Current management of diabetic macular edema (DME) predominantly involves treatment with short-acting intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) and/or corticosteroids; however, short-acting therapies (lasting between 1 and 6 months) require frequent injections to maintain efficacy, meaning a considerable treatment burden for diabetic patients with multiple comorbidities. Continuous injections needed in some cases are an economic burden for patients/healthcare system, so real-life clinical practice tends to adopt a reactive approach, ie, watch and wait for worsening symptoms, which consequently increases the risk of undertreatment and edema recurrence. On March 7th 2019, a group of experts in retinal medicine and surgery held a roundtable meeting in Madrid, Spain to discuss how to (1) optimize clinical outcomes through earlier use of fluocinolone acetonide (FAc) implant (ILUVIEN^®) in patients with persistent or recurrent DME despite therapy; and, (2) to provide guidance to assist physicians in deciding which patients should be treated with ILUVIEN. In this regard, a 36-month follow-up consensus protocol is presented. In conclusion, patients that achieve a complete or partial anatomical, and preferably functional, response following one or two intravitreal dexamethasone implants, but with recurrence of edema after 3– 4 months, are deemed by the authors most likely to benefit from ILUVIEN, and the switch to FAc implant should not be delayed more than 12 months after the initiation of at least the first dexamethasone implant.

Objective: To assess the diagnostic performance of an interactive platform for ophthalmology in a real-world clinical setting at a tertiary care center.Methods: A prospective, observational, cross-sectional study was conducted on consecutive patients referred by general practitioners to the Ophthalmology Department of a third-level University Hospital. Participants underwent automated ocular evaluation using DORIA (Robotic Ophthalmological Diagnosis through Artificial Intelligence) including the Eyelib™ Robotized scan (MIKAJAKI, Geneva, Switzerland).Results: Of 2,774 referred patients, 2,478 (89.3%) attended their appointments and were examined. Among them, the mean age was 58.5 ± 14.5 years and 1,535 (61.9%) were women. Visual acuity loss with 591 (24.2%) patients and fundus examination 421 (17.3%) patients were the most common referral reasons. Based on DORIA results, ophthalmologists concluded that 807 patients (32.6%) required no further ophthalmological care, 858 (34.6%) needed follow-up with a general ophthalmologist, and 341 (13.8%) were referred to primary care. In a detailed assessment of 2,478 cases, 1,148 (46.3%) were discharged or referred to primary care, while 472 (35.5%) individuals required specialized ophthalmology care.Conclusion: The platform might be considered as a valuable solution to the waiting list issue, reducing specialist interventions, and optimizing healthcare resources. Real-world findings suggest potential cost savings and improved patient management. Further studies are necessary to validate its comparative effectiveness.

Objective: The aim of this study was to evaluate the clinical outcomes of sutureless scleral-fixated (SSF) Soleko Fil Carlevale intraocular lens (SC-IOL) implants associated with pars plana vitrectomy (PPV) in patients with aphakia secondary to complicated cataract surgery or IOL luxation nationwide. Methods: A multicenter, national, retrospective study of 268 eyes (268 patients) which underwent simultaneous PPV and SC-IOL implantation was conducted. Demographics; ocular data; pre-surgical, surgical and post-surgical details; and refractive results were collected. Intra- and postoperative complications and management details were described. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central retinal thickness (CRT) were collected at 1 week and at 1, 3, 6 and 12 months post-surgery. Kaplan–Meier curves were constructed to assess the cumulative probability of postoperative BCVA, IOP levels, macular edema (ME) and corneal decompensation. Results: The cumulative probability of final VA ≤ 0.3 logMAR was 64.4% at 12 months follow-up. The probability of IOP > 21, ≥25 and ≥30 mmHg was 29.8%, 16.9% and 10.1%, respectively, and the cumulative probability of IOP-lowering treatment was 42.3% at 12 months. Glaucoma surgery was required in 3.7% of the eyes (10/268). The cumulative probability of postoperative ME development was 26.6% at 12 months, managed with topical treatment alone (73.5%) and intravitreal injections (26.5%). Corneal transplantation was required in 3.7% of the eyes (10/268). Conclusions: Sutureless scleral-fixated SC-IOL is an adequate therapeutic alternative in the management of aphakia with good visual results and an acceptable safety profile in routine clinical care. Longer-term studies are needed to evaluate its results and complications compared to other therapeutic alternatives.