Prevention and Treatment of Retinal Vein Occlusion: The Role of Diet-A Review.

Retinal vein occlusion (RVO) is the second most common retinal disorder. In comparison to diabetic retinopathy or age-related macular degeneration, RVO is usually an unexpected event that carries a greater psychological impact. There is strong evidence to suggest that cardiovascular diseases are the most common risk factors in this pathology and it has long been known that a higher consumption of fish, nuts, fruits, and vegetables has a protective effect against these types of conditions. In the last several years, interest in plant-based diets has grown in both the general population and in the scientific community, to the point to which it has become one of the main dietary patterns adopted in Western countries. The aim of this review is to investigate the potential impact of macro- and micronutrients on retinal vein occlusion.

A Mediterranean Diet May Be Protective in the Development of Diabetic Retinopathy.

The Mediterranean diet is recognized as one of the healthiest available dietary patterns. This perception results from its beneficial effects on the cardiovascular system and, also, on hypertension, diabetes, and cancer compared with other diets. Its impact on the course of diabetes is assessed in the available scientific literature; however, little information is available about its impact on diabetic retinopathy. The MD is characterized mainly by the consumption of fish, seafood, foods of plant origin, and fresh fruit and vegetables. It is also recommended to consume legumes, which are a source of folic acid, magnesium, iron, and dietary fiber. High consumption of nuts and unrefined grains is also recommended in the MD. Marine fish provide polyunsaturated acids from the omega-3 group. Olive oil plays a very important role, especially olive oil obtained from mechanical pressing. Additionally, olive oil contains vitamins E, K, and polyphenols. Polyphenols, which are present in a diverse range of vegetables, fruits, and seeds, have the ability to decrease oxidative stress, inflammation, and insulin resistance. Resveratrol is naturally found in grape skins and seeds, as well as in peanuts and berries, and is a constituent of red wine. Resveratrol can inhibit increased vascular leakage and loss of pericytes and regulate the level of VEGF protein in the retina, thus inhibiting the development of DR. Consumption of fruits, vegetables, fish, and olive oil may be correlated with a lower risk of diabetic retinopathy. This paper presents the definition of the Mediterranean diet and its influence on the course of diabetes and diabetic retinopathy.

Current Approach to the Pathogenesis of Diabetic Cataracts.

Cataracts remain the first or second leading cause of blindness in all world regions. In the diabetic population, cataracts not only have a 3-5 times higher incidence than in the healthy population but also affect people at a younger age. In patients with type 1 diabetes, cataracts occur on average 20 years earlier than in the non-diabetic population. In addition, the risk of developing cataracts increases with the duration of diabetes and poor metabolic control. A better understanding of the mechanisms leading to the formation of diabetic cataracts enables more effective treatment and a holistic approach to the patient.

Assessment of the Refractive Error and Stabilisation of Refraction after Cataract Surgery in Relation to the Length of the Eyeball.

The aim of this study was to analyse the changes in refraction, depending on the length of the eyeball, in patients who had undergone cataract surgery using the phacoemulsification method and to assess the stability of refraction. A total of 90 patients (46 to 85 years of age) took part in the study and were divided into three groups: emmetropic, hypermetropic, and myopic. Two types of intraocular lenses were used: Bausch (Akreos AO) and Rayner (C-flex). In conclusion, stabilization of refraction was achieved in the third week in 91% of the emmetropic, 77% of the myopic, and 46% of the hypermetropic patients, respectively. The correct postoperative refraction was achieved using optical biometry and the Barrett Universal II formula to calculate the power of the lens implant.

The Role of Resveratrol in Eye Diseases-A Review of the Literature.

Resveratrol (3,5,4'-trans-trihydroxystilbene) is a polyphenolic phytoalexin belonging to the stilbene family. It is commonly found in grape skins and seeds, as well as other plant-based foods. Oxidative stress and inflammation play a key role in the initiation and progression of age-related eye disorders (glaucoma, cataracts, diabetic retinopathy, and macular degeneration) that lead to a progressive loss of vision and blindness. Even though the way resveratrol affects the human body and the course of many diseases is still the subject of ongoing scientific research, it has been shown that the broad spectrum of anti-inflammatory and neuroprotective properties of resveratrol has a beneficial effect on eye tissues. In our research, we decided to analyze the current scientific literature on resveratrol, its possible mechanisms of action, and its therapeutic application in order to assess its effectiveness in eye diseases.

