Zofia Michalewska - Academia.edu (original) (raw)
Papers by Zofia Michalewska
![Research paper thumbnail of [Diagnosis and evaluation of macular hole with the HRT 2 retina module]](https://attachments.academia-assets.com/42239985/thumbnails/1.jpg)
](Der Ophthalmologe
This prospective study analyzed the usefulness of the HRT 2 retina module as a diagnostic tool fo... more This prospective study analyzed the usefulness of the HRT 2 retina module as a diagnostic tool for macular hole diagnosis. The influence of the preoperative status on postoperative anatomic and functional results is also discussed. Preoperative and postoperative retinal tomography maps (HRT 2) were compared with optical coherent tomography (OCT III) and spectral optical coherent tomography (SOCT). Fifty eyes of 46 consecutive patients with stage III/IV macular hole underwent vitrectomy with internal limiting membrane peeling and fluid/air exchange. HRT 2, OCT III, and, in eight cases, SOCT images were analyzed. The mean best corrected visual acuity 1 week before surgery was 0.086+/-0.074 (0.01-0.35). The final best corrected visual acuity 12 months after surgery was 0.32+/-0.24 (0.01-1.0). Anatomic success was noted in 46/50 eyes 1 month after the first surgery and in all eyes after the second intervention. In 33/50 eyes (66%), visual acuity improved over two lines. In 13 eyes visual acuity remained stable, and in four eyes worse visual acuity was noted postoperatively. The mean macular hole diameter in HRT 2 was 497.2 microm and in OCT III was 490 microm. Different values were observed in cases of oval macular holes. The mean macular hole area was 0.193 mm(2). The macular hole radius in HRT 2 can be compared with the minimal diameter in OCT III. It influences the final visual acuity 12 months after surgery. The HRT 2 macular module enables diagnosis of macular hole and evaluation of its postoperative status. This technique has some advantages because it enables measurement of the macular hole's radius, area, and depth. In cases when the macular hole's radius as measured in HRT and OCT III differs, HRT seems to give more exact data because it shows the entire surface rather than just a cross-section of the retina. Macular hole radius and area as measured with HRT 2 can influence postoperative functional results.
Klinische Monatsblätter für Augenheilkunde
In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (... more In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (ILM) and epiretinal membranes (ERM) during vitreoretinal surgery for PVR retinal detachment. We treated 27 eyes of 27 patients with severe PVR retinal detachment with vitreoretinal surgery. After complete vitrectomy and removal of epiretinal membranes we injected 0.15 % trypan blue solution and proceeded with further removal of the visualized remaining epiretinal membranes and ILM. We performed relaxing retinotomies in 14 eyes. Follow-up lasted six months. After the first surgery the retina was reattached in 24 of 27 eyes and after the second surgery in all eyes. The final visual acuity was: hand movements in 3 eyes, 1/50 or better in 24 eyes (eight of them had a visual acuity of 0.1 - 0.5). No case of macular pucker was observed during the follow-up. Trypan blue staining during vitreoretinal surgery in PVR retinal detachment therapy allows complete removal of ILM, ERM, and peripheral vitreous. It upgrades the quality of the surgery.
Klinika oczna
The aim of this paper is to present the use of bimanual phacoemulsification technique in combined... more The aim of this paper is to present the use of bimanual phacoemulsification technique in combined phacoemulsification and vitrectomy surgery. Combined phacoemulsification and vitrectomy procedure was performed in 20 eyes. Phacoemulsification was performed through two paracenteses. Soft acrylic intraocular lenses were implanted into the capsular bag through a paracentesis 1.8 mm wide. Standard three-port pars plana vitrectomy followed. Indications for vitrectomy were diabetic retinopathy, retina detachment, uveitis, macula hole. All surgeries were performed as one-day surgeries. Follow-up lasted six months. Visual acuity improved in 19/20 eyes (95%). The achieved functional results were similar to that achieved in standard phacoemulsification combined with vitreoretinal surgery. Surgery time did not differ significantly from time needed to perform a standard procedure. The bimanual technique allowed the stablization of the anterior chamber during vitreoretinal surgery. No serious postoperative complications occurred. The presented method improves the quality of combined surgery, ensures stability of the anterior chamber, reduces postoperative astigmatism, lowers the risk of inflammation.
Klinika oczna
The aim of this paper is to present an alternative method of phacoemulsification. Bimanual phacoe... more The aim of this paper is to present an alternative method of phacoemulsification. Bimanual phacoemulsification through two paracenteses was performed in 15 eyes. After cataract removal intraocular lenses were implanted into the capsular bag through a small paracentesis (less than 2 mm). Anatomical and functional results were good in all cases. After comparison with conventional phacoemulsification we concluded, that the bimanual technique shortens the time of ultrasounds usage and reduces postoperative astigmatism. Phacoemulsification performed through two paracenteses can be the next step in cataract surgery development.
