Aqueous levels of VEGF correlate with retinal non-perfusion areas in patients with diabetic macular edema and macular edema secondary to central retinal vein occlusion.

AIM: To evaluate the association between the level of vascular endothelial growth factor in the aqueous humor and the size of capillary non-perfusion areas in patients with macular edema secondary to retinal vein occlusion and diabetic retinopathy. MATERIAL AND METHODS: The study group consisted of 24 patients (24 eyes) at the age of 55-78 years, with diffuse macular edema secondary to retinal vein occlusion and diabetic retinopathy. The control group consisted of 26 subjects aged 55-87 years who were admitted for scheduled cataract surgery. The VEGF aqueous humor levels, retinal thickness using optical coherence tomography, as well as the size of non-perfusion areas measured on fluorescein angiography images were evaluated in each enrolled subject. RESULTS: The vascular endothelial growth factor aqueous humor levels were found to be significantly higher in patients with macular edema as compared to controls (p = 0.0002). In the diabetic macular edema and retinal vein occlusion group, the con- centration of vascular endothelial growth factor in aqueous humor positively correlated with the extent of non-perfusion areas measured on fluorescein angiograms (Rs = + 0.45, p = 0.02;). Multivariate analysis of patients and controls performed using the general linear model, adjusted for age, sex, intraocular pressure and the presence of diabetes, revealed that macular edema was an independent factor associated with higher aqueous VEGF concentrations (ß = +0.74, p = 0.0012). CONCLUSIONS: Macular edema secondary to either retinal vein occlusion or diabetic retinopathy is associated with the increased levels of vascular endothelial growth factor in the aqueous humor. Therefore, the management of patients with macular edema secondary to retinal vein occlusion or diabetic retinopathy should aim at reducing the ocular vascular endothelial growth factor concentrations, especially in the presence of capillary non-perfusion areas.

The Role Oxidative Stress in the Pathogenesis of Eye Diseases: Current Status and a Dual Role of Physical Activity.

Extensive research during the past three decades has demonstrated the mechanisms by which an imbalance in the redox status of prooxidant/antioxidant reactions in cells with advantage of prooxidant reactions (oxidative stress, OS) can cause peroxidation of nucleic acids, bases, lipids, proteins and carbohydrates, thus resulting in their damage. These actions result in stimulation of signal transduction pathways and activation of transcription factors that can lead to chronic inflammation and cause tissue dysfunction. The most important oxidants are reactive oxygen species (ROS) and reactive nitrogen species (RNS) generated by various metabolic pathways, physical, chemical and biological factors, and pathological conditions. The eye is one of the major target of the ROS/RNS attack due to exposition on several environmental factors like high pressure of oxygen, light exposure, ultraviolet rays, ionizing radiation, chemical pollutants, irritant, and pathogenic microbes, which are able to shift the redox status of a cell towards oxidizing conditions. There is increasing evidence indicating that persistent OS contributes to the development of many ocular diseases. Increases in the accumulation of hydrogen peroxide and markers of the oxidative damage to DNA, lipids, proteins observed in several eye diseases and usage of antioxidants in their treatment and prevention emphasize the involvement of OS pathways. This paper summarizes the present state of knowledge in the involvement of OS in the etiology of non-cancer ocular diseases (dry eye syndrome; corneal and conjunctive diseases; cataract; glaucoma; age-related macular degeneration; retinitis pigmentosa; diabetic retinopathy, autoimmune and inflammatory uveitis) and cancer ocular diseases (melanoma; retinoblastoma; lymphoma). The paper also discusses the potential applications of antioxidants in the prevention of eye diseases and shows a duality of physical exercise actions: protection against the ROS/RNS damage by regular-moderate physical activity and damaging effect through mediation of OS by endurance exercise without adaptable physical training.

[Outcomes of surgical management of retinopathy of prematurity--an overview]. / Wyniki leczenia operacyjnego retinopatii wczesniaczej--przeglad pismiennictwa.

