Levels of antibodies against human heat shock protein (HSP) 60 in patients with glaucoma in Poland.

BACKGROUND: Although elevated intraocular pressure is a major risk factor for the development of glaucoma, there is increasing evidence that the immune system may be involved in the development of normal-tension glaucoma (NTG). The aim of this study was to determine if NTG is associated with elevated levels of antibodies against human heat shock protein (HSP) 60. MATERIAL AND METHODS: The study was conducted in 139 subjects (35 subjects with NTG [Group 1], 34 subjects with primary open-angle glaucoma /POAG/ [Group 2], 24 subjects with autoimmune rheumatic diseases [Group 3], and 36 healthy controls [Group 4]). All subjects had complete ophthalmologic examination (visual acuity, slit-lamp examination, tonometry, gonioscopy; visual-field examination, and optical coherence tomography /OCT/ of the optic nerve head and the macula). Blood samples were collected for the measurements of serum levels of antibodies against human HSP60. RESULTS: The subjects with rheumatic diseases had the highest median serum level of antibodies against HSP60 - 20.49 ng/mL. The values in the subjects with NTG, POAG, and in controls were 18.79 ng/mL, 18.61 ng/mL and 17.61 ng/mL, respectively (p=0.96). CONCLUSIONS: This study does not confirm the hypothesis that normal-tension glaucoma is associated with elevated blood levels of antibodies against human heat shock protein (HSP) 60.

[Atypical case of acute retinal necrosis secondary to the primary herpes simplex infection]. / Nietypowy przypadek ostrej martwicy siatkówki w przebiegu pierwotnego zakazenia wirusem herpes simplex.

Acute retinal necrosis is a rare manifestation of viral chorioretinitis, accompanied by occlusive vasculitis, which is associated with poor visual prognosis. The main causal factors include varicella-zoster virus in older patients and herpes simplex in younger ones. The disease typically manifests as a reactivation of latent infections. We present a case of a 57-year-old female with atypical clinical manifestation of acute retinal necrosis secondary to the primary viral infection with herpes simplex. The serology panel of vitreous tap and blood sample confirmed viral aetiology (H. simplex). The initial clinical signs included optic disc edema with retinitis presenting as self-limiting, slowly progressing, peripheral lesions, later followed by uveitis. The antiviral therapy resolved the symptoms of uveitis and enabled healing of retinal lesions, however the natural course of disease was later complicated with retinal detachment. It was successfully treated with vitreoretinal surgery. Despite aggressive treatment, the final visual outcome was unfavourable, due to optic nerve atrophy.

Selected autoantibodies and normal-tension glaucoma.

BACKGROUND: Although intraocular pressure is an important risk factor in glaucoma, there is growing body evidence indicating an immunological component in the pathogenesis of normal-tension glaucoma (NTG). The aim of this study was to determine if NTG coexists with elevated levels of autoantibodies detected in rheumatic diseases. MATERIAL AND METHODS: We enrolled 105 patients into the study: 35 with NTG, 34 with primary open-angle glaucoma (POAG), and 36 controls. All patients underwent ophthalmic examination and blood tests. Blood was examined for the level of: antibodies against antinuclear antibodies (ANA), antibodies to extractable nuclear antigens (ENA), immunoglobulins (IgG, IgA, IgM), rheumatoid factor, anti-citrullinated protein antibodies (ACPA), and antiphospholipid antibodies (anticardiolipin antibodies, beta2-glycoprotein I antibodies, antiprothrombin antibodies). RESULTS: The level of ANA was increased among 6 patients in the NTG group (17.1%), 8 in the POAG group (23.5%), and 6 in the control group (16.5%). The difference was not statistically significant (p=0.97). None of the patients in the NTG, POAG, or control group had positive antibodies to ENA. The level of immunoglobulins IgG, IgM, and IgA in the 3 groups was similar and within normal values. The median level of rheumatoid factor and ACPA was the highest in the NTG group, but it was within normal laboratory values. There was a statistically significant difference between antiprothrombin antibodies IgG between the NTG and POAG group (p=0.01), but not between the NTG and control group (p=0.24). CONCLUSIONS: The results of our study do not confirm the hypothesis that NTG coexists with elevated blood levels of antibodies, which are a characteristic feature of rheumatic diseases.

The efficacy of bevacizumab in diabetic macular oedema in a 12-month follow-up.

