 (44.07%) RVO eyes and 142 (50.7%) control eyes (no statistically significant difference was found; p = 0.455). Mean follow‐up (FU) was 35.98 months (min 6 – max 112). Throughout the FU, the incidence of spontaneous release of VMA (RVMA) in RVO eyes was significantly higher in comparison with that of the control group [59 (41.84%) RVO eyes versus 18 (12.33%) control eyes; p < 0.0001]. The number of injections in VMA+ eyes was significantly higher when compared with VMA− eyes. No significant difference was found between VMA+ and VMA− eyes regarding their mean best‐corrected visual acuity (BCVA) at baseline and at each annual time point (p = 0.2). Differences in central macular thickness (CMT) were significant only at the baseline evaluation (p = 0.0303). Conclusions: Vitreomacular adhesion (VMA) was not found to be more prevalent in eyes with RVO compared to healthy fellow eyes, and RVO, in turn, did not result in a higher persistence of VMA over time. This suggests that VMA and RVO might be two independent retinal phenomena, with no mutual pathogenetic influence. Vitreomacular adhesion (VMA) might have an impact on the response to treatment, since it was found to result in a more intensive treatment regimen; however, it did not affect visual and anatomic outcomes. These results do not support vitrectomy or PVD induction in the prevention, nor the treatment, of RVO. [ABSTRACT FROM AUTHOR]

Kimberly L Spooner,1,2 Gerry Guinan,3 Saskia Koller,3 Thomas Hong,1 Andrew A Chang1,2 1Sydney Institute of Vision Science, Sydney Retina Clinic, Sydney, NSW, Australia; 2Save Sight Institute, University of Sydney, Sydney, NSW, Australia; 3So What Research, Pty Ltd, Sydney, NSW, AustraliaCorrespondence: Andrew A ChangSydney Institute of Vision Science, Sydney Retina Clinic, Level 13 187 Macquarie Street, Sydney 2000, NSW, AustraliaTel +61 2 9221 3755Fax +61 2 9221 1637Email achang@sydneyretina.com.auAim: The incidence and prevalence of diabetes mellitus (DM) in Australia is increasing. Thus, it is essential that practitioners appreciate the impending effect that increasing incidence of diabetes has on patients and the wider community. Accordingly, this study examines the humanistic burden of intravitreal injections for the treatment of diabetic macular oedema (DMO) among several health variables.Methods: Survey data from a representative sample of Australian adults undergoing treatment for DMO were examined. Respondents participated via an online survey recruited by means of a national online consumer panel and the New South Wales and Victorian Diabetes Foundations. The online survey included questions relating to the humanistic burden of disease, such as the emotional and physical impact of intravitreal injection therapy; the practical impacts of injection therapy; and to identify potential improvements to treatment regimens.Results: Sixty-five participants took part in the online survey. Of these, 49% had their most recent injection

