Dominika Nowakowska

Leki oryginalne i generyczne w okulistyce — bezpieczeństwo i skuteczność terapii

Teoretycznie, lek oryginalny i generyczny nie powinny wykazywac istotnych roznic w praktyce klinicznej. Jednak istnieją liczne publikacje wskazujące na mozliwośc pogorszenia miejscowego i/lub ogolnego stanu chorego przy zamianie preparatu oryginalnego na preparat generyczny. W przypadku lekow odtworczych brak jest danych dotyczących bezpieczenstwa i skuteczności pochodzących z randomizowanych kontrolowanych badan klinicznych, a procesy produkcyjne lekow generycznych i oryginalnych nie są jednolite w roznych firmach. Zmiennośc pH, substancji pomocniczych, toniczności i wielu innych czynnikow moze miec powazny wplyw na tolerancje, bezpieczenstwo i skutecznośc lekow generycznych. Ocena dzialania tych lekow jest szczegolnie trudna w odniesieniu do preparatow okulistycznych. W związku z samą specyfiką budowy anatomicznej oka niemozliwe jest wykonywanie niektorych badan farmakokinetycznych in vivo , a na efekt terapeutyczny moze miec wplyw nawet budowa buteleczki, wielkośc kropli czy ilośc substancji czynnej w jednej kropli.

Visual rehabilitation training in a patient with large central scotoma due to Leber’s hereditary optic neuropathy

Background. Leber’s hereditary optic neuropathy (LHON) is a disease associated with pathogenetic mutations of mitochondrial DNA which affects predominantly young adult males and leads to loss of central vision, low visual acuity and unstable fixation. The purpose of this study was to allow the patient to establish the best possible fixation in the best area of retinal sensitivity in LHON patient with central scotoma. Methods. A 17 years old patient with confirmed mitochondrial LHON 11778G > A mutation was included in the study. The patient underwent 16 visual rehabilitation sessions — two for each of 8 weeks using the training module available in the equipment — MAIA microperimeter. Visual acuity and standrad microperimetry examination were performed before and 8 weeks period of training. To measure the fixation stability with MAIA microperimeter, P1, P2 and Bivariate Contour Ellipse Area (BCEA) parameters were used. Results. Visual acuity of the trained better eye was 0.08 at the baseline versus 0.063 after 8 weeks training. Fixation stability parameter was P1-21%, P2-64% at the first session versus P1-60%, P2-90% at the last session. BCEA values 29.2°˛ before and 14.2°˛ after training, respectively. Conclusions. Visual training via microperimetry could potentially be a method that improves the fixation stability in patients with LHON.

Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

INTRODUCTION. The aim of our study is to describe the anatomical and functional results of pars plana vitrectomy (PPV) among diabetic patients treated due to tractional retinal detachment (TRD) or non-clearing vitreous haemorrhage (VH). MATERIALS AND METHODS. A retrospective analysis was made of clinical data of 45 eyes treated with 23G PPV for TRD (17 eyes) or VH (28 eyes). Preoperative and final visual outcomes and postoperative complications were recorded. The mean follow-up period was 12 months. RESULTS. The postoperative visual acuity (VA) improved significantly in 60% of eyes, but remained unchanged or was worse in 40%. Improvement of VA was more pronounced in the VH group. PPV was performed with silicone oil tamponade in 66.5%, air tamponade in 29%, and gas tamponade in 4.5%. Postoperative complications included: retinal re-detachment (seven eyes), secondary glaucoma (nine eyes), and recurrent VH (two eyes). CONCLUSIONS. PPV is an effective treatment method of complications of severe proliferative diabetic retinopathy inter alia the TRD and VH. Because surgical management of TRD and VH is demanding, anatomical and functional results are limited by complications.

The use of heads up surgery in cataract surgery and vitrectomy

The term heads up surgery is derived from the term head up display, which is used in the aviation industry to describe a method of data display at the level of the pilot eyes. During the heads up surgery, the operator performs the procedure observing the microscopic image transmitted from a 3D camera onto a large, flat-screen monitor instead of the direct view through the operating microscope. This makes it possible for any number of students to track the course of the surgery using 3D glasses. Another advantage of this technique is its unique ergonomics. Besides the monitor and the 3D glasses, the 3D visualization system includes a 3D camera and a console with 3D image processing software.

Outcomes of Vitrectomy in Pediatric Retinal Detachment with Proliferative Vitreoretinopathy

Aim To report outcomes of pars plana vitrectomy (PPV) in pediatric retinal detachment (RD) with proliferative vitreoretinopathy (PVR), complications, factors influencing the final anatomical and functional results. Methods Retrospective consecutive case series of 14 eyes. Average postoperative follow-up period was 34 months. Results Mean age of patients was 10 years; eleven patients (79%) were males. The most common etiology was trauma (57%), the second—myopia (36%) and one case of uveitis (7%). At the day of presentation, the best-corrected visual acuity (BCVA) was worse than hand motion (50%); macula was detached in 86% of cases. Simultaneous PPV and phacoemulsification with intraocular lens (IOL) implantation were performed in 12 cases (86%). The most common endotamponade during PPV was silicone oil (93%). Anatomic reattachment was accomplished in 86% of cases. Final BCVA was equal or better than 0.1 in 50% of patients. The postoperative complications were found in 5 eyes (36%). Conclusion Complete PPV was allowed for anatomically reattached retina and preserved vision in pediatric complex RD with PVR. However, visual outcomes were not satisfactory. Preserving vision in children with RD is of great importance for their future motor and intellectual development. This trial is registered with ClinicalTrials.gov Identifier: NCT03208205.

Clinical outcomes of primary vitrectomy in pseudophakic retinal detachment

PURPOSE. To evaluate the efficacy of primary pars plana vitrectomy (PPV) for rhematogenous retinal detachment (RD) in pseudophakic eyes. MATERIALS AND METHODS. The medical records of 63 patients who had undergone PPV after phacoemulsification were reviewed retrospectively. The mean follow-up period was 10 months. Statistical analysis evaluated functional and anatomical results as well as general (diabetes, hypertension) and ocular (myopia, glaucoma, floppy iris syndrome, intraoperative complications during cataract surgery, YAG capsulotomy) conditions. RESULTS. The median period from cataract surgery to RD onset was 15 months. Retinal attachment was achieved in 92% of eyes. The final visual acuities were improved significantly from 1.7 logMAR to 0.7 logMAR. Silicon oil was used as a tamponade in 38 eyes and SF6 gas in 25 eyes. Better functional results were achieved with SF6 gas tamponade. No intraoperative complications were reported. Most of the patients were males (71%). Statistical analysis revealed that general and ocular conditions did not influence functional results. CONCLUSIONS. Primary PPV, especially with gas as a tamponade, is an effective procedure in the surgical treatment of pseudophakic RD. The advantages include good anatomical and functional outcomes and low complication rate. Neither clinical nor surgical factors have been identified as responsible for the visual outcomes.

Postoperative presbyopia correction with intraocular lenses implantation in cataract patients – current trends

The most effective and most frequently used method for presbyopia correction in cataract patients involves the implantation of presbyopic intraocular lenses. Diffractive intraocular lenses and extended depth of focus IOLs are the two main trends in presbyopia correction in cataract patients nowadays. Mariusz spyra1, ewelina Cisek2,3, agnieszka Cisek1,3, stanisław Orkisz3, Paweł Klonowski2, tomasz Chorągiewicz2, Dominika Nowakowska2, Robert Rejdak2