Agnieszka Kubicka-Trząska

Circulating antiretinal antibodies predict the outcome of anti-VEGF therapy in patients with exudative age-related macular degeneration.

Purpose:  To determine serum antiretinal antibody (ARA) levels in response to treatment with intravitreal bevacizumab of exudative age‐related macular degeneration (AMD).

Circulating anti-retinal antibodies in response to anti-angiogenic therapy in exudative age-related macular degeneration

To determine changes in anti‐retinal antibodies (ARAs) during anti‐VEGF therapy in patients with exudative age‐related macular degeneration (AMD) and to assess the correlations between ARAs and disease activity.

Ruthenium-106 Plaque Therapy for Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome

Diffuse choroidal hemangiomas associated with Sturge-Weber syndrome (SWS) are classically treated with external beam radiotherapy (EBR), but there are a few reports usually of single cases indicating the usefulness of plaque therapy. We present our observations on two cases of diffuse choroidal hemangiomas with exudative retinal detachment associated with SWS treated with Ruthenium-106 plaque therapy. Outcomes included best-corrected visual acuity (BCVA) and regression in tumor thickness measured by ultrasonography. The initial BCVA of the affected eyes was counting fingers at 1 meter and light projection. Pretreatment tumors thickness was 3.5 mm and 4.7 mm. In a follow-up period of 18–24 months, significant reduction in thickness of choroidal hemangiomas up to 1.2 mm and 1.4 mm with prompt resolution of exudative retinal detachment was observed. BCVA achieved 20/200 and 20/400, respectively. The findings in this paper indicate that Ruthenium-106 plaque therapy is effective in treatment of diffuse choroidal hemangiomas associated with SWS.

THE ANALYSIS OF SPONTANEOUS CLOSURE MECHANISMS AND REGENERATION OF RETINAL LAYERS OF A FULL-THICKNESS MACULAR HOLE: Relationship with Visual Acuity Improvement.

Purpose: To analyze the spontaneous closure mechanisms, retinal layer regeneration, and best corrected visual acuity (BCVA) in the full-thickness macular hole (FMTH). Methods: Ten eyes of 10 patients were studied. The measured outcomes included the time of persisting clinical symptoms and spontaneous closure of FTMH, BCVA, and spectral domain optical coherence tomography (SD-OCT) of vitreomacular interface. Results: In a follow-up period, all eyes showed closure of FTMH (closure range: 3–64 weeks). The “bridging” phenomenon was a main mechanism of a spontaneous FMTH closure. Additionally, posterior vitreous detachment with the release of vitreomacular traction was observed in 4 eyes (40%). The statistical analysis showed that shorter the duration of symptoms, shorter the duration of the spontaneous FTMH closure (r = 0 673, P < 0 05). No significant association was observed between the time of spontaneous closure FTMH, the age of patients, and BCVA. The regeneration of the outer nuclear layer (ONL) and external limiting membrane (ELM) was confirmed in 10 and 9 eyes, respectively. In six eyes, connections between inner and outer segments of photoreceptors were rebuilt; in these cases, the final BCVA was the best. None of the eyes showed the regeneration of the connections between the outer segments of photoreceptor and retinal pigment epithelium (RPE). Conclusion: The main mechanism leading to a spontaneous closure of FTMH is the “bridging” phenomenon. Vitreous detachment and vitreomacular traction release are not necessary conditions promoting the closure of FTMH. Shorter duration of symptoms and regeneration of photoreceptors IS/OS interface provide a better final BCVA.

Serum anti-endothelial cell antibodies in patients with age-related macular degeneration treated with intravitreal bevacizumab

To analyse the prevalence and changes in circulating anti‐endothelial cell antibodies (AECA) during anti‐vascular endothelial growth factor (anti‐VEGF) therapy.

Cesarean section and eye disorders

Recently, a growing tendency for cesarean birth has been noted both, in Poland and worldwide. Non-obstetric problems constitute a large part of indications for cesarean section. Many ophthalmologists and obstetricians still believe that high myopia, the presence of peripheral retinal degenerations, history of retinal detachment surgery, diabetic retinopathy, or glaucoma are indications for surgical termination of pregnancy. However, these recommendations are not evidence-based. The literature offers no proof that high myopia and previous retinal surgery increase the risk of retinal detachment during spontaneous vaginal delivery. There is only one indication for cesarean section in myopic patients, i.e. the presence of choroidal neovascularization, which can cause subretinal bleeding with acute visual loss. Prolonged and intensified Valsalva maneuver during labor in patients with an active proliferative diabetic retinopathy may be an indication for an elective cesarean section. Uterine contractions during the second stage of vaginal delivery lead to a marked elevation of intraocular pressure. Intraocular pressure fluctuations during the delivery may damage retinal ganglion cells, resulting in further progression of visual field. Thus, glaucoma associated with advanced visual field changes is the next ophthalmic indication for cesarean section. The report presents the current state of knowledge concerning the effect of pregnancy on pre-existing ocular disorders and the influence of physiological changes on the clinical course of these diseases during the stages of natural delivery. The authors discuss also the ophthalmic indications for cesarean section.