Background: Licensed ranibizumab (0.5 mg/0.05 ml Lucentis®; Novartis International AG, Basel, Switzerland) and aflibercept (2 mg/0.05 ml Eylea®; Bayer AG, Leverkusen, Germany) and unlicensed bevacizumab (1.25 mg/0.05 ml Avastin®; F. Hoffmann-La Roche AG, Basel, Switzerland) are used to treat macula oedema due to central retinal vein occlusion, but their relative clinical effectiveness, cost-effectiveness and impact on the UK NHS and Personal Social Services have never been directly compared over the typical disease treatment period. Objective: The objective was to compare the clinical effectiveness and cost-effectiveness of three intravitreal antivascular endothelial growth factor agents for the management of macula oedema due to central retinal vein occlusion. Design: This was a three-arm, double-masked, randomised controlled non-inferiority trial. Setting: The trial was set in 44 UK NHS ophthalmology departments, between 2014 and 2018. Participants: A total of 463 patients with visual impairment due to macula oedema secondary to central retinal vein occlusion were included in the trial. Interventions: The participants were treated with repeated intravitreal injections of ranibizumab (n = 155), aflibercept (n = 154) or bevacizumab (n = 154). Main outcome measures: The primary outcome was an increase in the best corrected visual acuity letter score from baseline to 100 weeks in the trial eye. The null hypothesis that aflibercept and bevacizumab are each inferior to ranibizumab was tested with a non-inferiority margin of –5 visual acuity letters over 100 weeks. Secondary outcomes included additional visual acuity, and imaging outcomes, Visual Function Questionnaire-25, EuroQol-5 Dimensions with and without a vision bolt-on, and drug side effects. Cost-effectiveness was estimated using treatment costs and Visual Function Questionnaire-Utility Index to measure quality-adjusted life-years. Results: The adjusted mean changes at 100 weeks in the best corrected visual acuity letter scores were as follows – ranibizumab, 12.5 letters (standard deviation 21.1 letters); aflibercept, 15.1 letters (standard deviation 18.7 letters); and bevacizumab, 9.8 letters (standard deviation 21.4 letters). Aflibercept was non-inferior to ranibizumab in the intention-to-treat population (adjusted mean best corrected visual acuity difference 2.23 letters, 95% confidence interval –2.17 to 6.63 letters; p = 0.0006), but not superior. The study was unable to demonstrate that bevacizumab was non-inferior to ranibizumab in the intention-to-treat population (adjusted mean best corrected visual acuity difference –1.73 letters, 95% confidence interval –6.12 to 2.67 letters; p = 0.071). A post hoc analysis was unable to demonstrate that bevacizumab was non-inferior to aflibercept in the intention-to-treat population (adjusted mean best corrected visual acuity difference was –3.96 letters, 95% confidence interval –8.34 to 0.42 letters; p = 0.32). All per-protocol population results were the same. Fewer injections were required with aflibercept (10.0) than with ranibizumab (11.8) (difference in means –1.8, 95% confidence interval –2.9 to –0.8). A post hoc analysis showed that more bevacizumab than aflibercept injections were required (difference in means 1.6, 95% confidence interval 0.5 to 2.7). There were no new safety concerns. The model- and trial-based cost-effectiveness analyses estimated that bevacizumab was the most cost-effective treatment at a threshold of £20,000–30,000 per quality-adjusted life-year. Limitations: The comparison of aflibercept and bevacizumab was a post hoc analysis. Conclusion: The study showed aflibercept to be non-inferior to ranibizumab. However, the possibility that bevacizumab is worse than ranibizumab and aflibercept by 5 visual acuity letters cannot be ruled out. Bevacizumab is an economically attractive treatment alternative and would lead to substantial cost savings to the NHS and other health-care systems. However, uncertainty about its relative effectiveness should be discussed comprehensively with patients, their representatives and funders before treatment is considered. Future work: To obtain extensive patient feedback and discuss with all stakeholders future bevacizumab NHS use. Trial registration: Current Controlled Trials ISRCTN13623634. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 38. See the NIHR Journals Library website for further project information.

Macular oedema is a rare complication of fingolimod treatment. It usually presents within 3–4 months, but occasionally presents later. It can resolve without treatment despite continuation of fingolimod treatment. Herein we report a case of very late onset macular oedema in a 49-year-old woman with multiple sclerosis treated with fingolimod for 7 years. The patient presented with blurred vision in both eyes with visual acuities of 20/32 in her right eye and 20/25 in her left eye. She had macular oedema, that without discontinuing fingolimod treatment, resolved after 1 month. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the efficacy of a treat-and-extend (T&E) regimen of ranibizumab as the first-choice treatment in macular oedema (MO) secondary to branch retinal vein occlusion (BRVO). We conducted a retrospective study of 20 patients who developed MO due to BRVO treated with intravitreal ranibizumab in a T&E regimen between 2016 and 2017 with a minimum follow-up of two years. Patients were classified as complete responders if treated with ranibizumab alone or incomplete responders if salvage treatment with other medications or laser was needed. Data on best corrected visual acuity (BCVA) and central macular thickness (CMT) every 6 months were recorded. The mean BCVA (logMAR) improved from 0.60 ± 0.36 to 0.29 ± 0.44 and the CMT decreased from 559.85 ± 198.61 to 305.85 ± 11.78 μm. We found statistically significant differences between complete and incomplete responders on the average number of injections during the second year (2.46 ± 2.18 compared to 5.43 ± 1.27; p = 0.007) and change of the BCVA and CMT between both groups (p < 0.001) at 6, 12, 18 and 24 months. T&E seems to be effective in MO secondary to BRVO, improving visual function and decreasing CMT, with less need for injections.

Aflibercept is a hybrid protein-imitation of VEGF receptor with a prolonged activity. The review describes the structural properties of the Aflibercept molecule, the impact of the medication on the pathogenesis of retinal diseases, and the results of clinical studies into the safety and effectiveness of Aflibercept in the therapy of age related macular degeneration (VIEW1, VIEW2), diabetic macular oedema (VISTA, VIVID), macular oedema caused by the occlusion of the central retinal vein (GALILEO, COPERNICUS) or its branches (VIBRANT), and myopic choroidal neovascularization (MYRROR) Russian ophthalmological journal. 2017; 10 (2): 103-11. (in Russian). doi: 10.21516/2072-0076-2017-10-2-103-111.

