Macular function in patients with medium myopia.

PURPOSE: This work aims at assessing whether electrophysiological functional changes in the macular region appear in medium myopia, even in the presence of a normal macular OCT scan and how axial length correlates with macular OCT parameters in medium myopia. METHODS: The study included right eyes of 17 patients with myopia of medium degree (SE < - 6D to > - 3D). Control group consisted of 20 eyes of patients of age and sex that matched healthy controls with normal macular and optic nerve OCT results and normal axial length. Full ophthalmic examination (the distance best-corrected visual acuity, intraocular pressure, refractive error, the anterior and posterior segment of the eye in a slit lamp, the axial length of the eyeball) with OCT of the macular and optic disk and the PERG test were performed in the study and control groups. Only the patients with normal ophthalmic and OCT examination results were qualified. The interview covering questions on risk factors of myopia onset and progression such as prematurity, family history of myopia was carried out in both groups. In myopic group, the question relating to time of near work was also asked. Study and control groups were tested with the use of Shapiro-Wilk, Mann-Whitney, Student's t test, Pearson and Spearman's rank correlation tests. RESULTS: AL was significantly longer in myopia group (p < 0.01), and SE value was lower (p < 0.01). Longer implicit time of P50 was found in the study group, but amplitudes of P50 and N95 waves were not significantly reduced (p < 0.05). AL showed correlations with P50 implicit time (p < 0.05) and with reduction in retinal fiber nerve layer and ganglion cells and inner plexus layer (p < 0.05). CONCLUSION: Patients with myopia of medium degree have a dysfunction of retinal cone system of the macular region even when OCT scans show no abnormalities. Elongation of AL correlates with reduction in retinal fiber nerve layer and ganglion cells and inner plexus layer. Longitudinal follow-up studies may answer the question whether this increase in implicit time may be indicative of a faster myopia progression or of myopic retinal pathology, i.e., whether it may help to determine which patient would benefit from earlier or more intensive management of myopia progression.

The electrophysiological tests in the early detection of the visual pathway dysfunction in patients with microadenoma.

PURPOSE: To evaluate the validity of electrophysiological tests in the early diagnosis of a ganglion cells and/or optic nerve dysfunction in patients with pituitary microadenoma. METHODS: 66 eyes, from 33 patients with microadenoma with no evidence of the optic chiasm compression in magnetic resonance imaging (MRI) and the visual impairment in the routine ophthalmological examination, standard static perimetry (24-2 white on white) and optical coherence tomography (HD-OCT), were analysed. The pattern electroretinogram (PERG), standard pattern visual evoked potentials (PVEPs) and multichannel visual evoked potentials (mVEPs) (ISCEV standards) were performed. The results obtained from the electrophysiological tests were compared to the same number of age-matched healthy controls. RESULTS: Statistically significant differences between the patients with microadenoma and healthy controls were detected in all electrophysiological tests (p < 0.001). The most frequent abnormalities were observed in mVEPs (25/33 patients, 75.8%; 43/66 eyes, 65.2%). The most frequent features registered in this test were: (1°4')-an increase in the P100wave latency from uncrossed fibres (13/33 patients, 39.39%; 21/66 eyes, 31.8%) and (0°16')-an amplitude reduction of this wave from the crossed fibres (11/33 patients, 33.33%; 19/66 eyes, 28.8%). The changes in PVEPs (15/33 patients, 45.5%; 25/66 eyes, 37.9%) and PERG (10/33 patients, 30.3%; 15/66 eyes, 22.7%) were also registered. Of all the tests and parameters analysed in the study, the greatest diagnostic value in detecting the visual pathway dysfunction in this group of patients was the amplitude of P100 wave from the crossed fibres of the mVEPs (1°4') with a sensitivity of 60.6% and a specificity of 93.8%. These parameters suggest that this type of dysfunction is downstream to the chiasm and can also indicate the visual pathway dysfunction severity. CONCLUSIONS: In patients with microadenoma, the abnormalities in the electrophysiological tests are registered even without clinical evidence of visual impairment from the routine ophthalmological examination, SAP, OCT and chiasmal compression in MRI. The mVEPs have the most significant role in the diagnosis of the visual pathway dysfunction in patients with microadenoma.

