DIABETIC MACULAR EDEMA (DME) is arguably one of the most important challenges in ophthalmology. MACULAR EDEMA refractory to laser photocoagulation remains the most prevalent cause of untreatable vision loss in diabetes and is responsible for visual disability in millions of people worldwide. The lack of an effective therapeutic solution accounts for the range of interventions proposed. These include intraocular delivery of corticosteroids and anti- VEGF antibodies, and the surgical alternative of vitrectomy with or without removal of the internal limiting membrane (ILM).

Purpose: To evaluate the visual outcomes and surgical results of pars plana vitrectomy for DIABETIC MACULAR EDEMA unresponsive to laser therapy using optical coherence tomography (OCT).Materials & Methods: Standard pars plana vitrectomy with separation of posterior hyaloid was performed in 19 eyes of 17 patients with DIABETIC MACULAR EDEMA unresponsive to laser therapy (after 4 months). The MACULAR thickness was evaluated before and after surgery with OCT. Slit lamp examination and visual acuity measurement were performed periodically.Results: After follow up of 3 months, visual acuity improved in 13 cases, decreased in 2 cases and was unchanged in four patients. The postoperative foveal thickness (374.7±114.9) was thinner than the preoperative foveal thickness (512.5±162) that was statistically significant (p=0.002). Postoperative complications included cataract formation (4 cases) and vitreous hemorrhage in one case. Conclusion: In eyes with persistent MACULAR EDEMA unresponsive to laser therapy, vitrectomy appears to be beneficial in decreasing MACULAR thickness and improving visual acuity.

Objective: Remote Ischemic Preconditioning (RIPC) as the transient ischemia and reperfusion of the arm is a promising method for protecting different tissue from future ischemia. These effects might be mediated through vascular and endothelial growth factor (VEGF) pathway. We investigated the influence of RIPC on DIABETIC MACULAR EDEMA (DME) as a chronic ischemic condition in patients who were candidate to receive anti-VEGF therapy. Materials and Methods: In this Single blinded, randomized controlled trial, 40 eligible type 2 diabetes mellitus (T2DM) patients with MACULAR EDEMA who were candidate to receive anti-VEGF therapy randomized into intervention (CP) and sham controlling (SP). The CP received RIPC in three consecutive days before anti-VEGF injection. Data of optical cochrane tomography (OPC) before and 10 days after procedure were compared as outcomes. Results: Central foveal volume and visual acuity mean difference before and after intra-vitral anti-VEGF injection in both groups was significant. There were no significant mean differences in central MACULAR thickness in case groups. Comparing the mean between two groups did not show a significant difference in visual acuity, central foveal volume (P-value: 0. 69) and central MACULAR thickness (Pvalue: 0. 62). There were no significant differences in the desired changes pattern of DME between two groups (P-value: 1. 00). Conclusion: This pilot study did not show any additive positive effect of RIPC on retinal outcomes especially visual acuity in T2DM patients with DME who were received anti-VEGF treatment.

Background: Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause DIABETIC MACULAR EDEMA (DME). Laser photocoagulation of the macula is the standard treatment for DME,however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME. Methods: This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0. 05 mL or ranibizumab 0. 5 mg/0. 05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography. Results: Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20–74) years and a male-to-female ratio of 1: 2. 7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0. 05). There was no statistically significant difference in baseline DIABETIC retinopathy status or DME type between groups (both P >0. 05). In both groups, the median (IQR) BCDVA significantly improved from 0. 7 (0. 8) logMAR at baseline to 0. 4 (0. 1) logMAR at 6 months post-injection (both P = 0. 001), with no statistically significant difference between groups at all follow-up visits (all P >0. 05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0. 001), with no statistically significant differences between groups at all follow-up visits (all P >0. 05). No serious adverse effects were documented in either group. Conclusions: Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naive DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.

Objective:To explore the multifocal electroretinogram in patients with nonproliferative DIABETIC retinopathy with clinically-significant MACULAR EDEMA. Methods: Forty-one eyes with clinically significant MACULAR EDEMA were tested. The latencies and amplitudes of average responses of 5 eccentric rings from 0 to 26 degrees relative to the fixation point were compared with normal values obtained from 13 nonDIABETIC subjects. Results: Local electroretinogram responses were significantly delayed and decreased in amplitude in patients with clinically-significant MACULAR EDEMA.  Conclusion: Multifocal electroretinogram can be used to quantify the visual function in clinically significant MACULAR EDEMA.  

Background: Crocin can be utilized as an anti-inflammatory component of Saffron in DIABETIC MACULAR EDEMA (DME), which is known as the most common cause of vision loss in patients with diabetes mellitus (DM). Although anti-vascular endothelial growth factor (VEGF) agents are common in non-center involving DME (NCI-DME), there is no consensus on NCI-DME treatment. Methods: This before-after study was performed from October 2019 to August 2021. Twenty-six eyes of 16 patients with type 2 DM in Baghayipoor Clinic in Yazd, were treated with 15 mg crocin per day for 90 days. Patients had at least one eye with non-proliferative DR (NPDR) and NCI-DME along with no adherence to intravitreal injection or a contraindication of intravitreal injection. Central subfield thickness (CST), visual acuity, fasting blood sugar (FBS), and HbA1c were assessed once before and once after the study (day 90). Results: After 90 days of therapy, the mean CST significantly decreased to 2.8 μm (P-value=0.030), four patients had increased CST and 1 patient had a significantly decreased CST (≥25μm). The mean Logarithmic Minimum angle of resolution increased during the study. The Mean (±SD) FBS showed a significant improvement during the study from 174.7 (±60.41) at baseline up to 161.8 (±47.7) at day 90 (P-value = 0.012). HbA1c had no significant reduction. Nausea/vomiting and insomnia were among the reported adverse effects. Nevertheless, no one withdrew from the study because of the adverse effects. Conclusion: This study suggests Crocin’s positive impact on NCI-DME. It may also improve the glycemic profile of DIABETIC patients; however, more high-quality randomized clinical trials with larger sample sizes and longer durations are needed for validation.

DIABETIC MACULAR EDEMA (DME) is a leading cause of vision loss in the working-age population worldwide.Numerous early studies suggest an important role for intravitreal anti-VEGF agents such as bevacizumab in the management of DME. We reviewed manuscripts that had investigated pharmacokinetic, efficacy, safety, dose and frequency of intravitreal bevacizumab (IVB) injections as well as effect of MACULAR ischemia, initial MACULAR thickness and OCT pattern of DME on the final results of treatment with IVB. In summery literature searches disclosed that almost all studies published up to now provided evidence supporting use of IVB for treatment of either naïve or persistent DME in short and long-term up to two years.