Agnieszka Kubicka-Trzaska

Publications of Agnieszka Kubicka-Trzaska

• Microcirculation patterns in indocyanine green angiography and the results of plaque therapy in choroidal melanoma.

  Authors: Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Klinika oczna. 01/2011; 113(10-12):307-13.

  To determine the effect of radioactive plaque therapy on blood vessel behaviour in choroidal melanomas using indocyanine green (ICG) angiography. Fifty-five patients with choroidal melanoma wereTo determine the effect of radioactive plaque therapy on blood vessel behaviour in choroidal melanomas using indocyanine green (ICG) angiography. Fifty-five patients with choroidal melanoma were studied. Ruthenium-106 plaques were used in 30 eyes, in 11 the "sandwich method" (Ruthenium-106 plaque with transpupillary thermotherapy), was applied and 14 tumours were treated with Iodine-125. In all cases ICG angiography was performed prior to treatment and 12 months after, and at different time afterwards. Baseline tumour microcirculation patterns (MCPs) were studied prior to treatment and post-treatment blood vessels changes were evaluated. Total follow-up period ranged from 14-22 months (mean: 16 months). Pre-treatment ICG angiography revealed complex MCPs, combining parallel with cross-linking, arcs with branching, loops and networks patterns in 23 (41.8%) and non-complex MCPs, including straight, parallel without cross-linking and arcs without branching patterns in 32 (58.2%) melanomas. Twelve months after treatment, 38 tumours (69.1%) showed a significant changes in their MCPs. The mean ultrasonographic regression rate in tumours with complex MCPs was 57.4% as opposed to 36.2% in the group with non-complex MCPs (p = 0.01). No statistically significant correlation in the height regression rate was found among the various methods of therapy, however a significant difference between the type of therapy and MCPs changes was observed (p < 0.001). Melanomas treated with Ruthenium-106 and TTT demonstrated slight or no MCPs changes, while tumours treated with Ruthenium-106 and Iodine-125 plaques alone showed a significant MCPs changes (p < 0.001). The statistical analysis showed the correlation between the type of baseline MCPs and the degree of their changes after treatment (p < 0.001). Tumours with networks, loops, arcs with branching and parallel with crossing showed an increased regression as compared to other MCPs. Twelve patients whose tumours contained complex MCPs developed metastatic disease. This study suggests that the response of choroidal melanoma to irradiation is related to MCPs as identified by ICG angiography; the presence of complex MCPs is associated with a high regression rate after plaque therapy and a high risk of development of systemic metastatic disease.

• [Serum antiretinal antibodies (ARA) in patients with exudative age-related macular degeneration (AMD) treated with transpupillary thermotherapy (TTT) alone and with transpupillary thermotherapy (TTT) combined with injection of triamcinolone acetonide (sTTA) under posterior Tenon's capsule].

  Authors: Agnieszka Kubicka-Trzaska, Joanna Wilańska

  Klinika oczna. 01/2011; 113(1-3):28-33.

