Laser Treatment of Central Serous Chorioretinopathy - An Update.

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.

Optical Coherence Tomography Angiography Assessment of the Optic Nerve Head in Patients Hospitalized Due to COVID-19 Bilateral Pneumonia.

Background and objectives: We aimed to investigate changes in the radial peripapillary capillary (RPC) network using optical coherence tomography angiography (OCTA) in patients who recovered from coronavirus disease 2019 (COVID-19). Materials and Methods: This was a prospective study of patients hospitalized due to COVID-19 bilateral pneumonia between March and May 2021. The control group included healthy individuals matched for age and sex. Two months after discharge, the patients underwent ophthalmological examination, including optical coherence tomography (OCT) imaging. The RPC network and retinal nerve fiber layer (RNFL) of the optic disc (RNFL optic disc) were automatically evaluated and compared between the study groups. Additionally, the RPC parameters were compared between the men and women in the COVID-19 group, and correlations between the RPC and RNFL optic disc parameters were assessed. Results: A total of 63 patients (120 eyes) with bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 infection were examined. No ophthalmic symptoms were reported by the patients. No significant differences were observed in the RPC parameters between the patients from the COVID-19 group and the 43 healthy controls. Moreover, the RPC parameters did not differ between the men and women in the COVID-19 group. A positive correlation was found between the RPC and RNFL optic disc parameters in the COVID-19 patients (p < 0.001). Conclusions: No changes in the RPC network were observed among the patients with COVID-19 bilateral pneumonia in the early period after hospital discharge. However, a longer follow-up is needed to monitor COVID-19-related changes in the microvasculature of the optic nerve head.

Choroidal thickness in lamellar macular holes.

PURPOSE: (1) To assess the thickness of the central choroid (BM-CSI) in swept-source optical coherence tomography (SS-OCT) examination of lamellar macular holes (LMHs). (2) To establish correlations between the thickness of the central choroid (BM-CSI) in the LHM and the parameters of best-corrected visual acuity and reading vision in patients with LMH. METHODS: This prospective case-control study assessed a group of 30 patients (30 eyes) with LMHs and a control group of 45 patients (90 eyes). The thickness of the central choroid (BM-CSI) was measured with an SS-OCT device. The average choroidal thickness in the fovea was defined as average thickness in the central area of 1000 µm in diameter, according to the Early Treatment Diabetic Retinopathy Study (ETDRS). The results were correlated with best-corrected visual acuity (BCVA), and reading vision. RESULTS: The average choroidal thickness in the study group (SG) with LMH was 160.34 µm (SD = 77.1), whereas in the control group (CG), it was 225.11 µm (SD = 93.8). The difference of 64.77 µm was statistically significant (p < 0.05). The BCVA was within the range between 0.7 (logMAR) and 0.1 (logMAR), with an average of 0.36 (logMAR) (SD = 0.23). Reading vision was within the range between - 0.2 (logMAR) and 0.3 (logMAR), with an average of 0.27 (logMAR) (SD = 0.12). A significant correlation between BCVA and the choroid (BM-CSI) was found. The correlation coefficient is average (r = 0.44) and positive. With better BCVA, a significantly thicker choroid (BM-CSI) can be observed. No significant correlation between BM-CSI and reading vision was found. The correlation coefficient value is minor (r = - 0.289), whereas lower values of BM-CSI can be observed with worse reading vision. CONCLUSION: We suggest that the choroid may take part in the pathogenesis of LMH development. Its significant thinning may be responsible for the ischemic degenerative mechanism degenerating outer layers of retina, apart from tractional mechanism.

Expression of VEGFA-regulating miRNAs and mortality in wet AMD.

MicroRNAs (miRNAs) regulate gene expression; many of them act in the retinal pigment epithelium (RPE), and RPE degeneration is known to be a critical factor in age-related macular degeneration (AMD). Repeated injections with anti-VEGFA (vascular endothelial growth factor A) are the only effective therapy in wet AMD. We investigated the correlation between the expression of 18 miRNAs involved in the regulation of the VEGFA gene in serum of 76 wet AMD patients and 70 controls. Efficacy of anti-VEGFA treatment was evaluated by counting the number of injections delivered up to 12 years. In addition, we compared the relative numbers of deaths in patient with AMD and control groups. We observed a decreased expression of miR-34-5p, miR-126-3p, miR-145-5p and miR-205-5p in wet AMD patients as compared with controls. These miRNAs are involved in the regulation of angiogenesis, cytoprotection and protein clearance. No miRNA was significantly correlated with the treatment outcome. Wet AMD patients had greater mortality than controls, and their survival was inversely associated with the number of anti-VEGFA injections per year. No association was observed between miRNA expression and mortality. Our study emphasizes the need to clarify the role of miRNA regulation in AMD pathogenesis.

