Diabetic macular edema (DME) is a common microvascular complication of diabetes and a major cause of vision impairment. Intravitreal vascular endothelial growth factor (VEGF) inhibitors remain the gold standard for its management. However, the high cost and limited accessibility of reference anti-VEGF agents have driven growing interest in biosimilars-biologic therapies designed to match the efficacy, safety, and immunogenicity of their reference products. Following the expiration of patents for agents such as aflibercept and ranibizumab, several biosimilars have been developed, approved, and introduced into clinical practice. Evidence from real-world studies-including RE-ENACT2 (REal-life assessmENt of safety And effeCTiveness of Razumab) and REAR-RD2 (REal-world observational study to evaluate the risk factors in the management of REtinal Diseases-2)-as well as randomized clinical trials such as INSIGHT and CT-P42 has demonstrated clinical equivalence between these biosimilars and their reference anti-VEGF counterparts in the treatment of DME. This article provides an updated overview of the current evidence base, recent advances in regulatory pathways, and ongoing challenges in integrating biosimilars into routine DME management.

Here, we review and summarize the evolution of surgical techniques and outcomes of minimally invasive, knotless (flanged) approaches for the repair of iridodialysis. A thorough literature search was performed using PubMed, Medline, Cochrane Library, and Embase databases to identify studies related to iridodialysis repair. Iridodialysis repair, flanged polypropylene suture, knotless iridodialysis repair, and ab-interno and ab-externo procedures were the keywords used. Their bibliographies provided further references. Articles on surgical repair of iridodialysis that were published before April 2025 were included. Five relevant studies were found and reviewed in depth. The conventional methods, though effective, were technically demanding, time-consuming, and associated with complications such as suture slippage, iris prolapse, conjunctival erosion, and postoperative astigmatism. Recent advancements introduced minimally invasive and knotless suture techniques, notably those using flanged polypropylene sutures. Both ab-interno and ab-externo approaches have been described by various authors including Kausaka et al ., Rosenberg et al ., Peng et al ., Ramakrishnan et al ., and Khadia et al . These techniques employ simple ophthalmic instruments, minimize intraocular manipulation, and eliminate conjunctival dissection and suture knots. These methods ensure iris reattachment, shorter operative time, improved cosmetic outcomes, and a shorter learning curve for surgeons. Minimal invasive knotless iridodialysis techniques represent a significant advancement in anterior segment reconstruction surgeries. They offer a minimally invasive, safe, and efficient alternative to traditional suturing methods, with reduced complication rates and enhanced patient comfort. Regular follow-up focusing on visual recovery, intraocular pressure, and gonioscopic evaluation remains essential to ensure long-term success.

Ocular infections, ranging from conjunctivitis and keratitis to postoperative and device-associated endophthalmitis, remain a significant cause of preventable visual morbidity worldwide. In India and other low- and middle-income countries, the irrational use of topical and systemic antimicrobials, often without microbiological confirmation, has contributed to the emergence of multidrug-resistant ocular pathogens. Fluoroquinolone-resistant Pseudomonas aeruginosa , methicillin-resistant Staphylococcus aureus , and resistant Fusarium and Candida species are now major challenges in ophthalmic practice. The widespread availability of over-the-counter ophthalmic drops, empirical perioperative prophylaxis, and the use of steroid-antibiotic combinations exacerbate this problem. Antimicrobial stewardship (AMS) in ophthalmology, though relatively underdeveloped, is now a global priority. The Society of Antimicrobial Stewardship PractIce (SASPI) in India advocates an integrated AMS model linking diagnostic, preventive, therapeutic, and administrative strategies. For ophthalmologists, this translates into culture-guided therapy for recalcitrant or postsurgical infections, restricting the use of broad-spectrum or prolonged topical antimicrobials, enforcing asepsis during surgeries, and adopting antimicrobial auditing systems. The RED EYE AMSP model presented in this perspective provides a ten-point, ophthalmology-specific adaptation of the SASPI framework focusing on rational prescribing, evidence-based diagnostics, environmental safety, and interprofessional partnership. By embracing stewardship, ophthalmologists can preserve antimicrobial efficacy, minimize iatrogenic resistance, and contribute to the broader One Health goal of antimicrobial resistance containment.