  To assess serum level changes of antiretinal antibodies (ARA) in patients with exudative age-related macular degeneration (AMD), treated with transpupillary thermotherapy (TTT) alone and with TTTTo assess serum level changes of antiretinal antibodies (ARA) in patients with exudative age-related macular degeneration (AMD), treated with transpupillary thermotherapy (TTT) alone and with TTT combined with injection of triamcinolone acetonide (sTTA) under posterior Tenon's capsule and to compare the efficacy of TTT and TTT+sTTA. The purpose of the study was also to estimate if serum ARA may act as the biomarker of AMD. This prospective study comprised 46 patients (46 eyes) with exudative AMD. Patients were assigned into: group I (n = 24) received TTT alone and group II (n = 20) received TTT with sTTA. Follow-up was at 3, 6, 9 and 12 months, when best-corrected visual acuity (BCVA), Amsler grid-test, intraocular pressure (IOP), fluorescein angiography (FA) and central retinal thickness (CRT) by optical coherence tomography (OCT) were assessed. In all patients serum ARA was determined using indirect immunofluorescence (IIF) method on normal monkey retina as antigens substrate and FITC--labelled goat's anti-human IgA, G, M serum as the secondary antibody. Baseline serum ARA titres in group I ranged from 1: 40 to 1: 5120 and in group II--1: 40 to 1: 1280 (p = 0.1). In control group serum ARA was present in 46.4% of sera in titres from 1: 10 to 1: 40. These differences were statistcally significant (p < 0.001). Nine fluorescence patterns of ARA were detected by IIF method in both groups of AMD patients, while control sera showed only three types of reaction. Statistically significant correlation was found between CNV size, CRT and serum ARA titres in both groups of patients (p < 0.01). In a follow-up period decreasing serum ARA titres were noted, specially for subjects treated with combined therapy, however it was not statistically significant at 3, 6 and 9 months while achieved significance (p < 0.01) at month 12. BCVA improvement or stabilization was observed in 64% of eyes in group I and in 75%--in group II (p = 0.1). No leakage on FA was found in 66.7% and 70% of cases, in group I and II, respectively (p = 0.01). CRT reduction was observed in 50% (group I) and in 70% (group II) of eyes (p = 0.01) at month 12. Our preliminary observations indicate that serum ARA changes may reflect the activity of CNV in a course of AMD and may act as the biomarker of treatment efficacy. The use of sTTA in conjunction with TTT for CNV in AMD showed a tendency towards lower serum ARA titres and better functional results after treatment as compared with eyes treated with TTT alone.

• Macular microcirculation blood flow after pars plana vitrectomy with silicone oil tamponade.

  Authors: Agnieszka Kubicka-Trzaska, Joanna Kobylarz, Bozena Romanowska-Dixon

  Klinika oczna. 01/2011; 113(4-6):146-8.

  To assess the macular microcirculation blood flow with Doppler laser scanning (HRF-Heidelberg Retinal Flowmeter), in patients with complicated rhegmatogenous retinal detachment (RRD), after parsTo assess the macular microcirculation blood flow with Doppler laser scanning (HRF-Heidelberg Retinal Flowmeter), in patients with complicated rhegmatogenous retinal detachment (RRD), after pars plana vitrectomy (PPV), with silicone oil tamponade. Eleven patients (6 males and 5 females), aged 38-64 years, mean age: 52.4 years, with unilateral macula-on complicated RRD were included in a study. In all cases conventional (20-gauge) pars plana vitectomy with silicone oil tamponade was performed. Control group consists of the fellow eyes. In the early postoperative period (1-3 days after surgery), in all operated eyes the mean values of macular microcirculation blood flow were significantly reduced in the comparison with those of the control eyes (p = 0.01). The reduction of mean values of macular microcirculation blood flow was still observed in all silicone-oil-filled eyes one month after surgery as compared to the contralateral eyes (p = 0.01). There was no correlation between the values of macular microcirculation blood flow and the duration of RRD, baseline BCVA, refractive error, number of retinal tears, and the patient age. The preliminary results of this study suggest that PPV with silicone oil tamponade influences over the retinal blood flow. We have observed that silicone oil may have a negative long-term effect on the retinal microcirculation as it was noted one month after surgery.

• Acute retinal necrosis--a case report.

  Authors: Piotr Oleksy, Izabella Karska-Basta, Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Klinika oczna. 01/2011; 113(4-6):165-7.

