Age-related changes in retrobulbar circulation: a literature review.

INTRODUCTION: The advances in research methods used in ophthalmology allow for an increasingly accurate examination of the eyes, as well as the morphology and function of the vessels. Colour Doppler imaging is still the first-line method for the analysis of parameters of retrobulbar circulation. Therefore, the aim of this work was to present the current state of knowledge about anatomical and functional age-related changes in retrobulbar arteries. METHODS: A literature search was performed mainly based on the PubMed database. RESULTS: The anatomy of retrobulbar arteries, histological background of age-related vascular changes, age-related changes in retrobulbar blood flow in the ophthalmic artery, central retinal artery, short posterior ciliary arteries, and the reference values for the age-dependent retrobulbar circulation parameters measured by colour Doppler imaging are discussed in this review. CONCLUSION: The age of the subject should always be taken into account when interpreting the parameters of retrobulbar blood flow measured by colour Doppler imaging.

Evaluation of choroidal parameters in eyes at the first onset of acute anterior uveitis.

BACKGROUND: Little is known about choroidal involvement in anterior uveitis. The aim of our study was to evaluate changes in choroidal thickness and volume in eyes with acute anterior uveitis (AAU) using enhanced depth imaging-optical coherence tomography (EDI-OCT) at baseline and after treatment, which were compared with healthy fellow eyes. METHODS: For the study, 35 individuals with unilateral acute AAU at the first onset were enrolled. Subfoveal thickness and choroidal volume were measured with EDI-OCT in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields before and after the completion of treatment. Moreover, axial length measurements of both eye bulbs were determined by optical biometry. RESULTS: No statistically significant differences in choroidal thickness or choroidal volume were detected between AAU eyes at baseline and after treatment and fellow eyes. Positive correlations between the values of anterior chamber flare and absolute CT changes in both temporal and inferior ETDRS fields, as well as in superior outer ring were detected. Negative correlations between age and both choroidal thickness and choroidal volume were detected in AAU eyes at baseline and after treatment, as well as in fellow eyes. CONCLUSIONS: Evaluation of the choroid with EDI-OCT does not appear to be a reliable tool for the treatment monitoring of eyes with anterior uveitis.

[The utility of selected ocular examinations in individuals with systemic lupus erythematosus]. / Przydatnosc wybranych badan okulistycznych u chorych z toczniem rumieniowatym ukladowym.

Systemic lupus erythematosus belongs to the group of autoimmune diseases, in which the accumulation of antigen-antibody complexes may lead to multiple organ failure. Ocular manifestation of the disease is also possible. Ocular changes are attributable to either the disease itself or to the complications associated with administered therapies. The aim of this research was to present the utility of ophthalmic and diagnostic devices in interpreting ocular changes in patients with systemic lupus erythematosus. Ultrasound biomicroscopy and spectral domain optical coherence tomography provide the insight into the anterior segment morphology with special emphasis on the cornea and iridocorneal angle in patients with Systemic Lupus Erythematosus. Confocal microscopy presents particular corneal layers in vivo what enables detecting the location of inflammatory and chloroquine deposits. Ocular Response Analyzer estimates changes in corneal hysteresis and resistance parameters in patients with systemic lupus erythematosus. The optical coherence tomography of the macula and multifocal electroretinography enable detecting subclinical forms of maculopathy. Evaluation of arterial flow parameters and characteristics in ocular circulation measured during fluorescein angiography and colour Doppler imaging quantifies functional and morphological changes in ocular circulation. The appropriate use of diagnostic devices along with accurate interpretation of findings may be crucial for early detection of ocular changes in many diseases with ocular involvement, including systemic lupus erythematosus.

Failure and success in the treatment of breast carcinoma in men: a case report.

