Piotr Jurowski

Prevalence of ocular manifestations in systemic sclerosis patients.

Introduction Systemic sclerosis (scleroderma, SSc) is a severe chronic connective tissue disease caused by immune system disorders and changes in the structure and functions of blood vessels, which consequently leads to enhanced tissue fibrosis. The aim of the study was to evaluate changes in the organ of vision in systemic sclerosis patients. Material and methods Overall the study involved 27 patients with systemic sclerosis. The control group comprised 27 age- and gender-matched healthy individuals. All the study subjects underwent complete ophthalmological examination that in systemic sclerosis patients additionally involved fluorescein angiography. Results Ophthalmological examination revealed higher incidence of the following abnormalities in the study group, compared to the control: symptoms of dry eye syndrome (19 eyes, p < 0.02), astigmatism(in 30 eyes, p < 0.01), posterior subcapsular cataract (10 eyes, p < 0.05), increased intraocular pressure (> 21 mm Hg were observed in 11 eyes, p < 0.002) and vascular abnormalities within fundus in fluorescein angiography (20 eyes). Conclusions In patients with systemic sclerosis numerous abnormalities within the vision of organ may be found. Regular ophthalmological examinations are essential among the mentioned group. The examination should be particularly focused on the presence of retinal vascular abnormalities.

Serum MicroRNAs as Potential Biomarkers of AMD

Background Age-related macular degeneration (AMD) is a major cause of blindness worldwide. Circulating microRNAs (miRNAs) in serum have emerged as novel candidate biomarkers for many diseases. The aim of the present study was to identify a serum microRNA (miRNA) expression profile specific for dry and wet forms of AMD. Material/Methods Serum miRNA expression was first screened using TaqMan® Human MicroRNA Array A (Applied Biosystems). An extensive, self-validated, individual, quantitative RT-PCR (qRT-PCR) study was then performed on a cohort of 300 AMD patients (150 wet form and 150 dry form) and 200 controls. The Mann-Whitney U test and nonparametric Spearman’s rank correlation coefficient were used for statistical analysis. Results miRNA expression analysis revealed increased expression of miR661 and miR3121 in serum of patients with dry AMD and miR4258, miR889, and Let7 in patients with wet form. Expression of analyzed miRNA was not observed or remained at low level in controls. Conclusions Differences in miRNA serum profile exist between patients with wet and dry form of AMD, which indicates miRNAs as potential biomarkers of AMD. Further studies should be performed to confirm its significance in clinical practice.

Two-Year Accelerated Corneal Cross-Linking Outcome in Patients with Progressive Keratoconus

Purpose. To evaluate the long-term results of accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods. Sixteen patients underwent accelerated CXL at 6 mW/cm2 for 15 minutes in one eye. The follow-up visits were scheduled on 7 days, 14 days, and 3, 12, and 24 months after the treatment. Results. There were no significant differences (P > 0.05) between preoperative and 2-year postoperative mean values, respectively, in terms of uncorrected visual acuity, best spectacle-corrected visual acuity, maximum keratometry K max⁡, minimum keratometry K min⁡, corneal astigmatism, and corneal eccentricity index. We noted a significant flattening of the cornea in 18.7% of patients with a higher preoperative K max⁡ value (>50 D) and its steepening in patients with a lower K max⁡ value (<50 D) (6.25%). There was no significant difference in the central corneal thickness and the apical corneal thickness preoperatively and 2 years postoperatively. The mean demarcation line depth was 282 ± 11 μm. Persistent corneal haze was noted in 25% of patients. Conclusions. Accelerated CXL appears to be a relatively effective procedure for the treatment of keratoconus in 2-year follow-up.

Pulsatile ocular blood flow in subjects with sleep apnoea syndrome.

Introduction The aim of the study was to determine the correlation between pulsatile ocular blood flow (POBF) and sleep apnoea syndrome (SAS). Material and methods Patients were recruited from those who underwent polysomnography in the “Sleep Unit” of the physiology department (Medical University, Lodz, Poland). A total of 52 Caucasian patients, 34 with SAS and 18 age- and gender-matched controls, were included in the study. Comprehensive ophthalmic examination included the pulsatile ocular blood flow (POBF) measurements, disc analysis with Heidelberg Retina Tomograph II and Oculus Centerfield computerized perimetry as well as the best visual acuity, a slit lamp and indirect ophthalmoscopic evaluation of anterior and posterior segments and applanation tonometry. Results The observed prevalence of glaucoma in SAS patients was 5.9% (2 of 34). The mean values of POBF were 1069.21 ±235.94 µl/min in the SAS group and 1061.78 ±174.63 µl/min in the control group. The study revealed that the differences of mean POBF between the SAS patients and the control group were not statistically significant: Mann-Whitney U-test p > 0.05. No correlations were found between sleep apnoea syndrome and mean intraocular pressure (IOP), mean retinal nerve fibre layer (RNFL) thickness and visual field mean defect (MD). Conclusions No correlation was found between pulsatile ocular blood flow and sleep apnoea syndrome. Although some previous studies found an association between IOP, MD, RNFL thickness and sleep apnoea syndrome, our study did not confirm that. However, a high prevalence of glaucoma was found among SAS patients in Poland.