The Consequences of Glaucoma on Mobility and Balance Control in the Older Adults: A Cross-Sectional Study.

The aim of the study was to explore the functional impairments and related factors in older adults with moderate to advanced stages of glaucoma. Nineteen patients with glaucoma and 19 participants with no ocular disease performed step test and balance control tasks with analysis of overall stability index and fall risk index. Monocular and binocular Humphrey Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to measure physical activity level. Patients with glaucoma showed poorer values for most of the mobility and balance control parameters with medium and large effect sizes (0.3-0.5). Mobility scores in patients were partly associated with their monocular visual field defect (rs = .507, p < .05). Low physical activity was identified as a risk factor for falls (rs = -.453, p < .05) and postural instability (rs = -.457, p < .05). Functional declines in dynamic tasks were not related to glaucoma severity. Older adults with glaucoma display impairment with mobility and balance control compared to controls, associated with the degree of monocular visual field loss and lower daily physical activity.

XEN Gel Stent in the management of primary open-angle glaucoma.

PURPOSE: To assess the efficacy and safety of the XEN Gel Stent in patients with primary open-angle glaucoma. MATERIALS AND METHODS: Twenty eyes of 17 patients (6 males, 11 females) with primary open-angle glaucoma were implanted with XEN Gel Stent. The following data were ascertained in each participant at baseline and at 1, 3, 6, 9 and 12 months following implanting procedure: intraocular pressure, number of anti-glaucoma medications, retinal sensitivity (PS 24/2 w/w), pattern electroretinogram (ISCEV standard), as well as the number of complications. RESULTS: The mean intraocular pressure reduction in a 1-year follow-up was 18% (21.56 vs. 17.69 mmHg, p < 0.001). The mean number of anti-glaucoma medications was reduced from 3.2 to 1.6 (p = 0.001). The PERG parameters at baseline and at 12 months postoperatively included a stable amplitude of P50 (2.55 µV vs. 2.65 µV, p = 0.024) and N95 (3.45 µV vs. 3.38 µV, p = ns) waves. The delta N95 and delta P50 amplitudes remained stable over the follow-up period (p = ns). The mean deviation (MD) of PS 24/2 was - 6.54 dB vs. - 8.43 dB, p = ns, whereas the pattern standard deviation (PSD) was 6.18 dB vs. 6.91 dB, p = ns. Transient hypotony within the first postoperative week occurred in 18 eyes (90%), whereas hyphema occurred in two eyes (10%). Needle revision of a filtration bleb was performed in five eyes (25%). CONCLUSIONS: The XEN Gel Stent enables significant reduction in intraocular pressure with very low complication rates. It ensures a stabilization of the retinal function as established with the PERG.

Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up.

PURPOSE: To compare the 27G versus 25G vitrectomy in patients with epiretinal membrane (ERM). PATIENTS AND METHODS: Sixty pseudophakic eyes of 60 consecutive patients treated by pars plana vitrectomy (PPV) using 27G (30 eyes) or 25G (30 eyes) were prospectively evaluated including eye's inflammation, surgery time, ERM + ILM removal time and complications. Additionally, 1, 3, 7, 14, 30, 90 and 180 days after PPV, the following were estimated: intraocular pressure (IOP), sclerotomy wound closure time, distance best corrected visual acuity (DBCVA), foveal macular thickness (FMT) and surgically induced astigmatism (SIA). RESULTS: The eye's inflammation resolved within 30 days after surgery in both groups. The surgery and ERM + ILM times were longer in the 27G group (p ≤ 0.02). The most common postoperative complication was hypotony in both groups, more common in 25G group (23.3% vs. 10% of eyes). In 27G group, the mean IOP prior to 180 days postoperatively was higher (p < 0.05) and the sclerotomy wound closure time was shorter (p < 0.001). Mean DBCVA values (7, 14, 30 days after surgery) were significantly better in 27G group (p < 0.001). The mean FMT values were similarly and significantly reduced in both groups 1 day postoperatively (p < 0.05) as compared to preoperative values and then stabilized during follow-up. Mean SIA was lower in 27G group 30, 90 and 180 days after surgery (p < 0.001). CONCLUSION: The use of 27G PPV in patients with ERM significantly reduced sclerotomy wound closure time and surgically induced astigmatism, better stabilized intraocular pressure and allowed to achieve faster visual acuity improvement, as compared to 25G PPV.

