The purpose of this brief report is to report on the outcome of glaucoma management in children after pars plana vitrectomy (PPV) in Alexandria Main University hospital. The Medical records of children presenting with glaucoma after PPV were reviewed. Data extracted included patients' demographic data, antenatal, natal and postnatal history, indication for PPV and surgical details, details of glaucoma surgery, clinical preoperative and postoperative follow up. Success of glaucoma surgery was defined as an IOP ≤ 16 mmHg and ≥ 20% reduction from the presenting IOP. The study included 9 eyes of 8 children, that had undergone PPV for ROP (6 eyes) and vitreous haemorrhage (3 eyes). All study eyes were subjected to combined trabeculectomy-trabeculotomy with Mitomycin C. The mean ± standard deviation of the age at glaucoma surgery and follow up duration were 7.9±4.43 and 11.1±10.0 months respectively. The mean ± standard deviation of the preoperative and last visit IOP and C/D ratio were 22.9±6.9 mmHg, 0.8±0.2, 16.9±5.8 mmHg (P=0.063) and 0.4±0.3 (P=0.036) respectively. The success rate at final follow up was 55.6%. In this study, glaucoma after PPV has a poor prognosis and does not generally respond to combined filtering and angle surgery.

Diabetic retinopathy is a leading cause of vision impairment and blindness in individuals with diabetes. Under conditions of chronic hyperglycemia and retinal hypoxia, pathological angiogenesis develops, increasing the risk of retinal hemorrhage. Disease progression is driven by oxidative stress and chronic inflammation, which activate complex signaling cascades that promote neovascularization. Diabetic macular edema, caused by leakage from damaged retinal vessels, is the primary cause of vision loss in diabetic retinopathy. Based on the presence of retinal neovascularization, diabetic retinopathy is classified as nonproliferative or proliferative diabetic retinopathy. Current therapies, including laser photocoagulation, intravitreal anti-vascular endothelial growth factor injections, and vitreoretinal surgery, can only partially preserve vision, underscoring the importance of early intervention to control abnormal angiogenesis. Exosomes are lipid bilayer vesicles 30-150 nm in diameter that carry bioactive molecules such as proteins, mRNAs, miRNAs, and other noncoding RNAs. They are released by many cell types, including immune cells and retinal pigment epithelium, a major source of vascular endothelial growth factor in retinopathy. This review summarizes human studies investigating the therapeutic potential of exosomes in diabetic retinopathy, with a focus on miRNAs involved in angiogenesis and their utility as biomarkers and treatment targets. Altered expression of exosomal miRNAs, including downregulated miR-204-5p in vitreous humor and upregulated miR-15a in tears and vitreous humor, may serve as diagnostic biomarkers. Exosomes derived from bone marrow mesenchymal stem cells and ARPE19 cells suppress endothelial cell proliferation, migration, and tube formation. Modulation of specific miRNAs further reduces angiogenesis. Collectively, these findings suggest that miRNA-modulated exosomes represent a promising cell-free therapeutic strategy for proliferative diabetic retinopathy, although challenges related to exosome yield and purification remain.

A 23-year-old woman presented with sudden, severe vision loss in her right eye following intense emotional crying. Visual acuity was reduced to counting fingers with an unremarkable anterior segment examination. Fundus examination revealed a well-circumscribed, dome-shaped sub-internal limiting membrane hemorrhage involving the macula, with a visible fluid-blood level. Optical coherence tomography confirmed separation of the internal limiting membrane with a hyporeflective blood-filled cavity, consistent with sub-internal limiting membrane hemorrhage. Based on the characteristic imaging findings and a clear history of a Valsalva-like event, Valsalva retinopathy was diagnosed. Given the extensive macular involvement and the presence of fresh, non-clotted hemorrhage, neodymium-doped yttrium aluminum garnet laser membranotomy was performed at the lowest point of the hemorrhagic cavity. Immediate drainage of blood into the vitreous cavity was observed, accompanied by rapid visual improvement. Visual acuity improved to LogMAR 0.5 shortly after the procedure and further to LogMAR 0.2 at one-week follow-up. Subsequent fundus imaging demonstrated near-complete resolution of both sub-internal limiting membrane and intravitreal hemorrhage, and fundus fluorescein angiography showed no retinal structural damage. This case highlights intense emotional crying as a potential trigger for Valsalva retinopathy and supports early laser membranotomy as an effective treatment for macula-involving cases.