Background: Haemodialysis (HD) superimposes additional circulatory stress on the microvasculature, leading to endothelial dysfunction, which plays a key role in the development of haemodialysis-associated multiorgan dysfunction. This study was undertaken to evaluate the effect of a single HD session on retinal and choroidal microcirculation, using optical coherence tomography angiography (OCTA) in relation to changes in the blood levels of selected biochemical modulators of endothelial function. Methods: The vessel density (VD) of 35 patients was evaluated before and after a single HD session, using OCTA in the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC). Retinal thickness (RT) and choroidal thickness (CT) were also assessed. Asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1) and malondialdehyde (MDA) levels, oxidative stress (OS) status and systemic parameters were assessed before and after a single HD session. The correlation between changes in these parameters and changes in selected OCTA parameters was tested. Results: A single HD session resulted in a significant increase in RT and a decrease in CT. In addition to increased oxidative and osmotic stress resulting from a significant reduction in plasma osmolality, the HD session was associated with a significant increase in ET-1 levels and a decrease in ADMA levels. These biochemical changes correlated with changes in RT and CT, as well as with changes in VD in the retinal capillary plexuses and the CC. Increased ET-1 levels and decreased plasma osmolality were identified as predictors of RT increase, whereas increased MDA levels corrected serum creatinine-predicted CT reduction. Conclusions: Changes in ADMA and ET-1 and OS, as well as osmotic stress induced by a single HD session, affect the eye microcirculation and morphology of the retina and choroid. OCTA examination is a promising method for assessing microcirculation in HD patients.

Background/Objectives: Hemodialysis (HD) is the commonest life sustaining form of kidney replacement therapy in the world; however, this method of treatment have many adverse effects, and even a single HD session affects many organs, including the eyes. The aim of this study was to assess the effect of a single HD session on the ophthalmologic findings in patients with End-stage Renal Disease (ESRD). The second aim of the study was to examine the correlation of these changes with each other and between changes in systemic stressors related to the HD session. Methods: This was a single-center cross-sectional observational study conducted on 32 patients undergoing HD. Selected parameters of the anterior and posterior segment of the eye as well as systemic parameters were assessed before and after a single HD session. Results: Best corrected visual acuity (BCVA) improved, and lens thickness (LT), axial length (AXL), average macular thickness (MT), central MT and total vessel density (VD) of the deep capillary plexus DCP increased significantly after a single HD session. The Schirmer test results, tear break up time (TBUT), anterior chamber depth (ACD), central and average choroidal thickness (CT) decreased significantly after HD. Body weight loss was the only significant systemic change. Decrease in TBUT correlated positively with Schirmer's test results decrease. Increase in CCT correlated positively with AXL increase. Decrease in central and average CT correlated positively with IOP decrease. Increase in central MT correlated positively with increase in average MT. Decrease in central CT correlated positively with average CT decrease. Change in VD of the SCP correlated positively with change in VD of DCP. Apart from the positive correlation between SBP change and Schirmer's test results change, there were no correlations between systemic and ophthalmic parameters changes. Conclusions: Our study showed that HD affected the parameters of the anterior and posterior segments of the eye. Numerous correlations between these changes suggest that they are interrelated and represent the complex response of the eye to the HD process.

Adult-onset foveomacular vitelliform dystrophy is one of the most common macular dystrophies, classified within the group of pattern dystrophies. The condition typically arises after the fourth decade of life and manifests with subretinal vitelliform deposits in the macula that may progressively enlarge and later undergo resorption, ultimately resulting in retinal and retinal pigment epithelium atrophy. In most patients, the course is mild; however, significant vision loss may occur in older individuals, mainly as a result of chorioretinal atrophy or the development of subretinal neovascularization. On multimodal imaging, these lesions are hyperautofluorescent. On optical coherence tomography, they exhibit a dome-shaped configuration, while electrooculography and full-field electroretinography most often remain normal, indicating focal rather than global retinal dysfunction. The adult-onset foveomacular vitelliform dystrophy phenotype may mimic or coexist with other conditions, including age-related macular degeneration, vitreomacular traction, or central serous chorioretinopathy, which complicates diagnostic evaluation. In some patients, genetic associations have been identified with mutations in PRPH2, BEST1, IMPG1, and IMPG2. Clinical variability and inconsistent terminology have often led to misdiagnoses, underscoring the need for standardized diagnostic criteria.

