Unilateral Tamoxifen-Induced Retinopathy as a Consequence of Breast Cancer Treatment-Multimodal Imaging Value.

Tamoxifen is a drug used in breast cancer therapy, which inhibits the division of neoplastic cells targeting estrogen receptors. The drug is generally well-tolerated and its use does not cause serious side-effects. The standard dose of the drug is 20 mg once a day for 3 to 5 years. Available epidemiological data have shown that the incidence of ocular toxicity of tamoxifen ranges between 0.9% and 12.0% and increases with higher tamoxifen dose. A rare known complication of tamoxifen use is the development of retinopathy. We present a case of 57-year-old woman presented to an ophthalmologist with decreased visual acuity in her right eye. She has been treated with tamoxifen 20 mg daily for 7 years for breast cancer. Clinical examination and multimodal imaging methods help confirm the diagnosis of unilateral tamoxifen associated retinopathy (TAR). Optical coherence tomography angiography (OCTA) was crucial in the diagnostic process and differential diagnosis, especially in differentiating it from type 2 macular telangiectasias. The correct diagnosis of TAR is very important in deciding the treatment option of tamoxifen. Based on our diagnosis, the oncologist recommended another course of treatment. Tamoxifen therapy was discontinued and switched to letrozole 2.5 mg once a day. The patient attends ophthalmological examination regularly. Visual acuity, OCT and OCTA results remain stable.

Delivery in Myopic Women: A Comparison of Mode of Delivery in Years 1990, 2000, and 2010.

BACKGROUND A belief has existed for many years that severe myopia is a direct indication for cesarean section or an instrumental vaginal delivery, although many academic papers negated this opinion. The aim of this study was to analyze the mode of delivery of myopic patients in the years 1990, 2000, and 2010. MATERIAL AND METHODS Medical records of 3027 women in labor from the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw were analyzed in 3 time periods: year 1990 - group 1 (G1), year 2000 - group 2 (G2), and 2010 - group 3 (G3). Maternal age, severity and proportion of myopia, ophthalmological consultations, and mode of delivery were assessed. RESULTS In G1 there were 992 patients, in G2 there were 1010 patients, and in G3 there were 1025 patients. Myopic women in labor accounted for 20% of G1, 12% of G2, and 20% of G3. The mean maternal age was ±29.4 years in G1, ±30 years in G2, and ±31.5 years in G3. Myopia was divided into 3 levels of severity depending on the degree of refractive error: low myopia -6 DS. The number of ophthalmological examinations needed in myopic patients to decide on the mode of delivery showed an increasing tendency over the evaluated years, but the rates of referrals for cesarean section/assisted delivery decreased. CONCLUSIONS The proportion of myopic women in labor receiving ophthalmological consultations showed an increasing trend over time. Despite publication of the Ophthalmology-Obstetrics Consensus of the Polish Society of Ophthalmology guidelines, myopia still remains an indication for cesarean section (cesarian section), but not to shorten the second stage of delivery.

Observation and Clinical Pattern in Patients with White Dot Syndromes: The Role of Color Photography in Monitoring Ocular Changes in Long-Term Observation.

BACKGROUND The aim of this study was to assess the clinical course and distinctive features of different white dot syndromes (WDS) in patients attending the Ophthalmology Department, Medical University of Warsaw in the years 1995-2015. MATERIAL AND METHODS Sixty-two (62) patients (43 females and 19 males), aged 18 to 77 years, referred with a WDS were included in this prospective study, with observation period ranging from 5 months to 16 years. All patients underwent a complete ophthalmological examination and multimodal imaging studies. RESULTS In this cohort of 62 patients, the following WDS entities were identified: multifocal choroiditis with panuveitis (MFCPU), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), birdshot, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), subretinal fibrosis and uveitis, multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, and single cases of acute annular outer retinopathy (AAOR). CONCLUSIONS The study was performed at a Polish referral center and may to some extent reflect the varied geographical distribution of white dot syndromes, as none of the subjects was found to suffer from acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), or diffuse unilateral subacute neuroretinitis (DUSN). Long-term follow-up is warranted by the evolution of lesions in the eye fundus, while management depends on correct diagnosis of WDS. When the posterior pole is involved in some cases of the WDS an immunosuppressive treatment, the use of the PDT or anti-VEGF injections were necessary.

Macular assessment using Optical Coherence Tomography in patients after uneventful phacoemulsification treated postoperatively with bromfenac, diclofenac or dexamethasone.