Der Ophthalmologe
The aim of this prospective study was to analyze the specificity and sensitivity of HRT 3 compare... more The aim of this prospective study was to analyze the specificity and sensitivity of HRT 3 compared with spectral optical coherence tomography (SOCT) in differentiating full-thickness macular holes, lamellar macular holes, and macular pseudoholes. In 128 patients with a diagnosis made by SOCT of full-thickness macular hole, lamellar macular hole, or macular pseudohole, 161 eyes were examined with the HRT 3 Retina Module, and the results were compared. Using SOCT, full-thickness macular holes were diagnosed in 80 eyes, pseudoholes in 15 eyes, and lamellar macular holes in 66 eyes. Using HRT, full-thickness macular holes were diagnosed in 81 eyes, and pseudoholes and lamellar macular holes (non-full-thickness macular holes) were diagnosed in 80 eyes. In 160/161 cases, the diagnosis with HRT 3 was correct. Compared with SOCT, HRT 3 has a specificity of 98.7% and a sensitivity of 100% in differentiating full-thickness from non-full-thickness macular holes. The HRT 3 macular module enables diagnosis of macular holes. Full-thickness macular holes could be differentiated from non-full-thickness macular holes; however, lamellar macular holes could not be differentiated from macular pseudoholes.
Albrecht von Graæes Archiv für Ophthalmologie
ABSTRACT
Klinika oczna
The aim of this paper is to present corneal layers of healthy individuals with a confocal laser s... more The aim of this paper is to present corneal layers of healthy individuals with a confocal laser scanning ophthalmoscope (Heidelberg Retina Tomograph/ Restock Cornea Module). We analyzed 40 corneas of 20 healthy individuals and measured corneal thickness and thickness of corneal layers. We also describe cell characteristics of each layer. In the outer endothelium 846 cells/mm2 were observed. In the medium endothelium 5000 cells/mm2 and in the inner endothelium about 9000 cells/mm2 were noted. 34 Langerhans cells/mm2 in the centre and 92 Langerhans cells/mm2 were present. The mean keratocyte nuclei count in the stroma was 355/mm2. In the endothelium we noted a mean of 2960 cells/mm2. Our data are similar to data obtained by histopathological findings. HRT II cornea module is a noninvasive, rapid and repeatable instrument that enables not only measurement of corneal thickness but also the exact cell count. It can be an important tool in diagnosis and evaluation of treatment of various corneal diseases.
European journal of ophthalmology
To evaluate anatomic and functional results in patients with macular edema in retinal vein occlus... more To evaluate anatomic and functional results in patients with macular edema in retinal vein occlusion (RVO), treated with pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling, depending on the timing of surgery. A total of 35 consecutive patients underwent PPV with ILM peeling. Visual acuity, fluorescein angiography, and optical coherence tomography/spectral optical coherence tomography were performed preoperatively and 6-12 months postoperatively. Anatomic improvement was achieved in 29 patients (82.9%). In 6 patients, there was no improvement. Central macular thickness decreased in 17 patients (48.6%) with central retinal vein occlusion (CRVO) and in 12 patients (34.3%) with branch retinal vein occlusion (BRVO) (p<0.05). A total of 68% of eyes showed improvement in visual acuity (p<0.05). Visual acuity improved in 14 patients (mean 3.7 Snellen lines) with CRVO and in 10 patients ( mean 3.7 Snellen lines) with BRVO. The t test shows no statistically signifi...
Klinika oczna
To determine clinical effect of intravitreal bevacizumab (Avastin) in patients with cystoid macul... more To determine clinical effect of intravitreal bevacizumab (Avastin) in patients with cystoid macular edema after cataract surgery. Four eyes of four patients treated with 1 intravitreal injection of 1.25 mg Avastin. In three cases duration of cystoid macular edema was less then 4 months, in one eye cystoid macular edema was chronic (more than 4 months). Visual acuity and clinical effect in spectral optical coherence tomography (central retinal thickness and fovea anatomy) was examined before and after intravitreal injection. Visual acuity improved in 3 of 4 patients. In acute cystoid macular edema final visual acuity was 0.8-0.9, in chronic cystoid macular edema patient visual acuity improved from 0.05 to 0.2. In 3 of 4 patients central retinal thickness decreased and fovea anatomy was normalized. In patient with no clinical and anatomical improvement spectral optical coherence tomography examination revealed epiretinal membrane. Intravitreal Avastin may be successful treatment in mo...
Klinika oczna
Description of long-time observation of X-linked retinoschisis coexisting with choroidal neovascu... more Description of long-time observation of X-linked retinoschisis coexisting with choroidal neovascularization in two brothers. 27-year-old man reported sudden visual impairment in one eye. The same symptoms had patient's brother. Ophthalmic examination and imaging studies were performed. The diagnosis was made based on clinical features and imaging examinations. This case is unusual. At present there is no effective therapy.
