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1.
Med Sci Monit ; 29: e941926, 2023 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-38044597

RESUMO

Visualization of the retinal structure is crucial for understanding the pathophysiology of ophthalmic diseases, as well as for monitoring their course and treatment effects. Until recently, evaluation of the retina at the cellular level was only possible using histological methods, because the available retinal imaging technology had insufficient resolution due to aberrations caused by the optics of the eye. Adaptive optics (AO) technology improved the resolution of optical systems to 2 µm by correcting optical wave-front aberrations, thereby revolutionizing methods for studying eye structures in vivo. Within 25 years of its first application in ophthalmology, AO has been integrated into almost all existing retinal imaging devices, such as the fundus camera (FC), scanning laser ophthalmoscopy (SLO), and optical coherence tomography (OCT). Numerous studies have evaluated individual retinal structures, such as photoreceptors, blood vessels, nerve fibers, ganglion cells, lamina cribrosa, and trabeculum. AO technology has been applied in imaging structures in healthy eyes and in various ocular diseases. This article aims to review the roles of AO imaging in the diagnosis, management, and monitoring of age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, hypertensive retinopathy (HR), central serous chorioretinopathy (CSCR), and inherited retinal diseases (IRDs).


Assuntos
Coriorretinopatia Serosa Central , Retinopatia Diabética , Humanos , Retina/diagnóstico por imagem , Retina/patologia , Oftalmoscopia/métodos , Tomografia de Coerência Óptica/métodos , Retinopatia Diabética/patologia
2.
Med Sci Monit ; 28: e935135, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35046380

RESUMO

The number of patients with arterial hypertension is continually increasing. Hypertension can cause organ complications, called hypertension-mediated organ damage (HMOD). One example is hypertensive retinopathy, in which high blood pressure (BP) damages both the retinal microcirculation and the retinal nerve fiber layer (RNFL). This can result in progressive and painless vision deterioration in some groups of patients. Unlike anywhere else in the human body, the microvasculature of the retina can be observed in vivo, and the progression of changes can be closely monitored. The harmful effect of increased BP on the eye is not only limited to hypertensive retinopathy, but can also lead to an exacerbation of diabetic retinopathy (DR) and to an increase in intraocular pressure (IOP), and it can also trigger the formation of thromboembolic lesions. This review presents an update on the pathogenesis of hypertensive retinopathy and the use of adaptive optics (AO) combined with optical coherence tomography (OCT) to evaluate the retinal microvasculature. The latest progress and directions of research in the field of hypertensive retinopathy are also discussed.


Assuntos
Retinopatia Hipertensiva/diagnóstico por imagem , Retinopatia Hipertensiva/patologia , Tomografia de Coerência Óptica/métodos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Retinopatia Hipertensiva/tratamento farmacológico
3.
Ophthalmic Res ; 64(3): 345-355, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33454713

RESUMO

Retinal ganglion cells (RGCs) play a crucial role in the visual pathway. As their axons form the optic nerve, apoptosis of these cells causes neurodegenerative vision loss. RGC death could be triggered by increased intraocular pressure, advanced glycation end products, or mitochondrial dysfunction. In this review, we summarize the role of some neuroprotective factors in RGC injury: ciliary neurotrophic factor (CNTF), nerve growth factor (NGF), brain-derived neurotrophic factor, vascular endothelial growth factor, pigment epithelium-derived factor, glial cell line-derived neurotrophic factor, and Norrin. Each, in their own unique way, prevents RGC damage caused by glaucoma, ocular hypertension, ischemic neuropathy, and even oxygen-induced retinopathy. These factors are produced mainly by neurons, leukocytes, glial cells, and epithelial cells. Neuroprotective factors act via various signaling pathways, including JAK/STAT, MAPK, TrkA, and TrkB, which promotes RGC survival. Many attempts have been made to develop therapeutic strategies using these factors. There are ongoing clinical trials with CNTF and NGF, but they have not yet been accepted for clinical use.


Assuntos
Glaucoma , Células Ganglionares da Retina , Sobrevivência Celular , Fator Neurotrófico Ciliar , Humanos , Fator de Crescimento Neural , Retina , Fator A de Crescimento do Endotélio Vascular
4.
Cell Rep Med ; 5(3): 101437, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38428428

RESUMO

Leber hereditary optic neuropathy (LHON) is a mitochondrial disease leading to rapid and severe bilateral vision loss. Idebenone has been shown to be effective in stabilizing and restoring vision in patients treated within 1 year of onset of vision loss. The open-label, international, multicenter, natural history-controlled LEROS study (ClinicalTrials.gov NCT02774005) assesses the efficacy and safety of idebenone treatment (900 mg/day) in patients with LHON up to 5 years after symptom onset (N = 199) and over a treatment period of 24 months, compared to an external natural history control cohort (N = 372), matched by time since symptom onset. LEROS meets its primary endpoint and confirms the long-term efficacy of idebenone in the subacute/dynamic and chronic phases; the treatment effect varies depending on disease phase and the causative mtDNA mutation. The findings of the LEROS study will help guide the clinical management of patients with LHON.


