Ocular Manifestation in Systemic Sclerosis-A Literature Review.

Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease that affects more than 2 million people worldwide. It manifests through vasculopathy, an abnormal immunological response, and fibrosis leading to dysfunction of the multiple organs. The disease is categorized into two subtypes: limited cutaneous SSc and diffuse cutaneous SSc. Scleroderma can affect vital organs with respiratory, cardiac, renal, ocular, and dermatological complications. The ocular manifestations of the disease can occur in the anterior and posterior segments of the eye. Changes in the anterior segment related to the disease include eyelid skin remodeling, dry eye syndrome, and conjunctival abnormalities. The disease's impact on the posterior segment of the eye mostly causes pathologies in the retinal microcirculatory system and abnormalities in the optic nerve. This review provides detailed insights into ocular complications associated with scleroderma.

Retinal Microvasculature in Systemic Sclerosis Patients and the Correlation between Nailfold Capillaroscopic Findings and Optical Coherence Angiography Results.

Background: The comparison of retinal perfusion in the eyes of patients with systemic sclerosis (SSc) and in healthy controls using optical coherence tomography angiography (OCTA). The correlation between nailfold capillaroscopy results and OCTA findings among SSc. Methods: The study enrolled 31 patients with systemic sclerosis and 41 healthy controls. OCTA was performed in both groups to assess the retinal vasculature in the superficial (SCP) and deep (DCP) capillary plexuses and the foveal avascular zone (FAZ) area. Nailfold capillaroscopy (NC) was performed in SSc patients and compared to the FAZ area and the superficial and the deep vessel density. Results: In the SSc group, the parafoveal vessel density in DCP was significantly higher in relation to the mean value (p < 0.0001) and in each quadrant of the macula (p < 0.0001) compared to healthy subjects (p < 0.0001). The patients with early scleroderma patterns in capillaroscopy had a larger superficial and deep FAZ (p = 0.0104, p = 0.0076, respectively) than those with active and late patterns. There was a statistically significant difference in the FAZ when comparing early to active (p < 0.0001) and early to late scleroderma patterns (p < 0.0001). A statistically significant difference was found in the type of interstitial lung disease and the deep FAZ area (p = 0.0484). SSc patients with nonspecific interstitial pneumonia (NSIP) had a larger FAZ than those with usual interstitial pneumonia (UIP) (p = 0.0484). Moreover, NSIP cases had a higher parafoveal mean superficial vessel density than those with UIP (p = 0.0471). Conclusions: Our investigation showed that the peripheral microvascular system correlates with ocular microcirculatory impairment. The results indicate the important role of OCTA in the diagnosis, monitoring, and prognosis of microvascular changes in SSc.

Multimodal Imaging Techniques in Monitoring a Patient with Ocular Decompression Retinopathy.

Ocular decompression retinopathy (ODR) is characterized by multiple retinal hemorrhages. It is a rare complication associated with rapid decrease of intraocular pressure (IOP). The course of ODR is usually asymptomatic and self-limiting, which was confirmed by the observation of our patient. In this study, we present a 5-month follow up of a 77-year-old woman with acute right eye (RE) filtration angle closure who developed symptoms of ODR. Clinical examination and multimodal imaging modalities, including color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA) and fluorescein angiography (FA), were used to confirm the diagnosis and performed regularly in monitoring the course of the disease. Fundus lesions in the RE included diffuse intraretinal hemorrhages in the posterior pole, which gradually resolved during follow-up time. The fundus of the left eye (LE) was normal. The patient underwent conservative therapy, laser therapy and surgery, achieving stabilization of the IOP and improvement of the local condition in the RE. Of the various multimodal imaging techniques, color fundus photography and OCT seemed to be the most specific and helpful in monitoring the patient with ODR.

Impact of Thermal Pulsation System Therapy on Pre-Operative Intraocular Lens Calculations before Cataract Surgery in Patients with Meibomian Gland Disfunction.

