Solar retinopathy

Although solar retinopathy is characterised by a mild course in most cases, it can lead to permanent vision impairment and significantly restrict patient's ability to perform daily activities. The authors discuss the pathomechanism as well as signs and symptoms of solar retinopathy, additionally presenting the overview of diagnostic, armamentarium, differential diagnosis, prognosis and prevention.

High-definition optical coherent tomography findings in acute solar retinopathy - a case series

The paper reports the case series of solar retinopathy. High definition optical coherence tomography examinations performed within 2 days after solar light-induced injury indicated a characteristic retinal disorder - a curved, hyper-reflective lesion extending from the retinal pigment epithelium at the fovea to the parafoveal outer plexiform layer. The findings correspond to the layout of photoreceptor cells whose injury in patients with solar retinopathy is confirmed by histological studies reported in available publications.

Primary Intraocular Diffuse Large B-cell Lymphoma: Diagnostic Difficulties in Deep Retinal Infiltrations with Vitritis

PURPOSE

Primary intraocular lymphoma (PIOL) is a rare malignancy with an aggressive clinical course. It is usually considered as a subset of primary central nervous system lymphoma. Differential diagnosis should include infectious and non-infectious aetiologies, particularly the common masqueraders sarcoidosis, tuberculosis, viral retinitis and syphilis.

PATIENT

The article presents a case of bilateral vitreoretinal lymphoma manifesting as uveitis and vitritis resistant to corticosteroid therapy. The final diagnosis was based on a retinal biopsy.

RESULTS

The patient was successfully treated with systemic and local therapy. Long-term complete remission (CR) was reached. The relapse of diffuse large B-cell lymphoma was revealed in the frontal left lobe after 48 months of CR duration.

CONCLUSION

The diagnosis of PIOL is always very difficult. Cooperation of pathologists, ophthalmologists and hematologists is required for a quick and accurate diagnosis. Local and systemic treatment is needed to achieve CR, but the relapse rate remains very high.

The role of inflammation in the progression of ocular surface damage in children following allogeneic haematopoietic cell transplantation

The aim of the study was to evaluate HLA-DR expression and cellular morphology of the conjunctival epithelium cells in children who underwent haematopoietic cell transplantation, and to assess the relation between HLA-DR expression and cellular morphology. Impression cytology with staining was used to visualize epithelium cells, whereas immunohistochemistry was applied to assess HLA-DR expression. Elevated HLA-DR expression and increased cytological abnormalities were observed in the study group when compared to the controls. An increase in HLA-DR expression was accompanied by a decrease in the number of eyes with normal epithelium morphology together with the increase in squamous metaplasia features. We can conclude that inflammation of conjunctiva can follow stem cell allotransplantation. Ocular surface inflammation may lead to squamous metaplasia of the conjunctiva.

Early vitrectomy and diagnostic testing in severe infectious posterior uveitis and endophthalmitis

BACKGROUND

To determine the therapeutic and diagnostic value of vitreoretinal surgery in various types of severe viral retinitis and endogenous endophthalmitis.

MATERIAL/METHODS

Pars plana vitrectomy with silicon-oil tamponade was performed on 12 eyes (12 patients) with severe viral retinitis and endogenous endophthalmitis. The mean age of the patients was 35.2 years (range, 18-56 years). Investigations consisted of chest radiography, RT 23, serology (for toxoplasmosis, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus), and routine blood tests and urinalysis. Examination of vitreous samples consisted of polymerase chain reaction for cytomegalovirus, herpes simplex virus, and Mycobacterium tuberculosis, and cultures for fungi and bacteria. The results were analyzed 7 days and 6 months after surgery.

RESULTS

Analysis of vitreous samples showed cytomegalovirus in 3 patients, herpes simplex virus in 2, tuberculosis in 2, and Candida albicans in 5. All patients had improvement in visual acuity and severity of clinical signs seven days after surgery and in 10 cases after long-term follow-up. Final visual acuity was compromised by chronic macular edema, postinflammatory macular scarring, optic atrophy, subcapsular cataract formation, and capsular opacification after cataract surgery.

