Assessment of Changes in Cap and Residual Stromal Thickness Values during a 6-Month Observation after Refractive Lenticule Extraction Small Incision Lenticule Extraction

Background: In this study, the changes in corneal cap and residual stromal thickness (RST) values during a 180-day observation period after refractive lenticule extraction small incision lenticule extraction (ReLEx SMILE) were assessed. Methods: Fifty patients underwent ReLEx SMILE using the VisuMax 500 femtosecond laser, with corneal imaging conducted pre and post procedure via anterior segment optical coherence tomography (AS-OCT). Cap thickness in the center and 1.5 mm from the center in four meridians was measured at various intervals. Results: The results showed a significant decrease in cap thickness 180 days post procedure compared to earlier intervals (p < 0.05). Similarly, RST decreased gradually and significantly post procedure (p < 0.05). Notably, changes in cap thickness within the central 1.5 mm area were more dynamic than RST changes during the 6-month observation period following SMILE. Conclusions: The corneal cap thickness measured with swept-source AS-OCT within the central 1.5 mm area underwent more dynamic changes than the residual stromal thickness during the 6-month observation following SMILE.

FAST® questionnaire for identifying glaucoma patients at risk for ocular surface disease

OBJECTIVES

To evaluate the validity and reliability of the new Fast Assessment of the Ocular Surface Trouble (FAST®) questionnaire for identifying glaucoma or ocular hypertension (OHT) patients at risk of ocular surface disease (OSD).

METHODS

A multicenter, international, cross-sectional, epidemiological survey evaluated the most accurate interview items and ocular signs on the initial 14-item version of FAST® to develop a shorter version for routine, quick clinical use. Rasch analysis and least absolute shrinkage and selection operator (LASSO) method was used to reduce the number of items on the questionnaire. Sensitivity and specificity of FAST® were assessed with receiver operating characteristic (ROC) curves for the detection of OSD with the questionnaire and ophthalmic assessment.

RESULTS

A total of 2308 eyes (1154 patients) were analyzed in this study by 92 ophthalmologists. The initial version of the FAST® indicated 60% of the subjects had OSD. Rasch analysis allowed removal of some clinical signs. The LASSO method allowed elimination of some items from the original questionnaire for a 9-item and a 6-item version of FAST®. For the 6-item questionnaire, the sensitivity and specificity were 71.9% and 74.3% respectively and the area under the curve was 0.815.

CONCLUSIONS

The FAST® questionnaire is a valid and reliable tool for use in routine clinical practice and in clinical trials. The short versions of the questionnaire allow quick detection of the majority of patients with OHT or glaucoma at risk of dry eye.

Colour Doppler imaging of retrobulbar circulation in different severity of glaucoma optic neuropathy

AIMS

To compare retrobulbar hemodynamic measured by colour Doppler imaging (CDI) in patients with a different severity of glaucoma and to correlate variables CDI with the structural parameters of the retina and optic disc.

MATERIAL AND METHODS

Of 89 eyes studied, 31 had preperimetric, 29 early, 12 moderate and 17 advanced glaucoma. Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI) in ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs) were evaluated by CDI and compared between study groups. Retinal nerve fibre layer thickness (RNFL) and optic disc parameters measured with optical coherent tomography (OCT) were correlated with the Doppler variables.

RESULTS

In eyes with advanced, moderate and early glaucoma EDV SPCAs were significantly lower as well as RI SPCAs were significantly higher compared to the eyes with preperimetric glaucoma. In eyes with advanced and moderate glaucoma RI CRA (0.74 and 0.71) were significantly higher than in eyes with preperimetric glaucoma (0.68) (p=0.014 and 0.026). In eyes with advanced glaucoma PSV OA and PSV CRA were significantly lower than in eyes with preperimetric glaucoma (32.5 vs. 40.7 cm/s p=0.034 and 8.25 vs. 9.7 cm/s p=0.022, respectively). Positive, variable correlations were found between RNFL and EDV of all measured arteries (0.21<R<0.50, p<0,05).

CONCLUSIONS

Statistically significant alterations in the Doppler parameters of retrobulbar arteries in association with thinning of the RNFL were observed in patients with glaucoma along with a greater severity of optic neuropathy.

The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension

Purpose:

To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension.

Methods:

A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability.

Results:

Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001).

Conclusion:

Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

Content of PAHs in soil of a hazel orchard depending on the method of weed control

PAHs belong to persistent organic pollutants (POPs) found in the natural environment. They eventually accumulate in the highest quantities in soil. The purpose of this study has been to determine quantities of PAHs in soil depending on the method applied to control weeds in rows of a 4-year plantation of hazel (mulch fabric, bark chips, sawdust, manure compost, bare fallow, chemical fallow, grass sward). The highest concentration of PAHs (16 PAHs) was found in soil kept as bare fallow. The second most abundant concentration of these compounds was determined in soil under grass sward, followed by soil under sawdust, chemical fallow, and fabric. Less of these compounds accumulated in soil mulched with bark chips. The best method for protection of orchard soil against the accumulation of unwanted and toxic PAHs was mulching with manure compost. In most cases, lower concentrations of PAHs (total 16) were found in the subsoil (30-60 cm) than in the topmost soil layer, except the soil covered with mulch fabric, where fourfold more PAHs accumulated.