In patients with eye surface disorders such as dry eye syndrome or Meibomian gland dysfunction (MGD) it is necessary to improve the tear film condition in order to obtain visual system measurements before cataract surgery. The aim of the project was to analyze the Thermal Pulsation System (TPS) impact on the visual system parameters used in cataract surgery qualification. The study included six patients (11 eyes) with MGD diagnosis. All patients were treated with TPS. The obtained results were compared and used to calculate the power and type of the intraocular lens (IOL). As a treatment result, the power of astigmatism has changed in 64% of the eyes. Planned surgical treatment type has changed in 27% of cases. TPS also affected the cylinder axis in three eyes, which was 27% of cases. Based on the calculations, power of the recommended IOL has changed in five eyes (46%). Stabilization of visual system parameters after TPS allowed to improve the accuracy of the results. It also ensured the proper astigmatism treating method during cataract surgery and allowed selection of the proper IOL power and type.

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.

Focal Choroidal Excavation: Epidemiology, Clinical Characteristics and Multimodal Imaging Findings.

BACKGROUND: Focal choroidal excavation (FCE) is one of the pachychoroid spectrum diseases. It may be an isolated lesion or associated with other ophthalmological disorders. The aim of the study was to present the epidemiology, clinical features and multimodal imaging findings in FCE. METHODS: This is a case series of 14 consecutive patients with a diagnosis of FCE, confirmed by multimodal imaging, from a review of the 5076 optical coherence tomography (OCT) scans in 2538 patients. Choroidal thickness (CT) was measured under the fovea and in the area of maximum choroidal thickening in the affected eye and under the fovea in the fellow eye. RESULTS: The mean age of the subjects was 40 ± 13.58 years. FCE occurred unilaterally and was an isolated lesion in all cases. The fellow eye did not show any macular pathology in all patients. Twelve eyes presented conforming FCEs and two non-conforming FCEs. In 79% of cases, FCE was subfoveal. The mean maximum CT was 390 µm in the affected eye with the presence of pachyvessels. A total of 13 patients were asymptomatic, while one patient reported a visual disturbance due to neovascularization secondary to FCE. Of all the multimodal imaging techniques, optical coherence tomography (OCT) provided the most important data in the diagnosis of FCE. CONCLUSIONS: Our study confirmed that FCE is a rare ocular condition, but it may be more common in Caucasian population than previously known. Multimodal imaging methods, mainly OCT, are crucial in FCE diagnostics. Further studies are needed to expand the available knowledge about its etiology and clinical course.

Quality of Life in Patients with Unresolved Facial Nerve Palsy and Exposure Keratopathy Treated by Upper Eyelid Gold Weight Loading.

BACKGROUND: Loading of the upper eyelid with gold weights is a well-established procedure for the correction of paralytic lagophthalmos. There is no reliable research evaluating the results of this treatment from the patients' viewpoint. AIM: The aim of this research was to evaluate quality of life (QOL) domains through two standardized questionnaires (SF-36 and NEI-VFQ39) in patients treated by upper eyelid gold weight loading compared to healthy individuals (the "healthy" group) as well as patients with other ophthalmologic conditions (the "sick" group). PATIENTS AND METHODS: This prospective comparative clinical study of 416 surveys was conducted in 2012-2018. The study group includes 59 people: 40 women, 19 men aged 55.5 ± 17.4 treated with gold weights for corneal complications due to unresolved facial nerve palsy. General QOL was assessed using the SF-36 questionnaire. Eye-related QOL was assessed through the NEI-VFQ39 questionnaire. The results were compared with those obtained in 2 control groups: the "healthy" and the "sick," 53 individuals each. RESULTS: A statistically significant increase in QOL domains was noted in patients with facial nerve palsy after treatment (p<0.001). No statistically significant differences were found in categories defining the Physical Component Score in these patients as compared to those from the "sick" control group (p = 0.95). After surgery, the results of the Mental Component Score were comparable to those in the "healthy" control group (p = 0.51). The eye-related health scores changed significantly after surgery and differed significantly compared to the "sick" control group (p <0.05); however, they did not reach the level of the "healthy" control group (p <0.001). CONCLUSION: Patients with untreated facial nerve palsy had the lowest QOL levels among all individuals involved in this study. Treatment of lagophthalmos by gold weights significantly improved their QOL, with the greatest impact on mental aspects of health.