CONCLUSIONS

Modern laboratory tests are useful for quick and accurate diagnosis of atypical cases of severe infectious posterior uveitis. Early pars plana vitrectomy with silicon oil tamponade is valuable in diagnosing and treating severe infectious posterior uveitis and endophthalmitis.

[Analysis of rate, types and causes of uveitis in children hospitalized at Ophthalmology Clinic in Wroclaw in years 2001-2006]

PURPOSE

The aim of the paper was to analyse frequency, causes and type of uveitis at children hospitalized in Ophthalmology Clinic of Medical Academy in Wroclaw in years 2001-2006.

MATERIALS AND METHODS

Material from 64 (88 pairs) children's eyes was analyzed. There were 35 (54.7%) girls and 29 (45.3%) boys admitted to the Clinic with suspicion of uveitis.

RESULTS

There were 17 (26.6%) children with uveitis anterior, 15 (23.4%) with pars planitis and 32 (50.0%) with uveitis posterior. The uveitis occurred in both eyes in 33.9%. Aetiology of uveitis was recognized at 30 (46.9%) patients, at 12 (16.6%) cases uveitis was related to systemic disease. At 22 (34.4%) ill children recognition of aetiology was not possible. The most often cause of uveitis anterior was juvenile chronic arthrosis inflammation and it occurred at 8 (47.1%) children--5 girls, and 3 boys. For the most patients 12 (80.0%), in case of pars planitis recognition of aetiology was impossible. Toxoplasmosis was the most often cause for uveitis posterior and it occurred at 14 (43.8%) children.

CONCLUSIONS

Parasitic background is still considerable cause of uveitis among children. Juvenile chronic arthritis is the most often cause for uveitis anterior. In considerable amount of children cases, recognition of aetiology of uveitis was not possible.

Helicobacter pylori--a risk factor for the developement of the central serous chorioretinopathy

PURPOSE

To prove the influence oftte Helicobcter pylor for the development of the central serous chororetinopathy.

MATERIAL AND METHODS

We examined 55 patients with central serous chorioretinopathy confirmed by fluorescein angiogram and 55 controls. Each patient provided venous blood sample for IgG antibodies to Helicobacter pylori by enzyme-linked immunosorbent assay technique (ELISA) and a stool specimen for Helicobacter pylori antigens.

RESULTS

44% in CSC patients were positive results of stool examine and only 29% in group comtrol. In 67% of the patients we proved the presence of the antibodies IgG--anty Helicobacter pylori and in 47% controls. The difference was statistically significant.

CONCLUSIONS

Helicobacter pylori infection is statistically more frequently among the patients with CSC diagnosis than in healthy population.

[Profile of selected cytokines in various forms of uveitis]

PURPOSE

The estimation of the level of selected inflammatory mediators in serum of patients with various types of uveitis.

MATERIAL AND METHODS

The level of IL-1, IL-6 and TNF was assessed by means of microbiological tests and ELISA test in the group of 60 patients with uveitis, divided as regards to the character of uveitis and the type of the treatment and in control group.

RESULTS

The levels of IL-1, IL-6 and TNF were higher in serum of patients with uveitis then in the control group. Patients with known etiology of uveitis had higher level of IL-6 and TNE Patients with autoimmunological etiology of uveitis had higher level of IL-1 and IL-6 than volunteers in control group.

CONCLUSIONS

Higher levels of cytokines in serum of patients with uveitis than in control group indicate the activation of immunological response in various types of uveitis.

[Vitrectomy with peeling retinal limiting membrane (ILM) in eyes with diabetic macular edema]

PURPOSE

To evaluate the efficacy of pars plana vitrectomy with retinal internal limiting membrane (ILM) peeling in eyes with diabetic macular edema.

MATERIAL AND METHODS

Twenty five eyes of 25 patients with diabetic macular edema. All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling and air endotamponde. Preoperatively visual acuity (VA), funduscopic examination and the presence or absence of posterior vitreous detachment, were evaluated. Fluorescein angiography was performed in all patients prior to surgery. Eyes with cystoid macular edema or macular ischaemia were excluded. Postoperative VA, anatomic results, and complications were recorded. The follow-up was 7 to 27 months (mean 17).