Comparison of visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses.

PURPOSE: To compare visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses (IOLs). METHODS: All subjects underwent sequential bilateral cataract extraction with AtLisa tri 839 MP or Symfony IOL implantation. The design is prospective case series. Each group consists of 20 patients (40 eyes). At 1 year postoperatively, the following parameters were analysed: binocular uncorrected visual acuity (log MAR): for distance (UDVA) at 4 m, for intermediate distances (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire modified VFQ-25), photopic phenomena and postoperative complications. RESULTS: In the AtLisa tri 839 MP group, the mean binocular UNVA and UIVA were significantly better than in the Symfony group (UNVA: - 0.01 ± 0.04 vs. 0.21 ± 0.15; p = 0.000; 60 cm UIVA: - 0.01 ± 0.04 vs. 0.09 ± 0.09, p = 0.001; 70 cm UIVA - 0.05 ± 0.06 vs. 0.11 ± 0.08, p = 0.002; 80 cm UIVA - 0.01 ± 0.06 vs. 0.15 ± 0.08, p = 0.019). There were no significant between-group differences in the mean binocular UDVA and CS, with one exception: the mean binocular distance CS (18 cpd) under mesopic conditions was significantly better in the Symfony group than in the AtLisa tri 839 MP group (1.39 ± 0.22 vs. 1.17 ± 0.27; p = 0.015). The defocus curve analysis revealed significant between-group differences at vergences of 2.0 to - 4.0 D (p < 0.05), except for 2.0, 1.0, 0 and - 1.5. All subjects in AtLisa tri 839 MP group and 18 subjects (90%) in Symfony group were spectacle independent. Patients from both groups highly rated their overall vision quality in the VFQ-25 (1.67 ± 0.47 vs. 1.85 ± 0.5 in the Symfony and AtLisa tri 839 MP group, respectively, p = NS). The scores for daytime driving (1.00 ± 0.00 vs. 1.21 ± 0.36; p = 0.002), night driving (1.57 ± 0.55 vs. 2.13 ± 1.15; p = 0.027) and difficult situation driving (1.14 ± 0.31 vs. 1.53 ± 0.56; p = 0.049) were significantly better in the AtLisa tri 839 MP group than in the Symfony group. The incidence and perception level of halo and glare were significantly reduced (p = 0.00) in the Symfony group as compared to the AtLisa tri 839 MP group. The postoperative course was uneventful in all subjects. CONCLUSIONS: Visual outcomes achieved with both IOLs are comparable. In both groups, 90% of patients achieved spectacle independence. Whereas the AtLisa tri 839 MP IOL implantation was associated with slightly better intermediate distance VA and significantly better near VA, photic phenomena were less perceived by patients with Symfony IOLs.

The importance of the electrophysiological tests in the early diagnosis of ganglion cells and/or optic nerve dysfunction coexisting with pituitary adenoma: an overview.

BACKGROUND AND METHODS: Based on the available literature, it is suggested, in the clinical evaluation of the chiasmal tumors, that the following electrophysiological tests: visual evoked potentials to pattern-reversal stimulation, multifocal visual evoked potentials (mfVEPs), and pattern electroretinogram (PERG) play an important role in the diagnosis of the optic nerve and retinal dysfunction in the course of pituitary tumors. RESULTS: Macroadenomas and also microadenomas may cause dysfunction of retinal ganglion cells (RGCs) and their axons, even in the absence of changes in the routine ophthalmological examination, retinal sensitivity in standard automated perimetry, and retinal nerve fiber layer thickness in optical coherent tomography. The most frequently observed changes in electrophysiological tests were as follows: in PVEPs-the crossed/uncrossed asymmetry distribution, altered waveform, increase in P100-wave peak time, and/or reduction in amplitude; in mfVEPs-the peak time prolongation and/or amplitude reduction in C1-wave; in PERG-the reduction in N95-wave amplitude and decreased N95:P50 amplitude ratio. Hemifield PVEPs were more often abnormal than full-field PVEPs. Multi-channel recording is recommended for the assessment of the anterior visual pathway. The use of mfVEP offers the possibility to register localized disturbances of the optic nerve and ganglion cells. Additionally, an amplitude of N95-wave reduction in PERG correlated with a lack of postoperative visual acuity recovery. The postoperative improvement in the visual field was found to be associated with a normal N95:P50 amplitude ratio. The RGCs dysfunction manifested by decrease in PhNR/b-wave amplitude ratio was associated with the worse visual fields outcome. A review of the literature summarizing the electrophysiological testing in the pituitary adenoma is discussed. CONCLUSION: In patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.