Retina, 2015
To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM... more To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM flap technique results in satisfactory outcomes for the repair of large Stage IV idiopathic macular holes. Prospective comparative interventional study of 87 consecutive eyes. Participants were randomized into two treatment groups. In Group A, the classic inverted ILM flap technique was performed. In Group B, a modification of this procedure, the temporal inverted ILM flap technique, was performed. In the modified inverted ILM flap technique, peeling of the ILM was restricted to the temporal side of the fovea only-the macular hole was then covered with the temporal ILM flap. There was no significant difference in initial and final visual acuities between Groups A and B. In both groups, defects in photoreceptors and the external limiting membrane decreased with time. Successive postoperative examinations revealed an increasing number of patients with the dissociated optic nerve fiber layer appearance, although this was less frequent in Group B (modified ILM flap) than in Group A. The study results indicate that the temporal inverted ILM flap technique is as effective as the classic inverted ILM flap technique for the repair of large Stage IV macular holes.
Indian journal of ophthalmology, 2014
Our purpose was to study the clinical manifestation and course of optic pit maculopathy using Spe... more Our purpose was to study the clinical manifestation and course of optic pit maculopathy using Spectral Domain Optical Coherence Tomography (SD- OCT) images. We used SD-OCT to examine 20 eyes of 19 patients with a macular detachment in combination with an optic. We observed five different fovea appearances in regard to fluid localization. In five eyes, we recorded changes in the fluid distribution with SD-OCT. In 17/20 eyes, we noted a communication between the perineural and subretinal and/or intraretinal space at the margin of the optic disc. 3-dimensional SD-OCT (3D-SDOCT) scans revealed a three-fold connection, between subretinal and intraretinal space, perineural space, and the vitreous cavity. Therefore, we suppose that intraretinal or subretinal fluid in optic pit maculopathy may have both a vitreous and cerebrospinal origin. A membrane, covering the optic nerve was noted in 14 cases. Even if it seems intact in some B-scans, it is not complete in others several micrometers apa...
Klinika oczna, 2013
To compare the diagnostic ability of Heidelberg Retina Tomograph 3 and Spectral Domain Optical Co... more To compare the diagnostic ability of Heidelberg Retina Tomograph 3 and Spectral Domain Optical Coherence Tomography Copernicus in detection of optic disc changes in glaucomatous patients. Retrospective analysis of 24 eyes of 24 subjects with primary open angle glaucoma. All individuals had complete ophthalmic examination, Heidelberg Retina Tomograph 3 and Spectral Domain Optical Coherence Tomography examinations performed. Measurements in Spectral Domain Optical Coherence Tomography were obtained both automatically (Spectral Domain Optical Coherence Tomography software) and manually. Following diameters were analyzed: disc area, cup area, cup volume, C to D ratio (C/D ratio) and circumpapillary retinal nerve fiber layer thickness. Disc area, cup area, cup volume were classified as within normal limits more often in Spectral Domain Optical Coherence Tomography printouts than in Heidelberg Retina Tomograph (75%, 63% and 83% in SD-OCT auto, 70%, 57% and 83% in SD-OCT manu vs. 58%, 37% ...
Klinika oczna, 2007
The aim of this paper is presentation of a patient with retinal detachment due to airbag hit in a... more The aim of this paper is presentation of a patient with retinal detachment due to airbag hit in a car accident. 50 years old woman with posttraumatic retinal detachment underwent cerclage and pars plana vitrectomy and silicone oil injection. Phacoemulsification and intraocular lens implantation followed. Final visual acuity of 0.5 was achieved. No postoperative complications were observed. Despite the complicated preoperative situation, good anatomic and functional results could be achieved. Airbag may be also cause of severe ocular trauma.
Klinika oczna, 2007
A presentation of two patients with macular hole after ocular trauma due to paintball. HRT, OCT, ... more A presentation of two patients with macular hole after ocular trauma due to paintball. HRT, OCT, SOCT and visual field examinations were performed preoperatively and on 3 postoperative visits. Patients underwent pars plana vitrectomy with trypan blue staining. Final visual acuity 0.6 was achieved in the first patient 6 months after surgery. Best corrected visual acuity 0.2 was achieved in the second patient 3 months after surgery. Macular hole closure was observed on OCT, SOCT, HRT and indirect ophthalmoscopy examination. Pars plana vitrectomy with trypan blue staining and fluid-air exchange is a safe procedure in posttraumatic macular holes. HRT, Oct and SOCT are valuable tools for diagnosis of macular holes and for control after surgical intervention.
