Diabetic retinopathy is one of the major microvascular complications of diabetes mellitus. The most common causes of vision loss in diabetic retinopathy are diabetic macular edema and proliferative diabetic retinopathy. Recent developments in ocular imaging have played a significant role in early diagnosis and management of these complications. Color fundus photography is an imaging modality, which is helpful for screening patients with diabetic eye disease and monitoring its progression as well as response to treatment. Fundus fluorescein angiography (FFA) is a dye-based invasive test to detect subtle neovascularization, look for areas of capillary non-perfusion, diagnose macular ischemia, and differentiate between focal and diffuse capillary bed leak in cases of macular edema. Recent advances in retinal imaging like the introduction of spectral-domain and swept source-based optical coherence tomography (OCT), fundus autofluorescence (FAF), OCT angiography, and ultrawide field imaging and FFA have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in diabetic macular edema. This article will summarize the role of different imaging biomarkers in characterizing diabetic retinopathy and their potential contribution in its management.

AimTo study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).MethodsIn a randomised trial, patients with macula-off RRD (duration ≤3 months) with proliferative vitreoretinopathy grade ≤C1 and absence of pre-existing maculopathy were recruited from June 2016 to May 2018. Patients were randomised into two groups: group 1 (conventional treatment) underwent PPV alone, while group 2 underwent PPV with macular ILM peeling. The main outcome measures were macular ERM formation (detected on optical coherence tomography), corrected distance visual acuity (CDVA), retinal attachment and central macular thickness (CMT) at last follow-up (minimum 6 months).ResultsSixty patients (30 in each group) completed the required follow-up. The two groups were comparable in sex distribution, age, duration of RRD, baseline CDVA and duration of follow-up (median 15.5 vs 14 months). Macular ERM developed in 20% (n=6) and 0% of eyes in groups 1 and 2, respectively (p=0.002). Retinal reattachment was attained in all eyes. There was no statistical difference in final CDVA between the groups (p=0.43). Dissociated optic nerve fibre layer (DONFL) was found in 0% and 40% (n=12) of eyes in groups 1 and 2, respectively (p=0.0001). However, DONFL did not significantly affect the final CDVA (p=0.84). The final CMT was 266.0±37.5 µm and 270.0±73.7 µm in groups 1 and 2, respectively, with no statistical difference (p=0.62).ConclusionsILM peeling prevents macular ERM formation following PPV for RRD but provides similar visual outcomes as compared with conventional treatment.Trial registration numberCTRI2018/04/012978.

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Objective: To detect retinal involvement in coronavirus disease 2019 (COVID-19) patients in acute and convalescent phase by their fundus screening.Methods: In a prospective, cross-sectional, observational study (July–November 2020), 235 patients (142 acute and 93 convalescent phase) underwent fundus screening in a tertiary care center in North India. For convalescent phase, “hospitalized” patients (73) were screened at least 2 weeks after hospital discharge, and “home-isolated” patients (20) were screened 17 days after symptom onset/COVID-19 testing.Results: None in acute phase showed any retinal lesion that could be attributed exclusively to COVID-19. Five patients (5.38%) in convalescent phase had cotton wool spots (CWSs) with/without retinal hemorrhage, with no other retinal finding, and no visual symptoms, seen at a median of 30 days from COVID-19 diagnosis.Conclusions: CWSs (and retinal hemorrhages) were an incidental finding in COVID-19, detected only in the convalescent phase. These patients were much older (median age = 69 years) than the average age of our sample and had systemic comorbidities (diabetes mellitus, hypertension, etc.). We propose the term “COVID-19 retinopathy” to denote the presence of CWSs at the posterior pole, occasionally associated with intraretinal hemorrhages, in the absence of ocular inflammation in patients with a history of COVID-19 disease.