What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review.

Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.

Electro-oculogram in patients with neurofibromatosis type 1.

PURPOSE: The electro-oculogram (EOG) is a powerful test to evaluate the functional status of the retinal pigment epithelium (RPE). Clinically detectable changes of the RPE desribed in neurofibromatosis type 1 (NF-1) patients include combined hamartoma of the retina/RPE and congenital hypertrophy of the RPE. The goal of this study was to determine whether the function of RPE as measured by EOG is also changed in individuals with NF-1. PATIENTS: Studies were undertaken in 20 patients with clinically diagnosed NF-1 and compared to 16 normal healthy controls. METHODS: Standard EOG and flash ERG recordings were performed in accordance with International Society for Clinical Electrophysiology of Vision (ISCEV) standards. RESULTS: In NF-1 patients the Arden indexes of the EOG test were significantly higher primarily due to the lower values of dark troughs. Supernormal EOGs were present in 60% of NF-1 patients in comparison to the control group mean +2 SD. No one patient showed so high abnormalities during flash ERG examination. CONCLUSIONS: Dysfunction of the RPE may be characteristic feature of individuals with NF- 1.

[Assessment of foveal function in eyes of patients with exudative age-related macular degeneration before and after argon laser treatment]. / Ocena funkcji dolka w oczach z wysiekowa postacia zwyrodnienia plamki zwiazanego z wiekiem pacjentów przed i po leczeniu laserem argonowym.

PURPOSE: 1. Can foveal cone electroretinogram (FCERG) be a useful diagnostic test in evaluation of efficacy of argon laser treatment in eyes with exudative (wet) age-related macular degeneration (AMD)? 2. Comparison of FCERG with visual acuity, static perimetry and fluorescein angiography results. MATERIAL AND METHODS: FCERGs were recorded from 30 eyes with mean visual acuity 0.6 (Snellen Table) of 20 patients (mean age: 61 years) with wet AMD. The fovea was stimulated with 5-degree flickering light spot (f = 31.25 Hz), surrounded by a 20-degree annulus of intensive steady retinali illuminance. FCERGs were recorded and analysed in amplitude according to the computer-aided method recently put in practice in our laboratory. FCERGs were obtained twice for each AMD patients: before and 3 months after argon laser treatment. Electrophysiological data were also compared with the results of fluorescein angiography, visual acuity and static perimetry. RESULTS: In the group of patients with wet AMD, significant increase of FCERG amplitude (p < 0.001) after laser treatment was obtained in group I (33% of analysed eyes) and there were mainly patients with extrafoveal choroidal neovascularisation (CNV). Significant decrease of FCERG amplitude (p < 0.01) was obtained in group II (67% of analysed eyes). These were mainly patients with subfoveal CNV and also with extrafoveal CNV. In both groups after laser treatment we did not receive significant changes in visual acuity and macular perimetric mean sensitivity. CONCLUSIONS: These findings suggest that foveal cone ERG can be a useful, independent from fluorescein angiography, test for objective evaluation of efficacy of argon laser treatment in patients with wet AMD, opposite to visual acuity and static perimetry (macula threshold) examinations. FCERG probably indicates patients with better or worse prognosis.

[Evaluation of the influence of tobacco smoking on pulmonary function in youg men]. / Ocena wplywu palenia tytoniu na czynnosc ukladu oddechowego u mlodych mezczyzn.

UNLABELLED: According to WHO estimates in the early 1990s there were around 1.100 million smokers in the world, about one third of the global population over 15 years of age. The aim of the study was to evaluate tobacco influence on pulmonary function tests in young healthy men. The study was performed on 3004 subjects 18-23 years old. The subjects were divided into two groups, smokers (S n = 1726) and non-smokers (NS n = 1278). Each subject had spirometry and body pletysmography done. The analysis of influence of smoking on pulmonary function tests showed statistically significant decrease of TLC, FEV1, FEV1%/VC, PEF and FEF50 in the smokers' group. Percentage of people with airflow limitation (FEV1%VC < 85% N, FEV1 < 80% N, FEF50 < 70% N) was two times higher than in the non-smokers' group. IN CONCLUSION: smoking significantly increases the number of subjects with airflow limitation among healthy young males in Poland.

