OphthaTherapy. Therapies in Ophthalmology

The morphology of epiretinal membranes in SS-OCT and SS-OCT angiography and its impact on surgical outcomes

2025-01-14T09:05:26+01:00

The aim of this review is to revisit the current state of knowledge regarding epiretinal membranes, explore current methods of medical diagnosis, and assess the impact of Swept-source OCT (SS-OCT) and SS-OCT angiography (SS-OCT A) on therapeutic procedures. Several attempts have been made to establish a staging classification system for this well-known retinal pathology, yet not all of them proved to be clinically useful. This work intends to improve understanding of the pathophysiology of the disease, selecting the most important symptoms to aid classification according to the stage of advancement and correct recognition of the appropriate moment of surgical intervention to achieve a better postoperative effect. This article demonstrates the benefits of using SS-OCT and SS-OCT A in the treatment of epiretinal membrane, describing the morphological changes of the retina that can be observed.

Is there a relationship between the microbiome of the paranasal sinuses and nasal cavity and the primary acquired nasolacrimal duct obstruction? Literature review

2025-01-14T09:05:17+01:00

Hormonal factors, atopy, viral infections, gastroesophageal reflux, ischemic heart disease and swimming in a pool are believed to affect the development of primary acquired nasolacrimal duct obstruction (PANDO). It is suggested that patients with PANDO have more advanced inflammatory lesions revealed by the tomographic examination of the paranasal sinuses. The authors’ aim was to answer the question whether there is a connection between the chronic inflammation and disruption of the microbiome of the nasal cavity and sinuses and the development of inflammation in the lacrimal ducts.

Pubmed.gov was the information source. Years reviewed included 2018 to 2023. Inclusion criteria included presence of an abstract, pathology of the nasolacrimal ducts, acute and chronic inflammation of the nasolacrimal ducts, papers written in English, studies on humans, publications regarding pathology of the lacrimal sac and paranasal sinuses, case report. The exclusion criteria included: lack of abstract, pathologies of other sections of the drainage system, pathology of the nasolacrimal ducts, other than chronic or acute inflammation, papers written in a language other than English, lack of case report. No gender criterion was used.

Based on the data available in the literature, only 7 studies described the co-occurrence of pathologies of the lacrimal ducts and paranasal sinuses. Only 4 publications contained information on the microbiome and identified Streptococcus intermedius and Staphylococcus aureus, and in 2 cases no increase in pathological flora was revealed.

The question about the relationship between the microbiome of the lacrimal sac and the paranasal sinuses and their mutual impact on the developing inflammation has not been answered, which, according to the authors, requires further research.

Therapeutic options in the treatment of inflammatory glaucoma

2025-01-14T09:05:03+01:00

Therapeutic options in inflammatory glaucoma, both pharmacological and surgical methods, have been presented in this paper. Main goals of pharmacotherapy are: controlling inflammation and reducing intraocular pressure. Anti-inflammatory drugs primarily include topical glucocorticosteroids but also nonsteroidal anti-inflammatorydrugs and immunomodulatory therapy. Elevated intraocular pressure is treated with β-blockers, carbonic anhydrase inhibirozpotors, prostaglandin analogues and α2-adrenergic receptor agonists. If pharmacological treatment does not produce the desired results, surgical treatment must be considered. Due to the risk of reactivation of inflammation, it is recommended that it be performed 3 months after the inflammation has healed. Currently, trabeculectomy remains the gold standard. Among the invasive treatment techniques, we discuss trabeculectomy with the use of mitomycin C, micro-hook trabeculectomy, laser therapy, glaucoma drainage implants, deep sclerectomy and viscocanalostomy.

Treatment of Acremonium sp. keratomycosis – a review of literature

2025-01-14T09:05:24+01:00

Corneal infections may be caused by bacteria, viruses, fungi or protozoa. Fungal keratitis, usually associated with Fusarium, Candida and Aspergillus, develops from a saprophytic fungal infection as well, one of the agent being Acremonium sp. Acremonium infection occurs when a patient is suffering from a penetrating injury, common in ophthalmic patients. Symptoms of Acremonium- induced keratomycosis are similar to the usual presentation of a fungal infection – patients complain of decreased visual acuity, ocular pain, redness of the eye, floaters and corneal opacity. While there is no established method of treatment for Acremonium keratitis, usual antimycotics and antibiotics intended for keratomycosis are used – fluoroquinolones, azoles and polyenes. If pharmacotherapy does not yield favorable outcomes, surgical forms of treatment should be introduced, such as keratoplasty. If surgical methods are ineffective in infection control, an end-stage solution – enucleation is employed. Although Acremonium is an opportunistic fungal pathogen, the infection is generally effectively treated using pharmacotherapy.

Optimizing the care of the red eye patient: a new treatment direction

2025-01-14T09:05:07+01:00

Eye redness may be the result or symptom of various eye diseases or may appear for no apparent reason. In the case of red eye, therapeutic treatment is based on the correct diagnosis and, if possible, on causal treatment.

Therapeutic strategies in the treatment of local conjunctival hyperemia are also based on preventing vasodilation and thus reducing the red eye symptom.

Vasodilation is dependent on α-adrenergic receptors. Two classes of adrenergic receptors in the eye: α₁- and α₂ adrenergic receptors, which are responsible for the vascular tone of the conjunctiva. The end result of binding of agonists to α₁- and α₂-adrenergic receptors is vasoconstriction. However, the use of vasoconstrictor drugs is associated with the occurrence of tachyphylaxis, i.e. a decrease in effectiveness with long-term use and a rebound effect defined as hyperemia, which becomes even more severe after discontinuation of treatment. The introduction of brimonidine, which is a selective α₂-adrenergic agonist, into the treatment resulted in a reduction of these effects, which is also due to its effect on venous vessels and not causing the symptoms of tissue hypoxia. Compared to other vasoconstrictor drugs, it offers hope for patients with red eye symptoms to improve the local condition and their quality of life.

