Navigating the intersection of psychiatry and ophthalmology:A comprehensive review of depression and anxiety management in glaucoma patients

Glaucoma,a prevalent and debilitating eye disease,has long been associated with vision impairment and blindness.However,recent research has shed light on the often-underestimated psychological dimensions of this condition.Anxiety and depression,two pervasive psychiatric comorbidities,have been increasingly recognized among glaucoma patients.This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology,in the context of managing depression and anxiety in glaucoma patients.By meticulously examining peer-reviewed literature,we synthesize current knowledge on the prevalence,risk factors,and underlying mechanisms of anxiety and depression in glaucoma.The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders.Factors such as progressive vision loss,complex medication regimens,and the fear of further visual deterioration contribute to their vulnerability.Moreover,we delve into the bidirectional relationship between glaucoma and mood disorders,shedding light on the complex interplay between ocular and emotional health.Our review investigates the implications of anxiety and depression on glaucoma management,including their potential impact on treatment adherence,disease progression,and overall quality of life.We also explore the neurobiological pathways linking glaucoma and mood disorders,providing a foundation for future research and potential therapeutic interventions.In conclusion,recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care.This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma.By addressing anxiety and depression in glaucoma care,healthcare providers can enhance the overall quality of life for these patients,ultimately leading to improved outcomes and a brighter future for those affected by this condition.This review offers valuable insight for healthcare practitioners and researchers,providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.

Efficacy and safety of XEN 45 gel stent alone or in combination with phacoemulsification in advanced open angle glaucoma patients: 1-year retrospective study

AIM:To assess the effectiveness of the XEN 45 gel stent,either alone or combined with cataract surgery,in advanced stage open angle glaucoma(OAG)patients.METHODS:Retrospective and single-center study conducted on consecutive OAG patients who underwent a XEN 45 gel stent implantation surgery,between July 2017 and September 2018.The primary efficacy end-point was the mean intraocular pressure(IOP)reduction at the end of the follow-up period.Success was defined as an IOP reduction of at least 20%and an IOP value≤18 mm Hg without(complete)or with(qualified)hypotensive medication.RESULTS:Seventy-four patients(80 eyes)were included in the study.In the overall study sample,XEN implant significantly reduced IOP from 21.0(19.8 to 22.1)mm Hg at baseline to 9.3(8.2 to 10.4),10.7(9.6 to 11.9),13.4(12.2 to 14.7),14.5(13.6 to 15.4),14.7(13.8 to 15.6),and 14.7(13.9 to 15.4)mm Hg at 1 d,1 wk,1,3,6,and 12 mo of follow-up,respectively(P<0.0001 each).In the overall study population,at the end of the study the mean IOP reduction was 27.4%(23.3%to 31.5%).Adjusted IOP reduction was similar in XEN and XEN+phacoemulsification groups[30.0(23.4 to 36.4)mm Hg vs 24.8(18.4 to 31.2)mm Hg,respectively,P=0.2939].At the last follow-up visit,52(65.0%)eyes were considered success,29(36.3%)eyes as complete success and 23(28.7%)as qualified success.Mean number of hypotensive medications was significantly reduced from 2.8(2.7 to 3.0)at baseline to 1.1(0.8 to 1.3),P<0.0001.Kaplan-Meier survival analysis did not find any difference in the success rate between XEN and XEN+PHACO,mean hazard ratio 0.56,95%CI 0.26 to 1.23;P=0.1469.Needling was performed in 7(8.8%)eyes at months 1(n=3);3(n=2);4(n=1)and 11(n=1).Eleven(13.8%)eyes presented adverse events.CONCLUSION:XEN implant,either alone or in combination with phacoemulsification,significantly reduced the IOP and the number of hypotensive medications in patients with OAG in advanced stage.

Understanding practice patterns of glaucoma sub-specialists in India

AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This survey,conducted in 2013,was based on an interactive audience response system.RESULTS：The information was obtained from 146 glaucoma specialists.Approximately half（n=83;57%）had≥10y of experience in managing glaucoma and were in institutional practice（n=74,51%）.Goldmann applanation tonometry was preferred by 103（72%）specialists whilst n=25（17.4%）used non-contact tonometer.Indentation gonioscopy was favoured by two-thirds（n=90,66%）whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed（n=115,86%and n=114;83%respectively）.Nearly three quarter specialists（n=96;72%）preferred optical coherence tomography for imaging.The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser（iridotomy,n=117;93%）and medical management（prostaglandin analogue,n=104;78%）,respectively.Approximately only a third of the specialists surveyed（n=37;28%）were performing both trabeculectomy and implantation of a glaucoma drainage device and about half（n=64;47%）were not operating on congenital glaucoma at all.CONCLUSION：This survey has found conformance with preferred practice patterns in several areas of diagnosisand management of glaucoma,but there was diversity in a few areas.The information is a significant step towards improvement of glaucoma care in India,including planning for future strategies.