Processing of OPA1 with a novel N-terminal mutation in patients with autosomal dominant optic atrophy: Escape from nonsense-mediated decay

Autosomal Dominant Optic Atrophy (ADOA) is the most common dominantly inherited optic neuropathy. In the majority of patients it is caused by OPA1 mutations and those predicted to introduce a premature termination codon (PTC) are frequently detected. Transcripts containing PTC may be degraded by nonsense-mediated mRNA decay (NMD), however very little is known about an effect of OPA1 mutations on NMD activation. Here, using a combination of linkage analysis and DNA sequencing, we have identified a novel c.91C>T OPA1 mutation with a putative premature stop codon (Q31*), which segregated with ADOA in two Polish families. At the mRNA level we found no changes in the amount of OPA1 transcript among mutation carriers vs. non-carriers. Specific allele quantification revealed a considerable level of the OPA1 mutant transcript. Our study identifies a novel pathogenic OPA1 mutation and shows that it is located in the transcript region not prone for NMD activation. The data emphasizes the importance of analyzing how mutated genes are being processed in the cell. This gives an insight into the molecular mechanism of a genetic disease and promotes development of innovative therapeutic approaches.

Assessing Efficacy of Canaloplasty Using Continuous 24-Hour Monitoring of Ocular Dimensional Changes

PURPOSE

We investigated whether 24-hour monitoring of corneoscleral limbus area (CSLA) with the Sensimed Triggerfish contact lens sensor (CLS) can be used clinically to assess midterm efficacy of canaloplasty and to assess the relationships of CSLA changes with the heart rhythm.

METHODS

Ten eyes of 10 patients, with POAG, which were qualified either to canaloplasty or canaloplasty and phacoemulsification, were included in this study. Eyes were washed out before the surgery and control visits were done at days 1, 7, and 3, 6, 12 months postoperatively, at which subjects were examined. We performed 24-hour monitoring of CSLA changes and Holter ECG at washout, and at 3- and 12-month postop visits. Raw CLS signals were processed to lead two parameters describing short-term 24-hour variability of CSLA (VAR, â). Heart activity parameters from CLS were compared to those acquired from Holter ECG.

RESULTS

Mean post washout IOP was 20.6 ± 4.7 and decreased to 14.2 ± 3.0 mm Hg 1 year after surgery (P < 0.01). A decreasing trend in VAR and â parameters were noted. Statistically significant differences were found between the washout and 3-month postop visit for VAR and â (P = 0.014 and P = 0.027, respectively) as well as between the washout and 12-month postop result for the parameter â (P = 0.031). No statistically significant differences were found between the 3- and 12-month postop results for both considered parameters.

CONCLUSIONS

Canaloplasty alone or combined with cataract surgery is a successful surgical method of lowering IOP in glaucoma patients. Canaloplasty decreases 24-hour CSLA fluctuation pattern measured with CLS.

Prolonged postocclusive hyperemia response in patients with normal-tension glaucoma

Background

It is believed that endothelial dysfunction may be a link between systemic and ocular dysregulation in glaucoma. The aim of this study was to evaluate peripheral vascular reactive hyperemia in response to occlusion test and to correlate peripheral vascular findings with retrobulbar hemodynamics parameters in patients with normal-tension glaucoma.

Material/Methods

Forty-eight patients with normal-tension glaucoma (mean age 58.1 years, 38 women) and 40 control subjects (mean age 54.1 years, 36 women) were subjected to a brachial arterial occlusion test and color Doppler imaging (LOGIQ 9, GE Medical Systems) of the retrobulbar arteries. Finger hyperemia was assessed by using a 2-channel laser Doppler flowmeter (MBF-3D, Moor Instruments, Ltd.). Time parameters (time to peak flow, half-time of hyperemia, time of recovery) and amplitude parameters (maximum hyperemia response, biological zero) of the post-occlusive reactive hyperemia signal pattern as well as velocities and resistance index of the ophthalmic, central retinal, and short posterior ciliary arteries were evaluated and compared between study groups.

Results

In glaucoma patients, time to peak flow and half-time of hyperemia were significantly longer (21.4 vs. 12.0 s, p=0.02 and 74.1 vs. 44.2 s, p=0.03, respectively) and biological zero was significantly lower (2.4 vs. 3.2, p=0.01) comparing with healthy subjects. In glaucoma patients, peak-systolic and end-diastolic velocities of central retinal artery were significantly lower (12.8 vs.14.1, p=0.03 and 3.9 vs. 4.7, p=0.01, respectively) and resistance index of this artery was significantly higher (0.69 vs. 0.67, p=0.03) compared to controls. In the glaucoma group, maximum hyperemic response was negatively correlated with the resistance index of temporal short posterior ciliary arteries (r=−0.4, p=0.01), whereas in the control group half-time of hyperemia was negatively correlated with end-diastolic velocity of the central retinal artery (r=−0.3, p=0.03).

Conclusions

Arterial occlusion test elicited a prolonged systemic hyperemia response in patients with glaucoma as compared with healthy subjects. Retrobulbar blood flow alterations in glaucoma patients may be related to systemic vascular dysregulation.

Triple therapy: Phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of bevacizumab for diffuse diabetic macular edema

BACKGROUND

The aim of this study was to evaluate the visual acuity and structural outcomes of combined phacovitrectomy with ILM peeling, retinal endophotocoagulation and use of bevacizumab in patients with diffuse diabetic macular edema (DDME).

MATERIAL/METHODS

In this prospective, nonrandomized, interventional study we included 29 eyes of 26 patients with DDME. The best-corrected visual acuity (BCVA) and central retinal thickness and volume (CRT and CRV) were recorded at 4, 8, 12, and 16 months after surgery.

