OphthaTherapy. Therapies in Ophthalmology

Therapeutic options in the treatment of open angle glaucoma and their use in accordance with the latest guidelines

2024-05-31T17:25:06+02:00

Glaucoma is an optic neuropathy characterized by typical damage of the optic nerve with gradual atrophy of retinal ganglion cells and visual field defects. The goal of glaucoma therapy is to reduce intraocular pressure and reduce daily pressure fluctuations. Currently, in the treatment of primary open-angle glaucoma in Poland, we use four groups of drugs: β-adrenergic receptor antagonists, prostaglandin analogues, α-adrenergic receptor agonists and carbonic anhydrase inhibitors. First-line drugs, according to the guidelines of the Polish Ophthalmological Society, are prostaglandin analogues/prostamide. When considering the addition of a second drug to prostaglandins, brimonidine lowers intraocular pressure more strongly than dorzolamide or brinzolamide, similarly as timolol does. Drug containing two active substances are as effective as substances administered in two separate drops, therefore it is advantageous to use combined drug instead of using two different drugs.

Supplementation in diet of patients with retinal diseases

2024-05-31T17:23:04+02:00

Etiology of retinal diseases, such as age-related macular degeneration or diabetic retinopathy is multifactorial, where oxidative stress and inflammation play an important role. Therefore supplementation of diet in that group of patients with proper product, which contains substances with anti-oxidant and anti-inflammatory properties is advised for reducing the risk of progression of such diseases.

Contact lenses and dry eye syndrome: can they be reconciled?

2024-05-31T17:23:06+02:00

The function of the tear film is to moisturize, lubricate, nourish, and protect the delicate surfaces of the cornea and conjunctival epithelium covering the eyeball and eyelids. A healthy tear film is crucial for shaping and maintaining a smooth refractive surface of the cornea, ensuring proper optical function of the eye by eliminating small irregularities in the epithelium. Contact lens wearers often experience various discomforts related to wearing lenses, known as contact lens discomfort (CLD), which can lead to discontinuation of lens wear. CLD is frequently associated with dry eye disease, caused by tear film disorders resulting from incorrect composition, reduced production, or excessive evaporation of tears from the ocular surface. Contact lens wear can diminish corneal sensitivity and lead to a reflex blockade of sensation, causing a deficiency in the aqueous layer of the tear film. Additionally, wearing contact lenses may increase tear evaporation due to reduced blinking frequency and incomplete eyelid closure during blinking. This paper discusses therapeutic approaches and modifications in lens fitting aimed at maintaining a healthy ocular surface and improving comfort for contact lens wearers.

The role of resveratrol in inhibiting the development and progression of oxidative stress-induced retinal diseases

2024-05-31T17:23:39+02:00

In recent years, the importance of resveratrol as a biologically active natural nutrient with potential to prevent the development and progression of age-related degenerative diseases has been analyzed. The aim of the study is to review the current literature from the last 10 years or so, dealing with the subject of resveratrol properties, its impact on systemic condition and retinal diseases. This review confirms the important beneficial role of resveratrol and dietary supplements containing resveratrol in limiting the development and progression of diseases related to oxidative stress. The range of action of resveratrol is systemic, as evidenced by research. In ophthalmology, resveratrol is used primarily in degenerative retinal diseases and complications of metabolic diseases in which oxidative stress plays a key role. The data from the conducted studies provide the basis for the assumption that thanks to compounds such as resveratrol, we may gain a real impact on the occurrence of e.g. age-related macular degeneration and its course.

The influence of high additions in multifocal contact lenses for myopia control on binocular vision

2024-05-31T17:23:46+02:00

Objectives: This study aimed to investigate the influence of soft multifocal contact lenses with high additions designed for myopia control on binocular vision in young adults.

Methods: A prospective randomized, double-blind study including 24 subjects aged between 18 and 36 years. Subjects were divided into two groups. The first group wore multifocal soft contact lenses (MFSCLs) with a 3.0 mm central zone diameter, while the second group wore contact lenses with 4.5 mm central zones. Each subject was fitted with two MFSCLs: one with +2.00 D and the other with +4.00 D peripheral addition power and, additionally, with plano single vision contact lenses (SVCLs). Phoria at a distance and near, distance and near vergence ranges, vergence facility at near, stereopsis at near, and fixation disparity at near were measured in each study lens type.
Results: No significant influence of addition on distance phoria was found in either group (p = 0.446 and p = 0.317, for 3 mm and 4.5 mm central zone diameter, respectively). Additionally, no significant difference was observed for any MFSCLs and SVCLs in near phoria (p = 0.320), near vergence facility (p = 0.197), or near fixation disparity (p = 0.203). A decline in fusional vergence ranges at a distance in the base-out direction was noted in subjects wearing +4.00 D addition compared to +2.00 D addition (p = 0.002) and plano lenses (p = 0.014). Both additions reduced fusional vergence ranges at near the base out (p = 0.020) and shifted vergence ranges more in the exophoria base in directions (p = 0.014).

Conclusions: The study showed that MFSCLs with high additional power in the periphery have only a marginal impact on the binocular functions.

Treatment of conjunctivitis in the 21st century

2024-06-03T11:01:54+02:00

One of the reasons for the development of antibiotic resistance in ophthalmology is the indiscriminate use of antibiotics in the treatment of conjunctivitis, among other things. Therefore, in infectious conjunctivitis, the first-line treatment should be antiseptics rather than antibiotics. This should significantly reduce the development of antibiotic resistance, but also increase the effectiveness of treatment.