The Effect of Hyperlipidemia on the Course of Diabetic Retinopathy-Literature Review.

Diabetes mellitus is a very important social issue, and its retinal complications continue to be one of the major causes of blindness worldwide. The effect of glucose level on the development of retinal retinopathy has been the subject of numerous studies and is well understood. Hypertension and hyperlipidemia have been known to be important risk factors in the development of diabetes complications. However, the mechanisms of this effect have not been fully explained and raise a good deal of controversy. The latest research results suggest that some lipoproteins are closely correlated with the incidence of diabetic retinopathy and that by exerting an impact on their level the disease course can be modulated. Moreover, pharmacotherapy which reduces the level of lipids, particularly by means of statins and fibrate, has been shown to alleviate diabetic retinopathy. Therefore, we have decided to review the latest literature on diabetic retinopathy with respect to the impact of hyperlipidemia and possible preventive measures.

The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy-A Review of the Literature.

Diabetes is a major social problem. As shown by epidemiological studies, the world incidence of diabetes is increasing and so is the number of people suffering from its complications. Therefore, it is important to determine possible preventive tools. In the prevention of diabetic retinopathy, it is essential to control glycemia, lipid profile and blood pressure. This can be done not only by pharmacological treatment, but first of all by promoting a healthy lifestyle, changing dietary habits and increasing physical activity. In our work, we present a review of the literature to show that physical exercise and an adequate diet can significantly reduce the risk of diabetes and diabetic retinopathy.

Integrins: An Important Link between Angiogenesis, Inflammation and Eye Diseases.

Integrins belong to a group of cell adhesion molecules (CAMs) which is a large group of membrane-bound proteins. They are responsible for cell attachment to the extracellular matrix (ECM) and signal transduction from the ECM to the cells. Integrins take part in many other biological activities, such as extravasation, cell-to-cell adhesion, migration, cytokine activation and release, and act as receptors for some viruses, including severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). They play a pivotal role in cell proliferation, migration, apoptosis, tissue repair and are involved in the processes that are crucial to infection, inflammation and angiogenesis. Integrins have an important part in normal development and tissue homeostasis, and also in the development of pathological processes in the eye. This review presents the available evidence from human and animal research into integrin structure, classification, function and their role in inflammation, infection and angiogenesis in ocular diseases. Integrin receptors and ligands are clinically interesting and may be promising as new therapeutic targets in the treatment of some eye disorders.

Retinal Vascular Endothelial Cell Dysfunction and Neuroretinal Degeneration in Diabetic Patients.

Diabetes mellitus (DM) has become a vital societal problem as epidemiological studies demonstrate the increasing incidence of type 1 and type 2 diabetes. Lesions observed in the retina in the course of diabetes, referred to as diabetic retinopathy (DR), are caused by vascular abnormalities and are ischemic in nature. Vascular lesions in diabetes pertain to small vessels (microangiopathy) and involve precapillary arterioles, capillaries and small veins. Pericyte loss, thickening of the basement membrane, and damage and proliferation of endothelial cells are observed. Endothelial cells (monolayer squamous epithelium) form the smooth internal vascular lining indispensable for normal blood flow. Breaking its continuity initiates blood coagulation at that site. The endothelium controls the process of exchange of chemical substances (nutritional, regulatory, waste products) between blood and the retina, and blood cell passing through the vascular wall. Endothelial cells produce biologically active substances involved in blood coagulation, regulating vascular wall tension and stimulating neoangiogenesis. On the other hand, recent studies have demonstrated that diabetic retinopathy may be not only a microvascular disease, but is a result of neuroretinal degeneration. Neuroretinal degeneration appears structurally, as neural apoptosis of amacrine and Muller cells, reactive gliosis, ganglion cell layer/inner plexiform (GCL) thickness, retinal thickness, and retinal nerve fiber layer thickness, and a reduction of the neuroretinal rim in minimum rim width (MRW) and functionally as an abnormal electroretinogram (ERG), dark adaptation, contrast sensitivity, color vision, and microperimetric test. The findings in early stages of diabetic retinopathy may precede microvascular changes of this disease. Furthermore, the article's objective is to characterize the factors and mechanisms conducive to microvascular changes and neuroretinal apoptosis in diabetic retinopathy. Only when all the measures preventing vascular dysfunction are determined will the risk of complications in the course of diabetes be minimized.

