Fusarium Keratitis-Review of Current Treatment Possibilities.

In many parts of the world, fungi are the predominant cause of infectious keratitis; among which, Fusarium is the most commonly isolated pathogen. The clinical management of this ophthalmic emergency is challenging. Due to the retardation of the first symptoms from an injury and the inability to differentiate fungal from bacterial infections based on clinical symptoms and difficult microbial diagnostics, proper treatment, in many cases, is postponed. Moreover, therapeutical options of Fusarium keratitis remain limited. This paper summarizes the available treatment modalities of Fusarium keratitis, including antifungals and their routes of administration, antiseptics, and surgical interventions.

Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review.

Selective laser trabeculoplasty (SLT) is a glaucoma treatment that reduces intraocular pressure (IOP). Its mechanism is based on the biological effects of the selective application of laser energy to pigmented trabecular meshwork (TM) cells, resulting in increased outflow facility. Herein, we review current publications on SLT and summarize its efficacy and safety for different indications in open-angle glaucoma (OAG) and ocular hypertension (OHT) treatment. SLT effectively reduces IOP when used as a primary treatment. In patients whose IOP is medically controlled, SLT helps to reduce medication use, and when maximally tolerated topical therapy is ineffective, SLT facilitates the realization of the target IOP. SLT is a repeatable procedure for which the vast majority of complications are mild and self-limiting. With effective IOP reduction, low complication rates and the potential to repeat the procedure, SLT offers the possibility of delaying the introduction of medical therapy and other more invasive treatment modalities while simultaneously avoiding the accompanying complications. With this knowledge, we suggest that SLT be considered as an essential primary treatment option in OAG and OHT, switching to other treatment modalities only when laser procedures are insufficient for achieving the required target IOP.

Elevated serum concentrations of metalloproteinases (MMP-2, MMP-9) and their inhibitors (TIMP-1, TIMP-2) in patients with Graves' orbitopathy.

BACKGROUND: Graves' orbitopathy (GO), also known as thyroid-associated ophthalmopathy, is characterized by dramatic tissue reactivity. Both inflammation and tissue remodeling characterize the clinical course of GO. Some data has been found regarding the association of MMPs and TIMPs in GO. MATERIAL AND METHODS: Serum concentrations of MMP-9, MMP-2, TIMP-1, and TIMP-2 were determined by ELISA method. OBJECTIVES: Forty-eight patients (34 females, 14 males, with median age 51.5 years) with GD and hyperthyroidism were enrolled in the study. In 28 patients, active, moderate-to-severe grade orbitopathy was diagnosed. The aim of this study was to assess the serum concentrations of MMP-2, MMP-9, TIMP-1, and TIMP-2 in patients with Graves' disease (GD), with and without GO, and their relationship with disease severity, as well as to evaluate how these concentrations change after successful treatment. RESULTS: Median serum concentrations of MMP-2 and MMP-9 were significantly higher in all patients with GD as well as in the subgroup with GO than in the control group. Median serum concentrations of TIMP-1 and TIMP-2 were significantly higher in all patients with GD than in controls. The same significant differences were observed in the subgroups with and without GO in comparison with controls. The GO subgroup showed a significant positive correlation between the MMP-9 concentration and the serum level of TSHRAb antibodies, and a clinical activity score ≥4 according to EUGOGO. CONCLUSIONS: In our study we found that only MMP-9 differentiates the patients with and without GO, and may be used as a marker of the disease severity in patients with this manifestation of GD.

CD28/CTLA-4/ICOS haplotypes confers susceptibility to Graves' disease and modulates clinical phenotype of disease.

