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Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticoster-oids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments. publishersversion published

Objetivo: Apresentar um caso de hemorragia pré-macular tratada com hialoidetomia por Neodímio (Nd):YAG laser. Materiais/Métodos: Uma mulher de 78 anos recorreu ao Serviço de Urgência com perda súbita de visão no olho direito (máxima visão corrigida: 20/400). Observou-se uma hemorragia na interface vítreoretina no exame de fundo de olho e se estabeleceu um diagnóstico de hemorragia pré-foveal após alguns exames, possivelmente devido a um macroaneurisma. Realizou-se um punção com um impacto de 5 mJ de (Nd): YAG. Após 2 meses, os exames mostraram uma área pré-macular limpa com contorno foveal preservado e depois de 3 meses, a paciente estava assintomática. Conclusões: Os macroaneurismas arteriais retinianos são anomalias adquiridas, relacionadas com fatores de risco cardiovascular. A sua progressão é imprevisível, sendo a hemorragia pré-macular uma das complicações que comprometem a visão. Não há normas para o tratamento da hemorragia. O laser (Nd):YAG é um método não invasivo, económico e seguro. Neste caso, permitiu una recuperação rápida sem dano macular significativo., Revista Sociedade Portuguesa de Oftalmologia, Vol. 42 N.º 2 (2018)

This article reviews clinically relevant data regarding traumatic maculopathy (TM), frequently observed in clinical practice, especially due to sport or traffic accident injuries. It is characterized by transient gray-whitish retinal coloration and reduction of visual acuity (VA) with closed, blunt object globe trauma of their prior. It may be limited to the posterior pole (Berlin's edema), or peripheral areas of the retina. Spectral-domain optical coherence tomography (SD-OCT) provides detail insight using high resolution cross-sectional tomographs of the ocular tissue. It is a potent non-invasive tool for the clinician to follow-up. Clinicians are, thereby empowered with a tool that enables evaluation of the retinal status and allows for prediction of the prognosis. Spectral-domain optical coherence tomography supports the idea that the major site of injury is in the photoreceptor and layers of the retinal pigment epithelium (RPE). Depending on the severity of the trauma, SD-OCT may reveal differential optical densities of intraretinal spaces ranging from disappearance of the thin hyporeflective optical space in mild lesions, or areas of disruption of the inner segment/outer segment (IS/OS) junction and hyperreflectivity of the overlying retina, pigment disorders and retinal atrophy, in more severe cases. The prognosis for recovery of vision is generally good, and improvement occurs within 3-4 weeks.