First Nation-Wide Study of the Incidence and Characteristics of Retinal Detachment in Poland during 2013-2019.

AIMS: The present study aimed to analyze the incidence and characteristics of all types of retinal detachment (RD) in the overall population of Polish adults during 2013-2019. METHODS: Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund (NHF) database were evaluated. International Classification of Diseases codes (ICD-9 and ICD-10) and unique NHF codes were used to identify RD patients and RD treatment procedures. RESULTS: In the period 2013-2019, 71,073 patients with RD were newly diagnosed in Poland. The average incidence was 32.64/100,000 person-years (95% CI: 31.28-33.99) and it increased with the age of patients, with the highest rate in the group of patients ≥70 years of age. The overall incidences of rhegmatogenous RD, traction RD, serous RD, other RD and unspecified RD were 13.72/100,000, 2.03/100,000, 1.02/100,000, 7.90/100,000 and 7.97/100,000 person-years, respectively. The most common surgical treatment for RD in Poland was PPV performed on average in 49.80% of RD patients. The risk factor analyses showed that rhegmatogenous RD was significantly associated with age (OR 1.026), male sex (OR 2.320), rural residence (OR 0.958), DM type 2 (OR 1.603), any DR (OR 2.109), myopia (OR 2.997), glaucoma (OR 2.169) and uveitis (OR 2.561). Traction RD was also significantly associated with age (OR 1.013) and male sex (OR 2.785) as well as with any DR (OR 2.493), myopia (OR 2.255), glaucoma (OR 1.904) and uveitis (OR 4.214). Serous RD was significantly associated with all analyzed risk factors except DM type 2. CONCLUSIONS: The total incidence of retinal detachment in Poland was higher than found in previously published studies. Our study demonstrated that diabetes type 1 and diabetic retinopathy are risk factors of development of serous RD, which is presumably associated with the disruption of the blood-retinal barriers in these conditions.

Pupil diameter during cataract surgery after intracameral injection of the first ready-to-use combination of mydriatics and anaesthetic at the beginning of surgery in patients with a preoperative pupil diameter <6 mm.

PURPOSE: We evaluated, in a real-life setting, the effect of Mydrane® (ready-to-use combination of tropicamide, phenylephrine hydrochloride and lidocaine, injected into the anterior chamber at the beginning of cataract surgery to induce mydriasis and intraocular anaesthesia) on the pupil diameter during cataract surgery in patients with a preoperative pupil diameter <6 mm after the use of topical mydriatics. METHODS: We collected and analysed the data of 59 consecutive patients whose pupils dilated to a diameter <6 mm after the administration of mydriatic eye drops during the preoperative visit and who received Mydrane® during cataract surgery. RESULTS: In the group of 59 patients with a preoperative pupil diameter <6 mm after topical mydriatics, cataract surgery was performed in 36 patients (61.0%) using only Mydrane® to obtain mydriasis, with no additional drug or medical device. The mean pupil diameters in this group (36 of 59) during the preoperative assessment after topical mydriatics and just before capsulorhexis when Mydrane® was injected during surgery were 5.1 ± 0.74 and 6.15 ± 1.14 mm. Additional drugs were used in 23 patients (39%). In this group, the mean pupil diameters after topical mydriatics and just before capsulorhexis using Mydrane® were 4.58 ± 1.06 and 5.6 ± 1.26 mm, respectively. CONCLUSION: In a real-life setting, the mean pupil diameter achieved during cataract surgery after the intracameral injection of Mydrane® in patients with a preoperative pupil diameter <6 mm was over 1 mm larger than the mean pupil diameter after topical mydriatics, despite the trauma caused by the operation.

Incidence and survival of ocular melanoma in National Cancer Registry of Poland in 2010-2017.

