Functional and structural outcomes and complications after pars plana vitrectomy for severe features of proliferative diabetic retinopathy in type 1 and type 2 diabetes mellitus.

PURPOSE: To evaluate the functional and structural outcomes as well as postoperative complications after pars plana vitrectomy (PPV) for severe features of proliferative diabetic retinopathy (PDR) in type 1 and type 2 diabetes mellitus (DM) patients. METHODS: Twenty two eyes of type 1 diabetics (DM1 group) and 27 eyes of type 2 diabetics (DM2 group) were included. Best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative structural changes in optical coherence tomography (OCT) and postoperative complications such as recurrent vitreous haemorrhage, diabetic macular oedema, secondary glaucoma and persistent tractional retinal detachment (TRD) were assessed and compared between the two groups. RESULTS: Complete reattachment of retina was achieved in 88.9% from the DM1 group and in 95.5% from the DM2 group and remained attached in follow-up. BCVA in DM2 group was significantly lower preoperatively (p = 0.04). Mean postoperative BCVA significantly improved in both studied groups, but it was more evident in eyes of type 2 diabetics compared to type 1 diabetics. In eyes in the DM1 group there was perceptible stabilisation of BCVA. Poor visual acuity or lack of improvement in BCVA in the DM1 group was related to preoperative subretinal haemorrhage in macular region, and TRD involving macula, whereas in the DM2 group-to preoperative subretinal haemorrhage and neovascular glaucoma. The postoperative structural changes (disruption of EZ and ELM) were observed more often in DM2 group, but had the greatest impact on BCVA in eyes of type 1 DM. Complications after PPV for PDR were rare and hadn't a significant influence on the final functional outcomes in both groups. CONCLUSIONS: Functional improvement after PPV for severe features of proliferative diabetic retinopathy were more noticeable in patients with type 2 DM. Postoperative structural changes had more negative impact on BCVA in type 1 diabetics.

Vascular density and macular sensitivity in eyes after scleral buckling surgery for macula-on rhegmatogenous retinal detachment.

PURPOSE: To investigate the structure and function of the retina after scleral buckling (SB) surgery due to macula-on rhegmatogenous retinal detachment (RRD). METHODS: Twenty eyes with repaired macula-on RRD and 20 fellow eyes were included. All patients within 6-12 months of the procedure, were examined to evaluate retinal structure using spectral domain optical coherence tomography (SD-OCT) and vessel density (VD) by OCT angiography (OCTA). Best corrected visual acuity (BCVA) and microperimetry (MP) tests were used to assess retinal function. RESULTS: Analysis of the microvascular network using OCTA between the operated and healthy fellow eyes showed a significant reduction on VD in superficial vascular plexus (SVP), deep vascular plexus (DVP) and radial peripapillary capillaries (RPC) (p< 0.001, p = 0.019 and p = 0.008, respectively). Comparison of retinal structure in SD-OCT showed no significant differences on thickness in ganglion cell complex (GCC) and peripaillary retinal nerve fiber layer (pRNFL) (p> 0.05) between examined eyes. Retinal function analysis by MP examination showed a decrease of retinal sensitivity (p = 0.0013) whereas postoperative BCVA showed no differences (p = 0.62) in the operated eyes. Significant Pearson's correlations were observed between retinal sensitivity and VD in SVP, RPC (p< 0.05). CONCLUSION: In the eyes after SB surgery due to macula-on RRD, changes in retinal sensitivity were accompanied by impairment of the microvascular network assessed by the OCTA.

CLU Polymorphisms in Patients with Pseudoexfoliation Syndrome in Polish Population.

PURPOSE: To evaluate CLU polymorphisms in patients with pseudoexfoliation syndrome. MATERIALS AND METHODS: We studied 81 patients (23 males and 58 females, the median age 76 years) and 91 control subjects (27 males and 64 females, the median age 75 years). Genotypes of the CLU polymorphisms (SNPs), rs3087554 and rs2279590, were determined using a commercially available validated genotyping assays. The χ 2 test was performed to compare patient and control groups for possible associations between SNP genotype/allele frequency and disease state. RESULTS: There were no significant differences for both allele and genotype frequencies between PEX patients and controls for rs3087554 and rs2279590 polymorphisms. The haplotypes distribution shows statistically significant difference between groups (p=0.03). The haplotype (CT) more often was found in controls than in PEX patients, conferring an 18-fold decreased risk to the disease. CONCLUSION: Our results indicate that CLU variants may contribute to the risk of PEX in the Polish population.

