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Background: Diabetic macular edema (DME) is defined as a retinal thickening in one-disc diameter of the center of the macula. It is a number of microvascular retinal changes that lead to blood-retinal barrier disruption, causing leakage of fluid and plasma components into the inner and outer plexiform layers. Aim of the Work: To conduct a systematic review and a meta-analysis estimating the efficacy and complications of posterior sub-Tenon's capsule injection of triamcinolone acetonide (STTA) compared to intravitreal injection of triamcinolone acetonide (IVTA) for management of DME. Materials and Methods: A comprehensive literature search was conducted using the databases Google Scholar, PubMed, MEDS, web of science, EMBASE, and Cochrane Library for published studies from January 01, 2000 to September 01, 2019. This meta-analysis included ten studies. They were randomized controlled clinical trials, and about 343 patients with DME (469 eyes) participated in these studies. Results: This study demonstrated a statistically significant change in the mean of best-corrected visual acuity (BCVA) improvement and central macular thickness (CMT) reduction in both groups when comparing the baseline to 1- and 3-month follow-ups after the injection, though with no statistically significant difference in the IVTA compared to the STTA group. At a 6-month follow-up, both groups showed no significant differences in the BCVA and CMT compared to the baseline. Both groups showed no statistical differences in the BCVA or CMT over the follow-up periods. Regarding intraocular pressure (IOP) changes, the present study showed that the mean IOP was elevated in both groups at 1- and 3-month follow-ups after the injection compared to their baseline. There was a statistically significant difference between both groups at 1 and 3-months. The IOP was more elevated in the IVTA compared to the STTA group. At a 6-month follow-up, both groups showed no significant difference in the IOP elevation compared to the baseline. IOP elevation was the most reported adverse effect in all included studies. Cataract formation is also reported in some studies, though no other complications, such as endophthalmitis, vitreous hemorrhage, and/or retinal detachment, are reported in any of the studies. Conclusion: STTA injection has a comparable effect to the IVTA injection and carries a lower risk of intraocular complications. It is considered an easy, safe, and valid alternative to intravitreal injection for the treatment of DME.

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Context: Macular edema (ME) is a common pathologic condition causing vision impairment. Diabetic retinopathy is a common cause of ME which can also develop after cataract surgery. Optical coherence tomography (OCT) is a noninvasive diagnostic technique that provides imaging of fine retinal details. Proper diagnosis of the underlying etiology shall affect the management. Aims: This study aims to differentiation between diabetic and pseudophakic ME (DME and PME) using OCT. Settings and Design: Cross-sectional study of 2 Groups; A: 30 eyes with DME and B: 20 eyes with PME. Subjects and Methods: Full clinical evaluation, OCT scanning, and data analysis were done for both groups. Statistical Analysis Used: SPSS software v. 16 was used for: Descriptive statistics, mean, range, and standard deviation. Student's t-test was used for comparison between means. Pearson correlation coefficient was used to assess correlation between variables. Results: Maximum macular thickness and central macular thickness were elevated in both groups but were higher in PME group (P = 0.042 and P = 0.00001, respectively). Macular thickness/volume ratio (TVR) was higher in PME group (P = 0.00001). Cystic changes had different distribution patterns; ganglion cell layer and retinal nerve fiber layer layers were free in PME(Pseudophakic macular edema) while inner nuclear layer and outer nuclear layer were affected in both groups (P = 0.0061). Epiretinal membranes were found much more in DME group (P = 0.0452). Dome-shaped macula was frequently noticed in PME group (P = 0.043). Conclusions: PME and DME have different OCT features; higher TVR, dome-shaped macula, absence of ERM suggest PME while lower TVR, presence of inner retinal cysts and/or ERM suggest DME.

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Purpose: The purpose is to compare the changes in the peripapillary blood flow in primary open-angle glaucoma (POAG) after administration of dorzolamide 2%/timolol 0.5% fixed combination versus latanoprost 0.005%/timolol 0.5% fixed combination, using spectral-domain optical coherence tomography angiography (OCTA). Patients and Methods: In this prospective, comparative, nonrandomized study, patients with POAG received simultaneous treatment with dorzolamide 2%/timolol 0.5% fixed combination in the right eye (Group 1) and latanoprost 0.005%/timolol 0.5% fixed combination in the left eye (Group 2) for 1 week. Intraocular pressure (IOP) was measured using applanation tonometry; and peripapillary capillary density and retinal nerve fiber layer (RNFL) thickness was assessed using OCTA before starting treatment and 1 week after the treatment. Results: IOP reduction was superior in Group 2; however, this was not statistically significant. Both groups showed an increase in the peripapillary capillary density and RNFL thickness after 1 week of the treatment as evaluated by OCTA angiography. However, this increase was not statistically significant. There was only a statistically positive correlation between IOP reduction and increase in the superior-hemiradial peripapillary capillary density (P = 0.037) in Group 1 and between IOP reduction and increase in the total RNFL thickness and superior hemi-RNFL thickness (P = 0.044, 0.032, respectively) in Group 1. Conclusion: Intraocular pressure decreased in both groups with no significant difference between both groups. There was more increase in radical peripapillary capillary density and RNFL thickness following treatment in dorzolamide 2%/timolol 0.5% group compared to the other groups; however, the difference between the two groups was not statistically significant.

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Purpose: This study to assess the efficacy and the safety of repeated dexamethasone intravitreal implant (Ozurdex^®) in vascular macular edema in real-life practice. Materials and Methods: This was a 22-month prospective study, including eyes with vascular macular edema according to the inclusion criteria. Baseline and follow-up visits included best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, dilated fundoscopy, intraocular pressure (IOP) measurement, and central macular thickness (CMT) measurement with optical coherence tomography. Main outcomes included changes in BCVA and CMT at the 1^st, 2^nd, 4^th, and 6^th months; time to retreatment; and incidence of side effects. Results: A total of 31 eyes of 24 patients were included in the present study. After the first intravitreal injection, BCVA (baseline 0.940 ± 0.463 LogMAR) improved significantly to 0.483 ± 0.323 LogMAR at 2^nd month (P = 0.000), 0.657 ± 0.357 at 4^th month (P = 0.000), and 0.690 ± 0,448 at 6^th month (P = 0.001). Mean CMT (baseline = 582.51 ± 148.20) decreased statistically significantly at 2^nd month and 4^th month after the first intravitreal injection (245.87 ± 103.86 and 456.68 ± 182.735, respectively, both P < 0.001 vs. baseline). At the 6^th month, CMT was 407.93 ± 212.70 for the 16 eyes that had not been reinjected versus baseline CMT 576.93 ± 158.56 (P = 0.008). After other Ozurdex^® injections, we had the same visual acuity gain and CMT reduction, an average of 2.03 ± 0.83 injections were done. The most common side effects were cataract development and rise in IOP. Conclusion: Ozurdex^® implant is an effective treatment for vascular macular edema with a good safety profile; however, its effectiveness seems to decrease with time requiring repeated injections.

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