According to the guidelines by the ETROP (Early Treatment for Retinopathy of Prematurity) study group, laser therapy is the gold standard in the treatment of retinopathy of prematurity. However, progression of the disease is seen in 12% of eyes despite the treatment. Since there is no causal treatment, new therapies of retinopathy of prematurity, are continually sought, such as anti-VEGF agents, beta-blockers, or insulin-like growth factor gene therapy. In cases with concomitant retinal detachment, surgery is performed. The standard therapy for retinopathy of prematurity stages 4-5 involves pars plicata vitrectomy and lensectomy (stage 5), ab externo surgery (scleral buckling) and lens-sparing vitrectomy (some cases of stage 4). Classic vitrectomy with lensectomy is reserved only for cases with advanced retinal tractions, retina-lens apposition or for cases of intraoperative lens damage during the lens-sparing vitrectomy. The ab externo surgery does not eliminate vitreous tractions, but it stabilises the neovascular membrane activity (transforming it into a scar). The indication for this type of operation is stage 4 retinopathy of prematurity with peripheral proliferations, except for the posterior--aggressive form of retinopathy of prematurity. Many papers have been published on combined therapy involving vitrectomy and conservative treatment. In conclusion, optimal timing of surgical intervention is difficult to determine in stages 4 and 5, because the anatomical and functional outcomes in stage 5 are unfavourable. Both, ab externo surgery and vitrectomy tend to produce poor macular vision in eyes with advanced retinopathy of prematurity, therefore surgical intervention at stage 4 just before the local macular retinal detachment provides better anatomical and functional outcomes.

[Idiopathic choroidal neovascularization--case report]. / Idiopatyczna neowaskularyzacja podsiatkówkowa--opis przypadku.

PURPOSE: To report a patient with peripapillary idiopathic choroidal neovascularization treated with an anti-VEGF (anti- vascular endothelial growth factor) agent (bevacizumab) observed during for 9 months. PATIENT AND METHODS: Twenty nine years old man was referred to the Department for diagnosis and treatment because of unilateral visual acuity decrease in the right eye (VA RE--0.1) and metamorphopsias. The routine ophthalmic examination revealed macular edema and peripapillaryedema with epiretinal and intraretinal hemorrhages. The optical coherence tomography, fluorescein angiography, as well as laboratory tests were performed in order to exclude uveitis. Due to the difficulties in the diagnosis indocyanine green angiography was also performed. Based on clinical symptoms and the findings of the additional diagnostic procedures, the patient was diagnosed with idiopathic choroidal neovascularization. The patient was qualified for anti-VEGF therapy and received three intravitreal injections of bevacizumab at the dose of 1.25 mg, at monthly intervals. RESULTS: Significant improvement of visual acuity (VA RE - 1.0) and regression of the peripapillary edema with hemorrhages were achieved after the third injection of 1.25 mg bevacizumab. At 6 months, peripapillary scarring was observed in the area involved by the primary lesions. CONCLUSIONS: Anti-VEGF therapy is the effective treatment of idiopathic choroidal neovascularization in the described case. The visual acuity improvement and rapid regression of posterior segment lesions after bevacizumab administration were observed.

[Glaucoma after laser diode treatment in retinopathy of prematurity--case series]. / Jaskra po leczeniu laserem diodowym w przebiegu retinopatii wczesniaczej -opis przypadków.

