P28-A146†The impact of COVID-19 pandemic on eye banking in the Lublin Eye Bank, Poland.

PURPOSE: The purpose of this study was to investigate the impact of the COVID-19 pandemic on the Lublin Eye Bank activities. METHODS: We compared the corneal donors screening rules, number of harvested corneas before, during, and after the pandemic (2019, 2020, 2021, 2022 years). RESULTS: In 2019 we had 182 corneal donors and 360 harvested corneas; in 2020 - 114 donors and 227 corneas; in 2021 - 151 donors and 300 corneas, and in 2022 till the 15th November - 115 donors and 228 corneas. From the 11th March 2020, when the World Health Organization had declared a global pandemic, our Eye Bank ceased all activities until the 10th May 2020. We started then, according to recommendations of Polish Transplantation Society, performing a nasopharyngeal swabs specimen collecting for every corneal donor. In 2020 we noted only 1 positive donor, whereas in 2021 we had 9 and in 2022 - 12 SARS-CoV-2 positive donors, respectively. Overall mean reduction in the number of corneal donors and obtained corneal tissues of 6,3% was observed in the Lublin Eye Bank CONCLUSION: COVID-19 pandemic had an influence on the Lublin Eye Bank activities.Fortunately, the pandemic did not have a major impact on the number of donors as well as the corneas collected in our bank.

Subcutaneous Dirofilariosis of the Eyelid Brought to Poland from the Endemic Territory of Ukraine.

We present the case of a 60-year-old man who was diagnosed with a subcutaneous nodule on the upper eyelid of his left eye. The patient reported multiple mosquito bites during numerous work trips to Ukraine. Histopathological examination of the nodule isolated during surgery suggested Dirofilaria repens infestation. The infection was brought to Poland from the territory of Ukraine. Ophthalmologists must be aware of uncommon presentations of parasitic infestations when they consider infections of the ocular adnexa.

Massive Demodicosis of the Eyes in a Patient with Sjögren Syndrome: A Case Report.

PURPOSE: Demodex mites infestation, typically asymptomatic, is a problem for patients with weakened immune systems because it often takes the form of symptomatic, massive infection. The Demodex mites play an important role in the occurrence of a range of eye surface diseases such as Demodex blepharitis, Meibomian gland dysfunctions, conjunctivitis and corneal changes. The ocular infection is closely related to the systemic invasion. Our goal was to minimize infestation and alleviate the symptoms of massive demodicosis so as to prevent further damage to the cornea. METHODS: Our research note involves a 61-year old woman diagnosed with secondary Sjögren syndrome due to rheumatoid arthritis. On the background of the autoimmune disease, corneal perforation of the left eye occurred that was cured by surgery. Then during the follow-up visit the patient was found (microscopically) massively infected with Demodex mites and the developed symptoms were particularly severe. RESULTS: Adequate dry eye syndrome and massive demodicosis therapy significantly reduced the number of Demodex mites and improved the patient's condition. CONCLUSION: We would like to draw the attention of the physicians of different specialties that special care should be taken with respect to the therapy of dry eye syndrome and ocular demodicosis in patients with immunological disorders to achieve therapeutic success and avoid particularly dangerous consequences of these diseases.

Clinical Efficacy of Platelet-Rich Plasma in the Treatment of Neurotrophic Corneal Ulcer.

PURPOSE: Platelet-rich plasma (PRP) is an autologous blood product without preservatives and rich in proteins and growth factors which make it possible for cells to differentiate, proliferate, and migrate, thus stimulating healing and regeneration of tissues. The aim of this study was to evaluate the efficiency of autologous platelet-rich plasma in the treatment of neurotrophic keratopathy. METHODS: The study group consists of 25 patients with nonhealing corneal ulcers due to herpes simplex or herpes zoster infection and facial nerve or trigeminal nerve paralysis as a result of a neurosurgical operation caused by a tumour or stroke. The patients were given autologous platelet-rich plasma drops five times a day and additionally preservative-free artificial tears and a vitamin A ointment at night for maximum 3 months. The following were evaluated: best corrected visual acuity (BCVA), healing of corneal surface, subjective symptoms, and changes in corneal thickness with the use of anterior segment optical coherent tomography (AS-OCT). RESULTS: BCVA before the treatment was 0.10 ± 0.14, and after the treatment it was -0.3 ± 0.27 (p=0.001). Improved visual acuity and less subjective symptoms were observed in all patients. Complete healing of the ulceration was observed in 20 patients (80%). Four patients (16%) experienced considerable improvement of their clinical condition (reduced size and depth of the ulceration and inflammatory state: smaller conjunctival injection and swelling, improved visual acuity, and less subjective symptoms). In one of the patients, an amniotic membrane was transplanted due to the lack of improvement of his local condition. In all patients, the progression of corneal thinning was stopped. An average corneal thickness in its thinnest point was 322.3 ± 125.8 µm before the treatment, and 404.5 ± 118.7 µm (p < 0.05) after the treatment. None of the patients reported general or local side effects of the treatment. CONCLUSIONS: Autologous platelet-rich plasma is a blood-based product which seems efficient in the treatment of neurotrophic keratopathy.

