Since the introduction of focal/grid macular laser over 25 years ago and until recently, laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). Whilst laser photocoagulation was shown to halve the risk of moderate visual loss over 3 years, from 24% to 12%, only < 5% of patients achieves better visual acuity. Within the last 5 years, the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor (VEGF) agents have come into clinical practice for the management of DME and several recent randomized clinical trials have shown superior effectiveness of anti-VEGF treatments compared to conventional macular laser. The introduction of depot steroid injections as flucinolone acetoinde has also lead to a current increase in interest in the use of intravitreal corticosteroids for DME treatment. In this review, we discuss the ocular treatment options currently available for the treatment of DME, mainly focusing on macular laser as well as intravitreal anti-VEGF and corticosteroid treatments.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Diabetic complications are known to be one of the leading causes of visual loss in the working age group in the developed world. The vitreous plays an important role in the development and progression of proliferative diabetic retinopathy and its complications. Despite the proper management of diabetics, complications due to disease progression necessitating diabetic vitrectomy occurs at a rate of 0.2% of people with diabetes. Vitrectomy has been used for the management of the complications of proliferative diabetic retinopathy since 1970, since then, the continuing developments in instrumentations and techniques have greatly improved outcome and minimized complications. This article reviews the updates in vitrectomy for the management of diabetic retinopathy, including indications, outcome, instrumentations, techniques and complications. The Medline database was searched for all literatures using the words, proliferative diabetic retinopathy, vitrectomy, diabetic macular edema, and vitreolysis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aims: To review the literature on Screening for Diabetic Retinopathy. Materials and Methods: A comprehensive review of the English language literature, published from March 1980 to June 2014 using key words in Zetoc. Results: Several methods were found to achieve adequate sensitivities and specificities for diabetic retinopathy screening. Studies were compared with respect to (a) Classifications used to grade diabetic retinopathy (b) The evidence for population-based screening for diabetic retinopathy (c) Alternatives to digital photography for screening (d) Reference standards used to study the effectiveness of screening methods (e) The evidence for mydriatic versus non-mydriatic digital photography, or a combination of the two (f) The number of photographic fields captured (g) Measurement of distance visual acuity (h)  Cost-effectiveness of screening for diabetic retinopathy (i) Future developments in screening for diabetic retinopathy Conclusion: Based on an assessment of available studies, the most effective DR screening strategy is the use of mydriatic or staged mydriasis with digital retinal photography. Variables between different screening strategies include whether Visual Acuity is measured and the number of fields captured.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Cataract is a common condition observed in patients with diabetes mellitus frequently requiring surgical intervention. Cataract surgery in diabetic patients may result in poor visual outcomes due to the progression of diabetic retinopathy and accelerated development of diabetic macular edema. Researchers and surgeons are interested in learning whether patients with diabetes have increased risks for complications from cataract surgery. In this review, I will evaluate the current management of the adverse events that may occur due to cataract surgery in diabetic patients.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Imaging of the fundus has revolutionized our understanding of the pathogenesis of diabetic retinopathy (DR), allowed standardized grading and follow-up with the ability to evaluate treatments in randomized clinical studies. Ocular imaging provides the tools for screening of diabetic individuals to detect and treat changes before vision loss. Modern instruments allow rapid in vivo imaging of the diabetic fundus using multiple modalities with higher resolution. Images can be transmitted, manipulated, analyzed, and graded with increasing ease. These imaging techniques are now entwined in the paradigms for newer treatments for DR. This paper aimed to provide a brief overview of current imaging modalities including conventional and digital fundus imaging, scanning laser ophthalmoscopy, fluorescein angiography, wide-field retinal imaging, and optical coherence tomography. Future developments in these imaging techniques are discussed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Current gold standard treatment for proliferative diabetic retinopathy (PDR) is panretinal photocoagulation (PRP) aimed at reducing the drive for new vessel proliferation. The focus is now changing to include the use of anti-vascular endothelial growth factor (VEGF) agents in conjunction with the gold standard in order to improve efficacy and reduce known side-effects associated with PRP, thus providing better outcomes for this group of advanced retinopathy. This paper aims to summarize our current knowledge behind the development of PDR, with review of treatment with anti-VEGF agents. Systematic search of both PubMed and the Cochrane Central Register of Controlled Trials was performed to identify relevant articles. Only articles in the English-language were selected for review. The use of anti-VEGF agents in conjunction with PRP has been shown to be beneficial in the regression of new vessels, reduction of macular edema as well as reduced duration of vitreous hemorrhage. In addition, its use during surgical intervention for PDR can reduce the duration of surgery and early postoperative complications. Despite the lack of large randomized controlled trials in this area there is significant evidence from case series showing the beneficial as well as the adverse effects of this treatment modality. The need for a large randomized controlled trial is an important development for diabetic retinopathy management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]