BioMed Research International, 2014
To report choroidal thickness and volume in healthy eyes using swept source optical coherence tom... more To report choroidal thickness and volume in healthy eyes using swept source optical coherence tomography (SS-OCT). A prospective observational study of 122 patients examined with swept source OCT (DRI-OCT, Topcon, Japan). In each eye, we performed 256 horizontal scans, 12 mm in length and centered on the fovea. We calculated choroidal thickness manually with a built-in caliper and automatically using DRI-OCT mapping software. Choroidal volume was also automatically calculated. We measured axial length with optical low-coherence reflectometry (Lenstar LS 900, Haag-Streit, Switzerland). The choroid has focally increased thickness under the fovea. Choroid was thinnest in the outer nasal quadrant. In stepwise regression analysis, age was estimated as the most significant factor correlating with decreased choroidal thickness (F=23.146, P&amp;amp;amp;amp;amp;lt;0.001) followed by axial length (F=4.902, P=0.03). Refractive error was not statistically significant (F=1.16, P=0.28). SS-OCT is the first commercially available system that can automatically create choroidal thickness and volume maps. Choroidal thickness is increased at the fovea and is thinnest nasally. Age and axial length are critical for the estimation of choroidal thickness and volume. Choroidal measurements derived from SS-OCT images have potential value for objectively documenting disease-related choroidal thickness abnormalities and monitoring progressive changes over time.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2015
To report on choroidal thickness and the morphology of the outer choroidoscleral boundary in swep... more To report on choroidal thickness and the morphology of the outer choroidoscleral boundary in swept-source OCT in patients with full-thickness macular holes (FTMH) before and after surgery. Single center matched case-control study of 32 patients with FTMH (group 1), fellow eyes (group 2), and 32 eyes of 32 healthy controls (group 3). All eyes from group 1 had vitrectomy with a minimum follow-up of 3 months. Main outcome measures were the visibility and regularity of the outer choroidoscleral boundary (CSB), and additionally the eventual visibility of the suprachoroidal layer (SCL). Choroidal thickness was indifferent between groups. Choroidal thickness did not change after surgery (p = 0.1). CSB was visible in all cases. CSB was irregular in 59 % of eyes in group 1, in 40 % of eyes in group 2, and in any eye in group 3. SCL was visible in 34 % of eyes in group 1, and remained visible after surgery. In group 2, SCL was observed in 44 % of eyes, and in group 3 in one eye. Choroidal thickness does not differ between eyes with FTMH and their fellow eyes and healthy controls. CSB is more often irregular and SCL is more often visible in eyes with FTMH and their fellow eyes than in healthy controls. In fellow eyes of FTMH, the visibility of SCL was observed more often in eyes with partial vitreous detachment (p = 0.0). Three months after surgery, choroidal thickness does not change, the irregularities of CSB and SCL remain visible. More frequent changes of the outer choroidoscleral boundary in FTMH, and especially in their fellow eyes, may suggest a role of the choroid in the pathogenesis of FTMH.
Indian Journal of Ophthalmology, 2014
To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided b... more To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided bevacizumab treatment for neovascular age- related macular degeneration (AMD). Single center observational study. We confirmed wet AMD in 47 eyes of 45 patients by fluorescein angiography and SD-OCT. After bevacizumab injection, we examined the patients at 4-week intervals. During each follow-up control, we performed SD-OCT and a complete ophthalmic examination. Criteria for reinjection were visual acuity loss of more than five ETDRS letters, and/or increase of central retinal thickness, sub-retinal fluid, intra-retinal fluid, pigment epithelium detachment. If reinjection criteria were not met, we advised the patient to return in 4 weeks&amp;amp;amp;amp;amp;#39; time for the next scheduled follow-up. We used 3-dimensional SD-OCT to measure photoreceptor defects and sub-retinal fibrosis. The main efficacy endpoints were the SD-OCT measurements of the size of photoreceptor defects, the size of external membrane defects and the central retinal thickness. Over the 12 months study period, the percentage of scans in 3-D imaging mode showing visible defects of the junction between inner and outer segments of photoreceptors increased from 38.96 to 53.8%. The percentage of scans in 3-D imaging mode with visible sub-retinal fibrosis increased from 33 to 52% and mean central retinal thickness decreased from 333 μm (96-900 μm) to 272 μm (P = 0.011). In long-term anti- Vascular endothelial growth factor (VEGF) treatment for neovascular AMD, photoreceptor defects and fibrosis progress despite a decrease in central retinal thickness and improvements in visual acuity. We would encourage further discussion as to whether this is the natural course of the disease or a result of the treatment.
Case Reports in Ophthalmology, 2011
The aim of this paper is to present retinal pigment epithelium (RPE) defects in spectral domain o... more The aim of this paper is to present retinal pigment epithelium (RPE) defects in spectral domain optical coherence tomography (SD-OCT) and their gradual resolution over time. Observational case series of 3 eyes of 3 patients who were followed for a period of 3-6 years after undergoing surgery to mechanically close the borders of large stage IV macular holes. Photoreceptor defects and RPE defects were measured during this period with SD-OCT. In all cases, a reduction in the size of the areas of photoreceptor and RPE defects was noted, which correlated with late improvement in visual acuity (VA). In eyes with no underlying retinal pigment epithelial or choroidal disease, restoration of RPE is possible in vivo for up to several years after surgery for macular hole closure. An improvement in VA is possible, even lasting many years after successful macular hole surgery, which corresponds to a decrease in both RPE defects and the size of the defects in the junction between the inner and outer segments of photoreceptors.