Evaluation of TGF-Beta 2 and VEGFα Gene Expression Levels in Epiretinal Membranes and Internal Limiting Membranes in the Course of Retinal Detachments, Proliferative Diabetic Retinopathy, Macular Holes, and Idiopathic Epiretinal Membranes.

PURPOSE: To evaluate the expression profiles of the VEGFα and TGFß in the ERMs and ILMs in retinal disorders. METHODS: In this nonrandomized prospective study, 75 patients (34 females and 41 males) referred to pars plana vitrectomy (PPV) due to different retinal diseases were enrolled to the study. The samples of ERMs and ILMs collected during PPV were immediately put in TRIzol® Reagent (Life Technologies, USA) and stored at -70°C until RNA extraction. Gene expression analysis was done with TaqMan® Gene Expression Assays (Applied Biosystems, USA) following the manufacturer's instructions. RESULTS: The gene expression levels of VEGFα as well as of TGFß2 were significantly higher in ERMs than in ILMs in all studied groups. The level of TGFß2 expression exhibits a significantly lower values in iERMs as compared with the RRD group (p = 0.043). There were differences in TGFß2 expression in ILM in groups studied: DR versus RRD, p = 0.003; DR versus iERM, p = 0,047; and iERM versus RRD, p = 0.004. CONCLUSIONS: Our results revealed that factors associated with angiogenesis and wound healing processes in eyes with RRD, PDR, iERM, and MH were more upregulated in ERMs than in ILMs. This may indicate that ILM is not responsible for reproliferation and its peeling should be avoided in routine PPV.

Long-Term Anatomic and Functional Outcomes after Macular Hole Surgery.

AIM: To evaluate the structural and functional outcomes in patients who underwent macular hole (MH) surgery in the long-term follow-up. MATERIALS AND METHODS: Forty-four eyes of 40 patients (28 females and 12 males) were examined. The examination included visual acuity, optical coherence tomography, and colour vision testing. The same evaluation was performed in 30 fellow eyes. RESULTS: MH closure was obtained in 42 eyes (95.45%). There was no reopening of the initially closed MHs. In long-term postoperative examination, we observed IS/OS junction defects in 28 (63.6%) eyes and ELM defects in 19 (43.2%) eyes. We found that the IS/OS junction defects correlated with the diameter of the MH (p=0.016), whereas ELM defects correlated with both the diameter of the MH (p=0.001) and duration time of the MH (p=0.008). The presence of ELM defects in OCT was the cause of inferior BCVA in long-term observation time (p=0.004). The mean BCVA before the MH surgery was 0.15. It improved significantly both in early (p < 0.001) and long-term postoperative observation (p < 0.005). Generally, the functional outcomes were better in eyes with short-time duration of the MH, when a smaller diameter (<400 µm) of the hole was measured and a V-shaped closure of the MH and the restoration of the ELM line on OCT were present. Pseudoprotanomaly was noted in 13 (35.1%) eyes. In the fellow eye group, mean BCVA was 0.95 (range, 0.6-1.0). In 3 eyes, we detected vitreomacular traction, and in 4 eyes, initial cataract. These conditions, as well as probably early stage of diabetes mellitus, influenced functional outcomes of studied eyes. CONCLUSIONS: The anatomic and functional outcomes after macular surgery are satisfactory and improve with time. After a successful closing of the MH, the restoration of the retina progresses at a slower pace than improvement in visual acuity.

Immunohistochemical analysis of microsomal glutathione S-transferase 1 and clusterin expression in lens epithelial cells of patients with pseudoexfoliation syndrome.