BACKGROUND: Oncology trends are based on data coming from different countries and ocular melanoma is the most common primary eye cancer in adults. OBJECTIVES: To investigate the incidence and characteristics of ocular melanoma in the overall population of Poland. MATERIAL AND METHODS: The retrospective survey of both the National Cancer Registry (NCR) and National Health Fund (NHF) databases was performed to identify all ocular melanoma cases in Poland in 2010-2017. RESULTS: The mean incidence of ocular melanoma was 8.76/1,000,000 person-years; the lowest incidence was observed in the 19-29 age group (1.17/1,000,000 person-years) and the highest in the group over 70 (22.88/1,000,000 person-years). There were no statistically significant trends in the incidence rates over the study period. The overall incidences of uveal, eyelid and conjunctival melanoma were 6.67/1,000,000, 0.47/1,000,000 and 0.28/1,000,000 person-years, respectively. The 5-year overall survival (OS) was 60.76%; the higher risk of death was associated with male sex (hazard ratio (HR) = 1.2959), older age at diagnosis (HR = 1.0379), chemotherapy treatment (HR = 1.6774), metastasis (HR = 1.5716), loco-regional hyperplasia (HR = 1.5936), and systemic tumor spread (HR = 3.9872), compared to the carcinoma in situ. The risk of death was reduced by radiotherapy treatment (HR = 0.6645). CONCLUSIONS: The incidence rate of ocular melanoma in Poland is in the middle of the range worldwide, and the 5-year OS is relatively low.

12-month interim results of a prospective study of patients with mild to moderate open-angle glaucoma undergoing combined viscodilation of Schlemm's canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery.

PURPOSE: To characterize clinical outcomes of combined viscodilation of Schlemm's canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery in eyes with mild to moderate open-angle glaucoma (OAG). METHODS: In this prospective case series, the OMNI glaucoma surgical platform (Sight Sciences, Menlo Park, CA) was utilized to perform the procedure either combined with phacoemulsification or as a standalone procedure. Changes from baseline in intraocular pressure (IOP) and IOP-lowering medications were evaluated through the first 12 months of a planned 24-month follow-up period. RESULTS: Among 17 eyes of 15 subjects, mean IOP was reduced from 20.4 mmHg to 12.7-13.7 mmHg through 12 months of follow-up (p < 0.001 at every time point) and mean medications reduced from 2.5 to 0.1-0.6 (p < 0.001 at every time point). IOP reductions in eyes undergoing standalone surgery were approximately 2-4 mmHg greater at each time point compared to eyes undergoing surgery combined with phacoemulsification; this may be related to a higher baseline IOP in the former eyes (22.1 vs 18.5 mmHg). Six eyes developed hyphema, of which three required washout for elevated IOP on the first postoperative day; six additional eyes had IOP elevations that resolved with medical management. CONCLUSION: Viscodilation of Schlemm's canal and collector channels paired with ab interno trabeculotomy performed with a single integrated instrument (OMNI), whether as standalone or combined with phacoemulsification, effectively lowers both IOP and the need for IOP-lowering medications through 12 months of follow-up.

Incidence and Characteristics of Retinoblastoma in Poland: The First Nationwide Study 2010-2017.

Background: The present study aimed to investigate the incidence and characteristics of retinoblastoma in the overall population of Poland. Methods: The retrospective survey of both National Health Fund (NHF) and National Cancer Registry (NCR) databases were performed to identify all retinoblastoma cases in Poland in the years 2010-2017. Results: During 2010-2017, the mean age-standardised incidence of retinoblastoma (the unit of incidence is per 1,000,000 person-years) was 10.15 (95% CI 7.23-13.08) among children aged 0 to 4 years and 5.39 (95% CI 4.18-6.60) in those aged 0 to 9 years. During 2010-2014 (to allow 5 years of follow-up), the mean incidence of retinoblastoma by birth cohort analysis in Poland was 4.89 (95% CI 4.04-5.74) per 100,000 live births, corresponding to an incidence of 1 per 20,561 (95% CI 15,855-25,267) live births. In Poland, 14.6% of children with retinoblastoma had enucleation of the eye globe, 76.8% received different types of chemotherapy combined with focal treatment, 5.9% were treated with external beam radiotherapy, and 2.7% were treated with focal treatments only. Conclusions: The incidence of retinoblastoma and the pattern of medical management of retinoblastoma in Poland was similar to that reported in developed countries in Western Europe, Asia, and North America.

Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study.

Purpose: To evaluate the effect of Mydrane (contains tropicamide, phenylephrine hydrochloride, and lidocaine hydrochloride) on time needed to induce mydriasis and mydriasis stability during cataract surgery. Methods: This was an observational, non-interventional, multicenter study of patients undergoing cataract surgery who received Mydrane for mydriasis and intraocular anesthesia. The study was conducted at seven ophthalmology departments at university hospitals in Poland. Patients admitted for cataract surgery within a 2-week period were asked to participate in the study. Patients whose pupils dilated to a diameter ≥6 mm after topical mydriatic administration during preoperative examinations were scheduled to receive Mydrane and included in the registry. No additional inclusion criteria were used. Patients' medical histories, examination results, and operative details were recorded. Pupil diameter was measured during surgery. Surgeons were asked to complete a Likert-based survey in parallel. Results: A total of 307 patients were enrolled. The mean pupil diameter was 7.0 ± 1.0 mm before capsulorhexis and 6.9 ± 1.2 mm before lens implementation. A pupil diameter ≥6 mm was achieved in 91.9% and 87.6% of patients before capsulorhexis and lens implantation, respectively. We asked 58 surgeons whether they agreed with the statement "Mydriasis was obtained in a short time after the administration of Mydrane"; the surgeons agreed with this statement after 92.2% (283/307) of surgeries. In addition, after 88.2% of surgeries, the surgeons agreed with the statement "Mydriasis was stable after the administration of Mydrane." Conclusions: Mydriasis was rapidly and stably obtained after Mydrane injection, as demonstrated by pupil diameter measurements during surgery and surgeons' feedback.

Immersion Biometry for Intraocular Lens Power Calculation with Fourth-Generation Formulas.

BACKGROUND: Fourth-generation formulas for intraocular lens power calculations, including the Barrett Universal II formula, the Olsen formula or the Holladay 2 formula, were thoroughly validated with optical biometry measurements. They precisely predict the effective lens position not only in normal eyes but also in eyes with unusual anatomy. However, in the setting of dense nuclear or posterior subcapsular cataracts, optical biometers fail to obtain accurate measurements and third-generation formulas, i.e. the Hoffer Q or the SRK/T, combined with ultrasound measurements are a method of choice. Considering that optical biometry was fine-tuned to immersion ultrasound, we hypothesize that fourth-generation formulas will yield precise intraocular lens power calculations with immersion ultrasound measurements. METHODS: We retrospectively analyzed 50 eyes of 50 patients who underwent uneventful cataract surgery. All patients had intraocular lens power calculated based on immersion ultrasound measurements. Refractive error predictions were compared between third-generation formulas and fourth-generation formulas. RESULTS: There were no statistically significant differences in the median absolute error between formulas. In the study, 86%, 88%, 86%, 84%, 88% and 80% of eyes were within 1 D of target refraction for the SRK/T, the Barrett II, the Hoffer Q, the Holladay 1, the Holladay 2 and the Olsen formula respectively. CONCLUSION: Fourth-generation formulas combined with immersion ultrasound produced similar results to third-generation formulas. However, the percentage of eyes within 1 D of target refraction remains inferior to previously reported results for optical biometry measurements.

First nation-wide study of diabetic retinopathy in Poland in the years 2013-2017.