Der Ophthalmologe
This prospective study analyzed the usefulness of the HRT 2 retina module as a diagnostic tool fo... more This prospective study analyzed the usefulness of the HRT 2 retina module as a diagnostic tool for macular hole diagnosis. The influence of the preoperative status on postoperative anatomic and functional results is also discussed. Preoperative and postoperative retinal tomography maps (HRT 2) were compared with optical coherent tomography (OCT III) and spectral optical coherent tomography (SOCT). Fifty eyes of 46 consecutive patients with stage III/IV macular hole underwent vitrectomy with internal limiting membrane peeling and fluid/air exchange. HRT 2, OCT III, and, in eight cases, SOCT images were analyzed. The mean best corrected visual acuity 1 week before surgery was 0.086+/-0.074 (0.01-0.35). The final best corrected visual acuity 12 months after surgery was 0.32+/-0.24 (0.01-1.0). Anatomic success was noted in 46/50 eyes 1 month after the first surgery and in all eyes after the second intervention. In 33/50 eyes (66%), visual acuity improved over two lines. In 13 eyes visual acuity remained stable, and in four eyes worse visual acuity was noted postoperatively. The mean macular hole diameter in HRT 2 was 497.2 microm and in OCT III was 490 microm. Different values were observed in cases of oval macular holes. The mean macular hole area was 0.193 mm(2). The macular hole radius in HRT 2 can be compared with the minimal diameter in OCT III. It influences the final visual acuity 12 months after surgery. The HRT 2 macular module enables diagnosis of macular hole and evaluation of its postoperative status. This technique has some advantages because it enables measurement of the macular hole's radius, area, and depth. In cases when the macular hole's radius as measured in HRT and OCT III differs, HRT seems to give more exact data because it shows the entire surface rather than just a cross-section of the retina. Macular hole radius and area as measured with HRT 2 can influence postoperative functional results.
Klinische Monatsblätter für Augenheilkunde
In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (... more In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (ILM) and epiretinal membranes (ERM) during vitreoretinal surgery for PVR retinal detachment. We treated 27 eyes of 27 patients with severe PVR retinal detachment with vitreoretinal surgery. After complete vitrectomy and removal of epiretinal membranes we injected 0.15 % trypan blue solution and proceeded with further removal of the visualized remaining epiretinal membranes and ILM. We performed relaxing retinotomies in 14 eyes. Follow-up lasted six months. After the first surgery the retina was reattached in 24 of 27 eyes and after the second surgery in all eyes. The final visual acuity was: hand movements in 3 eyes, 1/50 or better in 24 eyes (eight of them had a visual acuity of 0.1 - 0.5). No case of macular pucker was observed during the follow-up. Trypan blue staining during vitreoretinal surgery in PVR retinal detachment therapy allows complete removal of ILM, ERM, and peripheral vitreous. It upgrades the quality of the surgery.
Klinika oczna
The aim of this paper is to present the use of bimanual phacoemulsification technique in combined... more The aim of this paper is to present the use of bimanual phacoemulsification technique in combined phacoemulsification and vitrectomy surgery. Combined phacoemulsification and vitrectomy procedure was performed in 20 eyes. Phacoemulsification was performed through two paracenteses. Soft acrylic intraocular lenses were implanted into the capsular bag through a paracentesis 1.8 mm wide. Standard three-port pars plana vitrectomy followed. Indications for vitrectomy were diabetic retinopathy, retina detachment, uveitis, macula hole. All surgeries were performed as one-day surgeries. Follow-up lasted six months. Visual acuity improved in 19/20 eyes (95%). The achieved functional results were similar to that achieved in standard phacoemulsification combined with vitreoretinal surgery. Surgery time did not differ significantly from time needed to perform a standard procedure. The bimanual technique allowed the stablization of the anterior chamber during vitreoretinal surgery. No serious postoperative complications occurred. The presented method improves the quality of combined surgery, ensures stability of the anterior chamber, reduces postoperative astigmatism, lowers the risk of inflammation.
Klinika oczna
The aim of this paper is to present an alternative method of phacoemulsification. Bimanual phacoe... more The aim of this paper is to present an alternative method of phacoemulsification. Bimanual phacoemulsification through two paracenteses was performed in 15 eyes. After cataract removal intraocular lenses were implanted into the capsular bag through a small paracentesis (less than 2 mm). Anatomical and functional results were good in all cases. After comparison with conventional phacoemulsification we concluded, that the bimanual technique shortens the time of ultrasounds usage and reduces postoperative astigmatism. Phacoemulsification performed through two paracenteses can be the next step in cataract surgery development.
