OphthaTherapy. Therapies in Ophthalmology

Artificial Intelligence in Ophthalmology – Threat or Aid?

Jakub Joński — 2024-06-12

Objective: This review seeks to identify and analyze the drawbacks and advantages associated with the integration of artificial intelligence (AI) into the field of ophthalmology.

Methods: A comprehensive review of scientific literature, articles, and publications on PubMed was undertaken. Various aspects, including the effectiveness and diagnostic speed of diabetic retinopathy, as well as ethical considerations and data security, were evaluated. Results were meticulously checked, compared, and summarized. In total, 98 articles were scrutinized using keywords in both Polish and English, including “artificial intelligence,” “ethics,” “diabetic retinopathy,” and “machine learning.”

Results and discussion: The application of AI in ophthalmology demonstrates significant potential in improving the diagnosis of diabetic retinopathy. AI-based systems not only contribute to facilitating and streamlining the diagnostic and therapeutic processes but also enhance therapy efficiency. However, issues related to patient data protection, physician responsibility, the cost of training adequately skilled personnel, trust in the accuracy of diagnoses, and the long-term consequences of replacing human intervention with AI necessitate careful consideration.

Conclusions: AI presents substantial opportunities in ophthalmology but simultaneously poses challenges that demand diligence and attention. It is imperative to develop norms and guidelines for the responsible use of AI in ophthalmic practice, ensuring benefits for patients while minimizing potential risks and maintaining high ethical standards. This proactive approach is crucial for harnessing the full potential of AI in healthcare.

Idiopathic macular hole – literature review

Agata Niedzielska-Krycia — 2024-06-12

Full-thickness idiopathic macular hole (MH) is a common cause of visual loss, affecting 3 per 1000 people. It usually affects females in their sixth to eighth decades of life. Best Visual Acuity decreases to less than 0.5. A typical MH’s symptom is the pincushion metamorphopsia, where the shape of an observed object is enrolled inwards and lines are bowed towards the center, in the direction of the fixation point. Over the years many theories of MH formation have been revealed. A recently approved theory states that vitreomacular adhesion with focal contraction of the perifoveal cheloid and pathologic traction can lead to a loss of full-thickness central retina causing a MH. The most valuable diagnostic procedure for MH is optical coherence tomography. Among other useful examinations are fluorescein angiography and angio-OCT. Classification of the stages of development of MH is done with an anatomical Gass classification and the recent The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and MH. Natural history of the MH differs in the early and advanced stages. Pharmacological vitreolysis with ocriplasmin is used in the treatment of the disease. The most effective therapy is the posterior pars plana vitrectomy. Dye and peeling of the internal limiting membrane helps to achieve the closure of the MH and the good visual acuity.

Dry eye disease – the problem of modern days

Marta Misiuk-Hojło — 2024-06-30

Dry eye syndrome is a common ophthalmic condition caused by a deficiency in the tear film, leading to discomfort and damage to the ocular surface. Dry eye syndrome is divided into three main categories: ADDE (aqueous deficient dry eye), EDE (evaporative dry eye), and a mixed form. Diagnosis involves assessing clinical symptoms, laboratory tests, and patient history. Treatment depends on the cause and severity of symptoms, including artificial tears, anti-inflammatory medications, autologous serum eye drops, and innovative lipid microemulsion eye drops. These modern drops stabilize the tear film, protect the ocular surface, and support regenerative processes, providing patients with relief and improved quality of life.

Pigmentary glaucoma – a case report

Katarzyna Paczwa — 2024-06-30

Pigmentary glaucoma is a type of secondary open-angle glaucoma. Mainly it is a consequence of pigment dispersion syndrome, which is characterized by pigment accumulation in the anterior segment of the eye. Pigment in the trabecular meshwork can cause increased intraocular pressure leading to glaucomatous damage of the optic nerve. We present a case of 40-year-old myopic male with typical symptoms of pigmentary dispersion syndrome who received late diagnosis of the disease. The correct diagnosis of pigmentary dispersion syndrome is crucial in preventing glaucomatous vision impairment.

