Progressive outer retinal necrosis syndrome in the course of systemic lupus erythematosus.

Progressive outer retinal necrosis syndrome (PORN) is a severe clinical variant of necrotizing herpetic chorioretinitis, which occurs almost exclusively in patients with advanced acquired immunodeficiency syndrome (AIDS). To date, only a few cases of PORN have been reported in patients, mostly among those who were immunocompromised. To our knowledge, only one case of PORN in a patient with systemic lupus erythematosus (SLE) has been described. We report the case of a 44-year old HIV-negative patient with lupus nephritis, whom was being treated by mycophenolate mophetil (MMF), arechin and prednisone. After 14 months of MMF therapy, the patient revealed PORN symptoms; and several months later, the patient developed Type B primary central nervous system lymphoma (PCNSL). PORN is usually compared to acute retinal necrosis (ARN) syndrome, because of having the same causative agent: varicella zoster virus (VZV). There are also some similarities in clinical findings. Our observation supports the hypothesis that PORN symptoms in HIV-negative patients can be an intermediate form between ARN and PORN, and can vary according to the patient's immune status.

Progressive outer retinal necrosis in immunocompromised kidney allograft recipient.

Ocular complications in patients who underwent renal transplantation are attributed to side effects of the immunosuppressive regimen. Progressive outer retinal necrosis (PORN) syndrome is a clinical variant of necrotizing herpetic retinopathy and it occurs almost exclusively in patients with acquired immunodeficiency syndrome. We present a case of a human immunodeficiency virus-negative patient who underwent renal transplant and, after a few years, developed bilateral PORN associated with viral infections. Varicella zoster virus (VZV) and BK virus were identified by polymerase chain reaction from the vitreous fluid. It is unclear which of the viruses identified had the dominant role in the pathogenesis of PORN and other organ damage, or whether their actions were synergistic. Adequate antiviral immune surveillance, as well as pre-transplant vaccination against VZV, may reduce the incidence of VZV infection and its complications.

The role of inflammation in the progression of ocular surface damage in children following allogeneic haematopoietic cell transplantation.

The aim of the study was to evaluate HLA-DR expression and cellular morphology of the conjunctival epithelium cells in children who underwent haematopoietic cell transplantation, and to assess the relation between HLA-DR expression and cellular morphology. Impression cytology with staining was used to visualize epithelium cells, whereas immunohistochemistry was applied to assess HLA-DR expression. Elevated HLA-DR expression and increased cytological abnormalities were observed in the study group when compared to the controls. An increase in HLA-DR expression was accompanied by a decrease in the number of eyes with normal epithelium morphology together with the increase in squamous metaplasia features. We can conclude that inflammation of conjunctiva can follow stem cell allotransplantation. Ocular surface inflammation may lead to squamous metaplasia of the conjunctiva.

[Pharmacodynamics and pharmacokinetics of prostaglandins and their derivates in eye tissues]. / Farmakokinetyka i farmakodynamika prostaglandyn i ich pochodnych w tkankach oka.

This paper presents the classification of prostaglandins and their receptors. The ocular distribution of the receptors and the effects of their agonists are presented. The efficacy in lowering intraocular pressure of different prostaglandins and their derivatives, especially the PGF2a group, is discussed. The history of latanoprost development is also presented. Good therapeutic index characterises two antiglaucomatous PG-derivatives: latanoprost and unoprostone.

[Goniodysgenesis associated with Rubinstein-Taybi syndrome]. / Goniodysgeneza w zespole Rubinsteina-Taybiego.

Rubinstein-Taybi syndrome is a constellation of clinical findings characterized by mental and motor retardation, broad thumbs and broad first toes, typical facies. Ocular and adnexal abnormalities are quite common and include antimongoloid slant of the palpebral fissures, epicanthal folds, congenital obstruction of the lacrimal excretory system, ptosis, strabismus, congenital cataract and congenital glaucoma. The authors describe the case of a 1-year-old male with the Rubinstein-Taybi syndrome associated with unilateral congenital glaucoma. The case emphasizes the importance of detailed complete ocular examinations in patients with Rubinstein-Taybi syndrome, and also highlights the occurrence of ocular abnormalities rarely associated with this disease.

[Purtscher's retinopathy--anatomic and pathogenic determinants in the evolution of the disease]. / Retinopatia purtschera--uwarunkowania anatomiczne, patogeneza i ewolucja choroby.

