Objective To assess the effectiveness of intravitreal ranibizumab or aflibercept versus medical therapy for treatment of patients presented with acute central serous chorioretinopathy. Patients and method This comparative controlled clinical trial involved 45 eyes of 45 patients having acute central serous chorioretinopathy. Patients were divided into three equal groups: the first patient group received intravitreal aflibercept, the second one received intravitreal ranibizumab, and the third one, control group, received medical therapy: oral spironolactone 100 mg once daily and topical bromfenac 0.09% q.i.d. All groups were observed over a duration of 6 months and assessed for best-corrected visual acuity (BCVA), pattern on fundus fluorescein angiography, duration of visual recovery, recurrence rate, and possible complications after intravitreal injections. The central macular thickness (CMT), the subfoveal choroidal thickness (CT), the subretinal fluid (SRF), and the foveal vascular density were compared across the groups. Results By the end of the follow-up, BCVA significantly (P<0.01) improved in all groups. However, group comparison revealed no significant differences (P>0.05). A significant reduction in the CMT due to resolution of the SRF existed at 2 weeks after treatment in all groups till complete resolution at 6 months. For subfoveal CT, within-group analysis reported nonsignificant (P>0.05) differences in the intravitreal injection groups, whereas a significant (P<0.05) reduction in CT was recorded in the control group at 3 and 6 months. The foveal vascular density showed nonsignificant differences (P<0.05) within and among study groups. Conclusion Intravitreal injections had similar effects as medical treatment in improving BCVA, CMT, and SRF but had weaker action on CT.

Purpose Diabetic macular ischemia is a vision-threatening complication of diabetes mellitus. Early detection of ischemic changes can preserve the vision. The aim of the study was to detect the early macular ischemic changes in patients with no diabetic retinopathy (NDR), using optical coherence tomography angiography, and to correlate these changes with the best-corrected distance visual acuity (BCDVA). Patients and methods A case–control study was conducted to compare 30 diabetic eyes with NDR with 30 healthy control eyes. The glycemic control was determined by glycosylated hemoglobin level less than 6.5%. The diabetic group was further subdivided into those with normal BCDVA and those with decreased BCDVA. The outcome measures included BCDVA and optical coherence tomography angiography features. Results Compared with controls, the diabetics with decreased BCDVA were found to have significantly thinner central macular thickness (P<0.001), larger foveal avascular zone (FAZ) area (P<0.001) in the superficial and deep capillary plexuses (sFAZ and dFAZ), and lower vascular density (VD) (P<0.05) regarding the central density and the superior, inferior, and temporal quadrants. In addition, they showed significantly larger associated capillary dropout areas in the superficial and deep capillary plexuses and significantly lower foveal and parafoveal VD compared with diabetics with normal BCDVA (P<0.001 and 0.05, respectively). Diabetics with normal BCDVA showed no significant difference from the controls regarding the dFAZ and VD but showed significantly lower sFAZ area (P<0.05). Conclusion Diabetic ischemic microvascular changes including decreased VD and enlarged FAZ areas precede clinically visible retinopathy and might be correlated with decreased visual acuity in patients with NDR.