RESULTS

The mean preoperative BCVA was 0.74±0.36 logMAR (0.3-1.5) and improved finally to 0.4±0.24 logMAR (-0.1-1.0) p=0.000006. The mean preoperative CRT in the 1mm zone was 516±184 microm (256-950) and decreased postoperatively at the last control to 237±75 microm (117-489) p=0.000003. The mean preoperative CRV in the 1mm zone was 0.39±0.14 microL (0.19-0.74) and decreased postoperatively at the last control to 0.17±0.06 microL (0.09-0.36) p=0.000003. The mean preoperative CRT in the 6 mm zone was 407±105 microm (279-640) and decreased postoperatively at the last control to 282±40 µm (212-380) p=0.000004. The mean preoperative CRV in the 6 mm zone was 11.4±2.9 microL (7.85-17.93) and decreased postoperatively at the last control to 7.92±1.0 microL (5.62-10.97) p=0.000003. The 23 (79.3%) eyes showed improvement in BCVA ≥0.2 logMAR, 5 (17.2%) eyes improvement or stabilization of BCVA and 1(3.5%) eye deterioration. Preoperative BCVA was a positive factor for prognosis of BCVA at 12th month follow-up (b=0.42; p=0.006), while the negative factors were: previous panretinal photocoagulation (b=-0.24; p=0.04), presence of vitreomacular traction (b=-0.29; p=0.02) and preoperative CRT in the 1000 microm zone (b=-0.24; p=0.07). A greater visual acuity improvement occurred in eyes with worse baseline visual acuity (b=-1.01; p=0.00001). The presentation of vitreomacular traction (b=-0.38; p=0.02), previous panretinal photocoagulation (b=-0.31, p=0.04) and greater preoperative CRT in the 1000 µm zone (b=-0.31; p=0.07) were negative factors for visual improvement.

CONCLUSIONS

This combined treatment resulted in improvement or stabilization of BCVA and decrease of CRT and CRV. Larger comparative studies are necessary to establish the real impact of this therapeutic approach.

Severe decrease in visual acuity with choroidal hypoperfusion after photodynamic therapy

Background

Photodynamic therapy (PDT) is considered a selective method of treatment which works in areas of choroidal neovascularization (CNV); however, there are reports of choroidal hypoperfusion after PDT. This paper presents a clinical case of choroidal circulation disturbances caused by PDT, accompanied by CNV progression.

Case Report

The patient, a 75-year-old woman, was qualified for PDT in the right eye – first treatment due to progression of occult CNV. Best corrected visual acuity (BCVA) in the right eye at baseline was +0.3 logMAR. After PDT, a rapid decrease in visual acuity to +0.7 logMAR in the right eye was observed, central choroidal hypoperfusion in fluorescein angiography (FA) with subretinal fluid appeared and, as a consequence, progression of neovascular age-related macular degeneration (AMD). After stabilizing the local state through conservative therapy, a decision was made to treat the right eye with intravitreal injections of vascular endothelial growth factor (VEGF) inhibitor. During a 12-month period of observation, 7 doses of ranibizumab were administered. A regression in activity of wet AMD was observed, with visual acuity of +0.6 logMAR.

Conclusions

Choroidal circulation disturbance after PDT is possible and has to be taken into account. Sporadically, it can lead to an acute decrease in visual acuity and local state. After stabilization of AF and optical coherence tomography imaging, further treatment of neovascular AMD with intravitreal injections of anti-VEGF agents should be considered.

Intraocular pressure and ocular hemodynamics in patients with primary open-angle glaucoma treated with the combination of morning dosing of bimatoprost and dorzolamide hydrochloride

AIMS

This prospective, multicenter, single-masked study evaluated the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retinal and retrobulbar hemodynamics in patients with primary open-angle glaucoma (POAG) treated with morning-dosed bimatoprost 0.03%.

METHODS

Eighty-nine patients (aged, 60.7 ± 11.8 years, range 33-80; 68 women) with POAG received bimatoprost dosed once in the morning for 1 month, after which dorzolamide was added twice daily for 2 months. IOP (Goldmann) and arterial blood pressure (BP) and diurnal ocular perfusion pressures (OPP) were measured every 2 hr for 24 hr. Heidelberg retina flowmetry of the retinal microcirculation was recorded four times daily in 64 patients and colour Doppler imaging of the ophthalmic and central retinal arteries was recorded five times daily in 25 patients. All measurements were taken after the two phases of treatment and compared using anova analysis with Bonferroni adjustment.

RESULTS

Mean baseline IOP was 16.5 ± 3.4 mmHg. Mean diurnal IOP with dorzolamide adjunctive therapy (12.9 ± 2.1 mmHg) was significantly lower compared to mean IOP with bimatoprost monotherapy (13.6 ± 2.2 mmHg) (p = 0.03). Adjunctive dorzolamide therapy significantly decreased vascular resistance in the ophthalmic artery (p = 0.02). Mean diastolic BP and OPP were significantly lower after adjunctive therapy. There were no changes in retinal microcirculation between the two phases of treatment.

CONCLUSIONS

Adjunctive dorzolamide therapy to morning-dosed bimatoprost 0.03% reduced diurnal IOP and vascular resistance in the ophthalmic artery but did not alter retinal circulation in this group of patients with POAG.

