Observation and Clinical Pattern in Patients with White Dot Syndromes: The Role of Color Photography in Monitoring Ocular Changes in Long-Term Observation.

BACKGROUND The aim of this study was to assess the clinical course and distinctive features of different white dot syndromes (WDS) in patients attending the Ophthalmology Department, Medical University of Warsaw in the years 1995-2015. MATERIAL AND METHODS Sixty-two (62) patients (43 females and 19 males), aged 18 to 77 years, referred with a WDS were included in this prospective study, with observation period ranging from 5 months to 16 years. All patients underwent a complete ophthalmological examination and multimodal imaging studies. RESULTS In this cohort of 62 patients, the following WDS entities were identified: multifocal choroiditis with panuveitis (MFCPU), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), birdshot, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), subretinal fibrosis and uveitis, multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, and single cases of acute annular outer retinopathy (AAOR). CONCLUSIONS The study was performed at a Polish referral center and may to some extent reflect the varied geographical distribution of white dot syndromes, as none of the subjects was found to suffer from acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), or diffuse unilateral subacute neuroretinitis (DUSN). Long-term follow-up is warranted by the evolution of lesions in the eye fundus, while management depends on correct diagnosis of WDS. When the posterior pole is involved in some cases of the WDS an immunosuppressive treatment, the use of the PDT or anti-VEGF injections were necessary.

Complete recovery of visual acuity as the main goal of treatment in patients with dysthyroid optic neuropathy.

INTRODUCTION: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy. MATERIAL AND METHODS: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA< 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment - intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment - endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment - additional MP therapy and/or surgical decompression. RESULTS: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves' orbitopathy clinical activity score (p = 0.035). CONCLUSIONS: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON.

Clinical analysis of patients with pemphigoid-like ophthalmological symptoms.

PURPOSE: The aim of this study was a clinical analysis of patients with symptoms typical of pemphigoid. MATERIAL AND METHODS: 21 patients were enrolled on the study within the period 1988-2004. The frequency and type of ophthalmological and extraocular symptoms and accompanying diseases were assessed. The analysis also contains immunological findings as well as administered treatment. RESULTS: Ophthalmological changes were detected in 100% of examined patients with pemphigoid. The most frequent were dry eye syndrome and conjunctivitis. Immunohistochemical tests revealed the presence of antibodies in 68.2% of the examined cases. All patients required specific treatment--local, general and surgical. Despite the administered therapy the development of cicatricial changes was observed. CONCLUSIONS: Chronic conjunctivitis and keratitis require diagnostics into pemphigoid. Intensive therapy is necessary in patients with ocular cicatricial pemphigoid (OCP) because of high risk of blindness. Delayed diagnostics disable immunohistochemical confirmation of disease.

[Multifocal choroiditis and panuveitis (MCP)--diagnosis, ocular symptoms and treatment]. / Wieloogniskowe zapalenie naczyniówki i calej blony naczyniowej--diagnostyka, objawy oczne i leczenie.

Multifocal choroiditis and panuveitis (MCP) belong to white dot syndromes, which are an idiopathic inflammatory process damaging the retinal pigment epithelium and choriocapillaris. We observed fourteen patients with typical ocular changes for MCP (panuveitis with typical multiple yellow, white or gray focal lesions in fundus of the eye). In 8 patients typically were observed--glaucoma, cataract, macular edema. We applied topical drops (corticosteroids, antiglaucomatous), and in 5 patients oral encorton was necessary to include.

[Optical coherence tomography in Stargardt's dystrophy]. / Choroba Stargardta w obrazie optycznej koherentnej tomografii.

Stargardt's disease is one of the central retinal dystrophies with its onset in first two decades of life presenting gradual decrease in visual acuity and typical features in fluorescein angiography. The aim of the study was to evaluate the macular area in patients with diagnosed Stargardt's disease with the use of optical coherence tomography. 11 patients (22 eyes) were enrolled to the study. OCT examination revealed characteristic similar features of macular images in all patients. They included decreased thickness of the retina, most prominent in foveola, and changes in external retinal layers: lack of photoreceptors and nuclear external layer and changes in retinal pigment epithelium. Because of typical features in macular appearance, optical coherence tomography may become a useful tool for confirming diagnosis of Stargardt's disease.

[Diagnostics and pharmacological treatment of ocular cicatrical pemphigoid]. / Diagnostyka i leczenie zachowawcze ocznego pemfigoidu bliznowaciejacego.

Ocular cicatricial pemphigoid (OCP) is an autoimmune disease characterize by mucous membrane fibrosis and skin changes resulting with scarring. The pathogenic mechanisms of ocular cicatricial pemphigoid are incompletely understood. Antibasement membrane antibodies which lead to subepithelial blistering, granulation tissue and inflammatory infiltrate formation in the substantia propria are thought to be the main pathophysiological mechanisms in cicatricial pemphigoid. It has been found eosinophils and increased collagen type I and III. Human leukocyte antigen HLA-DR2, HLA-DR4 and DQw7 genotypes have been identified as conferring increased susceptibility to the development of this disease. Ocular cicatrical pemphigoid (OCP) is one of the forms of bullous pemphigoid. Initial symptoms of ocular pemfigoid are not characteristic. Conjunctival fibrosis may cause severe entropion, trichiasis, symblepharon, dry eye syndrome, corneal epithelial erosions or ulceration. Secondary glaucoma is one of the most frequent complications. Ocular cicatricial pemphigoid may be chronic, acute, or subacute disease with periodic exacerbation of conjunctival inflammation. The treatment in this disease are topical drops or ointment (lubricants, corticosteroids, antibiotics, antiglaucomatous). Oral dapsone and corticosteroids may control the activity of the disease. In other progressive cases immunosuppressive drugs must be used (azathioprine, cyclophosphamide, methotrexate, mycophenolan mofetil, daclizumab, intravenous immunoglobulin therapy). To make an early diagnosis of ocular cicatricial pemphigoid, biopsy and immunohistochemical analysis of conjunctiva should be performed in every case of persistent conjunctival inflammation.

[Fungal infections of the eye--current antifungal agents]. / Zakazenia grzybicze narzadu wzroku--wspólczesne leki przeciwgrzybicze.

Antifungal agents used in ocular infections are presented. The most common etiology of fungal infections is described. Mechanisms and range of action, available drugs and the latest groups of antifungal agents during clinical trials are presented.