RESULTS

Intraoperatively, thick posterior hyaloid was found to be attached to the posterior pole in 20 cases. The mean postoperative VA (0.2) was significantly better than the preoperative VA (0.08) (p = 0.0001). VA improved postoperatively in 21 eyes (84%), at least two lines on the Snellen chart in 8 eyes (32%). It remained unchanged in 4 eyes (16%). Confluent hard exudates in fovea were present significantly more frequently in eyes without VA improvement (p = 0.004). The postoperative VA was better in eyes that had not undergone photocoagulation (improvement by 0.14 line) than in others (improvement by 0.11 line) but the difference was non-significant. Reduction of macular exudates was noted in every case in the follow-up over 6 months. Postoperative complication included retinal detachment were treated by re-vitrectomy with oil endotamponade. Cataract has been noted in six eyes.

CONCLUSIONS

Vitrectomy including removal of ILM in diabetic macular edema, leads to improvement of visual acuity and long-term stabilization of visual function.

[Estimation of immunological markers in children with intermediate uveitis symptoms]

PURPOSE

The purpose of this study was to estimate markers of immunological response in the blood of children with intermediate uveitis.

MATERIAL AND METHODS

The records of 13 children (26 eyes), aged 10-17 years, with idiopathic intermediate uveitis were reviewed. In all cases indicators of inflammation and immunological response parameters were analyzed during the active stage of the disease.

RESULTS

In almost all patients ((90%) with intermediate uveitis disturbances in the level and activity of lymphocyte system, were detected. There were also nonspecific changes in immunoglobulins level in all patients, in 31% in more then one class of immunoglobulins. Chemiluminescence of phagocytic cells were reduced in more than 50% of children, and increase in their phagocytic activity was observed in 62% of patients. Circulating immune complexes were present in 50% of cases.

CONCLUSIONS

The study presents data supporting the theory of autoimmunological background of the intermediate uveitis.

[Vitrectomy in treatment of ocular tuberculosis--case report]

The authors present a case of ocular tuberculosis in otherwise healthy young men, diagnosed with positive tuberculin test and positive PCR for Mycobacterium tuberculosis in conjunctiva and vitreous samples. An early vitrectomy and typical systemic treatment (tuberculostatic drugs) resulted in regression of the disease.

[Ocular symptoms of autoagression in patients with idiopathic inflammatory bowel disease]

PURPOSE

of this research was to present a prospective estimation of the ocular symptoms appearance in a group of patients with ulcerous colitis (CU) or Crohn disease (CD). It was also, to demonstrate dependence between the frequency, intensity, and duration of the main disease and the way of its treatment. The research program established a retrospective analysis of symptoms presented typically in non-specific colitis in a group of patients with recurrence acute iridocyclitis (IA) and HLA B27 positive.

MATERIALS AND METHODS

The research group contained 63 patients: 51 with CU and 12 with CD. Clinical symptoms and inflammatory indicators such as CRP, OB, pulse, and body temperature were taken into consideration by designation of intensity of main disease. Second group contained 28 patients with IA and duration of CU or CD symptom was analyzed in it.

RESULTS

Symptoms of iridocyclitis acute non granulomatous were observed in 7.9% of cases. In 6.3% episcleritis was diagnosed and in one patient with CU scleritis (1.5%). In the second group of patients only in one case (3.5%) typical symptoms for chronic colitis were presented.

CONCLUSIONS

In patients with non-specific chronic colitis careful ophthalmological examination should be performed, especially oriented for uveitis diagnosis.

[Vitrectomy in the treatment of endogenous fungal endophthalmitis in a patient after renal transplantation]

The authors present a case of fungal endophthalmitis in the immunosuppressed patient after renal transplantation. The treatment comprised pars plana vitrectomy with silicone oil tamponade, peribulbar injections of Fungizone and intravenous Diflucan. Diagnostic and therapeutic difficulties in endogenous endophthalmitis are discussed.

