Marta Misiuk-Hojło

Roles of endothelin-1 and selected proinflammatory cytokines in the pathogenesis of proliferative diabetic retinopathy: Analysis of vitreous samples.

PURPOSE To investigate the roles of endothelin-1(ET-1), TNF-alpha, IL-6 in the pathogenesis of proliferative diabetic retinopathy (PDR) in type 2 diabetes. METHODS Vitreous and blood serum samples were collected during vitrectomy from 19 patients with PDR and 15 patients who underwent vitrectomy for other reasons. The concentrations of ET-1, TNF-alpha, IL-6, vWF, sE-selectin were determined by ELISA. RESULTS Intraocular and serous concentrations of ET-1, TNF-alpha, IL-6, vWF, sE-selectin were higher in patients with PDR than in the control group. The vitreous ET-1/plasma ET-1 ratios the group of diabetic patients and in the control group were similar. Also TNF-alpha, IL-6 vitreous/plasma ratio were not statistically different between the analysed groups. Correlation between intraocular ET-1 and TNF-alpha concentrations in patients with PDR and between the increases in both factors in the vitreous and HbA(1)c concentration were shown. In the vitreous the increase in vWF depended on elevated levels of vWF in the serum. E-selectin concentration correlated with diastolic blood pressure. CONCLUSION These data provide evidence of the activation of the local synthesis of ET-1, TNF-alpha, IL-6 in PDR. The relationship between the increase in vitreous ET-1, TNF-alpha concentrations and HbA(1)c concentration is a important confirmation of the necessity to optimise diabetes treatment.

Proliferative diabetic retinopathy―The influence of diabetes control on the activation of the intraocular molecule system

AIMS Demonstrate the influence of type 2 diabetes control on the degree of retinal endothelial damage (vWF, E-selectin) and local increases in the concentrations of selected adhesion molecules (ICAM-1, VCAM-1, E-selectin) in proliferative diabetic retinopathy (PDR). METHODS Vitreous and serum samples were collected during vitrectomy from 19 patients with PDR and 15 patients who underwent vitrectomy for other reasons. Tests were performed using the ELISA method. RESULTS Serum and intraocular concentrations of ICAM-1, VCAM-1, E-selectin, vWF were considerably higher in the subjects with PDR than in the controls. In the vitreous, the increase in vWF depended on the elevated levels of vWF in the serum (r=0.905, p<0.001). E-selectin correlated with diastolic blood pressure (r=0.506, p=0.045). The concentrations of vWF and E-selectin in both samples were related to the significant increases in intraocular ICAM-1, ICAM-1, VCAM-1 in the serum of PDR patients. Increased VCAM-1 level in the vitreous correlated with the concentration of HbA(1)c (r=0.59, p=0.007). CONCLUSIONS Upon local and systemic damage to the endothelium there were significant increases in ICAM-1, VCAM-1, E-selectin. A significant positive correlation of VCAM-1 increase in the vitreous with HbA(1)c is an important argument for the influence of diabetes on immuno-inflammatory activation in the retinal microcirculation.

Cancer-associated retinopathy in patients with breast carcinoma

Introduction:Cancer-associated retinopathy (CAR) is a paraneoplastic neurological syndrome resulting in progressive loss of vision and clinical signs of retinal degeneration. It is associated with various types of cancer and is also considered to be an autoimmune disorder that involves cross-reaction between autoantibodies and retinal proteins. The aim of this study was to establish whether immunoreactivity to retinal antigens (RAs) observed in patients with breast cancer is accompanied by any visual impairments.Materials and Methods:Sera of 295 patients with diagnosed breast cancer were screened for the presence of anti-RAs antibodies using immunoblotting. Cellular immunoreactivity to RAs present in retinal extracts and to purified recoverin and arrestin was determined by means of a lymphocyte proliferation assay. Six patients with high-titer antibodies to RAs then underwent ophthalmic and neurological examinations.Results:Four serum samples contained high-titer antibodies to a 46-kDa protein, most probably retinal α-enolase, three had antibodies to a 48-kDa protein identified as retinal arrestin, while 56-, 43-, 41-, and 34-kDa antigens were recognized only by one serum sample each. Moreover, weak cellular response to all the RAs tested was observed in one patient and another patient responded only to retinal extract. Two of the examined patients displayed symptoms of CAR.Conclusions:Immunoreactivity to RAs in patients with breast cancer may also be present in cases without clinical signs of CAR.