Ricardo Alexandre Stock, Daiane Karen Galvan, Rafael Godoy, Elcio Luiz Bonamigo Universidade do Oeste de Santa Catarina, Joaçaba, Santa Catarina, Brazil Purpose: To analyze, using optical coherence tomography, the macular thickness values of patient groups using nonsteroidal anti-inflammatory drug (NSAID) eye drops or artificial tears during uncomplicated cataract surgery.Methods: A total of 77 eyes from 42 patients were analyzed. The patients were divided into three groups, each using one of the following ophthalmic sterile suspensions: nepafenac (21 eyes), propylene glycol (24 eyes), or ketorolac tromethamine (32 eyes).Results: The mean macular thicknesses of the nepafenac group, preoperatively as well as at 1, 7, and 45 days postoperatively, were 216.42, 216.61, 222.47, and 218.28, respectively; those of the propylene glycol control group were 218.29, 214.50, 219.37, and 228.45, respectively; and those of the ketorolac tromethamine group were 217.46, 220.71, 225.25, and 228.46, respectively. There were no significant differences between groups at any time, with p-values of 0.971, 0.6742, 0.6711, and 0.327, respectively.Conclusion: During the study period, no significant differences in macular thickness were observed between the patient groups using two types of NSAIDs or between those groups and the control group that used propylene glycol, indicating that neither drug was superior to the other or the placebo. However, a slight macular thickening, without reduction of visual acuity, was observed in all groups. Keywords: macular edema, nepafenac, ketorolac tromethamine, OCT, cataract surgery, macular thickness, prevention

Background: The current article is a short review of an Alimera Sciences-sponsored symposium held during The 15th International Ocular Inflammation Society Congress in Taiwan on the 14th November 2019 entitled, 'Preventing relapse of non-infectious uveitis effecting the posterior segment of the eye – evaluating the 0.2 μg/day fluocinolone acetonide intravitreal implant.' Main text: The fluocinolone acetonide intravitreal implant was approved in Europe for the prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye and offers a systemic therapy-sparing treatment option by providing low daily dose of corticosteroid into the vitreous for up to 3 years. In the symposium, the presenters reported clinical outcomes from patients with non-infectious uveitis effecting the posterior segment of the eye to support the effectiveness and safety of the implant for up to 3 years in both randomised controlled trials and real-world practices. Conclusions: Data showed that over a 36 month period, treatment with the fluocinolone acetonide intravitreal implant was associated with significantly fewer episodes of uveitic recurrence, a significantly longer time to uveitic recurrence, greater improvement in visual acuity, a lower need for adjunctive therapy, and an acceptable safety profile. [ABSTRACT FROM AUTHOR]

Purpose: To investigate clinical baseline characteristics and optical coherence tomography biomarkers predicting visual loss during observation in eyes with diabetic macular oedema (DMO) and good baseline visual acuity (VA). Methods: A sub‐analysis of a 12‐month, retrospective study, including patients with baseline VA ≤0.1 logMAR (≥20/25 Snellen) and centre‐involving DMO. The primary outcome measure was the correlation between baseline characteristics and VA loss ≥10 letters during follow‐up. Results: A total of 249 eyes were included in the initial study, of which 147 eyes were observed and 80 eyes received anti‐vascular endothelial growth factor (VEGF) treatment at baseline. Visual acuity (VA) loss ≥10 letters occurred in 21.8% (observed cohort) and in 24.3% (treated cohort), respectively. Within observed eyes, presence of hyperreflective foci [HRF; odds ratio (OR): 3.18, p = 0.046], and disorganization of inner retina layers (DRIL; OR: 2.71, p = 0.026) were associated with a higher risk of VA loss ≥10 letters. In observed eyes with a combined presence of HRF, DRIL and ellipsoid zone (EZ) disruption, the risk of VA loss was further increased (OR: 3.86, p = 0.034). In eyes with combined presence of DRIL, HRF and EZ disruption, risk of VA loss was 46.7% (7/15 eyes) in the observed cohort, and 26.3% (5/19 eyes) in the treated cohort (p = 0.26). Conclusion: Patients with DMO and good baseline VA, managed by observation, are of increased risk for VA loss if DRIL, HRF and EZ disruption are present at baseline. Earlier treatment with anti‐VEGF in these patients may potentially decrease the risk of VA loss at 12 months. [ABSTRACT FROM AUTHOR]