BACKGROUND: Male breast cancer (MBC) represents a rare cause of vertebral body compression fractures along with severe pain restricting the patient's daily functioning. Limited number of cases, lack of awareness among patients and physicians leading to delayed management, further increase the average age and disease progression at presentation, resulting in a poor prognosis. Additionally, studies on MBC treatment protocols and the use of female algorithms are unavailable. The implementation of vertebroplasty or kyphoplasty often results in unsatisfactory outcome due to recurrent pain and loss of vertebral height. Stentoplasty could become an alternative procedure, as described in the following case study. CASE REPORT: 54-yr-old male patient with history of breast carcinoma presented with pain in the vertebral column. Baseline X-ray and CT scan revealed multiple osteosclerotic and osteolytic metastatic lesions in the thoracic vertebrae along with a compression fracture at T9. Stentoplasty was performed to limit fracture progression. Intraoperative scan revealed restoration of the vertebral body shape. Following surgery, direct reduction in pain was obtained. Postoperative 1-year follow-up did not show any loss in height of the operated vertebra. Results of adjuvant chemotherapy administration and a new method of treatment of compression fractures caused by metastatic lesions were compared with previously published studies. CONCLUSIONS: Stentoplasty with Vertebral Body Stenting-System is an innovative method that can be applied in kyphoplasty for compression fractures caused by metastatic lesions. Nevertheless, further research on the systemic treatment of MBC is needed.

The Effect of Oral Isotretinoin Therapy on Meibomian Gland Characteristics in Patients with Acne Vulgaris.

INTRODUCTION: The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. METHODS: Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3 months after the start of therapy, and 1 month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. RESULTS: In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = - 0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates. CONCLUSION: Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage.

Effect of Pterygium Removal Combined with Conjunctival Autograft on Corneal Parameters in Swept-Source Imaging.

BACKGROUND: Both pterygium ingrowth and excision determine alterations in corneal topography. The aim of this study was to evaluate the influence of pterygium removal combined with conjunctival autografts in addition to the use of human fibrin tissue glue on changes in corneal parameters as measured by 3-D swept-source anterior segment optical coherence tomography (AS-OCT) imaging. METHODS: Sixteen eyes (16 patients) with pterygium that qualified for surgical treatment were enrolled in this study. Eye examination, slit lamp, and 3-D AS-OCT (CASIA 2) assessment were performed before the surgery and 7 days, 1 month, and 6 months after pterygium excision. Topographic parameters of both anterior and posterior surfaces of the cornea were analysed at each follow-up visit. RESULTS: The gradual decrease in total astigmatism power from preoperative median 2.75 (6.15) D to 1.2 (1.1) D at 6-month follow-up (p = 0.034) was noted from the day 7 visit. Values were strongly influenced by variations of anterior cornea astigmatism. In contrast, a gradual total HOA reduction at the 1-month (from median 0.79 (1.3) D to 0.44 (0.27) D; p = 0.038) and at 6-month visits (0.25 (0.09); p = 0.001) was observed. Similarly, values were strongly influenced by variations of the anterior. Additionally, total average keratometry values increased from preoperative 44.05 (2.25) D to 44.6 (1.9) (p = 0.043) 1 month after the surgery. CONCLUSIONS: Significant steepening of the anterior cornea and a reduction in both astigmatism and HOA were observed after pterygium excision. The anterior corneal surface was an essential component of the total postoperative corneal topography values. Three-dimensional swept-source AS-OCT imaging seems to be a valuable tool for monitoring both the progression of the disease and postoperative effects in pterygium eyes.

Impact of systemic steroids combined with immunosuppressive treatment on glaucomatous features in patients with systemic lupus erythematosus.

AIM: To evaluate the incidence of increased intraocular pressure (IOP) and glaucomatous changes in systemic lupus erythematosus (SLE) patients in comparison with systemic steroids and immunosuppressive treatment. METHODS: Sixty-two women with SLE were divided into two groups: treated (n=47, 94 eyes) and not treated (n=15, 30 eyes) with systemic glucocorticosteroids (GC; GC-free). Twenty-one individuals in GC group were treated with immunosuppressive agents (immunomodulating and biologic). The visual acuity and IOP with ocular pulsatile amplitude (OPA) measurements, as well as scanning laser polarimetry (GDx) with nerve fiber index (NFI) measurement, spectral domain optical coherence tomography (SD-OCT) of the optic disk with retinal nerve fiber layer (RNFL) analysis and the macular region with ganglion cell analysis (GCA) were performed. RESULTS: Mean IOP values in group with combined GC and immunosuppressive therapy was 15.8±2.56 mm Hg and was significantly lower than in individuals with exclusive GC treatment (17.63±4.38 mm Hg, P=0.043). Contrary, no differences in mean IOP values between GC-free group and individuals treated with combined GC and immunosuppressive therapy were detected (P=0.563). Similarly, mean IOP in GC was 17.14±3.94 mm Hg and in GC-free patients was equal to 16.67±3.45 mm Hg (P=0.671). According to treatment regimen no statistical differences in optic disk SD-OCT for RNFL thickness, RNFL symmetry, cupping volume and the C/D ratio were observed. Similarly, no statistical differences for the mean and minimal ganglion cell layer (GCL) thickness measured in macular SD-OCT or NFI in GDx were detected. CONCLUSION: Combined immunosuppressive and systemic GC therapy in SLE patients may lower the risk of iatrogenic ocular hypertension. No relationship between treatment regimen and glaucomatous damage of optic nerve fibers in analyzed groups with SLE is detected.

