The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species.

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Oxidative stress plays a critical role in accelerating retinal pigment epithelial dysfunction and death in degenerative retinal diseases, including age-related macular degeneration. Given the key role of oxidative stress-induced retinal pigment epithelial cell death and secondary photoreceptor loss in the pathogenesis of age-related macular degeneration, we hypothesized that a novel thiol antioxidant, N-acetylcysteine amide (NACA), might ameliorate cellular damage and subsequent loss of vision. Treatment of human retinal pigment epithelial cells with NACA protected against oxidative stress-induced cellular injury and death. NACA acted mechanistically by scavenging existing reactive oxygen species while halting production of reactive oxygen species by reversing lipid peroxidation. Furthermore, NACA functioned by increasing the levels of reduced glutathione and the phase II detoxification enzyme glutathione peroxidase. Treatment of mice exposed to phototoxic doses of light with NACA maintained retinal pigment epithelial cell integrity and prevented outer nuclear layer cell death as examined by histopathologic methods and rescued photoreceptor function as measured by electroretinography. These observations indicate that NACA protects against oxidative stress-induced retinal pigment epithelial and photoreceptor cell death in vitro and in vivo. The data suggest that NACA may be a novel treatment in rescuing retinal function and preventing vision loss secondary to retinal degenerative diseases, including age-related macular degeneration.

Optical coherence tomography (OCT) is an important imaging modality in the setting of diabetic macular edema (DME). Its use allows more precise evaluation of retinal pathology in DME, including retinal thickness and edema, vitreomacular interface abnormalities, subretinal fluid, and foveal microstructural changes. Additional advantages include its ability to quantitatively monitor response to treatment of DME by laser, intravitreal pharmacotherapies, and vitreoretinal surgery. OCT measurements are now used in all major clinical studies of DME treatment as critical endpoints. This article presents a review of both time-domain and spectral-domain OCT in the diagnosis and management of DME. The authors discuss the various parameters evaluated by the OCT systems and provide an evidence-based evaluation of their accuracy, significance, reliability, and limitations. As the capability of OCT continues to advance, it appears that its use will play an increasingly important role in the understanding, evaluation, and treatment of DME.

1. McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol. 1983;8(1):1-16. 2. Fader RC, McGinnis MR. Infections caused by dematiaceous fungi: chromoblastomycosis and phaeohyphomycosis. Infect Dis Clin North Am. 1988;2 (4):925-938. 3. Rosen T, Overholt M. Persistent viability of the Medlar body. Int J Dermatol. 1996;35(2):96-98. 4. da Silva JP, Alviano DS, Alviano CS, et al. Comparison of Fonsecaea pedrosoi sclerotic cells obtained in vivo and in vitro: ultrastructure and antigenicity. FEMS Immunol Med Microbiol. 2002;33(1):63-69. 5. Galor A, Karp CL, Forster RK, Dubovy SR, Gaunt ML, Miller D. Subconjunctival mycetoma after sub-Tenon's corticosteroid injection. Cornea. 2009;28 (8):933-935. 6. Brandt ME, Warnock DW. Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 2003;15(suppl 2): 36-47.

Cobalamin C disease results in progressive retinal degeneration with its onset in the first few months of life and progressing rapidly over the first few years of life.

Background/aimsTo assess the outcomes of home monitoring of distortion caused by macular diseases using a smartphone-based application (app), and to examine them with hospital-based assessments of visual acuity (VA), optical coherence tomography-derived central macular thickness (CMT) and the requirement of intravitreal injection therapy.DesignObservational study with retrospective analysis of data.MethodsParticipants were trained in the correct use of the app (Alleye, Oculocare, Zurich, Switzerland) in person or by using video and telephone consultations. Automated threshold-based alerts were communicated based on a traffic light system. A ‘threshold alarm’ was defined as three consecutive ‘red’ scores, and turned into a ‘persistent alarm’ if present for greater than a 7-day period. Changes of VA and CMT, and the requirement for intravitreal therapy after an alarm were examined.Results245 patients performing a total of 11 592 tests (mean 46.9 tests per user) were included and 85 eyes (164 alarms) examined. Mean drop in VA from baseline was −4.23 letters (95% CI: −6.24 to −2.22; p<0.001) and mean increase in CMT was 29.5 µm (95% CI: −0.08 to 59.13; p=0.051). Sixty-six eyes (78.5%) producing alarms either had a drop in VA, increase in CMT or both and 60.0% received an injection. Eyes with persistent alarms had a greater loss of VA, −4.79 letters (95% CI: −6.73 to −2.85; p<0.001) or greater increase in CMT, +87.8 µm (95% CI: 5.2 to 170.4; p=0.038).ConclusionSmartphone-based self-tests for macular disease may serve as reliable indicators for the worsening of pathology and the need for treatment.

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