OphthaTherapy. Therapies in Ophthalmology

Floppy eyelid syndrome as an ocular condition associated with increased body mass index - classification, diagnostics and treatment

Sat, 31 Dec 2022 00:00:00 +0100

Floppy eyelid syndrome is a common ophthalmic condition characterized by a sagging eyelid, which causes its spontaneous wrinkling during sleep. It can be a result of local and systemic diseases. A characteristic group of patients who suffer from floppy eyelid syndrome are middle-aged men with an increased body mass index. Obesity in this group of patients is recognized as the strongest risk factor for the occurrence of obstructive sleep apnea syndrome. The aim of the article is to review the diagnostic methods that are used in the case of floppy eyelid syndrome. The paper also discusses therapeutic methods including surgical techniques.

The use of somatotropin and myopia

Marek E. Prost — Sat, 31 Dec 2022 00:00:00 +0100

Aim of the study: Long-term observation of changes of the eye axial length and refraction in children treated with growth hormone.

Material and methods: The studies were performed in 11 children treated with somatropin, who had eye examinations performed annually, including measurements of the eye axial length and refraction. The observation period was 5–9 years.

Results: 55% of the observed children showed an excessively increase in the axial eye length and the development or progression of pre-existing myopia.

Conclusion: The use of somatropin in children may cause excessive elongation of the eye axial length and the development or progression of pre-existing myopia.

Exudative retinal detachment and optic disc swelling in the course of posterior scleritis: case study and literature review

Małgorzata Michali, Rafał Pławszewski, Edyta Sutor — Sat, 31 Dec 2022 00:00:00 +0100

Objectives: The objective of the present paper is to present a rare case of posterior scleritis with exudative retinal detachment and optic disc oedema.

Materials: The paper discusses a case of a 28-year-old patient with unilateral posterior scleritis, exudative retinal detachment and optic disc oedema. The patient presented with reduced visual acuity and inflammation within his right eyeball coat.

Test results: Upon admission, retinal detachment in all quadrants was diagnosed, with subretinal exudate, choroidal folds, but no pathology involving the anterior segment. B projection ultrasound revealed thickening of the posterior sclera of around 2.0 mm and complete retinal detachment in the right eye. Visual acuity results were OD = 1/50 Sc, OS = 45/50 Sc. Elevated intraocular pressure of the right eye was detected at 44.0 mmHg A CT scan of the orbits with contrast revealed significant asymmetry of the eyeballs (right 22 × 22 mm, left 21 × 21 mm) as well as posterior thickening of the right eyeball coat to 2.0 mm. On top of that, on the second day of the patient’s hospital stay, an ophthalmic exam showed obscured borders of the right optic nerve. Systemic treatment was initiated, comprising steroids, non-steroidal anti-inflammatory drugs and intraocular pressure lowering drugs. Additionally, topical treatment was provided with regard to the right eye. A number of laboratory tests were carried out to rule out systemic diseases that could have caused posterior scleritis. After discharge, the patient received follow up care from the hospital’s ophthalmology clinic and remained on topical and systemic steroids. Oral systemic steroid therapy was maintained over a period of a few months, with gradual dose reduction. At follow-up visits, his visual acuity remained stable at OD = 40/50 Sc, OS = 45/50 Sc.

Conclusions: Posterior scleritis is a condition that requires prompt diagnosis and systemic treatment.

Do preservatives enhance corneal permeability and thus the effectiveness of ophthalmic drugs?

Marta Misiuk-Hojło, Martyna Tomczyk-Socha — Sat, 31 Dec 2022 00:00:00 +0100

Preservatives used in ophthalmic preparations are chemical compounds with an antibactericidal effect. They ensure the sterility of the drug, preventing accidental contamination with microorganisms and the development of microorganisms in the bottle, which may cause infection of the eye tissues, and additionally change the physicochemical properties of the active substance. The most commonly used preservative in ophthalmology is benzalkonium chloride which, by acting as a surfactant, unseals the connections between corneal epithelial cells, facilitating the penetration of the drug. Studies in rabbits using benzalkonium chloride have shown a significant increase in corneal penetration. Studies comparing the same effectiveness of drugs without preservatives in relation to drugs with preservatives have been carried out many times, showing similar effects of preparations in most studies. Some studies, however, describe a better effect of preserved drugs, which will be presented in the article.

Choroidal neovascularization related to melanocytic naevus – a single centre study

Emilia Zwolińska, Iwona Rospond-Kubiak — Sat, 31 Dec 2022 00:00:00 +0100

Purpose: To assess the angiographic and optical coherence tomography angiography (OCTA) features as well as the natural course of the choroidal neovascularization (CNV) associated with choroidal naevi.

