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To evaluate the indications for pIOL explantation, pIOL survival time, and visual outcomes and access endothelial cell loss (ECL) after explantation.

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Background The variable visual function observed in diabetic retinopathy (DR) patients is not fully explained by the classic staging system. Our purpose was to evaluate choroidal changes, in standardized sectors, in DR patients and to find associations between choroidal measurements and visual function. Methods Cross-sectional study that included the right eye of diabetic patients (n = 265) without active edema, ischemia or neovascularization and age-matched controls (n = 73). Optical coherence tomography (OCT) imaging was performed with enhanced depth imaging protocol. Choroidal vascularity index (CVI) was calculated in a 5 mm scan centered in the fovea. Results CVI decreased with age (p < 0.001) but was not influenced by axial length. A multivariate analysis adjusting for age confirmed a significant difference in CVI between DR eyes that had previous treatments (intravitreal injections and/or photocoagulation) compared to control eyes (p = 0.013) and to DR eyes that never required treatment (p = 0.002). There was no significant difference between non-DR diabetic patients and normal controls. Considering the group of DR patients that had previous treatments, in eyes without optic media opacification, BCVA correlated with CVI (r = − 0.362, p < 0.001), whereas full retina thickness and individual retinal layer thickness did not (p > 0.066). Conclusions A reduction in CVI was observed in patients with a more advanced stage of DR. In treated DR patients with stable disease, choroidal biomarkers correlated with best-corrected visual acuity whereas retinal biomarkers did not. Trial registration: N/A

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We read with interest your review on treatment guidelines for recurrent vulvo-vaginal candidosis (RVVC). 1 In the ReCiDiF regimen, 2 using the same amount of fluconazole as in Sobel's regimen, 3 personalised care is crucial. In order to prevent women taking more drugs than needed, the program checks women at regular intervals for clinical cure, wet mount microscopy findings and Candida culture results, to reduce their fluconazole treatment to bi-weekly or monthly intake instead of weekly, provided the results are negative on all three tests.In line with your comments on the lack of evidence of risk factors, the ReCiDiF trial helped us to better understand what happens when women don't respond to maintenance therapy. 4 Firstly, we discovered that patients failing therapy more often developed nonalbicans Candida, 2 which typically does not respond to triazole therapy. Secondly, despite the fact that some patients with RVVC are less tolerant to glucose than healthy individuals, 5,6 this was not a risk factor for non-response to maintenance fluconazole therapy. 7 Thirdly, women with an impaired innate immune response (aberrant mannose binding lectin polymorphism) were more likely to have RVVC, but non-responders less so than optimal responders. 8 Also, the presence of atopy (eczema, asthma) in personal or family histories increased the chances of not responding well to therapy. 9 Finally, non-responders were more likely to be colonised with Candida in other locations than the vagina, especially anally and orally. Sexual habits, like oral or anal sex, did not influence this finding.In conclusion, the personalised ReCiDiF regimen to treat RVVC not only permits finding the lowest dose to remain symptom free, it also helps to explain why some women need other, non-azolebased antimycotic therapy.

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