PURPOSE: To evaluate visual acuity and anatomic response of the macula following intravitreal bevacizumab injections in diabetic macular oedema. MATERIAL AND METHODS: In the retrospective, non-randomised study 35 eyes of 28 subjects (whose mean age was 59.6 years) with focal or diffuse diabetic macular oedema were included. Patients underwent best corrected visual acuity testing with Snellen charts converted to a number of letters, intraocular pressure measurement, slit lamp examination, macular biomicroscopy, central macular thickness measurement by optical coherence tomography as well as fluorescein angiography at baseline and all follow-up visits. Patients were treated with one or two intravitreal injections of 1.25 mg of bevacizumab. RESULTS: A total of 49 intravitreal injections were performed. All patients had a 6-12-month follow-up after the first injection. The mean baseline best-corrected visual acuity was 5.0 ± 4.3 letters and the mean central macular thickness in the baseline optical coherence tomography was 482.0 ± 109.7 µm. An improvement in the mean best-corrected visual acuity (6.2 ± 6.3, p = 0.020) and central macular thickness (426.8 ± 131.7 µm, p = 0.010) was statistically significant during the follow-up after first injection. There was no statistically significant difference in the best-corrected visual acuity (6.2 ± 6.5, p = 0.055) and central macular thickness (461.2 ± 148.3 µm, p 0.200) after the second injection. There was no correlation between the best corrected visual acuity and central macular thickness. No serious adverse events were observed. CONCLUSIONS: Intravitreal bevacizumab injections significantly improve visual acuity and decrease central macular thickness in patients with diabetic macular edema. This treatment is safe for patients but the therapeutic effect is temporary.

Multifocal syphilitic chorioretinitis--a case report.

The aim of the paper is to report a case of a 22-year-old male patient with chronic bilateral uveitis and retinitis secondary to syphilis. Until the diagnosis, the patient had been treated symptomatically with ceftriaxone which resulted in visual acuity improvement. The patient was referred to the Sexually Transmitted Disease Clinic for causal treatment after which he did not continue further ophthalmic monitoring. After a year he contacted the Department again due to vision deterioration and a relapse of retinitis and choroiditis was diagnosed. The patient was referred to the Sexually Transmitted Disease Clinic for causal treatment which he never received as he did not present there. Since the beginning of the 21st century the incidence of syphilis has significantly increased. Although it is an infectious disease with potentially permanently debilitating effect e.g. on vision, its treatment is not compulsory in Poland. Infectious etiology and primary syphilis should always be considered in patients with progressive retinitis, choroiditis and vitritis.

[Complications of intravitreal injections--own experience]. / Powiklania po iniekcjach do komory ciala szklistego--doswiadczenia wlasne.

PURPOSE: Authors present complications associated with intravitreal injection perfomed in Ophthalmic Clinic CMKP MATERIAL AND METHODS: retrospective study, between January 2006 and July 2009 we performed intravitreal injections with triamcinolone acetonide (Kenalog, 4 mg), ranibizumab (Lucentis, 0.5 mg), bevacizumab (Avastin, 1.25 mg) and pegaptanib (Macugen, 0.3 mg). We treated eyes with age-related macular degeneration, diabetic macular edema, after retinal venous occlusion, with uveitis, Irvine-Gass syndrome, idiopathic juxtafoveolar teleangiectasia and central serous retinopathy. RESULTS: 943 eyes received intravitreal injections. The most common ocular complication was subconjunctival hemorrhage which was seen in 36% cases. Temporary elevated intraocular pressure above 21 mmHg was noticed in 18 eyes (5%) after anti-VEGF agents injections and in 30 eyes (23.4%) after Kenalog injection. Anterior uveitis developed in sixteen cases (1.7%) from the Avastin (5 eyes) and Lucentis (3 eyes) group. Anterior-posterior inflammation occurred in 8 eyes (0.8%), including four eyes (0.4%) with sterile endophthalmitis (3 following bevacizumab and 1 following ranibizumab injection), one eye (0.1%) with pseudoendophthalmitis (after triamcinolone). There were three cases of suspected endophthalmitis (2 following bevacizumab and 1 following triamcinolone injection). The infectious endophthalmitis after triamcinolone injection was culture-proven and revealed Staphylococcus epidermidis. Cataract formation or progression was noted in 34 eyes totally. In Kenalog group progression of cataract was seen in 23.4% of eyes (30 cases) during 2-years of follow-up and in anti-VEGF agents group--in two cases (0.6%) and 2 cases of iatrogenic cataract. Three diabetic patients suffered systemic adverse events: one patient developed renal insufficiency, one patient developed cerebrovascular accidents and one suffered a myocardial infarction resulting in death. CONCLUSIONS: Intravitreal injections are associated with a low incidence of serious adverse events. The most common ocular complication was subconjunctival hemorrhage. There was one case of serious complication--the culture-proven infectious endophthalmitis after Kenalog injection. Cataract formation and increase of intraocular pressure were more often observed following intravitreal triamcinolone injection.