Der Ophthalmologe
The aim of this prospective study was to analyze the specificity and sensitivity of HRT 3 compare... more The aim of this prospective study was to analyze the specificity and sensitivity of HRT 3 compared with spectral optical coherence tomography (SOCT) in differentiating full-thickness macular holes, lamellar macular holes, and macular pseudoholes. In 128 patients with a diagnosis made by SOCT of full-thickness macular hole, lamellar macular hole, or macular pseudohole, 161 eyes were examined with the HRT 3 Retina Module, and the results were compared. Using SOCT, full-thickness macular holes were diagnosed in 80 eyes, pseudoholes in 15 eyes, and lamellar macular holes in 66 eyes. Using HRT, full-thickness macular holes were diagnosed in 81 eyes, and pseudoholes and lamellar macular holes (non-full-thickness macular holes) were diagnosed in 80 eyes. In 160/161 cases, the diagnosis with HRT 3 was correct. Compared with SOCT, HRT 3 has a specificity of 98.7% and a sensitivity of 100% in differentiating full-thickness from non-full-thickness macular holes. The HRT 3 macular module enables diagnosis of macular holes. Full-thickness macular holes could be differentiated from non-full-thickness macular holes; however, lamellar macular holes could not be differentiated from macular pseudoholes.
Albrecht von Graæes Archiv für Ophthalmologie
ABSTRACT
Klinika oczna
The aim of this paper is to present corneal layers of healthy individuals with a confocal laser s... more The aim of this paper is to present corneal layers of healthy individuals with a confocal laser scanning ophthalmoscope (Heidelberg Retina Tomograph/ Restock Cornea Module). We analyzed 40 corneas of 20 healthy individuals and measured corneal thickness and thickness of corneal layers. We also describe cell characteristics of each layer. In the outer endothelium 846 cells/mm2 were observed. In the medium endothelium 5000 cells/mm2 and in the inner endothelium about 9000 cells/mm2 were noted. 34 Langerhans cells/mm2 in the centre and 92 Langerhans cells/mm2 were present. The mean keratocyte nuclei count in the stroma was 355/mm2. In the endothelium we noted a mean of 2960 cells/mm2. Our data are similar to data obtained by histopathological findings. HRT II cornea module is a noninvasive, rapid and repeatable instrument that enables not only measurement of corneal thickness but also the exact cell count. It can be an important tool in diagnosis and evaluation of treatment of various corneal diseases.
European journal of ophthalmology
To evaluate anatomic and functional results in patients with macular edema in retinal vein occlus... more To evaluate anatomic and functional results in patients with macular edema in retinal vein occlusion (RVO), treated with pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling, depending on the timing of surgery. A total of 35 consecutive patients underwent PPV with ILM peeling. Visual acuity, fluorescein angiography, and optical coherence tomography/spectral optical coherence tomography were performed preoperatively and 6-12 months postoperatively. Anatomic improvement was achieved in 29 patients (82.9%). In 6 patients, there was no improvement. Central macular thickness decreased in 17 patients (48.6%) with central retinal vein occlusion (CRVO) and in 12 patients (34.3%) with branch retinal vein occlusion (BRVO) (p<0.05). A total of 68% of eyes showed improvement in visual acuity (p<0.05). Visual acuity improved in 14 patients (mean 3.7 Snellen lines) with CRVO and in 10 patients ( mean 3.7 Snellen lines) with BRVO. The t test shows no statistically signifi...
Klinika oczna
To determine clinical effect of intravitreal bevacizumab (Avastin) in patients with cystoid macul... more To determine clinical effect of intravitreal bevacizumab (Avastin) in patients with cystoid macular edema after cataract surgery. Four eyes of four patients treated with 1 intravitreal injection of 1.25 mg Avastin. In three cases duration of cystoid macular edema was less then 4 months, in one eye cystoid macular edema was chronic (more than 4 months). Visual acuity and clinical effect in spectral optical coherence tomography (central retinal thickness and fovea anatomy) was examined before and after intravitreal injection. Visual acuity improved in 3 of 4 patients. In acute cystoid macular edema final visual acuity was 0.8-0.9, in chronic cystoid macular edema patient visual acuity improved from 0.05 to 0.2. In 3 of 4 patients central retinal thickness decreased and fovea anatomy was normalized. In patient with no clinical and anatomical improvement spectral optical coherence tomography examination revealed epiretinal membrane. Intravitreal Avastin may be successful treatment in mo...
Klinika oczna
Description of long-time observation of X-linked retinoschisis coexisting with choroidal neovascu... more Description of long-time observation of X-linked retinoschisis coexisting with choroidal neovascularization in two brothers. 27-year-old man reported sudden visual impairment in one eye. The same symptoms had patient's brother. Ophthalmic examination and imaging studies were performed. The diagnosis was made based on clinical features and imaging examinations. This case is unusual. At present there is no effective therapy.
