Off-label use of intravitreal triamcinolone acetonide for diabetic macular edema in a pregnant patient

We present a case of diabetic macular edema in a pregnant patient treated with a single intravitreal injection of triamcinolone acetonomide. Initial presentation and serial examinations after treatment included visual acuity, slit-lamp examination, indirect ophthalmoscopy, and optical coherence tomography. Resolution of visual acuity and macular edema were present six weeks after injection and persisted throughout the duration of the pregnancy without further intervention. No adverse outcomes for either mother or fetus were noted. To our knowledge, this is the first report of intravitreal triamcinolone administration in this patient population to be published in the medical literature

Commensal microflora-induced T cell responses mediate progressive neurodegeneration in glaucoma

Glaucoma is the most prevalent neurodegenerative disease and a leading cause of blindness worldwide. The mechanisms causing glaucomatous neurodegeneration are not fully understood. Here we show, using mice deficient in T and/or B cells and adoptive cell transfer, that transient elevation of intraocular pressure (IOP) is sufficient to induce T-cell infiltration into the retina. This T-cell infiltration leads to a prolonged phase of retinal ganglion cell degeneration that persists after IOP returns to a normal level. Heat shock proteins (HSP) are identified as target antigens of T-cell responses in glaucomatous mice and human glaucoma patients. Furthermore, retina-infiltrating T cells cross-react with human and bacterial HSPs; mice raised in the absence of commensal microflora do not develop glaucomatous T-cell responses or the associated neurodegeneration. These results provide compelling evidence that glaucomatous neurodegeneration is mediated in part by T cells that are pre-sensitized by exposure to commensal microflora.National Institutes of Health (U.S.) (Grant EY025913)National Institutes of Health (U.S.) (Grant EY027067)National Institutes of Health (U.S.) (Grant EY025259)National Institutes of Health (U.S.) (Grant NS038253)National Institutes of Health (U.S.) (Grant AI69208