  We present a case of acute retinal necrosis (ARN) which is a rare but devastating and rapidly progressive viral retinitis. It is caused mainly by Herpes simplex virus (HSV) or Varicella zoster virusWe present a case of acute retinal necrosis (ARN) which is a rare but devastating and rapidly progressive viral retinitis. It is caused mainly by Herpes simplex virus (HSV) or Varicella zoster virus (VZV) (2), but also Cytomegalovirus (CMV) and Epstein-Barr virus infections may be aethiological factors of ARN. A 17-year-old male patient was referred with history of painful sudden worsening of visual acuity in the left eye and the presence of floaters in the visual field of the right eye. Based on the ophthalmological examination the diagnosis of bilateral ARN was established. Aqueous humor aspirates were analyzed using polymerase chain reaction (PCR) for Herpes simplex virus (HSV), Varicella zoster virus (VZV), Cytomegalovirus (CMV) and Epstein-Baar virus (EBV). PCR confirmed the presence of Varicella zoster virus in aqueous humor samples. Prompt systemic antiviral therapy combined with steroids was initiated. Since a rapid and accurate diagnosis is crucial for prompt administration of antiviral therapy, PCR-based analysis of intraocular fluids orovides a valuable tool in the establishina an etiologic factor in patients with retinitis caused by herpesvirus.

• [Abnormal pupils' reactions].

  Authors: Joanna Kowal, Anna Strzałka, Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Klinika oczna. 01/2010; 112(4-6):156-60.

  Examination of the pupils' light reaction and estimation of the pupils' diameter are the components of the routine physical examination of a patient. Disturbances in pupils' light reaction, unequalExamination of the pupils' light reaction and estimation of the pupils' diameter are the components of the routine physical examination of a patient. Disturbances in pupils' light reaction, unequal size of the pupils indicate damage of the nervous system and require careful diagnosis, both neurological and ophthalmological. Different aspects of anatomy, physiology and the most common pathological syndromes associated with disturbed pupils' light reaction and unequal diameters of the pupils were presented in the article. Early diagnosis and proper treatment can allow to improve prognosis in the analyzed patient group.

• [Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)--a therapeutic dilemma].

  Authors: Agnieszka Kubicka-Trzaska, Piotr Oleksy, Izabella Karska-Basta, Bozena Romanowska-Dixon

  Klinika oczna. 01/2010; 112(4-6):127-30.

  To present a rare idiopathic inflammation of the posterior segment of the eye - acute posterior multifocal placoid pigment epitheliopathy (APMPPE). A 17 years old male patient was referred to theTo present a rare idiopathic inflammation of the posterior segment of the eye - acute posterior multifocal placoid pigment epitheliopathy (APMPPE). A 17 years old male patient was referred to the Department of Ophthalmology of Medical College, Jagiellonian University in Krakow with the diagnosis of bilateral choroiditis of unknown etiology. The patient underwent the basic ophthalmological examination followed by fluorescein (FA) and indocyanine green (ICGA) angiography. Laboratory testing for Lyme disease, sarcoidosis and syphilis, as well as genetic testing, to determine the presence of HLA antigen complex, were performed Based on the outcomes of performed investigations the definitive diagnosis of APMPPE was established. Systemic steroidotherapy was initiated due to rapid progression of the inflammatory changes, progression of the central visual field changes and profound visual acuity deterioration. APMPPE is a rare, inflammatory and idiopathic eye disease with no clear indications for pharmacological therapy. However decision about necessity and sort of pharmacological therapy should be taken under consideration individually for each patient. ostra tylna wieloogniskowa plackowata epiteliopatia barwnikowa, steroidoterapia. acute posterior multifocal placoid pigment epitheliopathy, steroidotherapy.

• [Ocular masquerade syndrome in a patient with chronic lymphocytic leukemia].

  Authors: Agnieszka Kubicka-Trzaska, Monika Gedliczka, Bozena Romanowska-Dixon

  Klinika oczna. 01/2010; 112(10-12):314-7.