Retina, 2015
To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM... more To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM flap technique results in satisfactory outcomes for the repair of large Stage IV idiopathic macular holes. Prospective comparative interventional study of 87 consecutive eyes. Participants were randomized into two treatment groups. In Group A, the classic inverted ILM flap technique was performed. In Group B, a modification of this procedure, the temporal inverted ILM flap technique, was performed. In the modified inverted ILM flap technique, peeling of the ILM was restricted to the temporal side of the fovea only-the macular hole was then covered with the temporal ILM flap. There was no significant difference in initial and final visual acuities between Groups A and B. In both groups, defects in photoreceptors and the external limiting membrane decreased with time. Successive postoperative examinations revealed an increasing number of patients with the dissociated optic nerve fiber layer appearance, although this was less frequent in Group B (modified ILM flap) than in Group A. The study results indicate that the temporal inverted ILM flap technique is as effective as the classic inverted ILM flap technique for the repair of large Stage IV macular holes.
Indian journal of ophthalmology, 2014
Our purpose was to study the clinical manifestation and course of optic pit maculopathy using Spe... more Our purpose was to study the clinical manifestation and course of optic pit maculopathy using Spectral Domain Optical Coherence Tomography (SD- OCT) images. We used SD-OCT to examine 20 eyes of 19 patients with a macular detachment in combination with an optic. We observed five different fovea appearances in regard to fluid localization. In five eyes, we recorded changes in the fluid distribution with SD-OCT. In 17/20 eyes, we noted a communication between the perineural and subretinal and/or intraretinal space at the margin of the optic disc. 3-dimensional SD-OCT (3D-SDOCT) scans revealed a three-fold connection, between subretinal and intraretinal space, perineural space, and the vitreous cavity. Therefore, we suppose that intraretinal or subretinal fluid in optic pit maculopathy may have both a vitreous and cerebrospinal origin. A membrane, covering the optic nerve was noted in 14 cases. Even if it seems intact in some B-scans, it is not complete in others several micrometers apa...
Klinika oczna, 2013
To compare the diagnostic ability of Heidelberg Retina Tomograph 3 and Spectral Domain Optical Co... more To compare the diagnostic ability of Heidelberg Retina Tomograph 3 and Spectral Domain Optical Coherence Tomography Copernicus in detection of optic disc changes in glaucomatous patients. Retrospective analysis of 24 eyes of 24 subjects with primary open angle glaucoma. All individuals had complete ophthalmic examination, Heidelberg Retina Tomograph 3 and Spectral Domain Optical Coherence Tomography examinations performed. Measurements in Spectral Domain Optical Coherence Tomography were obtained both automatically (Spectral Domain Optical Coherence Tomography software) and manually. Following diameters were analyzed: disc area, cup area, cup volume, C to D ratio (C/D ratio) and circumpapillary retinal nerve fiber layer thickness. Disc area, cup area, cup volume were classified as within normal limits more often in Spectral Domain Optical Coherence Tomography printouts than in Heidelberg Retina Tomograph (75%, 63% and 83% in SD-OCT auto, 70%, 57% and 83% in SD-OCT manu vs. 58%, 37% ...
Klinika oczna, 2007
The aim of this paper is presentation of a patient with retinal detachment due to airbag hit in a... more The aim of this paper is presentation of a patient with retinal detachment due to airbag hit in a car accident. 50 years old woman with posttraumatic retinal detachment underwent cerclage and pars plana vitrectomy and silicone oil injection. Phacoemulsification and intraocular lens implantation followed. Final visual acuity of 0.5 was achieved. No postoperative complications were observed. Despite the complicated preoperative situation, good anatomic and functional results could be achieved. Airbag may be also cause of severe ocular trauma.
Klinika oczna, 2007
A presentation of two patients with macular hole after ocular trauma due to paintball. HRT, OCT, ... more A presentation of two patients with macular hole after ocular trauma due to paintball. HRT, OCT, SOCT and visual field examinations were performed preoperatively and on 3 postoperative visits. Patients underwent pars plana vitrectomy with trypan blue staining. Final visual acuity 0.6 was achieved in the first patient 6 months after surgery. Best corrected visual acuity 0.2 was achieved in the second patient 3 months after surgery. Macular hole closure was observed on OCT, SOCT, HRT and indirect ophthalmoscopy examination. Pars plana vitrectomy with trypan blue staining and fluid-air exchange is a safe procedure in posttraumatic macular holes. HRT, Oct and SOCT are valuable tools for diagnosis of macular holes and for control after surgical intervention.