The paper presents the cases of bilateral acute ischaemia in the central and peripapillary retina during acute pancreatitis. The authors discuss the typical clinical picture, natural history of the disease and possible pathogenical mechanisms of the embolisation of terminal retinal arterioles.

[Cataract surgery in adults and children with chronic uveitis]. / Chirurgia zacmy u doroslych i dzieci z przewleklym zapaleniem blony naczyniowej.

PURPOSE: To present preoperative strategies and results of cataract surgery in patients with different types of uveitis. PATIENTS AND METHODS: The results of 18 cases of extracapsular cataract extraction with or without intraocular lens implantation were retrospectively analysed. Age of patients ranged from 10 to 71 years (mean age: 35 years). Etiology of uveitis was determined in 10 cases (63%). Preoperative management was determined by the diagnosis of uveitis. The postoperative observation time ranged from 3 years to 6 months (mean: 25 months). RESULTS: Visual acuity improved postoperatively in 17 eyes (96%), and was better than 0.5 in 10 eyes (63%). The reasons for lower visual acuity were: cystoid macular edema in 6 cases (33%), band keratopathy, amblyopia and floaters in the vitreous. CONCLUSIONS: Establishing the diagnosis and controlling the inflammation pre- and postoperatively are the basic conditions for the surgical outcomes in cataract surgery in patients with history of uveitis.

[Primary open angle glaucoma,age and age-related cardiovascular disease risk factors]. / Jaskra pierwotna otwartego kata a wiek i zwiazane z nim czynniki ryzyka krazeniowego.

The authors present current opinions about influence of age and different cardiovascular and rheological risk factors on POAG and normal tension glaucoma (NTG), especially in age-related diseases: systemic hypertension and hypotension, nocturnal systemic hypotension, diabetes, obesity and high blood viscosity. The work points out the importance of cooperation between ophthalmologist and specialist of internal medicine in treating patients with POAG and NTG.

[Flash electroretinography and pattern-type visual evoked potentials in early glaucoma]. / Elektroretinogram blyskowy i wzrokowe potencjaly wywolane typu pattern we wczesnej neuropatii jaskrowej.

PURPOSE: The aim of this prospective study was to evaluate diagnostic sensitivity of flash-erg, oscillatory potentials (OPs), and pattern-visual evoked potentials (pVEP) in early glaucoma. MATERIAL AND METHODS: Erg, OPs and pVEP were registered in 416 eyes primary open angle glaucoma (120 eyes), normal tension glaucoma (137), ocular hypertension (74), glaucoma-like discs (86) in age-matched groups, by Tomey 400. RESULTS: There were no statistically significant differences between parameters of flash-erg and pVEP of examined population and control group. Significant reduction in OPs amplitude in NTG patients were found. CONCLUSIONS: Flash erg and pVEP have low diagnostic value in early glaucoma. OPs could be useful in scientific research on pathogenesis of glaucomatous neuropathy.

[Coexistence of migraine and glaucoma-like visual field defects]. / Wspólistnienie migreny i jaskropodobnych zmian w polu widzenia.

PURPOSE: Functional and morphological evaluation of the optic nerve heads in patients suffering from migraine. MATERIAL AND METHODS: 21 patients--13 women and 8 men (mean age 40 +/- 10) with neurologically confirmed diagnosis of common and classic migraine were examined. The headache history was obtained by standard questions. The patients suffered from migraine from 2 to 30 years and the frequency of attacks was from < 10 to > 100/year. Ophthalmologic examination involved evaluation of visual acuity, anterior segment, irido-corneal angle, retina and optic disc. In all cases optic disc photography, diurnal tension curve and two central visual field examinations with Octopus 101 programm G2 were performed. RESULTS: In all cases IOP was normal (< 21 mm Hg). In 4 eyes (2 patients) there was early glaucomatous-like damage of the optic disc, without visual field defect. In most of these patients the optic nerve head looked normal, in part of them slightly pale. In 28% patients glaucomatous-like visual field defects were found (MD-3.9 dB to 6.6 dB). There was statistically significant relationship between increase of MD and frequency of migraine attacks (Mann-Withney U test, a = 0.05). CONCLUSIONS: Static perimetry of the central visual field has high diagnostic value in ocular vasospastic syndrome. Functional dysregulation of the optic nerve head circulation in patients with migraine might be involved in the pathogenesis of normal-tension glaucoma.