The clinical value of the multi-channel PVEP and PERG in the diagnosis and management of the patient with pituitary adenoma: a case report.

PURPOSE: To present a patient with a diagnosis of pituitary adenoma and progressive visual pathway dysfunction detected in the electrophysiological tests in one-year follow-up. Patient is a 59-year-old male with a non-secreting pituitary macroadenoma. METHODS: Routine ophthalmological evaluation, standard automatic perimetry (SAP), retinal nerve fibers layer and the ganglion cell complex thickness in optical coherent tomography (OCT), as well as electrophysiological examinations (pattern electroretinogram-PERG, multi-channel pattern visual evoked potentials-multi-channel PVEPs record according to ISCEV standards) were performed. The examination and additional tests were conducted 3 times (in 0, 6 and 12 months) and 6 months after neurosurgery. RESULTS: Visual acuity, funduscopic examinations, SAP, OCT and electrophysiological test results at the first visit were all normal. In both eyes, the abnormalities were observed only in the multi-channel PVEP and PERG despite the absence of the changes in the routine ophthalmological examination and additional tests after 6- and 12-month follow-up. The tumor growth but without chiasmal compression was confirmed by magnetic resonance imaging. The progression of the optic pathway dysfunction in the electrophysiological tests was a cause of surgical removal of the pituitary tumor. CONCLUSION: This case highlights novel observations that in patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.

Clinical results after microincision biaxial cataract surgery and implantation of an Incise intraocular lens.

PURPOSE: To evaluate clinical outcomes after uncomplicated microincision biaxial cataract surgery and implantation of Incise intraocular lens (IOL). METHODS: This study included 47 eyes of 29 patients (mean age 62.2 ± 8.6 years), who underwent 1.4-mm biaxial cataract surgery with implantation of the Incise IOL (Bausch and Lomb). At third month, surgically induced astigmatism (SIA) was calculated. Three, 6 and 12 months postoperatively, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corrected near visual acuity (CNVA) LogMAR ETDRS, spherical equivalent refraction (SER), photopic distance corrected contrast sensitivity (CS) with and without glare (85 cd/m2) (CSV-1000) were assessed. One year after surgery, late complications were assessed and subjects were questioned for subjective symptoms. RESULTS: Mean of SIA was equal 0.29 ± 0.16 D. Three months postoperatively: mean UDVA improved from 0.83 to 0.04 (p < 0.001), CDVA from 0.58 to -0.05 (p < 0.001) and CNVA from 0.58 to -0.02 (p < 0.001) and all were stable during 1-year follow-up. Three months postoperatively, the mean SER was equal 0.07 ± 0.61 D and was within ±0.5 D in 79%, and within 1 D in 88% of eyes. During follow-up period, corrected CS with and without glare for distance was found to be within normal limits. The only late complication was posterior capsule opacification (PCO). Subjective quality of vision was very high; none of patients complained about glare. CONCLUSIONS: Biaxial cataract surgery with implantation of the Incise IOL provided excellent clinical outcomes by minimizing SIA, stable refraction and low incidence of PCO.

Evaluation of retinal ganglion cell function after intraocular pressure reduction measured by pattern electroretinogram in patients with primary open-angle glaucoma.

BACKGROUND: To evaluate retinal ganglion cell (RGC) function after intraocular pressure (IOP) reduction measured by pattern electroretinogram (PERG) in patients with newly diagnosed, non-treated preperimetric and early stages of primary open-angle glaucoma (POAG). METHODS: Twenty-four eyes from 24 patients with POAG: 11 eyes with preperimetric glaucoma and 13 eyes with early glaucoma received Ganfort ® (bimatoprost + timolol) once a day for a period of 1 month. Before and after the treatment, following measurements were analyzed: IOP, mean ocular perfusion pressure (MOPP), peak time of P50 and amplitude of P50 and N95 waves in PERG (ISCEV standard 2012). Correlations between PERG P50 and N95 waves, IOP and MOPP were calculated. RESULTS: After therapy, IOP significantly decreased in all eyes, on average 31%. Significant increase in MOPP in all eyes on average 14% was detected. PERG amplitude of P50 and N95 waves increased in 75 and 79% eyes, respectively, on average P50 by 28% and N95 by 38%. There were no significant interactions between the change of PERG parameters in time and stage of glaucoma. CONCLUSIONS: Significant IOP-lowering therapy can improve RGC function measured by PERG, in patients with preperimetric and early stages of POAG.