Co-Transplantation of Bone Marrow-MSCs and Myogenic Stem/Progenitor Cells from Adult Donors Improves Muscle Function of Patients with Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is a genetic disorder associated with a progressive deficiency of dystrophin that leads to skeletal muscle degeneration. In this study, we tested the hypothesis that a co-transplantation of two stem/progenitor cell populations, namely bone marrow-derived mesenchymal stem cells (BM-MSCs) and skeletal muscle-derived stem/progenitor cells (SM-SPCs), directly into the dystrophic muscle can improve the skeletal muscle function of DMD patients. Three patients diagnosed with DMD, confirmed by the dystrophin gene mutation, were enrolled into a study approved by the local Bioethics Committee (no. 79/2015). Stem/progenitor cells collected from bone marrow and skeletal muscles of related healthy donors, based on HLA matched antigens, were expanded in a closed MC3 cell culture system. A simultaneous co­transplantation of BM-MSCs and SM-SPCs was performed directly into the biceps brachii (two patients) and gastrocnemius (one patient). During a six­month follow­up, the patients were examined with electromyography (EMG) and monitored for blood kinase creatine level. Muscle biopsies were examined with histology and assessed for dystrophin at the mRNA and protein level. A panel of 27 cytokines was analysed with multiplex ELISA. We did not observe any adverse effects after the intramuscular administration of cells. The efficacy of BM­MSC and SM­SPC application was confirmed through an EMG assessment by an increase in motor unit parameters, especially in terms of duration, amplitude range, area, and size index. The beneficial effect of cellular therapy was confirmed by a decrease in creatine kinase levels and a normalised profile of pro-inflammatory cytokines. BM-MSCs may support the pro-regenerative potential of SM-SPCs thanks to their trophic, paracrine, and immunomodulatory activity. Both applied cell populations may fuse with degenerating skeletal muscle fibres in situ, facilitating skeletal muscle recovery. However, further studies are required to optimise the dose and timing of stem/progenitor cell delivery.

Pro-inflammatory cytokines associated with clinical severity of dry eye disease of patients with depression.

PURPOSE: The aim of this study was to assess the correlation of inflammatory cytokines levels in tears with severity of dry eye disease in a cohort of patients with depression. MATERIAL AND METHODS: Tear fluid samples were collected from 32 patients with depression treated with antidepressants, and 34 healthy subjects. Cytokines were assessed by ELISA. All the subjects completed the Beck Depression Inventory and performed the ophthalmic examination, including dry eye tests. RESULTS: The tear fluid levels of IL-6, IL-17 and TNF-α in depressive patients were higher than in controls. The clinical severity of dry eye disease correlated significantly with the IL-17 and TNF-α levels. CONCLUSIONS: Our results suggest a crucial role of inflammatory cytokines, especially IL-17 and TNF-α, in the development of severe dry eye disease in patients with depression. Clarification of the role pro-inflammatory cytokines in the pathogenesis of ocular findings in depressive patients may be useful in establishing immunotherapeutic strategies for this disease.

Neuroretinal Apoptosis as a Vascular Dysfunction in Diabetic Patients.

BACKGROUND: Diabetic retinopathy (DR) is an important complication of diabetes and is considered one of the main causes of blindness in moderate-income and highly-developed countries. As it is a major socioeconomic problem, defining all mechanisms that may lead to DR development is of great importance. In the 21st century diabetic lesions occurring in the retina are well known. However what kind of retinal neuronal damage occurs in the course of diabetes remains unclear. RESULTS: In this manuscript we present the most recent knowledge about suggested mechanisms of diabetic retinopathy, including neuroretinal apoptosis. Getting a deep insight into the role of apoptosis and degeneration of retinal neurons leading to DR will have vital consequences. CONCLUSION: The findings of this review confirm that it is very likely that in the nearest future diabetic retinopathy treatment will be based on administration of neuroprotective agents. The implementation of neuroprotective drugs may slow down retinopathy progression, making it possible to avoid the currently used therapeutic procedures, such as laser photocoagulation, intravitreous injections or posterior vitrectomy, which are not only risky for the healthy part of the retina but also relatively expensive.