Aim: To assess macular thickness and volume using optical coherence tomography in patients treated with different anti-inflammatory agents after uneventful phacoemulsification. Material and methods: We analysed macular parameters using optical coherence tomography in 50 consecutive patients (mean age 70.5 years) who underwent uneventful phacoemulsification cataract surgery at the Ophthalmology Department, Medical University of Warsaw between March 2012 and January 2013. Patients were divided into 3 groups, according to 3 different anti- -inflammatory agents used during the postoperative period: group T receiving dexamethasone 0.1% (n=17), group Y receiving bromfenac sodium 0.09% (n=16) and group D receiving diclofenac sodium (n=17). We evaluated macular scans obtained the day before surgery and on days 1., 7., 30. and 90. postoperatively. Central subfield thickness, cube volume and cube average thickness were measured during the optical coherent tomography. The data was analysed statistically using the SAS 9.2 software. The graphs were prepared using the STATISTICA 12 software. Results: A significant increase in central subfield thickness was observed on day 30. postoperatively. However, there were no statistically significant differences in macular thickness between the study groups. Conclusions: Central retinal thickness increases after uneventful phacoemulsification despite active anti-inflammatory treatment and irrespective of the drug class used.

Central corneal thickness and intraocular pressure before the intravitreal administration of ranibizumab and in the early period following the injection.

The aim of the study was to determine the differences in the central corneal thickness and intraocular pressure measured before intravitreal administration of ranibizumab and at 30 to 60 minutes after the injection. The intraocular pressure was analysed as a stand-alone parametre and in correlation with the central corneal thickness. 72 patients (144 eyes) were enrolled. The treated eyes were compared to the fellow, non-treated eyes. The mean central corneal thickness in a treated eye was 558 /Im and 596,µm at baseline (before the injection) and after the injection, respectively (p< 0.05). The mean intraocular pressure not correlated to the central corneal thickness in a treated eye 15.29 mmHg and 16.83 mmHg at baseline and post-injection, respectively (p< 0.05). When assessed in correlation with the central corneal thickness, the intraocular pressure did not increase post-injection in the treated eyes.

Doppler flow parameters in orbital arteries in gestational diabetes mellitus patients.

OBJECTIVE: To evaluate the blood flow in orbital arteries in patients with gestational diabetes mellitus (GDM). MATERIAL: We have examined 65 GDM patients and 38 healthy pregnant women at 28-32 weeks. Doppler parameters were assessed in ophthalmic, central retinal and short posterior ciliary arteries. RESULTS: In ophthalmic arteries V2 was significantly higher and RI lower in GDM. In the subgroup treated with insulin V1 and V2 in ciliary artery and V2 in central retinal artery were significantly lower and PI in ciliary artery was higher when compared to subgroup on diet. CONCLUSION: Doppler examination can be useful in detection of pre-clinical ophthalmological changes in GDM patients.

Asteroid hyalosis--current state of knowledge.

The search query into the Cochrane Library, Medline, Web of Science, Embase, Scopus and ScienceDirect enabled selection of research papers addressing the issue of asteroid hyalosis published in English between 1963 and January 2014. Asteroid hyalosis is a degenerative condition of the vitreous in which small, creamy or white, spherical particles (asteroid bodies) are randomly diffused within the vitreous. They consist mainly of calcium and phosphorus and have a structure of hydroxy lapatite. In 80.2-92.0% of cases the condition affects one eye only and it occurs in 0.36-1.96% of population, mostly in patients over 50 years of age and in males. Hypercholesterolemia and hypertension are systemic risk factors, but asteroid hyalosis is postulated to occur more often in retinitis pigmentosa and Leber amaurosis caused by mutations in lecithin retinol acyltransferase gene. Asteroid hyalosis also causes calcification of some intraocular lenses--mostly silicone ones. Vitreous of patients with asteroid hyalosis shows reduced gel liquefaction and anomalous vitreoretinal adhesion.

Optical coherence tomography in diagnosing, differentiating and monitoring of choroidal nevi - 1 year observational study.

