Nailfold Videocapillaroscopy in Patients with Central Serous Chorioretinopathy and Its Relationship to Morphological and Functional Findings

The aim of the study was to evaluate the results of nailfold videocapillaroscopy (NVC) in patients with central serous chorioretinopathy (CSC) and their correlation with different functional, morphological features and general risk factors. Material and methods: The examined group included 59 CSC patients (14 F, 45 M, mean age 47.2 ± 9.4) and 53 healthy controls (13 F, 40 M, mean age 46 ± 11.5). The NVC was qualified as a normal or abnormal pattern. In the CSC group, the ophthalmoscopy, angio-Optical Coherence Tomography (OCT-A), OCT and microperimetry were performed. The medical history regarding CSC, chronic general disorders and known risk factors was recorded. Results: In the CSC group an abnormal NVC pattern was more common (33.88% CSC vs. 7.54%, p < 0.001). Dilated apical part of capillaries, microaneurysmal dilatation, megacapillaries, fresh microhaemorrhages, bizarre and broken capillaries were observed only in CSC patients. Dilation of capillaries (47.56% vs. 13.21%, p = 0.004), ramified capillaries and neoangiogenesis (38.98% vs. 5.66%, p < 0.001), glomerular loops (32.20% vs. 1.88% p < 0.001) were more frequent in the CSC group. Conclusions: The presence of various NVC abnormalities confirms microvascular involvement in CSC pathogenesis. The results correlate with visual acuity, microperimetry, OCT data and stress. The NVC technique may play a useful diagnostic and prognostic role in CSC.

Erratum to the article: The implication of ocular manifestation of COVID-19 for medical staff and patients - systematic review

Erratum to the article: Latalska M, Mackiewicz J. The implication of ocular manifestation of COVID-19 for medical staff and patients - systematic review. Ann Agric Environ Med. 2020;27(2):165-170. doi:10.26444/aaem/122790. The Editors of the journal Annals of Agricultural and Environmental Medicine inform that in the article The implication of ocular manifestation of COVID-19 for medical staff and patients - systematic review by Latalska Małgorzata, Mackiewicz Jerzy (Ann Agric Environ Med. 2020;27(2):165-170. doi:10.26444/aaem/122790), in Table 2, the article by Chen L, Deng C, Chen X et al. Ocular manifestations and clinical characteristics of 534 cases of COVID19 in China: A cross-sectional study. medRxiv 2020 ( doi.org/10.1101/2020.03.12.20034678 ) was incorrectly quoted. The printed version is Chen et al, 2020 [16]. This is incorrect and should be Chen et al, 2020 [29].

The implication of ocular manifestation of COVID-19 for medical staff and patients - systematic review

INTRODUCTION

SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a coronavirus that causes COVID-19 (coronavirus disease 2019) with mild to severe respiratory illness. It is a highly contagious disease transmitted through direct or indirect contact with infected people or contaminated surfaces, mainly through respiratory droplets, but other routes are being investigated.

OBJECTIVE

It is known that coronaviruses (CoVs) can cause a variety of ocular pathologies in animals, including conjunctivitis, anterior uveitis, retinitis, and optic neuritis, many of which are severe. However, there is no evidence of the SARS-CoV-2 presence in the eye tissue of asymptomatic patients, even if the symptomatic incidence is low. This systematic review presents updated literature on this issue.

ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE

COVID-19 has now spread throughout the continents and poses a global threat to public health. The risk of rapidly overloading health care systems and causing substantial mortality worldwide is real. On 11 March 2020, the World Health Organization (WHO) announced coronavirus as a global pandemic. Several studies described a few cases with initial ocular symptoms followed by systemic symptoms of the disease.

SUMMARY

Although the frequency of transmission of SARS-CoV-2 infection through the eye is low, ocular symptoms are not uncommon in COVID-19. In some cases, eye symptoms may be the first signs of illness. This implies the need for hygienic recommendations and use of personal protective equipment (PPE) for medical staff and other services to minimize COVID-19 infection of both health-care workers and patients. A triage for ophthalmic outpatient clinic is mandatory.

