OphthaTherapy. Therapies in Ophthalmology

Differential diagnosis of pituitary macroadenoma before performing head and orbits neuroimaging

Grzegorz Rotuski, Jaromir Wasyluk, Radosław Różycki — Mon, 31 Mar 2025 00:00:00 +0200

Visual field defects resulting from compressive or infiltrative lesions in the visual pathway often differ from typical textbook patterns. This results from asymmetric tumor growth or uneven impact of individual nerve fibres, which also differ in their susceptibility to damage. In addition, the reliability of perimetry based on false positive and negative errors on the part of the examined person must be taken into account. Neuroimaging comes in handy with interpretation of doubtful cases. Unfortunately, sometimes the visual field defects can mimic glaucomatous defects, especially in correlation with elevated intraocular pressure as an incidental finding. This delays making the critical diagnosis and proper treatment of the patient. In ophthalmological practice, knowledge of the proliferative processes of the central nervous system, together with the basic characteristics of these diseases, plays a crucial role in the clinical assessment of indications for extended diagnostics.

Ocular manifestations as the first symptom or manifestation of COVID-19: a literature review

Mon, 30 Sep 2024 00:00:00 +0200

The aim of this review is to analyze the available scientific literature on the impact of COVID-19 on eye health. A systematic literature review was conducted using medical databases. The focus was on publications regarding the ophthalmic manifestations of COVID-19, analyzing reported symptoms and pathophysiological mechanisms. The literature analysis revealed that COVID-19 can manifest as various eye conditions, such as conjunctivitis, keratopathy, uveitis, retinopathy, and optic neuropathy. Additionally, cases related to retinal microangiopathy and thrombosis have been described, which can lead to permanent vision loss. These findings suggest that SARS-CoV-2 may directly or indirectly affect various structures of the organ of vision through inflammatory and thrombotic mechanisms.

Low-level light therapy as a potential prophylaxis of myopia: a literature review

Michael Chandra Sarsono — Mon, 31 Mar 2025 00:00:00 +0200

Myopia is a common refractive problem found in children and adults. High myopia can lead to severe ocular complications; therefore, controlling myopia is very important as a prophylactic measure. Low-level light therapy (LLLT) is starting to be widely used as an intervention to control myopia. This article describes myopia control using LLLT, aiming for the public and clinicians to understand and utilize this technology optimally. Based on clinical studies and randomized controlled trials (RCTs), LLLT was shown to be effective in controlling myopia through significant changes in axial length (AL), spherical equivalent refraction (SER), and choroidal thickness. Although the current studies are from China, LLLT can also be considered for myopia control in other countries.

Nodular posterior scleritis with recurrence in contralateral eye – case report

Paulina Siwik, Tomasz Chudoba, Joanna Sempińska-Szewczyk — Mon, 31 Mar 2025 00:00:00 +0200

Posterior scleritis is a rare, in 80% idiopathic disorder. It can be divided into 2 subtypes: diffuse and nodular. The aim of this study is to report clinical, imaging findings, differential diagnosis and treatment, of a patient with nodular posterior scleritis.

A 45-year-old woman was diagnosed as recurrence of nodular posterior scleritis, after extensive examination. At admission best corrected visual acuity was 20/20 in her left eye. Fundus examination revealed an amelanotic yellowish subretinal mass under the superior nasal arcade, associated with subretinal fluid surrounding it. B-scan ultrasonography, optical coherence tomography findings confirmed the diagnosis. The patient was treated with intraveonous steroids for 3 days, followed by oral in tapered dose over 3 weeks. After 7 weeks follow-up subretinal mass totally regressed. The diagnosis of nodular posterior scleritis may provide diagnostic dilemma. Multimodal imaging may be helpful in differential diagnosis. Majority of cases have an excellent prognosis with no recurrence.

Neuroprotection in glaucoma – what is the role of brimonidine?