[Pharmacodynamics and pharmacokinetics of prostaglandins and their derivates in eye tissues]

This paper presents the classification of prostaglandins and their receptors. The ocular distribution of the receptors and the effects of their agonists are presented. The efficacy in lowering intraocular pressure of different prostaglandins and their derivatives, especially the PGF2a group, is discussed. The history of latanoprost development is also presented. Good therapeutic index characterises two antiglaucomatous PG-derivatives: latanoprost and unoprostone.

[Cataract surgery in adults and children with chronic uveitis]

PURPOSE

To present preoperative strategies and results of cataract surgery in patients with different types of uveitis.

PATIENTS AND METHODS

The results of 18 cases of extracapsular cataract extraction with or without intraocular lens implantation were retrospectively analysed. Age of patients ranged from 10 to 71 years (mean age: 35 years). Etiology of uveitis was determined in 10 cases (63%). Preoperative management was determined by the diagnosis of uveitis. The postoperative observation time ranged from 3 years to 6 months (mean: 25 months).

RESULTS

Visual acuity improved postoperatively in 17 eyes (96%), and was better than 0.5 in 10 eyes (63%). The reasons for lower visual acuity were: cystoid macular edema in 6 cases (33%), band keratopathy, amblyopia and floaters in the vitreous.

CONCLUSIONS

Establishing the diagnosis and controlling the inflammation pre- and postoperatively are the basic conditions for the surgical outcomes in cataract surgery in patients with history of uveitis.

[Purtscher's retinopathy--anatomic and pathogenic determinants in the evolution of the disease]

The paper presents the cases of bilateral acute ischaemia in the central and peripapillary retina during acute pancreatitis. The authors discuss the typical clinical picture, natural history of the disease and possible pathogenical mechanisms of the embolisation of terminal retinal arterioles.

[Goniodysgenesis associated with Rubinstein-Taybi syndrome]

Rubinstein-Taybi syndrome is a constellation of clinical findings characterized by mental and motor retardation, broad thumbs and broad first toes, typical facies. Ocular and adnexal abnormalities are quite common and include antimongoloid slant of the palpebral fissures, epicanthal folds, congenital obstruction of the lacrimal excretory system, ptosis, strabismus, congenital cataract and congenital glaucoma. The authors describe the case of a 1-year-old male with the Rubinstein-Taybi syndrome associated with unilateral congenital glaucoma. The case emphasizes the importance of detailed complete ocular examinations in patients with Rubinstein-Taybi syndrome, and also highlights the occurrence of ocular abnormalities rarely associated with this disease.

[Flash electroretinography and pattern-type visual evoked potentials in early glaucoma]

PURPOSE

The aim of this prospective study was to evaluate diagnostic sensitivity of flash-erg, oscillatory potentials (OPs), and pattern-visual evoked potentials (pVEP) in early glaucoma.

MATERIAL AND METHODS

Erg, OPs and pVEP were registered in 416 eyes primary open angle glaucoma (120 eyes), normal tension glaucoma (137), ocular hypertension (74), glaucoma-like discs (86) in age-matched groups, by Tomey 400.

RESULTS

There were no statistically significant differences between parameters of flash-erg and pVEP of examined population and control group. Significant reduction in OPs amplitude in NTG patients were found.

CONCLUSIONS

Flash erg and pVEP have low diagnostic value in early glaucoma. OPs could be useful in scientific research on pathogenesis of glaucomatous neuropathy.

[Primary open angle glaucoma,age and age-related cardiovascular disease risk factors]

The authors present current opinions about influence of age and different cardiovascular and rheological risk factors on POAG and normal tension glaucoma (NTG), especially in age-related diseases: systemic hypertension and hypotension, nocturnal systemic hypotension, diabetes, obesity and high blood viscosity. The work points out the importance of cooperation between ophthalmologist and specialist of internal medicine in treating patients with POAG and NTG.

[Coexistence of migraine and glaucoma-like visual field defects]

PURPOSE

Functional and morphological evaluation of the optic nerve heads in patients suffering from migraine.

MATERIAL AND METHODS

21 patients--13 women and 8 men (mean age 40 +/- 10) with neurologically confirmed diagnosis of common and classic migraine were examined. The headache history was obtained by standard questions. The patients suffered from migraine from 2 to 30 years and the frequency of attacks was from < 10 to > 100/year. Ophthalmologic examination involved evaluation of visual acuity, anterior segment, irido-corneal angle, retina and optic disc. In all cases optic disc photography, diurnal tension curve and two central visual field examinations with Octopus 101 programm G2 were performed.