Photopic negative response of full-field electroretinography in patients with different stages of glaucomatous optic neuropathy.

PURPOSE: To evaluate photopic negative response (PhNR) discrimination ability between healthy and glaucomatous patients. METHODS: Ninety eyes of 50 patients with primary open angle glaucoma (POAG) and 45 eyes of 23 healthy age- and sex-matched controls were investigated. Based on European Glaucoma Society criteria, POAG patients were divided into three groups: early, moderate and advanced glaucoma. Following measurements were analysed: mean defect (MD) from Humphrey Visual Field Analyzer, SITA standard 24-2 white on white perimetry; nerve fibre index (NFI) obtained from scanning laser polarimetry; and GDx and PhNR amplitude and PhNR/b-wave ratio. PhNR was elicited by red stimuli with flash strength of 1.6 cd s/m(2) on blue background of 25 cd/m(2). Correlations between retinal ganglion cells function (PhNR), retinal sensitivity (MD) and structure (NFI) were calculated. Sensitivity and specificity of PhNR parameters were calculated with standard formulas. Receiver operating characteristic (ROC) curves were used to determine optimal cut-off values. The area under the curve (AUC) was used to compare the ROC curves results between PhNR amplitude and ratio. RESULTS: PhNR amplitude and ratio were significantly reduced in early, moderate and advanced glaucoma groups compared to controls. The sensitivity and specificity to detect glaucoma in early POAG were equal to 53.3 and 90.0% for PhNR amplitude and 60.0 and 70.0% for PhNR ratio; in moderate POAG 63.3 and 80.0% for PhNR amplitude and 60.0 and 86.7% for PhNR ratio; and in advanced POAG 76.6 and 80.0% for PhNR amplitude, 90.0 and 73.3% for PhNR ratio. There were no significant differences between AUC for PhNR amplitude (0.76-0.86) and PhNR ratio (0.78-0.86), p > 0.05. PhNR amplitudes and ratios correlated significantly with MD measured by SAP and NFI obtained from GDx (p < 0.05). PhNR amplitude significantly decreases with advancement of visual field defects in glaucoma patients. CONCLUSIONS: PhNR reveals dysfunction of RGCs in early, moderate and advanced stage of POAG. PhNR has good discrimination ability in detecting glaucomatous patients. PhNR might be a useful test in glaucoma diagnosis.

The macular function and structure in patients with diabetic macular edema before and after ranibizumab treatment.

PURPOSE: To evaluate macular function and structure in patients with diabetic macular edema prior to, as well as 3 and 6 months after intravitreal ranibizumab treatment. PATIENTS AND METHODS: Seventeen eyes of 17 patients with type 2 diabetes mellitus and diabetic macular edema (DME) were treated with intravitreal injections of 0.5 mg ranibizumab. Prior to the first injection, as well as after 3 and 6 months, the following examinations were performed: assessment of distance best-corrected visual acuity (log MAR), perception of metamorphopsia (M-Chart), slit lamp examination of the anterior and posterior segment of the eye (Volk 90D lens), evaluation of the retinal and choroidal circulation (fluorescein angiography), assessment of the structure and thickness of the macula (OCT), as well as evaluation of the macular function (PERG and mfERG). RESULTS: We observed that ranibizumab significantly improved visual acuity after 3 and 6 months from the beginning of the treatment, which was a consequence of reduced macular edema and vascular leakage. There was a statistically significant decrease in metamorphopsia frequency at month 3; however, at month 6 it was a statistically insignificant when compared to the baseline. The results of electrophysiological examinations revealed no improvement in ranibizumab-treated patients. CONCLUSION: Improvement of visual acuity and reduction in macular thickness were maintained up to the 6-month follow-up. The results of electrophysiological examinations revealed that ranibizumab injections tend to stabilize bioelectrical macular function of the outer, middle and inner retinal layers, which was impossible to recognize on the basis of visual acuity and OCT. Therefore, the electrophysiological examinations should be used as an additional objective tool for the evaluation of the anti-VEGF treatment effectiveness in DME.