Marta Misiuk-Hojło, Małgorzata Mimier-Janczak — Mon, 31 Mar 2025 00:00:00 +0200

Glaucoma is a chronic, multifactorial, progressive optic neuropathy and if left untreated, leads to total blindness. Damage to retinal ganglion cells and their axons in glaucoma may be caused by increased intraocular pressure, ischemia, oxidative stress, glutamate neurotoxicity, or deficiency of neurotrophic growth factor. Brimonidine is an α₂-adrenergic receptor agonist, a drug commonly used to lower intraocular pressure. Its action is to inhibit the production of aqueous humor and increase its outflow by an unconventional (uveoscleral) route. The neuroprotective mechanism of action of brimonidine is believed to be related to the reduction of extracellular glutamate and blocking the activation of N-methyl-D-aspartate (NMDA) receptors, as well as the activation of brain-derived neurotrophic factor (BDNF protein) and fibroblast growth factor and their receptors, vascular modulation improving microcirculation, and regulation of cell survival and apoptosis signals. Studies have shown that 0.2% brimonidine protects retinal ganglion cells from death, not only in the mechanism of lowering IOP. The use of neuroprotective treatment of retinal ganglion cells is a promising route in glaucoma therapy.

Patient treated with antimalarial drug under the supervision of a rheumatologist and ophthalmologist

Dorota Szumny, Agnieszka Matuszewska — Mon, 31 Mar 2025 00:00:00 +0200

Patients who come to see an ophthalmologist often have systemic diseases, the treatment of which can affect the condition of the eye. Such medications include the so-called antimalarial drugs chloroquine and hydroxychloroquine, which are used in the treatment of systemic lupus erythematosus or rheumatoid arthritis. During their use, regular ophthalmological follow-up is necessary.

In the early stages of antimalarial use, patients are usually asymptomatic, while advanced maculopathy or peripheral retinopathy can cause irreversible vision loss. The main risk factors for maculopathy are high doses (more than 5 mg/kg/24 h for hydroxychloroquine) and a long duration of use (greater than 5 years). Renal or liver impairment or concomitant use of tamoxifen increase the risk of ocular damage. Risk factors also include age and concurrent retinal disease.

Ophthalmic screening should include evaluation of visual acuity, colour vision, Amsler test, fundus and additional tests such as optical coherence tomography, electroretinogram, fundus autofluorescence, and visual field. The decision to discontinue the drug should be made jointly with the rheumatologist or attending physician, after taking into account the systemic effects of the drug.

Updates on eyelid hygiene influence on the ocular surface health

Monika Udziela — Mon, 31 Mar 2025 00:00:00 +0200

The ocular surface diseases including dry eye syndrome are still increasing issue among patients worldwide. This is related to climatic changes, nutrition, lifestyle, environment of work, and other factors. Symptoms and signs occur in patients of diff erent age-groups. One of the important element of prophylaxis and treatment of the ocular surface disorders is eyelid margin hygiene. Non appropriate management might be ineff ective and even may lead to some complications.

Digital eye strain – myth or reality?

Tue, 31 Dec 2024 00:00:00 +0100

The digital revolution brought about a rapid rise in the popularity of digital technologies, reshaping every aspect of life. Technological progress and frequent use of electronic devices have led to vision problems known as Computer Vision Syndrome or Digital Eye Strain. Digital eye strain, asthenopia, and computer vision syndrome refer to a group of symptoms resulting from using digital screens, including eye irritation and dryness, accommodation and convergence issues, and musculoskeletal pains. The severity of these symptoms depends on exposure time, the nature of visual tasks, working conditions, and individual visual abilities. Treatment of digital eye strain depends on diagnostic results and underlying conditions, and any occurring symptoms, such as asthenopia or poor ergonomic setup, should be addressed according to professional guidelines. The aim of this paper is to present the issue of digital eye strain and propose solutions that can aid in diagnosing and effectively combating its symptoms.