Background: Whether they are injected peri- or intraocularly, corticosteroids are still essential tools in the therapeutic arsenal for treating inflammatory macular oedema. A few years ago, however, only triamcinolone acetonide was available to ophthalmologists. While this compound was initially developed for rheumatological or dermatological use, it has been increasingly deployed in ophthalmology, despite still being off-label. In 2011, the system for delivery of dexamethasone from a biodegradable, injectable implant into the vitreous cavity obtained approval for use in inflammatory macular oedema. While the efficacy and safety of triamcinolone in macular oedema, including inflammatory oedema, have already been studied, there are currently no publications on subconjunctival triamcinolone injections, which are simple, effective and well tolerated. To date, the dexamethasone 700 μg implant has been authorized for the treatment of noninfectious intermediate and posterior uveitis, but there have been no studies to evaluate the efficacy and safety of the different peri- and intraocular strategies, including the treatment of inflammatory macular oedema.Methods: This protocol is therefore designed to compare the efficacy and safety of peri- and intraocular corticosteroid injections in the treatment of inflammatory macular oedema. In this ongoing study, 142 patients will be included, and the oedematous eye will be randomised to treatment with either subconjunctival triamcinolone injection or an intravitreal implant containing 700 μg dexamethasone. Follow-up is planned for 6 months with monthly visits. Each visit will include visual acuity measurement, a slit lamp examination, fundoscopy, intraocular pressure measurement, laser flare measurement (if available) and spectral domain optical coherence tomography.Discussion: The results of this trial will have a real impact on public health if it is shown that a Kenacort retard® (i.e. triamcinolone) injection costing just €2.84 and performed in the physician's office (with no additional overhead costs) is at least as effective as the dexamethasone 700 μg implant (Ozurdex®; costing approximately €960 with the injection performed in a dedicated room), with no increased side effects.Trial Registration: ClinicalTrials.gov, NCT02556424. Registered on 22 September 2015. [ABSTRACT FROM AUTHOR]

We aimed to evaluate whether macular laser still has a role in the treatment of macular oedema (MO) caused by branch retinal vein occlusion (BRVO) and provide an overview of recent studies on commonly available treatment options. A literature search was last conducted in PubMed on 26 February 2019, limited to human randomized controlled trials published in English since 2008. Seventeen articles addressing 13 trials were included in this assessment. In trials evaluating intravitreal corticosteroid and macular laser, triamcinolone was non‐inferior to laser in regard to visual acuity (VA) and central retinal thickness (CRT) outcomes. Combination treatment of dexamethasone and laser resulted in better VA and lower CRT after 6 months. In trials evaluating vascular endothelial growth factor (VEGF) inhibitors versus macular laser treatment, or sham and rescue laser, better VA and CRT of VEGF inhibition treatment was consistently reported. Results of combination treatment versus VEGF inhibition monotherapy were inconsistent, with four of six studies reporting comparable outcomes and injection burden. Study comparison was affected by considerable differences in study design and inadequate reporting of laser protocol and rescue laser. Studies evaluating angiostatic treatment as monotherapy largely report the use of rescue laser, indicating that some patients would benefit from supplemental laser treatment even in the era of intravitreal therapy. Thus, we suggest further studies on optimal design of combination therapy prioritizing longer follow‐up time to sufficiently evaluate the delayed effect of laser. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery. Methods: This prospective non‐randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery. Results: Central retinal thickness (CRT) increased in DEX but not in TA‐treated eyes at 7 days (+1.2 ± 20.1 μm and −9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and −3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and −5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and −0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed. Conclusions: Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery. [ABSTRACT FROM AUTHOR]