Assessment of macular function, structure and predictive value of pattern electroretinogram parameters for postoperative visual acuity in patients with idiopathic epimacular membrane.

PURPOSE: To evaluate macular function and structure before and after epimacular membrane surgery and to estimate the usefulness of pattern ERG test parameters in predicting the postoperative visual acuity. METHODS: We evaluated 32 eyes of 32 patients (mean age 70.8 ± 6.7 years) before and 12 months after successful 25G pars plana vitrectomy with epimacular membrane removal and internal limiting membrane peeling. Distance best-corrected visual acuity (DBCVA-logMAR), foveal thickness (optical coherence tomography-OCT) and macular function [pattern electroretinogram-PERG (ISCEV standard): amplitudes (A) of P50- and N95-waves, implicit time (IT) of P50-wave] were assessed. To estimate the differences between the mean values of considered characteristics, the t test or Wilcoxon matched pair test was used. Correlation between preoperative data of PERG and preoperative and final DBCVA were investigated using Pearson correlation analysis. A receiver operating characteristic curve was constructed to obtain a cutoff value allowing prediction of visual prognosis. We tried to obtain the P50 and N95 amplitudes cutoff value in prediction of good visual outcome (DBCVA of 0.3 or less). RESULTS: Twelve months after surgery, mean of DBCVA significantly increased in comparison with preoperative value (0.31 ± 0.12 vs. 0.6 ± 0.15; p < 0.001) and 23/32 eyes (72 %) achieved visual improvement of two and more Snellen lines. In OCT test, the significant reduction in foveal thickness mean (313.34 ± 47.01 vs. 509.03 ± 93.88 µm; p < 0.001) was obtained. In PERG test, the significant increase in the mean amplitudes of P50- (AP50) and N95 (AN95)-waves as well as significant decrease in the mean implicit time (IT) of P50-wave were achieved (AP50: 3.41 ± 1.48 vs. 2.38 ± 1.23 µV; p < 0.001; AN95: 5.46 ± 1.72 vs. 3.75 ± 1.48 µV; p < 0.001; IT P50: 55.00 ± 3.60 vs. 56.75 ± 5.78 ms; p < 0.001). Twelve months postoperatively, DBCVA was significantly correlated with preoperative IT P50 (r = 0.39; p = 0.027), AP50 (r = -0.68; p < 0.001) and AN95 (r = -0.73; p < 0.001). CONCLUSION: Removal of idiopathic epimacular membranes with internal limiting membrane peeling not only provided increase in visual acuity and reduction in foveal thickness but also caused improvement of innermost retinal layer function in macular region. Pattern ERG test might be a valuable tool in predicting the postoperative visual acuity.

PARS PLANA VITRECTOMY IN ADVANCED CASES OF VON HIPPEL-LINDAU EYE DISEASE.

PURPOSE: To investigate spectrum of patients with Von Hippel-Lindau disease (VHL) that required pars plana vitrectomy and evaluate anatomical and functional outcomes of surgery. METHODS: Twenty-three patients who underwent surgery for advanced VHL eye disease were assessed by genetic tests, diagnostic tests for systemic lesions, and clinical eye examination. The vitrectomized eyes were divided into two groups: with or without retinotomy (group R vs. NR). Functional and anatomical outcome was analyzed and compared between the groups. RESULTS: All patients had central nervous system hemangioblastomas and 57% had other systemic tumors. Point germline mutations, large partial deletions, and complete vhl gene deletions were found in 64%, 27%, and 9% of patients, accordingly. Destruction of hemangioblastomas by retinotomy, laser, or cryotherapy and anatomical attachment of the retina were achieved in all eyes. Preoperative mean distance best-corrected visual acuity was logarithm of the minimum angle of resolution 2.66 (20/9,140) in group R and 1.76 (20/1,150) in group NR (P < 0.05). At 6 months postoperatively, distance best-corrected visual acuity improved in 20 eyes (83%). After over 24 months postoperatively, distance best-corrected visual acuity remained better than preoperatively in 36% in the R group and in 70% in the NR group of eyes. During 24 months postoperatively in 17 eyes, new retinal capillary hemangiomas developed. The mean number of new retinal capillary hemangiomas per eye was higher in group R than in group NR (3.14 vs. 0.70; P < 0.01). In group R, number of new retinal capillary hemangioblastoma was higher in retinal segments where retinotomy was performed (n = 29) than in other areas (n = 13) (P < 0.01). CONCLUSION: Advanced VHL eye disease correlates with occurrence of central nervous system and systemic lesions. Spectrum of vhl gene mutation in the patients corresponds to that of the general VHL population. Pars plana vitrectomy in advanced VHL eye disease can improve or preserve visual function, but postoperative progression of ocular VHL disease can be accelerated in cases where retinotomy is performed.