Assuntos
Atrofia Óptica Hereditária de Leber , Ubiquinona/análogos & derivados , Humanos , Atrofia Óptica Hereditária de Leber/tratamento farmacológico , Atrofia Óptica Hereditária de Leber/genética , Atrofia Óptica Hereditária de Leber/diagnóstico , Antioxidantes/uso terapêutico , Ubiquinona/uso terapêutico , Ubiquinona/genética , Mutação
5.
Semin Ophthalmol ; 37(5): 602-610, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35125052

RESUMO

PURPOSE: Open-angle glaucoma (OAG), accounting for 90% of all glaucoma cases, is a progressive optic nerve neuropathy. It may lead to irreversible loss of visual field and complete blindness. When conservative treatment becomes insufficient to stop OAG progression, a surgical intervention is considered. Currently, canaloplasty procedure is being introduced instead of conventional trabeculectomy for invasive OAG treatment. The aim of the study is to asses safety and efficacy of canaloplasty. METHODS: This prospective study included 67 eyes that received 360° canaloplasty with placement of a tensioning suture. Primary OAG (n = 35), secondary OAG in pseudoexfoliative syndrome (n = 13), and pigmentary glaucoma (n = 19) patients were included. Control check-ups were conducted pre-operatively and in a 18-month follow-up time. Study endpoints involved reduction in IOP values and in the number of glaucoma medications after the intervention. RESULTS: The intervention led to a significant 38% reduction in IOP value from the preoperative baseline to 18 months after the intervention. The number of medications decreased significantly by 89%. At 18 months postoperative, 79% eyes did not require any glaucoma medications. The incidence of complications after canaloplasty was low, and none of the adverse effects were vision threatening. A surgically-induced astigmatism was the most frequent complication. Pigmentary glaucoma patients were the most beneficial subgroup, with 50% reduction in IOP, the highest success rate, and 98% reduction in the number of medications used. CONCLUSION: This study proved that canaloplasty is an efficient and safe procedure in OAG eyes.


Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Aberto , Cirurgia Filtrante/métodos , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Estudos Prospectivos , Resultado do Tratamento
6.
Ann Med ; 54(1): 1538-1547, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35616902

RESUMO

BACKGROUND: Throughout the years significant progress has been observed in all medical fields. It was possible to achieve thanks to a wide range of scientists, including physician-scientists. However, in recent years their number is significantly declining. Thus we have aimed to explore the attitudes of medical students towards research. METHODS: The cross-sectional study was conducted among medical students of Medical University of Warsaw between the 1st and 23rd of December 2019. Survey examining scientific interests and activities, opinions on selected research issues, and perception of potential barriers to research activities has been distributed to 838 students and collected from 695 (391 students of the 2nd year and 304 of the 5th year) with a response rate of 82.9%. Descriptive statistics, the Chi-squared test, U-Mann-Whitney, and Kruskal-Wallis tests were used for between-group comparisons. The differences were considered statistically significant if the p values were <.05. RESULTS: 55.2% of responders rated their scientific interests in high school as high, with no significant differences between 2nd and 5th-year students. 33.8% (n = 233) of all students plan to pursue research activity after graduation, and 52.8% (n = 360) plan to obtain PhD title. Students who presented higher scientific interests in high school more often were involved in research projects at the university (24.7% vs 17.5%, p = .044), and showed higher interest in pursuing a research career (37.9% vs 28.9%, p = .02). Lack of time and knowledge on starting a research project were perceived as the main barriers to scientific work. CONCLUSIONS: Many medical students express research interests, are involved in scientific projects, and plan to pursue their careers in this direction. There is a majority of students with lower attitudes towards research. Medical universities should consider adapting their curricula accordingly to accommodate the needs of both groups and respond to the shortage of physicians working in clinics and research.KEY MESSAGESOne-third of medical students plan to pursue career in medical research after graduation.Students who presented higher scientific interests in the high school are more often involved in research projects at the university and show higher interest in pursuing a research career.According to medical students, lack of time, resources and funding and insufficient knowledge how to start a research project are the most important barriers to research activity.


Assuntos
Pesquisa Biomédica , Estudantes de Medicina , Atitude , Escolha da Profissão , Estudos Transversais , Humanos , Inquéritos e Questionários
7.
Antioxidants (Basel) ; 10(11)2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34829613

RESUMO

Age-related macular degeneration (AMD) and glaucoma are ophthalmic neurodegenerative diseases responsible for irreversible vision loss in the world population. Only a few therapies can be used to slow down the progression of these diseases and there are no available treatment strategies for reversing the degeneration of the neural retina. In AMD, the pathological process causes the malfunction and damage of the retinal pigmented epithelium and photoreceptors in the macula. In glaucoma, damage of the retinal ganglion cells and their axons is observed and treatment strategies are limited to intraocular pressure lowering. Therefore, other prophylactic and/or therapeutic methods are needed. Oxidative stress is involved in the neurodegenerative process accompanying both AMD and glaucoma; therefore, the use of antioxidant agents would clearly be beneficial, which is supported by the decreased prevalence and progression of AMD in patients adherent to a diet naturally rich in antioxidants. Dietary antioxidants are easily available and their use is based on the natural route of administration. Many preclinical studies both in vitro and using animal models of retinal degeneration showed the efficacy of dietary antioxidants, which was further proved in clinical trials. Resveratrol is beneficial both in AMD and glaucoma animal models, but confirmed only among AMD patients. For AMD, carotenoids and omega-3 fatty acids were also proved to be sufficient in preventing neurodegeneration. For glaucoma, coenzyme Q10 and alpha-lipoic acid showed efficacy for decreasing retinal ganglion cell loss and inhibiting the accompanying destructive processes. Interestingly, the benefits of vitamins, especially vitamin E was not confirmed, neither in preclinical nor in clinical studies.

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