AIMS: To assess the prevalence and time trends of diabetic retinopathy (DR) in the overall population of Poland from 2013 to 2017 and diagnose the risk factors of occurring DR among patients with diabetes mellitus (DM). METHODS: Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund (NHF) database were evaluated. International Classification of Diseases codes (ICD-9 and ICD-10) and unique NHF codes were used to identify DM type 1 and type 2 patients, DR and treatment procedures including laser photocoagulation, pars plana vitrectomy (PPV), anti-VEGF and steroid intravitreal injections. RESULTS: The overall registered prevalence of DR in the entire population of Poland was 0.81%. The mean prevalence of DR was 20.01% in the population with type 1 DM and 9.70% in the population with type 2 DM. In the study period, women represented 56.36% of all individuals registered with DR and 55.09% of all DM patients. In Poland, only 6.34% of all DM patients with DR received specific treatment with laser photocoagulation of the retina (82.32%), PPV (11.56%), anti-VEGF or steroid injections (5.15% and 0.97%, respectively). Cox regression hazard analysis showed that the risk of DR was associated with DM treatment only by GPs, female sex, coexisting systemic diseases and urban residence in both type 1 and type 2 DM. CONCLUSIONS: A 5-year retrospective analysis reveals the mean prevalence of DR in the population with type 1 and type 2 DM in Poland was rather low.

Ophthalmic manifestations of atopic dermatitis.

Atopic dermatitis is a chronic condition of complex etiology, whose clinical course involves remission and recurrence. It is not an isolated disease entity affecting only the skin, but one that co-occurs with disorders of other organs. Numerous literature reports have long confirmed the relationship between the disorder and a growing number of ophthalmic manifestations such as keratoconus and retinal detachment. Further studies are required to establish the cause of correlations and to allow for implementation of appropriate prophylaxis and treatment. The aim of the present paper is to review published literature regarding the correlation between atopic dermatitis and ophthalmic manifestations in adults and children.

Budget impact analysis of lens material on the posterior capsule opacification (PCO) as a complication after the cataract surgery.

BACKGROUND: Over 300,000 cataract operations are performed in Poland every year, and the most common, late complication of cataract removal surgery is posterior capsule opacification (PCO). The risk of PCO depends on the lens material. Hydrophobic acrylic lenses cause PCO less frequently as lymphatic endothelial cells show lower affinity for the surface of the lens made of silicone. The objective of this study is to assess the economic impact of using hydrophobic acrylic lenses compared to using hydrophilic acrylic lenses for cataract treatment in the Polish inpatient and outpatient settings. METHODS: A budget impact analysis (BIA) compared the economic outcomes associated with using hydrophobic acrylic lenses versus using hydrophilic lenses for patients undergoing cataract surgery. The BIA predicted annual expenses in the following scenarios: performing Nd:YAG to treat PCO within 2 and 3 years after implantation of hydrophobic or hydrophilic acrylic lenses for different lens structure. Data used to assess the frequency of PCO was determined in systematic literature review. Costs of current and predicted interventions were estimated based on average data from 19 Polish hospitals. Prices of health services were taken from official public tariff lists. RESULTS: The use of a hydrophobic lens significantly limits the number of complications after cataract surgery relative to a hydrophilic lens. As hydrophobic lenses have a higher unit price their use increases the cost of treatment which currently is not reflected by adequate difference in price of the service. Total annual National Health Fund (NHF) expenses for 3-year follow-up model range from 139.1 million EUR to 143.1 million EUR depending on the lens structure, due to the cost of complications. CONCLUSIONS: BIA indicates the possibility of introducing surcharge for the use of hydrophobic lenses, which could increase the frequency of their use and reduce the number of complications after cataract surgery. It was estimated that total NHF expenses reach the minimum value for the surcharge at the level of 9 EUR. The surcharge of 14 EUR is the maximum value that does not increase the initial NHF expenses.

Cytomegalovirus Retinitis Screening and Treatment in Human Immunodeficiency Virus Patients in Malawi: A Feasibility Study.

