Role of Intravitreal Dexamethasone Implant in the Management of Treatment-Naive Diabetic Macular Edema: A Pre-Cataract Surgical Approach for Patients with Systemic Contraindications to Anti-VEGF Therapy.

Purpose: Diabetic macular edema (DME) is a significant cause of vision impairment, posing challenges in its management due to variable responses and patient diversity. While anti-vascular endothelial growth factor (anti-VEGF) agents have revolutionized DME treatment, some patients are not suitable candidates for this therapy. Intravitreal corticosteroid therapy, such as the dexamethasone implant (DEX), has emerged as an alternative. This study aimed to comprehensively investigate the role of intravitreal DEX in treatment-naive DME patients with systemic contraindications to anti-VEGF therapy, administered one month before cataract surgery. Patients and Methods: A single-center retrospective study included 20 eyes with controlled diabetes, visually significant cataracts, untreated DME, and systemic contraindications for anti-VEGF therapy. Patients underwent DEX treatment followed by cataract surgery after one month. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were assessed at multiple time points. Results: BCVA significantly improved on days 30, 90, and 180 post-DEX (P<0.00001). CMT showed a significant decrease at day 30 (P<0.00001), which was sustained through days 90 and 180 (P<0.00001). Recurrent DME was observed in 25% of eyes on day 90. IOP increased significantly at days 30 (P<0.00001) and 90 (P=0.0006), returning to baseline by day 180. However, only two eyes needed topical anti-glaucoma treatment. No other ocular or systemic adverse events were noted. Conclusion: Intravitreal DEX administered one month before cataract surgery offers a promising treatment strategy for treatment-naive DME patients with systemic contraindications to anti-VEGF therapy. The study's findings provide insights into improving visual acuity and reducing macular thickness, along with manageable IOP changes. This personalized approach is a valuable addition to DME management, especially for complex medical cases, warranting further research and consideration for clinical practice.

Efficacy of an Indian Bevacizumab BIOSimilar (BEVATAS) for Type 1 and Aggressive Posterior Retinopathy of Prematurity (BIOS-ROP Study).

Purpose: To evaluate the role of an Indian bevacizumab biosimilar (Bevatas®), for the management of type 1 retinopathy of prematurity (ROP) and aggressive posterior ROP (APROP) over 24-weeks. Patients and Methods: A retrospective, single-center, interventional study of 144 eyes of type 1 (100 eyes) and APROP (44 eyes). All eyes received a single dose of 0.625mg Bevatas injection, and were advised additional laser therapy for suboptimal response. Results: The study population had a mean gestational age of 28.94 (±2.32) weeks, an average birth weight of 1.2 (±0.34) kg, and modest male predominance (52.05%). Complete regression of ROP was seen in 65.97% of 144 eyes after 24 weeks of bevacizumab monotherapy, and in 97.22% of eyes (140 eyes) after adding laser photocoagulation. The remaining four eyes (all had APROP) developed Stage 4 ROP and needed vitreous surgery. After monotherapy with bevacizumab biosimilar, type 1 ROP eyes had significantly higher rate of complete ROP regression than APROP eyes (87% vs 18.18%; P<0.00001). All eyes with type 1 ROP, and 90.91% of eyes with APROP, regressed after receiving additional laser therapy. The study population experienced no ocular or systemic adverse effects. Conclusion: The BIOS-ROP study demonstrates that intravitreal bevacizumab biosimilar monotherapy offers significant benefit for type 1 ROP, but not APROP. Low-cost biosimilars can help sustain healthcare systems in lower-middle income countries (LMICs) with escalating healthcare expenditures. They can also improve healthcare equity by making vision-saving therapies like bevacizumab more affordable and accessible.

Impact of COVID-19 Pandemic on Retinopathy of Prematurity Services in the Indian Public Healthcare System.

Purpose: To analyze the impact of the COVID-19 pandemic on the retinopathy of prematurity (ROP) services at Special Newborn Care Units (SNCUs), which provide care for sick neonates in the Indian public healthcare system. Methods: A retrospective chart analysis of 508 babies screened for ROP at two SNCUs in West Bengal (India). We compared the data from the lockdown period (April, 2020-June, 2020; study arm) with the same period of the preceding year, 2019 (control arm). Results: Out of the 508 babies, 187 were screened during the lockdown and 328 during 2019. The odds of developing ROP were 2.08 times (95% CI:1.25-3.48; P=0.002) higher during the lockdown period (35/187 babies; 18.72%) as compared to the previous year (34/328 babies; 10.37%). Also, the risk of sight-threatening ROP (ST-ROP) increased significantly during the lockdown (12/35 ROP babies; 34.29%) compared to the previous year (4/34 ROP babies; 11.76%) (odds ratio: 3.9; 95% CI:1.1-13.7; P=0.015). Notably, all babies with ROP during the lockdown presented more than 30 days after birth, compared to none in the previous year. All babies requiring laser therapy recovered completely in both groups. Conclusion: An increased odds of developing ROP, including ST-ROP, was observed during the COVID-19 pandemic. Delayed ROP screening, which was noted in all study eyes, can have a detrimental effect on long-term visual prognosis. The findings of our research call for modifying the present healthy policy framework to make it more adaptable to disruptions in healthcare services, given the cyclical nature of the worldwide COVID-19 pandemic.

Management of Submacular Hemorrhage Using Intravitreal Brolucizumab with Pneumatic Displacement: A Case Series.

The management of submacular hemorrhage (SMH) necessitates rapid clearing of the bleed for optimal visual outcomes. We present a series of 3 cases with large fresh SMH (≤7 days) secondary to MNV that were treated with intravitreal injection (IVI) of brolucizumab along with SF6 gas injection. A face-down position was recommended for 5 days after the injection, with follow-up visits at regular intervals. All eyes demonstrated notable improvement in visual acuity with complete resolution of SMH lasting up to 6 months. There were no ocular or systemic side effects. Thus, IVI brolucizumab with SF6 gas injection is efficacious and safe for the management of large SMH secondary to MNV.

Intravitreal Brolucizumab for Choroidal Neovascularization Associated to Angioid Streaks.

A 44-year-old-female with angioid streak- (AS-) associated choroidal-neovascularization (CNV) was treated with one dose of intravitreal brolucizumab (IB). At one-month, the patient's visual acuity (VA) improved from 20/120 to 20/40 with a dry macula on spectral-domain optical-coherence tomography (SD-OCT). After observation, the VA improved further to 20/32 with absence of any fluid on the SD-OCT at three months. No ocular or systemic adverse events were noted. In conclusion, intravitreal brolucizumab (IB) is an efficacious and safe therapeutic option for the management of CNV secondary to AS. Further prospective studies with a larger sample size, varied therapeutic regimens, and longer follow-up period are needed to corroborate our findings.

Contralateral Effect following Intravitreal Brolucizumab Injection in Diabetic Macular Edema.

The authors describe a novel case of a 48-year-old male with bilateral diabetic macular edema (DME) who underwent intravitreal injection (IVI) of brolucizumab in the left eye. At four weeks, the patient demonstrated a bilateral response by way of improvement in the best-corrected visual acuity (BCVA) and reduction in the central macular thickness (CMT) in both eyes. Further studies on the ocular and systemic assays of the brolucizumab molecule are warranted to evaluate its systemic escape and to better understand the pharmacokinetics behind the bilateral effect.

Retinal vein occlusion in COVID-19: A novel entity.

Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the "cytokine-storm" as the pathogenesis for systemic manifestations of COVID-19.