Pseudoexfoliation syndrome (PEX) is an age-associated, sight disorder affecting elastic fibers in the eye and visceral organs but its exact etiology remains unknown. The purpose of the current study was to determine the morphology and ultrastructure of lens epithelial cells (LECs), and to use immunohistochemistry to examine localization of microsomal glutathione S-transferase 1 (MGST1) and clusterin. Anterior lens capsules were obtained from 24 patients (13 PEX and 11 controls) who underwent phacoemulsification. Immunohistochemistry was performed, using antibodies against MGST1 and clusterin, to determine their expression. The morphology and ultrastructure of LECs were evaluated by light and transmission electron microscopy, respectively. The PEX LECs were characterized by significantly lower MGST1 (P=0.0001) and clusterin expression (P=0.0005) compared with the control group patients. PEX LECs were also observed to have significantly increased thickness compared with the control group patients (P=0.0002). The current findings suggest that low MGST1 and clusterin expression levels may be an early clinical indicator of PEX, and that oxidative stress may serve an important role, but that the specific etiology of this disease has yet to be revealed.

Use of nonsteroidal anti-inflammatory drugs in diabetic retinopathy.

INTRODUCTION: Diabetic macular edema, a manifestation of diabetic retinopathy, occurs more frequently in type 2 diabetes mellitus. There is evidence that inflammation plays a prominent role in the pathogenesis. A number of pro-inflammatory cytokines are consistently elevated in the vitreous of patients with advanced stages of diabetic retinopathy. Nonsteroidal anti-inflammatory drugs inhibit the catalytic activity of the cyclooxygenase isoenzymes COX-1 and COX-2, the key enzymes in inflammatory processes. PURPOSE: To present current knowledge of benefits and limitations of using nonsteroidal anti-inflammatory drugs in diabetic retinopathy. CONCLUSIONS: Nonsteroidal anti-inflammatory druds may be considered as an adjuvant treatment in diabetic retinopathy especially in patients with diabetic macular edema.

The opinion of the Expert Group of the Polish Society of Ophthalmology on using nepafenac in the prevention of postoperative macular edema after cataract surgery in diabetic patients.

Nepafenac is an innovative non-steroidal anti-inflammatory drug used in ophthalmology for the prevention of macular edema after cataract surgery. Along with its anti-inflammatory effect, nepafenac has some unique properties which distinguish it from other non-steroidal anti-inflammatory drugs. It is a prodrug activated to amfenac after it penetrates through the corneal layers to the aqueous humour and the ciliary body. Having electrically neutral molecules of lipophilic properties, nepafenac does not accumulate in the cornea and does not cause its degeneration. Additionally, it quickly achieves higher concentrations in the aqueous humour as compared to other non-steroidal anti-inflammatory drugs. Nepafenac shows high selectivity and activity against COX-2 isoform, the key enzyme implicated in inducing inflammation, which is the main cause of macular edema. Furthermore, nepafenac has the unique scleral and suprachoroidal distribution pathways. Finally, its effect on the intraocular pressure is none to negligible. Nepafenac treatment should be initiated prior to cataract surgery and continued long enough to reduce the risk of late-onset macular edema. The Expert Group of the Polish Society of Ophthalmology consider using nepafenac in the prevention of post­operative macular edema in diabetic patients undergoing cataract surgery as expedient and reasonable. The proposed optimum pre- and postoperative treatment regimen can be modified for individualised therapy.

Photoreceptor Inner and Outer Segment Junction Reflectivity after Vitrectomy for Macula-Off Rhegmatogenous Retinal Detachment.