[Results of screening for primary glaucoma from data in materials from the Medical Diagnostic Center DOLMED in Wroclaw]. / Wyniki badan przesiewowych w kierunku jaskry pierwotnej w materiale Dolnoslaskiego Centrum Diagnostyki Medycznej DOLMED we Wroclawiu.

PURPOSE: The aim of this study was to estimate the prevalence of morphological signs of glaucomatous optic neuropathy (GON) and IOP > 21 mm Hg in adult population. MATERIAL AND METHODS: The retrospective epidemiologic study of 11,989 persons (mean age 37.7 years +/- 11.6) was based on data of Medical Diagnostic Center DOLMED in Wroclaw. IOP was measured by air-push tonometer and optic disc was estimated in direct ophthalmoscopy. RESULTS: GON was found in 0.92% and IOP > 21 mm Hg in 30.81% of the examined population. About 50% of GON was found in the group with normal IOP. The positive correlation was proved between GON and age. Mean IOP and prevalence of GON was not significantly different between the sexes and between right and left eyes. CONCLUSION: Screening of primary glaucoma should be based on stereoscopic examination of optic disc. High values of IOP should be verified. Raised IOP should be estimated as a risk factor of POAG.

[Investigations correlating age and selected vascular risk factors in primary glaucoma based on screening data the Medical Diagnostics Center DOLMED in Wroclaw]. / Badania korelacji wieku i wybranych krazeniowych czynników ryzyka z cechami jaskry pierwotnej na podstawie wyników badan przesiewowych przeprowadzonych w Dolnoslaskim Centrum Diagnostyki Medycznej DOLMED we Wroclawiu.

AIM: The purpose of the study was to investigate the associations of glaucomatous optic neuropathy (GON) features and level of IOP with age and selected cardiovascular risk factors: systolic and diastolic blood pressure (BPs and BPd), heart rate, hematocrit and cholesterol level, diabetes, body mass index. MATERIAL AND METHODS: The retrospective study of 11,989 persons (mean age 37.7 years +/- 11.6) was based on data of Medical Diagnostic Center DOLMED in Wroclaw. All data were analysed statistically. RESULTS: Positive statistically significant correlation was found between BPs, BPd, cholesterol level and GON. Significant differences were proved in the BPs/IOP and BPd/IOP rations and the groups with and without GON. Mean IOP was higher in the group with GON. Positive relationship was found between cardiovascular risk factors and IOP level. There was no positive correlation between level of IOP and age of the analysed group.

[Current theory on mechanical damage in glaucomatous optic neuropathy]. / Wspólczesne rozumienie teorii mechanicznego uszkodzenia nerwu wzrokowego w jaskrze.

The paper presents the contemporary interpretation of mechanically theory of glaucomatous optic neuropathy (GON). The authors explained influence of high intraocular pressure on morphology of lamina cribrosa in vivo and in vitro experiments, extracellular matrix of the optic nerve, retinal ganglion cells and nerve fibers within the optic nerve head.

[Early diagnosis of optic nerve neuropathy in multiple sclerosis]. / Wczesne rozpoznawanie uszkodzenia nerwu wzrokowego w przebiegu stwardnienia rozsianego.

PURPOSE: To evaluate diagnostic sensitivity of clinical tests in optic demyelinating neuropathy. MATERIAL AND METHODS: We examined 21 persons (38 eyes) with confirmed sclerosis multiplex (SM) with no episodes of posterior optic neuritis in the history of the disease. The examination method included: Static perimetry of central visual field (30 degrees, by Octopus 101), pattern visual evoked potentials (p VEP), colour photographs of optic disc and magnetic resonance imaging (MR) of central nervous system, optic nerves and optic chiasm. Visual acuity and colour vision were normal. RESULTS: There was statistically significant elongation in the latency of P 100 in pattern VEP (> 118 ms, 3 x SD), and significant reduction in mean light sensitivity (MS) in central visual field. MRI revealed demyelinisation in cortex and/or spinal cord of all patients and demyelinating lesion in optic nerve of one patient. There was no Gd-DTPA enhancement. In statistical analysis there was no correlation between results of pattern VEP, IMR, morphology of optic disc, and duration of SM, stage of the disease (in Kurtzke gradation scale) or age of patient. In regression analysis there were statistically significant relationships (p < 0.05) between results of central static perimetry, duration and stage of disease.