Setting/venue: Ocular Oncology Service, Department of Ophthalmology, Poznan University of Medical Sciences.

Material and methods: Retrospective chart analysis of the patients who presented to the Ocular Oncology Service in Poznan, Poland between 2011–2021 with the diagnosis of suspicious choroidal naevus. In all patients full ophthalmic examination and multimodal imaging, including fundus photography, autofluorescence, B-ultrasound, optical coherence tomography (OCT), OCT angiography (OCTA) and fluorescein angiography (FAF), were performed.

Results: There were 9 lesions in 9 patients, 9 women aged 14–79 years (mean age: 58.2 years). All the lesions were located in the posterior pole and most of them were pigmented (88.9%). CNVs associated with choroidal naevi were type I in 66.7% and type II in 33.3% of cases. 5 patients required treatment: anti-VEGF injection (alone or with transpupillary thermotherapy) was administered. The median follow-up was 24 months (range: 2–145). In two of all treated patients (40%), we observed BCVA gain (2–4 lines), in one patient (20%) it remained stable and in two (40%) it deteriorated. The final visual acuity was below 0.1 only in 1 patient. During the period of observation none of the lesions progressed to uveal melanoma.

Conclusions: CNV associated with choroidal naevus could be the reason for subretinal fluid (SRF) leakage and visual loss. The response to anti-VEGF treatment is satisfactory in the majority of patients. Choroidal naevi with accompanying CNV have none or very low malignant transformation potential.

Sutureless transscleral intraocular lens implantation – own observation study

Hanna Jakubowicz-Laska, Małgorzata Marczak — Sat, 31 Dec 2022 00:00:00 +0100

Aim of the study: Presentation of the results of Carlevale™ intraocular lens implantation with a transscleral sutureless fixation method, based on our own experience.

Material and methods: The sutureless transscleral implantation of a Carlevale™ lens was performed in 39 people (40 eyes) with postoperative aphakia after dislocation of lens, including 10 post-traumatic ones, and in one patient with a dislocated transscleral intraocular lens fixated with non-absorbable sutures. Patients were followed for 6 to 18 months.

Results: 80% of patients after surgery achieved visual acuity equal to or better than before surgery (20% achieved Snellen acuity 1.0 without correction). Intraoperative and postoperative complications were observed in slightly more than half of the patients. The most common were keratopathy, slight bleeding into the vitreous chamber, conjunctival wound dehiscence, and intraocular pressure fluctuations. Most of these complications did not have any lasting consequences.

Conclusions: Sutureless transscleral implantation of an intraocular lens seems to be an effective and relatively safe method of treating aphakia. However, the assessment of the durability of sutureless fixation requires further research.

Systemic contraindications for laser vision correction – an overview

Zofia Pniakowska, Piotr Jurowski, Joanna Wierzbowska — Sat, 31 Dec 2022 00:00:00 +0100

Laser vision correction (LCV) is a common corneal surgery for the treatment of refractive errors. The rapid development of LVC techniques make this procedures safe and efficient. Despite the high safety profile of corneal refractive surgery, there are however some clinical conditions that constitute absolute or relative contraindication for this procedures. The aim of the paper was to overview and summarise the currently known systemic contraindications for LVC.

Causes of disqualification from the laser vision correction surgery

Dominika Kalwa-Grabowska, Ilona Piotrowiak-Słupska, Bartłomiej J. Kałużny — Sat, 31 Dec 2022 00:00:00 +0100

The aim of the article is to establish the reasons for disqualification from laser vision correction surgery and to compile data on the most common reasons for not qualifying for the procedure. The specific patients in which the procedure can be performed should be carefully considered. For people who are not qualified for surgery, there are many alternative methods of correcting vision defects.

Beyond monofocal optics, below extended depth of focus IOLs – new standard in cataract surgery with monofocal plus?

Andrzej Dmitriew, Ewa Goździewska, Jarosław Kocięcki — Sat, 31 Dec 2022 00:00:00 +0100

Recently, due to higher demand for presbyopia correction, we are seeing an increase in the variety of premium intraocular lenses, which are used during cataract surgery. Premium intraocular lenses include multifocal lenses, lenses with extended depth of focus/field, and recently developed enhanced monofocal or monofocal plus lenses. In the article, we discuss the characteristics of monofocal plus lenses and lenses with extended depth of focus/field, the basics of enhanced monovision technique, and general rules of patient’s qualification for these types of lenses.