Levels of Trace Elements in the Aqueous Humor of Cataract Patients Measured by the Inductively Coupled Plasma Optical Emission Spectrometry.

Trace elements play an important role in the pathogenesis of several serious ophthalmological disorders, such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, cataract, etc. This study aimed to measure alterations of chemical elements' (67) levels in the aqueous humor of patients undergoing cataract surgery. The pilot study included 115 patients, (age 74 ± 7.27, female 64.35%, male 35.65%). The aqueous levels of elements were measured by the use of the inductively coupled plasma optical emission spectrometry (ICP-OES), quality controlled with certified standards. The classification of elements based on their concentration was achieved by hierarchical cluster analysis. This is the first screening study that quantifies over 60 elements which are present in the fluid from the anterior chamber of the eye of cataract patients. The obtained results can be suitable for understanding and identifying the causes that may play a role in the initiation and progression of lens opacity.

Pars plana vitrectomy with transscleral fixation of posterior chamber lens in the treatment of post-traumatic lens dislocation.

PURPOSE: To present our experience with post-traumatic lens dislocation management by vitrectomy followed with sutureless artificial lens fixation. METHODS: The retrospective study involved 15 patients (12 men and 3 women) aged from 36 to 78 (on average, 63 years old), from the Vitreoretinal Surgery Teaching Hospital, operated in the years 2013-2015. All cases concerned ocular traumas with dislocation of the natural or artificial lens to the anterior chamber, vitreous body chamber, or post-traumatic aphakia. After vitrectomy, patients had the implant fixated with a technique devised by Scharioth-sutureless fixation of posterior chamber implants in the groove area, with haptics placed in scleral tunnels parallel to the corneal limbus. Preoperative and postoperative condition of the eye was assessed. RESULTS: The average period of observation was 29 weeks. Average pre-surgery refraction was + 10.75, while post-surgery + 1.25. Average best-corrected visual acuity in Snellen charts before surgery was 0.3 and at the end of the observation period 0.5. The improvement in visual acuity after surgery in relation to visual acuity before surgery was statistically significant (P = 0.005). In the first 2 weeks after surgery, minor hypotonia was observed in three of the patients, while in two-moderate bleeding to the vitreous body and the anterior chamber, which subsided without surgical intervention. A slight decentration of the implant observed in two cases did not affect later refraction or BCVA. CONCLUSION: Basing on the abovementioned facts, we believe that this surgical approach facilitates the fixation of the dislocated lens and allows a successful treatment of secondary implantation or repositioning of a dislocated intraocular lens.

Tear film proteome in age-related macular degeneration.

PURPOSE: Age-related macular degeneration (AMD) is the main reason for blindness in elderly people in the developed countries. Current screening protocols have limitations in detecting the early signs of retinal degeneration. Therefore, it would be desirable to find novel biomarkers for early detection of AMD. Development of novel biomarkers would help in the prevention, diagnostics, and treatment of AMD. Proteomic analysis of tear film has shown promise in this research area. If an optimal set of biomarkers could be obtained from accessible body fluids, it would represent a reliable way to monitor disease progression and response to novel therapies. METHODS: Tear films were collected on Schirmer strips from a total of 22 patients (8 with wet AMD, 6 with dry AMD, and 8 control individuals). 2D electrophoresis was used to separate tear film proteins prior to their identification with matrix-assisted laser desorption/ionization time of flight spectrometer (MALDI-TOF/TOF) and matching with functional databases. RESULTS: A total of 342 proteins were identified. Most of them were previously described in various proteomic studies concerning AMD. Shootin-1, histatin-3, fidgetin-like protein 1, SRC kinase signaling inhibitor, Graves disease carrier protein, actin cytoplasmic 1, prolactin-inducible protein 1, and protein S100-A7A were upregulated in the tear film samples isolated from AMD patients and were not previously linked with this disease in any proteomic analysis. CONCLUSION: The upregulated proteins supplement our current knowledge of AMD pathogenesis, providing evidence that certain specific proteins are expressed into the tear film in AMD. As far we are aware, this is the first study to have undertaken a comprehensive in-depth analysis of the human tear film proteome in AMD patients.

