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Candida endophthalmitis is a severe complication of candidemia. Currently, the recommended treatment of fungal endophthalmitis is a combination of intravitreal and systemic antifungal drugs, and in some cases vitrectomy is also required. Intravitreal therapies that are commonly used are amphotericin B and voriconazole, although recently the use of intravitreal caspofungin has been described in a few case reports. However, clinical experience with intravitreal caspofungin is still limited. We report a case of bilateral candida tropicalis endophthalmitis, initially managed with repeated 100 μg/0.1 ml caspofungin intravitreal injections and posteriorly treated with pars plana vitrectomy in both eyes. Intravitreal caspofungin could be a safe intravitreal alternative to habitual antimycotic drugs in cases with resistant candida endophthalmitis.Abbreviations: Intensive Care Unit (ICU); Best-Corrected Visual Acuity (BCVA) [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long-term cumulative probability of intraocular pressure (IOP) elevation with the intravitreal dexamethasone implant (IDI) when used to treat different indications: diabetic macular edema, uveitis, retinal vein occlusion. Methods: 705 IDI injections (429 eyes) were assessed and Kaplan-Meier graphs were generated to assess: the probability of different levels of IOP elevation (IOP≥21, ≥25 or ≥35 mmHg), IOP change ≥10 mmHg, initiation of IOP-lowering treatment, glaucoma surgery, IOP change with repeat injections and IOP elevation in eyes with glaucoma and ocular hypertension (OHT). Results: The cumulative probability of IOP ≥21, ≥25 and ≥35 mmHg was 50%-60%, 25%-30% and 6%-7% at 12–24 months, respectively. The probability of initiating IOP-lowering medication was 31%-54% at 12–24 months. Glaucoma and OHT eyes had a higher probability of mild IOP elevation (≥21 mmHg, 65.1%, 75% and 57.8%, p = 0.01), yet a similar moderate (≥25 mmHg, 22.3%, 28% and 30.2%, p = 0.91) and severe elevation of IOP (≥35 mmHg, 3.7%, 7.1% and 4%, p = 0.71) as normal eyes. Glaucoma surgery was required in only 0.9% cases (4/429). At baseline, 8.8% of the treated eyes had glaucoma, 6.7% OHT and 16.9% were already on IOP-lowering medication. Conclusions: In the long-term (24 months), IOP elevation is common, generally mild (30% IOP, ≥25 mmHg) and well-tolerated, resolving with topical treatment (54%) and rarely requiring surgery (0.9%). [ABSTRACT FROM AUTHOR]

Background: To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting.Methods: 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months.Results: Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates.Conclusion: Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes of eyes that did or did not develop an epiretinal membrane (ERM) after repair of primary pseudophakic or aphakic rhegmatogenous retinal detachment by pars plana vitrectomy alone., Methods: Interventional, prospective, consecutive case series. Of 312 consecutive eyes that underwent pars plana vitrectomy for primary rhegmatogenous retinal detachment, 28 (8.97%) developed ERM during the postoperative period. Best-corrected visual acuity (BCVA) and fundus examinations were performed 1 month and 3, 6, and 12 months postoperatively., Results: Eyes with an ERM more often had a break at the equator (odds ratio, 3.92; 95% confidence interval, 1.3–11.2; P < 0.011). At ERM diagnosis, BCVA ranged from 20/400 to 20/25 with a mean of 20/100 (0.75 logarithm of the minimum angle of resolution), and BCVA at the final visit ranged from 20/200 to 20/25 with a mean of 20/63 (0.53 logarithm of the minimum angle of resolution). Of the 22 eyes that underwent surgical removal of the ERM, BCVA was ≥ 20/40 in 5 (22.7%) before the surgical procedure and in 13 (59%) at the final follow-up visit., Conclusion: The incidence of ERM after pars plana vitrectomy alone for the repair of primary pseudophakic or aphakic rhegmatogenous retinal detachment was similar to reported incidences after scleral buckling. Best-corrected visual acuity improved after surgical removal of ERM, although eyes with the macula detached had lower final BCVA.