Background: Age-related macular degeneration (AMD) is the primary cause of severe visual acuity loss in individuals over 60 with increasing prevalence. Currently, no effective treatments exist for geographic atrophy and macular scarring, highlighting the need for visual rehabilitation in these patients. Microperimetry offers functional assessment at any AMD stage and employs fixation training to help patients utilize the most effective retinal areas for vision. Methods: A prospective study involving 25 patients (50 eyes) aged 67 to 90. The MAIA II microperimeter assessed scotoma size and location, retinal sensitivity, macular integrity, fixation parameters (P1, P2, 63%BCEA, 95%BCEA), fixation stability, and preferred retinal locus. Quality of life was evaluated using the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). A subgroup with inactive AMD-related macular changes, either bilateral geographic atrophy (13 patients, 26 eyes) or bilateral scarring (12 patients, 24 eyes), was identified, all exhibiting bilateral absolute central scotomas of at least 2 degrees. Each patient completed 10 fixation training sessions with a microperimeter, training the eye with better acuity weekly. One-week post-training, a functional assessment was performed on both trained and untrained eyes. Results: Fixation training significantly improved best corrected visual acuity (BCVA) in trained eyes (mean change -0.14 logMAR, p < 0.001, large effect size) and also in fellow untrained eyes (-0.16 logMAR, p < 0.001). BNVA improved from 2.25 to 1.86 in trained eyes (p < 0.001) and from 2.96 to 2.76 in untrained eyes (p = 0.004). Fixation stability parameters improved significantly, including increases in P1 and P2 and reductions in Bivariate Contour Ellipse Area (BCEA). Quality of life measured using the NEI-VFQ-25 questionnaire improved significantly in 9 of 11 domains. Conclusions: Microperimetry may be a valuable tool for assessing visual function in AMD patients. Fixation training with the MAIA II microperimeter is both safe and effective for vision rehabilitation in those with geographic atrophy and macular scarring.

Age-related macular degeneration is the leading cause of vision loss among elderly patients. Treatment for the exudative (neovascular) form of age-related macular degeneration involves intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents. However, this therapy is long term and burdensome, and therefore new substances and treatment regimens are being sought. According to scientific reports and real-world clinical observations, switching to a different drug during treatment is beneficial for many patients. This paper presents two clinical cases in which switching medications during anti-vascular endothelial growth factor therapy proved beneficial both functionally and morphologically.

Background/Objectives: Dry-eye disease (DED) is a disorder of the eye surface associated, among other things, with tear film instability. It can lead to abnormal biometry results, especially with respect to keratometry. DED is more common in the elderly population. Its prevalence is often underestimated. Failure to provide adequate treatment prior to biometry may result in refractive errors after cataract surgery. The purpose of this study was to quantify the impact of DED on refractive predictability in cataract surgery and assess whether short, preoperative ocular-surface optimization reduces the mean absolute error (MAE) of postoperative refraction, regardless of DED. Methods: Seventy patients undergoing cataract surgery were divided into three groups: A—individuals with DED who were receiving treatment; B—individuals without DED who were receiving treatment; and C—a control group. In all groups, biometry was performed twice, before and after treatment (groups A and B) or at two-week intervals without treatment (group C). All of the individuals underwent cataract surgery. Refractive error was calculated one month after surgery for both biometry measurements (before and after treatment). Results: After dry eye treatment, a reduction in refractive error was achieved in both groups with and without DED. The MAE in the group with DED was 0.39 ± 0.31 vs. 0.27 ± 0.30 (p < 0.001), and the MAE for those without DED was 0.30 ± 0.25 vs. 0.24 ± 0.20 (p = 0.043). No significant differences in biometric measurements were observed in any of the groups. The most variable parameter was corneal astigmatism in the DED group. Conclusions: Proper preparation of the eye surface for biometric measurement reduces refractive errors after surgery.

