Diabetic Macular Edema: State of Art and Intraocular Pharmacological Approaches.

Diabetic macular edema (DME) is the main cause of vision loss in diabetic retinopathy (DR). Although it is one of the main complications of diabetes, the pathogenesis of DME is not completely understood. The hyperglycemic state promotes the activation of multiple interlinked pathways leading to DME. Different classifications have been proposed: based on clinical features, on pathogenesis or on diagnostic tests (optical coherence tomography - OCT and fluorescin angiography - FA). The multimodal imaging allows a better analysis of the morphological features of the DME. Indeed, new inflammatory biomarkers have been identified on OCT. Also, several studies are evaluating the role of the morphological features, identified on multimodal imaging, to find new prognostic factors. Over the past decade, great progresses have been made in the management of DME. Therapeutic alternatives include intraocular injection of anti-vascular endothelial grow factor agents (anti-VEGF) and steroid molecules, focal/grid laser photocoagulation and vitreo-retinal surgery. This review is focused on the description and analysis of the current intravitreal therapeutic pharmacological strategies. Current guidelines recommend anti-VEGF as first line therapy in DME. Corticosteroids are becoming increasingly relevant blocking the inflammatory cascade and indirectly reducing VEGF synthesis.

Multimodal imaging of multifocal chorioretinitis secondary to endogenous candida infection.

PURPOSE: To present multimodal imaging of multifocal chorioretinitis secondary to endogenous candida infection in a young adult. METHODS: A 49-year-old woman who presented for evaluation of bilateral endogenous candida chorioretinitis underwent complete ophthalmic examination, in addition to fundus photography (FP), enhanced depth imaging optical coherence tomography, fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA). RESULTS: Multimodal imaging of both eyes of the patient affected by endogenous candida chorioretinitis was performed. FP showed multiple white chorioretinal lesions at the posterior pole, FAF showed dark dot at the posterior pole surrounded by hyperautofluorescence area, FA showed early hyperfluorescence round perifoveal lesion at the posterior pole and small hyperfluorescence dots under the inferior retinal vessels. Early ICGA showed hypofluorescence dots at the posterior pole. Late ICGA showed dark hypofluorescence dots at the posterior pole surrounded by faint hyperautofluorescent ring. OCTA showed dark areas corresponded to hypoperfusion areas seen with early ICGA. CONCLUSION: We reported multimodal imaging of an unusual occurrence of multifocal chorioretinitis due to immunosuppression. These findings suggested that the infection resulted from choroidal infiltration via the short posterior ciliary arteries with resultant breakthrough into the retina, rather than via the central retinal artery. By comparing findings on OCTA with data obtained from traditional systems, we are gaining essential information on the pathogenesis of endogenous candida chorioretinitis.

Role of Statins and Ascorbic Acid in the Natural History of Diabetic Retinopathy: A New, Affordable Therapy?

BACKGROUND AND OBJECTIVE: Diabetic retinopathy (DR) is a worldwide health problem, and intravitreal injections of anti-inflammatory and antiangiogenic agents represent the leading therapy to effectively treat DR and its complications. However, they are expensive, invasive, and stressful for patients. This study aims to demonstrate that statins and vitamin C (alone or in combination with statins) as complementary therapy could have an impact on the nonproliferative DR (NPDR) complication rate. PATIENTS AND METHODS: A retrospective review was conducted with 479 patients with NPDR. Statins and vitamin C intake were analyzed, along with the rate of diabetic macular edema (DME), vitreous hemorrhage (VH), circinate maculopathy (CM), and proliferative DR (PDR). RESULTS: Lower DME (P = .07) and VH (P = .018) rates were observed in patients who took statins compared with those who were statin-naïve. This difference was significant after accounting for vitamin C intake, with a lower rate of DME (P = .01) and VH (P = .008) in patients with statin-vitamin C combination therapy. CONCLUSION: Statins, alone or with vitamin C, appear to reduce the complication rate of NPDR. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S23-S27.].