BioMed Research International, 2014
To report choroidal thickness and volume in healthy eyes using swept source optical coherence tom... more To report choroidal thickness and volume in healthy eyes using swept source optical coherence tomography (SS-OCT). A prospective observational study of 122 patients examined with swept source OCT (DRI-OCT, Topcon, Japan). In each eye, we performed 256 horizontal scans, 12 mm in length and centered on the fovea. We calculated choroidal thickness manually with a built-in caliper and automatically using DRI-OCT mapping software. Choroidal volume was also automatically calculated. We measured axial length with optical low-coherence reflectometry (Lenstar LS 900, Haag-Streit, Switzerland). The choroid has focally increased thickness under the fovea. Choroid was thinnest in the outer nasal quadrant. In stepwise regression analysis, age was estimated as the most significant factor correlating with decreased choroidal thickness (F=23.146, P&amp;amp;amp;amp;amp;lt;0.001) followed by axial length (F=4.902, P=0.03). Refractive error was not statistically significant (F=1.16, P=0.28). SS-OCT is the first commercially available system that can automatically create choroidal thickness and volume maps. Choroidal thickness is increased at the fovea and is thinnest nasally. Age and axial length are critical for the estimation of choroidal thickness and volume. Choroidal measurements derived from SS-OCT images have potential value for objectively documenting disease-related choroidal thickness abnormalities and monitoring progressive changes over time.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2015
To report on choroidal thickness and the morphology of the outer choroidoscleral boundary in swep... more To report on choroidal thickness and the morphology of the outer choroidoscleral boundary in swept-source OCT in patients with full-thickness macular holes (FTMH) before and after surgery. Single center matched case-control study of 32 patients with FTMH (group 1), fellow eyes (group 2), and 32 eyes of 32 healthy controls (group 3). All eyes from group 1 had vitrectomy with a minimum follow-up of 3 months. Main outcome measures were the visibility and regularity of the outer choroidoscleral boundary (CSB), and additionally the eventual visibility of the suprachoroidal layer (SCL). Choroidal thickness was indifferent between groups. Choroidal thickness did not change after surgery (p = 0.1). CSB was visible in all cases. CSB was irregular in 59 % of eyes in group 1, in 40 % of eyes in group 2, and in any eye in group 3. SCL was visible in 34 % of eyes in group 1, and remained visible after surgery. In group 2, SCL was observed in 44 % of eyes, and in group 3 in one eye. Choroidal thickness does not differ between eyes with FTMH and their fellow eyes and healthy controls. CSB is more often irregular and SCL is more often visible in eyes with FTMH and their fellow eyes than in healthy controls. In fellow eyes of FTMH, the visibility of SCL was observed more often in eyes with partial vitreous detachment (p = 0.0). Three months after surgery, choroidal thickness does not change, the irregularities of CSB and SCL remain visible. More frequent changes of the outer choroidoscleral boundary in FTMH, and especially in their fellow eyes, may suggest a role of the choroid in the pathogenesis of FTMH.
Indian Journal of Ophthalmology, 2014
To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided b... more To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided bevacizumab treatment for neovascular age- related macular degeneration (AMD). Single center observational study. We confirmed wet AMD in 47 eyes of 45 patients by fluorescein angiography and SD-OCT. After bevacizumab injection, we examined the patients at 4-week intervals. During each follow-up control, we performed SD-OCT and a complete ophthalmic examination. Criteria for reinjection were visual acuity loss of more than five ETDRS letters, and/or increase of central retinal thickness, sub-retinal fluid, intra-retinal fluid, pigment epithelium detachment. If reinjection criteria were not met, we advised the patient to return in 4 weeks&amp;amp;amp;amp;amp;#39; time for the next scheduled follow-up. We used 3-dimensional SD-OCT to measure photoreceptor defects and sub-retinal fibrosis. The main efficacy endpoints were the SD-OCT measurements of the size of photoreceptor defects, the size of external membrane defects and the central retinal thickness. Over the 12 months study period, the percentage of scans in 3-D imaging mode showing visible defects of the junction between inner and outer segments of photoreceptors increased from 38.96 to 53.8%. The percentage of scans in 3-D imaging mode with visible sub-retinal fibrosis increased from 33 to 52% and mean central retinal thickness decreased from 333 μm (96-900 μm) to 272 μm (P = 0.011). In long-term anti- Vascular endothelial growth factor (VEGF) treatment for neovascular AMD, photoreceptor defects and fibrosis progress despite a decrease in central retinal thickness and improvements in visual acuity. We would encourage further discussion as to whether this is the natural course of the disease or a result of the treatment.
Case Reports in Ophthalmology, 2011
The aim of this paper is to present retinal pigment epithelium (RPE) defects in spectral domain o... more The aim of this paper is to present retinal pigment epithelium (RPE) defects in spectral domain optical coherence tomography (SD-OCT) and their gradual resolution over time. Observational case series of 3 eyes of 3 patients who were followed for a period of 3-6 years after undergoing surgery to mechanically close the borders of large stage IV macular holes. Photoreceptor defects and RPE defects were measured during this period with SD-OCT. In all cases, a reduction in the size of the areas of photoreceptor and RPE defects was noted, which correlated with late improvement in visual acuity (VA). In eyes with no underlying retinal pigment epithelial or choroidal disease, restoration of RPE is possible in vivo for up to several years after surgery for macular hole closure. An improvement in VA is possible, even lasting many years after successful macular hole surgery, which corresponds to a decrease in both RPE defects and the size of the defects in the junction between the inner and outer segments of photoreceptors.