  To report a rare case of a masquerading syndrome in a course of chronic lymphocytic leukemia (CLL). A 57 years old woman with bilateral lacrimal glands enlargement and chronic uveitis unresponsive toTo report a rare case of a masquerading syndrome in a course of chronic lymphocytic leukemia (CLL). A 57 years old woman with bilateral lacrimal glands enlargement and chronic uveitis unresponsive to local steroids, was studied. Patient's general history was positive for chronic lymphocytic leukemia, B cell (B-CLL); actually remission. The patient underwent complete ophthalmic examination with additional A and B-scan ultrasonography (USG), computed tomography (CT) and nuclear magnetic resonance (NMR) imaging of orbital cavities and also biopsy of both lacrimal glands was performed. USG, CT and NMR scans revealed the intraocular inflammation and inflammatory enlargement of both lacrimal glands. The histopathological examination of lacrimal glands showed the presence of lymphocytic infiltrations within the glands' tissue. The patient started with chemotherapy: Fludarabin and Cyclophosphamide. Within weeks the intraocular inflammation was under control and the resolution of lacrimal glands edema was noted. Malignancy should be considered in cases of chronic uveitis that do not respond to steroid therapy. Chronic lymphocytic leukemia rarely masks as chronic intraocular inflammation, in a sporadic cases however it may herald the relapse of the disease.

• [Intravitreal ranibizumab in diabetic macular edema].

  Authors: Agnieszka Kubicka-Trzaska

  Klinika oczna. 01/2010; 112(10-12):333-6.

  Anti-vascular endothelial growth factor (anti-VEGF) therapies that inhibit choroidal angiogenesis and reduce vascular permeability have revolutionized clinical practices for neovascular eye diseases.Anti-vascular endothelial growth factor (anti-VEGF) therapies that inhibit choroidal angiogenesis and reduce vascular permeability have revolutionized clinical practices for neovascular eye diseases. Ranibizumab (Lucentis) is a Fab-antibody with high affinity for VEGF, and has a potential to bind to all VEGF isoforms. Diseases of retinal and choroidal vasculature are the most prevalent causes of vision loss in developed countries. Among them diabetic macular edema (DME) is the most common sight threatening complication of diabetes. VEGF plays a critical role in the pathogenesis of DME. Due to modest outcomes with macular photocoagulation, other treatment modalities for DME have been evaluated. The results of the pilot studies and preliminary results of multicenter randomized, controlled studies showed that intraocular injections of ranibizumab decrease the mean retinal thickness and improve the BCVA (best corrected visual acuity) in patients with DME.

• [Punctate inner choroidopathy--a case report and literature review]

  Authors: Karolina Ziaja, Agnieszka Kubicka-Trzaska, Izabella Karska-Basta, Bozena Romanowska-Dixon

  Klinika oczna. 02/2009; 111(4-6):142-4.

  We present the case of punctate inner choroidopathy in a 45 years old woman B.S. In the case of PIC we should perform special tests, that may confirm diagnosis, help in the appropriate treatment andWe present the case of punctate inner choroidopathy in a 45 years old woman B.S. In the case of PIC we should perform special tests, that may confirm diagnosis, help in the appropriate treatment and avoid complications.

• [Polypoidal choroidal vasculopathy--a rare form of choroidal neovascularization]

  Authors: Monika Weglarz, Izabella Karska-Basta, Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Klinika oczna. 02/2009; 111(4-6):145-8.

  PURPOSE: To present two cases of polypoidal choroidal vasculopathy (PCV). MATERIAL AND METHODS: Two 85- and 76-years old female patients were enrolled in the study. One patient was referred to thePURPOSE: To present two cases of polypoidal choroidal vasculopathy (PCV). MATERIAL AND METHODS: Two 85- and 76-years old female patients were enrolled in the study. One patient was referred to the Ophthalmology Clinic in Krakow with the presumptive diagnosis of the choroid tumor in the left eye. The other one was suspected of choroidal neovascularization (CNV) in the course of age-related macular degeneration (AMD) in the left eye. Both patients underwent the basic ophthalmic examination, fluorescein (FA) and indocyanine green (ICGA) angiography. Additionally ocular ultrasonography and MRI of the head and orbits were performed in the patient suspected of the choroid tumor. RESULTS: Performed investigations, especially the results of ICGA allowed to establish the definitive diagnosis of polypoidal choroidal vasculopathy in both cases. CONCLUSIONS: Our study shows potential diagnostic difficulties occurring in patients with PCV and indicate ICGA as the method of choice confirming the diagnosis.