[Dry eye disease in patients treated with antidepressants]. / Zespól suchego oka u pacjentów leczonych lekami antydepresyjnymi.

PURPOSE: Dry eye disease is defined as a multifactorial disease of tears and ocular surfaces that causes discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. This study aimed to determine dry eye findings in patients with depression. MATERIAL AND METHODS: There were 40 patients with depression aged 18-65 years old. A comprehensive ophthalmic examination, including intraocular pressure and dry eye tests, was performed. RESULTS: Among patients with depression 24 patients (70%) had dry eye syndrome. Compared with patients who did not have dry eye, the patients with dry eye were significantly older than the patients without dry eye (44 years old and 36 years old, respectively). Time in duration of depression in patients with depression and with dry eye lasted over 54 months and time of taking antidepressants was longer than 18 months and was significant, in comparing to the patients without dry eye (36 months and 10 months, respectively). CONCLUSIONS: Dry eye is frequent disease in patients with depression, especially in older patients, who have longer duration of depression, and taking antidepressant medication for a longer period of time. Using of antidepressant may be cosidered as potential cause of dry eye syndrome.

[Evaluate the effectiveness of laser therapy in the treatment of diabetic maculopathy]. / Ocena skutecznosci laseroterapi w leczeniu makulopatii cukrzycowej.

UNLABELLED: Diabetes mellitus concerns a growing number of people in the world. Its complications are an important social problem. Diabetic macular edema (DME) is one of the leading causes of visual loss in the course of the disease. Deterioration of vision is typically the patients with long-standing, poorly controlled diabetes, both type 1 and 2. DME can occur at any stage of the disease. Because structural changes in the macula are reversible in the initial period, it is important to start treatment early. In the treatment of diabetic uses three techniques retinal laser--direct photocoagulation, photocoagulation a "grid" and the panphotocoagulation. The aim of this study was to evaluate the effectiveness of laser therapy in the treatment of diabetic macular edema. MATERIALS AND METHODS: The study included 90 patients (180 eyes) with DME, 50 women and 40 men aged from 18 to 80 years with a visual acuity of 0.08 to 0.7 with the best corrected on the Snellen chart. 9 people were with type 1 diabetes, 81 with type 2. 86 patients applied insulin, 4 people took drugs. Eye with poor visual acuity was qualified for the treatment. In all patients enrolled in the study visual acuity, anterior segment of the eye in the slit lamp and fundus by indirect ophthalmoscopy with Volk 78D lens were evaluated. DME was diagnosed on the basis of the results of fluorescein angiography and optical coherence tomography. In the patients laser therapy was performed twice: on day 1 after qualification and four months later. Performed two types of laser: the focal photocoagulation and the type of "grid" depending on the severity of DME. Retinal photocoagulation was performed using a diode laser 810 nm Diode Laser Systems OcuLight SL and SLx Iris Medical Models. Patients were monitored at 4 and 8 months after the laser therapy. The results were statistically analyzed. RESULTS: Duration of diabetes less than 10 years was in 67 patients, over 10 years in 23. In patients with diabetes under 10 years predominated limited type of macular edema (92.65%), in patients over 10--diffuse (72.73%). As a result of the treatment in 34 patients (37.8%) visual acuity was improved. 91.18% of them had limited macular edema. In 47 patients (52.2%) showed the stabilization of vision. These patients had also more limited type of edema (74.47%). In 9 patients (10%) visual impairment were observed and they were mostly patients with diffuse macular edema (66.67%). Average visual acuity in patients with limited macular edema before laser therapy was 0.37 +/- 0.18. In the four months after the laser treatment improved slightly (0.38 +/- .18). After 8 months of treatment the average visual acuity in this group remained at a level of 0.44 +/- 0.16. In patients with diffuse macular edema output type visual acuity was significantly lower and averaged only 0.16 +/- 0.1. In 4 months after the laser was found in this group decreased vision (Vo = 0.13 +/- 0.08). In 8 months after surgery visual acuity averaged 0.15 +/- 0.09. Average visual acuity before laser therapy in this group was 0.36 +/- 0.17, and 8 months after was at the level of 0.43 +/- 0.16. In patients with diabetes more than 10 years laser therapy has not brought the desired effect, and visual acuity were as follows: before treatment--0.18 +/- 0.16 and 8 months after--0.17 +/- 0.14 (p < 0.0001). Average macular thickness before laser therapy in patients with limited edema was 348.14 +/- 33.47 microns. In 4 months after the laser has been observed decreased to 340.29 +/- 31.2 microns, and after 8 months of further withdrawal of edema to an average of 337.88 +/- 32.95 microns. In patients with diffuse type average macular thickness was 394.38 +/- 38.18. After 4 months of laser treatment exacerbation of edema (mean 399 +/- 38.08). After 8 months, the thickness of macula in this group was average 388.95 +/- 32.85. CONCLUSIONS: Laser therapy is an effective type of treatment for DME. Better results after laser therapy are obtained in patients with a short-term macular edema and good visual acuity. In order to maintain useful visual acuity, patients with DME should undergo laser treatment in the early stages of the disease.

