Diabetic Macular Edema: From Old Concepts to New Therapeutic Avenues

Ahmad M Mansour, Jose S Pulido, Fernando Arevalo

Medical hypothesis discovery and innovation in ophthalmology, Vol. 4 No. 4 (2015), 1 December 2015

Diabetic macular edema (DME) is an important cause of blindness in the working population and is currently challenging to treat. Current interventions include focal laser or intravitreal injections. This article outlines a new treatment protocol based on the concept that peripheral ischemia is the introduction to angiogenesis, that will ultimately gather its momentum at the fovea. Performing extreme peripheral light laser panretinal photocoagulation (PRP) back to the equator reduces excessive expression of the vascular endothelial growth factor (VEGF) in the eye. Subsequently, this decreases VEGF-induced DME and provides long-term protection for the development of neovascularization. Initial exacerbation of DME often accompanies PRP, Therefore; first injections of anti-VEGF agents (with or without dexamethasone implant) can forestall worsening of DME preventing loss of vision. However, on the other hand, applying peripheral PRP and intraocular injections can induce posterior vitreous detachment (PVD). This could help release vitreomacular adhesions (VMA) and vitreomacular traction (VMT), decreasing DME severity and improving response to intravitreal injections. The current approach works by laser ablation of the peripheral retina that should stop the drive for VEGF release; moreover, laser ablation should produce secondary, accidental and beneficial PVD. This approach precludes focal laser therapy and paves the path for prolonged anti-VEGF therapy.

Refractive and Aberration Outcomes After Customized Photorefractive Keratectomy in Comparison With Customized Femtosecond Laser

Valleh Sajjadi, Mohammad Ghoreishi, Ebrahim Jafarzadehpour

Medical hypothesis discovery and innovation in ophthalmology, Vol. 4 No. 4 (2015), 1 December 2015

To compare the refractive and visual outcomes and higher order aberrations in patients with low to moderate myopia who underwent customized photorefractive keratectomy (PRK) or  femtosecond laser in situ keratomileusis (Femto-LASIK) this study performed This research includes data of 120 consecutive eyes of 60 patients with myopia between -3.00 D and -7.00 D with or without astigmatism in two surgery groups: PRK and Femto-LASIK. Refractive, visual, and aberration outcomes of the two methods of surgery were compared after 6 months of follow-up. After 6 months of follow-up, sphere and cylinder were found significantly decreased and there was no statistically significant difference between the two groups. The mean of uncorrected distance visual acuity in LogMar format for the PRK and Femto-LASIK groups was -0.03±0.07 and -0.01±0.08, respectively, which was not significantly different between the two groups. Higher orders and spherical aberrations increased in both groups significantly, while total aberrations decreased in both groups. After surgery, no differences were observed between the two groups in the amount of aberrations. Both PRK and Femto-LASIK are effective and safe in correcting myopia. In this study PRK induced more spherical and higher order aberrations than Femto-LASIK.

Eye and Periocular Skin Involvement in Herpes Zoster Infection

Chris D Kalogeropoulos, Ioannis D. Bassukas, Marilita M. Moschos, Khalid F. Tabbara

Medical hypothesis discovery and innovation in ophthalmology, Vol. 4 No. 4 (2015), 1 December 2015

Herpes zoster ophthalmicus (HZO) is a clinical manifestation of the reactivation of latent varicella zoster virus (VZV) infection and is more common in people with diminished cell-mediated immunity. Lesions and pain correspond to the affected dermatomes, mostly in first or second trigeminal branch and progress from maculae, papules to vesicles and form pustules, and crusts. Complications are cutaneous, visceral, neurological, ocular, but the most debilitating is post-herpetic neuralgia. Herpes zoster ophthalmicus may affect all the ophthalmic structures, but most severe eye-threatening complications are panuveitis, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) as well. Antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of HZO are critical in limiting visual morbidity. Vaccine in adults over 60 was found to be highly effective to boost waning immunity what reduces both the burden of herpes zoster (HZ) disease and the incidence of post-herpetic neuralgia (PHN).

Single Injection of Bupivacaine for Correction of Strabismus

Kimia Ziahosseini, Ian Bruce Marsh

Medical hypothesis discovery and innovation in ophthalmology, Vol. 4 No. 4 (2015), 1 December 2015

To evaluate the effectiveness of a single injection of Bupivacaine (BPX) application for correction of eso/exodeviations this study has been performed. A retrospective review of 30 patients with eso/exodeviations less than 20 prism diopters (PD). Preoperative deviations were recorded in PD, using the alternate prism cover test. Postoperative angles at 1 and 3 months were measured in the same manner. The mean angle of deviation for near in all patients reduced significantly by 3.1 PD and 2.1 PD at 1 and 3 months. The mean angle of deviation for distance in all patients also decreased significantly by 2.3 PD and 1.9 PD at 1 and 3 months. As conclusions, single injection of BPX in a heterogeneous group of patients with horizontal strabismus caused a mild improvement in a qualitative success rate of 37%.

Persian Traditional Medicine and Ocular Health

Hasan Namdar, Elham Emaratkar, Mohammad Bagher Hadavand

Medical hypothesis discovery and innovation in ophthalmology, Vol. 4 No. 4 (2015), 1 December 2015

In Persian Traditional Medicine (PTM), specific attention has been made to the prevention of diseases. The physicians of PTM believe that overeating could cause accumulation of substances in the body and cause diseases which is called “Emtela”. Foods discussed in connection with ocular health could be divided into two classes of useful and harmful foods.  Harmful foods f such as beef, geese, eggplant, cauliflower and cheese which may cause poor vision. Dehydrating foods could be named as walnut and salty fish, hot foods such as garlic, onion and pepper. These kinds of foods causes dry eye. Beneficial nutriments for ocular health are thyme and saffron and fruits such as grape, fig, apple, plum and berries. One should not drink water with meals or immediately afterwards. Drinking cold water (icy water) cause difficulty in absorption of nutrients. Drinking water at once may have destructive subsequences to eyes; therefore, water should be drunk in suitable temperature and sipped. It is not safe to drink water first thing in the morning. Sleeping right after eating is harmful too. Avicenna believes that sleeping on belly after a full meal is the most harmful attitude for eyes. Galen says that old people need deep and continuous sleep more than others. From the view of PTM, moving eyes in directions, making delicate works, trying to look at delicate and find pictures and reading small letters would remove ocular fatigue. Urine, excretion, perspiration and vomiting are among systems in discharging the harmful substances from body system which are used by the body to clean itself from harmful substance. There have been mentions of local medicine for improving vision as well, for instance, using fennel extracts, pomegranate juice and honey which are used in special methods and are suitable for vision improvement. Local administration of pomegranate blossoms is suitable for treating inflammatory reactions.