Introduction: Phase III clinical trials of dexamethasone intravitreal implant for diabetic macular oedema (DMO) have reported significant improvements in visual acuity (VA). Studies evaluating the treatment of DMO in routine clinical practice provide data to identify areas that need improvement. This study evaluated 12-month treatment outcomes of dexamethasone implant for DMO in routine clinical practice. Methods: Retrospective data analysis of eyes that started dexamethasone implant for DMO from 1 June 2013 to 30 April 2019 in routine clinical practice tracked in the Fight Retinal Blindness! Registry.

Purpose: Compare the 3-year outcomes of ranibizumab versus aflibercept in eyes with diabetic macular edema in daily practice.Methods: This was a retrospective analysis of naive diabetic macular edema eyes starting intravitreal injections of ranibizumab (0.5 mg) or aflibercept (2 mg) from January 1, 2013 to December 31, 2017 that were collected in the Fight Retinal Blindness! Registry.Results: We identified 534 eyes (ranibizumab-267 and aflibercept-267) of 402 patients. The adjusted mean (95% confidence interval) visual acuity change of +1.3 (20.1 to 4.2) letters in the ranibizumab group and +2.4 (20.2 to 5.1) letters (P = 0.001) in the aflibercept group at 3 years was not clinically different. However, the adjusted mean CST change seemed to remain significantly different throughout the 3-year period with higher reductions in favor of aflibercept (287.8 [2108.3 to 267.4] mm for ranibizumab vs. 2114.4 [2134.4 to 294.3] for aflibercept; P , 0.01). When baseline visual impairment was moderate (visual acuity #68 Early Treatment Diabetic Retinopathy Study letters), we found a faster improvement in visual acuity in eyes treated with aflibercept up until 18 months of treatment than eyes treated with ranibizumab, which then stayed similar until 36 months of treatment, whereas there was no apparent difference when baseline visual impairment was mild (visual acuity $69 Early Treatment Diabetic Retinopathy Study letters). The rate of serious adverse events was low.Conclusion: Aflibercept and ranibizumab were both effective and safe for diabetic macular edema over 3 years.

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Rationale:Tumors of the scaphoid are rare, and some can cause pathological fractures. No cases of pathological fractures of the scaphoid have been reported in children. The most common treatment for pathologic fractures of the scaphoid bone associated with a benign lesion in adults is surgical, with intralesional curettage associated with autologous bone grafting and internal fixation.Patient concerns:A 10-year-old boy presented with wrist pain after falling from his height.Diagnoses:X-ray, CT-scan and MRI showed a pathological undisplaced fracture of the scaphoid on a benign lytic lesion.Interventions:The arm was immobilized in a below-elbow cast.Outcomes:The fracture healed within 4 months of immobilization. 3 years after the fracture, the functional status was normal, and the lytic lesion could not be seen on radiographs.Lessons:Retrospectively, the most probable etiology was a ganglion cyst. Our case suggests that some pathological fractures of the scaphoid may not need surgery, especially not in children.