Late-onset lattice corneal dystrophy without typical lattice lines caused by a novel mutation in the TGFBI gene.

PURPOSE: The aim of this study was to report the clinical, histopathological, and molecular findings in a patient with late-onset lattice corneal dystrophy (LCD) without typical lattice lines and a novel mutation in the TGFBI gene. METHODS: Corneal lesions were visualized by slit-lamp examination and by in vivo confocal microscopy. Histopathological examination was performed on the patient's corneal specimen obtained during a deep anterior lamellar keratoplasty. By using genomic DNA as a template, all coding regions of the TGFBI gene were amplified and directly sequenced. The presence of the mutation was verified using restriction endonuclease digestion. Eight different computational methods and multiple sequence alignments were used to predict the pathogenicity of the novel genetic variant. RESULTS: The corneal phenotype was characterized by the presence within the stroma of round, oval, and short comma-shaped structures with indistinct margins. Lattice lines were not visible. Histopathological study revealed positive Congo red areas of amyloid deposits typical for LCD. A novel heterozygous missense mutation p.Leu565Pro was identified in exon 13 of the TGFBI gene. The amino acid substitution was unambiguously predicted to have a high pathogenic potential. CONCLUSIONS: The mutant codon 565 is located at the C-terminus in the region corresponding to a highly conserved amino acid in the fourth fascilin domain of the TGFBI protein. The novel variant expands the spectrum of TGFBI mutations causing LCD and located in this region. An increased number of known mutations will facilitate future studies of genotype-phenotype correlations and molecular pathogenesis of corneal dystrophies.

The cause of Actinomyces canalictulis--a case study.

Actinomycosis of the lacrimal ducts is a rare chronic infection, caused by bacteria of the genus Actinomyces, usually A. israelii. The analyzed case of a 72-year-old man draws attention to the chronic nature of the infection and the need to thoroughly investigate the microbiological material sampled from the lacrimal ducts. Good effects of treatment resulted from oral use of doxycycline and local application of erythromycin. A precise removal of actinomycotic deposits and the applied antibiotic therapy resulted in a complete recovery without recurrences. The analyzed case confirms incidents in Poland of actinomycosis of the lacrimal ducts, and draws attention to this group of microorganisms that may cause infections in ophthalmology. This confirms the need for accurate diagnosis of microbial infections in the lacrimal ducts towards anaerobic bacteria. This would contribute to greater detection of a rare form of infection.

Amniotic membrane transplantation in treatment of persistent corneal ulceration after severe chemical and thermal eye injuries.

PURPOSE: To analyze results of amniotic membrane transplantation (AMT) in treatment of corneal ulceration after severe chemical and thermal injuries. METHODS: Analysis of 55 AMT in 53 patients (53 eyes) with corneal ulceration and limbal deficiency 180-360° of the limbus after grade 4-6 (Dua classification, 2001) chemical and thermal injuries was performed. Mean terms of the operation were 46.1 ± 46.4 days after the injury (range 8-181 days). Preoperative visual acuity (VA) was <0.01 in 33/53 patients (62.3%). Mean follow-up period was 8.8 ± 10.1 months (range 1.5-46 months). RESULTS: Further corneal ulceration was prevented in 54/55 cases (98.1%), cornea epithelialized after 42/55 AMT (76.3%). Mean terms of corneal epithelialization were 24.2 ± 26.7 days after AMT (range 6-123 days). Corneal defect recurred in 3/42 successful cases (7.1%). Limbal deficiency of different extent with subsequent corneal conjunctivalization developed in all successful patients. The VA was ≥0.01 (range 0.01-1.0) in 23/42 patients (54.8%) with corneal epithelialization. The VA at the last visit was improved on 2 and more lines on the eye chart compared to preoperative VA in 15/42 patients with corneal epithelialization (35.7%), did not change in 18/42 successful patients (42.9%), and decreased on one line in 9/42 of these patients (26.2%). Symblepharon developed in 23/42 successful patients (54.7%). CONCLUSIONS: Amniotic membrane transplantation may stop ulceration and promote corneal epithelialization in the majority of patients with the most severe chemical or thermal eye injuries in case of timely application of the operation and adequate fixation of the AMT graft.