Introduction: Stargardt's disease is a rare autosomal recessive macular dystrophy with an incidence of 1:8000- 10000 caused by mutations in the ABCA4 gene, which normally is responsible for encoding a protein involved in the visual cycle. This mutation leads to fatty material buildup on the macula, which can have the following consequences: central vision loss, sensitivity to light and occasionally color blindness. Case Report: A 44-year-old woman arrived at the Opthalmology Clinic in February 2024 complaining about decreased visual acuity in her right eye. She is known with moderate myopia. On examination, her best-corrected visual acuity was 0.2 oculus dexter (OD) and 0.05 oculus sinister (OS). Intraocular pressure measured 23 mmHg oculus uterque (OU). On dilated fundus exam, the vitreous was clear OU. Both disc were tilted associated with temporal staphyloma. The peripheral retinas OU presented spiculiform-like retinal pigment epithelium (RPE) hyperpigmentation. A chorioretinal atrophic lesion of approximately 2 papillary diameter was visible in the central macula. Fundus autofluorescence OU revealed multiple mixted lesions of hypo and hyperautofluorescence in posterior pole extending outside the peripheral arcades. In her OS a central wedge-shaped area of hypoautofluorescence appeared. On macular optical coherence tomography (OCT) examination, retinal thickness in the central 1 mm ETDRS circle was 671 µm OD and 156 µm OS with the disappereance of outer retinal layers. Based on the ocular fundus appereance, autofluorescence and OCT findings, diagnosis is compatible with OU: Stargardt disease OD: Macular oedema, OS: Atrophic lesion. Patient was started on oral acetazolamide 250 mg three times a day together with aspacardine. After only a week, a decrease of central foveal thickness was exibited to 294 µm OD. Discussions : Usually, patients with Stargardt's disease present macular atrophy and the interesting part of this case is the macular oedema that appeared, which is uncommon for the disease. The macular oedema in this specific case can be explained by fluid accumulation in the subretinal space caused by break-down of the RPE or Müller cell disfunction. Conclusions: The patient was diagnosed based on clinical observations, even though a genetic test is required to confirm the pathology. OD showed oedema, which in scientific articles is very rarely described correlated with Stargardt's disease. This association is relevant for further research on this topic. [ABSTRACT FROM AUTHOR]

Background: MIRAgel® (MIRA, Waltham, MA, USA) is a hydrogel scleral buckle introduced in 1979 to treat rhegmatogenous retinal detachments. Its use was discontinued because late complications that require surgical removal were reported. Methods: Case report. Results: We report a case of left eye MIRAgel® buckle surgery 28 years ago presenting with a tender palpable erythematous swelling at the lower lid, with marked conjunctival chemosis and progressive ophthalmoplegia. Imaging revealed a large, well-defined, horseshoe-shaped lesion in the extraconal space of the left orbit with globe distortion, with histological confirmation of an expanded hydrogel buckle. He recovered well following removal of the explant but developed chronic macular oedema a year later, which persisted despite sub-Tenon’s triamcinolone injections. Repeat imaging demonstrated remaining hydrogel explant. Macular oedema settled well upon successful surgical removal with no recurrence to date. Conclusion: Our case is the first to describe macular oedema as a late MIRAgel-related complication, with complete removal of the explant being the definitive treatment. Macular oedema indicates postoperative inflammation secondary to the remaining explant fragments. Given the friability of hydrolysed MIRAgel®, we recommend ophthalmologists to warn patients regarding the possibility of further inflammation in the globe or the orbit in case of incomplete removal.

Blood–retinal barrier (BRB) dysfunction underlies macular oedema in many sight-threatening conditions, including diabetic macular oedema, neovascular age-related macular degeneration and uveoretinitis. Inflammation plays an important role in BRB dysfunction. This study aimed to understand the role of the inflammatory cytokine IL-17A in BRB dysfunction and the mechanism involved. Human retinal pigment epithelial (RPE) cell line ARPE19 and murine brain endothelial line bEnd.3 were cultured on transwell membranes to model the outer BRB and inner BRB, respectively. IL-17A treatment (3 days in bEnd.3 cells and 6 days in ARPE19 cells) disrupted the distribution of claudin-5 in bEnd.3 cells and ZO-1 in ARPE19 cells, reduced the transepithelial/transendothelial electrical resistance (TEER) and increased permeability to FITC-tracers in vitro. Intravitreal (20 ng/1 μL/eye) or intravenous (20 ng/g) injection of recombinant IL-17A induced retinal albumin leakage within 48 h in C57BL/6J mice. Mechanistically, IL-17A induced Janus kinase 1 (JAK1) phosphorylation in bEnd.3 but not ARPE19 cells. Blocking JAK1 with Tofacitinib prevented IL-17A-mediated claudin-5 dysmorphia in bEnd.3 cells and reduced albumin leakage in IL-17A-treated mice. Our results suggest that IL-17A can damage the BRB through the activating the JAK1 signaling pathway, and targeting this pathway may be a novel approach to treat inflammation-induced macular oedema.

Diabetic macular oedema (DMO) is one of the leading causes of vision loss associated with diabetic retinopathy (DR). New insights in managing this condition have changed the paradigm in its treatment, with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) having become the standard therapy for DMO worldwide. However, there is no single standard therapy for all patients DMO refractory to anti-VEGF treatment; thus, further investigation is still needed. The key obstacles in developing suitable therapeutics for refractory DMO lie in its complex pathophysiology; therefore, there is an opportunity for further improvements in the progress and applications of new drugs. Previous studies have indicated that Rho-associated kinase (Rho-kinase/ROCK) is an essential molecule in the pathogenesis of DMO. This is why the Rho/ROCK signalling pathway has been proposed as a possible target for new treatments. The present review focuses on the recent progress on the possible role of ROCK and its therapeutic potential in DMO. A systematic literature search was performed, covering the years 1991 to 2021, using the following keywords: “rho-Associated Kinas-es”, “Diabetic Retinopathy”, “Macular Edema”, “Ripasudil”, “Fasudil” and “Netarsudil”. Better insight into the pathological role of Rho-kinase/ROCK may lead to the development of new strategies for refractory DMO treatment and prevention.