Sclerokeratoplasty as the Therapy for Corneal Perforation due to Exposure and Neurotrophic Keratopathy.

A case report of exposure and neurotrophic keratopathy after acoustic neuroma surgery resulting in perforation if not managed appropriately and timely is presented. Sclerokeratoplasty on 360 degrees may be an effective treatment method of corneal perforation in complete anaesthetic cornea when the standard penetrating keratoplasty failed. At a 12-month follow-up, the patient is doing well. UCVA is 0.5, the IOP is normal, and the graft remains clear. Systemic immunosuppression is the main disadvantage of this method. Further investigation is needed to assess the effectiveness and safety of this method.

Diagnostic imaging of the nasolacrimal drainage system. Part I. Radiological anatomy of lacrimal pathways. Physiology of tear secretion and tear outflow.

Excessive watering of the eye is a common condition in ophthalmological practice. It may be the result of excessive production of tear fluid or obstruction and insufficiency of efferent tear pathways. The differentiation between obstruction and insufficiency of the lacrimal pathways is still clinically questionable. In the diagnostic process it is necessary to perform clinical tests and additional diagnostic imaging is often needed. Dacryocystography, with or without the extension of the dynamic phase or subtraction option, still remains the criterion standard for diagnostic imaging of the lacrimal obstruction. It may help to clarify the cause and exact place of the obstruction and provide information for further management, especially surgical treatment. Increasingly, new techniques are used in diagnostic imaging of the lacrimal tract, such as computed tomography, magnetic resonance, and isotopic methods. Adequate knowledge of the anatomy and physiology of the lacrimal system and the secretion and outflow of tears is the basis for proper diagnostic imaging. The purpose of this paper is to present the exact anatomy of the lacrimal system, with particular emphasis on the radiological anatomy and the current state of knowledge about the physiology of tear secretion and drainage.

Phacoemulsification with corneal astigmatism correction with the use of a toric intraocular lens in a case of megalocornea.

We report the case of a 49-year-old patient with megalocornea and coexisting corneal astigmatism. The corneal diameter in the right eye was 15.0 mm and in the left eye, 14.9 mm. In both eyes, a nuclear sclerotic cataract developed, with the tendency toward cortical mass swelling in the right eye. The aim of surgical treatment was to remove the cataract with simultaneous correction of corneal astigmatism by implanting an Acrysof toric intraocular lens (IOL). Intraocular lens stabilization was obtained by suturing it to an capsular tension ring (CTR) in the anterior chamber. The IOL-CTR complex was rotated into the lens capsule and aligned with the steep meridian of corneal astigmatism. The surgical technique provides a stable refractive and functional effect in patients with megalocornea and coexisting cataract and corneal astigmatism.

Lens epithelial cell damage after exposure to deionized water to prevent posterior capsule opacification after phacoemulsification: an in vitro study.

