Diabetic Macular Edema: From Old Concepts to New Therapeutic Avenues

Diabetic macular edema (DME) is an important cause of blindness in the working population and is currently challenging to treat. Current interventions include focal laser or intravitreal injections. This article outlines a new treatment protocol based on the concept that peripheral ischemia is the introduction to angiogenesis, that will ultimately gather its momentum at the fovea. Performing extreme peripheral light laser panretinal photocoagulation (PRP) back to the equator reduces excessive expression of the vascular endothelial growth factor (VEGF) in the eye. Subsequently, this decreases VEGF-induced DME and provides long-term protection for the development of neovascularization. Initial exacerbation of DME often accompanies PRP, Therefore; first injections of anti-VEGF agents (with or without dexamethasone implant) can forestall worsening of DME preventing loss of vision. However, on the other hand, applying peripheral PRP and intraocular injections can induce posterior vitreous detachment (PVD). This could help release vitreomacular adhesions (VMA) and vitreomacular traction (VMT), decreasing DME severity and improving response to intravitreal injections. The current approach works by laser ablation of the peripheral retina that should stop the drive for VEGF release; moreover, laser ablation should produce secondary, accidental and beneficial PVD. This approach precludes focal laser therapy and paves the path for prolonged anti-VEGF therapy

Forgotten exogenous corticosteroid as a cause of central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is an idiopathic ocular condition – first described in 1866 – that is well known to ophthalmologists. It is less well known to other practitioners. Glucocorticoids have been strongly implicated as a pathogenic factor. We report three patients who developed CSCR following exogenous administration of corticosteroid. Because our patients did not suspect the use of corticosteroid to be important or causative, they did not volunteer the historical detail, and admitted to exogenous corticosteroid injection only with intensive questioning. For their part, physicians should be cognizant of the risk of corticosteroid-induced CSCR, particularly in patients with a prior history of the potentially sight-threatening disease. The development of CSCR is an important iatrogenic and often unrecognized side effect of exogenously administered corticosteroid

Diabetic Macular Edema: From Old Concepts to New Therapeutic Avenues

Diabetic macular edema (DME) is an important cause of blindness in the working population and is currently challenging to treat. Current interventions include focal laser or intravitreal injections. This article outlines a new treatment protocol based on the concept that peripheral ischemia is the introduction to angiogenesis, that will ultimately gather its momentum at the fovea. Performing extreme peripheral light laser panretinal photocoagulation (PRP) back to the equator reduces excessive expression of the vascular endothelial growth factor (VEGF) in the eye. Subsequently, this decreases VEGF-induced DME and provides long-term protection for the development of neovascularization. Initial exacerbation of DME often accompanies PRP, Therefore; first injections of anti-VEGF agents (with or without dexamethasone implant) can forestall worsening of DME preventing loss of vision. However, on the other hand, applying peripheral PRP and intraocular injections can induce posterior vitreous detachment (PVD). This could help release vitreomacular adhesions (VMA) and vitreomacular traction (VMT), decreasing DME severity and improving response to intravitreal injections. The current approach works by laser ablation of the peripheral retina that should stop the drive for VEGF release; moreover, laser ablation should produce secondary, accidental and beneficial PVD. This approach precludes focal laser therapy and paves the path for prolonged anti-VEGF therapy

Detection of Elevated Signaling Amino Acids in Human Diabetic Vitreous by Rapid Capillary Electrophoresis

Elevated glutamate is implicated in the pathology of PDR. The ability to rapidly assess the glutamate and amino acid content of vitreous provides a more complete picture of the chemical changes occurring at the diabetic retina and may lead to a better understanding of the pathology of PDR. Vitreous humor was collected following vitrectomies of patients with PDR and control conditions of macular hole or epiretinal membrane. A capillary electrophoresis method was developed to quantify glutamate and arginine. The analysis is relatively fast (<6 minutes) and utilizes a poly(ethylene)oxide and sodium dodecylsulfate run buffer. Both amino acid levels show significant increases in PDR patients versus controls and are comparable to other reports. The levels of vitreal glutamate vary inversely with the degree of observed hemorrhage. The results demonstrate a rapid method for assessment of a number of amino acids to characterize the chemical changes at the diabetic retina to better understand tissue changes and potentially identify new treatments

On the collisional disalignment of dust grains in illuminated and shaded regions of IC 63