Prognostic value of plasma N-terminal pro-B-type natriuretic peptide concentration in patients with normal and impaired left ventricular systolic function undergoing surgery for abdominal aortic aneurysm.

Introduction Implantation of an aortic-bifemoral prosthesis is characterised by a high (> 5%) rate of perioperative cardiovascular events. The main aim of the study is to demonstrate the usefulness of the determination of NT-proBNP concentration as a method of risk stratification of left ventricular dysfunction in patients subjected to surgery for aortic-bifemoral prosthesis implantation. Material and methods Forty consecutive patients were examined and subjected to aortic-bifemoral prosthesis implantation. The examined patients were divided into two groups: 1) with normal left ventricular systolic function and EF ≥ 58% (group I), 2) with left ventricular systolic dysfunction and EF < 58% (group II). Results In group I the median EF before surgery was 69.5% and the concentration of NT-proBNP 141.5 pg/ml. On day 7 after surgery respective values were EF 65.5%, NT-proBNP 498.55 pg/ml. In group II the median EF before surgery was 54%, and NT-proBNP concentration 303.9 pg/ml. Conclusions The concentration of plasma NT-proBNP before surgery well correlated with left ventricular ejection fraction. The values of NT-proBNP > 303.9 pg/ml strongly correlated with increased risk of left ventricular systolic dysfunction after surgery and they seem to have high prognostic value for the occurrence of cardiovascular events in this group of patients. The determination of NT-proBNP level on day 7 after surgery strongly correlated with the decrease of left ventricular ejection fraction in patients after the prosthesis implantation. It is a valuable diagnostic and prognostic factor of circulatory system efficiency before making a decision to discontinue hospitalization.

Correctable and non-correctable visual impairment among young males: a 12-year prevalence study of the Military Service in Poland

Purpose:  To evaluate the prevalence of correctable and non‐correctable visual impairment in a representative sample of young males commissioned for Military Service in Poland.

Ocular findings among young men: a 12-year prevalence study of military service in Poland

Purpose:  To determine the prevalence of ocular diseases among young men and to assess the main ocular causes reflecting discharge from military service in Poland.

Quantitative thermographic analysis of viscoelastic substances in an experimental study in rabbits.

PURPOSE: To measure the temperature parameters on the corneal surface during the delivery of standardized ultrasound energy assisted with ophthalmic viscosurgical devices (OVDs) or different temperatures of irrigating solutions in an experimental animal model. SETTING: Department of Ophthalmology and Visual Rehabilitation, Medical University of Lodz, and Central Institute for Labor Protection, National Research Institute, Warsaw, Poland. METHODS: Thirty rabbits (60 eyes) were randomly divided into 6 groups in which different OVD or balanced salt solutions (BSS) were used: group 1: Viscoat (sodium hyaluronate 3%–chondroitin sulfate); group 2: Provisc (sodium hyaluronate 1%); group 3: soft‐shell technique; group 4: Celoftal (hydroxypropyl methylcellulose 2%); group 5: BSS 22°C; and group 6: BSS 4°C. After the nucleus and lens cortex were removed, the anterior chamber was filled with OVD or BSS and a phaco tip was introduced into the pupillary plane and switched on. The same phaco tip parameters were used in all groups. For thermographic measurements (ie, maximal temperature [MT], dynamic rise in temperature [DRT], and time when the maximal level of temperature [TMLT] was achieved), a thermocamera was used. RESULTS: Mean preoperative temperature on the rabbit corneal surface was 22.76°C ± 1.48°C (SD). Working with a phaco tip increased the temperature in each group. A significantly higher MT was observed in group 5 (27.85°C ± 0.52°C), followed by group 2 (27.75°C ± 0.54°C), group 3 (27.74°C ± 0.46°C), and group 4 (27.25°C ± 0.60°C), than in group 6 (26.81°C ± 0.34°C) and group 1 (26.52°C ± 0.48°C) (P<.05). Significantly higher values of DRT and shorter TMLT values were observed in group 5 (1.16°C/s ± 0.42°C/s, 4 seconds) and group 6 (0.91°C/s ± 0.13°C/s, 5 seconds) than in groups 2, 3, 1, and 4 (0.09°C/s ± 0.07°C/s, 30 seconds; 0.08°C/s ± 0.04°C/s, 40 seconds; 0.07°C/s ± 0.03°C/s, 45 seconds; 0.06°C/s ± 0.02°C/s, 50 seconds, respectively) (P<.0001). CONCLUSIONS: Currently used OVDs potentially offer different levels of protection against the increase in temperature that occurs during phacoemulsification. Therefore, the surgeon should consider this aspect when choosing an OVD, particularly in difficult cases (ie, hard nucleus, shallow anterior chamber, endothelial abnormalities).

