Secondary Neovascular Glaucoma in the Course of Diabetes in a Kidney Transplant Recipient: Case Report and Review of the Literature.

BACKGROUND: The increase in intraocular pressure during hemodialysis challenges nephrologists and ophthalmologists. It most often affects patients with previously diagnosed glaucoma and is particularly dangerous in the setting of diabetic retinopathy. Hypoperfusion and hypoxia of the retina may occur, leading to pathologic neovascularization in the retina and the anterior chamber angle. Changes in the filtration angle block the outflow of aqueous humor and cause secondary glaucoma. A special type of glaucoma is neovascular glaucoma, developing among others in patients with diabetic retinopathy. This study describes a patient with secondary neovascular glaucoma in whom a significant increase in intraocular pressure was observed during hemodialysis, not responding to the applied topical treatment. METHODS: The patient experienced severe pain, and her cornea was constantly injured by paracentesis. Ultimately, secondary glaucoma led to a significant decrease in vision in both eyes. The patient was enrolled on a transplant waiting list and transplanted with priority. RESULTS: The patient experienced some urologic and infectious complications, although 7 months after transplantation, her creatinine concentration was 1.2 mg/dL, and the ocular disease was stabilized. The intraocular pressure decreased, but there were still values above the norm, which required periodic injections of anti-vascular endothelial growth factor into the vitreous chamber and 5-fluorouracil injections under the conjunctiva. CONCLUSIONS: Patients with diabetes and secondary neovascular glaucoma on dialysis constitute an extremely difficult therapeutic problem and require the involvement of several specialists. Successful kidney transplantation, besides ameliorating general clinical conditions, may increase the chance of successful ophthalmologic treatment.

[Metallic foreign bodies in the orbit]. / Metaliczne cialo obce oczodolu.

Authors present a case of metallic foreign bodies (part of the hammer) in apex of the orbit in a 57-year-old man. In CT scan it was localized between rectus lateral muscle and optic nerve. We remove it through transantral approach. We discuss about diagnosis and indication to transnasal and transsinusal (trough maxillary and ethmoidal sinuses) approaches to the retrobulbar part of the orbit.

[Vitreous hemorrhages in proliferative diabetic retinopathy treated with pars plana vitrectomy--own material]. / Wylewy krwi w przebiegu proliferacyjnej retinopatii cukrzycowej leczone metoda witrektomii przez pars plana--material wlasny.

UNLABELLED: The paper presents the retrospective analysis of diabetic patients with vitreous hemorrhage due to proliferative retinopathy treated surgically with vitrectomy at the Department of Ophthalmology, Medical University of Gdansk in 2008-2010. The aim of the study was to evaluate the effect of tamponade and antiplatelet/anticoagulation treatment on the recurrence of vitreous hemorrhage. MATERIAL AND METHODS: the pars plana vitrectomy was performed in 68 diabetic patients (76 eyes) with vitreous hemorrhage secondary to proliferative retinopathy. Multiple pars plana vitrectomy was performed in 4 patients, both eyes were operated in 8 patients. The patients' age ranged from 27 to 87 years. The correlation between the duration of insulin therapy, degree of disease progression, antiplatelet/anticoagulation treatment, the time since the last vitrectomy, type of vitreous tamponade, and the recurrence of hemorrhages were evaluated. The follow-up was 12 months. RESULTS: overall, 83 pars plana vitrectomy procedures were performed. Silicone oil was used in 42 procedures, and expandable gas in 9 cases. 32 eyes were left without any tamponade. During the follow-up the vitreous hemorrhage reoccurred in 10 cases -including 5 eyes left without the tamponade, 4 eyes with gas tamponade and 1 eye with silicone oil tamponade. CONCLUSIONS: pars plana vitrectomy with silicon oil tamponade ensures the effective hemostasis in patients with proliferative diabetic retinopathy.

Detachment of the choroid after strabismus surgery in high myopia.

We present a case of 60 years old woman, who underwent strabismus surgery due to cosmetically disturbing large divergent strabismus. Before surgery we found exotropia of the LE of 40 PD with hypotropia of 15 PD. Patient had surgery of convergent strabismus on this eye in childhood. LE was amblyopic since childhood, BCVA = 1/50, with moderate axial myopia and astigmatism (-2.75/-2.0 ax 165). We performed lateral rectus recession of 8 mm and medial rectus anteposition of 2 mm with simultaneous vertical transposition of these muscles 7 mm upwards. Despite special attention during scleral pass of the needle due to thin myopic sclera, a single microperforation occurred, followed by seemingly insignificant vitreal flow. On the next day after surgery horizontal orthoposition was achieved with reduction of hypotropia to 7 PD. However, we found small vitreal hemorrhage and significant retinal folding. On USG exam we found large choroidal detachment in all quadrants. As there was possibility of simultaneous retinal detachment, patient was hospitalized in Department of Ophthalmology of Medical University of Gdansk, where conservative treatment was applied and retinal detachment excluded. Four weeks after surgery complete choroidal attachment was achieved.