Abstract Background Uveitis, a group of disorders characterised by intraocular inflammation, causes 10–15% of total blindness in the developed world. The most sight-threatening uveitis affects the posterior segment of the eye (posterior-segment involving uveitis (PSIU)). Numerous different outcomes have been used in clinical trials evaluating alternative treatments for uveitis, limiting inter-trial comparison and aggregation of data. We aim to develop a core outcome set (COS) that would provide a standardised set of outcomes to be measured and reported in all effectiveness trials for PSIU. Methods A three-phase design will be used informed by recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) initiative. Phase 1: a comprehensive list of outcomes will be identified through both a systematic review of effectiveness trials of PSIU and qualitative research with stakeholders. The qualitative study will comprise focus groups with patients and their carers in parallel with one-to-one telephone interviews with health professionals and policy-makers. In the focus groups, patients will be grouped according to whether or not their uveitis is complicated by the sight-threatening condition uveitic macular oedema (UMO) since it is hypothesised that the presence of UMO may significantly impact on patient experience of PSIU. Phase 2: Delphi methodology will be used to reduce the range of potential outcomes for the core set. Up to three Delphi rounds will be used through an online survey. Participants will be asked to rate the importance of each outcome on a 9-point Likert scale where 9 is most important. Phase 3: a consensus meeting will be held with key stakeholders to discuss the Delphi results and ratify the final outcomes to be included in the COS. Discussion The development of an agreed COS for PSIU would help ensure that outcomes which matter to key stakeholders are captured and reported in a consistent way. A COS for PSIU would allow greater comparison and aggregation of data across trials for the better evaluation of established and emerging therapies through evidence synthesis and meta-analysis to inform clinical guidelines and health policy. Trial registration COMET. http://comet-initiative.org/studies/details/640 . August 2015.

Delivery of pharmaceuticals to the posterior segment presents challenges that arise from the anatomy and clearance pharmacokinetics of the eye. Systemic and several local administration options [topical, periocular, intravitreal (IVT) and subretinal] are in clinical use, each with a unique benefit to risk profile shaped by factors including the administered agent, frequency of dosing, achievable pharmaceutical concentrations within posterior segment structures versus elsewhere in the eye or the body, invasiveness of the procedure and the inherent challenges with some administration methods. The use of the suprachoroidal space (SCS), which is the region between the sclera and the choroid, is being explored as a potential approach to target pharmacotherapies to the posterior segment via a minimally invasive injection procedure. Preclinical data on agents such as vascular endothelial growth factor inhibitors and triamcinolone acetonide (TA) indicate that administration via suprachoroidal injection results in more posterior distribution of the pharmacologic agent, with higher exposure to the sclera, choroid, retinal pigment epithelium cells and retina, and lesser exposure to the anterior segment, than observed with IVT administration. Based in part on these findings, clinical trials have explored the efficacy and safety of suprachoroidal administration of pharmacologic therapies in conditions affecting the posterior segment. Data on a proprietary formulation of TA administered by suprachoroidal injection show improvement in anatomic and visual outcomes in subjects with noninfectious uveitis, with the potential to mitigate the known risks of cataract and increased intraocular pressure (IOP) associated with the use of intraocular corticosteroids. Suprachoroidal administration appears to be a promising treatment modality and is also in the early stages of investigation for other possible applications, such as injection of antiglaucoma agents into the anterior SCS for long‐lasting control of elevated IOP, and as a mode of delivery for gene‐ or cell‐based therapies for retinal disorders. [ABSTRACT FROM AUTHOR]