UNLABELLED: The aim of this study was to analyze treatment and outcomes in children with glaucoma secondary to diode laser photocoagulation in retinopathy of prematurity. METHODS: The group of 1507 newborns, examined as outpatients between 2008 and 2013, were retrospectively analyzed. Five patients (0.3%) (nine eyes) with glaucoma following laser treatment for retinopathy of prematurity were identified. Demographic and clinical data was obtained from medical records and compared with corresponding results in the group of glaucoma-free children subjected to diode laser photocoagulation for retinopathy of prematurity. The statistical analysis included Shapiro-Wilk test and U-Mann-Whitney test with statistical significance level p < 0.05. RESULTS: The following data was collected - mean post-menstrual age at the moment of photocoagulationwas 42 Hbd (38-42) and it was 49.9 (43-54) weeks at the moment of diagnosis of angle-closure glaucoma. The intraocular pressure was significantly elevated in nine in ten eyes which was confirmed objectively and the mean intraocular pressure was 32.0 mmHg (21.6-42.4). The mean corneal diameter was 11.25 mm (10-13) and it was associated with the decreased corneal thickness in pachymetry (p < 0.05). Six eyes (66.6%) required surgical intervention and intraocular pressure normalization was achieved in all patients. Additionally, the affected eyes tended to be myopic (mean spherical equivalent -1.625 diopter) and have a greater axial length (p < 0.05). CONCLUSIONS: Secondary glaucoma can develop following laser treatment for severe retinopathy of prematurity. Topical treatment and surgical intervention provide effective management.

[Terson syndrome--a literature review]. / Zespól Tersona - przeglad pismiennictwa.

Tersone syndrome was first described in 1900 as haemorrhages in the eye that occur as a consequence of intracranial hemorrhage. The main cause of the syndrome in adults is a subarachnoid hemorrhage following the rupture of intracranial aneurysm. The pathogenesis has not been fully understood. It is believed that the increase of intracranial pressure results in the hemodynamic changes in ocular vessels. Reported symptoms include decrease of visual acuity following generalized symptoms such as headache, loss of consciousness and meningealsigns. Physical examination usually reveals vitreous hemorrhage (classic Terson's syndrome) and other forms of intraocular hemorrhage. The authors reviewed the available literature on the Terson's Syndrome. Clinical presentation, pathogenesis, diagnosis, and available treatment options are presented and discussed, considering the rare occurrence of this disease.

[Morphology of the optic nerve disc in eyes with myopia in correlation to the refractive error]. / Ocena morfologii tarczy nerwu wzrokowego w oczach krótkowzrocznych w zaleznosci od wielkosci wady.

PURPOSE: To asses morphology of the optic nerve disc in correlation to the refractive error in eyes with myopia. MATERIAL AND METHODS: The examined group consisted of 47 patient (84 eyes), age 20 to 36 years (mean age 28 +/- 4,5), with refractive error -4.00 Dsph to -14.25 Dsph +/- 0.75 Dcyl. This group was divided into two subgroups according to value of refractive error. The control group contained matched persons according to the gender and age. The basic ophthalmological examination and scanning laser ophthalmoscopy with HRT retinal tomography were performed. RESULTS AND CONCLUSIONS: In patients with moderate and high myopia there was an increase of the optic nerve disc area and volume, and area and volume of the neuroretinal rim in comparison to the emmetropic eyes. In patients with high myopic eyes there was an increase of the area and depth of the optic nerve cup. The area of the optic nerve disc and the neuroretinal rim was found to be bigger as the refractive error increased in group of moderate myopia. There were no statistically significant differences of thescanning laser ophthalmoscopy with HRT parameters (C/D AR and L C/D R) of the cup to the area and the diameter of the disc between myopic and emmetropic eyes.

[Polypoidal choroidal vasculopathy with spontaneous regression of subfoveal changes--case report]. / Polipoidalna waskulopatia naczyniówkowa z samoistna regresja zmian poddolkowych--opis pacjenta.