The SARS-CoV-2 infection manifests with diverse clinical manifestations, with severity potentially influenced by the viral variant. COVID-19 has also been shown to impact ocular microcirculation in some patients, but whether this effect varies by viral lineage remains unclear. This prospective study compared clinical features and ocular parameters assessed via optical coherence tomography angiography (OCTA) in patients recovering from SARS-CoV-2 infections during the dominance of two distinctive viral lineages, Alpha (B.1.1.7) and Delta (B.1.617.2), and compared them to a control group. The following parameters were measured: vessel density (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CCP) using OCTA, with a manual assessment of the foveal avascular zones in the SCP (FAZs) and DCP (FAZd). A control group was also included. Among 63 patients in the Alpha group and 41 in the Delta group, no eye-related symptoms were reported during the examination. However, the Delta group showed significantly lower VD in the SCP and DCP across all quadrants (p < 0.001–0.039), while the Alpha group showed reduced VD in the foveal CCP (p = 0.005) and significantly wider FAZs and FAZd (p = 0.002 for both). In conclusion, ocular microcirculatory changes differed between the two variants, with Alpha associated with foveal choroidal VD reduction and larger FAZs and Delta linked to lower SCP and DCP VD across multiple regions. These findings highlight the potential for SARS-CoV-2 variants to differentially impact ocular vasculature, underscoring the need for variant-specific follow-up in COVID-19 patients.

Diabetes is considered an epidemic of the 21st century, and the most common microvascular complication, which affects every third patient, is diabetic retinopathy. In the course of retinopathy, the endothelial barrier of the retinal vessels is damaged, which begins with damage to the glycocalyx. Sulodexide rebuilds the glycocalyx and increases the tightness of the blood-retinal barrier, thereby protecting the retinal vessels against damage caused by hyperglycemia. Its multidirectional mechanism of action makes it an effective drug in the treatment of mild and moderately advanced non-proliferative diabetic retinopathy. It is recommended by many scientific societies in the treatment of vascular diseases. Clinical studies confirm its high effectiveness in the treatment of diabetic retinopathy, especially when this disease is accompanied by macular edema. Sulodexide is an effective and safe drug.

Aims/Purpose: To evaluate the impact of dry eye disease (DED) on refractive errors in patients after cataract surgery.Methods: Fifty patients undergoing cataract surgery were studied. Two study groups and a control group were distinguished. The first study group (group A, n = 22, 44%) were patients with preoperatively diagnosed DED who received appropriate treatment (eyelid margin hygiene and moisturizing the ocular surface). The second study group (group B, n = 14, 28%) were patients in whom such treatment was also implemented, despite the lack of a diagnosis of DED. The remaining patients (n = 14, 28%) were the control group (Group C). Biometric measurements with calculation of intraocular lens (IOL) power were performed twice in all of them (before and after treatment of DED). Refraction and refractive errors were evaluated one month after surgery.Results: Significant improvement in best corrected visual acuity (BCVA) was obtained in all groups after surgical treatment. In both study groups, a significant reduction in the mean absolute error (MAE) after the treatment was achieved – in study group A, the MAE was 0.37 ± 0.30 D vs 0.24 ± 0.33 D, p = 0.003. In study group B, MAE was 0.29 ± 0.26 D vs 0.23 ± 0.23 D, p = 0.017. The control group showed no difference in MAE (0.27 ± 0.18D vs 0.33 ± 0.21 D, p = 0.322). In study group A, there was a significant reduction in the percentage of MAE in the ± 0.25 D range (36.36% vs 77.27%, p = 0.016). The results are comparable with previous publications.Conclusions: Diagnosis and treatment of dry eye syndrome before cataract surgery is an important factor in reducing refractive errors after surgery. The use of lubricating drops and eyelid margin hygiene before biometry can be considered for all patients undergoing cataract surgery.