[Endophthalmitis following intravitreal triamcinolone acetonid injection--a case report]. / Zapalenie wnetrza galki ocznej po iniekcji doszklistkowej octanu triamcynolonu--opis przypadku.

PURPOSE: To report a case of acute endophthalmitis following intravitreal triamcinolone acetonide injection. MATERIAL AND METHODS: A 54-year-old woman with diabetic macular edema developed endophthalmitis after triamcinolone injection. First she was treated with intravitreal antibiotic injections and next with four surgeries--facovitrectomy, revitrectomy, silicone oil removal and revitrectomy. RESULTS: The initial visual acuity was 0.5. From the vitreous cultured Staphylococcus epidermidis. Depite the intensive medical intervention, the toxic retinal damage occurred and the final visual acuity was hand movement. CONCLUSIONS: intravitreal triamcinolone injections can induce bacterial endophthalmitis, which has a devastating effect on the ocular tissues and results in severe loss of vision. The procedure of injection in diabetic and immunocompromised patients should be performed with great care.

[Secondary epithelial cyst of the iris--case report]. / Wtórna nablonkowa torbiel teczówki--opis przypadku.

Authors present a case of 33 years old man who developed implantation secondary cyst of the iris, after penetrating trauma in a childhood. He was treated with cyst aspiration and endolaser photocoagulation of the cyst base. Postoperatively visual function significantly improved. No recurrence of cyst was observed. Within 6 months cataract developed with pupillary obstruction caused by irydocorneal adhesions, which required reoperation. Authors indicate that management of secondary cyst of the iris may require repeated laser or surgical treatment.

[Vitrectomy with peeling retinal limiting membrane (ILM) in eyes with diabetic macular edema]. / Witrektomia z usunieciem blony granicznej wewnetrznej siatkówki w leczeniu cukrzycowego obrzeku plamki.

PURPOSE: To evaluate the efficacy of pars plana vitrectomy with retinal internal limiting membrane (ILM) peeling in eyes with diabetic macular edema. MATERIAL AND METHODS: Twenty five eyes of 25 patients with diabetic macular edema. All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling and air endotamponde. Preoperatively visual acuity (VA), funduscopic examination and the presence or absence of posterior vitreous detachment, were evaluated. Fluorescein angiography was performed in all patients prior to surgery. Eyes with cystoid macular edema or macular ischaemia were excluded. Postoperative VA, anatomic results, and complications were recorded. The follow-up was 7 to 27 months (mean 17). RESULTS: Intraoperatively, thick posterior hyaloid was found to be attached to the posterior pole in 20 cases. The mean postoperative VA (0.2) was significantly better than the preoperative VA (0.08) (p = 0.0001). VA improved postoperatively in 21 eyes (84%), at least two lines on the Snellen chart in 8 eyes (32%). It remained unchanged in 4 eyes (16%). Confluent hard exudates in fovea were present significantly more frequently in eyes without VA improvement (p = 0.004). The postoperative VA was better in eyes that had not undergone photocoagulation (improvement by 0.14 line) than in others (improvement by 0.11 line) but the difference was non-significant. Reduction of macular exudates was noted in every case in the follow-up over 6 months. Postoperative complication included retinal detachment were treated by re-vitrectomy with oil endotamponade. Cataract has been noted in six eyes. CONCLUSIONS: Vitrectomy including removal of ILM in diabetic macular edema, leads to improvement of visual acuity and long-term stabilization of visual function.

[Outcome results in macular hole surgery with internal limiting membrane removal]. / Wyniki usuniecia blony granicznej wewnetrznej siatkówki w chirurgii otworu w plamce.

