Ogugua Okonkwo

By Ogugua N. Okonkwo

Diabetic retinopathy (DR) in its advanced stage is a leading cause of blindness and visual impairment. Despite efforts at early detection of DR, disease monitoring, and medical therapy, significant proportions of people living with diabetes still progress to develop the advanced proliferative disease, which is characterized by neovascularization, actively proliferating fibrovascular membranes, and retinal traction. The surgical removal of this proliferating tissue and the treatment of the retinal ischemic drive can be very rewarding, providing significant stability of the retina and in several cases improved retinal anatomy and vision. Diabetic vitrectomy comprises a broad range of surgical techniques and maneuvers, which offer the surgeon and patient opportunity to reverse deranged vitreoretinal anatomy and improve or stabilizes vision. Advances in vitreoretinal technology have contributed greatly to more recent improved outcomes; it is expected that future advances will offer even more benefit.

Part of the book: The Eye and Foot in Diabetes

By Ogugua Ndubuisi Okonkwo, Toyin Akanbi and Chineze Thelma Agweye

Diabetic macular edema is a complication of diabetes mellitus (DM) which contributes significantly to the burden of visual impairment amongst persons living with diabetes. Chronic hyperglycemia triggers a cascade of pathologic changes resulting in breakdown of the retinal blood barrier. Understanding the pathophysiological and biochemical changes occurring in diabetes has led to developing novel therapeutics and effective management strategies for treating DME. The clinical utility of optical coherence tomography (OCT) imaging of the retina provides a detailed assessment of the retina microstructure, valid for individualization of patient treatment and monitoring response to treatment. Similarly, OCT angiography (dye-less angiography), another innovation in imaging of DME, provides an understanding of retinal vasculature in DME. From the earlier years of using retinal laser photocoagulation as the gold standard for treating DME, to the current use of intravitreal injection of drugs, several clinical trials provided evidence on safety and efficacy for the shift to intravitreal steroids and anti-vascular endothelial growth factor use. The short durability of available drugs leading to frequent intravitreal injections and frequent clinic visits for monitoring constitute an enormous burden. Therefore, extended durability drugs are being designed, and remote monitoring of DME may be a solution to the current challenges.

Part of the book: Diabetic Eye Disease

By Ogugua Ndubuisi Okonkwo, Chineze Thelma Agweye, Toyin Akanbi and Utam Ashibel Utam

Since its inception, retinal imaging has been vital in documenting and understanding macular diseases. The early thinking was to document retinal pathology as it became possible to visualize the retina using an ophthalmoscope. This reasoning quickly evolved into the need to monitor disease evolution and treatment changes using digital images. With further rapid advancement in imaging technology, it has become possible to visualize and image at a subcellular level, the macula, in health and disease. Technological advances have resulted in the scanning laser ophthalmoscope, optical coherence tomography, and adaptive optics incorporation into imaging. The “dye” and “non-dye” based evaluation of retinal vasculature has improved our understanding of various macula and retinovascular diseases. The fundus photograph and optical coherence tomography are the most utilized technologies for imaging the macula. With an expected increase in diabetic retinopathy and macular degeneration patients, more macular imaging will be done in years to come. Consequently, more macula image data will be available for data analysis using artificial intelligence, improving our predictive ability and personalization. Therefore, macular imaging will assume increasing significance and imaging techniques for the macula should be known and understood. This chapter provides an exhaustive list of common and less-known imaging techniques for macular imaging and an overview of their use in evaluating the macula in clinical practice and research.

Part of the book: Macular Diseases - An Update [Working title]