[Evaluation of the arterial blood flow parameters in the eye of myopic patients]. / Ocena parametrów predkosci krwi w naczyniach tetniczych galki ocznej u chorych krótkowzrocznych.

UNLABELLED: Myopia is a common refractive defect. Has a good vision from near and deterioration of vision with increasing distance. The main reason for its occurrence is too long axis of the eyeball. The consequence of elongation of the eyeball is the development of degenerative changes in the retina. Despite much research has failed to clearly identify the causes of degenerative changes in those short-sighted. The aim of the study was to evaluate the maximum and minimum speed in arterial blood vessels of the eye in people with myopia. MATERIAL AND METHODS: The study included 70 patients (138 eyes), 53 women and 17 men, aged from 18 to 79 years, with myopia of -0.25 to -18.0 Dsph and length of the eyeball from 22.61 to 33.36 mm. Depending on the kind and the degree of the progress of degenerative changes, patients were divided in 4 groups: I - without degenerative changes on the fundus (n=32; K-23, M-9); II- with the short-sighted sickle (n=20; K-14, M-6); Ill - with the structure thinned down of the retina, accompanying the short-sighted sickle (n = 8; K-6, M-2); IV - with extensive choroidal-retina disappearances in the fundus (n = 10; K-7, M-3). In all individuals enrolled underwent Color Doppler ultrasound with apparatus SSA 770A Toshiba Aplio with linear probe frequency 12 MHz, judging maximum (Vmax) and minimum (Vmin) speed in the arteries of the eye: ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) located on the nasal and temporal side of the optic disc. The results were statistically analyzed. RESULTS: No statistically significant relationship between the nature of degenerative changes of the eye, and blood velocity in the OA. There was a increase in Vmax and Vmin blood in OA in Group IV, but these changes were not statistically significant. Statistically significant correlation was observed while in the CRA. With a decrease in Vmax and Vmin of blood flowing through a vessel exacerbation of retinal degeneration. Vmax and Vmin changes in the blood did not correlate significantly SPCA with retinal degeneration, although the results were much worse in the temporal vessels. CONCLUSIONS: With the deterioration of blood flow parameters of the central retinal artery and short posterior ciliary arteries comes to the severity of the retinal degeneration in myopic patients. More severe impairment of blood circulation in the temporal ciliary explain higher incidence of degenerative changes in the temporal side of the optic disc.

[Blood flow in vessels supplying the eye in persons with degenerative myopia. Part I. Blood flow in the ophthalmic artery]. / Przeplyw krwi w naczyniach zaopatrujacych galke oczna u osób z krótkowzrocznoscia degeneracyjna. Cz. I. Przeplyw krwi w tetnicy ocznej.

