One-year outcomes of the Polish treatment program for the wet form of age-related macular degeneration using intravitreal therapy.

PURPOSE: To report 12-month outcomes of a Polish National Treatment Program using aflibercept and ranibizumab in eyes with wet, age-related macular degeneration in routine clinical practice. MATERIAL AND METHODS: This was a non-randomized, retrospective, observational multicenter study. Anonymous data contained in the electronic Therapeutic Program Monitoring System were utilized in this study. RESULTS: The study population consisted of 2828 eyes from 2718 patients. The median age was 76.0 [70.0, 81.0] years; 61.7% were female. Best corrected visual acuity increased from 58.86 [50.05, 69.95] letters to 65.1 [50.1, 73.9] letters (p < 0.001). The median change in best corrected visual acuity was 0.0 [-4.0, 12.2] letters: 2.9 [-2.9, 15.1] letters for treatment-naïve eyes and 0.0 [-4.0, 8.8] letters for those continuing treatment (p < 0.001). The median central retinal thickness was significantly reduced from 341.0 [281.0, 422.0] to 275.0 [221.0, 344.0] µm (p < 0.001). The median number of visits was 9.0 [8.0, 9.0]. The median number of injections was 7.0 [6.0, 8.0]: 8.0 [7.0, 8.0] for treatment-naïve eyes and 6.0 [5.0, 7.0] for those continuing treatment (p < 0.001). CONCLUSION: Eyes treated as part of the Polish therapeutic program gained functional stability and morphological improvement. Treatment-naïve eyes showed the greatest functional benefit.

MMP targeting in the battle for vision: Recent developments and future prospects in the treatment of diabetic retinopathy.

Matrix metalloproteinases (MMPs) are enzymes capable of degrading nearly all types of extracellular matrix. They perform a wide range of roles in physiological processes, which is the reason for their strict regulation by numerous mechanisms including natural tissue inhibitors of metalloproteinases (TIMP). Research only started to shed light on more troublesome aspects of MMPs function, like cancer progression, Alzheimer's disease, atherosclerosis, ageing. Moreover, their profound role in diabetes is being carefully investigated including one of its most debilitating complications - diabetic retinopathy (DR), the leading cause of acquired blindness worldwide. Traditional treatment of this condition seems to be only mildly satisfactory, which elicited substantial interest in the field of new therapeutic methods including MMP targeting. So far, significant roles of MMP-2 and MMP-9 in the development of retinopathy have been established, with special attention given to the process of blood-retinal barrier impairment. Further exploration revealed MMP-10 and MMP-14 involvement as well as changes in MMP/TIMP ratio. In this review, we provide insight into MMPs role in diabetic retinopathy with a clarification of various mechanisms regulating MMP activity in the light of the recent studies. We conclude with an overview of novel DR therapies targeting MMPs and point to the need of further examination of their usefulness in clinical setting, with an eye towards future research.

A Review of Current Myopic Foveoschisis Management Strategies.

Myopic foveoschisis (MF) is common in highly myopic eyes with posterior staphyloma, and optical coherence tomography is essential for establishing the diagnosis and monitoring disease progression. Untreated MF may lead to significant visual loss due to secondary complications. Vitrectomy with or without internal limiting membrane peeling followed by gas tamponade is the standard treatment; however, in recent years, new techniques, including macular buckling, have been introduced. We selected a total of 41 articles with 30 describing various modifications of pars plana vitrectomy, six describing the macular buckling technique, and five reporting combined surgery. The present review describes current MF treatment strategies, including outcomes, and provides a comprehensive understanding of current therapeutic options. Early detection and surgical intervention in eyes with specific risk factors may contribute to both improved visual recovery and more favorable anatomical outcomes.

Determination of Tryptophan and Its Major Metabolites in Fluid from the Anterior Chamber of the Eye in Diabetic Patients with Cataract by Liquid Chromotography Mass Spectrometry (LC-MS/MS).

Tryptophan (TRP) is to an essential amino acid and its catabolites are significant to human health. By using ultra-high-performance liquid chromatography coupled to electrospray ionization triple quadrupole mass spectrometry (UHPLC-ESI-MS/MS), levels of three major components of kynurenic pathway namely tryptophan (TRP), kynurenic acid (KYNA) and kynurenine (KYN) in fluid from the anterior chamber of the eye were determined. The analysis was carried out on a Synergi 4 µ Fusion-RP column using gradient elution mode. For quantitative determination, l-tryptophan-amino-15N, 99 ATOM % 15N was used as an internal standard. The method was linear in the concentration range 4⁻2000 ng mL-1 for TRP, KYNA and KYN. The mean recoveries measured at four concentration levels for TRP, KYN and KYNA included the following ranges 94.3⁻96.1; 91.0⁻95.0; and 96.0⁻97.6%, respectively. The intra-day precision parameters were smaller than 4.4, 6.4 and 5% respectively. The developed method was applied to study the level of TRP, KYNA and KYN in eye fluid for the retrospective case series which included 28 patients suffering from cataracts and diabetes (n = 8). The experimental data was subjected to statistical analysis. The Mann-Whitney U-test revealed clear differences in the level of TRP catabolites and the ratios of TRP/KYN representing the activities of specific enzyme of kynurenine pathway in examined groups of patients. A level of probability p < 0.05 was used throughout a paper to denote statistically significant differences between the groups.