Increased proinflammatory cytokines in tears correspond with conjunctival SARS-CoV-2 positivity in symptomatic COVID-19 patients.

Tear fluid cytokine levels may serve as biomarkers of innate immune system response against SARS-CoV-2 infection. Therefore, our aim was to analyze panel of selected inflammatory cytokines in tears of COVID-19 patients in relation to presence of SARS-CoV-2 viral load in conjunctival secretions. In this study concentrations of TNF-α, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p70, GM-CSF, and IFN-γ were determined by a magnetic bead assay in tear film collected from 232 symptomatic COVID-19 patients. SARS-CoV-2 ocular infection was confirmed based on positive conjunctival swab-based RT-PCR testing. Viral RNA in conjunctival sac was detected in 21 patients (9%). No relation between presence and the duration of ophthalmic symptoms and SARS-CoV-2 infection detected in conjunctival secretions was found. The tear film concentrations of IFN-γ, TNF-α, IL-5, IL-8 and GM-CSF were found to be significantly greater among patients with positive conjunctival swab results as compared to the group negative for SARS-CoV-2 in conjunctival sac. Our current data depict a group of inflammatory mediators in human tears, which may play a significant role in ocular pathology of SARS-CoV-2 conjunctival infection.

Safety and Efficacy of Isolated Endoscopic Cyclophotocoagulation in Pseudophakic Patients with Primary Open-Angle Glaucoma-12-Month Follow-Up.

BACKGROUND: We evaluated the safety and efficacy of endoscopic cyclophotocoagulation (ECP) for eyes with primary open-angle glaucoma (POAG). METHODS: We included a total of 104 pseudophakic eyes treated with ECP. Visual acuity and intraocular pressure (IOP, mmHg) measurements were evaluated preoperatively and on days 1 and 7 and 2 and 12 months postoperatively. IOP ≤ 15 or ≥30% reduction from baseline were defined as therapeutic success. RESULTS: The mean baseline IOP was 23.89 ± 8.63, and it decreased significantly at the day 1 (16.25 ± 7.32, p < 0.0001), day 7 (17.81 ± 6.37, p < 0.0001), 2nd month (17.77 ± 8.54, p < 0.0001) and 12th month (16.42 ± 7.05, p < 0.0001) follow-up visits. Therapeutic success was achieved in 55 (61.80%) eyes at the 12-month follow-up. Patients with POAG duration longer than 10 years or those using alpha agonist eye drops had a lower rate of therapeutic success (odds ratio: 0.52, 95% CI = 0.32-0.85, p < 0.05 and odds ratio: 0.92, 95% CI = 0.55-0.95, p = 0.024, respectively). A longer disease course was associated with higher IOP values (Rs =+0.281; p = 0.024) postoperatively. The number of antiglaucoma medications decreased significantly from 2.55 ± 1.16 to 2.11 ± 1.14 (p = 0.003). The ECP complications included a minor IOP increase (9.37%), pupil irregularity (15.73%), and the presence of fibrin (3.29%). CONCLUSIONS: The ECP is an effective and safe option, especially in eyes with a shorter glaucoma course.

Long-Term Effects of Adjuvant Intravitreal Treatment with Autologous Bone Marrow-Derived Lineage-Negative Cells in Retinitis Pigmentosa.