Fungal keratitis – current diagnosis and therapeutic possibilities

2024-05-31T17:21:35+02:00

Keratitis and subsequent damage to the cornea resulting from infectious causes is one of the most serious problems facing ophthalmology today. One of the most common etiologies is fungal infection. Symptoms range from pain and visual deterioration, Wessely ring, inflammatory reaction in the anterior chamber or ropost. Diagnosis in addition to the classic medical and ophthalmologic examination consists of microscopic examination of scrapings, Gram examination combined with culture gives a 90% chance of detecting a fungal etiology. Good results are also observed with PCR testing, which helps speed up diagnosis. Treatment is time-consuming and has a high risk of complications. Two techniques are used to treat fungal infections of the cornea, surgical and pharmacological, such as the antifungal polyene antibiotics nystatin, natamycin, amphotericin B or thiazole derivatives like fluconazole and voriconazole. For filamentous fungi, natamycin 5% or voriconazole 1% are used at various intervals. Natamycin, despite the much poorer availability of the drug in countries such as Africa, has much better clinical results along with a lower risk of complications, as confirmed by the MUTT. A big problem also is subsequent bacterial superinfection, leading to the need for topical antibiotics. Surgical treatment is used in case of failure of pharmacotherapy, up to 4 weeks after the diagnosis of the disease, but it carries a high risk of complications. In the early stages of the disease, a new cross-linking technique can be considered, which is described as an alternative to direct antifungal or antibacterial treatment.

Optical hazard of solar radiation on the dilated eye’

2024-05-31T17:23:43+02:00

Administration of drops to dilate pupils is a common medical procedure around the world prior to an eye examination. Drops cause clinically significant dilation of the pupil (mydriasis) and inhibit its response to the visible wavelengths [1, 2]. The energy absorbed by the retina is proportional to the aperture size [3], therefore the risk of a lesion increases with the diameter of the pupil [4]. There are a vast number of approved drugs, which brochures warn patients about potential risks. Not all mentions protecting eyesight from the light [5–7]. None of them indicate the solar radiation, the sun, the sunlight or similar as potential hazard. Within this research, I adopt international standards for artificial light sources [4, 8] to define the safety class and risk group for the solar radiation affecting the dilated eye. The solar radiation is hazardous, following standards’ thresholds [4, 8]. I indicate a lack of clarity and a single-minded approach in the drugs’ characteristics regarding this specific hazard. I encourage drug producers and medical society to validate this risk.

Clinical importance of proper regeneration of the ocular surface after cataract surgery

2024-06-03T09:20:46+02:00

Ophthalmic surgeries, including cataract surgery, lead to higher occurrence of eye surface disease. Tear film abnormalities are present in more than 60% of cataract patients. Patients with increased risk of perioperative dry eye syndrome should be treated before the surgery. Artificial tears are the first line treatment. In case they are insufficient, immunomodulants are used. Eyelid margin hygiene also exerts positive effect in patients with Meibomian gland dysfunction. Out of artificial tears ingredients, hyaluronic acid and Ginkgo biloba extract show positive effect.

The results of surgical treatment to correct eyelid retraction with blepharotomy – preliminary report

2024-05-31T17:23:19+02:00

The study presents early results of the surgical treatment of patients with fixed upper eyelid retraction exceeding 1 mm as a complication of Graves’ disease, trauma, or high myopia.

10 patients (8 women and 2 men), with an average age of 45, participated in the study. A total of 17 upper eyelids were operated on using the full-thickness blepharotomy method. According to the EUGOGO scale for the surgery 2 patients had mild retraction, 7 – moderate retraction, and 1 – severe retraction. The procedures were performed under local anesthesia, following current knowledge and described operative techniques.

Each operated patient achieved both aesthetic and functional improvement compared to the baseline. The results were evaluated based on the reduction of the upper eyelid relative to the corneal limbus, reaching a level covering the corneal limbus. The average satisfaction score obtained was 8 points in 0–10-point scale.

Blepharotomy is an effective therapeutic procedure for upper eyelid retraction, reducing eye exposure symptoms and restoring a normal appearance of the eyelids. The procedure has rare serious side effects, and patients are content with the results.

Postponed surgical management of suprachoroidal hemorrhage

2024-05-31T17:23:41+02:00

Material and methods: A 68-year-old female patient was referred to clinic with a suprachoroidal hemorrhage of the left eye arising during phacoemulsification with rupture of the lens capsule and displacement of cortical masses into the vitreous chamber. She reported severe complaints of pain in the left eye. Her visual acuity was at a level of light perception with no localization and intraocular pressure (IOP) at 60 mmHg. B-projection ultrasonography showed significant elevation of the choroid with dense echoes of extravasated blood in the suprachoroidal space. After analysis of the local and clinical condition, a vitrectomy procedure was performed from the pars plana approach (PPV). Due to persistently high IOP, the patient was qualified for a PPV again, 23 days after the suprachoroidal hemorrhage has occurred.

Results: The follow-up, 10 days after the second PPV procedure, has shown an improvement of the local condition and normalization of intraocular pressure to a 17 mmHg. The patient reported no complaints of pain.

Monofocal plus – future or present?

2024-05-31T17:25:09+02:00

The implantation of extended deep-of-focus intraocular lenses during cataract surgery allows patients to achieve spectacles independence. Correct calculation of the power of the lenses and the use of monovision significantly improves the level of satisfaction after the procedure. The choice of the target postoperative refraction of the dominant eye within the limits of emmetropia and the non-dominant eye with slight myopia within the range of -1.0 D can provide satisfactory visual acuity for a long distance, intermediate and near vision, without the need for glasses. Some authors classify some types of monofocal plus on an equal footing with lenses with an extended depth of focus. They are the latest solution in cataract surgery and are characterized by a low tendency to cause side effects typical of multifocal lenses.