Future possibilities in glaucoma therapy

Glaucoma is a group of eye diseases causing irreversible optic nerve damage. This review presents 4 elements of future glaucoma treatment strategies: baroprotection, vasoprotection, neuroprotection and gene therapy. New baroprotection includes compounds that alter the actin cytoskeleton (rho-kinase inhibitors, latrunculin, cytochalasin), new drugs that enhance aqueous outflow via the trabecular meshwork (statins, steroid antagonists) and via the uveoscleral route (EP2 agonists, 5-HT2 agonists), as well as new classes of components that suppress aqueous humor formation (cannabinoids). Vasoprotection includes blocking reperfusion injury (NOS-2 inhibitors, endothelin blockers, MMP-9 inhibitors). Concerning neuroprotection antiamyloids antibodies, erythropoietin and caspase inhibitors are discussed. Gene therapy may target various effectors: the trabecular meshwork (cytoskeleton regulatory proteins, miocyllin, MMPs), the ciliary body epithelium (genes modifying aqueous humor production, neuropeptides), the ciliary body cells (MMPs, genes of local PGs biosynthesis, ciliary muscle relaxants), the retinal ganglion cells (neurotrophin genes, anti-apoptotic genes), Müller cells (neurotrophins, GLAST) and conjunctiva (gene of chloramphenicol acetyltransferase, inhibitor p21). Experimental studies on the graft mesenchymal stem cells and mature retinal cells to replace the dead retinal ganglion cells are advanced. Immunotherapy, offering a vaccination, providing protection against loss of retinal ganglion cells, has been investigated.

The additive effect of dorzolamide hydrochloride (Trusopt) and a morning dose of bimatoprost (Lumigan) on intraocular pressure and retrobulbar blood flow in patients with primary open-angle glaucoma

Aims

To assess the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retrobulbar haemodynamics in patients with primary open-angle glaucoma (POAG) treated with morning-dosed bimatoprost 0.03%.

Methods

Twenty-five patients with POAG were evaluated in a prospective, single-masked study. After a 1 week run-in period with bimatoprost all patients were treated with bimatoprost dosed once in the morning for 1 month, after which dorzolamide was added twice daily for 2 months. Goldmann applanation IOP, arterial blood pressure (ABP) and heart rate were measured every 2 h for 24 h and diurnal ocular perfusion pressure (OPP) was calculated. Colour Doppler imaging (CDI) of the ophthalmic artery (OA) and the central retinal artery (CRA) was recorded five times daily. All measurements were taken after the two phases of treatment and were compared.

Results

The mean baseline IOP was 14.8±3.5 mm Hg. Mean IOP following bimatoprost monotherapy (12.8±2.9 mm Hg) and after 2 months of dorzolamide adjunctive therapy (12.2±2.6 mm Hg) were not statistically significantly different (p=0.544). Only at the 4:00 h time point was IOP significantly reduced using the bimatoprost/dorzolamide combined treatment (p=0.013). The 24 h IOP fluctuations were lower when dorzolamide was added (6.0±2.3 mm Hg vs 4.6±1.5 mm Hg, p=0.0016). Repeated analysis of variance detected a significant decrease of vascular resistance in the OA (p=0.0167) with adjunctive dorzolamide treatment.

Conclusions

The addition of dorzolamide to morning-dosed bimatoprost had an additive hypotensive effect only on the night-time IOP curve at 4:00 h and resulted in a lower IOP fluctuation. Dorzolamide added to bimatoprost may reduce vascular resistance in the OA.

Safety of ranibizumab therapy in wet AMD and the role of vascular endothelial growth factors in physiological angiogenesis

Vascular endothelial growth factor - A (VEGF-A), is a major factor implicated in choroidal neovascularisation (CNV) and therefore a target for therapeutic agents in wet age related macular degeneration (AMD). Ranibiuzumab (Lucentis) blocks all active isoforms of VEGF-A and the products of their degradation. It penetrates through all layers of the retina in order to reach the target tissue. It is quickly removed from the system and it is characterised by low level of immunogenicity. The essence of angiogenesis is formation of new vessels by branching and expansion of already existing ones. Angiogenesis is an important physiological process that takes place during the healing of wounds, reconstruction of hypoxic injury and reproduction. However some diseases such as cancer, arthritis, diabetes and neovascular AMD are associated with persistent unregulated angiogenesis. There is an important question whether binding vascular-endothelial growth factors in wet AMD therapies using ranibizumab is correlated with the increase of the incidence of systematic adverse effects (AEs), such as cardiovascular episodes or thrombosis. The aim of this article is to present ranibizumab as a safe drug in treating wet AMD patients. Even though the concentration of Lucentis administered in a dose of 0.3 or 0.5 mg into the vitreous body in the organism is very low, the incidence of AEs during the anti-VEGF therapy was traced. In MARINA and ANCHOR studies, occurrence of possible AEs was observed. No statistically significant differences were shown in the AEs frequency between the patients treated with ranibizumab and the control group, and in correlation with the general population of patients suffering from wet AMD.

Optical coherence tomography in imaging of macular diseases

OCT (opitcal coherence tomography), is a diagnostic method that enables the analysis of the retinal structures by means of high-resolution tomographic cross-sections of the retina. Whereas fluorescein and indocyanine angiography allow visualization of the retinal epithelium layer and chorioretinal vessels, OCT may help in diagnosing and monitoring the condition of many internal retinal layers. Ultrasound B-mode examinations have a resolution of about 150 microm while OCT provides a resolution of 10 microm. OCT makes it possible to detect and measure morphological changes, retinal thickness, retinal volume, thickness of retinal nerve fiber layer and various parameters of the optic disc. We use OCT in the analysis of the retinal structures in various pathologies such as macular holes and pseudo-holes, epiretinal membranes, macular edemas of various origins, including vasooclusive disease and diabetic macular edema, lesions of vitreoretinal interface and vitreoretinal traction, serous and hemorrhagic detachments of the retina and of pigment epithelium, age related macular degeneration, diabetic retinopathy, glaucoma. OCT is an examination that is fast, sensitive, reproducible, non-invasive, non-contact and easy to perform and interpret for a retinologist. The aim of this article is to present OCT principles and techniques as well as OCT interpretation and images of most common retinal diseases: age related macular degeneration--dry and wet form, retinal angiomatous proliferation (RAP), central serous chorioretinopathy, epiretinal membranes, macular holes, diabetic retinopathy.