Macular Integrity Assessment and Fixation Analysis in Chronic Central Serous Chorioretinopathy.

PURPOSE: To investigate retinal sensitivity characteristics associated with morphologic changes in the eyes exhibiting chronic central serous chorioretinopathy (CSC), using macular integrity assessment (MAIA) microperimetry. METHODS: A retrospective, cross-sectional, observational study was constructed. The eyes of patients classified as chronic CSC, according to the onset of subjective symptoms with serous retinal detachment, as confirmed by optical coherence tomography examination, were included in the study. Retinal sensitivity and fixation were analyzed by performing microperimetry examinations using the MAIA instrument. RESULTS: We reviewed microperimetry examinations of 15 eyes of 15 patients (age: 28-51 years) with chronic CSC and mean best-corrected visual acuity of -0.2 logMAR units. The mean retinal integrity in the chronic CSC group was 49.0 ± 27.6, which was significantly different from the control eyes. The mean average threshold in the eyes with chronic CSC was 24.7 ± 5.8 dB, which also was significantly different from the control eyes. Fixation stability was significantly different between the CSC and control eyes for the P1 parameter (90.1 ± 13.7 versus 99.3 ± 1.5), and for the P2 parameter (97.4 ± 4.0 versus 100.0 ± 0.0). CONCLUSION: New microperimetry technology may provide valuable information regarding the visual status of chronic CSC cases. Our findings suggest that retinal sensitivity and fixation stability in chronic CSC eyes may serve as useful indicators for assessing the effectiveness of clinical treatments.

Biological model of Danio rerio (zebrafish) ­ a new research trend in ophthalmology. / [Nowy kierunek badan naukowych w okulistyce z wykorzystaniem modelu Danio rerio (zebrafish)].

Dynamic progress in medicine has enabled availability of new diagnostic methods, improved drugs and therapies. However, we are still searching for a perfect model to reflect the complexity of physiological and pathological processes in a human body. Among laboratory animals, an aquatic species of zebrafish (lat. Danio rerio) has become an emergent biological model. The paper presents examples of using zebrafish in medical research, especially in opthamology.

Nasally located congenital optic disc pit with concomitant maculopathy.

Optic disc pit is a congenital optic disc anomaly, which can be associated with maculopathy. The case of an unusually nasally located pit with concomitant maculopathy in a 64-year-old woman is presented.

Efficacy of intravitreal aflibercept in patients with exudative age-related macular degeneration.

AIM OF THE STUDY: To evaluate the efficacy of intravitreal aflibercept administered to patients with exudative age-related macular degeneration. MATERIALS AND METHODS: 70 patients with exudative age-related macular degeneration confirmed clinically and in additional diagnostic procedures (fluorescein angiography and spectral domain-optical coherence tomography) were enrolled. All patients were administered three doses of intravitreal aflibercept at one-month intervals. Some patients (seven) received an additional injection of the drug two months after the last of the three injections. The best-corrected visual acuity and the optical coherence tomography findings were assessed at baseline and after the treatment. RESULTS: At baseline, the mean best corrected visual acuity was 0.20. After the injection of aflibercept it improved to the mean value of 0.32 with the difference being statistically significant (p < 0.001, Student's t-test). The mean central subfield thickness at baseline was 311.4 µm. It decreased to mean value of 254.5 pµn with the difference being statistically significant (p<0.001, Student's t-test). CONCLUSIONS: Intravitreal injections of aflibercept improved clinical and anatomical parameters in patients with exudative age-related macular degeneration in the initial phase of treatment.

Charles Bonnet syndrome secondary to exudative age-related macular degeneration - a case report.

Charles Bonnet syndrome is a condition manifesting as visual hallucinations associated with vision impairment in patients without the underlying n euro psychiatric pathologies. As the incidence of age-related macular degeneration is on the rise, we can anticipate increasingly frequent cases of Charles Bonnet syndrome in our patients. The aim of the paper is to present a case of a 75-year-old patient who developed visual hallucinations secondarily to severe bilateral vision impairment due to exudative age-related macular degeneration. Patients with advanced age-related macular degeneration and no history of neuropsychiatric disorders may present with visual hallucinations.