BACKGROUND: The aim was to study the effects of distilled deionized water (DDW) on lens epithelial cells (LECs) after two different exposure times in the context of preventing posterior capsule opacification (PCO) after phacoemulsification. MATERIAL/METHODS: Twenty-one subjects (21 eyes) (12 women, 9 men), with a mean age of 74.5 + or - 7.1 years, were in this study. Anterior capsulotomy specimens obtained during cataract phacoemulsification were immersed in a hypotonic solution of DDW. In group I (10 eyes) the anterior capsule fragments were exposed to DDW for 1 minute and in group II (11 eyes) for 3 minutes. The fragments then underwent histological examination; photographic documentation was made and measurements were done with an image analysis system. Log-linear analysis was performed to determine the odds ratio (OR). The significance of particular histological findings was evaluated with Fisher's exact test and Kendall's tau b coefficient was determined by analyzing contingency tables. RESULTS: Basement membrane and LECs showing different degrees of damage, from vacuolar degeneration to epithelial detachment and from karyorrhexis to total cytolysis, were detected in the microscopic specimens. The probability of lens epithelial cell cytolysis after 3-minute exposure was 3.5 times higher than after 1-minute exposure to DDW. CONCLUSIONS: Exposure to DDW causes different degrees of damage to LECs, ranging from reversible changes to total cell death. The changes seen in LECs are dependent on the duration of their exposure to DDW.

[Causes of epiphora in diagnosed and treated patients in Department of Ophthalmology in Military Institute of Health Service]. / Okulistyczne przyczyny patologicznego lzawienia u pacjentów diagnozowanych i leczonych w Poradni Przyklinicznej Kliniki Okulistycznej WIM.

PURPOSE: Analysis of causes of epiphora in patients which have been examined in Department of Ophthalmology in Military Institute of Health Service from 2004 to 2007. MATERIAL AND METHODS: The study has comprised 330 subjects: 241 women and 89 men (mean age 58.85 +/- 19.93 years). All patients have been examined because of epiphora (eyelid and lacrimal punctum position, medial canthal tendon laxity--horizontal resting position, lateral distraction test, fluorescein dye disappearance test, syringing of the upper and lower canaliculus, dacryocystography and/or lacrimal scintigraphy). RESULTS: There have been 3% patients with epiphora who have been examined in our clinic. Duration of epiphora has been mean 39.24 months. The main causes of epiphora have been: primary acquired nasolacrimal duct obstruction, idiopathic acquired dacryostenosis, punctal stenosis (22.42%, 19.7%, 19.09%), and rare: diverticulum, punctal papilloma, stenosis after radiotheraphy, Recklinghausen's disease. CONCLUSIONS: The correct diagnosis is the condition for the proper planning of the therapy schedule. Epiphora is frequent and annoying symptom.

[A 0,05% cyclosporine treatment of the advanced dry eye syndrome]. / Leczenie zaawansowanych przypadków zespolu suchego oka 0,05% roztworem cyklosporyny.

PURPOSE: The purpose of our study has been to present the results obtained from the treatment with 0.05% cyclosporine solution in drops in patients with severe aggravation of dry eye syndrome manifestations who otherwise did not suffer from any systemic disease (a three-month treatment). Another group in whom we used the same treatment were those who suffered from dry eye syndrome, which developed in the course of Sjogren's syndrome, and graft versus host disease following bone marrow transplantation (a six-month treatment). MATERIAL AND METHODS: The study comprised 15 dry eye syndrome patients (30 eyes), who were divided into three groups. In Group I were those with severe aggravation of dry eye syndrome manifestations without concomitant systemic diseases (3 women), aged 54 to 59 years (mean 57). Group II comprised the patients with Sjogren's syndrome (8 women, 1 man), aged 45 to 59 years (mean 55.5) with graft versus host disease. In Group III, there were 3 women, aged 52 to 59 years (mean 55) with graft versus host disease. All the patients were administered 0.05% cyclosporine topically twice daily. The Group I patients were given 0.05% cyclosporine solution for 3 months, those in Groups II and III for 6 months. Subjective complaints were classified according to the protocol of Dr. Mann Pharma/Bausch & Lomb. RESULTS: The effectiveness of the therapy with 0.05% cyclosporine solution was evaluated by the mean number of points in a five-point Schirmer II test score, measured before and after the treatment. The Group I patients (dry eye syndrome without systemic diseases) were found to have the highest mean number of points - 4. In the Sjogren's syndrome Group, the mean number of points was 3.1; and in Group III (graft vs host disease) the mean value was 2 points. Since the number of patients was different in particular groups, the findings have not been compared between themselves. CONCLUSIONS: Using 0.05% cyclosporine solution is effective in treating patients with dry eye syndrome but without systemic diseases. In such cases a short, three-month treatment is sufficient. The 0.05% cyclosporine treatment is just as effective in patients with dry eye syndrome and Sjogren's syndrome or graft versus host disease. Yet in such cases the treatment has to be longer and take six months. We observed a mean increase points in the five-point Schirmer II test score in all our patients.

