Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema.

BACKGROUND: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern. OBJECTIVE: To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME. METHODS: Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness. RESULTS: Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily fluorescein angiography (FA) and human graders and found generally no worsening of MP associated with anti-VEGF agents use in diabetic patients with DME. Some of these studies, however, depended on post-hoc analysis. Several more recent, but smaller case series, have utilized the relatively new and non-invasive optical coherence tomography angiography (OCTA) in this evaluation and found more conflicting results. CONCLUSION: The large clinical trials recently performed depended mainly on FA in the analysis of MP changes following injections and generally found no worsening of MP. More recently, smaller case series have utilized OCTA in this analysis, yielding more conflicting results. Large randomized controlled trials using OCTA are thus needed.

Pattern of Childhood Uveitis in Egypt.

Purpose: To report the pattern of childhood-onset uveitis observed in Egypt from May 2010 to May 2017 Methods: Retrospective evaluation of the data of all patients with uveitis diagnosed before the age of 16 and visiting uveitis referral clinics in 5 Egyptian Governorates (Alexandria, Cairo, Al Bohayra (Damanhour), Al Gharbeya (Tanta), and Sohag) between May 2010 and May 2017. Results: A total of 413 uveitis patients were enrolled. These included 219 male and 194 female patients. Uveitis was bilateral in 68.3% of the patients. The most frequently observed ocular complications were cataract, glaucoma, and cystoid macular edema. The percentage of children with a visual acuity ≥1.00 logMAR in at least one eye by the final visit was 21.8%. Conclusion: Pediatric uveitis is a vision-threatening condition which caused more than one-fifth of the children in this study to lose vision in one or both eyes.

Adherence to Intravitreal Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Drugs in Diabetic Macular Edema in an Egyptian Population: A Health Belief Model.

PURPOSE: To determine the factors that influence the adherence to follow-up and injections in patients with diabetic macular edema (DME) utilizing a health belief model (HBM) as a theoretical framework, and using demographic variables and knowledge about DME as factors that influence individual perceptions. MATERIAL AND METHODS: A structured questionnaire was developed utilizing the six domains of HBM and using knowledge and other demographics as modifying variables. The questionnaire was checked for validity and reliability, and then used to collect data from patients with DME who were candidates for intravitreal injections according to pro-re-nata regimen, and completed one year after the first injection. Univariate and multivariable analysis was performed to identify factors associated with poor adherence. RESULTS: Of all 343 included patients (168 women and 175 men; mean [SD] age, 58[10] years, 71 (20.7 %) patients dropped visits and/or injections during the first year of treatment. Mean number of dropped injections was 1.32 ± 0.65 (range 1-5 injections). Factors associated with non-adherence were unilaterality of the injection (p < 0.001), absence of funding (p = 0.002), higher perceived barriers (p = 0.011), lower perceived benefits (p = 0.015), lower self-efficacy (p = 0.023), and lower perceived susceptibility (p = 0.029). In multivariable logistic regression model, the final goodness of fit with the data of the model was high (χ2/df = 1.81, p < 0.001). CONCLUSIONS: Funding and psychological burden are the main controllable factors for compliance to anti-VEGF therapy in DME. Identifying reasons for non-adherence could contribute to a better outcome.

ICL versus Veriflex phakic IOL for treatment of moderately high myopia: randomized paired-eye comparison.

PURPOSE: To compare the objective and subjective outcome of implantable collamer lenses (ICLs; Staar Surgical, Monrovia, CA) versus Veriflex lenses (AMO, Santa Ana, CA) for the correction of moderately high myopia. METHODS: A prospective randomized comparative eye study was performed on 24 patients with bilateral myopia that ranged from -6 to -14.5 diopters (D). One eye was implanted with an ICL and the other eye was implanted with a Veriflex phakic intraocular lens (PIOL). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), contrast sensitivity, patient satisfaction, central endothelial cell count, and PIOL centration were determined 6 months after surgery RESULTS: The logMAR UDVA and CDVA improved significantly in both groups (P < .001). There was no statistically significant difference in postoperative logMAR UDVA (P = .41) or logMAR CDVA (P = .36) between the two groups. Postoperative deviation from target refraction was -0.06 ± 0.41 D in the ICL group and -0.07 ± 0.49 D in the Veriflex group (P = .15). The difference in both induced and absolute postoperative HOAs between groups was not statistically significant. The area under the log contrast sensitivity function increased significantly in both groups postoperatively. The difference in patient satisfaction between both PIOLs was not statistically significant. A higher but statistically insignificant central endothelial cell count loss occurred in the Veriflex group (P = .11). CONCLUSION: Both ICL and Veriflex PIOLs have equally satisfactory objective and subjective visual outcomes after surgery.