BACKGROUND: Mechanism of hemodynamic disturbances of blood circulation within the afferent vessels supplying the retina and the choroid, considered as one of main underlying causes of degenerative changes in myopic patients, is exceptionally likely, although not entirely proven. PURPOSE: To estimate the blood flow parameters in the ophthalmic artery of myopic subjects, depending on the extent and severity of progression of degenerative lesions observed in ocularfundi. METHODS: A prospective study included 70 myopic persons, aged from 18 to 79 years (44.9 +/- 18.3) with the mean axial ocular length of 27.9 +/- 5.37 mm. According to the extent and severity of degenerative lesion progression, patients were divided into 4 groups: I - no degenerative changes on the fundus (n = 32; K--23, M--9), II--myopic crescent (n = 20; K--14, M--6), III--retinal thinning accompanying the myopic crescent (n = 8; K - 6, M - 2), IV--extensive chorioretinal atrophy in the fundus (n = 10; K--7, M--3). Using colour Doppler ultrasonography (Aplio SSA Toshiba, frequency of the head of 12 MHz) the following parameters of the blood flow in the opthalmic artery were determined: the maximum (Vmax), minimal (Vmin) and mean (Vm) velocity, resistive index (RI) as well as pulsation index (PI). Differences were analysed statistically (the variance analysis and the Spearman's rank correlation coefficient). P < 0.05 was assumed as statistically significant. RESULTS: In groups I and II blood flow parameters were comparable. In group III Vmax, Vmin and Vm were lower than in groups I and II. However, an increase in these parameters was shown in group IV. The PI remained on the comparable level, and the RI across all the study groups. The observed differences were not statistically significant. CONCLUSIONS: The severity of degenerative retinal change progression at different stages of myopia is related to the blood flow in the ophthalmic artery, although these associations are not statistically significant. Blood flow discrepancies between the right and left artery, resulting from anatomical asymmetries, does not seem to be significant for the development of degenerative changes.

[Blood flow in vessels supplying the eye in persons with degenerative myopia. Part II. Blood flow in the central retinal artery]. / Przeplyw krwi w naczyniach zaopatrujacych galke oczna u osób z krótkowzrocznoscia degeneracyjna. Czesc II. Przeplyw krwi w tetnicy srodkowej siatkówki.

PURPOSE: To analyse the blood flow parameters in the central retinal artery (CRA) of myopic patients depending on the severity of the degenerative changes in ocular fundi. METHODS: 70 myopic subjects, aged 18 to 79 years, with the axial ocular length ranging between 22.61 and 33.36 mm (27.9 +/- 5.37) were examined. According to the extent and severity of degenerative lesion progression, patients were divided into 4 groups: I--no degenerative changes on the fundus (n = 32; K--23, M--9), II--myopic crescent (n = 20; K--14, M--6), III-- retinal thinning accompanying the myopic crescent (n = 8; K--6, M--2), IV--extensive chorioretinal atrophy in the fundus (n = 10; K--7, M--3). Blood flow parameters in the central retinal artery were determined using Doppler Color ultrasonography (Aplio SSA, Toshiba), with the 12 MHz probe. The following, standard parameters were analysed: maximum (Vmax), minimum (Vmin) and mean (Vm) velocity at systole, resistive index (RI) and pulsation index (PI). The differences were analysed statistically using the variance analysis and the Spearman's rank correlation coefficient, with the p < 0.05 assumed as statistically significant. RESULTS: The severity of degenerative retinal changes correlated with the blood flow in CRA. At lowered Vmax, Vmin, Vm acompanying the elevated RI and Pi the lesions progressed rapidly and were considerably more advanced and extensive. CONCLUSIONS: The extent and severity of degenerative processes within the myopic retina are directly proportional to blood flow deterioration in the central retinal artery. This association can explain the development and progression of myopic retinopathy.

A Becker myotonia patient with compound heterozygosity for CLCN1 mutations and Prinzmetal angina pectoris.

Becker myotonia is a recessive muscle disease with prevalence of > 1:50,000. It is caused by markedly reduced function of the chloride channel encoded by CLCN1. We describe a Polish patient with severe myotonia, transient weakness, and muscle cramps who only responds to lidocaine. In addition, the patient has Prinzmetal angina pectoris and multiple lipomatosis. He is compound heterozygeous for a novel p.W303X and a frequent p.R894X CLCN1 mutation. CLCN1 exon number variation was excluded by MLPA. His son with latent myotonia was heterozygeous for p.R894X. We discuss the potential relations of the three rare diseases and the inheritance of p.R894X.

[Endoscopic resection of sphenoid sinus tumor compressing the optic nerve]. / Endoskopowe usuniecie guza zatoki klinowej wchodzacego do szczytu oczodolu.

Thanks to recent technical refinements the orbital apex can be explored endoscopically and this approach is used for tumor biopsy in some specialized centers. Nevertheless, only a few instances of total tumor resection have been reported to date. In this contribution we report a case of a 64 years old woman in whom we used neuronavigated endoscopy and intraoperative Doppler sonography, for total removal of a tumor located in the sphenoid sinus and invading the orbital apex. The visual acuity improved from 5/16 to 5/6 and HP diagnosis was cystis spuria.