OBJECTIVE: To assess the utility of the optical coherence tomography (OCT) in diagnosing, differentiating and monitoring of choroidal nevi situated in the posterior pole and optic disc area. MATERIAL AND METHOD: 116 consecutive patients (65 women, 51 men) aged 27-95 years, with choroidal nevus were included to the research. Routine ophthalmoscopic evaluation and OCT using the Zeiss Stratus OCT as well as fundus photography were performed in each patient. The OCT was used to assess the structure of the retina overlying the choroidal nevus, the retinal pigment epithelium (RPE) - choriocapillaris complex, as well as the anterior portion of the choroidal lesion. In 31 patients due to suspected malignant melanoma fluorescein angiography and ultrasound were additionally performed. Follow-up OCT was done after 12 months in 51 out of 85 patients with characteristics of choroidal nevi, and after 6 and 12 months in 27 patients with "suspicious" lesion. RESULTS: The basal dimension of the lesion ranged from 0.5 mm to 12 mm (mean 2.75mm), mean thickness was 1.25 mm. The pigmented lesion did not affect visual acuity. In 85 patients the lesion was flat or slightly elevated, without secondary changes in the retina. In 31 patients additional changes in the retina were observed - most frequently subretinal fluid. Two patients were eventually diagnosed with malignant melanoma. The follow-up OCT did not show progression in neither patients without secondary changes nor those with risk factors of malignancy. CONCLUSION: Optical coherence tomography enables detailed evaluation of the retina overlying the pigmented lesion. Secondary changes in the retina need additional exams and strict observation. OCT could be an additional tool in the evaluation of treatment of malignant melanoma.

[Peripheral retina in AMD patients]. / Zwyrodnienie plamki zwiazane z wiekiem a obwód siatkówki.

PURPOSE: To determine the frequency and possible correlation between peripheral retinal lesions and AMD. MATERIAL AND METHODS: 92 patients (50-89 years old), with AMD were evaluated by indirect ophthalmoscopy and biomicroscopy with triple mirror. The control group consisted of 92 patients without any lesions in macula and other retinal changes. RESULTS: At the AMD patients the peripheral benign lesions were found more frequent than in control group (p = 0.003, especially: drusen (p = 0.026), atrophy (p = 0.011), and chorioretinal degeneration (p = 0.001). CONCLUSIONS: The presence of peripheral retinal lesions may correlate with AMD evaluation.

Angioid streaks - clinical course and photodynamic therapy. Case report.

Angioid streaks develop as a result of damage to the Bruch's membrane. They may occur as idiopatic angioid streaks or in association with pseudoxanthoma elasticum, Paget's disease and the haemoglobinopathies. Other pathologies of the fundus of eye may coexist together with angioid streaks, such as drusen of an optic disc and granular-like retina in posterior pole known as "peau d'orange". Subretinal neovascularization as well as atrophy in macula are also observed in the cases of long-lasting pathologies. The diagnosis is based mainly on clinical manifestations. Photodynamic therapy in treatment patients with secondary choroidal neovasularisation appeared to be effective.

[Helicoidal peripapillary chorioretinal degeneration (HCPD)]. / Okolotarczowa degeneracja naczyniówki i siatkówki.

Helicoidal peripapillary chorioretinal degeneration (HCPD) is characterized by bilateral wing- shaped atrophic areas in retina, radiating from the optic disc. Two cases (women: 23 and 58 years old) of this rare degeneration are presented. No changes of eye fundus and erg, eog, visual field evaluations had been noticed during 2 years follow-up.

[Optical coherence tomography in Stargardt's dystrophy]. / Choroba Stargardta w obrazie optycznej koherentnej tomografii.

Stargardt's disease is one of the central retinal dystrophies with its onset in first two decades of life presenting gradual decrease in visual acuity and typical features in fluorescein angiography. The aim of the study was to evaluate the macular area in patients with diagnosed Stargardt's disease with the use of optical coherence tomography. 11 patients (22 eyes) were enrolled to the study. OCT examination revealed characteristic similar features of macular images in all patients. They included decreased thickness of the retina, most prominent in foveola, and changes in external retinal layers: lack of photoreceptors and nuclear external layer and changes in retinal pigment epithelium. Because of typical features in macular appearance, optical coherence tomography may become a useful tool for confirming diagnosis of Stargardt's disease.

[Central retinal vein occlusion in the tumor of colon and kidney--difficulties in diagnosis]. / Zakrzep zagrazajacy zyly srodkowej siatkówki w przebiegu guza jelita grubego i nerki--trudnosci diagnostyczne.

Central retinal vein occlusion (CRVO) is one of the commonest ophthalmic diseases of vascular background following systemic disorders. The complex etiology of the disease is often responsible for difficulties in establishing diagnosis. Trousseau was the first to describe in 1865 the increased risk of venous thrombosis in cancer patients. Segev et al. published the case of bilateral CRVO and colon cancer, which was not previously recognized. Another case of a patient with early symptoms of CRVO and generalized neoplastic disease, was identified in Department of Ophthalmology of Warsaw Medical University.