Graves' disease, an autoimmune disease with heterogeneous symptoms including Graves' orbitopathy, has a combined genetic/environmental background, where variations within CD28/CTLA-4/ICOS genes are considered as disease markers.Association of CD28c.17+3T>C(rs3116496), CTLA-4g.319C>T(rs5742909), CTLA-4c.49A>G(rs231775), CTLA-4g.*642AT(8_33), CT60(rs3087243), Jo31(rs11571302), ICOSc.1554+4GT(8_15) polymorphisms with susceptibility to Graves' disease and clinical outcome was investigated. The study group comprised of 561 Polish Caucasians, including 172 unrelated Graves' disease patients. CTLA-4c.49A>G, CTLA-4g.319C>T, and CT60 were genotyped by PCR-RFLP; Jo31 and CD28c.17+3C>T by minisequencing; CTLA-4g.*642AT(8_33) and ICOSc.1554+4GT(8_15)-PCR and fluorescence-based technique. CD28c.17+3T>C(rs3116496)T/CTLA-4g.319C>T(rs5742909)C/CTLA-4c.49A>G(rs231775)G/CTLA-4g.*642AT(8_33)(AT16-21)/CT60(rs3087243)G/Jo31(rs11571302)G/ICOSc.1554+4GT(8_15)(m) and TCA(AT<16)GT(m) haplotypes increased risk of Graves' disease, especially in males, as well as overall Graves' orbitopathy development with severe outcome. TCG(AT16-21)GG(l) haplotype increased risk of Graves' disease and reduced the chance of successful medical treatment. Although this haplotype was mainly observed in patients without signs of Graves' orbitopathy, if Graves' orbitopathy developed it favored a Graves' orbitopathy outcome. Haplotype TCA(AT>21)GT(m) increased Graves' disease risk in women and, in all patients, was linked to Graves' disease without Graves' orbitopathy. TCG(AT<16)GG(m) haplotype was predominantly observed in patients without Graves' orbitopathy, whereas TCA(AT16-21)GG(m) was absent in those patients. TCA(AT16-21)GG(m) occurred in patients with a mild Graves' orbitopathy outcome. The marker CTLA-4g.*642AT(8_33) was the only independent Graves' disease risk factor, whereas CT60 was an independent factor for disease progression. Sporadic Graves' disease was related to presence of CTLA-4c.49A>G[A] and the rare CTLA-4g.319C>T[T] allele variant. Familial background of the disease was exclusively associated with CTLA-4g.*642AT(8_33)[AT>21]/[AT>21] genotype. CD28/CTLA-4/ICOS loci may confer inherited susceptibility to Graves' disease or may be involved in susceptibility to Graves' disease and play a pathogenetic role.

PPARg2 Ala¹² variant protects against Graves' orbitopathy and modulates the course of the disease.

Orbital fibroblast differentiation to adipocytes is a peroxisome proliferator-activated receptor g (PPARg)-dependent process essential for pathogenic tissue remodeling in Graves' orbitopathy (GO). PPARg2 Pro¹²Ala polymorphism modulates expression and/or function of the molecule encoded by this gene and is a promising locus of GO. Here, we analyzed associations of PPARg2 Pro¹²Ala with clinical manifestation of GO in 742 Polish Caucasians including 276 Graves' disease (GD) patients. In our study, the Ala¹² allele and Ala¹² variant (Ala¹²Ala and/or Pro¹²Ala genotype) decreased the risk of GO (p = 0.000012 and p = 0.00013). Moreover, Ala¹²Ala genotype was observed only in patients without GO (p = 0.002). GD patients with Ala¹² variant had less active and less severe eye symptoms. Female carriers of the Ala¹² allele rarely developed GO, but the marker was not related to symptoms of GO. The opposite finding was recorded in males, in whom the studied polymorphism was related to activity, but not to the development, of GO. In Ala¹² variant carriers without familial history of thyroid disease, risk of GO was lower than in persons with a familial background. The Ala¹² allele seemed to protect smokers from GO, but in nonsmokers, such a relation was not obvious. A multivariate analysis indicated the Pro¹²Ala marker as an independent risk factor of eye symptoms (p = 0.0001) and lack of Ala increases the risk of GO 3.24-fold. In conclusion, the gain-of-function Ala¹² variant protects against GO and modulates the course of the disease.

[The cyanoacrylate tissue adhesives in treatment diseases of the anterior eye segment]. / Cyjanoakrylowe kleje tkankowe w leczeniu schorzen przedniego odcinka galki ocznej.