[Photodynamic therapy with verteporfin in treating the choroidal neovascularisation secondary to multifocal choroiditis]. / Terapia fotodynamiczna z uzyciem verteporfiny w leczeniu neowaskularyzacji podsiatkówkowej w wieloogniskowym zapaleniu blony naczyniowej.

Apart from AMD and pathologic myopia the posterior uveitis is the most common pathology being the cause of secondary choroidal neovascularisation (CNV). For many years the method of choice in treating those pathologies was the theramal laser photocoagulation with obvious limitations in the cases of subfoveal CNV. The implementation of PDT modality to every day's clinical practice expanded the range of CNV treatment methods. The following case report shows the results of treating the CNV secondary to multifocal choroiditis with PDT. During the 6 months of follow-up period we consider PDT as an effective, safe modality in treating the CNV secondary to inflammation. In the result of single PDT therapy the VA improvement of 4 ETDRS lines and it's stabilization on the level of 20/25 with the decrease of metamorphopsia was gained.

[Vitreoretinal surgery in ocular trauma]. / Zastosowanie chirurgii witreoretinalnej w urazach oczu.

PURPOSE: This retrospective study was undertaken to review the structure of patients that admitted to the hospital during one year, due to the different types of ocular trauma as well as to analyze the rate of the vitreo-retinal procedures being employed to treat those patients. MATERIAL AND METHODS: As many as 1212 consecutive patients (1252 eyes) submitting to the out-patients Department of Ophthalmology of the Medical University Hospital in Gdansk between the 1st of January and the 30th of December 2004, presenting with eye injury were evaluated. The majority of the patients were males (746) with the mean age of 46.8 years. The females in the number of 466 were 48,5 years old in average. In 40 cases of ocular trauma both eyes were affected. The routine ophthalmologic examination was provided including the anamnesis and collecting the information regarding the circumstances of the injury. The ultrasound (USG) examination, fluorescein angiography (FA) and CT scan was provided when the intraocular foreign body (IOFB), the macular hole or uveal rupture were suspected. THE RESULTS: Most of the patients who admitted to the Clinic were applied the first aid and dismissed. That referred to 1210 of 1252 eyes. In 42 cases patients were hospitalized: 5 eyes received standard treatment while 37 eyes were operated. Twenty five eyes required vitreoretinal surgery - pars plana vitrectomy (PPV) due to the IOFB (6/25), vitreous hemorrhage (2/25), retinal detachment (10/25), dislocation of the lens (4/25) and the uveitis (3/25). CONCLUSIONS: PPV revealed to be the most effective modality used for treating the most severe eye injuries. The analyze included the cases treated in one year time only, as the strategies of treatment tend to change in time as well as the techniques of operation. The time of observation was limited to 12 month additionally in purpose to make comparison easier in the different Polish centers surveys, regarding the treatment of mechanical eye injuries.

[Serum lipid profile in non-exudative AMD patients treated with locally administrated beta-blockers]. / Lipoproteiny osocza chorych z niewysiekowa postacia AMD leczonych miejscowo betablokerami.

Reduced perfusion in the choroidal vessels has been proposed as the vascular pathogenesis for AMD. As no specific therapy is currently available, the authors decided to evaluate the possible benefits of topically administrated betaxolol in non-exudative AMD patients. 114 randomly selected patients with NE AMD was divided into 2 groups: group I (64 patients) and group II (50 patients). The subjects in group I have been treated with topical 0.5% betaxolol, while in the group II with artificial tears twice daily for one year. None of the patients had received prior topical or systemic treatment lowering IOP. The subjects in both groups had follow-up for 1 year, during which lipoproteins' profile sampling was performed twice at baseline and after 52 weeks. Both, baseline and outcome measures included: complete ophthalmologic examination. The changes in serum lipoproteins levels varied, but the statistical analyze did not show the significant differences.

[Vitrectomy with daunorubicin]. / Witrektomia z daunorubicyna.

PURPOSE: The vitreoretinal re-proliferations (PVR) are the most eminent cause of retinal surgery misfortunes. Daunorubicin has been widely discussed as the antimetabolic drug for PVR treatment for recent 20 years. The aim of the study was to evaluate the usefulness of daunorubicin, applied intravitreally during vitrectomy, as an antiproliferative factor stopping the vitreoretinal re-proliferations in eyes with rhegamatogenous retinal detachment complicated with PVR. MATERIAL AND METHODS: Vitrectomy, with daunorubicin infusion (1 microg/ml), was performed in 6 eyes with rhegamatogenous retinal detachment and PVR. In 6 other cases of retinal detachment, the gentamycine (20 mg/ml) solution was used as a vitrectomy infusion. During the 12 months follow-up, the risk of PVR relapse was evaluated. RESULTS: There was no signs of PVR relapse in the eyes treated with daunorubicin during the 12 months follow-up. As in the group of patients that had no daunorubicin infusion the PVR re-proliferation occurred in 2 of 6 operated eyes. CONCLUSIONS: 12 months follow-up showed that Daunorubicine could be a useful adjuvant drug reducing the rate of re-proliferations in the patients with rhegamatogenous retinal detachment.