Corneal endothelial cells' protection against thermal injury: influence of ophthalmic viscoelastic substances in experimental study on rabbits.

Purpose To quantify the maximal level of temperature and the time the maximal temperature is achieved and correlate the temperature parameters to the mean rate of endothelial cell loss after standardized ultrasound delivery assisted with four viscoelastic substances or different temperature of balanced salt solution (BSS). Methods Thirty rabbits (60 eyes) were divided into six groups in which different viscoelastic substances or different temperature of BSS were used: Group 1, Viscoat; 2, Proviso; 3, soft shell technique; 4, Celoftal; 5, BSS 22 °C; and 6, BSS 4 °C. The same parameters of ultrasound energy were delivered by standard phaco tip introduced into pupillary plane. Thermocamera was employed for measurements of temperature parameters. Endothelium cell count was measured before surgery and 1 month postoperatively. Results Maximal level of temperature was measured as follows: Group 5, 27.85 ± 0.52 °C; Group 2, 27.75 ± 0.54 °C; Group 3, 27.74 ± 0.46 °C; Group 4, 27.25 ± 0.60 °C; Group 6, 26.81 ± 0.34 °C; Group 1, 26.52 ± 0.48 °C (p<0.05). The time the maximal temperature is achieved was statistically shorter in Groups 5 and 6: 4 seconds, 5 seconds, respectively p<0.0001, as compared with Group 2 (30 seconds), Group 3 (40 seconds), Group 1 (45 seconds), and Group 4 (50 seconds). The mean rate of endothelial cell loss was calculated as follows: Group 1, 4.35%±2.55%; Group 2, 8.43%±5.2%; Group 3, 6.25%±4.20%; Group 4, 6.53%±4.65%; Group 5, 14.3%±3.85%; and Group 6, 8.78%±4.45%. Conclusions Viscoelastic substances offer different levels of endothelial cell protection against temperature increase during phacoemulsification. The mean rate of endothelial cell loss correlates with the time the maximal temperature is achieved rather than with the value of maximal level of temperature. This implicates that surgical strategy should consider the choice of the most effective viscoelastic substances, particularly in difficult cases, e.g., hard nucleus, shallow anterior chamber, primary endothelial abnormality.

A prospective study on different methods for the treatment of choroidal neovascularization. The efficacy of verteporfin photodynamic therapy, intravitreal bevacizumab and transpupillary thermotherapy in patients with neovascular age-related macular degeneration

Summary Background The aim of this study was to compare the efficacy of verteporfin photodynamic therapy (PDT), intravitreal injections of bevacizumab (IVB) and transpupillary thermotherapy (TTT) in patients with neovascular age-related macular degeneration (AMD). Material/Methods The study design was a prospective, interventional, comparative case series. Between December 2006 and March 2009, 426 eyes of 426 consecutive patients presenting with neovascular AMD were included into the study. Patients presented with subfoveal CNV predominantly classic, minimally classic, and occult with no classic component; lesion size less than 5000 μm in the greatest linear dimension, and the area of hemorrhages ≤1/3 were randomized to receive either PDT (group I) or IVB (group II) in a 1:1 ratio. Other patients with CNV were included into the group III and received TTT. Results One hundred eyes were treated with PDT. Mean baseline logMAR BCVA was 0.62 and final visual acuity decreased to 0.74 (p<0.05, Wilcoxon test); 104 eyes were treated with IVB. Mean baseline BCVA was 0.82 and final visual acuity increased to 0.79 (p>0.05, Wilcoxon test); 222 patients were treated with TTT. Mean baseline BCVA was 1.10 and final visual acuity decreased to 1.15 (p>0.05, Wilcoxon test). Among all eyes the average number of treatment sessions was 2.34 (SD 1.17). Conclusions Our study shows that IVB injections had the best efficacy in the improvement of final BCVA. However, both IVB and TTT demonstrated good stabilization of vision. Although after PDT final BCVA was significantly worse from baseline, it may also be beneficial for some patients with neovascular age-related macular degeneration.