• [Dry eye syndrome and allergic conjunctivitis--epidemics of XXI century--diagnostic problems and management].

  Authors: Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Przegla̧d lekarski. 01/2009; 66(11):967-71.

  Recently, allergic conjunctivitis and dry eye syndrome have been thought to be the epidemics of XXI century. Allergic conjunctivitis is the commonest form of allergy worldwide. Clinical symptoms ofRecently, allergic conjunctivitis and dry eye syndrome have been thought to be the epidemics of XXI century. Allergic conjunctivitis is the commonest form of allergy worldwide. Clinical symptoms of dry eye are the most common cause of patients complains in out-patient ophthalmological clinics. Both, allergic conjunctivitis and dry eye syndrome, may be associated with some systemic diseases. Thus, it is crucial to perform complete allergic tests in patients suspected of allergic conjunctivitis. The assessment of IgE in tears is a very sensitive test in these cases because physiologically this immunoglobulin is not detectable in tear film. In cases of dry eye syndrome the measurement of tear osmolarity has been is thought to be the most specific and sensitive test, recently.

• [Guidance for the treatment of neovascular age-related macular degeneration (AMD)].

  Authors: Izabella Karska-Basta, Agnieszka Kubicka-Trzaska, Piotr Oleksy, Bozena Romanowska-Dixon

  Przegla̧d lekarski. 01/2009; 66(11):972-5.

  Neovascular age-related macular degeneration (AMD) is becoming an increasing socio-medical problem as the proportion of the aged population is continuously increasing. However, new researches in theNeovascular age-related macular degeneration (AMD) is becoming an increasing socio-medical problem as the proportion of the aged population is continuously increasing. However, new researches in the pathogenesis of the disease offer the opportunity to develop more effective therapies of AMD. This article will focus on the options in the management of neovascular age-related macular degeneration and recent therapeutic options. The recent development of anti-VEGF (vascular endothelial growth factor) substances for use in clinical routine has markedly improved the prognosis of patients with neovascular AMD. Intravitreal treatment with substances targeting all isotypes of Vascular Endothelial Growth Factor (VEGF), for the first time results in a significant increase in visual acuity in patients with neovascular AMD. The combination with occlusive therapies like photodynamic therapy (PDT) potentially offers a reduction of re-treatment frequency and long-term maintenance of the treatment benefit. Further developments interacting with various steps in the angiogenic cascade are under clinical or preclinical evaluation and may soon become available. Nevertheless, the growing number of novel therapeutic options will have to provide proof of concept in randomized controlled clinical trials.

• [Serum antiretinal antibodies (ARA) in patients with exudative age-related macular degeneration (AMD)--preliminary findings].

  Authors: Agnieszka Kubicka-Trzaska, Joanna Wilańska

  Przegla̧d lekarski. 01/2009; 66(11):944-7.

  Age-related macular degeneration (AMD) is the leading cause of blindness in the Western world. Despite the magnitude of this clinical problem, the pathogenesis of the disease remains stillAge-related macular degeneration (AMD) is the leading cause of blindness in the Western world. Despite the magnitude of this clinical problem, the pathogenesis of the disease remains still unclear. To determine the tissue specificity and titer of antiretinal antibodies (ARA) in sera of patients with exudative AMD. Forty-six patients (92 eyes) 16 males and 30 women with exudative AMD were stratified arbitrary into four groups of AMD activity/severity: group I (n = 19)--patients with active choroidal neovascularization (CNV) in one eye and with drusen in the other eye; group II (n = 14)--patients with bilateral CNV; group III (n = 10)--patients with CNV in one eye and with disciform scar in the contralateral eye; group IV (n = 3)--patients with bilateral disciform scars. In all patients serum ARA were determined using indirect immunofluorescence detection on normal monkey retina as antigens substrate and FITC--labelled goat's anti-human IgA, G, M serum as the secondary antibody. In all patients' serum ARA were present in the range of titres from 1:40 to 1:5120. Control sera (n = 28, 28 males) demonstrated the presence of ARA in titres 1:10 to 1:40 in 46.4% cases. High serum titres of ARA characterized AMD patients with bilateral CNV and CNV in one eye and drusen in the contralateral eye. Low titres of ARA were detected in serum of patients with bilateral disciform scars. Indirect immunofluorescence (IIF) showed eight types histological patterns of patients' sera reactivity against retinal tissue. No correlation was found between serum ARA type and macular lesion activity. Our preliminary observations indicate a common presence of various ARA in serum of patients with AMD. Thus, it cannot exclude that ARA are involved in the pathogenesis or progression of AMD.