RESULTS

In all cases IOP was normal (< 21 mm Hg). In 4 eyes (2 patients) there was early glaucomatous-like damage of the optic disc, without visual field defect. In most of these patients the optic nerve head looked normal, in part of them slightly pale. In 28% patients glaucomatous-like visual field defects were found (MD-3.9 dB to 6.6 dB). There was statistically significant relationship between increase of MD and frequency of migraine attacks (Mann-Withney U test, a = 0.05).

CONCLUSIONS

Static perimetry of the central visual field has high diagnostic value in ocular vasospastic syndrome. Functional dysregulation of the optic nerve head circulation in patients with migraine might be involved in the pathogenesis of normal-tension glaucoma.

[Results of screening for primary glaucoma from data in materials from the Medical Diagnostic Center DOLMED in Wroclaw]

PURPOSE

The aim of this study was to estimate the prevalence of morphological signs of glaucomatous optic neuropathy (GON) and IOP > 21 mm Hg in adult population.

MATERIAL AND METHODS

The retrospective epidemiologic study of 11,989 persons (mean age 37.7 years +/- 11.6) was based on data of Medical Diagnostic Center DOLMED in Wrocław. IOP was measured by air-push tonometer and optic disc was estimated in direct ophthalmoscopy.

RESULTS

GON was found in 0.92% and IOP > 21 mm Hg in 30.81% of the examined population. About 50% of GON was found in the group with normal IOP. The positive correlation was proved between GON and age. Mean IOP and prevalence of GON was not significantly different between the sexes and between right and left eyes.

CONCLUSION

Screening of primary glaucoma should be based on stereoscopic examination of optic disc. High values of IOP should be verified. Raised IOP should be estimated as a risk factor of POAG.

[Investigations correlating age and selected vascular risk factors in primary glaucoma based on screening data the Medical Diagnostics Center DOLMED in Wroclaw]

AIM

The purpose of the study was to investigate the associations of glaucomatous optic neuropathy (GON) features and level of IOP with age and selected cardiovascular risk factors: systolic and diastolic blood pressure (BPs and BPd), heart rate, hematocrit and cholesterol level, diabetes, body mass index.

MATERIAL AND METHODS

The retrospective study of 11,989 persons (mean age 37.7 years +/- 11.6) was based on data of Medical Diagnostic Center DOLMED in Wrocław. All data were analysed statistically.

RESULTS

Positive statistically significant correlation was found between BPs, BPd, cholesterol level and GON. Significant differences were proved in the BPs/IOP and BPd/IOP rations and the groups with and without GON. Mean IOP was higher in the group with GON. Positive relationship was found between cardiovascular risk factors and IOP level. There was no positive correlation between level of IOP and age of the analysed group.

[Current theory on mechanical damage in glaucomatous optic neuropathy]

The paper presents the contemporary interpretation of mechanically theory of glaucomatous optic neuropathy (GON). The authors explained influence of high intraocular pressure on morphology of lamina cribrosa in vivo and in vitro experiments, extracellular matrix of the optic nerve, retinal ganglion cells and nerve fibers within the optic nerve head.

[Central visual field in patients with multiple sclerosis without symptoms of optic neuritis]

PURPOSE

To estimate central visual field (30 degrees) of patients suffering from multiple sclerosis (SM). SM was confirmed by magnetic resonance imaging.

MATERIAL AND METHODS

There was no posterior optic neuritis in the history of the disease. The visual acuity of examined the 28 eyes was 1,0. The results of static perimetry were analysed by regression analysis.

RESULTS

There were significant relationships between mean sensitivity (MS) and duration of the disease, stage of the disease (in Kurtzke gradation scale) and age. Mean defect (MD) was significantly higher in the upper half of central visual field and between 15-30 degrees (p < 0.05). We observed positive relationships between MD, short time fluctuation (STF) and corrected loss variance (CLV). We found negative correlations between MS, MD, CLV and STF. Mean reliability factor RF was < 10%.