Levels of Trace Elements in the Aqueous Humor of Cataract Patients Measured by the Inductively Coupled Plasma Optical Emission Spectrometry

Trace elements play an important role in the pathogenesis of several serious ophthalmological disorders, such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, cataract, etc. This study aimed to measure alterations of chemical elements' (67) levels in the aqueous humor of patients undergoing cataract surgery. The pilot study included 115 patients, (age 74 ± 7.27, female 64.35%, male 35.65%). The aqueous levels of elements were measured by the use of the inductively coupled plasma optical emission spectrometry (ICP-OES), quality controlled with certified standards. The classification of elements based on their concentration was achieved by hierarchical cluster analysis. This is the first screening study that quantifies over 60 elements which are present in the fluid from the anterior chamber of the eye of cataract patients. The obtained results can be suitable for understanding and identifying the causes that may play a role in the initiation and progression of lens opacity.

Expression of VEGFA-regulating miRNAs and mortality in wet AMD

MicroRNAs (miRNAs) regulate gene expression; many of them act in the retinal pigment epithelium (RPE), and RPE degeneration is known to be a critical factor in age‐related macular degeneration (AMD). Repeated injections with anti‐VEGFA (vascular endothelial growth factor A) are the only effective therapy in wet AMD. We investigated the correlation between the expression of 18 miRNAs involved in the regulation of the VEGFA gene in serum of 76 wet AMD patients and 70 controls. Efficacy of anti‐VEGFA treatment was evaluated by counting the number of injections delivered up to 12 years. In addition, we compared the relative numbers of deaths in patient with AMD and control groups. We observed a decreased expression of miR‐34‐5p, miR‐126‐3p, miR‐145‐5p and miR‐205‐5p in wet AMD patients as compared with controls. These miRNAs are involved in the regulation of angiogenesis, cytoprotection and protein clearance. No miRNA was significantly correlated with the treatment outcome. Wet AMD patients had greater mortality than controls, and their survival was inversely associated with the number of anti‐VEGFA injections per year. No association was observed between miRNA expression and mortality. Our study emphasizes the need to clarify the role of miRNA regulation in AMD pathogenesis.

A Review of Current Myopic Foveoschisis Management Strategies

Myopic foveoschisis (MF) is common in highly myopic eyes with posterior staphyloma, and optical coherence tomography is essential for establishing the diagnosis and monitoring disease progression. Untreated MF may lead to significant visual loss due to secondary complications. Vitrectomy with or without internal limiting membrane peeling followed by gas tamponade is the standard treatment; however, in recent years, new techniques, including macular buckling, have been introduced. We selected a total of 41 articles with 30 describing various modifications of pars plana vitrectomy, six describing the macular buckling technique, and five reporting combined surgery. The present review describes current MF treatment strategies, including outcomes, and provides a comprehensive understanding of current therapeutic options. Early detection and surgical intervention in eyes with specific risk factors may contribute to both improved visual recovery and more favorable anatomical outcomes.

Loss of NRF-2 and PGC-1α genes leads to retinal pigment epithelium damage resembling dry age-related macular degeneration

Age-related macular degeneration (AMD) is a multi-factorial disease that is the leading cause of irreversible and severe vision loss in the developed countries. It has been suggested that the pathogenesis of dry AMD involves impaired protein degradation in retinal pigment epithelial cells (RPE). RPE cells are constantly exposed to oxidative stress that may lead to the accumulation of damaged cellular proteins, DNA and lipids and evoke tissue deterioration during the aging process. The ubiquitin-proteasome pathway and the lysosomal/autophagosomal pathway are the two major proteolytic systems in eukaryotic cells. NRF-2 (nuclear factor-erythroid 2-related factor-2) and PGC-1α (peroxisome proliferator-activated receptor gamma coactivator-1 alpha) are master transcription factors in the regulation of cellular detoxification. We investigated the role of NRF-2 and PGC-1α in the regulation of RPE cell structure and function by using global double knockout (dKO) mice. The NRF-2/PGC-1α dKO mice exhibited significant age-dependent RPE degeneration, accumulation of the oxidative stress marker, 4-HNE (4-hydroxynonenal), the endoplasmic reticulum stress markers GRP78 (glucose-regulated protein 78) and ATF4 (activating transcription factor 4), and damaged mitochondria. Moreover, levels of protein ubiquitination and autophagy markers p62/SQSTM1 (sequestosome 1), Beclin-1 and LC3B (microtubule associated protein 1 light chain 3 beta) were significantly increased together with the Iba-1 (ionized calcium binding adaptor molecule 1) mononuclear phagocyte marker and an enlargement of RPE size. These histopathological changes of RPE were accompanied by photoreceptor dysmorphology and vision loss as revealed by electroretinography. Consequently, these novel findings suggest that the NRF-2/PGC-1α dKO mouse is a valuable model for investigating the role of proteasomal and autophagy clearance in the RPE and in the development of dry AMD.

