In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the working-age population. In the next 15 years, the number of patients suffering from diabetes mellitus is expected to increase significantly. By the year 2030, about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide (prevalence 7.7%), while in 2010 there were 285 million people with diabetes mellitus (prevalence 6.4%). This accounts for an increase in patients with diabetes in industrialized nations by 20% and in developing countries by 69% until the year 2030. Due to the expected rise in diabetic patients, the need for ophthalmic care of patients (i.e., exams and treatments) will also increase and represents a challenge for eye-care providers. Development of optimized screening programs, which respect available resources of the ophthalmic infrastructure, will become even more important. Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy. Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels. Additionally, regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy. In this way, the risk of blindness can considerably be reduced. In advanced stages of diabetic retinopathy, pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment. In recent years, the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema.

Background/Aims: To evaluate the retinal toxicity of Brilliant Blue G (BBG) following intravitreal injection in rat eyes and examine the biocompatibility and the staining properties in humans. Methods: BBG was injected into the 11 rat eyes to evaluate toxic effects with balanced salt solution (BSS) serving as control. Retinal toxicity was assessed by retinal ganglion cell (RGC) counts and by light microscopy 7 days later. In addition, BBG was applied during vitrectomy for macular hole (MH) (n = 15) or epiretinal membranes (ERM) (n = 3) in a prospective, non-comparative consecutive series of patients. Before and after surgery, all patients underwent a complete clinical examination including measurement of best corrected visual acuity (VA) and intraocular pressure, perimetry, fundus photography and optical coherence tomography. Patients were seen 1 day before surgery and then in approximately four weeks intervals.

Background/aims: Contaminated ophthalmic solutions represent a potential cause of avoidable ocular infection. This study aimed to determine the magnitude and pattern of microbial contamination of multi-dose ocular solutions at the Department of Ophthalmology, University of Nairobi, at the Kenyatta National Hospital, Kenya. Methods: 101 vials were obtained for microbial examination after an average use of 2 weeks. The dropper tip and the residual eye drop were examined for contamination. The specimens were cultured, the number of colonies counted, the organisms identified and susceptibility testing to selected antimicrobial agents was done. Results: Six (6%) of the 101 analysed vials were contaminated: 4/77 vials (5%) from a multi-user setting and 2/24 vials (8%) from a single user setting. Three contaminations (3/38, 8%) occurred in vials from the eye ward, another three (3/59, 5%) in vials from the outpatient clinic. Most bacteria identified belonged to the normal commensal flora of the eye. Isolated contaminants were micrococci (n = 2), Staphylococcus epidermidis, Haemophilus sp, Bacillus sp and a Gram negative rod. The dropper tip was more often contaminated (n = 6) than the residual solution (n = 1), and only one vial showed a contamination of both the drop and the tip. Conclusion: Our data show a contamination rate of 6%, which is in the lower range of data published on the contamination of eye drops elsewhere (0.07% to 35.8%).

To assess quality of life in uveal melanoma patients within the first and second year after CyberKnife radiosurgery. Overall, 91 uveal melanoma patients were evaluated for quality of life through the Short-form (SF-12) Health Survey at baseline and at every follow-up visit over 2 years after CyberKnife radiosurgery. Statistical analysis was carried out using SF Health Outcomes Scoring Software and included subgroup analysis of patients developing secondary glaucoma and of patients maintaining a best corrected visual acuity (BCVA) of the treated eye of 0.5 log(MAR) or better. Analysis of variance, GreenhouseGeisser correction, Student's t-test, and Fisher's exact test were used to determine statistical significance. Physical Functioning (PF) and Role Physical (RP) showed a significant decrease after CyberKnife radiosurgery, whereas Mental Health (MH) improved (P = 0.007, P < 0.0001 and P = 0.023). MH and Social Functioning (SF) increased significantly (P = 0.0003 and 0.026) in the no glaucoma group, MH being higher compared with glaucoma patients (P = 0.02). PF and RP were significantly higher in patients with higher BCVA at the second followup (P = 0.02). RP decreased in patients with BCVA < 0.5 log(MAR) (P = 0.013). Vitality (VT) increased significantly in patients whose BCVA could be preserved (P = 0.031). Neither tumor localization nor size influenced the development of secondary glaucoma or change in BCVA. Although PF and RP decreased over time, MH improved continuously. Prevention of secondary glaucoma has a significant influence on both SF and MH, whereas preservation of BCVA affects VT. Emotional stability throughout follow-up contributes positively toward overall quality of life. CyberKnife radiosurgery may contribute to attenuation of emotional distress in uveal melanoma patients.