[Combined surgical and pharmacological treatment of diabetic maculopathy]

There are at least three avenues of investigation that support the theoretical value of vitrectomy for the treatment of DME, based on (1) vitrectomy with ILM peeling for the relief of traction on the macula, (2) vitrectomy to improve oxygenation of the macula leading to decreased vascular permeability with subsequent resolution or decrease in DME, and (3) ILM peeling to remove a part of the Müller cell endfeet and the horizontal gliosis. Visual improvement could be due to the induction of a higher overexpression of GFAP at the Müller cells level. It is likely that the proliferation of GFAP-stained gliofibrils, observed in these cells, preserves the blood-retinal barrier, reinforces architectural cohesion, and opposes the installation of the edema. In addition, the search for a specific pharmacological treatment is ongoing on the basis of new findings regarding the involvement of cytokines and growth factors in the formation of macular edema. Vascular endothelial growth factor (VEGF), inhibitors are currently being investigated in clinical studies. However, endogenous VEGF is required for visual function. Growing body evidence indicates that VEGF acts also on nonvascular cells, it plays survival role on Müller cells and photoreceptors. Therefore anti-VEGF therapies should be administered with caution.

Müller glial cells--the mediators of vascular disorders with vitreomacular interface pathology in diabetic maculopathy

The key to identifying the type of diabetic maculopathy is determining the status of posterior vitreous adhesion. In the pathological state, the breakdown of the internal and external blood-retina barrier is evident, however the mechanism is usually complex. The common denominator for these disorders are Müller glial cells, which mediate in maintaining the blood-retina barrier by linking the vessels, neurons and the vitreous in anatomical network and into functional dependence. The breakdown of the blood-retina barrier results in proliferation of Müller cells. Molecular changes in these cells increase endothelial barrier properties, but also induce pathological processes on the vitreo-retinal junction, resulting in increased adhesiveness of the collagen fibers of vitreous to retinal internal limiting membrane. The ability of Müller cells to reactive gliosis is influenced by the healthy functioning of the retinal pigment epithelium, which is a source of trophic factors necessary for appropriate Müller cells morphogenesis. Vitrectomy with the removal of ILM eliminates the vitreofoveal interface pathology, additionally provoking reactive gliosis within the macula. Intraoperative use of anti-VEGF supports short-term tightness of the blood-retina barrier in the perioperative neuralgic period. In the future, supplying astrocytes may be a strategy that will allow not only the inhibition of pathological neovascularization but also the restoration of the physiological network of capillaries in avascular retina areas. The delivery of recombinant PEDF allows for the recovery of Müller cells, and thus creates the conditions favourable for the survival of nerve cells in loss of retinal homeostasis.

Combined therapy in exudative age-related macular degeneration

PURPOSE

Therapeutic options in active exudative age-related macular degeneration (AMD) are following means used to destroy the choroidal neovascularization (CNV) lesion: laser photocoagulation, radiotherapy, transpupillary thermotherapy, photodynamic therapy (POT) or removal of neovascular membrane through vitreoretinal surgery. Another possibility is to suppress the development of neovasculanization through intravitreal administration of anti-VEGF agents: ranibizumab, bevacizumab (off-label), sodium pegaptanib or steroids (off-label). The aim of this paper is to present the early phase of treating exudative AMO with combined therapy: photodynamic therapy with intravitreal ranibizumab injection.

MATERIAL AND METHODS

Our observation is based on three clinical cases. Observations are being carried out on larger patient groups according to the treatment scheme presented in this paper.

RESULTS

In the three cases described one POT procedure and the saturation phase of three ranibizumab injections allowed a significant improvement in visual acuity and closure of CNV leakage confirmed by fluorescein angiography (FA) and optical coherence tomography (OCT). Treatment is being continued according to AMO activity: next POT in case of leakage in FA, another ranibizumab injection according to PRONTO study reinjection criteria.

CONCLUSIONS

The pathomechanism of exudative AMB confirms reasonability of combined treatment. Considering the stages of neovascularization in exudative AMO. VEGF inhibition combined with POT has a synergistic action and increases the effectiveness of both therapies alone. L.arge clinical studies (FOCUS) show that combined therapy reduces the number or required POT procedures. In combined therapy modification of POT parameters should be considered: reduction of energy and laser exposure time.

The impact of common classes of topical antiglaucoma medications on central corneal thickness--own observations

PURPOSE

To investigate the influence of common classes of topical antiglaucoma medications used either in monotherapy or combined therapy on CCT.

MATERIAL AND METHODS

In a retrospective study 487 eyes from consecutive 260 patients (148 F/112 M) with open angle glaucoma were examined. Depending on the topical treatment they were classified into 7 groups: A/PGA (n=212), B/BB (n= 54), C/CAI (n=36), D/PGA + CAI (n=25) E/PGA + BB (n=23) F/BB + CAI (n=54), G/ non-treated (n=83). The CCT was measured using ultrasound pachymetry Tomey AL-2000. The central corneal power was measured with the Topcon keratometer. ANOVA analyses were used for statistical analysis.

RESULTS

There were no statistically significant differences between CCT of all groups (F = 1.06, p = 0.3931); the lowest values were in the eyes treated with PGA + BB (535.9 microm SD 31.4) and the highest in the eyes treated with PGA + CAI (571.3 microm SD 46.3). The Mean CCT in group A was 550.4 microm (SD 40.8), group B 552.5 microm (SD 34.7), group C 562.6 microm (SD 40.2), group D 571.3 microm (SD 46.3), group E 535.9 microm (SD 31.4), group F 559.5 microm (SD 32.5), group F 557.5 microm (SD 42.2). There were no statistically significant differences between CCT of eyes treated with different PGA. The highest CCT was found in the eyes treated with bimatoprost (554.4 microm SD 46.0) and the lowest in the eyes treated with latanoprost (546.4 microm SD 37.7).