Hypertensive retinopathy in the end-stage renal failure ­ study case. / Retinopatia nadcisnieniowa w przebiegu schylkowej niewydolnosci nerek ­ opis przypadku.

The case of 26-year-old woman with a transient deterioration of binocular vision secondary to chronic renal failure due to glomerulonephritis is presented. The patient reported the onset of the disease at the age of 2. As her kidney disease was poorly controlled, she developed renal hypertension followed by bilateral hypertensive retinopathy. The patient was hospitalized in the Department of Nephrology, where she received dialyses and her blood pressure was normalised. The follow up in the Ophthalmology Clinic was continued for 9 months. The treatment of her primary disease resulted in a significant resolution of retinopathy and improved her visual acuity.

Efficacy of intravitreal aflibercept in patients with exudative age-related macular degeneration.

AIM OF THE STUDY: To evaluate the efficacy of intravitreal aflibercept administered to patients with exudative age-related macular degeneration. MATERIALS AND METHODS: 70 patients with exudative age-related macular degeneration confirmed clinically and in additional diagnostic procedures (fluorescein angiography and spectral domain-optical coherence tomography) were enrolled. All patients were administered three doses of intravitreal aflibercept at one-month intervals. Some patients (seven) received an additional injection of the drug two months after the last of the three injections. The best-corrected visual acuity and the optical coherence tomography findings were assessed at baseline and after the treatment. RESULTS: At baseline, the mean best corrected visual acuity was 0.20. After the injection of aflibercept it improved to the mean value of 0.32 with the difference being statistically significant (p < 0.001, Student's t-test). The mean central subfield thickness at baseline was 311.4 µm. It decreased to mean value of 254.5 pµn with the difference being statistically significant (p<0.001, Student's t-test). CONCLUSIONS: Intravitreal injections of aflibercept improved clinical and anatomical parameters in patients with exudative age-related macular degeneration in the initial phase of treatment.

Biological model of Danio rerio (zebrafish) ­ a new research trend in ophthalmology. / [Nowy kierunek badan naukowych w okulistyce z wykorzystaniem modelu Danio rerio (zebrafish)].

Dynamic progress in medicine has enabled availability of new diagnostic methods, improved drugs and therapies. However, we are still searching for a perfect model to reflect the complexity of physiological and pathological processes in a human body. Among laboratory animals, an aquatic species of zebrafish (lat. Danio rerio) has become an emergent biological model. The paper presents examples of using zebrafish in medical research, especially in opthamology.

Nasally located congenital optic disc pit with concomitant maculopathy.

Optic disc pit is a congenital optic disc anomaly, which can be associated with maculopathy. The case of an unusually nasally located pit with concomitant maculopathy in a 64-year-old woman is presented.

[Bilateral abnormalities in central serous chorioretinopathy seen in optical coherence tomography, ultra-widefield fluorescein angiography and microperimetry--case report]. / Obustronne zmiany w przebiegu centralnej surowiczej chorioretinopatii w obrazie badan optycznej koherentnej tomografii, szerokokatnej angiografii fluoresceinowej i mikroperymetrii--opis przypadku.

Central serous chorioretinopathy is a common retinopathy, which is manifested by the idiopathic detachment of the neurosensory retina in the posterior pole, secondary to fluid leakage from choroidal vessels at the level of retinal pigment epithelium. The disease is typically unilateral and affects young men. We present a case of a 48-year old man, admitted to the Department of Vitreo-Retinal Surgery, Medical University in Lublin, reporting vision impairment in his right eye. The bilateral ocular exam followed by optical coherence tomography, ultra-widefield fluorescein angiography and microperimetry revealed bilateral central serous chorioretinopathy. This case presents a bilateral manifestation of central serous chorioretinopathy and emphasizes the role of advanced diagnostic imaging techniques in analyzing retinal function and disease management.