W ostatnich latach średnia długość życia wydłużyła się. Zaawansowany wiek jest głównym czynnikiem ryzyka rozwoju chorób przewlekłych, takich jak choroby układu krążenia (CVD, cardiovascular diseases) i zwyrodnienie plamki żółtej związane z wiekiem (AMD, age-related macular degeneration), które często są powiązane z wysokimi kosztami diagnostyki, leczenia i opieki. Zarówno CVD, jak i AMD są jednymi z najczęściej diagnozowanych chorób u osób starszych, które znacznie obniżają jakość życia tych pacjentów i często prowadzą do niepełnosprawności. Choroby sercowo naczyniowe są główną przyczyną zgonów na świecie, a AMD jest główną przyczyną ślepoty u dorosłych. Oczekuje się, że częstość występowania obu wymienionych chorób wzrośnie w ciągu najbliższych dziesięcioleci. Choroby te są związane nie tylko z podeszłym wiekiem. W ostatnim czasie coraz więcej dowodów sugeruje, że istnieje wiele podobieństw w czynnikach ryzyka i mechanizmach patogenetycznych zarówno AMD, jak i CVD. Zapalenie i stres oksydacyjny zostały powiązane z rozwojem CVD, a także AMD. Ponadto AMD wiąże się ze zwiększonym ryzykiem CVD, śmiertelności z powodu chorób sercowo-naczyniowych i ogólnej śmiertelności. Dla zdrowego starzenia się zapobieganie chorobom jest ważniejsze niż leczenie i rehabilitacja. W związku z tym pojawia się pytanie, czy mająca działanie przeciwzapalne dieta śródziemnomorska może być kolejnym ogniwem łączącym CVD i AMD, a także wspólną linią obrony przed AMD i CVD?

Secondary glaucoma induced by silicone oil is one of the most serious complications following vitrectomy with endotamponade. The pathogenesis of elevated intraocular pressure is multifactorial and includes both early mechanisms – such as pupillary block or migration of oil into the anterior chamber – and late mechanisms, associated with chronic inflammation, synechial closure of the drainage angle, and infiltration of the trabecular meshwork by emulsified oil droplets. Treatment includes standard hypotensive pharmacotherapy, prophylactic peripheral iridotomy to prevent pupillary block, and, in selected cases, removal of the silicone oil. In advanced cases, surgical methods are employed, such as trabeculectomy, drainage implants, or cyclophotocoagulation. Early identification of the mechanisms leading to secondary glaucoma and the implementation of an appropriate therapeutic strategy remain crucial for preserving visual function in patients after retinal surgery.

BACKGROUND:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with endothelial dysfunction, which may also compromise the microcirculation within ocular tissues. This prospective study evaluated associations between radial peripapillary capillary (RPC) vessel density (VD) and systemic treatment, age, hypoxia, D-dimer, and interleukin-6 (IL-6) levels in patients recovering from coronavirus disease 2019 (COVID-19) related pneumonia. METHODS:Sixty-three individuals who were admitted to the hospital due to COVID-19 bilateral pneumonia underwent ophthalmic examination two months post-discharge. RPC VD was measured using optical coherence tomography angiography. Associations with age, arterial hypertension, and systemic treatment (dexamethasone, remdesivir, and oxygen therapy), oxygen saturation, D-dimer, and IL-6 levels were evaluated. The control group comprised 43 control participants with no history of COVID-19 who attended routine ophthalmic examinations. RESULTS:No ophthalmic abnormalities were detected. RPC VD did not differ significantly with hypertension or systemic treatment with dexamethasone and remdesivir. However, patients receiving oxygen therapy had higher RPC VD. A borderline inverse correlation was observed between inferior RPC VD and age. There were no correlations between RPC VD and oxygen saturation. Significant inverse correlations were found between nasal RPC and mean RPC with D-dimer levels and between inferior RPC VD and IL-6 levels. No significant differences in RPC parameters were observed when comparing the COVID-19 group with controls. CONCLUSIONS:Hypertension or systemic treatment had no significant effect on RCP VD. However, VD in specific RPC areas correlated inversely with D-dimer and IL-6 levels, highlighting the need for monitoring peripapillary microvasculature for potential long-term ocular effects of COVID-19.

Retinal artery occlusion (RAO) is an emergency condition causing acute retinal ischemia and is considered an equivalent of ischemic stroke. The occurrence of an episode of RAO is associated with significant impairment of visual functions and correlates with an increased risk of future vascular events. Although RAO requires immediate diagnosis and treatment, there are currently no clear guidelines specifying optimal management. This review discusses current and future therapeutic strategies following an episode of RAO, including secondary prevention.