CONCLUSIONS

In this study CCT appears not to differ in eyes treated with different classes of antiglaucoma medications either in monotherapy or combined therapy. CCT appears not to differ in eyes treated with different prostaglandin and prostamide anal logs. CCT of treated glaucoma eyes does not differ from CCT of untreated glaucoma eyes.

Atypical peripapillary location of choroidal neovascularization--case reports

Choroidal neovascularization (CNV) is one of the main reasons for sight loss in adults. CNV located at the border of the optic disc or adherent atrophy is described as peripapillary choroidal neovascularisation (PPCNV). The aim of the work is to present a course of changes and the effects of treatment with intravitreal ranibizumab injections for peripapillary subretinal neovascularization, its consequences and accompanying other CNV foci in two patients. The diagnosis and monitoring of the therapeutic effects were based on the results of fluorescein angiography and OCT. In a 53-year-old female patient three injections of ranibizumab at a dose of 0.05 mg were administered according to a saturation regimen. Visual improvement of 5 lines on an ETDRS board (25 letters) was obtained, as well as withdrawal of the subretinal fluid from the area of the macula in OCT and limitation of the peripapillary exudate visible in 12 months follow-up angiography. In a 70-year-old female patient bilateral development of symmetric peripapillary CNV foci was observed accompanied by a occult CNV focus in the left eye macula. Spontaneous CNV limitation without macular lesions was visible in the right eye. Intravitreal ranibizumab injections were given into the left eye. A 12 months follow-up revealed vision stabilisation in both eyes at the baseline level.

CONCLUSIONS

Intravitreal injections can be used in the treatment of atypical extramacular CNV, responsible for secondary damage to the fovea. Ranibizumab, a non-selective VEGF-A inhibitor, allows the elimination of changes in the central retina, closure or significant limitation of the exudates and vision improvement. Spontaneous limitation of lesions may also be frequently expected in the eyes with peripapillary CNV foci.

[Autonomic nervous system and primary open angle glaucoma--pathogenetic and clinical correlations]

Primary open angle glaucoma is linked to autonomic nervous system dysfunction. In a review the role of autonomic nervous system as an important determinant of systemic hemodynamic parameters such as heart rate and blood pressure, was presented. Human circadian clock and its impact on autonomic nervous system was emphasized. Finally some autonomic function tests and therapeutical implications were described.

[Risk factors in age-related macular degeneration and glaucoma--own observations]

PURPOSE

To assess the differences between the prevalence of risk factors in patients with age- related macular degeneration (AMD), with glaucoma and with both diseases.

MATERIAL AND METHODS

The study included 255 patients, 156 F/99 M, in age 30 to 92 years, mean age 70.9 years. They were divided into 3 groups: AMD Group (83 patients, 46 F/37 M, mean age 71.5), Glaucoma Group (34 patients, 17 F/17 M, mean age 67.1) and AMD + Glaucoma Group (138 patients, 93 F/45 M, mean age 70.9). In all groups age, sex, family history of AMD and glaucoma, hypertension, hypotension, hypercholesterolemia, diabetes, coronary heart disease, vasospasm (cold hands), migraine, heart failure and stroke in anamnesis, smoking, type of diet (high or low fat intake, high or low vitamin intake), UV exposition, cataract surgery in anamnesis, bright-coloured iris, disc hemorrhages and peripapillary atrophy were determined, and compared between them. T-student test, ANOVA, Bonferoni, Kruskall-Wallis and chi-square tests and logistic analysis (likelihood ratio chi-square) were used for statistical analysis.

RESULTS

Family history of glaucoma were higher in the Glaucoma Group (odds ratio OR 9.0 p = 0.004) than in the AMD Group (odds ratio OR 9.0 p = 0.004) and than in the AMD + Glaucoma Group (OR 3.01 p = 0.001). Disc hemorrhages were higher in the Glaucoma Group (OR 13.0 p = 0.020) than in the AMD Group (OR 13.0 p = 0.020). High fat intake in diet were lower in the Glaucoma Group as compared to the AMD Group (OR 0.5 p = 0.03). Cholesterol high level and UV exposition were lower in the Glaucoma Group than in the AMD + Glaucoma Group (OR 0.278 p = 0.020 and OR 0.23 p = 0.040 respectively). Coronary heart disease and peripapillary atrophy were lower in the AMD Group as compared to the AMD + Glaucoma Group (OR 0.43 p = 0.004 and OR 0.5 p = 0.040).

CONCLUSIONS

The study has found that high fat intake in diet was higher in the patients with AMD and family history of glaucoma, and disc hemorrhages were higher in the patients with glaucoma. The following risk factors: high level of cholesterol, UV exposition, coronary heart disease and peripapillary atrophy, were higher in the patients with co-existing both diseases.

The effectiveness of phacodeepsclerectomy performed with implantation sk-gel and T-flux--12 months observations

PURPOSE

The purpose of this work was to present effectiveness and safety of phacodeepsclerectomy with SK-gel and T-flux implant in 12 months observation.

MATERIALS AND METHODS

Retrospective analysis included group I (SK-gel)--40 eyes and group II (T-flux)--23 eyes. At the control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment of the eye were examined. Control testing was done in the first day and 7-th day, and 1, 3, 6, 12 months after surgery. In the case of elevated IOP (>15 mmHg) goniopuncture was performed. IOP (> 15 mmHg) with fibrosis signs of the filtration bleb was an indication to use antimetabolites. Complete and qualified success rate was defined as IOP < or = 18 mmHg. In statistical analysis one-way ANOVA and Kaplan-Meier survival analysis, were used.

