Diabetic retinopathy (DR) can lead to vision-threatening complications, and tools that capture microvascular damage beyond standard clinical grading of disease severity may improve risk prediction. Optical coherence tomography angiography (OCTA) quantifies retinal perfusion, but its prognostic value in referable DR is not fully established. We aimed to validate baseline deep capillary plexus (DCP) OCTA metrics for predicting one-year complications in eyes with referable DR. In this prospective longitudinal study in 137 eyes of 96 participants, we assessed baseline predictors of DR complications, defined as best-corrected visual acuity (BCVA) loss (≥ 10 letters on the ETDRS chart), center-involving diabetic macular edema, anti-VEGF injections, pan-retinal photocoagulation, or vitreous hemorrhage. Baseline variables included BCVA, low-luminance visual acuity (LLVA), ocular parameters, demographic characteristics, systemic variables, and OCTA metrics (foveal avascular zone area, vessel density [VD] and geometric perfusion deficit in the superficial capillary plexuses [SCP] and [DCP]). Logistic regression prioritized variables with pathophysiologic relevance while minimizing risk of collinearity. Receiver operating characteristic (ROC) curves assessed whether DCP OCTA metrics improved discrimination beyond a clinical model with traditional risk factors. Over one year, 34 eyes (24.8%) experienced one or more complications. Multivariate analysis including DR severity, DCP VD, and LLVA identified higher baseline DR severity (OR, 5.77; 95% CI: 1.93 to 17.27; P = 0.002) and lower DCP VD (OR, 0.59; 95% CI: 0.36 to 0.95; P = 0.031) as significant predictors. Adding DCP VD to the clinical model significantly improved discrimination. These findings support DCP OCTA metrics as capillary-level biomarkers for risk stratification in referable DR and highlight the need for larger longitudinal studies to confirm clinical utility.

Background Proliferative diabetic retinopathy (PDR) often requires pars plana vitrectomy (PPV) for complications such as vitreous hemorrhage and tractional retinal detachment. Cataract progression following PPV is common, and the role of combined PPV with cataract extraction (PPVCE) remains debated. This study aimed to compare visual outcomes and post-operative complications between PPV alone and PPVCE in patients with PDR and coexisting cataract. Methods This retrospective observational study was conducted at Hospital Sultanah Bahiyah, Kedah, Malaysia, and included diabetic patients with PDR and coexisting cataract who underwent either PPV alone or PPVCE. Pre-operative and post-operative data were collected, including best-corrected visual acuity (BCVA) and post-operative complications. The main outcome measures were a change in BCVA and the incidence of post-operative complications. Comparative statistical analyses were performed between the two groups. Results A total of 115 eyes were evaluated (PPV=43; PPVCE=72), with a mean follow-up period of 1.27 years. The PPVCE group was significantly older than the PPV group (49.22 vs 43.30 years, p=0.01). Both groups demonstrated improvement in BCVA, with no significant between-group difference in final BCVA at last follow-up (p=0.44). Significant visual improvement was observed in vitreous hemorrhage (VH) cases compared to tractional retinal detachment (TRD). Notably, 48.8% of patients in the PPV-alone group required subsequent cataract extraction during follow-up. There were no significant differences in complication rates, including ocular hypertension and neovascular glaucoma, between the two groups (p=0.33 and p=0.53, respectively). Conclusion PPV and PPVCE provide comparable visual and safety outcomes in patients with PDR and cataracts. However, the high rate of subsequent cataract surgery following PPV alone suggests that a combined approach may reduce the need for re-operations and improve overall patient management in appropriately selected patients.

This review evaluates the role of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents as peri-operative adjuvants in pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). We synthesize current evidence on their use before, during, and after PPV, with emphasis on benefits, limitations, risks, and implications for surgical planning.

This report presents a case of amelanotic metastatic cutaneous melanoma to the vitreous masquerading as a fungal endophthalmitis. A 74-year-old immunocompromised man with a history of Stage 4 metastatic cutaneous melanoma presented with 1+ vitreous cell and a fluffy white peripheral infiltrate in the left eye. Following subsequent vitrectomy for a vitreous hemorrhage, this patient developed preretinal macular deposits that continued to increase in size while undergoing treatment for a presumed fungal endophthalmitis. The patient went on to develop a total retinal detachment with a diffuse hemorrhagic retinopathy. Cytopathologic analysis revealed necrotic melanoma cells from the preretinal surface and within the vitreous cavity. This case highlights the importance of including vitreous metastasis in the differential of vitritis in the setting of cutaneous melanoma. Optical coherence tomography can be used to monitor the progression of preretinal deposits, with an increase in size of the deposits prompting reevaluation of treatment options.