BACKGROUND: Cytomegalovirus retinitis is a treatable cause of blindness in people with human immunodeficiency virus (HIV) typically with CD4 counts <50 cells/mm3. Diagnosis is with indirect fundoscopy, and treatment is with intravitreal ganciclovir injections or systemic therapy. However, diagnosis and treatment are not widely available in Malawi, which has an adult HIV prevalence estimated at 10.6%. This study aimed to establish the prevalence of cytomegalovirus retinitis among people with HIV in Malawi and the feasibility of screening. METHODS: Patients with CD4 counts <200 cells/mm3 were examined from 2 HIV clinics in Lilongwe and the main government hospital. Data were collected on antiretroviral therapy, ocular symptoms, and visual acuity. Fundoscopy was performed to investigate for features of cytomegalovirus retinitis. Retinal photographs were reviewed by an ophthalmologist. Patients diagnosed with cytomegalovirus retinitis were offered weekly ganciclovir injections, because systemic treatment was not available. RESULTS: Five of the 102 people with HIV screened had cytomegalovirus retinitis (4.9%). All affected patients had CD4 counts <50 cells/mm3 (mean, 15 cells/mm3; range, 3-22 cells/mm3). Visual acuity was unhelpful in identifying those with cytomegalovirus retinitis. Symptomatically, only blurred vision was useful. Two patients consented to treatment, 1 of which improved but relapsed after defaulting. CONCLUSIONS: Cytomegalovirus retinitis screening based on CD4 count is essential to early recognition because visual acuity and symptoms are unreliable. Cytomegalovirus retinitis is a significant yet neglected public health issue in Malawi. Oral valganciclovir is essential to reduce blindness and mortality in those diagnosed but is not yet available. Further screening and advocacy are needed.

Incidence and Characteristics of Endophthalmitis after Cataract Surgery in Poland, during 2010-2015.

Background: The assessment of the incidence and characteristic of acute and chronic postoperative endophthalmitis (POE) after cataract surgery in Poland during 2010-2015. Patients and methods: All hospitalizations of patients, in the National Database of Hospitalizations, who underwent cataract surgery alone or in combined procedures in Poland between January 2010 and December 2015, with a billing code of endophthalmitis, were selected. Acute endophthalmitis was identified if symptoms occurred within 1-42 days from the cataract surgery and chronic endophthalmitis if symptoms occurred ≥43 days after cataract surgery, respectively. Results: In total, 1331 cases of POE after 1,218,777 cataract extractions were identified. The overall incidence of POE decreased from 0.125% in 2010 to 0.066% in 2015. In multiple logistic regression analyses, increasing age was significantly associated with acute POE, while type II diabetes mellitus, extracapsular cataract extraction, and one-day surgery were significantly associated with chronic POE. The combined cataract surgery and male sex were significant risk factors for both acute and chronic POE. A total of 62.51% of all eyes affected by POE received antibiotic treatment and 37.49% had vitrectomy treatment. Conclusions: During the study period, the total incidence of postoperative endophthalmitis after cataract surgery decreased significantly.

Transient visual field impairment after cold provocation in glaucoma patients with Flammer syndrome.

BACKGROUND: It is still debatable whether visual field defects in glaucoma have a reversible component and to what extent a temporary loss can be provoked. OBJECTIVE: To investigate the response of the visual function to a cold provocation in glaucoma patients, particularly to test whether subjects with Flammer syndrome (FS) behaved differently from subjects without FS. METHODS: Ten (10) primary open-angle glaucoma (POAG) patients with FS, 7 POAG patients without FS, and 11 healthy controls were tested with program G2 on the Octopus 101 perimeter before and after putting one hand in cold water (4°C) for 2 min. The mean sensitivity (MS) of each visual field was included in the statistical analysis. RESULTS: In glaucoma patients with FS, the mean MS significantly decreased after cold provocation (delta MS = -0.91 dB, CI = -1.43 to -0.39, p = 0.0014). In contrast, the mean MS in glaucoma patients without FS did not change significantly (delta MS = 0.17 dB, CI = -0.43 to 0.78, p = 0.56). Likewise, the mean MS did not change significantly in the healthy controls (delta MS = 0.23 dB, CI = -0.27 to 0.72, p = 0.36). CONCLUSIONS: Cold provocation induced a transient visual field deterioration in the glaucoma patients with FS but not in the glaucoma patients without FS or in the healthy controls. We assume this effect to be the result of a transient reduction of ocular blood flow.

Patient-oriented mobile applications in ophthalmology.