Management of ocular surface disorders according to the guidelines of the Tear Film & Ocular Surface Society Dry Eye Workshop (DEWSII) Report

2025-01-14T09:05:05+01:00

Ocular surface disorders, including dry eye disease, affect 5–50% of the population, with prevalence increasing with age, especially among women. Symptoms such as dryness, burning, and eye fatigue significantly reduce quality of life. The tear film consists of aqueous-mucin and lipid fractions, providing protection and hydration for the eye. Meibomian gland dysfunction, which disrupts the lipid layer, accounts for most cases of dry eye disease by causing excessive tear evaporation. A modern approach to ocular surface disorder therapy, combining pharmacotherapy, neuromodulation, and advanced technologies, may relieve daily chronic eye pain.

Eye-drops in therapy – facts and myths about preservatives

2025-01-14T09:05:10+01:00

Drugs in ophthalmology are most often applied topically in the conjunctival sac. All preparations administered through this route must meet specific requirements and, therefore, not just a simple solution or suspension of the drug in water. In addition to the therapeutic substance, eye drops contain various additives: buffers, preservatives, stabilisers, antioxidants, and isotonic substances to increase solubility and viscosity. Excipients are essential components of drugs that determine their quality and properties and can increase the effectiveness of treatment, e.g. by increasing the penetration of the drug through biological barriers. However, because of the high demands placed on ocular medicines, the choice of excipients is very limited.

This article discusses the facts and myths surrounding the use of excipients, including preservatives, in eye drops.

Negative dysphotopsia after cataract surgery – a problem that exists

2025-01-14T09:05:12+01:00

The aim of this review is to present the most recent knowledge, based on available references, about the problem of negative dysphotopsias, which occur after cataract surgeries. It seems however, despite being quite frequent when taking into account the number of cataract excisions, it lacks common knowledge. Up to this day, the principle of the symptom has a lot of unknowns. Surgical and non-surgical solutions used in cases of unacceptable levels of patient symptoms will be discussed.

A review of conservative and therapeutic management in the treatment of pterygium

2025-01-07T22:52:58+01:00

Pterygium is a degenerative change consisting of an abnormal overgrowth of the degenerative conjunctiva, which grows on the cornea and causes discomfort and progressive vision problems. The initial symptom of pterygium may also be local, chronic and recurrent conjunctivitis. Some of the most common causes of this disease are exposure to UV radiation, the irritating effect of wind and dust, as well as local insufficiency of limbal stem cells. In the following article, we will discuss the available treatment methods and their impact on the prevention of pterygium recurrence, as well as focus on the pharmacotherapy used to support recovery after surgery.

Monofocal plus lens – a perfect solution for (nearly) every patient? Surgeons’ own experience with RayOne EMV

2025-01-14T09:05:09+01:00

Objective: This article aims to briefly characterise the most popular IOLs on the market and focus on Rayner EMV: monofocal plus lens being a very good compromise between a good deal of spectacle independence, its price and coexisting ocular conditions allowing for its implantation. Setting the postoperative refraction at minimonovision as was done in this study allows for even greater depth of field and thus minimalizes the need for glasses when performing most everyday activities.

Methods: To summarise the IOLs characteristics a literature search was conducted. In the second part of the article surgeons’ own experience is shown together with postoperative results and patients’ satisfaction survey.

Results: Uncorrected binocular visual acuity was very high: 74% of patients reached 6/6 on Snellen chart or better, and for 96% of patients mean UCVA both eyes was 6/6.5 or better. Mean binocular UCVA both eyes was 6/5.5. Near visual acuity score: 43% of patients did not require spectacle correction for near reading and 91% of patients were able to read line D-0,75 or more on Snellen reading chart. Halo or glare effect were noted in 5 cases but only in two of them resulted in lower score in patients’ satisfaction questionnaire (to 64 and 79% of maximum score). In three remaining cases patients gave 95% of maximum score and stated that even though they noted halo and / or glare it did not comprise their visual quality. In patients’ satisfaction questionnaire score given by drivers was 90%; non-drivers were even more satisfied and gave 92% of maximum score – it shows very high percentage of satisfied patients in both groups.

Conclusion: Rayner EMV IOL is an affordable and valuable option for patients who would like to increase their spectacle independence postoperatively and should be considered along with premium multifocal IOLs. Reducing spectacle dependence with the pseudophakic mini-monovision technique could improve the functionality, independence and quality of life for many patients.

Homocystinuria as a cause of ocular complications requiring surgical intervention

2025-01-14T09:05:14+01:00

A 41-year-old man underwent surgery in both eyes due to diagnosed lens subluxation with significant decrease in visual acuity. In the left eye, an acute attack of angle-closure glaucoma caused by lens subluxation into the anterior chamber resulted in a combined procedure of lensectomy with posterior vitrectomy and silicone oil endotamponade due to iatrogenic retinal detachment. In the right eye, a procedure was performed to remove the subluxated natural lens with simultaneous intrascleral fixation of an artificial lens. During this procedure, the author’s “Vampire” technique was used to facilitate the removal of the practically subluxated natural lens and reduce the risk of vitreous loss. Due to intraoperative complications, the left eye required further surgical procedures. Silicone oil removal from this eye was combined with repeat diagnostic testing to identify the cause of lens subluxation. The cause was found to be previously undiagnosed homocystinuria.

SMILE (small incision lenticule extraction): New horizons in laser vision correction procedures-limited invasiveness in light of recent research.

2025-01-14T09:05:20+01:00