Emerging Pharmacotherapies for Diabetic Macular Edema

Diabetic macular edema (DME) remains an important cause of visual loss in patients with diabetes mellitus. Although photocoagulation and intensive control of systemic metabolic factors have been reported to achieve improved outcomes in large randomized clinical trials (RCTs), some patients with DME continue to lose vision despite treatment. Pharmacotherapies for DME include locally and systemically administered agents. We review several agents that have been studied for the treatment of DME

A 7-Year Old Boy with a Swollen Eye (PowerPoint)

Orbital inflammationA 7-year old male with erythema of the left eyelid. Previous history significant for refractive error, use of eyeglasses, asthma, eczema, and ADHD.VA: 20/40 OD, 20/25 OS; Optic disc hyremia OSCT; MRIB-cell lymphocytic infiltrateIV steroids1. Brannan PA. A review of sclerosing idiopathic orbital inflammation. Curr Opin Ophthalmol, 18, 402-404, 2007. 2. Brannan PA, Kersten RC, Kulwin DR. Sclerosing idiopathic orbital inflammation. J Pediatr Ophthalmol Strabismus, 43(3), 183-184,2006. 3. Hsuan JD, Selva D, McNab AA, et al. Idiopathic sclerosing orbital inflammation. Arch Ophthalmol, 124:1244-1250, 2006. 4. Rootman J, Robertson W, Lapointe JS: Inflammatory diseases, in Rootman J (ed): Diseases of the Orbit: A Multidisciplinary Approach. Philadelphia, JB Lippincott, 2003, 159-178. 5. Thorne JE, Volpe NJ, Wulc AE, Galetta SL. Caught by masquerade: sclerosing orbital inflammation. Surv Ophthalmol, 47(l):50-54, 2002

A 7-Year Old Boy with a Swollen Eye

Orbital inflammationA 7-year old male with erythema of the left eyelid. Previous history significant for refractive error, use of eyeglasses, asthma, eczema and ADHD.VA: 20/40 OD, 20/25 OS; Optic disc hyperemia OSCT; MRIB-cell lymphocytic infiltrateIV steroids1. Brannan PA. A review of sclerosing idiopathic orbital inflammation. Curr Opin Ophthalmol, 18, 402-404, 2007. 2. Brannan PA, Kersten RC, Kulwin DR. Sclerosing idiopathic orbital inflammation. J Pediatr Ophthalmol Strabismus, 43(3), 183-184,2006. 3. Hsuan JD, Selva D, McNab AA, et al. Idiopathic sclerosing orbital inflammation. Arch Ophthalmol, 124:1244-1250, 2006. 4. Rootman J, Robertson W, Lapointe JS: Inflammatory diseases, in Rootman J (ed): Diseases of the Orbit: A Multidisciplinary Approach. Philadelphia, JB Lippincott, 2003, 159-178. 5. Thorne JE, Volpe NJ, Wulc AE, Galetta SL. Caught by masquerade: sclerosing orbital inflammation. Surv Ophthalmol, 47(l):50-54, 2002

Resolution of Pigmented Keratic Precipitates Following Treatment of Pseudophakic Endophthalmitis Caused by Propionibacterium Acnes

Propionibacterium acnes is a well-recognized cause of chronic postoperative endophthalmitis after cataract surgery. The subtle clinical signs of this infection and its initial favorable response to topical steroids may lead to delayed diagnosis and treatment. Two patients with culture proven P. acnes endophthalmitis after cataract surgery that presented with prominent pigmented keratic precipitates (KPs) and low-grade iritis in the involved eye were managed. Both cases had initial treatment with diagnostic pars plana vitrectomy (PPV) with intraocular antibiotic (IOAB) injection. Secondary treatment for recurrence was required in both patients. The KPs and iritis resolved after removal of intraocular lens (IOL) and capsular bag

Management of Ruptured Retinal Arterial Macroaneurysm with Intravitreal Bevacizumab

The authors report the management of a ruptured retinal arterial macroaneurysm and associated hemorrhages with intravitreal injections of bevacizumab. A 79-year-old woman presented with a history of systemic arterial hypertension and a ruptured retinal arterial macroaneurysm with pre-retinal, intraretinal, and subretinal hemorrhages extending into the macula. Visual acuity at presentation was 20/400. The patient was treated with two intravitreal injections of bevacizumab at 4-week intervals. Steady clearing of the pre-retinal, intraretinal, and subretinal hemorrhages was observed with restoration of final visual acuity to 20/20 in the 12 months after the initial presentation. It appears that the novel application of intravitreal bevacizumab may be used in the treatment of ruptured retinal arterial macroaneurysm

Methicillin-resistant Staphylococcus epidermidis isolation from the vitrectomy specimen four hours after initial treatment with vancomycin and ceftazidime

A patient presented with acute-onset, postoperative endophthalmitis and visual acuity of light perception. Because of a time delay in arranging a pars plana vitrectomy (PPV), the patient was treated with a prompt vitreous tap for culture an injection of vancomycin and ceftazidime. Four hours later, the PPV was performed and additional antibiotics were injected. The cultures from both the initial needle tap and the subsequent PPV isolated methicillin-resistant Staphylococcus epidermidis sensitive to vancomycin, but resistant to fourth-generation fluoroquinolones. The patient eventually recovered a visual acuity of 20/80 before developing retinal detachment. This case illustrates the time lag necessary to sterilize the vitreous cavity, and suggests a possible two-step staged treatment strategy for situations in which access to PPV equipment and support staff may be limited

Ruboxistaurin: Review of Safety and Efficacy in the Treatment of Diabetic Retinopathy

Ruboxistaurin (Eli Lilly, Indianapolis, IN), an orally active inhibitor of the β isoform of protein kinase C (PKC), has been studied as a systemic treatment for diabetic retinopathy. PKC-β appears to be overactivated in response to hyperglycemia. This overactivation associates with various pathological effects within the retinal vascular system, including ischemia, vascular leakage, and angiogenesis. Several randomized clinical trials of ruboxistaurin have been performed. In most trials, the primary outcomes were not achieved. Analysis of secondary outcomes data from these trials has demonstrated some evidence of safety and efficacy in the treatment of diabetic retinopathy. At this time, ruboxistaurin has not received approval from the US Food and Drug Administration