BACKGROUND: Mobile solutions will improve patient care only if they are equally valued by physicians and their patients. Although mobile applications are gaining acceptance among ophthalmologists and optometrists, little is known about their adoption among patients. Therefore, this study was designed to analyse the market for patient-oriented mobile applications in ophthalmology. METHODS: Search engines of Google Play and App Store were utilised to find patient-oriented mobile applications. All applications were divided into seven subspecialties; dry eye, strabismus and amblyopia, macular degeneration, cataract, glaucoma, diabetic retinopathy and general ophthalmology. Subsequently, number of downloads, average patient rating, year of release and source of clinical information provided in the application were collected. Furthermore, in order to evaluate whether development of software responds to epidemiological demand, number of applications in each subspecialty was correlated with the prevalence of particular diseases. RESULTS: Fifty-six applications that met established criteria were found. The overall number of downloads was estimated at the level of 1.5 million, whereas the weighted average rating for all applications was 4.21/5. The number of applications by subspecialty did not correlate with the prevalence of particular eye disorder. The dry eye was the most frequently downloaded and best rated subspecialty. CONCLUSIONS: The overall number of patient-oriented applications in ophthalmology is low. Subspecialties are not equally equipped with patient-oriented mobile solutions. Furthermore, the number of applications or downloads in each subspecialty does not correlate with the number of potential users such as patients with particular eye disorders. Finally, ophthalmologists should encourage software developers to meet future demand for mobile solutions in eye disorders.

Peripapillary retinal nerve fiber layer thickness measured by optical coherence tomography in different clinical subtypes of multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory demyelinating autoimmune disease of the central nervous system (CNS) with axonal degeneration as major determinant of neurological disability. Assessment of unmyelinated retinal nerve fibers using optical coherence tomography (OCT) may be useful for diagnosing the onset and rate of progression of neurodegeneration. OBJECTIVE: To assess the incidence and severity of damage of the peripapillary retinal nerve fiber layer (RNFL) in two different MS subtypes: non-progressive [Prog(-)MS] and progressive [Prog(+)MS]. METHODS: 48 patients (96 eyes) with MS were included: 13 males, 35 females; aged 22-62 years (mean 38.8; SD ±â€¯10.02) in two subgroups: 26 Prog(-)MS and 22 Prog(+)MS. 3 subtypes of Prog(+)MS were identified by neurologist, according to Lublin criteria: 3 patients had PPMS (14%), 7 had SPMS(32%), 12 had PRMS(54%). RRMS subtype was considered a non-progressive phenotype, designated as Prog(-)MS. All 22 patients with progressive MS phenotypes were included in one group, designated as Prog(+)MS. Progressive disease can be defined over 1 year. The expanded EDSS score was determined by the treating MS specialist and confirmed by the study investigators through the records review. Definition included a 3-strata progression magnitude in the absence of a relapse, confirmed after 3 months within the leading Functional System and required an Expanded Disability Status Scale step≥4 and pyramidal score≥2. 11 Prog(-)MS (16 eyes) and 10 Prog(+)MS (13 eyes) patients had a history of optic neuritis (ON). EDSS score was 1.5-6.5 (mean 3.83 ±â€¯1.62) in the Prog(+)MS group and 1.0-3.5 (mean 1.40 ±â€¯0.57) in the Prog(-)MS. CONTROL GROUP: 31 healthy volunteers (3 males, 28 females), aged 20-62 years (mean 37.4 ±â€¯10.88). Peripapillary RNFL thickness was measured around the optic nerve head (ONH) using spectral-domain OCT (Topcon OCT 1000 MarkII, FastMap v. 3.40, Topcon, Japan). Scans were obtained according to OSCAR-IB consensus criteria. The generalized estimating equation model (GEE) was used in the statistical analysis to assess differences in RNFL thickness between Prog(-)MS and Prog(+)MS patients, taking into consideration history of ON, EDSS score, immunomodulatory therapy, MS progression, MS duration, age and gender. The protocol was approved by the Ethical Committee of the Medical Centre of Postgraduate Education, Warsaw, Poland and informed consent was obtained from all subjects. RESULTS: There was a significant difference between Prog(-)MS and Prog(+)MS groups for mean, nasal and superior quadrant of RNFL thickness. For individuals with a history of ON, significant differences were found between the two MS phenotypes regardless of RNFL thickness measurements. CONCLUSIONS: A significant correlation was established between RNFL thickness and progression of neurodegeneration in MS patients with no regard to history of ON. RNFL thickness may be considered a MS biomarker and potential diagnostic tool for assessment of disease progression.