[Central visual field in patients with multiple sclerosis without symptoms of optic neuritis]. / Ocena centralnego pola widzenia u pacjentów ze stwardnieniem rozsianym bez klinicznych objawów neuropatii nerwu wzrokowego.

PURPOSE: To estimate central visual field (30 degrees) of patients suffering from multiple sclerosis (SM). SM was confirmed by magnetic resonance imaging. MATERIAL AND METHODS: There was no posterior optic neuritis in the history of the disease. The visual acuity of examined the 28 eyes was 1,0. The results of static perimetry were analysed by regression analysis. RESULTS: There were significant relationships between mean sensitivity (MS) and duration of the disease, stage of the disease (in Kurtzke gradation scale) and age. Mean defect (MD) was significantly higher in the upper half of central visual field and between 15-30 degrees (p < 0.05). We observed positive relationships between MD, short time fluctuation (STF) and corrected loss variance (CLV). We found negative correlations between MS, MD, CLV and STF. Mean reliability factor RF was < 10%. CONCLUSION: Static perimetry seems to be a useful test in early diagnosis and monitoring of optic nerve neuropathy in SM.

[Incidence of and treatment outcome for diabetic maculopathy--material from the Eye Clinic in Wrocçaw in 1991-1994]. / Czestosc wystepowania i wyniki leczenia makulopatii cukrzycowej--material Kliniki Okulistyki we Wroclawiu w latach 1991-1994.

PURPOSE: To evaluate the incidence of ME, its characteristics, and results of its treatment with laser coagulation. MATERIAL AND METHODS: In the analysed group there were 478 subjects with diabetes mellitus--84 with a diagnosis before 30 years of age and 394 with a diagnosis at 30 years of age or older. In the older-onset group there were 64% taking insulin. Mean age of the group was 61 years and mean period of duration of diabetes was 16 years. The methods of ophthalmological examination included stereoophthalmoscopy and fluorescein angiography. In 845 examined eyes there were 832 eyes with mild-to-severe nonproliferative and moderate-to-high risk proliferative diabetic retinopathy. RESULTS: The incidence of macular edema was 81.6%. These data suggest high incidence of macular edema and its high severity (V < 0.2 = 47%) over the 15-years period of duration of diabetes. Treatment included focal coagulation, macular grid and PRK performed with argon laser. CONCLUSION: The results of laser coagulation demonstrated that focal photocoagulation was effective in reducing the risk of moderate visual loss. When macular edema was more severe, macular grid before scatter (panretinal) photocoagulation for proliferative retinopathy decreased the frequency of persistent ME.

[Panretinal photocoagulation with argon laser--material from the Eye Clinic in Wroclaw in 1991-1994]. / Fotokoagulacja obwodu siatkówki laserem argonowym w retinopatii cukrzycowej--material Kliniki Okulistyki we Wroclawiu w latach 1991-1994.

PURPOSE: To evaluate the results of PRK performed between 1990 and 1994 in Wroclaw University Eye Clinic. MATERIALS AND METHODS: PRK was performed in 630 eyes with: (1) PDR--451 immediately treated eyes (moderate PDR--184 eyes, with "high-risk" characteristics--227 eyes, PDR advanced--after cryopexion--40 eyes); (2) severe NPDR--119 eyes (with PDR in fellow eye or with ME) and (3) less severe DR--60 eyes treated with immediate or delayed, full or mild scatter coagulation (with macular edema, both eye moderate NPDR, other systemic risk factors). Follow-up treatment: Additional scatter or local photocoagulation was performed in 34 cases increasing activity of neovascularisation or increase in frequency/extend of vitreous hemorrhage. RESULTS: In a period 3 to 36 months of follow-up (mean period = 25 months) in the group of 451 eyes with PDR 28.2% of eyes showed visual improvement, 48.3% of eyes showed no change and 23.5% of eyes worsened. In the group of 119 eyes with severe NPRD 75.6% showed visual improvement and 24.4% showed no change. In the group of 60 eyes with less severe DR 27.8% showed improvement, 36.7% showed no change and 35.5% worsened. CONCLUSION: Our results are relatively good and in agreement with other studies.