Purpose. To evaluate the spatial distribution of photoreceptor inner and outer segment junction (IS/OS) reflectivity changes after successful vitrectomy for macula-off retinal detachment (PPV-mOFF) using spectral domain optical coherence tomography (SdOCT). Methods. Twenty eyes after successful PPV-mOFF were included in the study. During a mean follow-up period of 15.3 months, SdOCT was performed four times. To evaluate the IS/OS reflectivity a four-grade scale was used. Results. At the first follow-up visit the IS/OS had very similar reflectivity in entire length of the central scan with total average value of 1,05. At the second visit the most significant increase of the reflectivity was observed in temporal and nasal parafovea with average values of 2,17 and 2,22, respectively. The third region of increased reflectivity of an average value of 2,33 appeared during the third follow-up visit and was located in the foveola. At the last follow-up visit in entire central cross section the IS/OS reflectivity exceeded grade 2 reaching the highest average values in nasal and temporal parafovea and foveola. Conclusions. A gradual increase of the IS/OS reflectivity was observed in eyes after PPV-mOFF. The process is not random and starts independently in the peripheral and central part of the macula which may be attributed to the variable regenerative potential of cones and rods.

The diagnostic function of OCT in diabetic maculopathy.

Diabetic maculopathy (DM) is one of the major causes of vision impairment in individuals with diabetes. The traditional approach to diagnosis of DM includes fundus ophthalmoscopy and fluorescein angiography. Although very useful clinically, these methods do not contribute much to the evaluation of retinal morphology and its thickness profile. That is why a new technique called optical coherence tomography (OCT) was utilized to perform cross-sectional imaging of the retina. It facilitates measuring the macular thickening, quantification of diabetic macular oedema, and detecting vitreoretinal traction. Thus, OCT may assist in patient selection with DM who can benefit from treatment, identify what treatment is indicated, guide its implementing, and allow precise monitoring of treatment response. It seems to be the technique of choice for the early detection of macular oedema and for the followup of DM.

Treatment of full-thickness pressure ulcers with a gentamicin sponge: a case report.

BACKGROUND: Five pressure ulcers (stage III and stage IV) were successfully treated with collagen sponges filled with gentamicin. CASE DESCRIPTION: All ulcers occurred in an immobile 94-year-old woman with advanced dementia. One of the pressure ulcers, located on the patient's sacrum, was considered life-threatening due to size and depth. All ulcers were treated with a collagen sponge filled with gentamicin; the sponge was replaced at variable intervals, ranging from 6 days to 2 months, depending on absorption of the collagen. All 5 pressure ulcers improved based on reductions in wound depth and surface area. Two of the pressure ulcers healed completely; in these wounds, gentamicin sponge therapy was initiated shortly after development of the ulcer. None of the wounds exhibited evidence of reinfection following initiation of therapy. No adverse events were observed. The rate at which the collagen sponge was absorbed slowed significantly after the initial treatment phase. CONCLUSIONS: In this patient, the use of a collagen sponge filled with gentamicin was effective in preventing infection and promoting healing of multiple full-thickness pressure ulcers. Long-term use was not associated with any adverse effects, even in this frail and immobile patient.

Endothelial cell markers in patients with pseudoexfoliation syndrome.

The aim of the study was the assessment of the von Willebrand antigen (vWF Ag), E-selectin, and P-selectin concentration in blood plasma of patients with pseudoexfoliation syndrome (PEX). The group studied comprised 30 patients with PEX, aged from 50 to 86 years (mean 73, SD ± 8 years). Patients with cardiovascular and cerebrovascular diseases, diabetes mellitus, infectious disease, cancer, renal or liver insufficiency, connective tissue disease, current smoking, and hormone, antiplatelet, hypolipidemic, antioxidant, or antihypertensive drug therapy were excluded from the study. Each subject underwent a complete ophthalmological examination. Venous blood samples from the cubital vein were taken into sodium citrate solution. VWF Ag, sP-selectin, and sE-selectin concentration were determined by a commercially available enzyme-linked immunosorbent assay (MedSystems, Diagnostica Stago/Roche, R&D). Concentrations of vWF Ag, soluble E-selectin, and soluble P-selectin in blood plasma in the study group were compared with the levels in blood plasma in the control group. No significant differences were found between the groups. Our results indicate that there might be no correlation between PEX and such endothelial cell markers as vWF Ag, sP-selectin, and sE-selectin concentrations. Since the study size is limited, further investigations to confirm that there is no association between endothelial dysfunction in PEX and risk of future cardiovascular disease are necessary.