RESULTS

After 12 months mean IOP in the SK-gel group was 12.7 +/- 0.6 mmHg and in T-flux group 14.6 +/- 0.7 mmHg. It was a decrease in the mean IOP by 39.1% (p < .001) and 35.7% (p < .001). In both groups fewer medications were used than before surgery. Complete surgical and qualified success rate was reached in group I (81.7% and 91.9%) and in group II (72.7% and 83.8%). Nd:YAG goniopuncture performed in 10 eyes with implant SK-gel (25.0%) and 6 eyes with implant T-flux (26.1%) (p >.05). Subconjunctival injections with 5-FU were done in 5 eyes in the SK-gel group (12.5%) and in 3 eyes in the T-flux group (13.0%) (p > .05).

CONCLUSIONS

Phacodeepsclerectomy (PDS) with SK-gel and T-flux implant are both effective and safe surgical methods in the treatment of POAG in 12 months observation.

[Efficacy of pneumatic traheculoplasty (PNT) in patients with open angle glaucoma and ocular hypertension--a preliminary report]

PURPOSE

To evaluate the efficacy of PNT in lowering intraocular pressure (IOP) in patients treated for open angle glaucoma (OAG) and ocular hypertension (OH).

MATERIAL AND METHODS

The study group consisted of 24 eyes of 14 patients (10 F and 4 M), aged from 35 to 72 (mean 53.7 +/- 8.7) who were treated for OAG or OH. Twelve patients were treated with prostaglandin analogues (PA) in monotherapy, one patient with PG and nonselective beta-bloker (BB) and one patient with PG, BB and topical carbonic anhydrase inhibitor (CAI). The baseline mean IOP measured with Goldmann tonometry one hour before first PNT procedure was 20.7 +/- 3.3 mmHg (range 16-27). The PNT was performed routinely at 0 and 7-10 day using PNT Unit 1000-Coronado (Ophthalmic International, Inc., Fountain Hills, Arizona, U.S.A.). Then the IOP was measured monthly and if increased to the preoperative values the procedure was repeated. The mean observation time was 6 months, with the shortest and longest follow-up being 4 and 12 months, respectively. The IOP changes were estimated one hour after the first PNT on day 0, then on day 7-10, after 1, 2, 3, 4, 5 and 6 months. A paired Student's t test was used for statistical analysis.

RESULTS

The mean IOP measured one hour after PNT was 19.26 +/- 4.0 mmHg (p = 0.17). After 7 days mean IOP was 17.35 +/- 2.64 mmHg (p<0.01), after one month 16.52 +/- 2.81 mmHg (p<0.01) and after next months 16.37 +/- 2.61 mmHg (p<0.01), 17.63 +/- 2.28 mmHg (p<0.01), 15.64 +/- 2.06 mmHg (p<0.01), 16.14 +/- 3.42 mmHg (p< 0.01) i 16.64 +/- 3.14 mmHg (p<0.01), respectively. The mean IOP reduction was 1.48 mmHg (7.14%) one hour after PNT procedure, 3.39 mmHg (16.35%) after 7-10 days, 4,22 mmHg (20.35%) after one month, then respectively 4.37 mmHg (21.07%), 3.11 mmHg (15.02%), 5.10 mmHg (24.59%), 4.60 mmHg (22.18%) and 4.10 mmHg (19.77%) after 2, 3, 4, 5 and 6 months of observation. In 8 eyes the procedure was repeated again after 3 months, in 4 eyes after 6 months and in 2 eyes after 12 months. After the procedures transient moderate conjunctival hyperemia was observed in 24 eyes (100%) and mild subconjunctival hemorrhagies in 4 eyes (16%). Lasting a few hours after the PNT procedure foreign body sensations occured in 3/14 patients (21%).

CONCLUSIONS

PNT is an effective method of lowering IOP in patients treated for OAG and OH.

[Topical prostaglandins influence over cornea--preliminary report]

In the article the recent research on the biology of corneal stroma and biological impact of topical prostaglandin analogues on this tissue, were presented. The outcome of some studies, regarding influence of this class of antiglaucoma medication on central corneal thickness (CCT), were included. The impact of CCT on the readings of intraocular pressure and the aspect of diurnal fluctuations of CCT were also emphasized.

[The present role of prostaglandin analogues in the medical treatment of glaucoma]

Therapy with prostaglandin analogues (PGA), a novel class of intraocular-lowering medications, represents a safe and very effective pharmacologic method of treating patients with glaucoma and ocular hypertension. The convince dosing regimen, once-daily, higher efficacy and higher systemic safety profile seen with PGA compared with beta-blockers caused that these agents have been approved by regulatory bodies for both the first-line and adjunctive therapy. Short, retrospective analysis of the medical treatment of glaucoma in the Ophthalmology Clinic of Military Health Service Institute in Warsaw, in 2003-2004, was presented.

[Subconjuctival application of 5-fluorouracil (5-FU) following surgical treatment of glaucoma with deep sclerectomy--indications, complications and initial evaluation of effectiveness]

PURPOSE

5-FU is an antimetabolite which increases efficacy of deep sclerectomy by inhibiting subconjuctival fibrosis and fibroblast proliferation. The objective of the study was to analyze glaucoma patients who had undergone sclerectomy and in a post-surgery period required subconjuctival 5-FU injections.

MATERIAL AND METHODS

Out of 120 patients who had undergone deep sclerectomy between January through November 2004, 17 were included in the study since they required subconjuctival 5-FU injections in a post-operative period. The analysis comprised of: (1) indications for antimetabolite administration; (2) time that elapsed from the surgery to the first antimetabolite administration; (3) mean dosage; (4) complications observed; and (5) initial evaluation of the treatment.