CONCLUSION

Static perimetry seems to be a useful test in early diagnosis and monitoring of optic nerve neuropathy in SM.

[Early diagnosis of optic nerve neuropathy in multiple sclerosis]

PURPOSE

To evaluate diagnostic sensitivity of clinical tests in optic demyelinating neuropathy.

MATERIAL AND METHODS

We examined 21 persons (38 eyes) with confirmed sclerosis multiplex (SM) with no episodes of posterior optic neuritis in the history of the disease. The examination method included: Static perimetry of central visual field (30 degrees, by Octopus 101), pattern visual evoked potentials (p VEP), colour photographs of optic disc and magnetic resonance imaging (MR) of central nervous system, optic nerves and optic chiasm. Visual acuity and colour vision were normal.

RESULTS

There was statistically significant elongation in the latency of P 100 in pattern VEP (> 118 ms, 3 x SD), and significant reduction in mean light sensitivity (MS) in central visual field. MRI revealed demyelinisation in cortex and/or spinal cord of all patients and demyelinating lesion in optic nerve of one patient. There was no Gd-DTPA enhancement. In statistical analysis there was no correlation between results of pattern VEP, IMR, morphology of optic disc, and duration of SM, stage of the disease (in Kurtzke gradation scale) or age of patient. In regression analysis there were statistically significant relationships (p < 0.05) between results of central static perimetry, duration and stage of disease.

[Panretinal photocoagulation with argon laser--material from the Eye Clinic in Wroclaw in 1991-1994]

PURPOSE

To evaluate the results of PRK performed between 1990 and 1994 in Wroclaw University Eye Clinic.

MATERIALS AND METHODS

PRK was performed in 630 eyes with: (1) PDR--451 immediately treated eyes (moderate PDR--184 eyes, with "high-risk" characteristics--227 eyes, PDR advanced--after cryopexion--40 eyes); (2) severe NPDR--119 eyes (with PDR in fellow eye or with ME) and (3) less severe DR--60 eyes treated with immediate or delayed, full or mild scatter coagulation (with macular edema, both eye moderate NPDR, other systemic risk factors). Follow-up treatment: Additional scatter or local photocoagulation was performed in 34 cases increasing activity of neovascularisation or increase in frequency/extend of vitreous hemorrhage.

RESULTS

In a period 3 to 36 months of follow-up (mean period = 25 months) in the group of 451 eyes with PDR 28.2% of eyes showed visual improvement, 48.3% of eyes showed no change and 23.5% of eyes worsened. In the group of 119 eyes with severe NPRD 75.6% showed visual improvement and 24.4% showed no change. In the group of 60 eyes with less severe DR 27.8% showed improvement, 36.7% showed no change and 35.5% worsened.

CONCLUSION

Our results are relatively good and in agreement with other studies.

[Incidence of and treatment outcome for diabetic maculopathy--material from the Eye Clinic in Wrocçaw in 1991-1994]

PURPOSE

To evaluate the incidence of ME, its characteristics, and results of its treatment with laser coagulation.

MATERIAL AND METHODS

In the analysed group there were 478 subjects with diabetes mellitus--84 with a diagnosis before 30 years of age and 394 with a diagnosis at 30 years of age or older. In the older-onset group there were 64% taking insulin. Mean age of the group was 61 years and mean period of duration of diabetes was 16 years. The methods of ophthalmological examination included stereoophthalmoscopy and fluorescein angiography. In 845 examined eyes there were 832 eyes with mild-to-severe nonproliferative and moderate-to-high risk proliferative diabetic retinopathy.

RESULTS

The incidence of macular edema was 81.6%. These data suggest high incidence of macular edema and its high severity (V < 0.2 = 47%) over the 15-years period of duration of diabetes. Treatment included focal coagulation, macular grid and PRK performed with argon laser.

CONCLUSION

The results of laser coagulation demonstrated that focal photocoagulation was effective in reducing the risk of moderate visual loss. When macular edema was more severe, macular grid before scatter (panretinal) photocoagulation for proliferative retinopathy decreased the frequency of persistent ME.