The cyanoacrylates were first synthesized in 1949 by H. Coover. They are used in medicine for over 50 years. The main advantage of synthetic tissue adhesives is cheap and simple production process, which gives possibility of using the cyanoacrylates in many surgical disciplines of medicine. That makes also synthetic tissue adhesives better than biological tissue glue (for example fibrin- based adhesives) which preparation is much more complicated and expensive. Nowadays the cyanoacrylates are often used in ophthalmology, mostly in treatment diseases of the anterior segment--for example corneal thinning, ulceration and perforation of cornea. In this paper possible uses of cyanoacrylate tissue adhesives in ophthalmology are presented. The method of application of the cyanoacrylates on the surface of damaged cornea is presented. On base of analysis provided in many clinical centres, the advantages, disadvantages and clinical effects of using tissue adhesives are discussed in this paper. The latest results of using cyanoacrylate tissue adhesives in anterior segment surgery, especially in closing corneal incisions made during cataract operation are presented too. The article contains also information about experimental researches relating to application tissue glue in vitreoretinal surgery and operative glaucoma treatment.

[Influence of material on biocompatibility of intraocular lenses]. / Wplyw materialu na biokompatybilnosc soczewek wewnatrzgalkowych.

There are many types of intraocular lenses (IOL), different in optic features and materials. The first indication for IOL implantation was aphakia after cataract surgery. The problem of aphakia exists as long as cataract is treated, that is at least 45 hundreds of years. Correction of aphakia using glasses is uncomfortable for patients and even impossible in some cases. The invention of an artificial intraocular lens was a crucial event in the history of ophthalmology. Nowadays there are more indications for cataract surgery and implantation of intraocular lens, including correction of refractive errors. The first intraocular lenses were made of rigid plastic: polymethylmethacrylate (PMMA). In present times foldable intraocular lenses made of soft material: silicone, hydrogel and acrylic compounds are also produced. In this paper 4 groups of intraocular lenses: PMMA, silicone, hydrogel, acrylic and their influence on biocompatibility are discussed. This article contains also description of two types of IOL biocompatibility: uveal and capsular. Their clinical aspects, especially posterior capsule opacification are discussed. Factors affecting biocompatibility are shortly described. Some historical applications of IOL are presented. Regarding the latest experimental studies on improving IOL biocompatibility, results of IOL surface modification tests are presented. New perspective technologies of intraocular artificial lens production such as single crystal materials are also discussed.

[Effect of different shape and material of intraocular lens on posterior capsule opacification]. / Wplyw ksztaltu i materialu soczewki wewnatrzgalkowej na powstawanie przymglenia torebki tylnej.

In this paper we compare 4 groups of intraocular lenses: PMMA, silicone, hydrogel, acrylic and their influence on posterior capsule opacification is discussed. The possible clinical consequences of different shape in optic part of intraocular lens is also described. This article contains also a short presentation of posterior capsule opacification mechanism and intraocular lens materials biocompatibility in in-vivo and in-vitro experiments.

[Alport's syndrome--case report]. / Zespól Alporta--opis przypadku.

The history and clinical findings of 30-year man with Alport's syndrome are presented. The main features of Alport's syndrome are hereditary chronic nephritis leading to renal failure resulting in death and sensory-neural deafness. Ocular features include anterior lenticonus, macular and peripheral flecks resembling fundus albipunctatus. The etiology of this syndrome is unknown. It has been suggested that there may be a metabolic defect in the biosynthesis of collagen with changes in the glomerular basement membrane, cochlea and capsule of the lens. The retinal flecks may also be related to the different underlying glial cells, Mullers cells producing thick basement membrane. It is concluded that diagnosis of fundus albipunctatus should not be made in the absence of full renal investigation and audiometry.

[Obstructive sleep apnea syndrome as a risk factor of glaucomatous neuropathy]. / Zespól obturacyjnego bezdechu sródsennego jako czynnik ryzyka neuropatii jaskrowej.