Unveiling the silent link:Normal-tension glaucoma's enigmatic bond with cardiac blood flow

This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,characterized by optic nerve damage and visual field loss despite normal intraocular pressure,has long puzzled clinicians.One emerging perspective suggests that alterations in ocular blood flow,particularly within the optic nerve head,may play a pivotal role in its pathogenesis.While NTG shares commonalities with its high-tension counterpart,its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration.It navigates through the complex web of vascular dysregulation,blood pressure and perfusion pressure,neurovascular coupling,and oxidative stress,seeking to uncover the hidden threads that tie the heart and eyes together in NTG.This review explores into the intricate mechanisms connecting cardiovascular factors to NTG,shedding light on how cardiac dynamics can influence ocular health,particularly in cases where intraocular pressure remains within the normal range.NTG's enigmatic nature,often characterized by seemingly contradictory risk factors and clinical profiles,underscores the need for a holistic approach to patient care.Drawing parallels to cardiac health,we examine into the shared vascular terrain connecting the heart and the eyes.Cardiovascular factors,including systemic blood flow,endothelial dysfunction,and microcirculatory anomalies,may exert a profound influence on ocular perfusion,impacting the delicate balance within the optic nerve head.By elucidating the subtle clues and potential associations between cardiology and NTG,this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition.As the understanding of these connections evolves,so too may the prospects for early diagnosis and tailored interventions,ultimately enhancing the quality of life for those living with NTG.

Association between the M98K variant of the OPTN gene and the risk for primary open angle glaucoma:an updated meta-analysis

Background:The association between optineurin(OPTN)M98K variant and primary open angle glaucoma(POAG)has been widely investigated.However,the results remain controversial among published meta-analyses.Therefore,we conducted an updated meta-analysis to further explore the association between M98K and POAG and its subgroups.Methods:PubMed,Embase,Web of Science,and China National Knowledge Infrastructure(CNKI)databases were searched to find all articles describing the relationships between the M98K variant and POAG,which were published from the inception to 31 December,2019.The associations between M98K and overall POAG,normal tension glaucoma(NTG),high tension glaucoma(HTG),POAG in Asian and non-Asian populations,juvenile open angle glaucoma(JOAG)and adult-onset POAG were evaluated by calculating the pooled odds ratio(OR)and 95%confidence interval(CI).The Bonferroni correction was used to determine the statistically significant genetic models.Results:A total of 34 eligible articles involving 7,310 POAG patients and 5,173 controls were identified in the present meta-analysis.The articles achieved an average of 6.21 stars for quality assessment by the Newcastle-Ottawa Scale(NOS).Evidence from the pooled results indicated significant association between M98K and overall POAG susceptibility under the dominant model(OR=1.30,95%CI,1.12-1.52;P<0.001).In the subgroup analyses,no significant associations were found between M98K and the risks of NTG,HTG,JOAG,adult-onset POAG,Asian POAG or non-Asian POAG.Conclusions:The updated meta-analysis revealed that OPTN M98K was significantly associated with the susceptibility to overall POAG.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Novel automated non-invasive detection of ocular surface squamous neoplasia using artificial intelligence

Ocular surface squamous neoplasia(OSSN)is a common eye surface tumour,characterized by the growth of abnormal cells on the ocular surface.OSSN includes invasive squamous cell carcinoma(SCC),in which tumour cells penetrate the basement membrane and infiltrate the stroma,as well as non-invasive conjunctival intraepithelial neoplasia,dysplasia,and SCC in-situ thereby presenting a challenge in early detection and diagnosis.Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments,such as topical medicines,whereas advanced invasive lesions may need orbital exenteration,which carries a risk of death.Artificial intelligence(AI)has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management.AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN,aiding ophthalmologists in early detection and diagnosis.AI can also track and monitor lesion progression over time,providing objective measurements to guide treatment decisions.Furthermore,AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response.This manuscript highlights the role of AI in OSSN,specifically focusing on its contributions in early detection and diagnosis,assessment of lesion progression,treatment planning,telemedicine and remote monitoring,and research and data analysis.

Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period:A questionnaire-based study

BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have been extensively studied,whereas others,like eyelid malposition and thyroid eye disease,have received minimal or no research.AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.METHODS A cross-sectional survey was disseminated among ophthalmologists all over India.The survey included questions related to pre-operative evaluation,anaesthetic and surgical techniques preferred,post-operative care,the use of adjunctive therapies,and patient follow-up patterns.RESULTS A total of 180 ophthalmologists responded to the survey.Most practitioners(89%)felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised.The most common surgical techniques employed were lacrimal drainage procedures(Dacryocystorhinostomy)(63.3%),eyelid malposition repair(36.9%),and ptosis repair(58.7%).Post-operatively,47.7%of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries.Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.CONCLUSION Approximately 50%of ophthalmologists handle prevalent oculoplastic issues themselves,seeking the expertise of an oculoplastic surgeon under particular conditions.Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery.Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

Neuroprotective effect of mesenchymal stem cellderived extracellular vesicles on optic nerve injury in chronic ocular hypertension

Mesenchymal stem cells have neuroprotective effects that limit damage to the retina and photoreceptors,and which may be mediated by extracellular vesicles(or exosomes)released by mesenchymal stem cells.To investigate the neuroprotective effect of extracellular vesicles derived from umbilical cord mesenchymal stem cells on glaucoma,we established rat models of chronic ocular hypertension by injecting conjunctival fibroblasts into the anterior chamber to mimic optic nerve injury caused by glaucoma.One week after injury,extracellular vesicles derived from umbilical cord-derived mesenchymal stem cells were injected into the vitreous cavity.We found that extracellular vesicles derived from mesenchymal stem cells substantially reduced retinal damage,increased the number of retinal ganglion cells,and inhibited the activation of caspase-3.These findings suggest that mesenchymal stem cell-derived extracellular vesicles can help alleviate optic nerve injury caused by chronic ocular hypertension,and this effect is achieved by inhibiting cell apoptosis.

Comparison of encirclage and cryotherapy with argon laser in the management of traumatic cyclodialysis cleft

The study compared anatomical and functional outcome of a novel technique of encirclage and cryotherapy with the conventional argon laser in the management of traumatic cyclodialysis cleft in 19 patients(10: encirclage and 9: argon laser). The postoperative anatomical success was taken as rise in intraocular pressure(IOP) more than 6 mm Hg or the closure of cleft on gonioscopy or ultrasound biomicroscopy(UBM). Visual outcome was measured as change in logMAR visual acuity. Traumatic cataract and hypotony were present in majority. IOP>6 mm Hg was noted in 90% of encirclage group and in 77.70% of argon laser group. Two cases had non-closure of cleft. Encirclage is comparable to argon laser in terms of anatomical and functional success with possible advantage of single procedure and use in cases with failed laser.

Potential role of nuclear receptor ligand all-trans retinoic acids in the treatment of fungal keratitis

·Fungal keratitis(FK) is a worldwide visual impairment disease. This infectious fungus initiates the primary innate immune response and, later the adaptive immune response. The inflammatory process is related to a variety of immune cells, including macrophages, helper T cells, neutrophils, dendritic cells, and Treg cells, and is associated with proinflammatory, chemotactic and regulatory cytokines. All-trans retinoic acids(ATRA)have diverse immunomodulatory actions in a number of inflammatory and autoimmune conditions. These retinoids regulate the transcriptional levels of target genes through the activation of nuclear receptors.Retinoic acid receptor α(RAR α), retinoic acid receptor γ(RAR γ), and retinoid X receptor α(RXR α) are expressed in the cornea and immune cells. This paper summarizes new findings regarding ATRA in immune and inflammatory diseases and analyzes the perspective application of ATRA in FK.

Selective Laser Trabeculoplasty Complicated by Cystoid Macular Edema:Report of Two Cases

Purpose: Selective laser trabeculoplasty,a relatively novel treatment for open angle glaucoma,is frequently associated with mild post-operative intraocular inflammation. Methods: We report two uncommon cases of cystoid macular edema within a few weeks of routine selective laser trabeculoplasty. Results:Visual acuities and macular thicknesses of the two cases returned to baseline after medical treatment,but in one case, the cystoid macular edema persisted for months. Conclusion:Cystoid macular edema after selective laser trabeculoplasty is fortunately a rare complication, but it might be more common in patients with predisposing factors, and it can be resistant to treatment.

Hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome:A case report

BACKGROUND Hammered silver appearance of the corneal endothelium is considered a characteristic change in iridocorneal-endothelial syndrome.Herein we report an interesting case of hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome(FUS).CASE SUMMARY A 49-year-old man with progressive vision loss in the right eye for one year was admitted to our hospital.The clinical manifestations of the patient’s right eye were mild conjunctival hyperemia,scattered stellate keratic precipitates on the corneal endothelium,normal depth anterior chamber,2+cellular reaction in the aqueous humor,diffuse iris depigmentation,absence of synechia,Koeppe nodules,opalescent lens,and vitreous opacity.FUS and a complicated cataract were diagnosed based on the typical clinical manifestations.The corneal endothelial changes were recorded in detail by slit-lamp examination,specular microscopy,and in vivo confocal microscopy before cataract extraction,revealing a hammered silver appearance of the corneal endothelium in the affected eye,a wide-band dark area,as well as irregular corneal endothelial protuberances and dark bodies of various sizes.Subsequently,the patient underwent phacoemulsification combined with intraocular lens implantation,and his postoperative visual acuity recovered to 1.0.CONCLUSION Hammered silver appearance of the corneal endothelium in FUS,which is considered a more serious manifestation of endothelial damage,is rare and may be caused by many irregular protrusions in the corneal endothelium.

Bilateral choroidal detachment and exudative retinal detachment following laser peripheral iridotomy in a case of ocular Vogt-Koyanagi-Harada’s disease

Dear Editor,We present a case of bilateral choroidal detachment(CD)and exudative retinal detachment(ERD)following laser peripheral iridotomy(LPI)in a patient of ocular Vogt-Koyanagi-Harada’s disease(VKHD).A 42 yearold-lady presented to us with the complaint of sudden onset of pain,redness,and dimness of vision in her right eye for past two weeks.Her best-corrected visual acuity(BCVA)was 20/40 and 20/30 in right and left eye respectively.

Vision-Related Quality of Life in Ocular Hypertension Patients: Effects of Treatment

Purpose: To evaluate the quality of life related to vision (QoL) in patients with ocular hypertension under treatment. Methods: The study included two groups. The first one consisted of 60 ocular hypertension patients under topical hypotensive medications and the second one of 60 healthy persons. The Greek language version of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was completed by all patients. Results: The median scores of the total score and also for almost all the NEI VFQ-25 subscales were significantly decreased for the first group of ocular hypertension patients (OHT) under topical therapy. Females presented higher QoL than that of males. The patients who used one medication presented higher QoL than that of the patients who used more than one. The best corrected visual acuity (BCVA) and the intraocular pressure (IOP) were significantly correlated with QoL. The index of the visual fields, pattern standard deviation (PSD), was significantly related to the quality of life of OHT. The age, the cup to disk ratio and the central corneal thickness had also significant correlations with subscales of the QoL. Conclusions: The quality of life OHT patients under topical treatment is significantly decreased than healthy persons. Male sex and the number of medications affect QoL more. BCVA and IOP represent the clinical findings that best correlate with several subscales of QoL. PSD is a significant index that correlates well with the quality of life of OHT patients.

Combined Hamartoma of the Optic Disc and Retinal Pigment Epithelium—3 Years of the Follow-Up with Semi-Automated Kinetic Perimetry

Aim: To present a case of hamartoma of the optic disc and Retinal Pigment Epithelium (RPE) and follow up of the visual function over three-years period. Methods: A seventeen-year-old boy has observed reduced visual acuity in his left eye. The visual acuity was 0.2 and there was RAPD in the left eye. Fundoscopy revealed an elevation of the optic disc obscuring disc vessels with epiretinal gliosis. Fluorescein angiography demonstrated hyperfluorescent saccular dilatations with leakage in the late phase. Ocular Coherence Tomography (OCT) showed hyperreflective elevation of the optic disc and epiretinal membrane. There was a juxtapapillary scotoma in Semi-automated Kinetic Perimetry (SKP). There was no systemic diseases. Results of blood tests, CT and MRI of CNV were normal. Results: After 3 years period of the follow-up the visual acuity was 0.1 and there was a progression of the visual field defect to the altitudinal scotoma in the upper hemisphere. Fluorescein anhiography and OCT revealed the same. Conclusion: Hamartoma of RPE and optic disc is a rare condition consisting of glial, vascular and RPE cells. It should be differentiated from optic disc oedema and vascular tumors of the retina. Assessment of the visual function is very important in the longitudinal follow-up.