[Negative-type flash electroretinogram]. / Negatywny elektroretinogram blyskowy.

The authors explain the entity of the negative-type flash electroretinogram (negative ERG), its morphology and origin. They also describe some retinal diseases and syndromes with this type of ERG. On the basis of the literature and own experiences the authors emphasize its diagnostic and prognostic value.

[Adhesion molecules LFA-1(CD-11a), Mac-1(CD-11b) of t-lymphocytes in bronchoalveolar lavage fluid and blood in patients with chronic respiratory tract disease]. / Czasteczki adhezyjne LFA-1(CD11a), Mac-1(CD11b), ICAM-1(CD54) limfocytów T pochodzacych z plukania oskrzelowo-pecherzykowego i krwi u chorych na przewlekle choroby ukladu oddechowego.

Adhesion molecules play an important role in inflammatory processes and influence on recruitment of effector cells. The aim of our study was to assess the percentage of T-lymphocytes expressing LFA-1, Mac-1 and ICAM-1 in bronchoalveolar fluid (BALF) and blood of patients with sarcoidosis, atopic bronchial asthma and chronic bronchitis. The reference group consisted of patients with haemoptysis or suspected of having bronchial carcinoma. Expression of adhesion molecules was revealed by /APAAP/ alkaline phosphatase anti alkaline phosphatase method. The highest percentage of lymphocytes expressing all adhesions molecules in BALF and blood was observed in patients with chronic bronchitis. Reductions of T-cells in BALF of patients with bronchial asthma and sarcoidosis may reflect of their direct binding in inflammatory sites. This studies confirm the involvement of adhesion molecules in maintenance of chronic inflammatory processes in the respiratory tract.

[Efficacy of the FLUTTER VRP1 device for physiotherapy patients with chronic pulmonary disease]. / Przydatnosc przyrzadu flutter VRP1 w rehabilitacji chorych na przewlekle choroby ukladu oddechowego.

Respiratory physiotherapy is essential to the treatment of all acute or chronic respiratory disorders which expectoration difficulties are major problem. The Flutter VRP1 is an easy to use physiotherapy device; combines safe endobronchial positive expiratory pressure with vibratory effects. Flutter is a useful device for sputum expectoration and markedly improvement of lung parameters.

[Oscillatory potentials in electroretinographic evaluation of retinal function in insulin-dependent diabetics without retinopathy]. / Potencjaly oscylacyjne w elektroretinograficznej ocenie funkcji siatkówki u pacjentów z cukrzyca insulinozalezna bez objawów retinopatii.

PURPOSE: Can oscillatory potentials be a useful method for detection of retinal dysfunction in insulin-dependent diabetics without retinopathy? MATERIAL AND METHODS: In this study scotopic oscillatory potentials (OPs) were obtained in 35 subjects (70 eyes) with insulin-dependent diabetes without retinopathy (mean disease duration--5 years) and in 15 healthy subjects (30 eyes). This examination was performed according to the recommendations of the International Society of Clinical Electrophysiology of Vision (ISCEV). The oscillatory potentials were extracted from the maximal combined response by high-pass filtering. We analysed amplitude and peak-latencies of the first three electroretinographic oscillatory potentials O1, O2, O3, index of wavelets [sum of amplitudes (O1 + O2 + O3)] and compared with the results of the control group. RESULTS: In group of patients with insulin-dependent diabetes without retinopathy, we received statistically significant reduction of amplitude O1 (p < 0.003) and index of wavelets (p < 0.04). Reduced amplitude O1 was obtained in 10%, index of wavelets in 31.4% of analysed eyes. We didn't observe statistically significant changes in amplitudes O2, O3 and latencies O1, O2, O3. CONCLUSIONS: Our results suggest that retinal dysfunction is present in insulin-dependent diabetics without retinopathy 5 years after onset of the disease. The sum of amplitudes (O1 + O2 + O3) was the most sensitive parameter of retinal abnormalities. It seems reasonable to have more frequent ophthalmological examination of the diabetics with abnormal oscillatory potentials.