To analyze the feasibility and safety of frameless, image-guided robotic radiosurgery against uveal melanoma, we developed a streamlined procedure that is completed within 3 hours under retrobulbar anesthesia without immobilization. Twenty patients (10 men and 10 women) with medium (3-5-mm prominence) and large (>5-mm prominence) unilateral uveal melanomas were treated with a frameless robotic radiosurgery system. Median age was 61 years (range 32-78 years). All patients underwent a single-session procedure beginning with retrobulbar anaesthesia, followed by computerized tomography (CT) scanning that was used in the generation of a treatment plan, and then the delivery of a radiosurgical tumor dose between 18 and 22 Gy to the 70% isodose line. Three-dimensional treatment planning was aimed at securing the optical lens and the optic disc as much as possible. Follow-up occurred at 3, 6, 12, and 18 months after the radiosurgery with clinical, ultrasound, and CT studies.We were able to treat all patients in the frameless setup within 3 hours. In five patients with lateral and dorsal tumors, the dose to the optic lens could be kept below 2 Gy. The clinical response was evaluated for the first seven patients treated with a follow-up of at least 6 months. No local recurrences occurred with any of the clinically evaluated patients for a mean 13-month follow-up (range 6-22 months). Maximum median apical tumor height according to standardized A-scan ultrasound evaluations decreased from 7.7 to 5.6 mm (p < 0.1). The median reflectivity increased from 41% to 70% (p < 0.01). None of the patients developed a secondary glaucoma during the short-term follow-up period. Frameless, singlesession, image-guided robotic radiosurgery is a feasible, safe and comfortable treatment option for patients with uveal melanoma. Longer follow-up and analysis of a larger patient series is required for definitive clinical recommendations.

The aim of the study was to analyze the local efficacy and eye retention rate after frameless, image-guided robotic radiosurgery against uveal melanoma. A total of 217 patients, mostly with medium and large unilateral uveal melanomas (3% small, 62% medium, and 35% large) were treated. The median age was 64 years (range 21-95 years). All patients underwent a single-session procedure beginning with retrobulbar anesthesia, followed by MRI and computerized tomography scanning to generate the treatment plan. The tumor dose was 18-22 Gy (mean, 20.3 Gy) prescribed to the 70% isodose line. Follow-up occurred at 3, 6, 12, and 18 months and yearly thereafter with clinical, ultrasound, and MRI studies. The median follow-up time was 26.4 months. All patients were treated in the frameless setup within 3 h. The actuarial 3- and 5-year eye retention rates were 86.7 and 73%, respectively. Local control at 3 and 5 years was 87.4 and 70.8%, respectively. Serviceable vision was maintained in 30.9% of patients at last follow-up. Treatment-induced glaucoma developed in 33 patients at a median 20.8 months (range, 5.8-54.0 months). Other adverse effects were hemorrhage (26 patients) and macular edema (seven patients). Frameless, single-session, image-guided robotic radiosurgery is an effective and straightforward treatment option for patients with medium and large uveal melanoma that are otherwise difficult to treat.

There is a high prevalence of ocular morbidity in sickle cell disease patients at Korle-bu Hospital. Prevalence increased with age, systemic severity of sickle cell disease, and HbSC genotype.

No author has a financial or proprietary interest in any material or method mentioned.