The approach to cataract surgery procedures in Poland has changed significantly over the past few years. The authors outline the current principles of perioperative care in cataract surgery

Background and objectives: We aimed to investigate changes in the radial peripapillary capillary (RPC) network using optical coherence tomography angiography (OCTA) in patients who recovered from coronavirus disease 2019 (COVID-19). Materials and Methods: This was a prospective study of patients hospitalized due to COVID-19 bilateral pneumonia between March and May 2021. The control group included healthy individuals matched for age and sex. Two months after discharge, the patients underwent ophthalmological examination, including optical coherence tomography (OCT) imaging. The RPC network and retinal nerve fiber layer (RNFL) of the optic disc (RNFL optic disc) were automatically evaluated and compared between the study groups. Additionally, the RPC parameters were compared between the men and women in the COVID-19 group, and correlations between the RPC and RNFL optic disc parameters were assessed. Results: A total of 63 patients (120 eyes) with bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 infection were examined. No ophthalmic symptoms were reported by the patients. No significant differences were observed in the RPC parameters between the patients from the COVID-19 group and the 43 healthy controls. Moreover, the RPC parameters did not differ between the men and women in the COVID-19 group. A positive correlation was found between the RPC and RNFL optic disc parameters in the COVID-19 patients (p < 0.001). Conclusions: No changes in the RPC network were observed among the patients with COVID-19 bilateral pneumonia in the early period after hospital discharge. However, a longer follow-up is needed to monitor COVID-19–related changes in the microvasculature of the optic nerve head.

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.

Purpose of the study: The purpose of the study was to compare the morphological and functional results of the studied patients with idiopathic macular hole treated with a one-stage method (phacovitrectomy) and combined cataract and vitrectomy surgery. Material and methods: The study included 33 patients (33 eyes) with idiopathic macular hole treated at the Department of Retina and Vitreous Surgery in Lublin. Twenty-one eyes were surgically treated with phacovitrectomy (Group 1 MH). Twelve patients underwent two-stage, combined treatment with removal of the lens in the first stage and vitrectomy in the second (Group 2 MH). The assignment of patients to groups was random. All patients underwent 23-gauge sutureless vitrectomy with removal of the internal limiting membrane (internal limiting membrane peeling). SF6 gas was used as an intraocular tamponade at an isovolumetric concentration of 20% and face down position recommendation for 7 days. Cataract surgery was performed using the phacoemulsification method with an incision in the transparent part of the cornea with intracapsular, posterior chamber implantation of a monofocal lens. A 12-month observation period was established, measured from the date of vitrectomy performance, and in the case of a combined procedure, this period was extended by the time between each stage of treatment. At subsequent check-ups, the subjects underwent a complete ophthalmological examination, which included: best corrected distance visual acuity and best corrected near visual acuity, assessment of the anterior and posterior segments, in a slit lamp, measurement of retinal sensitivity in the macula using microperimetry, the Amsler test and optical coherence tomography examination of the macula. Results: In patients of the total studied group, an improvement in the best-corrected visual distance and near acuity was obtained, and in 88% retinal sensitivity in the macula was also achieved. In the group of patients subjected to phacovitrectomy (Group 1 macular hole) with an average minimum hole diameter of 487.48 µm before the procedure, after a one-year follow-up the mean best corrected distance visual acuity was 0.57 and best corrected near visual acuity 0.51, with macular retinal sensitivity of 26.65 dB. However, in the group of patients subjected to combined cataract and vitrectomy, an average minimum hole diameter of 521.58 µm 12 months after trans pars plana vitrectomy was performed as well as an average best corrected distance visual acuity of 0.64, best corrected near visual acuity of 0.5, and retinal sensitivity in the macula of 25.98 dB. There were no statistically significant differences between phacovitrectomy and the combined procedures in terms of the improvement in the values of distance and near visual acuity and macular retinal sensitivity 12 months after trans pars plana vitrectomy. A statistically significant improvement in retinal sensitivity in the macula was observed in Group 1 macular hole during the 12-month follow-up, while in the combined procedure group the improvement was not statistically significant. Conclusions: Vitrectomy is an effective method of treating maculopathy in the form of macular hole. Morphological and functional improvement was noted in all patients, regardless of the treatment method used. There were no statistically significant differences between phacovitrectomy and the combined procedure in terms of the improvement achieved in the values of distance visual acuity parameters, near vision and retinal sensitivity in the macula 12 months after trans pars plana vitrectomy. A common feature of patients with worse results on individual variables was a longer duration of the disease and a larger size of the hole prior vitrectomy.