Clinical and therapeutic profile of patients with glaucoma treated with latanoprost without macroglycerol-40 hydroxystearate (MGHS-40) – observational study

Małgorzata Zdzieszyńska — 2024-06-26

Purpose: The aim of the study was to evaluate the clinical and therapeutic profile of patients with open-angle glaucoma (OAG) and intraocular hypertension (IHT) who were treated with latanoprost eye drops without macroglycerol-40 hydroxystearate (MGHS-40).

Methods: This was a multicenter, open-label, observational, non-interventional study evaluating the clinical and therapeutic profile of patients with glaucoma who received therapy with latanoprost eye drops, without MGHS-40. The study, conducted between April 2022 and July 2023, involved 7171 patients and 270 physician-investigators from across the country. The study included adult patients with OAG and IHT in whom the physician made an independent decision to change therapy or include a drug containing latanoprost without MGHS-40.

Results: The results of the study showed that the mean intraocular pressure in this group of patients was 22.6 mmHg. Most of the study participants had a diagnosis of comorbidities – the most common being high blood pressure. Risk factors for OAG were also noted in more than 70% of patients. Predominant among these were a positive family history and smoking.

Conclusion: Our study shows that the latanoprost therapy without MGHS-40 is effective in lowering intraocular pressure. The main factors determining a doctor’s decision to use latanoprost without MGHS-40 were good topical tolerability and a simple formulation. The results suggest that this formulation has properties that could enhance patient compliance, possiblyincreasing long-term intraocular pressure-lowering effectiveness.

Latanoprost drops without added detergent in the treatment of glaucoma

Marta Misiuk-Hojło — 2024-06-30

Chronic nature of both the disease and its therapy forces ophthalmologists to choose the treatment with the lowest potential for adverse reactions, which may be caused by the active substance, excipient or preservative. Detergents used in ophthalmic drops include a derivative of macrogolglycerol hydroxystearate-40 (MGHS-40), which in in vitro tests showed pro-inflammatory and cytotoxic properties towards corneal epithelial cells, and this effect increased with increasing concentration and time. The analyzed observational study showed that latanoprost without MGHS-40 effectively reduces intraocular pressure, and the factors encouraging ophthalmologists to choose this preparation were good local tolerance and a simple composition (without detergents, preservatives and antioxidants), improving compliance. In the observational study, 82.3% received latanoprost without MGHS-40, and almost 60% started antiglaucoma treatment with this preparation.

Efficient antiseptic prophylaxis in the era of antibiotic resistance

Joanna Adamiec-Mroczek — 2024-10-03

An excessive use of antibiotic preparations in daily practice frequently without clear medical indications has led to the development of dangerous strains of bacteria resistant to the available pharmaceutical drug. Today, antibiotics are used not only to treat infections, but also as preoperative infection prevention. Intravitreal injection is one of the most commonly performed ophthalmological procedures where, until recently, perioperative antibiotics prevention was recommended. Currently, antibiotics in this procedure are not advised at all. Nowadays, for anti-infective prophylaxis we use iodopovidone and preparations that combine antiseptic and soothing effects.

The role of oxidative stress in retinal diseases

Anna Nowińska — 2024-10-03

Oxidative stress plays a key role in the pathogenesis of many diseases associated with aging, including atherosclerosis, neurodegenerative diseases, diabetes, and retinal diseases. The retina is a tissue that is particularly susceptible to the adverse effects of oxidative stress, as it is characterized by high metabolic rate and high oxygen consumption compared to other body tissues. This review article discusses the relationship between the cellular mechanisms of impaired prooxidant-antioxidant homeostasis and the development of age-related macular degeneration and diabetic retinopathy. Natural defense mechanisms of maintaining redox homeostasis and therapeutic strategies based on the use of antioxidants are also described.

