A hypothetical therapeutic effect of light peripheral panretinal photocoagulation in neovascular age-related macular degeneration

Background: Vascular endothelial growth factor (VEGF) is a significant modulator of ocular angiogenesis, including that of neovascular age-related macular degeneration (nAMD). Intravitreal injection of anti-VEGF is the benchmark treatment for most retinal vascular diseases, including nAMD, diabetic maculopathy, and macular edema secondary to retinal venous occlusion. Anti-VEGF treatment is a high-frequency, time-consuming, non-cost-effective therapy, especially in countries and regions with limited resources. This treatment is easily restricted, and in practice, maintaining long-term periodic care is challenging for patients. Hypothesis: Light peripheral panretinal photocoagulation (PPRP) is applied in a mild form (barely visible mild light gray mark) anterior to the equator so as not to jeopardize the visual field. PPRP lessens the ischemia that causes neovascularization and decreases the metabolic demand in the peripheral retina. PPRP reduces serum angiopoietin-2 and VEGF levels in patients with type 2 diabetes mellitus with proliferative diabetic retinopathy. We propose using light PPRP to suppress VEGF secretion, aiming to attenuate the VEGF drive and halt choroidal neovascular growth in eyes with nAMD. Our regimen is based on two concepts: first, nAMD is a diffuse or generalized disease that affects the posterior segment; and second, PPRP is very effective in regressing diabetic retinopathy. PPRP has reportedly been successful in cases of macular edema (diabetic or following venous occlusion) resistant to VEGF antagonists. Light PPRP may be used as prophylaxis, adjunctive treatment, or monotherapy in nAMD when intravitreal injections of VEGF antagonists are not feasible. Conclusions: The established light PPRP therapy could be promising as a one-time, cost-effective therapy or prophylaxis in patients with nAMD or at high risk. This proposed modality could be suitable for patients who have injection phobia or prefer a one-time affordable therapy to the long-term monthly visits to retinologists. Future trials are necessary to verify the safety and efficacy of this proposed treatment modality in selected patients with nAMD

Optical Coherence Tomography in Diabetic Retinopathy

Optical coherence tomography (OCT) has become an indispensable modality of investigation in the assessment of diabetic retinopathy. It is a non-invasive and reliable imaging tool that provides a comprehensive analysis of the retina. The images are obtained very fast. It is useful for quantitative as well as qualitative assessment of structural changes that occur in diabetic retinopathy. It also enables the detection of subclinical diabetic macular edema. Various imaging biomarkers have been identified on OCT imaging. These markers help prognosticate the case and determine treatment response. The follow-up imaging helps assess the response to treatment and detect recurrence of disease or need for further treatment

Scleral abscess following posterior subtenon triamcinolone acetonide injection for diabetic macular edema

AbstractA 65-year-old male with uncontrolled diabetes, received posterior subtenon triamcinolone (PST) injection in the right eye for diabetic macular edema. Two days following PST, he developed scleral abscess at the injection site. The Gram stain showed Gram positive cocci in clusters. He responded favorably with systemic control of diabetes, topical concentrated cefazolin, concentrated tobramycin, and intravenous antibiotics. Possibility of infective complications should be considered when using periocular steroids, especially in diabetics. Strict control of diabetes and aggressive systemic antibiotics favor rapid healing in such cases

Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review

Our purpose is to review the closure time and optical coherence tomography (OCT) biomarkers that result in the non-surgical repair of idiopathic full-thickness macular holes (IFTMH). Our methodology consisted of a comprehensive literature review of the nonsurgical resolution of IFTMH followed by the calculation of the estimated closure time using the structural equation model. Forty-nine studies were found eligible yielding 181 eyes with IFTMH: 81.1% being small holes (<250 μm) with a median diameter of 166 μm. Final vision (mean 20/41) was related to initial vision (mean 20/65) and mean age (67 years). The hole diameter was correlated with initial vision and closure time (mean 3.9 months). Closure time was related to hole diameter and initial vision in the following algorithm: Closure time (month)= −0.057 + 0.008 diameter (μm) + 0.021 age (year) + 2.153 initial vision (logMAR). Biomarkers by OCT for self-closure included in decreasing frequency: pointed edge, de-turgescence of cystic macular edema (CME) with reversal of bascule bridge, and vitreomacular traction (VMT) release. The crucial function of Muller cell bridging in sealing the hole attests to its exceptional capacity for regeneration. After the hole has begun to close; however in less than 5%, a delayed restoration of the ellipsoid layer or a persistent outer foveal defect may prevent visual recovery and reopening of the hole is possible. In conclusion, eyes with small-size IFTMH and good baseline vision can have the additional option of close OCT monitoring for biomarkers of self-sealing biomarkers. When rehabilitative activity seems to be lacking, surgery is therefore mandatory

Prof Lalit Prakash Agarwal (1922-2004)—The Planner of the First-Ever National Blindness Control Program of the World

Prof Lalit Prakash Agarwal drafted the National Programme for Prevention of Visual Impairment and Control of Blindness (now called National Programme for Control of Blindness) in India in 1976, first of its kind in the world. With his vision well ahead of his time, he brought the concept of super-specialty in Indian ophthalmology. He founded Dr. Rajendra Prasad Centre for Ophthalmic Sciences, the apex governmental ophthalmological center of India. His contributions to modern Indian Ophthalmology were so profound that we may not be mistaken by calling him “the father of modern Indian Ophthalmology.

Regarding successful use of 23G cutter for anterior vitrectomy and scleral-fixated intraocular lens implantation

Letter to the edito

Spontaneous Resolution of Optic Disc Pit Maculopathy

I read with interest the article reporting spontaneous resolution of optic disc pit maculopathy in a boy.1 Though the presence of an optic disc pit and associated macular involvement is undoubted in the presented case, the provided optical coherence tomography (OCT) does not clearly show typical intraretinal schisis (Figure 1B)1 at multiple retinal levels which may communicate with the pit. Instead, it shows a sub-internal limiting membrane (sub-ILM) cavity. Such cavities are known to occur following the resolution of sub-ILM bleed due to various cause including Valsalva retinopathy,2 Terson syndrome, and also in some retinitis3 cases.4 In fact, some of these cavities may simulate a neurosensory retinal detachment or central serous chorioretinopathy on cursory clinical examination.5 To confirm that the features of the current patient1 are indeed related to the optic disc pit, it is necessary for the authors to provide an OCT scan which shows a connection of the presented cavity with the optic disc pit. Also, clear OCT scans of the fovea, both at presentation and at final follow-up would help our understanding of the visual recovery of the patient. The interval between the presenting (28 June 2012) OCT and final OCT (30 Nov 2012) is 5 months and not 6 months as described in the manuscript. For an effective comparison, both the presenting and final OCT scans should have been taken using either horizontal or vertical orientation over the macula. Though the spontaneous resolution of optic disc pit maculopathy is possible, visual recovery in usually unlikely and in such cases an alternate diagnosis needs to be excluded