Management of postoperative surface discomfort of the eye

Anna M. Roszkowska — Mon, 31 Mar 2025 00:00:00 +0200

None

Nd:YAG laser membranotomy in treatment of pre-macular hemorrhage in Valsalva retinopathy

Angelina Papeczyc, Daniel Czyżewski, Adam Chmiel, Małgorzata Frankowska-Gierlak — Mon, 31 Mar 2025 00:00:00 +0200

A 37-year-old patient was admitted to the ophthalmology department due to sudden vision deterioration in the right eye, preceded by vomiting two days earlier. Visual acuity was found at the level of counting fingers at 3 m. Fundus examination revealed a large pre-macular hemorrhage covering the entire area between the arcades. Based on clinical presentation, history, and imaging studies, a diagnosis of Valsalva retinopathy was made. With the patient’s consent, Nd:YAG laser treatment was performed on the lower part of the hemorrhage, resulting in blood displacement into the vitreous body and significant improvement in visual acuity to 0.6 BVCA immediately post-procedure.

Post-traumatic lagophthalmos complicated by ocular evisceration

Aleksandra Górska, Sebastian Sirek, Dorota Pojda-Wilczek — Mon, 31 Mar 2025 00:00:00 +0200

Introduction: Post-traumatic lagophthalmos is a significant clinical challenge, leading to serious ocular health consequences. This article examines the diagnostic, therapeutic aspects and outcomes of this important pathology.

Material and methods: A 78-year-old patient with lagophthalmos of the left eye after a traffic accident with loss of consciousness was referred to our clinic.

Results: Post-traumatic lagophthalmos is a complex clinical challenge. Craniofacial and eyelid reconstruction, despite a complex course, failed to fully restore function and aesthetics. Due to corneal complications and ocular inflammation, a left ocular evisceration with eyelid reconstruction using ear cartilage and a skin flap was performed.

Management of Trauma-Induced Anterior Necrotizing Scleritis in a High-Risk Occupational Setting: Resolution with Temporary Tarsorrhaphy

Ahmad Kunbaz, Omer Faruk Yilmaz, Halit Oguz — Mon, 31 Mar 2025 00:00:00 +0200

Objective: This case report highlights the challenges and innovative treatment approaches for managing trauma-induced anterior necrotizing scleritis (ANS), particularly in high-risk occupational settings, such as welding.
Methods: We present the case of a 44-year-old male welder who suffered a metal particle injury in his right eye, leading to ANS. Initial treatments included removal of the foreign body, suturing of the conjunctival tear, and administration of antibiotics and hydrating eye drops. Subsequent treatments for the ensuing ANS included systemic and topical steroids, cyclosporine drops, oral prednisone, vitamin C supplements, dura and amniotic membrane grafting, and autologous serum eye drops. Following the failure of these interventions, a temporary tarsorrhaphy surgery was performed.
Results: Despite the application of various conventional therapies, the patient’s condition did not improve significantly until temporary tarsorrhaphy was performed. This intervention, along with an intensive therapeutic regimen, led to the complete healing of the sclera and improved visual acuity.
Conclusion: This case underscores the complexity of treating ANS, especially in cases resistant to standard treatment modalities. The successful use of temporary tarsorrhaphy in conjunction with other treatments highlights the need for an individualized approach to manage such conditions. This case contributes to the growing body of evidence suggesting the potential benefits of revisiting traditional surgical interventions for treating refractory cases of ANS.

Ophthalmological injuries caused by gunshot wounds and shell fragments

Ndue Bardhi — Mon, 31 Mar 2025 00:00:00 +0200

This retrospective study analyses 57 gunshot eye injury cases at Trauma University Hospital in Tirana, Albania, from 1995–2006 using SPSS software. Gunshot eye injuries made up 33% of all explosion and firearm-related eye injuries, with peaks in 1997 and 1999 due to the escalation of conflict. Males constituted 93% of cases, with 38.5% aged 11–20. Severe injuries were 84%, with 90% causing serious eye damage and 10% resulting in death or bilateral blindness. Concomitant injuries occurred in 88% of cases, and all had foreign bodies complicating treatment. This study provides data to improve prevention, diagnosis, treatment, and rehabilitation of gunshot eye injuries.