Laser vision correction and binocular vision – case reports

Wiktor Truszkowski — 2024-06-30

Laser vision correction (LVC) is the removal of refractive errors, by changing the geometry of the cornea. It doesn’t directly affect binocular vision. However, the condition of the patient’s binocular vision is a very important. That affects the quality of life, which also indirectly translates into the patient’s satisfaction with the LVC procedure. Based on the presented cases, this article proves how important it is to examine binocular vision before laser vision correction. The influence of the prismatic effect of spectacle lenses on the control of binocular vision and the risk of strabismus decompensation, which
is most often associated with double vision. The described cases are people with problems with binocular vision. The article includes methods of treatment (contact lens test, vision therapy) to check and eliminate the above-mentioned problem.

Management strategies in benign eyelid lesions

Anna Jagielak-Grab — 2024-06-30

Eyelid tumors are a common discovery during an ophthalmological or dermatological examination. According to available knowledge, they constitute about 5–10% of skin tumors. The majority of them are benign and can be classified as inflammatory, infectious, traumatic or neoplastic lesions. Depending on the lesion type, there are different approaches to management that include: observation, topical application of steroids or antibiotics, injection of steroids, application of warm compresses, biopsy, excision, curettage, various types of laser therapy or plasma-based therapies, cryosurgery and electrocautery. Malignant eyelid tumors are not rare, therefore, an accurate diagnosis is crucial to provide best suited type of treatment. In many cases, an experienced physician is able to distinguish a benign lesion basing on clinical examination, however, it is often difficult to differentiate benign tumors from malignant and premalignant lesions. In case of any uncertainty, a biopsy followed by histopathological examination should always be taken into consideration.

Therapeutic approach to ocular coloboma - a case report of a 37-year-old patient with high myopia and choroidal coloboma of the right eye

Klaudia Szala — 2024-06-17

Introduction: Coloboma is a congenital malformation caused by a defect of optic fissure closure. We report a rare case of choroidal coloboma and management of possible complications.

Clinical case: A 37-year-old patient presented for the current evaluation of uveal coloboma located in the inferior-nasal quadrant with the involvement of the optic disc and advanced high myopia.

Conclusions: The management of coloboma includes follow-up of visual acuity level, anterior segment and fundus evaluations. Retinal detachment, cataract and choroidal neovascularization may occur secondary to the defect. Pars plana vitrectomy, autologous neurosensory retinal transplantation and laser therapy are considered methods in present case.

Levator palpebrae superioris lengthening in the treatment of keratopathy caused by lagophthalmos after orbital inflammation

Rafał Woś — 2024-06-12

This study aims to evaluate the efficacy of various management strategies for lagophthalmos in a 56-year-old female patient, with a focus on both non-surgical and surgical interventions. The patient underwent an array of non-surgical treatments, including artificial tears, ointments, and therapeutic contact lenses, aimed at maintaining ocular surface integrity. For surgical intervention, the study compared the outcomes of gold weight implantation (GWI), platinum weight implants, modified tarsorrhaphy (MT), and the elongation of the aponeurosis levator superioris muscle. Non-surgical management provided symptomatic relief and temporary protection of the corneal surface. Botulinum toxin A injection may result in improved eyelid closure without significant adverse effects. Surgically, GWI and platinum implants effectively reduced corneal exposure, though the latter presented fewer complications. MT proved advantageous in terms of accessibility and cost. The elongation technique showed improved aesthetic and functional outcomes, as evidenced by patient satisfaction scores.

Malignant glaucoma: disease course and treatment

Natalie Papachristoforou — 2024-06-30

Diagnosis of malignant glaucoma presents a challenge due to subtle symptoms in early stages of the disease, making increased intraocular pressure a pivotal indicator, often accompanied by inflammation and corneal edema. Diagnostic modalities, including ultrasound biomicroscopy and anterior segment optical coherence tomography, play crucial roles in visualizing anatomical changes in the ciliary body and anterior chamber. The classic slit lamp examination, complemented by tonometry, remains a fundamental diagnostic tool. A stepwise therapeutic approach is essential, beginning with pharmacological interventions aimed at intraocular pressure reduction and subsequent restoration of the anterior chamber configuration. The first stage of treatment is pharmacotherapy. Laser therapies, such as iridotomy and Nd:YAG laser treatment, address angle closure. In resistant cases, a surgical approach, such as irydo-zonulo-hialoidotomy may be considered.