Diabetic macular edema (DME) is a common complication of diabetic retinopathy. Treatment with intravitreal injections is effective in most cases but is associated with a high therapeutic burden for patients. This implies the need for long-term treatments, such as the fluocinolone acetonide (FAc) implant. A review of basic science, pharmacology, and clinical data was conducted to provide a state-of-the-art view of the FAc implant in 2024. Although generally well tolerated, the FAc implant has been associated with ocular hypertension and cataract, and caution should be advised to the patients in this regard. By synthesizing information across these domains, a comprehensive evaluation can be attained, facilitating informed decision-making regarding the use of the FAc implant in the management of DME. The main objective of this review is to provide clinicians with guidelines on how to introduce and use the FAc implant in a patient with DME.

Background: Multicentre surveillance studies show increasing resistance among ocular MDR bacteria causing sight-threatening infections, especially MRSA. MRSA is associated with poor visual outcomes despite treatment with topical fortified vancomycin (25–50 mg/mL), the current standard of care. We previously demonstrated that telavancin exhibits approximately 16-fold greater in vitro potency than vancomycin against ocular MRSA isolates, with lower cytotoxicity. Objectives: To compare the in vivo ocular tolerability of topical telavancin and vancomycin at 25 and 50 mg/mL in a murine maximum-tolerated-dose model. Methods: Immunocompetent female BALB/c mice (n = 24; six groups, four/group) received 20 instillations, 15 min apart over 5 h, of telavancin or vancomycin (25 or 50 mg/mL) or matching vehicles [250 or 500 mg/mL hydroxy-propyl-β-cyclodextrin (HPβCD) for telavancin; 0.9% NaCl for vancomycin]. Ocular irritation was graded 30 min after the final dose and cage-side observations were recorded 1, 3 and 5 h. Results: Vancomycin showed dose-dependent toxicity. At 25 mg/mL, all mice (4/4) exhibited hyperaemia, chemosis and eyelid closure; at 50 mg/mL, all had eyelid closure, chemosis, hyperaemia and corneal dryness, and 2/4 had white discharge. Telavancin 25 mg/mL was well tolerated: only 1/4 displayed mild chemosis and squinting, with no eyelid closure. Telavancin 50 mg/mL caused eyelid closure, chemosis and hyperaemia in 4/4 mice. The 250 mg/mL vehicle caused no clinically relevant ocular changes, although 1/4 mice showed squinting; 500 mg/mL vehicle induced mild chemosis and hyperaemia in 4/4 mice. Conclusions: The telavancin 25 mg/mL formulation was better tolerated than the fortified vancomycin formulation tested in this model. These findings support further preclinical evaluation for MDR Gram-positive ocular infections.

To compare refractive outcomes following bilateral implantation of three distinct extended depth-of-focus (EDOF) intraocular lens (IOL) technologies. Three EDOF IOL technologies implanted in eligible patients were assessed: non-diffractive (NDEDOF) Vivity®, bifocal refractive (REDOF) LENTIS® Comfort, diffractive (DEDOF) AT LARA®. A monofocal IOL (Clareon® Aspheric) was used as a comparator. Corrected and uncorrected distance, intermediate (IVA) and near (NVA) visual acuities were assessed at 1 and 3months. The occurrence of photic phenomena (PP) and spectacle independence were assessed at 1 and 3months using a modified McAlinden questionnaire. Ninety-two patients were analyzed. Binocular corrected distance visual acuity of 10/10 was achieved in 100% of patients in the monofocal, REDOF, and NDEDOF groups, and in 95% of the DEDOF group (P=0.98). Uncorrected intermediate and near visual acuities were better with EDOF IOLs compared to monofocal IOLs, with mean values of -0.1 and -0.2 logMAR, respectively. Photic phenomena were absent or mild (score<4/27) in 75% (NDEDOF), 78% (REDOF), 66% (DEDOF), and 91% (monofocal) of patients. The mean PP score was highest with the DEDOF lens (3.5/27, P7/15 in the monofocal group. Regardless of optical design, the EDOF IOLs provided better intermediate and near vision and greater spectacle independence compared to the monofocal IOL. Photic phenomena were generally mild, although more frequent with the diffractive design.

Nationwide multicenter surveillance demonstrates a substantial burden of antimicrobial resistance among ocular bacterial pathogens. In the 2009–2018 ARMOR collection, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 34.9% of S. aureus ocular isolates, and methicillin resistance was strongly associated with fluoroquinolone resistance. Ocular infections can destroy tissue within hours; timely microbiologic diagnosis and treatment adjustment are essential; however, culture is constrained by small specimen volumes, low inoculum, and prior antimicrobial exposure. To tackle multidrug-resistant (MDR) infections, we propose that phenotypic testing could be complemented with targeted whole-genome sequencing in cases of severe or persistent eye infections, to provide lineage characterization, resistance and virulence determinants, and critical features of pathogenic MDR bacteria that are clinically relevant to predict patient outcomes. A genome-informed workflow, sequencing from pure culture, and integration with phenotypic data could refine empiric therapy, enable earlier de-escalation, and strengthen surveillance of high-risk lineages to reduce vision-threatening treatment failures and save patients’ vision.

Severe bacterial keratitis and endophthalmitis are leading causes of corneal scarring, enucleation, and permanent vision loss, and are increasingly complicated by multidrug-resistant Gram-positive ocular pathogens. In the United States, according to the ARMOR surveillance program (2009–2020), methicillin resistance reached 45.9% of intraocular Staphylococcus aureus and 47.9% of coagulase-negative staphylococci (CoNS), with multidrug resistance exceeding 70% among methicillin-resistant intraocular isolates. While new antibiotics have been approved for systemic infections, vancomycin remains the standard of care for severe Gram-positive ocular infections. However, its ophthalmic use is constrained by limited ocular surface tolerability, physical incompatibility with intravitreal ceftazidime, and an association with hemorrhagic occlusive retinal vasculitis. To address this gap and further stimulate the development of next-generation targeted therapies in ophthalmology, this review focuses on current recommendations and new vancomycin alternative treatments for Gram-positive ocular infections in the antibiotic resistance era. This review details the current antimicrobial recommendations for the most frequent ocular infections, followed by the epidemiology and molecular mechanisms of resistance in S. aureus, CoNS, and S. pneumoniae. Finally, this review discusses new drugs that represent promising alternatives to vancomycin in ophthalmology.