RESULTS

In 13 patients (76.4%), the indication for 5-FU application was persistent intraocular pressure exceeding 15 mmHg; in one patient (5.8%), the 5-FU treatment was started due to an abrupt increase of the pressure from hypotony; in 6 subjects (35.2%), it was the thickening and vascular dilatation in the filtering bleb; in one subject (5.8%) encapsulated filtering bleb. Mean time of administering 5-FU was between the 2nd and 3rd week following surgery. Mean number of injections applied was 3.7 (18.5 mg 5-FU). The following complications were encountered: corneal superficial punctuate keratopathy (6 subjects), choroidal detachment (1 person), irregular astigmatism (1 person). In most cases IOP was well controlled by the end of the follow-up period (< or = 15 mmHg).

CONCLUSIONS

5-FU is safe and does not increase the perioperative risk, and has turned out to be effective in most cases of increased scarring in the filtering bleb site.

[Phacosclerectomy with acrylic implant--description of the method]

The surgical technique of deep sclerectomy with acrylic implant was described. The indications, advantages and possible complications of the method were presented.

[Optic nerve damage in multiple sclerosis patients]

PURPOSE

The aim of the work was to catch the type of damage of optic nerve in the group of patients with multiple sclerosis.

MATERIAL AND METHODS

The examinations were held on 77 eyes of 40 patients with multiple sclerosis. Among them 11 patients had previous optic neuritis, 29 have not problems with vision. The examination was conducted by CSV-1000 contrast test depict on contrast sensitivity function and anomaloscopy AN-69 appointing coefficient eta and threshold of red, green and blue hue.

RESULTS

As a result, two groups of selective damage and one of non-selective eyes were obtained. In 5 eyes (6.5% examined group eyes) were selective damage of contrast sensitivity in 18 cdg connected with increased threshold for blue hue. The second group of 4 eyes (5.2% examined eyes) were characteristic by damage of contrast sensitivity in 12 cdg and increased threshold of red hue on the border of probable protanomaly. The rest 60 eyes (77.9% the examined group) were non-selective in psychophysical tests. In the eyes of that group were stated non-specific dyschromatopsy connected with equal decrease of contrast sensitivity function, with the tendency to serious changes in high spatial frequency.

CONCLUSIONS

Psychophysical tests enable early diagnosis and monitoring of optic nerve damage in multiple sclerosis patients.

[Theoretical and clinical aspects of the use of prostaglandins in glaucoma therapy]

In the first part of the article the main information and recent research on the uveoscleral outflow pathway, including its morphology and physiology were presented. The structure of extracellular matrix of ciliary muscle and the changes of it, that are induced by prostaglandins, resulting in decreasing intraocular pressure were emphasized. In the second part biochemical characteristics of prostaglandin analogues, using nowadays were presented. Their efficacy in reducing intraocular pressure and safety profile were described.

[A multicentre, observative, non-invasive study of the tolerance of NYOLOL gel 0,1% in ocular hypertensive patients]

PURPOSE

To evaluate the safety and efficacy of Nyolol Gel 0,1%/Novartis vs. regular timolol formulation (Ofterisin 0,5%) in ocular hypertensive patients.

MATERIAL AND METHODS

A comparative, multicentred non-invasive, 16-weeks study. 192 glaucoma or ocular hypertensive patients were randomized into 2 groups: patients receiving regular timolol treatment (group I) and patients treated with timolol gel formulation. After 8 weeks of assigned treatment subjects from group I were switched to Nyolol gel and the subjects from group B - to regular timolol respectively. Intraocular pressure (IOP), objective and subjective tolerance of treatment were evaluated.

RESULTS

There were no differences between groups as far as level of IOP was concerned. The incidence of ocular adverse events was higher when patients were switched to timolol aqueous eye drops. Subjective local tolerance of timolol gel formulation was better than conventional eye drops.

CONCLUSIONS

Timolol 0,1% gel formulation with a once daily application provides an IOP reduction equivalent to timolol 0,5% solution given twice a day. Local tolerability and safety of gel formulation is better than aqueous solution, both in the patient's and physician's opinions.

[Influence of topically applied iodides on urinary iodine excretion and thyroid function]

PURPOSE

The present study was undertaken, to evaluate whether ophthalmic drug, containing iodine applied to conjunctival sac might result in a significant increase of urine iodine excretion and thus might be indirectly associated with the risk of iodine-induced hyperthyroidism. The aim of the study was to examine the occurrence of biochemically relevant changes in urine iodine excretion and in thyroid function after topical administration of ophthalmic drug containing iodine.

MATERIAL AND METHODS

In the study twenty-two patients without a history of thyroid disease were examined. The Vitreolent (Ciba Vision) was applied topically to conjunctival sac four times a day for one month. The urinary iodine excretion, using "Rapid Urinary Iodine Test" (Merck KgaA) and parameters of thyroid function (TSH, FT3, FT4) were measured before starting and after therapy.

RESULTS

The data showed, that was a significant increase in urinary iodine excretion at the end of therapy; as far as thyroid function was concerned, neither changes in level of TSH nor thyroid hormones were observed.

[Pathogenesis and management of Grave's ophthalmopathy]

The most recent hypothesis on pathogenesis of Graves' Ophthalmopathy (GO) and short characteristics of the disease was presented. Emphasis was placed on the necessity of coordinated treatment of the thyroid dysfunction and ophthalmopathy. Management of hyperthyroidism and Graves' ophthalmopathy, including the latest methods was described.