Safety profile of 0.0015%tafluprost eye drops in China:a post-marketing observational study

AIM:To investigate the treatment pattern and safety of tafluprost for glaucoma and ocular hypertension(OH)in clinical practice in China.METHODS:This post-marketing observational study included patients who received tafluprost to lower intraocular pressure(IOP)within 30d between September 2017 and March 2020 in 20 hospitals in China.Adverse drug reactions(ADRs)during tafluprost treatment and within 30d after the treatment were collected.RESULTS:A total of 2544 patients were included in this study,of them 58.5%(1488/2544)had primary open angle glaucoma(POAG),21.9%(556/2544)had OH and 19.7%(500/2544)used tafluprost for other reasons.Of 359 ADRs occurred in 10.1%(258/2544)patients,and no serious adverse event occurred.The most common ADR was conjunctival hyperemia(128 ADRs in 124 patients,4.9%).Totally 1670 participants(65.6%)combined tafluprost with carbonic anhydrase inhibitors(CAIs;37.1%,620/1670),sympathomimetics(33.5%,559/1670),β-blockers(33.2%,555/1670),other prostaglandin analogs(PGAs;15.6%,260/1670)and other eye drops(15.1%,253/1670).The highest incidence of conjunctival hyperemia was noted in patients who received tafluprost in combination with other PGAs(23 ADRs in 23 patients,8.8%,23/260)and the lowest was in combination with CAIs(16 ADRs in 16 patients,2.6%,16/620).Tafluprost was applied in primary angle-closure glaucoma(41.6%,208/500),after glaucoma surgery(17.8%,89/500)and after non-glaucoma surgery(15.8%,79/500).CONCLUSION:Tafluprost is safe for POAG and OH,and tolerable when combined with other eye drops and under various clinical circumstances.

Surgical outcomes of XEN45 implantation,trabeculectomy vs.penetrating canaloplasty in open-angle glaucoma:A non-randomized comparative study

To the Editor:Glaucoma is a leading cause of irreversible blindness worldwide.[1]Trabeculectomy with mitomycin C(MMC)has been the standard surgical intervention for reducing intraocular pressure(IOP)and slow down the progression of glaucoma.[2]However,some serious complications with devastating consequences can occur after trabeculectomy,such as bleb-related infections,suprachoroidal hemorrhage,vitreous hemorrhage,and malignant glaucoma.Over the last decade,many novel ophthalmic surgical devices have been used in glaucoma.The XEN45 microstent(Allergan,Dublin,CA,USA)is a hydrophilic cross-linked porcine gelatin stent.It is implanted ab-interno.

Intraocular lens selection in diabetic patients:How to increase the odds for success

The incidence of cataracts is significantly higher in diabetic individuals,particularly in younger age groups,with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics.Cataract surgery in diabetic patients poses many challenges:Poor epithelial healing,decreased corneal sensitivity,increased central corneal thickness,decreased endothelial cell count,variable topography,poor pupillary dilatation,anterior capsular phimosis,posterior capsular opacification(PCO),chances of progression of diabetic retinopathy(DR),zonular weakness,and vitreous prolapse and diabetic macular edema.Selection of an appropriate intraocular lens(IOL)is crucial for visual rehabilitation and monitoring DR.The choice of IOL in diabetic cataract patients is a challenging scenario.Square-edge IOLs are favored for their capacity to mitigate PCO,whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR.The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation,particularly in the presence of advanced retinopathy.Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications.Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes.This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

Diabetic retinopathy:A review on its pathophysiology and novel treatment modalities

Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),present in onethird of patients with diabetes,is a vision-threatening complication caused by uncontrolled diabetes,which greatly affects the retinal blood vessels and the lightsensitive inner retina,eventually leading to blindness.Several epidemiological studies elucidate that DR can vary by age of onset,duration,types of diabetes,and ethnicity.Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia.The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging.This review throws light on the pathological processes behind DR,the cascade of events that follow it,as well as the available and emerging treatment options.