[Visual evoked potentials in diagnosis and monitoring of optic neuropathy in the course of thyroid ophthalmopathy]. / Wzrokowe potencjaly wywolane w diagnostyce i monitorowaniu neuropatii nerwu wzrokowego w przebiegu oftalmopatii tarczycowej.

PURPOSE: To evaluate the usefulness of pattern visual evoked potentials (PVEP) in early diagnosis and monitoring of dysthyroid optic neuropathy (DON). MATERIAL AND METHODS: We recorded PVEP (UTAS E--1000) in 74 patients with thyroid ophthalmopathy (TO) including 12 patients with clinically evident DON--group I, 13 patients with subclinical DON (prolongation of latency of P100 wave in PVEP)--group II, and 49 patients without clinical or electrophysiological signs of DON--group III. Thirty six healthy subjects served as controls. The latencies of P100 and N75 waves were examined. In 50 TO patients we recorded changes in PVEP before and after treatment. RESULTS: The mean LP100 and LN75 were significantly longer in TO patients compared to control group. In groups I and II they were also significantly longer in comparison to group III. We observed prolongation of LP100 above the upper limit of normal values in all patients with clinically evident DON and in 13/62 (21%) cases without clinical signs of optic nerve dysfunction. The prolongation of LP100 was present in 16/21 (76.2%) eyes in group I and in 15/26 (57.7%) eyes in group II. Prolongation of LN75 was less frequent: group I--5/21 (23.8%), group II--2/26 (7.7%). After treatment in patients with clinically evident DON the latencies of both waves were significantly shorter in comparison to values obtained before therapy. In group II statistically significant differences were observed only in LP100. The percentage of eyes with prolonged latencies was significantly smaller after treatment (group I: LP100--3/23 (13.0%), LN75--1/23 (4.3%); group II: LP100--2/18 (11.1%), LN75--no prolongation was observed). CONCLUSIONS: PVEP is an useful method in diagnosis and monitoring of dysthyroid optic neuropathy. It can reveal even asymptomatic optic nerve dysfunctions. Detection of subclinical neuropathy using PVEP enables early--thus more effective--treatment. The most important factor in PVEP evaluation is the latency of P100 wave, the latency of N75 wave is less useful.

[Implantation of posterior chamber lenses with trans-scleral fixation]. / Wszczepy soczewek tylnokomorowych mocowanych do twardówki.

PURPOSE: The aim of this study is the presentation of our experiences in implantations of posterior chamber lenses with transscleral fixation. MATERIAL AND METHODS: The surgery was performed in 66 patients (66 eyes) using modified technique described by Lindquist et al. Primary implantations were performed in 53% subjects, in the remaining secondary implantations. RESULTS: After surgery we achieved visual acuity improvement in 80.3%, good visual acuity (0.5-1.0) in 68.4% of subjects. The main postoperative complications were: deformation of the pupil and decompensation of corneal endothelium. CONCLUSIONS: Implantation of posterior chamber lenses with transscleral fixation is preferable (alternatively for anterior chamber lenses) in young patients as well as in subjects with glaucoma, elevated intraocular pressure, iris coloboma and corneal problems.

[Foveal electroretinogram: its application in the diagnosis of macular diseases. Preliminary report]. / Elektroretinogram dolkowy--zastosowanie w diagnostyce chorób plamki. Doniesienie wstepne.

PURPOSE: To present difficult method of recording and analysis of the Foveal Cone Electroretinogram (FCERG, a type of focal ERG) for evaluation of foveal cone function in healthy subjects and patients with different macular diseases. The FCERG signal is of great importance in diagnosis of these diseases because the full-field ERG is dominated by the extrafoveal cones activity. MATERIAL AND METHODS: In this study FCERGs were obtained in 90 healthy subjects (90 normal eyes), several with known macular diseases and subjects with optic neuritis and suspected maculopathy. The fovea was stimulated with a 5-degree flickering light spot surrounded by a 20-degree annulus of steady retinal illuminace. The stimulus was applied to the eye with the use of a hand-held stimulator-ophthalmoscope. FCERG signals were analysed by means of Fast Fourier Transformation method. RESULTS: Mean FCERG amplitudes, phase and standard deviation (SD) values were established in 3 control groups of different age. There was in decrease in amplitude of FCERGs with age, which is a agreement with literature data. In this study significant abnormalities of the FCERG recordings are illustrated in some cases of known macular diseases. CONCLUSION: Our preliminary clinical investigations manifest the value of the FCERGs in objective evaluations of macular diseases undetectable with conventional electroretinography.