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NRF-2/PGC-1α dKO mouse model shows a dry AMD-like phenotype.

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Loss of NRF-2/PGC-1α genes increased oxidative and ER stress in RPE cells.

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High oxidative stress was associated with impaired autophagy and proteasomal clearance.

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The pathology becomes manifest as an age-related loss of photoreceptor function.

Tear film proteome in age-related macular degeneration

Purpose

Age-related macular degeneration (AMD) is the main reason for blindness in elderly people in the developed countries. Current screening protocols have limitations in detecting the early signs of retinal degeneration. Therefore, it would be desirable to find novel biomarkers for early detection of AMD. Development of novel biomarkers would help in the prevention, diagnostics, and treatment of AMD. Proteomic analysis of tear film has shown promise in this research area. If an optimal set of biomarkers could be obtained from accessible body fluids, it would represent a reliable way to monitor disease progression and response to novel therapies.

Methods

Tear films were collected on Schirmer strips from a total of 22 patients (8 with wet AMD, 6 with dry AMD, and 8 control individuals). 2D electrophoresis was used to separate tear film proteins prior to their identification with matrix-assisted laser desorption/ionization time of flight spectrometer (MALDI-TOF/TOF) and matching with functional databases.

Results

A total of 342 proteins were identified. Most of them were previously described in various proteomic studies concerning AMD. Shootin-1, histatin-3, fidgetin-like protein 1, SRC kinase signaling inhibitor, Graves disease carrier protein, actin cytoplasmic 1, prolactin-inducible protein 1, and protein S100-A7A were upregulated in the tear film samples isolated from AMD patients and were not previously linked with this disease in any proteomic analysis.

Conclusion

The upregulated proteins supplement our current knowledge of AMD pathogenesis, providing evidence that certain specific proteins are expressed into the tear film in AMD. As far we are aware, this is the first study to have undertaken a comprehensive in-depth analysis of the human tear film proteome in AMD patients.

Electronic supplementary material

The online version of this article (10.1007/s00417-018-3984-y) contains supplementary material, which is available to authorized users.

Lawn mower injuries as a cause of serious visual acuity impairment - Case reports

[b]Abstract Objective.[/b] The aim of the study is to present four cases of lawn mowers injuries as a cause of serious visual acuity impairment. [b]Materials and Method[/b]. A retrospective study of four patients admitted in 2013-2015 to the Department of Vitreoretinal Surgery in Lublin with severe open or closed globe injury, one with an intraocular foreign body (IOFB). The presence of eye protective equipment was assessed, as well as visual acuity, eye tissue condition before and after treatment, and applied therapy.

RESULTS

In all cases an improvement was achieved in local conditions. The intraocular foreign body was removed, wounds sutured and damaged tissues placed in position. All eyeballs were saved. In three cases, visual acuity was improved to a usable level. Three patients underwent pars plana vitrectomy, one with IOFB removal from the vitreous cavity. [b]Conclusions[/b]. Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients' education. Current prevention strategies are inadequate, and therefore should be updated.

Subthreshold micropulse yellow 577 nm laser therapy of diabetic macular oedema in rural and urban patients of south-eastern Poland

Objectiv. To evaluate the efficacy of subthreshold micropulse yellow (577 nm) laser photocoagulation in diffuse macular edema (DME) in rural and urban patients of south-eastern Poland.

MATERIALS AND METHOD

Seventy-five eyes of 75 patients with diffuse DME were treated with subthreshold micropulse yellow laser photocoagulation with a 5% duty cycle at an energy level. The laser exposure time was 20 ms and the spot diameter was 100 μm. Best corrected visual acuity (BCVA), reading vision (Snellen) and optical coherence tomography-determined central retinal thickness (CRT) were estimated before and 2, 4 and 6 months after laser treatment. There were no statistically important differences in: the advancement of DME, HbA1c (glycated hemoglobin) level, duration of diabetes mellitus (DM), the degree of vision damage between rural and urban patients.