Better tolerance of preservative-free latanoprost compared to preserved glaucoma eye drops: the 12-month real-life FREE study.

BACKGROUND: Lack of efficacy due to bad compliance caused by intolerance issues is the main reason for a change to a better tolerated ocular treatment, such as using preservative-free (PF) eye drops. AIM: To assess the efficacy and local tolerance after 12 months and patient satisfaction regarding local treatment tolerance and handling at inclusion and after 6 months of PF latanoprost compared to preserved glaucoma eye drops. METHODS: This was an international, prospective, and observational real-life study. Up to three visits, one at inclusion and two follow-up visits (one after 6 and one after 12 months) were planned. Efficacy, local tolerance, and patient satisfaction were the main evaluation criteria. RESULTS: Data from 721 patients were available for the statistical analysis. Overall, 64.8% (467/721) of patients switched treatment before inclusion: 62.2% in the preserved and 68.9% in the PF latanoprost group. IOP values were similar between PF latanoprost and preserved eye drops and remained stable at all visits. Ocular signs and symptoms improved after switching to PF latanoprost; the prevalence of conjunctival hyperemia was significantly lower (P=0.0015) at both follow-up visits. At follow-up visit 1, 49.5% of the patients who switched to PF latanoprost decreased or stopped the use of artificial tears. Satisfaction regarding tolerance in patients using PF latanoprost improved significantly after the switch from preserved eye drops to PF latanoprost (88.9% and 42.5%, respectively, P<0.0001). CONCLUSION: This first real-life study showed that PF latanoprost was as efficacious but better tolerated than preserved eye drops over a sustained period of 12 months, while providing a significantly higher patient satisfaction and potentially allowing improvement in the patient's daily life.

Associations of Diabetic Retinopathy with Retinal Neurodegeneration on the Background of Diabetes Mellitus. Overview of Recent Medical Studies with an Assessment of the Impact on Healthcare systems.

Diabetes Mellitus (DM) is one of the biggest healthcare and financial problems worldwide. The disease is strongly associated with microvascular and macrovascular complications, causing co-existing diseases like Diabetic Retinopathy, Diabetic Neuropathy and Diabetic Nephropathy. Annual healthcare expenditures for diabetes treatment and complications prevention cost 727 billion USD in year 2017. Diabetes Mellitus, Diabetic Retinopathy and Diabetic Retinal Neuropathy are closely related diseases - originating from incorrectly controlled glycemia, blood pressure and lipid levels in the course of increasing resistance of the body tissues to insulin. Irrespectively of thorough programs for Diabetes Mellitus prevention and treatment, Diabetic Retinopathy management requires targeted treatment strategies for both microvasculopathy and retinal neurodegeneration, to delay disease severity course and risk of blindness. The study and conclusions in this article are based on web-available data and officially published articles related to the diabetes mellitus and associated diseases - Diabetic Retinopathy and Diabetic Retinal Neuropathy. The articles have been reviewed and analyzed to assess mutual relations between the discussed diseases.

Incidence and Characteristics of Cataract Surgery in Poland, during 2010-2015.