Aqueous levels of VEGF correlate with retinal non-perfusion areas in patients with diabetic macular edema and macular edema secondary to central retinal vein occlusion.

AIM: To evaluate the association between the level of vascular endothelial growth factor in the aqueous humor and the size of capillary non-perfusion areas in patients with macular edema secondary to retinal vein occlusion and diabetic retinopathy. MATERIAL AND METHODS: The study group consisted of 24 patients (24 eyes) at the age of 55-78 years, with diffuse macular edema secondary to retinal vein occlusion and diabetic retinopathy. The control group consisted of 26 subjects aged 55-87 years who were admitted for scheduled cataract surgery. The VEGF aqueous humor levels, retinal thickness using optical coherence tomography, as well as the size of non-perfusion areas measured on fluorescein angiography images were evaluated in each enrolled subject. RESULTS: The vascular endothelial growth factor aqueous humor levels were found to be significantly higher in patients with macular edema as compared to controls (p = 0.0002). In the diabetic macular edema and retinal vein occlusion group, the con- centration of vascular endothelial growth factor in aqueous humor positively correlated with the extent of non-perfusion areas measured on fluorescein angiograms (Rs = + 0.45, p = 0.02;). Multivariate analysis of patients and controls performed using the general linear model, adjusted for age, sex, intraocular pressure and the presence of diabetes, revealed that macular edema was an independent factor associated with higher aqueous VEGF concentrations (ß = +0.74, p = 0.0012). CONCLUSIONS: Macular edema secondary to either retinal vein occlusion or diabetic retinopathy is associated with the increased levels of vascular endothelial growth factor in the aqueous humor. Therefore, the management of patients with macular edema secondary to retinal vein occlusion or diabetic retinopathy should aim at reducing the ocular vascular endothelial growth factor concentrations, especially in the presence of capillary non-perfusion areas.

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.

Visual evoked potentials in a diagnosis of a visual pathway dysfunction of a child with an arachnoid cyst.

PURPOSE: The aim of this case report was to demonstrate the usefulness of the flash visual evoked potentials in monitoring the effects of intracranial hypertension in a preterm-born child with a congenital arachnoid cyst. METHODS AND RESULTS: At baseline, abnormalities were found in the right eye: exotropia and lack of foveal fixation. Visual acuity was not achieved. Pupillary responses were normal in both eyes. There was no evidence of nystagmus. Flash visual evoked potentials were normal and equal in both eyes. When repeated one year later the signal had deteriorated in both eyes; the peak times of N2 and P2 had increased. The increased VEP latencies were the only ocular signs noted. After referral to neurosurgery, intracranial hypertension was found and a shunt was performed. CONCLUSIONS: Flash visual evoked potentials may be a valuable test in monitoring patients with arachnoid cysts.

Bioelectrical function and structural assessment of the retina in patients with early stages of Parkinson's disease (PD).

