Diabetic macular edema (DME) is a major ocular complication of diabetes mellitus (DM), leading to significant visual impairment. DME’s pathogenesis is multifactorial. Focal edema tends to occur when primary metabolic abnormalities lead to a persistent hyperglycemic state, causing the development of microaneurysms, often with extravascular lipoprotein in a circinate pattern around the focal leakage. On the other hand, diffusion edema is due to a generalized breakdown of the inner blood–retinal barrier, leading to profuse early leakage from the entire capillary bed of the posterior pole with the subsequent extravasation of fluid into the extracellular space. The pathogenesis of DME occurs through the interaction of multiple molecular mediators, including the overexpression of several growth factors, including vascular endothelial growth factor (VEGF), insulin-like growth factor-1, angiopoietin-1, and -2, stromal-derived factor-1, fibroblast growth factor-2, and tumor necrosis factor. Synergistically, these growth factors mediate angiogenesis, protease production, endothelial cell proliferation, and migration. Treatment for DME generally involves primary management of DM, laser photocoagulation, and pharmacotherapeutics targeting mediators, namely, the anti-VEGF pathway. The emergence of anti-VEGF therapies has resulted in significant clinical improvements compared to laser therapy alone. However, multiple factors influencing the visual outcome after anti-VEGF treatment and the presence of anti-VEGF non-responders have necessitated the development of new pharmacotherapies. In this review, we explore the pathophysiology of DME and current management strategies. In addition, we provide a comprehensive analysis of emerging therapeutic approaches to the treatment of DME.
Purpose: To analyze the postoperative course, specifically postoperative complications, of pediatric patients who underwent cataract surgery by a single surgeon. The type of wound closure was compared to provide an evidence-based approach to surgical technique in pediatric cataract surgery. Methods: This retrospective study analyzed pediatric patients who underwent cataract extraction by a single surgeon from 2014 to 2020. Excluded from the study were patients with postoperative follow-up of less than 1 month. The primary outcome compared postoperative complications between patients with sutured and sutureless wound closure. Other outcomes analyzed included intraocular pressure, mean corrected distance visual acuity, and incidence of procedure needed to remove posterior capsule opacification. Results: The study comprised 116 eyes with sufficient follow-up; 86 had sutureless wound closure and 30 had sutured wound closure. An intraocular lens was placed in 52% of eyes in the sutureless group and in 80% of eyes in the sutured group. There was no statistically significant difference between preoperative and postoperative intraocular pressure between groups. The best corrected distance visual acuity was better in the sutured group at 6 months but not at the most recent follow-up visit. No cases of endophthalmitis were found in either group. There was no statistically significant difference between the incidence of retinal detachments and iris prolapse. Conclusions: The incidence of endophthalmitis, retinal detachment, and iris prolapse was similar between pediatric patients who underwent cataract removal with sutureless versus sutured wound closure. Therefore, it may be reasonable to avoid the suture after pediatric cataract surgery. [ J Pediatr Ophthalmol Strabismus . 2023;60(2):147–151.]
Many animals have the ability to learn, and some taxa have shown learned mate preference. This learning may be important for speciation in some species. The butterfly Heliconius melpomene is a model system for several areas of research, including hybridization, mate selection, and speciation, partially due to its widespread diversity of wing patterns. It remains unclear whether these butterflies can learn to prefer certain mates and if social experience shapes realized mating preferences. Here we test whether previous experience with a female influences male mate preference for two different H. melpomene subspecies, H. m. malleti and H. m. rosina. We conducted no-choice behavioral assays to determine if latency to court and whether males courted (vs no courtship) differed between naive males and males with previous exposure to a young, sexually mature, virgin female. To test whether assortative courtship preference is learned in H. melpomene, males were either paired with a female who shared their phenotype or one who did not. Naive H. m. malletti males courted assortatively, while naive H. m. rosina males did not. Experienced H. m. malleti males reduced their courting relative to naive males, suggesting that social experience with a sexually mature female that does not result in copulation may be perceived as a negative experience. In contrast, experienced H. m. rosina males exhibited similar courting rates to naive H. m. rosina males. Our results suggest that social experience can influence male mating behavior in H. melpomene and that behavioral plasticity may differ across populations in this species.
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