[The significance and interpretation of the electrophysiological and psychophysiological analyses in the diagnosis of glaucoma]. / Znaczenie i interpretacja badan elektrofizjologicznych i psychologicznych w diagnostyce jaskry.

The goal of this paper is to discuss and indicate which electrophysiological and psychophysical tests are useful for diagnosis and monitoring of glaucoma patients. In diagnosis of glaucoma, among electrophysiological methods, the authors perform mainly transient and steady-state pattern electroretinogram (PERG). Steady-state as well as transient PERG have the best sensitivity and specificity in diagnosis of this disease even in its early stages. Pattern visual evoked potentials (PVEPs) are less sensitive and specific, that is why this examination is rare in practical use. The authors describe the method of PERG, discuss most frequent mistakes in the method and interpretation of the obtained results. Among psychophysical tests the authors emphasize the significance of short-wave-length perimetry (blue-on-yellow) and standard static perimetry in early diagnosis of glaucoma. On the basis of literature, the authors present also other psychophysical methods, which can be applied in diagnosis of glaucoma.

[Pneumococcal pneumonia with a sever course]. / Paciorkowcowe zapalenie pluc o ciezkim przebiegu.

The authors present a case of a 70-years old patients with bilateral pneumonia of pneumococcal etiology. During the treatment, after the initial improvement respiratory failure was observed and mechanical ventilations was applied. Following this procedure appeared such complications as left pneumothorax and pleural empyema. After drainage and evacuation of purulent fluid from pleural cavity the clinical improvement was observed. The case shows how pneumonia is still dangerous, especially for patients with chronic obstructive pulmonary disease.

[Evaluation of pulmonary function tests in a population of young men from different regions of Poland]. / Ocena mechaniki oddychania w populacji mlodych mezczyzn z róznych rejonów polski.

The aim of study was the evaluation results of pulmonary function test (PFT) relationships between air pollution particular ozone concentration and smoking habit. PFT 417 volunteers (men aged 18-23) living in two regions of Poland were studied. These men were divided into 2 groups according to their living place: Warsaw and Gizycko (north-agricultural region of Poland). Inside each group smokers and non-smokers were separated. PNEUMOBIL-mobile PFT laboratory Compact Lab-Jaeger was used. Mean values of PFT between these two groups were not statistically significant. However the percent of population with low values of FEF50 (< 70%) living in Warsaw was five times higher then in population living in Gizycko (10.1% vs 1.7%). It possible that these results were associated with high concentration of ozone in atmosphere in Warsaw.

[Clinical examinations in Usher's syndrome]. / Badania kliniczne w zespole Ushera.

In this paper we are showing the results of clinical examinations in the family in which three siblings had the following symptoms: congenital deafness and nyctalopia. Clinical examinations including genetic counseling, audiometry, caloric test, Flash ERG, perimetry, computer tomography revealed total deafness, no vestibular function, and an advanced stage of retinitis pigmentosa. On the basis of clinical results, we determined the correct diagnosis: autosomal recessive Usher's syndrome-type 1. Diagnosis of the syndrome enables qualification of prognosis, complications, possibility of treatment and the risk of having the disease in the next generations. Early identification of the presence of Usher's syndrome can help in the formulation of an appropriate educational and training program. It seems purposeful that all patients with hearing loss should be examined by ophthalmologists.

[Electrophysiologic tests for diagnosis of congenital night blindness]. / Badania elektrofizjologiczne w diagnostyce wrodzonej slepoty nocnej.