• [Pregnancy and the eye]

  Authors: Agnieszka Kubicka-Trzaska, Izabella Karska-Basta, Joanna Kobylarz, Bozena Romanowska-Dixon

  Klinika oczna. 02/2008; 110(10-12):401-4.

  During pregnancy periodical hormonal, metabolic, hematological, vascular and immunological changes can be observed, that can influence the function of the eye. Some of them can be observed in an eyeDuring pregnancy periodical hormonal, metabolic, hematological, vascular and immunological changes can be observed, that can influence the function of the eye. Some of them can be observed in an eye due to pregnancy itself and would resolved spontaneously postpartum. Pregnancy can also induce or aggravate the preexisting conditions such as diabetic retinopathy or uveal melanoma. The autoimmune intraocular inflammation is modified by pregnancy manifesting by regression of the ocular symptoms. Pregnancy can have also beneficial effects on glaucoma because intraocular pressure has been reported to decrease during pregnancy. The presence of any ocular symptoms in a pregnant woman requires urgent ophthalmic examination and further management.

• [Small choroidal melanoma--a diagnostic problem]

  Authors: Bozena Romanowska-Dixon, Agnieszka Kubicka-Trzaska

  Klinika oczna. 02/2008; 110(7-9):308-13.

  The aim of this paper is to present the most common diagnostic problem associated with a small choroidal melanoma. In some cases other lesions such as a choroidal naevus, an exudative type of ageThe aim of this paper is to present the most common diagnostic problem associated with a small choroidal melanoma. In some cases other lesions such as a choroidal naevus, an exudative type of age related macular degeneration (AMD) with the presence of subretinal haemmorrhage, retinal pigment hypertrophy, choroidal haemangioma and choroidal metastatic tumours may mimic small choroidal melanomas. Based on the literature and on our own experience we present the basic clinical features of these lesions, their characteristic fluorescein angiography, indocyanine green angiography and ultrasonography pictures that can be helpful in differential diagnosis.

• Non-malignant uveitis masquerade syndromes.

  Authors: Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Klinika oczna. 01/2008; 110(4-6):203-6.

  The Uveitis Masquerade Syndromes (UMS) are a group of ocular diseases that mimic chronic intraocular inflammation. Many non-malignant conditions may result in an appearance mimicking an uveitis. TheThe Uveitis Masquerade Syndromes (UMS) are a group of ocular diseases that mimic chronic intraocular inflammation. Many non-malignant conditions may result in an appearance mimicking an uveitis. The authors review most common non-malignant conditions which may be considered masquerades such as: retained intraocular foreign body, rhegmatogenous retinal detachment, myopic degeneration, pigment dispersion syndrome, ocular ischemic syndrome, infectious intraocular inflammation, retinitis pigmentosa, multiple sclerosis and drug and post-vaccination reactions.

• Malignant uveitis masquerade syndromes.

  Authors: Agnieszka Kubicka-Trzaska, Bozena Romanowska-Dixon

  Klinika oczna. 01/2008; 110(4-6):199-202.