PURPOSE: To determine the visual outcome and anatomic closure rate of macular hole surgery using pars plana vitrectomy with internal limiting membrane (ILM) peeling. MATERIAL AND METHODS: Fifty three eyes of 52 consecutive patients with a full-thickness idiopathic macular holes (stage 3 or 4). All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling with trypan blue (TB) or indocyanine green (ICG) and gas endo-tamponade with instructions to the patient, to be face down for 4-5 days. Postoperative anatomic results, visual acuity (VA), and complications were recorded. The follow-up was 3 to 22 months. RESULTS: VA improved postoperatively in 45 eyes (84.9%), at least two lines on the Snellen chart in 24 eyes (45.3%). It remained unchanged in 6 eyes (11.3%) and deteriorated in 2 eyes (3.80%). The mean preoperative VA was 0.1 +/- 0.04 and does not differ significantly between stage 3 and 4. The improvement of postoperative VA was statistically significantly better in stage 3, in comparison to stage 4. The anatomical success rate (flat/closed) was 88.7% (47 eyes). There were no differences in VA improvement between TB- or ICG-stained eyes. CONCLUSIONS: 1. Vitrectomy with ILM removal in macular holes provides with meaning improvement in visual acuity. 2. Patients with macular hole in stage 3 have a better prognosis for visual rehabilitation. 3. A kind of dye and preoperative VA do not influence postoperative visual function improvement.

[Use of automatic alignment and combining adjacent images in fundus imaging]. / Zastosowanie metody automatycznego dopasowania i laczenia sasiadujacych zdjec w obrazowaniu dna oka.

The paper presents a method for automatic alignment and combining adjacent images of the fundus. Presented algorithm is based on specific arrangement of the vessels in the fundus. A correlation function is used to the adjacent images with extracted net of the vessels. An optimum location of the images is found by applying successive approximations method. An angle of rotation and shift of the combining images are taken into an account during this search. The paper shows also the examples of application of the method in fundus imaging.

[Glaucoma Service Database]. / Baza danych obslugujaca poradnie jaskrowa.

We present the common problems related to clinical databases. The Glaucoma Service Database created in our clinic is an attempt of developing the optimal medical database. The system organizes our repository of clinical data. It consist of 3 modules: 1) the users list with predefined privileges and rights, 2) lists of coded data for further use, that facilitate filling in the fields, 3) clinical details of all patients. The user interface of our database is very simply, thus it is very easy to use it even by unskilled staff. The accuracy of data is protected by system's internal algorithms. It could be used to investigate clinical epidemiology, risk assessment, post-marketing surveillance of drugs, practice variation and decision analysis. Data from Glaucoma Service Database can also help in the management of health service.

[Vitrectomy for idiopathic and secondary preretinal macular membrane]. / Skutecznosc witrektomii w leczeniu samoistnego i wtórnego rozrostu przedsiatkówkowej blony plamkowej.

PURPOSE: To evaluate the results of pars plana vitrectomy and membrane stripping for idiopathic and secondary preretinal macular membrane (PMM). MATERIAL AND METHODS: Twenty one consecutive subjects (21 eyes) ranging in age from 40 to 78 (mean 66.9) with PMM underwent vitrectomy and membrane peeling. 17 cases had membranes that were considered idiopathic, and 4 cases were associated with other disorders: 3 occurred after successful retinal reattachment surgery, 1--after laserotherapy in the course of diabetic retinopathy. Visual acuity (VA), Amsler grid, and postoperative complications were assessed. The follow-up was 1 to 22 months, mean 5.7. RESULTS: Visual acuity improved postoperatively in 15 eyes (71.4%), at least two lines on the Snellen chart in 8 eyes (38.1%), entirely in patients with idiopathic PMM. It remained unchanged in 3 eyes (14.3%) and deteriorated in 3 eyes (14.3%). Eyes with transparent membrane showed greater visual improvement than opaque ones. The preoperative Amsler test was positive in 15 patients (71.4%), postoperatively--in 4 cases (19%). 2 idiopathic cases with VA of 0.7 showed postoperatively VA of 1.0. Complications included retinal detachment in 2 eyes (1 in idiopathic and 1 in secondary PMM), and development of nuclear sclerotic cataract in 2 eyes. At 6 months of follow-up, a residual membrane formation in 1 cases appeared. Macular pseudohole was observed in 1 eye with no impact on visual results. CONCLUSIONS: 1. Vitrectomy with membrane peeling for preretinal macular membrane provides improvement in visual acuity and reduces metamorphopsia 2. Thin, cellophane-like appearance of the membrane gives a better prognosis of visual function improvement.