Prevalence of Demodex spp. in eyelash follicles in different populations

Introduction The pathologic relevance of Demodex infestation in blepharitis is still controversial. The aim of the study was to determine the prevalence of Demodex spp. in eyelash follicles and its relationship to eye symptoms. Material and methods A total of 290 individuals were studied for the presence of Demodex folliculorum and Demodex brevis within eyelash follicles. Participants belonged to one of four groups: inpatients, drug abusers, health professionals, and medical students. Ten eyelashes were epilated from each subject, placed on microscope slides and examined for parasites. The sample was defined as positive if at least one parasite or parasites ova were present. The presence of parasites was analyzed according to age, gender, place of living, reported eye problems, and use of contact lenses or glasses. Results The prevalence of Demodex spp. infestation among all studied subjects was 41%, with the highest infestation rate among inpatients (p < 0.01) and elderly people (p < 0.001). No difference regarding the presence of Demodex was found between women and men (p = 0.76). Demodex folliculorum was about 2.4 times more frequent than D. brevis. The prevalence of Demodex spp. in subjects with and without eye complaints suggesting blepharitis was similar (41.6% vs. 40.2%, respectively, p = 0.9). On the other hand, wearing glasses was linked to Demodex infestation (48.4% vs. 32.3%, p < 0.01). Conclusions Demodex is a common saprophyte found in human eyelash follicles. Its presence might be related to some ocular discomfort; however, in the vast majority of cases the infestation seems to be asymptomatic.

First Case of Heterochthonous Subconjunctival Dirofilariasis Described in Poland

A 55-year-old Polish male presented with discomfort, redness, itching, and swelling in the left eye that had begun three days before seeking medical help. Slit-lamp examination revealed an actively moving subconjunctival worm located inferotemporally (Figure 1). A complete, live, moving nematode was removed under local anesthesia, and it was first stored in physiological saline for microscopic examination and then, put into 70% alcohol with glycerin and submitted for parasitological identification. The diagnosis was based on the following morphological features of the parasite: body length = 85.1 mm; maximum body width = 0.545 mm; esophagus = 0.895 mm long; vulva a little behind the esophagus; tail = 0.10 mm long, almost terminal; and cuticle with longitudinal combs on the surface (Figure 2). The worm was identified as an immature female nematode of the species Dirofilaria repens (Onchocercidae). The patients blood tests were within the normal limits. Neither eosinophilia nor microfilaremia were detected.

Antibodies to 46-kDa retinal antigen in a patient with breast carcinoma and cancer-associated retinopathy

Cancer-associated retinopathy (CAR) is a rare paraneoplastic syndrome usually associated with small-cell lung carcinoma and serum autoantibodies against recoverin. We report the breast cancer woman with visual impairments and electrophysiological abnormalities characteristic of CAR. Her serum contained high-titer antibodies against α-enolase but not against other retinal proteins. This suggests that anti-enolase antibodies could be responsible for the development of CAR symptoms.

Mycotic Infections of the Eye.

Fungal infections of the eye are an important cause of significant visual loss and blindness in some regions of the world, especially developing countries. Ocular mycoses remain a diagnostic and therapeutic challenge to the ophthalmologist. Corneal infection is the most frequent presentation, but the orbit, eyelids, lacrimal apparatus, conjunctiva, sclera and internal structures of the eye can also be affected. Candida spp., Fusarium spp. and Aspergillus spp. are the most frequently isolated organisms in fungal keratitis and in endophthalmitis. The difficulties posed by ocular mycoses are mainly related to establishing the clinical diagnosis, isolation of the fungal pathogen and effective local treatment, particularly in infections of the cornea. The critical issue in diagnosing fungal infection of the eye is microbiological identification of the etiologic agent in clinical samples. Early diagnosis and prompt treatment allow serious complications, including blindness, to be avoided. Local, systemic and even surgical treatment is applied in the therapy.

Long-Term Outcomes of Prostaglandin Analog Versus Timolol Maleate in Ocular Hypertensive or Primary Open-Angle Glaucoma Patients in Europe

PURPOSE To determine the direct costs of therapy over 5 years of a European monotherapy cohort begun on a prostaglandin (PTG) versus timolol in patients with primary open-angle glaucoma or ocular hypertension. METHODS A retrospective, multicenter, active-controlled, observational study. Data were abstracted for European patients treated as initial monotherapy in 1996 or afterward, with 5 years of available records. RESULTS This study included 271 patients (166 on a PTG and 105 on timolol at baseline). The average cost/month/patient over 5 years was

Analysis of retinal nerve fibre layer, visual evoked potentials and relative afferent pupillary defect in multiple sclerosis patients

45.47±12.61 for PTG and

The Dry Form of Age-Related Macular Degeneration (AMD): The Current Concepts of Pathogenesis and Prospects for Treatment.

31.50±15.47 for timolol (P<0.001, based on German prices). After 5 years, although there was no difference in number of glaucoma medicines prescribed between groups (1.0 PTGs and 1.1 timolol, P=0.41), the timolol group demonstrated a higher intraocular pressure (17.7±2.9 vs. 16.5±3.0 mm Hg, P<0.001), more medication changes (P=0.01), greater incidence of glaucomatous progression (P=0.04), and less patients persistent on original monotherapy (P<0.001) than the PTG cohort. CONCLUSIONS Patients originally on timolol monotherapy have a lower cost of care over 5 years than those started on a PTG. However, timolol patients during follow-up may demonstrate a higher intraocular pressure, more progression, more medication changes, and lower persistency of the original monotherapy.