  The term "Masquerade Syndrome" was first used in ophthalmology in 1967 by Theodore, to describe a case of conjunctival carcinoma that manifested as chronic conjunctivitis. The Uveitis MasqueradeThe term "Masquerade Syndrome" was first used in ophthalmology in 1967 by Theodore, to describe a case of conjunctival carcinoma that manifested as chronic conjunctivitis. The Uveitis Masquerade Syndromes (UMS) are a group of various ocular diseases that may mimic chronic intraocular inflammation. Many malignant pathologies may result in an appearance masquerading as uveitis. The article reviews most common malignant conditions which may be considered masquerades such as primary intraocular lymphoma, leukemias, uveal melanoma, retinoblastoma, metastatic lesions, and paraneoplastic syndromes, among others. Diagnostic strategies, therapies, and prognosis are also reviewed.

• Exudative age-related macular degeneration or Best vitelliform macular dystrophy?--A case report.

  Authors: Agnieszka Kubicka-Trzaska, Agnieszka Filemonowicz-Skoczek, Izabella Karska-Basta, Bozena Romanowska-Dixon

  Klinika oczna. 01/2008; 110(4-6):183-7.

  To report a case of Best vitelliform macular dystrophy referred to the Department Ophthalmology in Krakow with a diagnosis of exudative age-related macular degeneration (AMD). 70-years old man wasTo report a case of Best vitelliform macular dystrophy referred to the Department Ophthalmology in Krakow with a diagnosis of exudative age-related macular degeneration (AMD). 70-years old man was diagnosed in our clinic because of a two years history of slow, progressive visual acuity worsening in both eyes with the presence of metamorphopsia. The basic ophthalmic examination was performed with additional diagnostic methods including: colour vision test (Panel D-15), Amsler grid test, contrast sensitivity test (Pelli-Robson chart), fluorescein angiography (FA), indocyanine green angiography (ICGA), electroretinogram (ERG), electrooculogram (EOG) and optical coherence tomography (OCT). Visual acuity in the right eye was: 0.16 and in the left: 0.25. Amsler grid test revealed the presence of bilateral mild etamorphopsia with the relative central scotoma. Pelli-Robson test showed decreased contrast sensitivity perception in both eyes; PO > LO. On fundoscopy in macula of both eyes the symmetrical round, elevated lesions of 1.5 dd with the meniscus of subretinal creamy-yellow masses were present. The early frames of FA showed the presence of round lesions with distinct borders, unchanged in size and shape throught the examination, hypofluorescent in the lower and hyperfluorescent in the upper half of the lesions. Late frames of FA revealed the irregular hyperfluorescence also in lower aspects of the lesions. ICGA showed: round hypofluorescent lesions with isofluorescence in the upper part of the lesions. ERG--revealed no pathology, EOG--showed decreased light response and depressed Arden ratio in both eyes. OCT demonstrated hiperreflectivity of the retinal pigment epithelium with elevation of retina and deletion of the foveolar depression in both eyes. Based on the results of performed tests the diagnosis of the Best vitelliform macular dystrophy was established. In some cases various pathologies involving the macula may mimic the exudative AMD. The basic ophthalmic examination supported by additional diagnostic methods allow to establish the definitive diagnosis in most cases of macular disorders.

• Alström syndrome--a case report and literature review.

  Authors: Izabella Karska-Basta, Agnieszka Kubicka-Trzaska, Agnieszka Filemonowicz-Skoczek, Bozena Romanowska-Dixon, Joanna Kobylarz

  Klinika oczna. 01/2008; 110(4-6):188-92.

