Diabetic macular edema (DME) is a complicated disease due to a multifactorial process comprising the breakdown of the blood retinal barrier with a subsequent fluid accumulation in the macula. Treatment of DME depends recently on more successful therapies such as anti-vascular endothelial growth factor (VEGF) therapies that could stabilize or improve vision in several cases. Ranibizumab has been submitted for approval as a treatment of visual impairment owing to DME.Objective: To assess the response of intravitreal injection (IVI) of ranibizumab in DME at Mansoura ophthalmology center. Patients and methods:This were a prospective study carried out on a total of 50 diabetic cases with DME. Full history was taken from included cases and full ophthalmological examination was conducted in addition to evaluation of the macular retinal maps using optical coherence tomography (OCT) (Spectral domain OCT 2000). Three monthly consecutive intravitreal injections of anti-VEGF of ranibizumab at a dosage of 0.5mg/0.05 ml were administered to all the cases.Results: There was highly statistically significant improvement in the visual acuity (VA) and highly statistically significant reduction in the macular thickness in the included cases after one month and after three months as compared with the pretreatment value (P<0.001). The degree of diabetic control didn't appear to affect the change of the macular thickness. Conclusion:The intravitreal ranibizumab injection effectively decreased macular thickness and improved VA. The structural and functional effects of ranibizumab appeared as early as after 1 month of treatment and maintained at 3 months following treatment.

To outline the outcome of intra ocular foreign body removal by pars plana vitrectomy.Patients and Methods: Case series prospective interventional study that was conducted on 34 patients who underwent pars plana vitrectomy for IOFB removal during the period from November 2019 to October 2020, and attending to the outpatient and emergency unit of Mansoura Ophthalmic Center, Mansoura University. The patients were examined then scheduled for PPV for intraoperative removal of IOFB. Results:The mean age of the studied patients was 34.94±10.946 years. The majority of patients (94.1%) were males. Most of the studied patients were at occupational exposure (73.5%), most of IOFBs in the studied patients were metallic (64.7%), while 35.3%were non-metallic. The mean value of initial BCVA was 0.05±0.081 that improved at 1 week after operation to the mean value of 0.13±0.121, and then continue to improve in the follow-up visits to 0.16±0.156 in the 2 nd visit after 3 weeks, 0.19±0.176 in the 3 rd visit after 8 weeks and 0.24±0.223 in the 4 th visit after 12 weeks. There were 2 cases of raised IOP (5.9%), one case ended with macular scar (2.9%), corneal edema was persistent in one case (2.9%), and Proliferative vitreoretinopathy was noted in 5 cases (14.7%). Conclusion:IOFB removal by PPV through anterior segment technique was effective, safe, with minimal complications as well as better visual outcome. Improvement of the final BCVA can be successfully predicted by foreign body size, impaction site, initial visual acuity, afferent pupillary defect, and Ocular trauma score.

Aim: To evaluate the surgical effects of internal limiting membrane (ILM) peeling with parsplana vitrectomy in diffuse diabetic macular edema with vitreo-macular traction as regard the best corrected visual acuity, central foveal thickness, residual epiretinal membrane and recurrent traction. Methods:The study included twenty eyes of twenty patients with diffuse diabetic macular edema and vitreomacular traction. Seven eyes underwent vitrectomy with ILM peeling (group I) and thirteen eyes underwent vitrectomy without ILM (group II). The inclusion criteria were diffuse diabetic macular edema with optical coherence tomography evidence of vitreo-macular traction with or without epiretinal membrane. Exclusion criteria involved any ocular disease can cause macular edema rather than diabetes mellitus and eyes with macular ischemia.The effect of ILM peeling was evaluated on the surgical outcomes as regard best corrected visual acuity, central foveal thickness, residual epiretinal membrane and recurrent traction at postoperative one, three and six months.Results: Statistically significant improvement of best corrected visual acuity and reduction of central foveal thickness occurred in all eyes postoperatively and over time with statistically insignificant difference between both groups. No eyes in group I and eight eyes in group II showed residual epiretinal membrane with a statistically significant difference between both groups. No eyes in group I and two eyes in group II showed recurrent traction due to residual epiretinal membrane with a statistically insignificant difference between both groups. Conclusion:ILM peeling has an important role in complete removal of epiretinal membrane and prevention of recurrent traction.

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