Treating Diabetic Macular Oedema (DMO): real world UK clinical outcomes for the 0.19mg Fluocinolone Acetonide intravitreal implant (Iluvien™) at 2 years

Abstract Background To compare visual function and structural improvements in pseudophakic eyes with diabetic macular oedema (DMO) treated with the 0.19mg Fluocinolone Acetonide (FAc) intravitreal implant (IluvienTM) in a ‘real world’ setting. Methods A single centre retrospective evaluation of patients with DMO unresponsive to conventional treatment treated with the FAc implant according to UK guidelines. Primary efficacy endpoint was best corrected visual acuity (BCVA); secondary endpoints included optical coherence tomography evaluations of the macula (a) central retinal and (b) peak macular thickness collected at annual time points. Primary safety endpoint was new rise in IOP >27mmHg or glaucoma surgery. Patients with <1 year follow-up were excluded. Results Twenty-nine eyes were included, with mean(SD) follow up of 792(270) days. Improvement in BCVA and reduction in macular oedema was noted at all timepoints. Mean improvement in BCVA from baseline was 6 ETDRS letters at year 1(n=29), 6.5L at year 2(n=22) and 11L at year 3(n=6). Mean central retinal thickness at baseline was 451 microns, 337 microns at year 1, 342 microns at year 2 and 314 microns at year 3. Two eyes required IOP-lowering drops post implant. Supplementary treatment for persistence or recurrence of DMO was necessary in 18 eyes over the total study period of 3 years with mean time to supplementary treatment being 12 months. Conclusions Our evaluation of the 0.19mg FAc implant delivered in a real-world setting, provides additional evidence that it is effective and safe in the treatment of patients with DMO, and can provide sustained benefit for patients with previously refractory disease

Valsalva maculopathy: To treat or not to treat

To discuss diagnostic strategies and management options in cases with suspected valsalva maculopathy (VM), to optimize visual outcome. We describe six cases with suspected VM. The preretinal hemorrhage resolved spontaneously in four out of six patients, without any intervention. One patient underwent neodymium-doped yttrium aluminum garnet hyaloidotomy and the other proceeded to have a vitrectomy for persistent diffuse vitreous hemorrhage. Considering the evidence available and the outcomes of our patients, we have devised a treatment algorithm for treating VM, which is elaborated in this article

Orbital cellulits following cataract surgery under peribulbar anaesthesia

[english] Introduction: Orbital cellulits following cataract surgery is extremely rare. We describe a case of orbital and facial cellulitis that occurred after routine cataract operation with peribulbar anaesthesia. There were no preoperative systemic or ocular risk factors for postoperative infection. Case description: An 89-year-old man presented to eye casualty, the day after he underwent an uneventful phacoemulsification and posterior chamber lens implantation in the left eye under peribulabr anaesthesia, with soreness, swelling and reduced visual acuity (6/18) in the operated eye. On initial presentation periorbital swelling was noted, the eye was minimally tender, intraocular pressure was raised at 28 mHg and fundoscopy was limited due to a hazy cornea. The patient was discharged on topical medication with a diagnosis of allergic reaction to postoperative drops.The following day, the patient re-presented with worsening orbital swelling involving the left cheek. Ocular findings remained unchanged. CT scan revealed left orbit soft tissue swelling and a locule of air medial to the medial rectus. There were no signs of sinus infection or periosteal inflammation. A diagnosis of left orbital and facial cellulitis was made and the patient was treated with intravenous antibiotics.Discussion: Our patient did not have any predisposing risk factors, therefore most likely cause of cellulitis is surgical trauma during administration of the peribulbar block. This case illustrates the need for adequate skin preparation before the administration of peribulbar anaesthesia and minimal tissue trauma during the procedure

The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review

Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique

Guidelines for the prevention and management of diabetic retinopathy and diabetic eye disease in India: A synopsis.

Diabetes mellitus now affects 65 million adults in India, which is likely to increase to over 130 million by 2045. Vision impairment and blindness from diabetic retinopathy (DR) and diabetic macular edema (DME) will increase unless systems and services are put in place to reduce the incidence of DR and DME, and to increase access to diagnosis and effective treatment. In India, sight-threatening DR (STDR) affects 5%-7% of people with diabetes, i.e., 3-4.5 million. This will increase as the number of people with diabetes increases and they live longer. The main risk factors for DR and DME are increasing duration of disease and poor control of hyperglycemia and hypertension. There is strong evidence that good control of hyperglycemia and hypertension reduce the incidence of STDR: interventions which lead to better self-management, i.e., a healthier diet and regular exercise, are required as well as taking medication as advised. There are highly effective and cost-effective treatments for STDR and up to 98% of blindness can be prevented by timely laser treatment and/or vitreous surgery. Given this increasing threat, the Queen Elizabeth Diamond Jubilee Trust endorsed the development of evidence-based guidelines for the prevention, detection, and management of DR and DME, and for cataract surgery in people with diabetes, specific to India as a component of the national DR project it has supported