Roman Goś

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.

Intraocular matrix metalloproteinase 2 and 9 in patients with diabetes mellitus with and without diabetic retinopathy

Introduction We aimed to investigate activities of metalloproteinases 2 (MMP-2) and MMP-9 in aqueous humour of patients with diabetes mellitus with various stages of diabetic retinopathy. Material and methods We included 36 samples of aqueous humour of patients suffering from diabetes mellitus, undergoing routine cataract surgery. Seven of them suffered from proliferative diabetic retinopathy (PDR), 3 had diabetic maculopathy and the remaining 26 had background or minimal background retinopathy only. Metalloproteinases 2 and MMP-9 activities in aqueous humour were measured by gelatin zymography combined with the densitometric imaging system. Total protein content in aqueous humour samples was also assessed. Results Metalloproteinases 2 activities were present in almost all samples of aqueous humour (32 of 36) and were 2.6-fold higher in patients who suffered from diabetic ocular complications (p < 0.0001). Activities of MMP-2 correlated well with the duration of the disease (correlation = 0.37, p = 0.03) and tended to correlate with total protein levels in aqueous humour (correlation = 0.43, p = 0.06). Metalloproteinases 9 activities were observed only in 2 of 7 patients with proliferative diabetic disease and the enzyme was absent from aqueous humour samples of patients without proliferative retinopathy. Conclusions Increased activities of MMP-2 in aqueous humour of patients with PDR may be related to the disease process and support the hypothesis that MMP-2 may be of particular importance in diabetic retinal neovascularization. MMP-9 may be activated at a certain disease stage only.

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.

Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes

OBJECTIVE The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. MATERIALS AND METHODS A total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. RESULTS In the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. CONCLUSIONS Comprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance.

Nitric oxide levels in aqueous humor after lens extraction and poly(methyl methacrylate) and foldable acrylic intraocular lens implantation in rabbit eyes

Purpose: To measure the nitric oxide (NO) level in the aqueous humor of rabbit eyes after common cataract surgery techniques. Setting: Department of Ophthalmology, Military Medical University, and Department of Immunology and Immunotoxicology of Respiratory System, Clinic of Pneumonology and Allergology, Medical University of Łódź, Łódź, Poland. Methods: Thirty rabbits were randomly divided into 4 groups, and surgery was performed as follows: Group 1, extracapsular cataract extraction (ECCE) and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation; Group 2, ECCE; Group 3, phacoemulsification and foldable acrylic IOL implantation; Group 4, phacoemulsification. The aqueous humor specimens were collected on days 1, 3, and 5. Nitric oxide measurements were performed indirectly with a spectrophotometer. The NO level in the aqueous humor collected before surgery served as a control group. Results: In the physiological condition, the concentration of NO was 26.52 nm/dL ± 4.86 (SD). Postoperatively, the highest NO level in each groups was as follows: Group 1, 46.26 ± 5.23 nm/dL on day 3; Group 2, 72.46 ± 6.94 nm/dL on day 1; Group 3, 41.04 ± 7.31 nm/dL on day 1; and Group 4, 32.67 ± 2.84 nm/dL on day 3. Significantly higher levels of NO (P < .05) were observed in Groups 1 and 2 at each follow‐up day; in Group 3, on days 1 and 3; and in Group 4, on day 3. Conclusions: Techniques of cataract extraction caused the NO level to increase; however, phacoemulsification with a foldable IOL caused the smallest release of NO. Rapid postoperative NO changes may theoretically contribute to blood−aqueous barrier breakdown secondary to cataract surgery.

Progression of diabetic retinopathy correlated with muscle perfusion disturbances of the lower limbs, with clinically important diagnostic recommendations

Introduction The objective of this study was to investigate the relationship between microvascular and macrovascular disturbances in patients with type 2 diabetes, as shown by results of ophthalmological examination and by vascular and perfusion examinations of the lower limbs. Material and methods A total of 85 patients with type 2 diabetes and an additional cardiovascular risk factor were enrolled in the study. All patients underwent complex ophthalmological examination, including fundus colour photography and fluorescein angiography, and were divided into two groups: group I with signs of diabetic non-proliferative retinopathy (NPDR), and group II with signs of diabetic proliferative retinopathy (P/PDR). After collection of the general medical history and analysis of medical data, patients underwent vascular and muscle perfusion examination of the lower limbs. Results In the P/PDR group, disturbances of lower-limb perfusion were more frequent than in the NPDR group. Analysis of the blood flow and results of lower-limb muscle perfusion for the two groups showed a significant relationship with the severity of microvascular complications observed in examination of the fundus. Conclusions Ophthalmological assessment of the progression of diabetic retinopathy in patients with type 2 diabetes is a reliable indicator of the changes in peripheral vessel systems and perfusion defects in the lower limbs.