Background: To assess the incidence and characteristic of cataract surgery in Poland from 2010 to 2015 and to interpret these findings. Patients and methods: Data from all patients who underwent cataract surgery alone or in combined procedures in Poland between January 2010 and December 2015 were evaluated. Patient data were from the national database of hospitalizations maintained by National Health Fund. Data on the population of Poland were obtained from Central Statistical Office of Poland. Results: In total, 1,218,777 cataract extractions (alone or combined with other procedures) were performed in 1,081,345 patients during 2010-2015. Overall, the incidence of cataract surgery increased from 5.22/1000 person-years in 2010 to 6.17/1000 person-years in 2015. Phacoemulsification was performed in 97.46% of cataract extractions, and 3.02% of cataract extractions were combined procedures. The rate of one-day procedures increased from 28.3% in 2010 to 43.1% in 2015. The probability of second-eye surgery 12 months after the first-eye surgery increased from 44% in 2010 to 73% in 2015 (log-rank test p < 0.0001). Conclusion: In Poland, from 2010 to 2015, the total incidence of cataract surgery, the number of people who underwent surgery, and the number of one-day cataract surgeries increased significantly.

GWAS links variants in neuronal development and actin remodeling related loci with pseudoexfoliation syndrome without glaucoma.

Pseudoexfoliation syndrome (PEXS) is an age-related elastosis, strongly associated with the development of secondary glaucoma. It is clearly suggested that PEXS has a genetic component, but this has not been extensively studied. Here, a genome-wide association study (GWAS) using a DNA-pooling approach was conducted to explore the potential association of genetic variants with PEXS in a Polish population, including 103 PEXS patients without glaucoma and 106 perfectly (age- and gender-) matched controls. Individual sample TaqMan genotyping was used to validate GWAS-selected single-nucleotide polymorphism (SNP) associations. Multivariate binary logistic regression analysis was applied to develop a prediction model for PEXS. In total, 15 SNPs representing independent PEXS susceptibility loci were selected for further validation in individual samples. For 14 of these variants, significant differences in the allele and genotype frequencies between cases and controls were identified, of which 12 remained significant after Benjamini-Hochberg adjustment. The minor allele of five SNPs was associated with an increased risk of PEXS development, while for nine SNPs, it showed a protective effect. Beyond the known LOXL1 variant rs2165241, nine other SNPs were located within gene regions, including in OR11L1, CD80, TNIK, CADM2, SORBS2, RNF180, FGF14, FMN1, and RBFOX1 genes. None of these associations with PEXS has previously been reported. Selected SNPs were found to explain nearly 69% of the total risk of PEXS development. The overall risk prediction accuracy for PEXS, expressed by the area under the ROC curve (AUC) value, increased by 0.218, from 0.672 for LOXL1 rs2165241 alone to 0.89 when seven additional SNPs were included in the proposed 8-SNP prediction model. In conclusion, several new susceptibility loci for PEXS without glaucoma suggested that neuronal development and actin remodeling are potentially involved in either PEXS onset or inhibition or delay of its conversion to glaucoma.

A common humoral background of intraocular and arterial blood pressure dysregulation.

BACKGROUND: It has been postulated that intraocular pressure, an important glaucoma risk factor, correlates positively with arterial blood pressure (blood pressure). However, results of experimental and clinical studies are often contradictory. It is hypothesized that, in some hypertensive patients, disturbances in intraocular pressure regulation may depend on biological effects of blood borne hormones underlying a particular type of hypertension, rather than on blood pressure level itself. REVIEW: This review compares the effects of hormones on blood pressure and intraocular pressure, in order to identify a hormonal profile of hypertensive patients with an increased risk of intraocular pressure surge. The PUBMED database was searched to identify pre-clinical and clinical studies investigating the role of angiotensin II, vasopressin, adrenaline, noradrenaline, prostaglandins, and gaseous transmitters in the regulation of blood pressure and intraocular pressure. RESULTS: Studies included in the review suggest that intraocular and blood pressures often follow a different pattern of response to the same hormone. For example, vasopressin increases blood pressure, but decreases intraocular pressure. In contrast, high level of nitric oxide decreases blood pressure, but increases intraocular pressure. CONCLUSIONS: Arterial hypertension is associated with altered levels of blood borne hormones. Contradicting results of studies on the relationship between arterial hypertension and intraocular pressure might be partially explained by diverse effects of hormones on arterial and intraocular pressures. Further studies are needed to evaluate if hormonal profiling may help to identify glaucoma-prone patients.