  To report a case of Alström syndrome referred as bilateral macular degeneration. A 52 years old man was diagnosed with an over 30 years history of progressive visual acuity worsening in both eyes,To report a case of Alström syndrome referred as bilateral macular degeneration. A 52 years old man was diagnosed with an over 30 years history of progressive visual acuity worsening in both eyes, with the presence of night blindness and photophobia. Since childhood the right eye has been positioned in a divergent deviation. General history revealed: high grade obesity, dilated cardiomyopathy with mitral insufficiency, diabetes mellitus type 2, hepatic cirrhosis with elevated serum enzymes, systemic hypertension. Family history: one patient's brother died at the age of 2 years because of a congenital heart disease, and the second brother was diagnosed for the congenital organic heart disease. The basic ophthalmic examination was performed with additional diagnostic methods including: kinetic visual field examination, Amsler grid test, panel D-15 test, fundus photography, ERG, EOG and VEP. Best corrected visual acuity of both eyes was 0.1. Amsler grid and color vision tests were normal. Visual field revealed concentric contraction in both eyes. The funduscopy showed pale optic discs, atrophic maculopathy, golden appearance of peripheral and midperipheral fundus, coarser pigmentary changes with a "bone-spicule" configuration and arterioral narrowing. The red free pictures demonstrated the atrophy of internal retinal layers and the infrared pictures revealed the atrophy of the external layers of the retina in posterior pole of the fundus. The flash ERG showed reduced amplitude of photopic and scotopic b-wave. The multifocal ERG demonstrated the normal function of the central retina. EOG revealed decreased Arden ratio in both eyes; 1.68 in the right and 1.32 in the left. The pattern VEP revealed the P100 amplitude reduction by 80% and elongation of latency by 120% in the right eye and normal in the left eye. The flash VEP showed normal latency and amplitude reduction by 50% in both eyes. Based on the results of performed tests the diagnosis of Alström syndrome was established. This rare congenital autosomal recessive condition is characterized by progressive cone-rod retinal dystrophy associated with obesity, sensorineural deafness, type 2 diabetes, congenital cardiac insufficiency secondary to dilated cardiomyopathy, systemic hypertension and kidney failure.

• [Transpupillary thermotherapy in exudative age-related macular degeneration]

  Authors: Agnieszka Kubicka-Trzaska, Maria Starzycka, Ewa Ortyl, Alina Górniak-Bednarz, Izabella Karska-Basta

  Klinika oczna. 02/2007; 109(4-6):142-5.

  PURPOSE: Assessment of TTT results in patients with exudative age-related macular degeneration. MATERIAL AND METHODS: The study comprised of 65 patients (73 eyes), in age 50-84 years (average age-75PURPOSE: Assessment of TTT results in patients with exudative age-related macular degeneration. MATERIAL AND METHODS: The study comprised of 65 patients (73 eyes), in age 50-84 years (average age-75 yrs). The diagnosis of exudative AMD was established on the basis of fundus examination and fluorescein angiography (FA) and in some cases on indocyanine green angiography. The baseline visual acuity (VA) ranged from counting fingers at 50 cm to 0.8. In 31 (42.5%) eyes occult CNV, in 11 (15%) minimally classic CNV and in 31 (42.5%) eyes predominantly classic CNV were observed. Subfoveal CNV was present in 70 (95.9%) eyes and perifoveal in 3 (4.1%). TTT was delivered using a diode laser at 810 nm wavelength, a spot size of 1.2 to 4.5 mm and a duration of 60 seconds for each spot with power settings between 320-800 mW. Follow-up examinations were carried out every 10-12 weeks. In cases with persistent leakage from CNV in late frames of FA a retreatment was performed. The follow-up period ranged from 6 to 28 months (average - 9.8 months). RESULTS: Visual acuity improved in 22 (30.1%) eyes, stabilized in 34 (46.6%) and deteriorated in 17 (23.3%). Fluorescein angiography showed no CNV leakage in 58 (79.5%) eyes. In 56 (71.8%) with regression of leakage in fluorescein angiography improvement or stabilization of visual acuity was detected. Subretinal haemorrhages after TTT were observed in 4 eyes (5.5%). At the end of the follow-up period fibrosis of CNV was detected in 12 eyes (16.4%). CONCLUSIONS: TTT is effective and safe method of treatment of occult and classic CNV in a course of wet AMD. In a majority of cases TTT results in total or partial regression of CNV and stabilization of visual acuity.