Primary treatment of diabetic macular edema

Diabetic macular edema (DME) is a leading cause of vision loss in older Americans. Thermal laser treatment remains the mainstay of treatment for DME. Recently, alternative primary treatments for DME have been evaluated. These treatments include intravitreal injections of steroids as well as pharmaceuticals containing antibodies against vascular endothelial growth factor (VEGF). Surgical treatment has been shown to be appropriate in selected cases. We review the evidence and scientific rationale for various primary treatment options in patients with DME. Regular and timely ophthalmologic evaluation remains crucial to recognition and treatment of macular edema in diabetic patients

Parental perception of neonatal intensive care in public sector hospitals in South Africa

Background. Little is known about parental experience and decision making with regard to premature  infants requiring intensive care in developing countries. We undertook this study to characterise parents' experience of physician counselling and their role in making life-support decisions for very low-birth-weight (VLBW) (birth weight < 1 501 g) infants born in South Africa's public-sector neonatal intensive care units (NICUs).Methods. Parents of surviving VLBW infants treated in three Johannesburg-area public hospitals and  attending follow-up clinics in August 2001 were interviewed regarding their experience of perinatal  counselling on outcomes (pain, survival, disability), perception of actual and optimal decision making, and satisfaction with NICU communication.Results. Parents of 51 infants were interviewed. Seventy-five per cent of parents reported antenatal counselling by physicians on at least one perinatal topic (severe disability,pain, death, finances or  religious/moral considerations). The majority of parents(> 60%) who received counselling thought that these topics had been discussed adequately. Most parents reported that doctors had the primary  decisionmaking role, either without consulting them (41 %) or after consulting them (37%). Joint decision making was rare (14%). Parents wanted more input in life-support decisions than they reported being given.Conclusion. Counselling is not consistently provided in publicsector hospitals in Johannesburg. Parents  of premature infants want a larger share in NICU decision making than they currently experience. Most parents were satisfied with communication later during their infant's hospitalisation. South Africa presents a unique opportunity to study the use of advanced medical technologies in a nation with marked disparities in access to care.