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Diabetic papillopathy (DP) is a rare ocular complication of diabetes presenting as acute disc edema. It is characterized by minimal or no visual symptoms and has tendency to resolve spontaneously in most of the patients with no visual sequel. Visual debility, if present, is attributable to diabetic macular edema (DME), advanced diabetic retinopathy or conversion to ischemic optic neuropathy. We report a case of 33 years old female who presented with bilateral papillopathy with best corrected visual acuity (BCVA) of 6/6 in both eyes. She had associated severe non proliferative diabetic retinopathy but noDME. On follow up, thepatient had good metabolic control and clinical improvement in DP, but she developed sudden diminution of vision in left eye as a result of non ischemic central retinal vein occlusion (CRVO) which was characterized by BCVA of 6/36, dilated tortuous veins and DME. No specific cause of non-ischaemicCRVOwas revealed on detailed work up. Structural and functional improvement was seenon monthly intravitrealanti vascular endothelial growth factor(VEGF) administration.Her BCVA post threeinjectionstood at 6/18. This is to report the possibility of development of CRVO in DP and highlight the need for close follow-up of such patients even in presence of strict diabetic control.

Purpose To report an uncommon case of intraoperative ocular decompression retinopathy (ODR). Case report A 48-year-old man presented with decreased vision and pain in the left eye (LE) for 10 days following trauma with a bamboo stick. He had visual acuity of counting finger close to face in the same eye, along with corneal edema, dilated pupil and posteriorly dislocated lens. Intraocular pressure (IOP) was 42 mm of mercury (Hg). He underwent 23-gauge pars plana vitrectomy with removal of the dislocated lens. Towards the end of otherwise uneventful surgery, blot hemorrhages appeared over the posterior pole and equator. The following day, his vision was counting finger close to face and IOP was 16 mm of Hg. Fundus examination revealed large blotches of hemorrhages at different levels of the retina, later confirmed by optical coherence tomography. Disc hyperfluorescence and blocked fluorescence corresponding to blot hemorrhages were seen on fundus fluorescein angiography. Blood investigations to rule out blood dyscrasias were within normal limits. Conclusion Ocular decompression retinopathy, though not common, has been reported to occur following various types of surgeries, especially if associated with preoperatively raised IOP. The event can also occur intraoperatively and the preoperative control of IOP is of paramount importance in the prevention of ODR.

Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.Seit der Ära, in der das Makulaforamen als unbehandelbar galt, hat die Makulaforamenchirurgie einen weiten Weg zurückgelegt und ist heute eine der erfolgreichsten Operationen. Das Peeling der Internal Limiting Membrane (ILM) ist ein wesentlicher Schritt der Makulaforamenchirurgie, seit die Rolle der ILM in der Ätiopathogenese und Progression des Makulaforamens bekannt ist. Jedoch brachte die neue Technik nicht nur Vorteile, sondern auch einige Nachteile, die nicht sofort ersichtlich waren. Mit dem Aufkommen der optischen Spektraldomänen-Kohärenztomographie wurden die kurz- und langfristigen Auswirkungen des ILM-Peelings auf die Makulastrukturen bekannt, und mit der Mikroperimetrie konnte die Auswirkung auf die Funktion der Makula bewertet werden. Die Technik hat sich im Laufe der Zeit vom totalen Peeling über den invertierten Flap bis hin zum nur temporären Peeling und dem temporären Flap weiterentwickelt, um die negativen Auswirkungen zu mildern und das chirurgische Ergebnis zu verbessern. Die ILM-Abrasionstechnik und Ocriplasmin können in bestimmten Fällen ein ILM-Peeling überflüssig machen, sie haben aber ihre eigenen Einschränkungen. Wir diskutieren hier die Rolle der ILM in der Pathogenese des Makulaforamens, die Vorteile und unerwünschten Wirkungen des ILM-Peelings sowie die verschiedenen Modifikationen des Verfahrens, um anschließend die Alternativen zu untersuchen.