[Geographic atrophy imaging using fundus autofluorescence method]. / Obrazowanie zaniku geograficznego za pomoca autofluorescencji dna oka.

Geographic atrophy is a manifestation of the advanced age-related macular degeneration and form of irreversible atrophy of retinal pigment epithelium and photoreceptor layer. Early detection of changes and the ability to evaluate disease progression accurately constitute a key problem in diagnosis and treatment planning. Fundus autofluorescence is a relatively new imaging method considered nowadays to be the best in diagnosis and observing the natural or treatment-altered course of disease. High resolution images showing the 3D distribution of retinal pigment epithelium autofluorescence as lipofuscin index can be obtained owing to the launch of the confocal scanning laser ophthalmoscope.

[Sub-internal limiting membrane haemorrhage--causes, diagnosis and treatment]. / Krwotok pod blona graniczna wewnetrzna siatkówki--przyczyny, diagnostyka i leczenie.

PURPOSE: The purpose of this study was to present cases of patients with massive sub-internal limiting membrane haemorrhage, who were treated with vitrectomy. MATERIAL AND METHODS: We present 2 patients with sub-internal limiting membrane haemorrhages diagnosed clinically, seen in spectral optical coherence tomography and confirmed during vitrectomy with the internal limiting membrane peeling. Visual acuity and clinical manifestation in spectral optical coherence tomography were assessed before and after vitrectomy. RESULTS: The haemorrhage was successfully removed from under the internal limiting membrane in both cases. Visual acuity improved and normal anatomical relationships were restored within the fovea in both patients as well. CONCLUSIONS: Vitrectomy is a safe and effective method, offering fast improvement of visual acuity in patients with massive sub-internal limiting membrane haemorrhage.

Oxidative Stress, Persistent Inflammation and Blood Coagulation Alterations in Serum Proteome of Patients with Neovascular Age-Related Macular Degeneration.

Neovascular age-related macular degeneration (AMD) is a major cause of irreversible blindness in elderly populations in developed countries. AMD's etiopathology is multifactorial, with strong environmental and genetic components, but the exact molecular pathomechanisms underlying the disease are still unknown. In this study, we analyzed blood serum collected from 74 neovascular AMD patients and 58 healthy controls to identify proteins that may serve as potential biomarkers and expand our knowledge about the etiopathogenesis of the disease. The study revealed 17 differentially expressed proteins-11 up-regulated and 6 down-regulated-in neovascular AMD, which are involved in the biological processes previously linked with the disease-oxidative stress and persistent inflammation, impaired cellular transport, lipid metabolism and blood coagulation. In conclusion, the differences in the expressions of the proteins identified in this study may contribute to our understanding of the mechanisms underlying AMD and possibly serve in future as promising biomarkers.

The Impact of a Single Haemodialysis Session on the Retinal Thickness and Optic Nerve Morphology.

BACKGROUND: The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients. METHODS: It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD. RESULTS: In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 µm, post-HD 272.14 ± 20.11 µm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm3, post-HD 7.52 ± 0.55 mm3; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 µm, post-HD 100.23 ± 14.7 µm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 µm, post-HD 70.6 ± 9.7 µm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 µm, post-HD 97.9 ± 12.94 µm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus. CONCLUSION: Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.

[Vitreomacular adhesion in HD-OCT images in the age-related macular degeneration]. / Przyleganie okoloplamkowe ciala szklistego w obrazie HD-OCT w przebiegu zwyrodnienia plamki zwiazanego z wiekiem.

PURPOSE: The aim of this study was to evaluate an incidence of the vitreomacular adhesion in patients with age-related macular degeneration. MATERIAL AND METHODS: We examined 472 eyes in 241 patients (136 W/ 105 M) in age of 54-92 years (mean 62.6 years +/- 8.5) with dry or wet age-related macular degeneration using Cirrus HD-OCT (Zeiss) macular cube 512x128 program or 5-line pro-gram. RESULTS: Vitreomacular adhesion was observed in 139 eyes with dry age-related macular degeneration (29.4%, p=0.000*), in 101 eyes with drusen (21.4%, p=0.000*), in 38 eyes with retinal pigment epithelium alterations (8%, p=0.202), in 278 eyes with wet age-related macular degeneration (58.9%, p=0.001*), in 21 eyes with pigment epithelial detachment (4.4%, p=0.303), in 161 eyes with choroidal neovascularzation (34. 1%, p=0.031*/ and in 96 eyes with scar (20.4%, p=0.040*). CONCLUSIONS: Probably, vitreomacular adhesion alone is not able to induce age-related macular degeneration, but it may be associated with choroidal neovascularization development, it can contribute to exudate formation and choroidal neovascularization, it may induces or sustains a chronic low-grade inflammation in the macula region.