Malignant glaucoma and central retinal vein occlusion after Nd: YAG laser posterior capsulotomy.

PURPOSE: The purpose of this paper is to present the case of malignant glaucoma complicated by CRVO occurring after Nd: YAG laser posterior capsulotomy. MATERIAL AND METHODS: A 75 years old woman with pseudophakia and cardiovascular disease had undergone Nd: YAG laser posterior capsulotomy, the day after capsulotomy IOP increased in that eye up to 50 mmHg. Medical treatment alone appeared to be unsuccessful. IOP remained elevated (50 mmHg) and lack of anterior chamber occurred. In the examination, the eye showed circumcorneal congestion, diffuse corneal edema, uniformly flat anterior chamber with dilated, nonreacting pupil, optic disc edema, retinal hemorrhages, dilated tortuous retinal veins and macular edema. Surgical therapy (pars plana vitrectomy and the anterior chamber reformation with air bubble) was performed in urgent course. RESULTS: Twenty four hours after surgical intervention anterior chamber remained deep, IOP reduced to 12,2 mmHg, B-scan ultrasonography did not show any aqueous pockets in the vitreous. In the following 10 days, the IOP remained within normal limits with a well-formed anterior chamber. The final best-corrected visual acuity of the eye was 0.3. CONCLUSIONS: Early recognition of malignant glaucoma and proper treatment is the most important step to save the eye from severe consequences and prevent irreversible vision loss.

[Open globe injuries--selected epidemiologic features in own material]. / Urazy przenikajace galki ocznej-- wybrane cechy epidemiologiczne w materiale wlasnym.

PURPOSE: To evaluate chosen epidemiological factors in perforating eye injuries in own material MATERIAL AND METHOD: Retrospective case review over period from 2001 to 2003 hospitalised in the Department of Ophthalmology in Bydgoszcz. The group studied comprised 78 patients (79 eyes) aged from 4 to 77 years. Analyzed were following data: age, gender, the extend of the injury, visual acuity at presentation, the presence of - and intraocular foreign body nature, type of injury, professional activity, and other factors (alcohol use, glasses). RESULTS: The group studied involved 89.7% men. Mean age of all the patients was 35.6 years (SD=17.1), male: 35 years (D=17.0), female: 41 (SD=18.5). Severe wounds, including corneal and scleral laceration totaled 32.9%. In 41.8% cases initial visual acuity was less than 0.001, including 42.4% of light perception. There was no light perception in 18.2% in this group. Intraocular foreign bodies were found in 39.2% of studied eyes (75.8% involved ferromagnet metal). Domestic activities accounted for 50% of injuries, and 33.3% occurred at worksite. In the group studied there were 28.2% of unemployed, the pensioners were affected in 9%. CONCLUSIONS: Most of the penetrating eye injuries affected young males aged mean 35 and happened at home. Almost one half of the patients experienced severe injuries leading to severe visual loss. Ferromagnet metal predominated intraocular foreign bodies.

[Difficulties in diagnosing Graves' ophthalmopathy--case report]. / Trudnosci w rozpoznawaniu orbitopatii tarczycowej--opis przypadku.

PURPOSE: The aim is to present diagnostic difficulties which may occur when diagnosing Graves' ophthalmopathy. MATERIAL AND METHODS: 49-year-old woman, who had been smoking 20 cigarettes a day since she was 21 years old, treated for Graves' disease for 14 years, with the right eyeball protrusion existing for 6 months, dysfunction of eye movements and diplopia, was admitted to the Diabetes and Endocrinology Center in Bydgoszcz. After ophthalmological examination the patient underwent MRI and USG of the orbits which showed a change in the inferior rectus muscle of the right eye which could correspond to orbit tumor. In the Ophthalmology Department of the Medical Academy in Bydgoszcz the opening of the orbit was carried out in order to confirm or to eliminate the neoplastic process. RESULTS: Surgery and control examinations excluded neoplastic process. CONCLUSION: It is very difficult to differentiate between inflammatory infiltration and neoplastic tumor in patients with unilateral protrusion in the course of Graves' ophthalmopathy.