Expression of double strand DNA breaks repair genes in pterygium.

PURPOSE: The alteration in the expression of some genes and proteins responsible for chosen DNA repair pathways in pterygium pathogenesis were studied. This study was focused on the examination of the expression of genes and RAD50 protein taking part in homologous recombination. METHODS: Peripheral blood lymphocytes, samples of pterygium tissue, samples of conjunctiva of patients suffering from pterygium as well as peripheral blood lymphocytes and conjunctiva of patients from the control group were examined. In order to identify genes products from RNA, Ribonuclease Protection Assai method was applied. LIM15, RAD50, RAD54, RAD52, MRE11, XRCC2, XRCC3, RAD51, RAD51B, RAD51C, RAD51D genes transcripts were detected. Expression of RAD50 protein was analyzed immunohistochemically. RESULTS: Peripheral blood lymphocytes analyses revealed lower level of RAD50 gene expression in the pterygium patients compared to the control group and the increased expression of XRCC2, XRCC3 and RAD51 genes in patients with pterygium, who declared the recurrence of the lesion in comparison to the patients with primary pterygium. Lower expression of the RAD54 gene in pterygium tissue comparing to conjunctiva from the eyes with pterygium was found. An expression of RAD50 gene in the conjunctiva originating from eyes with pterygium in comparison to the conjunctiva of control group was shown to be considerably higher. Expression of RAD50 protein in pterygium squamous epithelial cells was significantly higher than in conjunctiva from control group. CONCLUSION: There may exist a relationship between pterygium pathogenesis and damages of double strand DNA, however, the elucidation of its exact nature needs further study.

[Fungal infections of the cornea--diagnostics and management]. / Diagnostyka i postepowanie w grzybiczych zakazeniach rogówki.

Fungal keratitis, an important cause of corneal infectious disease, is one of the most challenging types of microbial keratitis to diagnose, isolate the etiologic fungal organism and treat successfully. Aspergillus spp. are most commonly responsible for fungal keratitis worldwide. Most cases occur in hot, humid climates. Fungi invade the ocular surface only when it is compromised and gain access into the corneal stroma through a defect in the epithelial barrier. Pathogens multiply then, and cause inflammatory reaction together with tissue necrosis. Symptoms of fungal keratitis typically are not as acute as those of other forms of microbial keratitis. On examination, both signs seen in other forms of microbial keratitis and specific features of fungal keratitis are observed. In all cases with suspected fungal keratitis, corneal smears and cultures should be performed as soon as possible. Antifungal therapy should be restricted to those cases with fungus-positive laboratory results. The use of topical corticosteroids in the treatment of fungal keratitis is contraindicated. In about one-third of patients pharmacological therapy is not successful. In those cases, surgical intervention is essential. The main goal of surgical intervention is to control infection and maintain the integrity of the globe. The most commonly performed surgery in fungal keratitis is therapeutic penetrating keratoplasty. The use of topical corticosteroids is contraindicated in early postoperative period.

[Morphological analysis of age-related changes in the human choroid]. / Analiza zmian morfologicznych zwiazanych z wiekiem w naczyniówce czlowieka.

PURPOSE: To investigate morphologic age-related changes in the human choroid and quantify choriocapillaris density and diameter, Bruch's membrane and entire choroid thickness. MATERIAL AND METHODS: 45 human eyes (aged from 17 to 84) were examined. After fixation of the eyeballs, cross-sections were done and the material was processed for light and electron transmission microscopy. Histomorphometric analysis was performed using H + E slides. Four measurements were performed in each slide at the area of 1000 microns located 4.5 mm temporally from the center of optic disc: Bruch's membrane thickness, longer and shorter diameter of the choriocapillaris, and thickness of the choroid. Statistical analysis was performed. RESULTS: In light and electron microscopy age-related changes were observed at the level of the retinal pigment epithelium, Bruch's membrane, choriocapillaris, and vessels of Sattler's and Haller's layer. Histomorphometric relationships between analyzed features were demonstrated at correlation diagrams. CONCLUSIONS: Age-related thickening of Bruch's membrane, decreased density and diameter of choriocapillaris, and also thinning of the entire choroid was observed.