[Evaluation analysis of blood flow of peripapillary area in glaucoma patients using scanning laser Doppler flowmetry]. / Ocena okolotarczowego przeplywu krwi u chorych na jaskre za pomoca skaningowego przeplywomierza laserowego.

PURPOSE: To evaluate capillary blood flow and velocity in retinal peripapillary area in primary open angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PEXG) and age matched control group (C) using scanning laser Doppler flowmetry (Heildelberg Retina Flowmeter). MATERIAL AND METHOD: One randomly selected eye of 17 POAG patients (mean age 59.3 +/- 2.6), 18 NTG patients (mean age 56.4 +/- 2.4), 17 PEXG patients (63.3 +/- 2.8) and 15 healthy subjects (mean age 55.8 +/- 3.8) underwent examination with scanning laser Doppler flowmetry. The measurements were performed at the superior and inferior temporal peripapillary retinal area. The measured parameters were capillary blood flow and velocity of the moving erythrocytes. Each image was analysed using the program AFFPIA. This software calculates the hemodynamic parameter flow of each pixel. Comparison of value obtained from patients and control participants were made using Student's t test. RESULTS: Scanning laser Doppler flowmetry results showed a significant reduction in blood flow at the superior and inferior temporal peripapillary area in POAG and NTG patients compared to control group (p < 0.04). The POAG and NTG patients had also significantly decreased velocity at the inferior temporal peripapillary retinal area compared to control group. No statistical difference was found between blood flow and velocity in POAG compared with NTG. When compared with the control participants, patients with PEXG showed significant decreases in the mean blood flow at the inferior temporal quadrant (p < 0.05), while the differences in the mean flow and velocity at the superior quadrant between those groups were not statistically significant. CONCLUSIONS: Our findings indicate a reduction in ocular blood flow at the temporal peripapillary retinal area in patients with POAG and NTG compared to age matched control participants. The peripapillary retinal microcirculation is not significantly altered in patients with PEXG compare with POAG and JNC. The blood flow parameters in the capillaries are lower in JNC retinas, the difference however is not significant. Further clinical investigation is required having groups homogeneous with respect to stage of glaucoma and controlled for factors known to effect perfusion pressure.

[The comparative analysis of changes in optic disc morphology after trabeculectomy, measured by scanning laser tomography]. / Porównawcza analiza zmian morfologicznych tarczy nerwu wzrokowego po trabekulektomii, przeprowadzona metoda skaningowej tomografii laserowej.

PURPOSE: The aim of this study was to investigate and estimate quantitative changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (Heidelberg Engineering, HRT Software 2.01). MATERIAL AND METHODS: The eyes of 42 consecutive patients (34 women and 8 men) undergoing trabeculectomy at the Department of Ophthalmology, Wroclaw Medical University, were enrolled into the study. Quantitative analysis of the optic nerve head parameters by scanning laser tomography were performed, as well as automated perimetry, before and after surgery. Post operative HRT images were obtained at 2-3 weeks, 4-6 months, 9-12 months and > 12 months after surgery. RESULTS: Forty one patients (97.6%) have obtained postoperatively IOP reduction greater than 30%. Two weeks after trabeculectomy seven HRT parameters showed statistically significant improvement: CA, CV, RA, RV, mean cup depth, CSM. Approximately 5 months after surgery only 2 parameters (mean cup depth & CSM) were statistically changed, as well as 12 months after surgery (mean and max cup depth), which cannot be explained by postoperative disc edema. A corresponding change was also noted in the visual field. There was no statistically significant association between optic disc morphology as measured by HRT and the degree of intraocular pressure reduction. CONCLUSION: All patients showing a 30% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. Further studies are required to provide information, to what extent the change in optic disc topography is dependent on the duration of elevated intraocular pressure or advanced stage of glaucomatous optic neuropathy.

[Vitrectomy in treatment of ocular tuberculosis--case report]. / Witrektomia w leczeniu gruzlicy ocznej--opis przypadku.

The authors present a case of ocular tuberculosis in otherwise healthy young men, diagnosed with positive tuberculin test and positive PCR for Mycobacterium tuberculosis in conjunctiva and vitreous samples. An early vitrectomy and typical systemic treatment (tuberculostatic drugs) resulted in regression of the disease.