[Geographic atrophy imaging using fundus autofluorescence method]. / Obrazowanie zaniku geograficznego za pomoca autofluorescencji dna oka.

Geographic atrophy is a manifestation of the advanced age-related macular degeneration and form of irreversible atrophy of retinal pigment epithelium and photoreceptor layer. Early detection of changes and the ability to evaluate disease progression accurately constitute a key problem in diagnosis and treatment planning. Fundus autofluorescence is a relatively new imaging method considered nowadays to be the best in diagnosis and observing the natural or treatment-altered course of disease. High resolution images showing the 3D distribution of retinal pigment epithelium autofluorescence as lipofuscin index can be obtained owing to the launch of the confocal scanning laser ophthalmoscope.

[Bilateral abnormalities in central serous chorioretinopathy seen in optical coherence tomography, ultra-widefield fluorescein angiography and microperimetry--case report]. / Obustronne zmiany w przebiegu centralnej surowiczej chorioretinopatii w obrazie badan optycznej koherentnej tomografii, szerokokatnej angiografii fluoresceinowej i mikroperymetrii--opis przypadku.

Central serous chorioretinopathy is a common retinopathy, which is manifested by the idiopathic detachment of the neurosensory retina in the posterior pole, secondary to fluid leakage from choroidal vessels at the level of retinal pigment epithelium. The disease is typically unilateral and affects young men. We present a case of a 48-year old man, admitted to the Department of Vitreo-Retinal Surgery, Medical University in Lublin, reporting vision impairment in his right eye. The bilateral ocular exam followed by optical coherence tomography, ultra-widefield fluorescein angiography and microperimetry revealed bilateral central serous chorioretinopathy. This case presents a bilateral manifestation of central serous chorioretinopathy and emphasizes the role of advanced diagnostic imaging techniques in analyzing retinal function and disease management.

[Vitreomacular adhesion in HD-OCT images in the age-related macular degeneration]. / Przyleganie okoloplamkowe ciala szklistego w obrazie HD-OCT w przebiegu zwyrodnienia plamki zwiazanego z wiekiem.

PURPOSE: The aim of this study was to evaluate an incidence of the vitreomacular adhesion in patients with age-related macular degeneration. MATERIAL AND METHODS: We examined 472 eyes in 241 patients (136 W/ 105 M) in age of 54-92 years (mean 62.6 years +/- 8.5) with dry or wet age-related macular degeneration using Cirrus HD-OCT (Zeiss) macular cube 512x128 program or 5-line pro-gram. RESULTS: Vitreomacular adhesion was observed in 139 eyes with dry age-related macular degeneration (29.4%, p=0.000*), in 101 eyes with drusen (21.4%, p=0.000*), in 38 eyes with retinal pigment epithelium alterations (8%, p=0.202), in 278 eyes with wet age-related macular degeneration (58.9%, p=0.001*), in 21 eyes with pigment epithelial detachment (4.4%, p=0.303), in 161 eyes with choroidal neovascularzation (34. 1%, p=0.031*/ and in 96 eyes with scar (20.4%, p=0.040*). CONCLUSIONS: Probably, vitreomacular adhesion alone is not able to induce age-related macular degeneration, but it may be associated with choroidal neovascularization development, it can contribute to exudate formation and choroidal neovascularization, it may induces or sustains a chronic low-grade inflammation in the macula region.

[Ophthalmological complications associated with clinically significant carotid stenosis]. / Objawy oczne towarzyszace klinicznie znaczacemu zwezeniu tetnicy szyjnej.

The aim of the study was to show ocular manifestations in carotid artery occlusive disease, with pathogenesis, diagnostic and therapeutic abilities of this changes. Carotid arteries are the main route by which the blood is supplied to the cerebrum and eyes. Clinical significant carotid artery stenosis is mainly caused by atherosclerosis. Most frequent neurological symptoms are transient ischemic attacks (TIA) and temporary visual loss (amaurosos fugax) are most common ocular symptoms. Other ocular pathologies in fundus examination are retinal embolies, retinal vein occlusion, anterior ischemic optic neuropathy, ocular ischemic syndrome or glaucoma. Most dangerous complications are stroke, blindness, or even patients death. Besides clinical examination the diagnosis is usually confirmed by carotid artery color Doppler ultrasound, magnetic resonance angiography and retinal fluorescein angiography. It is important to refer a patient with suspected or confirmed significant carotid artery stenosis for appropriate evaluation and treatment to a endovascular surgeon.

[Optical Coherence Tomography (OCT) examination in patients with central retinal artery occlusion]. / Badanie optycznej koherentnej tomografii (OCT) u chorych z zatorem tetnicy srodkowej siatkówki.

