Background: Proliferative Diabetic Retinopathy (DR) is one of the microvascular complications of diabetes mellitus (DM) that is prevalent to the blindness risk. The World Health Organization (WHO) considers Proliferative DR one of the priorities of eye diseases. This disease is caused by angiogenesis brought about by Vascular Endothelial Growth Factors (VEGF). The Anti-VEGF Bevacizumab (Avastin) injection is considered sufficient in preventing proliferative DR patients from blindness. This study aimed to identify the characteristics of patients with proliferative DR underwent Anti-VEGF injection at Cicendo Eye Hospital, Bandung. Methods: This was a retrospective study conducted from August−October 2014 using 40 medical records of patients with proliferative DR underwent Anti-VEGF Bevacizumab (Avastin) injection at the Cicendo Eye Hospital Bandung from January−December 2013. Inclusion criteria were the patients underwent anti-VEGF injection with complete medical records with minimum follow up of 3 weeks. Results: Among 40 patients, 55% were male and 45% were female. Furthermore, there was 100% found for DM Type 2. Moreover, random blood glucose varied among 140-200mg/dl (50%), while the hypertension was mostly at stage 2. Some of these patients had proliferative DR with vitreal hemorrhage (25%), macular edema (40%), and/or tractionalablasio retina (22.5%). Most patients had an improvement in their visual acuity (60%). Conclusions: Most of patients are male, aged 50-59 years old, random blood glucose among 140-200mg/dl, followed DM Type 2 and hypertension stage 2. Anti-VEGF injection improves visual acuity.

Background In this observational case series, we describe two cases of orbital cellulitis with periorbital abscess and rhinosinusitis in patients with type 2 diabetes mellitus. Orbital cellulitis is an ocular emergency because it’s not only sight- but also life-threatening if not properly treated. Case Report Two female patients presented to our hospital with progressive swelling and pain in the right eye. Ophthalmological examination of both patients showed diffuse inflammatory signs from the upper eyelid to the lower eyelid with pus production. A multidisciplinary approach including ENT, dermato-venereology, internist-endocrinologist, dentistry, and plastic reconstructive surgery departments was accomplished to achieve proper management. Both patients were diagnosed with orbital cellulitis, periorbital abscess, rhinosinusitis, diabetes mellitus, and dental problem. In the first case, initial empiric antibiotic therapy was given for two days, but there was no clinical improvement. Functional Endoscopic Sinus Surgery and debridement were performed on the 4th day of hospitalization. There was a significant improvement after the surgery and a new regimen of antibiotics (piperacillin-sulbactam 4x4.5 g intravenously and clindamycin 3x600 mg orally). The pus culture showed Klebsiella pneumonia and Enterobacter cloacae which were sensitive to piperacillin-sulbactam. In the second case, improvement was significant with given antibiotics medication (ampicillin-sulbactam 4x1.5 gram, and metronidazole 3x500 mg intravenously). The pus culture revealed no growth of bacteria, but gram-positive cocci were positive in the gram staining examination. Conclusion Multidisciplinary team plays a critical role in managing orbital cellulitis with periorbital abscess, rhinosinusitis, and type 2 diabetes mellitus to achieve a better prognosis and visual outcome.

Introduction: Non-arteritic Ischemic Optic Neuropathy is the most common type of ischemic optic neuropathy. Nearly half of NAION patients presented with 20/30 or better visual acuity. Central vision is often preserved relative to the visual field loss. Macular edema in NAION patient is rare, and its occurrence may confuse to other disease and lead to unnecessary treatment. Case Report: We identified three NAION patients presented with macular edema. The patients' age was above 40 and had diabetes mellitus (DM). Our patients had clinical findings consistent with NAION with poor visual acuity at the early presentation. Optical coherence tomography examination was performed, and all patients had prominent subretinal fluid. Intravitreal anti-VEGF injection was done on our first patient and no treatment was given to our second and third patient. All patients showed a significant improvement of macular edema. Discussion: Macular edema is a rare clinical manifestation that may contribute a visual deterioration in NAION. The incidence of macular edema in NAION patients is difficult to measure since OCT of macula is not routinely performed. In our report, we encountered three cases of NAION complicated by macular edema that underwent a different approach in therapy. Spontaneous regression of subretinal fluid was seen during observation without any treatment given. Our patients achieved a stable visual acuity and visual field defect. This finding is under the literature that spontaneous recovery will be observed during the natural course of acute NAION. Conclusion: Macular edema is an unusual but self-limiting presentation of NAION. Therefore, a comprehensive examination is needed to prevent any unnecessary treatment.