[Evaluation of the medial canthus blepharoplasty using the lazy-T method]. / Plastyka powieki kata wewnetrznego metoda lazy-T--ocena skutecznosci metody operacyjnej.

PURPOSE: To evaluate the efficacy of surgical "Lazy-T" method used to correct ectropion of the lower punctum with the inferior lid laxity and the medial canthal tendon. METHOD AND MATERIAL: Between January 2004 and February 2005, four patients of mean age 67 years (+/-12) were operated with this method. In two patients, one eyelid was operated; the other two patients underwent bilateral lid surgery. Preoperative qualifications included: subjective assessment of epiphora (range 0-10 points), where 0 represents loss of epiphora and 10 points maximum intensification with ectropion of the lower punctum, laxity of the inferior eyelid more than 10 mm, and laxity of the medial canthal tendon of 2-nd degree or more. Two subjects, who expressed their consent, underwent lacrimal scintigraphy. Surgical technique included excise of the middle part of the lid at its full thickness, laterally from lower punctum, and correction of the conjunctiva. The follow-up period was 6 months on average. RESULTS: All patients reported reduction of epiphora of 5 points on the average. Eyelid laxity decreased by mean 4.5 mm (+/- 1.0 mm). In two patients epiphora regressed, in two others - decreased. All patients evaluated the cosmetic result as satisfactory. CONCLUSIONS: The "Lazy-T" correction is an effective procedure, which restores the lower punctum into its normal anatomical position. It is a simple surgical technique that can free patients from epiphora.

[The usefulness of thermography in the diagnostics of dry eye syndrome]. / Przydatnosc termografii w diagnostyce zespolu suchego oka.

PURPOSE: The aim of the study was to evaluate corneal temperature in patients with dry eye syndrome, and in normal subjects by measuring with infrared radiation thermography. MATERIAL AND METHODS: Each eye of 9 patients with dry eye syndrome and each eye of 13 normal subjects, were evaluated in this study. The corneal surface temperature was measured during 15 seconds after opening the eye. RESULTS: Mean corneal temperature was lower in the dry eye syndrome patients compared with the control group. Decrease in time of mean corneal temperature in patients with dry eye syndrome, was lesser than in the control group. CONCLUSIONS: The study shows the usefulness of thermography in the diagnosis of dry eye syndrome.

[Mycotic lacrimal canaliculitis--cases report]. / Grzybicze zapalenie kanalików--opisy przypadków.

Mycotic lacrimal canaliculitis is a rare eye disease. Overuse of antibiotics and steroids in the treatment of eye infections is a very serious risk factor. Initial diagnosis of the mycotic infection may be difficult, thus infection may lasts for months. Chronic conjunctivitis, itching, burning sensations, poor response to the treatment may suggest a suspicion of the mycosis. In our paper we report two cases of the mycotic lacrimal canaliculitis, diagnosis and treatment. We could not culture fungal colonies, but we have found fungal structures in direct microscopic detection during the examination of deposits found in the canaliculi. In our opinion it is important to consider fungal infections during the treatment of chronic eye disorders.

[Surgical treatment of posttraumatic lower canaliculus interruption and results of treatment estimation]. / Chirurgiczne zaopatrzenie pourazowego przerwania kanalika lzowego dolnego oraz ocena wyników leczenia.