PURPOSE: To report a patient with polypoidal choroidal vasculopathy (PCV) with spontaneous regression of subfoveal changes during follow-up. MATERIAL AND METHODS: The seventy six years old men was referred to the treatment of exudative type of age related macular degeneration (AMD) in the RE. The routine ophthalmological examination, the optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) were performed. RESULTS: Decreasing of visual acuity of the RE and abnormal result of the Amsler test, hemorrhagic and exudative changes near inferior-temporalis vascular arcade were observed. Intraretinal fluid in the OCT was noted. FA revealed parapapillaris changes suggesting CNV. ICGA showed the presence of branching vascular network extending from choroidal vasculature (BVN) and polypoidal and aneurysmal vascular terminal lesion (PL) localized under retinal pigment epithelium (RPE). CONCLUSIONS: Based on the results PCV was diagnosed and the patient was referred to laserotherapy. Due to the regression of the eye fundus changes during the period of observation, confirmed by control OCT and FA the treatment was not implemented.

[Combined photodynamic therapy and intravitreal injection of triamcinolone acetonide in patients with wet form of AMD. Introductory report]. / Zastosowanie terapii laczonej PDT z iniekcjami doszklistkowymi octanu triamcinolonu u pacjentów z wysiekowa postacia AMD. Doniesienie wstepne.

PURPOSE: To evaluate the efficacy of combined PDT and 4 mg intravitreal triamcinolone acetonide injection, performed 48-72 hours after PDT, in patients with wet form of AMD. MATERIAL AND METHODS: Nonrandomised, interventional case series, 13 eyes of 13 patients with subfoveal CNV due to AMD that did not respond to PDT monotherapy - 7 females, 6 males - at the age of 65-85 (average age 76.6 +/- 6.7 years); standard PDT was performed in all patients followed by a 4 mg intravitreal injection of triamcinolone acetonide given 48-72 hours after PDT. Follow up visits were scheduled 1 and 7 days after the injection and then every 3 months afterwards and included: BVCA (Snellen chart), IOP measurements, FA, OCT, slit lamp and eye fundus examination. Lesions with active CNV leakage in FA were retreated every 3 months. RESULTS: Average observation time was 10.8 +/- 3.5 months. Baseline visual acuity before PDT monotherapy was applied (Vo) was 0.17 +/- 0.12 (0.06-0.5), and after the therapy decreased to (V1) 0.14 +/- 0.13 (0.05-0.2). After combined PDT and Tc treatment BVCA increased to (V2) 0.21 +/- 0.13 (0.06-0.5), p<0,03. 76,9% of patients gained or maintained visual acuity after combined therapy in the observation time. In 70% of eyes no signs of active CNV was observed in AF and OCT after 1 session of combined PDT and Tc treatment. Only 4 patients required 1 repeated treatment session. CONCLUSIONS: 1. Combination of PDT and IVTA may be effective in patients with wet AMD with no response to PDT alone and significantly reduces the repeated treatment rate. 2. Intravitreal Tc injection performed 48-72 hours after PDT may improve the final functional effects in treated eyes as compared with PDT monotherapy. Our results need further investigation.

In vitro scavenging activity for reactive oxygen species by N-substituted indole-2-carboxylic acid esters.

The hydroxyl radical (HO*)- and superoxide anion radical (O* (2))-scavenging activity, as well as the singlet oxygen ((1)O(2))-quenching property of N-substituted indole-2-carboxylic acid esters (INDs) were investigated by deoxyribose degradation assay, a chemiluminescence method and the electron spin resonance (ESR) spin-trapping technique. This novel group of compounds was developed as a search for cyclooxygenase-2 (COX-2)-selective enzyme inhibitors. The results obtained demonstrated that of the 16 compounds examined, five inhibited light emission from the superoxide anion radical (O* (2))-DMSO system by at least 60% at a concentration of 1 mmol/L, nine prevented the degradation of deoxyribose induced by the Fenton reaction system (range 3-78%) or scavenged hydroxyl radicals (HO*) directly (range 8-93%) and 14 showed the (1)O(2)-quenching effect (range 10-74%). These results indicate that majority of the indole esters tested possess the ability to scavenge O(-) (2) and HO radicals and to quench (1)O(2) directly, and consequently may be considered effective antioxidative agents.