PURPOSE: To present qualitative and quantitative changes in OCT image evolving during time in eyes with central retinal artery occlusion. MATERIAL AND METHODS: Results of OCT examination of 8 patients with central retinal artery occlusion were studied. The patients age ranged from 56 to 81 years (median - 63). The Group consisted of 5 men and 3 women. Follow-up period ranged from 6 o 28 months (median - 14 months). Patients were examined in acute stage of CRAO (1-3 days), 1, 3, 6, 9, 12 and 24 months after CRAO episode. The OCT examination was performed using Cirrus OCT (Zeiss) and macular region analyzed using a standard scanning protocol Macula Thickness: Macular Cube 512x128. RESULTS: In an acute stage of CRAO increased thickness and hyperreflectivity of the inner retinal layers with corresponding hyporeflectivity layer below was detected. During follow-up period thickness of inner retinal layers and total retinal thickness gradually decreased. The other retinal layers presented increased reflectivity over time. After 6 months of observation we observed an atrophy of the retinal layers and lack of fovea profile in all cases. CONCLUSIONS: The SD-OCT examination appears to be a perfect method for the determination of the dynamics of the edematous and atrophic changes evolving after CRAO in the macular area.

[Myelinated nerve fibers coexisted with epiretinal membrane in macula--case report]. / Wlókna rdzenne na tarczy nerwu wzrokowego wspólistniejace z blona przedsiatkówkowa--opis przypadku.

PURPOSE: We describe a case of peripapillary myelinated retinal nerve fibers complicated by epiretinal membrane in region of macula. MATERIAL AND METHODS: 72 years old man was refered to our Clinic with suspicion of retinal detachment of right eye. Visual acuity of right eye was based to 0.05, in left eye was 0.5. IOP was normal in both eyes. In biomcroscopic evaluation the slight cortical cataract was observed in both eyes. Stereoscopic evaluation of right eye revealed the presence of massive peripapillary myelinated retinal nerve fibers and epiretinal membrane in the macula. In the left eye the less intense peripapillary myelinated retinal nerve fibers were noticed as well and the macular region was unchanged. With the use of OCT examination of the retina the presence of epiretinal membrane in the right eye was confirmed. OCT in the fellow eye presented an undisturbed foveal profile without any epiretinal abnormalities. CONCLUSIONS: Myelinated retinal nerve fibers can be complicated by epiretinal membrane. Probably the presence of macular pathologies depends on the extensions of nerve fibers. OCT examination is very helpful to give a proper diagnosis.

[Focal retinal pigment epithelium proliferation as a risk factor for occult choroidal neovascularisation]. / Ogniskowa proliferacja nablonka barwnikowego siatkówki jako czynnik ryzyka rozwoju utajonej neowaskularyzacji naczyniówkowej.

PURPOSE: To evaluate the relationship between isolated focal retinal pigment epithelium (RPE) proliferation and development of occult choroidal neovascularisation. MATERIAL AND METHODS: The natural clinical course of 43 eyes of 39 patients was analyzed. Patients with RPE proliferation as an isolated manifestation of retinal degeneration were included in this study. The mean age of patients was 75.0 (69-94). The mean observation period was 41.4 months (6-63). RESULTS: In 30 eyes (70%), occult choroidal neovascularisation occurred, in 13 eyes (30%), that complication was not observed. The development of neovascularisation was correlated with the presence of neovascular membrane in the fellow eye. CONCLUSIONS: Based on presented data we can estimate that isolated focal proliferation of retinal pigment epithelium is an important risk factor for the development of occult choroidal neovascularisation.

[The Vogt-Koyanagi-Harada syndrome in 11-year-old girl]. / Zespól Vogta-Koyanagi-Harady u 11-letniej dziewczynki.

PURPOSE: The Vogt-Koyanagi-Harada syndrome is an idiopathic, multisystem disorder which typically affects pigmented individuals between 20-50 years old. The typical symptoms include granulomatous panuveitis with characteristic extraocular dermato-neurological manifestations. The case of VKH syndrome affecting Polish girl is very rare. CASE REPORT: A 11-year-old girl had an important decrease of visual acuity in both eyes (RE 0.1 and LE 0.2), with the presence of bullous serous retinal detachment in both eyes. Besides, in right eye some keratic precipitates were noted. The routine laboratory evaluation failed to provide a diagnosis. The patient was treated with an intravenous bolus of corticosteroid therapy and then, high dose of oral prednisone. RESULTS: After administered therapy the visual acuity improved rapidly in both eyes (RE 1.0 and LR 0.9), and the exudative retinal detachment resolved. After 5 months, the patient's examination showed a sunset glow fundus with several whitish rounded lesions in peripheral fundus, which is typical for the VKH syndrome. CONCLUSIONS: The VKH syndrome rarely affects young children, so the diagnosis may be difficult in the absence of the typical extraocular manifestations. In such atypical cases the diagnosis is based on the clinical evolution of the disease.