Purpose: To compare central retinal thickness (CRT) after panretinal photocoagulation (PRP) with a multispot semi‐automated PAttern‐SCAnning Laser (PASCAL) in one session (SS‐PRP) versus four monthly sessions (MS‐PRP) in diabetic retinopathy. Methods: Multicentre, prospective, randomized, single‐blinded, controlled trial evaluating the noninferiority of SS‐PRP versus MS‐PRP for CRT measured with macular spectral‐domain optical coherence tomography (SD‐OCT), with a 9‐month follow‐up in patients presenting severe nonproliferative diabetic retinopathy (DR) or mild proliferative DR without macular oedema (ME) at baseline. Results: Ninety‐seven eyes of 97 participants with a mean age of 57.0 ± 14.2 years were included. The mean change of CRT from baseline to 9 months was not statistically different in SS‐PRP or in MS‐PRP: +16.9 ± 28.3 μm versus +24.7 ± 31.8 μm, respectively (p = 0.224). The variation in mean best‐corrected visual acuity (BCVA) from baseline to 9 months was similar in both groups: −1.1 ± 6.5 letters versus −0.6 ± 6.2 letters (p = 0.684). The number of patients with stabilization of DR was not statistically different between the two groups. No severe complication was recorded in either group. Conclusion: This study showed the noninferiority of PRP performed in one session versus four monthly sessions with a PASCAL concerning central retinal thickness for treating mild proliferative or severe nonproliferative DR without ME at baseline. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between industry funding and outcome reporting bias in high‐quality studies investigating the use of intravitreal anti‐vascular endothelial growth factor (VEGF) agents for patients with macular oedema secondary to branch or central retinal vein occlusion (RVO). Methods: This systematic review in PubMed and Ovid MEDLINE examined all randomized clinical trials and meta‐analyses published in journals with impact factor of ≥2 that investigated effectiveness of intravitreal anti‐VEGF therapy in patients with RVO. The main outcome measure was correspondence between statistical outcome and abstract conclusion wording. Results: Forty‐five studies met inclusion criteria; 38 (84%) showed correspondence between outcome and abstract conclusion without difference between industry‐funded and nonindustry‐funded publications (p = 0.39) or between publications in journals with impact factor ≥3 versus <3 (p = 0.96). Conclusion: In high‐quality studies of intravitreal anti‐VEGF therapy for RVO, neither industry funding nor journal impact factor affected the rate of outcome reporting bias. [ABSTRACT FROM AUTHOR]

One of the major causes of eye blindness is identified to be as diabetic retinopathy, which if not detected in earlier stage would cause a serious issue. Long-term diabetes causes diabetic retinopathy. The significant key factor leading to diabetic retinopathy is exudates which affect the retina part and causes eye defects. Thus the first and foremost task in the automated detection of macular oedema is to detect the presence of these exudates. The authors use image processing techniques to detect the optic disc, exudates and the presence of macular oedema. Their method has the sensitivity 96.07%, selectivity 97.36%, and accuracy 96.62% for the exudates detection and in the case of macular oedema detection the sensitivity 97.75%, selectivity 100%, and accuracy 98.86% is achieved. The performance comparison with other methods reveals that their method can be used as a screening process for diabetic retinopathy. In addition to that, the algorithm can help to detect macular oedema.

Purpose: The COMRADE studies are the first randomized controlled head‐to‐head trials comparing the efficacy and safety of intravitreal ranibizumab versus dexamethasone (DEX) in patients with macular oedema secondary to retinal vein occlusion (RVO). The COMRADE extension trial was designed to provide additional 6‐month data of patients who completed the core studies. Methods: In this open‐label, phase IV study patients who completed the COMRADE core studies were prospectively enrolled. Overall, 92 branch RVO (BRVO) patients (ranibizumab 52, DEX 40) and 83 central RVO (CRVO) patients (ranibizumab 61, DEX 22) were treated, and 94.6% of BRVO patients and 97.6% of CRVO patients completed the extension study. Patients were assigned to the same treatment group as in the core studies. Patients were monitored monthly and received either 0.5 mg ranibizumab or a 0.7 mg DEX implant as needed. Results: Over the course of the extension, treatment‐emergent adverse events (TEAEs) of the study eye occurred in 55.8% of BRVO patients on ranibizumab and in 62.5% of those on DEX. Among CRVO patients, 65.5% in the ranibizumab group and 59.1% in the DEX group developed TEAEs. Overall, elevated intraocular pressure (IOP) was more frequent with DEX than ranibizumab treatment. Mean average change in best‐corrected visual acuity (BCVA) in BRVO patients was significantly better for ranibizumab than DEX (p = 0.0249). The CRVO results were consistent with BRVO's, although not significant (p = 0.1119). Conclusion: When used according to the European labels, ranibizumab revealed a better ocular safety profile and produced greater average BCVA gains than DEX. By the end of the additional 6‐month study period, this difference in BCVA was more pronounced in BRVO as in CRVO patients. The main limitation of the COMRADE studies was that DEX patients received only a single intravitreal treatment during the first 6 months, which is presumably not adequate. However, frequent DEX implants could lead to more steroid‐related side effects, especially to an increased intraocular pressure. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence, pattern and risk factors of Diabetic Retinopathy (DR) among patients with Diabetes Mellitus (DM) in a tertiary hospital in north-central Nigeria. Settings and Design: This was a hospital-based cross-sectional study conducted in Jos, north-central Nigeria. Materials and Methods: Consecutive adult patients with DM attending the endocrinology clinic who consented to the study were examined over a six-month period. Demographic data, duration of diabetes and history of any systemic disorder were obtained for each patient. A detailed ocular examination and fundus photography were performed and results of blood investigations such as Fasting Blood Glucose (FBG), Glycosylated Haemoglobin (HbA1c) and serum lipid profile were analysed. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0 software. Results: Three hundred and fifty-six patients were examined comprising of 120 (33.7%) males and 236 (66.3%) females giving a male to female ratio of 1:2. The mean age of the study population was 56.6 ± 12.3 years. Diabetic retinopathy and macular oedema were present in 66 (18.5%) and 51 (14.3%) patients respectively. Diabetes diagnosis of 10 years and above, FBG and HbA1c all had a statistically significant association with DR with p values <0.001. Conclusion: The prevalence of DR was 18.5% in a hospital cohort of diabetic patients in north-central Nigeria with long duration of diabetes and poor glycaemic control being the major risk factors for retinopathy. These findings highlight the need for regular eye screening and good glycaemic control in individuals with diabetes in our environment. [ABSTRACT FROM AUTHOR]