PURPOSE: To determine bioelectrical function and structural changes of the retina in patients with early stages of Parkinson's disease (PD). MATERIALS AND METHODS: Thirty-eight eyes of 20 patients with early idiopathic PD and 38 eyes of 20 healthy age- and sex-matched controls were ophthalmologically examined, including assessment of distance best-corrected visual acuity (DBCVA), slit lamp examination of the anterior and posterior segment of the eye, evaluation of the eye structures: paramacular retinal thickness (RT) and retinal nerve fiber layer (RNFL) thickness with the aid of OCT, and the bioelectrical function by full-field electroretinogram (ERG). Additionally, PD patients were interviewed as to the presence of dopamine-dependent visual functions abnormalities. RESULTS: In patients with early PD, statistically significant changes in comparison with the control group were observed in ERG. They contained a reduction in mean amplitudes of the scotopic a-wave (rod-cone response), the scotopic oscillatory potentials (OPs)--OP2 and OP3, the photopic b-wave, and a reduction in the overall index (OP1 + OP2 + OP3) and a prolongation of mean peak times of the scotopic OP1, OP2, OP3, OP4 (p < 0.05). A questionnaire concerning abnormalities of dopamine-dependent visual functions revealed that PD patients with abnormal peak times of OP1, OP2, and OP3 reported non-specific visual disturbances more frequently in comparison with PD patients with normal peak times of OPs. Other analyzed parameters of ERG, DBCVA, RT, and RNFL did not significantly differ between patients with PD and the control group. CONCLUSION: In patients with early PD, bioelectrical dysfunction of the retina was observed in the ERG test, probably as a result of dopamine deficiency in the retina. The results of our study indicate that ERG may also be a useful tool for understanding the reason for non-specific visual disturbances occurring in PD patients.

Electrophysiological function of the retina and optic nerve in patients with atrial fibrillation.

PURPOSE: To evaluate the effects of atrial fibrillation (AF) and ablation procedures on electrophysiological function in the retina and optic nerve. METHODS: Thirty two eyes of 17 patients with AF were analyzed. The full-field electroretinogram (ERG), pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) were performed. The results were compared to age-matched healthy controls (n = 30). In 12 eyes, electrophysiological tests were performed before and 3 months after ablation treatment. RESULTS: Statistically significant differences between AF patients and healthy controls were detected. In the full-field ERG, a reduction in the oscillatory potentials wave index (OPs WI; p = 0.012) and scotopic (0 dB) a-wave amplitude (p = 0.009) was observed. The amplitude of b-waves, scotopic (24 dB; p = 0.011), photopic single flash (p = 0.008) and photopic flicker (p = 0.009), was decreased. The photopic flicker b-wave peak time was increased (p = 0.005). Other parameters of ERG/PERG/PVEP did not differ significantly from controls. After the ablation procedure, the only statistically significant change was an increase in the OPs WI (p = 0.002). CONCLUSIONS: In the analyzed series of AF patients, retinal dysfunction was detected in the ERG test. The AF ablation may improve the retinal function as indicated by an increase in the OPs WI. The OPs WI has a potential value in the estimation of the effectiveness of AF ablation.

Pattern electroretinogram (PERG) in the early diagnosis of normal-tension preperimetric glaucoma: a case report.

INTRODUCTION: The purpose of this case is to present the use of pattern electroretinogram (PERG) in the early diagnosis of normal-tension preperimetric glaucoma in 56 years old woman. METHODS AND RESULTS: At baseline the results were as follows: distance-corrected visual acuity in the right eye (RE) and left eye (LE) 1.0 and 0.7, respectively (Snellen table), normal anterior segments in both eyes, normal fundus in the RE and abnormal cup to disc ratio (0.6) in the LE. Intraocular pressure (IOP) was within normal limits in both eyes: RE-14 mmHg, LE-18 mmHg (Goldmann tonometer). Results of standard automated perimetry (SAP), short wavelength automated perimetry (SWAP) and nerve fiber analyzer (GDx) were normal in both eyes. PERG result was normal in the RE but in the LE reduced amplitudes of P50 and N95 waves were observed. After topical treatment (Xalacom to the LE), a reduction of IOP to 13 mmHg was achieved and was accompanied by amplitudes increase of PERG waves. After discontinuation of the therapy, IOP increased to 18 mmHg and P50 and N95 amplitudes decreased to the values before treatment, suggesting the influence of IOP lowering therapy on electrical function of retinal ganglion cells. After 4 years from the baseline, static perimetry results were still normal, but abnormalities in retinal nerve fiber layer thickness were detected in GDx. CONCLUSIONS: PERG was a useful test not only for the early diagnosis of normal-tension preperimetric glaucoma, but also in evaluating the effectiveness of antiglaucomatous treatment.