RESUMO
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic eyes, and due to the rapid rise in the number of diabetic patients, the treatment burden has increased exponentially. The introduction of antivascular endothelial growth factor (anti-VEGF) therapy has been a major breakthrough in the management of center-involving DME, replacing laser photocoagulation as the first-line treatment. Despite the improvement in DME treatment with anti-VEGF therapy, persistent DME remains a challenge due to the extremely complex pathogenesis and the involvement of several different biochemical pathways. This review focuses on therapeutic options for persistent DME, which include corticosteroids, laser, and surgery. Novel agents for DME control such as new anti-VEGF, interleukin inhibitor, Rho-kinase inhibitor, and neuroprotective agents that are being investigated are reviewed as well. Future treatment perspectives include an individualized DME management.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Humanos , Inibidores de Interleucina , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologiaRESUMO
BACKGROUND: Cat scratch disease is a systemic infectious illness caused by the bacterium Bartonella henselae. The most common ophthalmological involvement due to infection by Bartonella is Parinaud oculoglandular syndrome, whereas the most common posterior segment findings are neuroretinitis and subsequent late macular star. Moreover, other findings, such as retinal or subretinal lesions, intermediate uveitis and angiomatous lesions, may be present. CASE PRESENTATION: A 37-year-old female patient with retinal findings and serological confirmation of Bartonella infection was evaluated via multimodal retinal exams. The patient received treatment with doxycycline 100 mg twice daily for 2 weeks. One month after treatment, complete improvement of her visual scotoma symptoms was confirmed. A swept-source optical coherence tomography exam also showed decreases in the size and intraretinal extension of the lesion. Improvement of light perception at the affected area was confirmed by microperimetry. CONCLUSIONS: Bartonella henselae infection, particularly retinitis, can present a variable spectrum of clinical and ophthalmological findings. Multimodal retinal exams can clearly identify lesion characteristics, thus providing important information for diagnosis and the evaluation of lesion improvement after antibiotic treatment.