Interstellar dust grain alignment causes polarization from UV to mm wavelengths, allowing the study of the geometry and strength of the magnetic field. Over the last couple of decades, observations and theory have led to the establishment of the radiative alignment torque mechanism as a leading candidate to explain the effect. With a quantitatively well constrained theory, polarization can be used not only to study the interstellar magnetic field, but also the dust and other environmental parameters. Photodissociation regions, with their intense, anisotropic radiation fields, consequent rapid H2 formation, and high spatial density-contrast provide a rich environment for such studies. Here we discuss an expanded optical, NIR, and mm-wave study of the IC 63 nebula, showing strong H2 formation-enhanced alignment and the first direct empirical evidence for disalignment due to gas-grain collisions using high-resolution HCO+(J = 1-0) observations. We find that a relative amount of polarization is marginally anticorrelated with column density of HCO+. However, separating the lines of sight of optical polarimetry into those behind, or in front of, a dense clump as seen from γ Cas, the distribution separates into two well defined sets, with data corresponding to "shaded" gas having a shallower slope. This is expected if the decrease in polarization is caused by collisions since collisional disalignment rate is proportional to RC∝nT" role="presentation">RC∝nT−−√ . Ratios of the best-fit slopes for the "illuminated" and "shaded" samples of lines of sight agrees, within the uncertainties, with the square root of the two-temperature H2 excitation in the nebula seen by Thi et al.Fil: Soam, Archana. Sofia Science Center; Estados UnidosFil: Anderson, B. G. Sofia Science Center; Estados UnidosFil: Acosta Pulido, Jose. Instituto de Astrofisica de Canarias; EspañaFil: Fernandez Lopez, Manuel. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Argentino de Radioastronomía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Argentino de Radioastronomía; ArgentinaFil: Vaillancourt, J. E.. Lincoln Laboratory; Estados UnidosFil: Widicus Weaver, S. L.. Department Of Chemistry; Estados UnidosFil: Piirola, V.. University Of Turku; FinlandiaFil: Gordon, M. S.. Sofia Science Center; Estados Unido

Diagnosing Vitreoretinal Lymphomas—An Analysis of the Sensitivity of Existing Tools

Vitreoretinal Lymphoma (VRL) is a rare ocular pathology that is notorious for mimicking chronic uveitis, which is a seemingly benign condition in comparison. The most common form of VRL is the diffuse large B-cell type, and there has been a high mortality rate. This dismal prognosis can be improved significantly if the disease is diagnosed early, but until now there is no consensus on an appropriate diagnostic algorithm. We conducted a retrospective search of PubMed Central® and analyzed results from thirty-three studies that were published between 2011–2021. The chosen studies incorporated some popular testing tools for VRL, and our analyses focused on comparing the average sensitivity of five diagnostic methods. The methods included cytology including ancillary immunohistochemistry, Myeloid Differentiation Factor 88 (MyD88) mutation analysis, polymerase chain reaction (PCR) for monoclonal rearrangements of immunoglobulin heavy chain (IgH) and T-cell Receptor (TCR) genes, flow cytometry, and IL10 and IL6 analysis. Across the varied diagnostic methods employed in thirty-three studies explored in this analysis, MyD88 mutation assay emerged as a strong contender given its sensitivity and low coefficient of variation. There is an imminent need for the introduction of newer assays that can further improve the sensitivity of identifying MyD88 mutation in cancer cells seen in the vitreous

Comparing gene panels for non-retinal indications: A systematic review

IMPORTANCE: The options for genetic testing continue to grow for ocular conditions, including optic atrophy, anterior segment dysgenesis, cataracts, corneal dystrophy, nystagmus, and glaucoma. Gene panels can vary in content and coverage, as we and others have evaluated in inherited retinal disease (IRD). OBJECTIVE: To describe gene panel testing options for inherited eye disease phenotypes and their differences. This review is important for making diagnostic decisions. EVIDENCE REVIEW: A licensed, certified genetic counselor (RP) used Concert Genetics and the search terms optic atrophy, corneal dystrophy, cataract, glaucoma, anterior segment dysgenesis, microphthalmia/anophthalmia, and nystagmus to identify available testing options performed by CLIA-certified commercial genetic testing laboratories. Other co-authors were surveyed with respect to genetic panels used for the indications of interest. Ophthalmic panels were then compared using Concert Genetics in addition to their own websites. FINDINGS: Panels from each clinical category were included and summarized. This comparison highlighted the differences and similarities between panels so that clinicians can make informed decisions. CONCLUSIONS: Access to genetic testing is increasing. The diagnostic yield of genetic testing is increasing. Each panel is different, so phenotyping or characterizing clinical characteristics that may help predict a specific genotype, as well as pre-test hypotheses regarding a genotype, should shape the choice of panels

Vitreoretinal Lymphoma Presenting as Frosted Branch Angiitis in a Patient With Diffuse Large B-Cell Lymphoma

Purpose: To describe the evaluation, diagnosis, and treatment of vitreoretinal lymphoma presenting as frosted branch angiitis in a patient with diffuse large B-cell lymphoma (DLBCL). Observations: A 57-year-old woman with a history of non-Hodgkin lymphoma and recent DLBCL relapse presented with frosted branch angiitis that raised suspicion for an infectious retinitis but was found to be vitreoretinal lymphoma. Conclusions and Importance: This case primarily highlights the importance of considering vitreoretinal lymphoma on the differential diagnosis of etiologies of frosted branch angiitis. Despite suspicion for vitreoretinal lymphoma, it is also important to treat empirically for infectious etiologies of retinitis in cases of frosted branch angiitis. In this case where the diagnosis was ultimately vitreoretinal lymphoma, weekly alternating intravitreal injections of methotrexate and rituximab led to improvement in visual acuity and retinal infiltration