Acute postoperative infectious endophthalmitis remains one of the most dreaded complications of ophthalmic surgery. One of the keys to success in treating this complication is to make an early clinical diagnosis and, if possible, an etiologic diagnosis that can guide treatment with antibiotic therapy. Different antibiotic therapy modalities have emerged over the years that have made it possible to treat even resistant strains of various microorganisms that cause endophthalmitis. Another relevant advance made in the etiological diagnosis of endophthalmitis is the advent of molecular biology techniques, such as the real-time polymerase chain reaction, which can detect minimal amounts of the genetic material of the causative microorganism present in the vitreous in a short period of time, thus improving treatment outcomes with better-guided therapy with intravitreal antibiotics. Aside from advances in postoperative diagnosis methods, the surgical treatment of endophthalmitis has had significant improvements in vitrectomy techniques, and in many cases, it has been proposed as the first-line treatment concomitantly with intravitreal antibiotic therapy. Moreover, there is increasing evidence that prophylaxis with intracameral antibiotic therapy further decreases postoperative endophthalmitis incidence.
Part of the book: Infectious Eye Diseases
Diabetes mellitus is a global epidemic that leads to multiple macrovascular and microvascular complications. The complex interrelated pathophysiological mechanisms triggered by hyperglycemia underlie the development of diabetic retinopathy (DR). Proliferative diabetic retinopathy (PDR) is a microvascular complication, considered the main cause of irreversible blindness in patients of productive age in the world. On the other hand, diabetic macular edema (DME) remains the clinical feature most closely associated with vision loss. In general, both manifestations are due to an increase in inflammatory factors, such as specific pro-inflammatory prostaglandins, interleukins and angiogenic substances including vascular endothelial growth factor (VEGF). Laser photocoagulation and VEGF inhibitors have been shown to be effective in the treatment of PDR and DME. Currently, randomized protocols suggest that VEGF inhibitors therapy could displace laser photocoagulation in the treatment of PDR with and without the presence of DME. The ongoing discussion still prevails about the different treatment modalities for both retinal manifestations in real-world settings.
Part of the book: Diabetic Eye Disease