[Optical coherence tomography in monitoring of choroidal folds after surgical excision of ethmoidal myxoma]. / Zastosowanie optycznej tomografii komputerowej w monitorowaniu faldów naczyniówki po chirurgicznym usunieciu sluzaka sitowia.

PURPOSE: We describe a case of choroidal folds coexisting with ethmoidal myxoma and the evolution of folds after tumor excision. Choroidal folds can occure in the case of intraorbital pathology. Optical coherence tomography is usefull in diagnosis and monitoring of these folds. MATERIAL AND METHODS: 45 years old woman was reffered to our clinic because of visal disturbances in her right eye. Visual acuity of right eye was 0.5, of the left eye 1.0. Intraocular pressure of both eyes was within normal limits. Biomicroscopic evaluation of the right eye revealed no changes in anterior segment but choroidal folds in posterior segment were evident. The left eye was normal. Computer tomography of the orbit documented the presence of tumor within the right ethmoid. The tumor was excised surgically and its myxoidal nature was confirmed. RESULTS: 3 months after that intervention retinal profile in posterior pole in optical coherence tomography was normal and visual acuity of right eye improved by 1 line in Snellen chart. CONCLUSIONS: Choroidal folds caused by ethmoidal myxoma can disapper after surgical excison of tumor. Optical coherence tomography is very useful in documentation of these changes.

[The analysis of morphological and functional macular changes after surgical treatment of idiopathic macular hole--the single centre experience]. / Analiza zmian morfologicznych i czynnosciowych plamki po leczeniu chirurgicznym idiopatycznego otworu plamki--wyniki wlasne.

PURPOSE: to evaluate morphological and functional macular changes after surgical treatment of idiopathic macular hole. MATERIAL AND METHODS: a retrospective study included 25 patients (30 eyes) who underwent surgery for idiopathic macular hole. Male patients constituted 27% and female patients 73% of the study group. Mean age was 67 years. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade (C3F8 or SF6). We evaluated age, sex, best corrected visual acuity as well a optical coherence tomography scans prior to surgery and postoperatively. The mean follow-up was 6 months. RESULTS: the mean preoperative best corrected visual acuity was 0.15 in Snellen charts (≤ 0.1 - 13 eyes, > 0.1 - 17 eyes) and it increased to 0.5 postoperatively. Five eyes were preoperatively classified as stage 2 Gass scale, 13 eyes as stage 3 and 13 eyes as stage 4. Postoperatively, 25 eyes were assorted as "U" shaped and 5 as "V" shape closure. CONCLUSIONS: surgical treatment of macular hole with pars plana vitrectomy significantly improves macular function measured by the best corrected visual acuity. The "U" shaped closure of macular hole promotes better visual outcomes.

Dry Eye Disease as a Cause of Refractive Errors After Cataract Surgery - A Systematic Review.

Dry eye disease (DED) is a multifactorial ocular surface disorder characterized by loss of tear film homeostasis with associated ocular symptoms, like dryness, foreign body sensation, and inflammation. Numerous reports confirm an increase in dry eye symptoms after cataract surgery. DED also significantly disturbs preoperative biometric measurements, mainly by changes in keratometry measurements. The purpose of this study is to evaluate the effect of DED on biometric measurements before cataract surgery and postoperative refractive errors. PubMed database was searched for keywords: cataract surgery, dry eye disease, refractive error, refractive outcomes, keratometry, and biometry. Four clinical studies evaluating the effect of DED on refractive errors were included. In all studies, biometry was performed before and after dry eye treatment, and the mean absolute error was compared. Various substances have been used to treat dry eye, such as cyclosporin A, liftitegrast, and loteprednol. The refractive error was significantly lower after treatment in all studies. The results unanimously indicate that refractive errors can be reduced by proper treatment of DED before cataract surgery.