The authors present the method of surgical treatment of posttraumatic lower canaliculus interruption using intubation through upper lacrimal canaliculus. The lacrimal system was intubated through the upper lacrimal canaliculus with a silicone drainage system for 6 weeks. The results were estimated on a base of dacrocystography and scyntygraphy of lacrimal system after 6 month. The presented surgical treatment is both easy for a beginning surgeon and brings good functional results.

[Immunological phenomenons in the pathology of the tear film. Is cyclosporine the turn point in the Sjögren's syndrome treatment? Preliminary report]. / Zjawiska immunologiczne prowadzace do patologii filmu lzowego. Czy cyklosporyna bedzie przelomem w leczeniu zespolu Sjögrena? Doniesienie wstepne.

PURPOSE: The purpose of this study is to examine the new way in the casual treatment, resulting in the normalization of immunological processes on the ocular surface. MATERIAL AND METHODS: 5 patients (4 women and 1 men with mean age of 55.5 years, range 45 to 59 years) with Sjögren's syndrome--type dry eye, were included in the study. Patients received topically 0.05% cyclosporine, ophthalmic emulsion twice a day for a 6 months. The severity of patients complaints was evaluated according to the Dr. Mann Pharma/Bausch & Lomb's record. RESULTS: Schirmer test II values, and lyzamine green staining scores, were evaluated priori to treatment and 6 months after the start. At the beginning of the study (day 0) the Schirmer test II values ranged from 1 to 5 mm (mean--2.2 mm). Break-up-time ranged from 3 to 6 sec (mean--4.8 sec). In all of 5 cases lyzamine green staining scores were 9. On month 6th, all of 5 patients had significant differences, compared to their baseline measurements in term of above mentioned parameters. The Schirmer test II values ranged from 8 to 12 mm (mean--10.3 mm). Break-up-time ranged from 9 to 13 sec (mean--11.2 sec), lyzamine green staining scores ranged from 2 to 3 points (mean--2.7). CONCLUSIONS: 0.05% cyclosporine, ophthalmic emulsion had a beneficial effect both on the subjective and objective clinical parameters of dry eye patients. The final conclusions must be supported by more cases.

[Surgery for involutional ectropion--case report]. / Operacje inwolucyjnego odwiniecia powieki dolnej--opis przypadku.

In this paper authors described methods of surgery in involutional ectropion, surgical anatomy and changes in the lower eyelid due to aging. The surgical treatment of advanced involutional ectropion and its results is presented.

[Dacryocystography and dacryoscintigraphy in diagnosis of naso-lacrimal duct obstruction]. / Dakriocystografia i dakrioscyntygrafia w diagnostyce niedroznosci dróg lzowych.

PURPOSE: To find the right diagnostic test through checking the drainage of lacrimal ducts. MATERIAL AND METHODS: Dacryocystography of lacrimal ducts was performed in 25 patients by using 0.5-1 ml of Lipidiol and conducting X rays in different head positions--3-4 photograph in A-P projection (exposition's parameters 85-90 kV and 12-15 mAs, distance lamp-table: 100-130 cm, Philips Diagnose 93). For stereo estimation--2 oblique photographs of head, deviated at 45 towards central body line. Patient is brought on vertical position and after 5 minutes radiography in A--P projection can show remaining contrast in lacrimal duct. Dacroscintigraphy was done in 200 patients by dropping in conjunctival sac 1 drop of sterile 99mTc, in dose 3.7-7.4 MBq (100-200 uCi). The patients head is immobilized on the support, close to detection head of gamma camera (ediso Nucline TH) with LEHR. Distribution of this drug was visible on the monitor and saved in the computer's memory. Data was registered during 10 minutes, summed up into end picture and then evaluated by sight. RESULTS: Many authors consider dacryoscintigraphy and dacryocystography as methods of choice in establishing correct diagnosis. High sensitiveness and mutual completion of both methods lets us quickly explain the reasons of epiphora and settle further management.