BACKGROUND: Autologous bone marrow-derived lineage-negative (Lin-) cells present antiapoptotic and neuroprotective activity. The aim of the study was to evaluate the safety and efficacy of novel autologous Lin- cell therapy during a 12-month follow-up period. METHODS: Intravitreal injection of Lin- cells in 30 eyes with retinitis pigmentosa (RP) was performed. The fellow eyes (FEs) were considered control eyes. Functional and morphological eye examinations were performed before and 1, 3, 6, 9, and 12 months after the injection. RESULTS: Patients whose symptoms started less than 10 years ago gained 14 ± 10 letters, while those with a longer disease duration gained 2.86 ± 8.54 letters compared to baseline at the 12-month follow-up (p = 0.021). There were significantly higher differences in response densities of P1-wave amplitudes in the first ring of multifocal ERGs in treated eyes than FE recordings in all follow-up points were detected. Accordingly, the mean deviation in 10-2 static perimetry improved significantly in the treated eyes compared with fellow eyes 12 months after the procedure. The QoL scores improved significantly and lasted until the 9-month visit. CONCLUSION: Lin- cell-based therapy is safe and effective, especially for a well-selected group of RP patients who still maintained good function of the foveal cones.

Impact of corneal parameters on intraocular pressure measurements in different tonometry methods.

AIM: To evaluate the impact of central corneal thickness (CCT) and corneal curvature on intraocular pressure (IOP) measurements performed by three different tonometers. METHODS: IOP in 132 healthy eyes of 66 participants was measured using three different tonometry techniques: Goldmann applanation tonometer (GAT), Pascal dynamic contour tonometer (DCT), and ICare rebound tonometer (RT). CCT and corneal curvature were assessed. RESULTS: In healthy eyes, DCT presents significantly higher values of IOP than GAT (17.34±3.69 and 15.27±4.06 mm Hg, P<0.0001). RT measurements are significantly lower than GAT (13.56±4.33 mm Hg, P<0.0001). Compared with GAT, DCT presented on average 2.51 mm Hg higher values in eyes with CCT<600 µm and 0.99 mm Hg higher results in eyes with CCT≥600 µm. The RT results were lower on average by 1.61 and 1.95 mm Hg than those obtained by GAT, respectively. Positive correlations between CCT in eyes with CCT<600 µm were detected for all IOP measurement techniques, whereas a similar relationship was not observed in eyes with thicker corneas. A correlation between IOP values and keratometry in the group with CCT<600 µm was not detected with any of the tonometry methods. In thicker corneas, a positive correlation was found for GAT and mean keratometry values (R=0.369, P=0.005). CONCLUSION: The same method should always be chosen for routine IOP control, and measurements obtained by different methods cannot be compared. All analysed tonometry methods are dependent on CCT; thus, CCT should be taken into consideration for both diagnostics and monitoring.

A Novel Approach to the Differentiation of Intrabulbar Tumors in Color Doppler Imaging.

AIM OF THE STUDY: The similarity of many benign intrabulbar lesions to a malignant tumor requires detailed differential diagnostics. However, none of the known methods can be used as the only one to determine the type of lesions. The aim of this study was to determine color Doppler imaging (CDI) markers characteristic of choroidal melanoma and metastatic intrabulbar tumors, increasing the diagnostic value and giving a new insight into the use of this method. MATERIALS AND METHODS: CDI was performed in 44 patients with malignant tumors and in 49 patients with benign tumors. Patients with malignant tumors were divided into melanomas (n = 28) and metastatic tumors (n = 16). Univariate analysis with the logistic regression method and multivariate stepwise logistic regression analysis to create models testing tumor malignancy and differentiating melanoma from metastatic lesions were used. Model sensitivity and specificity were evaluated by the receiver-operating characteristic curve. A K-fold validation was performed. RESULTS: Arterial blood flow, regular tumor surface, and tumor location in peripheral choroid were found significant for tumor malignancy. Mixed blood flow increased the accuracy of the test (p > 0.05). Model sensitivity and specificity were 83.7% and 75.7%. A regular tumor surface and hypoechoic or isoechoic tumor mass differentiated melanoma and metastatic masses in the regression model, with a sensitivity of 85.2% and a specificity of 75.0%. The area under curve (AUC) for both the models was 0.851 SE (standard error) 0.041 and 0.853 SE 0.063, respectively. AUC in five-fold cross-validation was 0.80 SE 0.0477 and 0.743 SE 0.094, respectively. CONCLUSIONS: Arterial or mixed blood flow, regular tumor surface, and tumor location in peripheral choroid may be characteristic of malignant tumors. Regular tumor surface and echogenicity of tumor mass could differentiate melanoma from metastatic tumor.