Sudden Visual Deterioration as the First Symptom of Chronic Kidney Failure.

Purpose: We report here a unique case of a sudden loss of vision as the first symptom of an advanced chronic nephropathy. Methods and Results: A 25-year-old man was referred to the Department of Ophthalmology with sudden visual deterioration presumptively diagnosed as bilateral retinitis. The patient had never been under any medical care before and had never had any clinical signs of any chronic disease. He underwent an ophthalmic examination with optical coherence tomography (OCT). Based on the clinical features, OCT scans and systemic blood pressure (BP) assessment (225/145 mm Hg), the patient was definitely diagnosed with hypertensive retinopathy and choroidopathy due to hypertensive crisis. After urgent diagnostic procedures, the patient was diagnosed with a chronic kidney disease at stage 5 in the course of chronic glomerulonephritis. Immediately, a renal replacement therapy was started and the patient was qualified for renal transplantation. Conclusion: Adolescents with an unclear picture of retinal lesions, who have neither a history nor clinical signs of a systemic disease, should undergo careful systemic screening with BP assessment. A sudden deterioration of vision may be the first symptom of a previously undiagnosed severe systemic disease (very rare chronic) that requires immediate treatment.

AJL macular buckle for the treatment of myopic foveoschisis with posterior staphyloma

Klinika Oczna 2017, 119 (2) ISSN 0023-2157 Index 362646 Introduction Pathological myopia is defined as a spherical aberration over -6.0 D or ocular length over 26.0 mm. In pathological myopia, the eye elongates anteroposteriorly which causes degenerative lesions to the sclera, retina, choroid and the optic disc. Posterior staphyloma with concomitant myopic foveoschisis or retinal detachment within the posterior pole is one of the most severe complications of pathological myopia. It presents a challenge for vitreoretinal surgery (1–3). Pars plana vitrectomy, without the indentation (buckling) of the posterior pole, may be insufficient to achieve vision improvement and restore normal macular anatomy in the these cases (4–6). The aim of this paper is to present the results of combined surgical treatment with pars plana vitrectomy, internal limiting membrane (ILM) peeling and implantation of the AJL macular buckle in a patient with myopic foveoschisis and posterior staphyloma secondary to pathological myopia. AJL macular buckle for the treatment of myopic foveoschisis with posterior staphyloma

Ocular paraneoplastic syndromes

Klinika Oczna 2017, 119 (1) ISSN 0023-2157 Index 362646 Wprowadzenie Okulistyczne zespoły paraneoplastyczne to rzadko występujące heterogenne schorzenia charakteryzujące się obecnością retinopatii o podłożu autoimmunologicznym, która towarzyszy systemowej chorobie nowotworowej (1–3). Patogeneza retinopatii paraneoplastycznej jest związana z zaburzeniem immunoregulacji i indukcją odpowiedzi układu odpornościowego przeciwko antygenom nowotworowym w postaci produkcji autoprzeciwciał lub aktywacji cytotoksycznych komórek limfocytarnych typu T. Reagują one krzyżowo z antygenami siatkówki, identycznymi z tymi, które występują w komórkach raka (3, 4). Antygeny komórek rakowych stymulują układ immunologiczny do produkcji m.in. swoistych autoprzeciwciał będących częścią odpowiedzi przeciwnowotworowej. Te przeciwciała przedostają się z surowicy przez barierę krew–siatkówka do siatkówki i tam wnikają w komórki fotoreceptorowe posiadające odpowiedni białkowy antygen (4). Te autoprzeciwciała prowadzą do destrukcji zarówno komórek siatkówki, jak i komórek nowotworowych i dlatego odgrywają podwójną rolę immunopatologiczną – poOkulistyczne zespoły paraneoplastyczne

Retinoblastoma in patients with 13q deletion syndrome – case series

Deletion of the long arm of chromosome 13 (13q deletion syndrome) is very rare chromosomal aberration which causes mental retardation and multiple congenital malformations. Furthermore, it is associated with the increased risk of retinoblastoma. The aim of the paper was to present two cases of retinoblastomna in children with 13q deletion syndrome, discussing the diagnostic and therapeutic management, clinical manifestation and the importance of genetic testing which helps to determine the type of retinoblastoma and may also contribute to the diagnosis of other congenital abnormalities associated with intraocular tumors.