The consequences of sleep apneas in patients with obstructive sleep apnea (OSA) syndrome may influence the function of visual system. In 21 patients with OSA syndrome (apnea/hypopnea index--AHI 50+/-20) the detailed ophthalmologic studies, including tonometry, biomicroscopic evaluation of the anterior segment of the eye, automatic perimetry and stereoscopic examination of the eye fundus have been performed. In 4 patients (19%) the signs of lesions in the optic tract have been found. These were: defects in visual field caused by glaucoma (primary open-angle glaucoma and normal-tension glaucoma) in 2 patients and defects in visual field (concentric and quadrantic homonymous) caused by diffuse lesions in the cortico-nuclear tract in 2 patients. In patients with the lesions in the optic tract there were severe disorders of breathing during sleep: AHI >60, mean SaO2 at the end of the apneas <86% and minimal SaO2 at the end of the apneas <70%. The authors conclude that in OSA patients there is a high risk of the lesions of the optic tract as a consequence of severe and repetitive hypoxemia during sleep.

[Effect of rilmenidine on intraocular pressure in rabbits, interaction with efaroxan and rauwolscine]. / Wplyw rilmenidyny na cisnienie wewnatrzgalkowe u królików. Interakcja z efaroksanem i rauwolscyna.

PURPOSE: Glaucoma is the main cause of blindness in the developed countries. Its progress can be diminished by decreasing intraocular pressure (IOP) using pharmacological or surgical treatment. Antiglaucoma agents, alpha 2-adrenergic's receptor agonists have been known for several years as IOP lowering. Due to the fact that the majority of them turned out to be imidazoline receptor agonists, it is worth checking if selective imidazoline receptor (l1) agonists alter IOP. Preliminary animal experiments show that they lower IOP. In our study we examined the influence of rilmenidine, a potent l1 receptor agonist, on IOP in rabbits. Furthermore, we tried to find out whether l1 and alpha 2 receptor antagonists (efaroxan and rauwolscine) counteract the pharmacological effect of rilmenidine. MATERIAL AND METHODS: The study was conducted on adult male White New Zealand rabbits. All the substances were administered topically, and IOP was measured by applanation tonometry after topical anaesthesia before and 1, 3 and 5 hours after drug instillation. RESULTS: Rilmenidine showed the lowering effect on IOP at the concentration of 0.4%. Efaroxan and rauwolscine partly inhibited rilmenidine effect. CONCLUSIONS: Rilmenidine is a potential antiglaucoma agent, though further studies are necessary.

[Analysis of phacoemulsification complications during mastering of the method]. / Analiza powiklan fakoemulsyfikacji w trakcie opanowywania metody.

PURPOSE: Intra-operative and postoperative complications of the first 50 phacoemulsifications were evaluated. The procedures were performed by one, skilled at ECCE surgeon. The phaco-chop technique was carried out in all cases with use of anterior chamber maintainer (ACM). MATERIAL AND METHODS: Eyes for surgery met the requirements: normal comea, presence of red reflex from the fundus and correct lens position. The patients were divided into 2 groups: I group--25 eyes had first surgery, II group--25 eyes had second surgery. On the first day after surgery complications and uncorrected acuity were evaluated. RESULTS: 50 eyes of 48 patients underwent operation. The mean age was 69.4 years 5% eyes had previous surgical record: 4--underwent trabeculectomy, 1--pars plana vitrectomy. The 12 intra-operative complications appeared in 10 eyes (20%): posterior capsule rupture without vitreous loss in 4% and 10% with vitreous loss, Descemet membrane detachment in 4%, iris dialysis in 2%, and persistent iris damage without sphincter disruption in 4%. The 16 postoperative complications concerned 10 eyes (20%): corneal oedema in 20%, transient intra-ocular pressure raise in 8%, hyphaema in 2%, and fibrin exudation in 2%. The majority of complications concerned the I group of eyes. The uncorrected visual acuity was 0.5 or better in 80% of eyes, on the first day after the operation. CONCLUSIONS: The use of ACM made the first steps in phacoemulsification rate during the learning course.

[Clinical use of the interaction between cyclosporine A and its inhibitors]. / Kliniczne zastosowanie interakcji pomiedzy cyklosporyna A i lekami hamujacymi jej metabolizm.

This article concerns cyclosporine A and cyclosporine--sparing agents. The drugs are evaluated due to their clinical usefulness in elevating cyclosporine blood level and their safety in long-term administration. We analyzed imidazole antifungal agents, calcium channel blockers and, additionally, pharmacological properties of cyclosporine A.