UNLABELLED: Electrophysiological study in diagnosis of congenital stationary night blindness. MATERIAL AND METHODS: The goal of this study was to describe a family with X-linked congenital stationary night blindness (CSNB) in which 3 brothers had similar symptoms: night blindness, reduced visual acuity and "negative" type of Flash ERG. RESULTS: Electrophysiological study permitted to differentiate CSNB from generalized progressive retinal degeneration, what has a prognostic value for these patients.

[Surgery for retinal detachment in the years 1989-1994]. / Leczenie operacyjne odwarstwien siatkówki w latach 1989-1994.

PURPOSE: Evaluation of early and long-term results of retinal detachments operated in the recent years. MATERIAL AND METHODS: 99 eyes of 98 patients were examined. The conventional methods of retinal detachment surgery have been applied, mostly (above 75%) encirclement with subretinal fluid drainage. RESULTS: Anatomical reattachment was applied in 81.8% of cases, but after follow-up, meanly 2.5 years this percent was 66.2% in the majority of cases functional results were also good; in 18.5% of the eyes with anatomical reatachment visual acuity did not improve. CONCLUSION: Encirclement of the eyeball with subretinal fluid drainage is the basic and the most useful method of surgical treatment in most cases of retinal detachment.

[Surgical methods in patients with cataract and myopia]. / Postepowanie chirurgiczne u chorych z zacma i krótkowzrocznoscia.

PURPOSE: To present own experiences in cataract surgery in myopic eyes. METHODS: 72 eyes of patients, aged 41-84, with 4-year follow-up were analysed. According to the degree of myopia, the patients were divided into 3 groups: MP up to -4.0 D (29 eyes), mp from -4.25 D to -8.0 D (27 eyes) and MP > -8.0 D (16 eyes). Extracapsular cataract extraction was performed in 55 eyes (76.4%) and intracapsular in 11 (15.2%). Posterior IOLS were implanted in 30 eyes (41.6%), anterior IOLS (including 4 secondary ones) in 26 (36.1%) and 16 eyes (22.2%) were operated on without IOLS implantation. RESULTS: Good visual acuity (> 0.5) was achieved in 73.6% of cases, useful visual acuity (> 0.1) in 89%. The results as well as the postoperative complications were compared with the control group of non-myopic eyes. Glaucoma was observed in 18% of myopic eyes and in 10% of non-myopic but it was not significant. CONCLUSION: The safest method of cataract surgery in myopic eyes is extracapsular extraction with posterior IOL implantation. These eyes should be operated on by very experienced surgeons.

[Implantation of intraocular lens in anterior and posterior chamber from our clinical material]. / Wszczepy sztucznych soczewek przednioi tylnokomorowych w materiale wlasnym.

The authors presented results of 346 cataract extraction with IOL implantation--in 184 eyes anterior and in 162 posterior chamber. The follow-up ranged from 3 months to 6 years (mean 1.6 year). In 80.6% of cases, visual acuity after surgery was 0.6-1.0. Corneal astigmatismus 2.5-5.0 D was found in 31.2% of the eyes. The authors analysed early and late complications, taking into account the differences between anterior and posterior chamber IOLs implantation.

[Modification of Bagolini's registration method of normal macular and perimacular electroretinography in normal and selected cases of central retinal diseases]. / Modyfikacja metody Bagoliniego rejestracji elektroretinogramu plamkowego i przyplamkowego w normie i w wybranych przypadkach schorzen centralnej czesci siatkówki.

The authors applied the modified method of Bagolini's et al., who were the first to make use of the technique based on standard stimulation of "pattern" type for simultaneous macular and perimacular ERG registration. UTAS E-1000 system was applied for stimulation and registration of bioelectrical signals. 26 eyes in 16 healthy patients, aged 18 to 41 years (mean 29.5), have been examined. The anterior and posterior segment of all examined eyes was not changed, function of both eyes was normal. The mean values of macular and perimacular potentials and M/P value, that is proportion of macular and perimacular potential and standard deviations have been determined. The examples of pathologically changed macular and perimacular potentials in some diseases of central retina have been presented.