RESULTS

The follow-up was 6 months later. The baseline BCVA was 0.20 and remained stable- 0.3 after 6 months. The Snellen at baseline was 1.0 and improved to 0.5 finally (p=0.0004). The CRT at baseline was 500 μm and changed to 346 μm (p=0.00000) at the final follow-up. Finally, no retinal damage was observed.

CONCLUSIONS

Place of residence had no statistically significant effect on the demographics data, baseline visual acuity, reading visual acuity and central retinal thickness. Subthreshold micropulse yellow laser showed a highly significant efficiency in the treatment of DME. The effects of the treatment were more significant in rural patients than in urban ones.

Efficacy of intravitreal aflibercept in patients with exudative age-related macular degeneration

AIM OF THE STUDY

To evaluate the efficacy of intravitreal aflibercept administered to patients with exudative age-related macular degeneration.

MATERIALS AND METHODS

70 patients with exudative age-related macular degeneration confirmed clinically and in additional diagnostic procedures (fluorescein angiography and spectral domain-optical coherence tomography) were enrolled. All patients were administered three doses of intravitreal aflibercept at one-month intervals. Some patients (seven) received an additional injection of the drug two months after the last of the three injections. The best-corrected visual acuity and the optical coherence tomography findings were assessed at baseline and after the treatment.

RESULTS

At baseline, the mean best corrected visual acuity was 0.20. After the injection of aflibercept it improved to the mean value of 0.32 with the difference being statistically significant (p < 0.001, Student's t-test). The mean central subfield thickness at baseline was 311.4 μm. It decreased to mean value of 254.5 pμn with the difference being statistically significant (p<0.001, Student's t-test).

CONCLUSIONS

Intravitreal injections of aflibercept improved clinical and anatomical parameters in patients with exudative age-related macular degeneration in the initial phase of treatment.

Nasally located congenital optic disc pit with concomitant maculopathy

Optic disc pit is a congenital optic disc anomaly, which can be associated with maculopathy. The case of an unusually nasally located pit with concomitant maculopathy in a 64-year-old woman is presented.

Optic nerve avulsion after blunt ocular trauma - Case report

INTRODUCTION

Avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma. The case reported is a 28-year old man presenting to the emergency department due to blunt trauma to his right eye globe with a tree branch. Lid haematoma and subconjunctival haemorrhage were present. Visual acuity soon after the injury was counting fingers (CF) and on admission to the Department of Ophthalmology he had no light perception (NLP). Fundus examination revealed prepapillary haemorrhage, which after few days dispersed into the vitreous cavity. Despite no light perception in the affected eye, the patient was qualified for vitrectomy. During surgery, an optic nerve avulsion with cicatricial gliosis was diagnosed. Six months after vitrectomy, the visual acuity was NLP in the right eye.

DISCUSSION

The clinical signs, mechanism, treatment and natural history of this poorly known disease are described.

CONCLUSION

Optic nerve avulsion must be considered in cases of trauma with forced rotation of the eye. Damage occurring at the disc may suggest mechanisms involving anterior luxation of the globe, retropulsion of the nerve, forced globe rotation, or a sudden explosive rise in intraocular pressure blowing the nerve off the sclera into its dural sheath. Damage and break of the nerve fibres are responsible for immediate visual impairments, and involving secondary haematomas and oedemas In spite of required safety precautions in agriculture work, eye injuries are still prevalent. Blunt ocular trauma remains a large part of this group, leading even to irreversible blindness.

[Biological model of Danio rerio (zebrafish) – a new research trend in ophthalmology]

Dynamic progress in medicine has enabled availability of new diagnostic methods, improved drugs and therapies. However, we are still searching for a perfect model to reflect the complexity of physiological and pathological processes in a human body. Among laboratory animals, an aquatic species of zebrafish (lat. Danio rerio) has become an emergent biological model. The paper presents examples of using zebrafish in medical research, especially in opthamology.

[Hypertensive retinopathy in the end-stage renal failure – study case]

The case of 26-year-old woman with a transient deterioration of binocular vision secondary to chronic renal failure due to glomerulonephritis is presented. The patient reported the onset of the disease at the age of 2. As her kidney disease was poorly controlled, she developed renal hypertension followed by bilateral hypertensive retinopathy. The patient was hospitalized in the Department of Nephrology, where she received dialyses and her blood pressure was normalised. The follow up in the Ophthalmology Clinic was continued for 9 months. The treatment of her primary disease resulted in a significant resolution of retinopathy and improved her visual acuity.