Purpose: Diabetic maculopathy can be treated with intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors. However, the therapy is not effective in all patients, and it would be desirable to have parameters for differentiating patients who will benefit from treatment from those who will not. Retinal fixation has been shown to be impaired in patients with low visual acuity (VA) secondary to macular disease, but the changes in fixational eye movements after anti‐VEGF treatment for diabetic maculopathy have not been investigated. Methods: Retinal fixation was studied in 29 patients with diabetic macular oedema before three monthly anti‐VEGF injections, and 1 and 4 months after the last injection. The change in VA was correlated with changes in area, frequency, amplitude and total number of fixational saccades. Results: During three monthly injections, best‐corrected visual acuity (BCVA) increased from (mean ± SD) 74.0 ± 11.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters to 78.3 ± 9.8 ETDRS letters, (p = 0.003) and central retinal thickness (CRT) decreased from (mean ± SD) 441.7 ± 107.0 μm to 339.5 ± 74.2 μm, (p = <0.0001), which was followed by the opposite changes after treatment (BCVA reduced nonsignificantly to 77.5 ± 10.4 ETDRS letters (p = 0.06), and CRT increased to 393.0 ± 9.8 μm, p = <0.0001). Both improvement and worsening of BCVA correlated with the fixation area (r2 = 0.28, p = 0.003 and r2 = 0.14, p = 0.045, respectively), but only improvement of BCVA correlated with the frequency (r2 = 0.15, p = 0.037) and total number of saccades (r2 = 0.18, p = 0.02). BCVA showed no correlation with the amplitude and most frequently occurring saccade amplitude. Conclusion: Fixational eye movements may be used to monitor short‐term effects of anti‐VEGF treatment on diabetic macular oedema. Future studies should aim at investigating a possible predictive value of fixational eye movements for visual function in the long term. [ABSTRACT FROM AUTHOR]

Background In late 2015, cut-off points were published for foveal thickness to diagnose diabetic macular oedema taking into account the presence of intraretinal fluid using optical coherence tomography (OCT) in primary care patients (90 µm in the presence of intraretinal fluid and 310 µm otherwise). Methods This cross-sectional observational study was carried out on 134 eyes of diabetic patients treated in specialised ophthalmology services in a Spanish region in 2012–2013, to externally validate the aforementioned cut-off points. The main variable (Clinical Standard) was the diagnosis of macular oedema through indirect ophthalmoscopy and posterior segment slit-lamp biomicroscopy. As validation variables, both the foveal thickness and the presence of intraretinal fluid obtained by OCT were used. Validation was performed using bootstrapping by calculating the area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Results Forty-one eyes presented diabetic macular oedema (30.6%). The bootstrapping validation parameters were: AUC, 0.88; sensitivity, 0.75; specificity, 0.95; PLR, 14.31; NLR, 0.26. These values were very similar to those of the original publication. Conclusion We have externally validated in specialised care patients the cut-off points published for the diagnosis of diabetic macular oedema. We suggest that others carry out validation studies in their communities.