Izabella Karska-Basta

Publications of Izabella Karska-Basta

• 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.

• A case of choroidal metastasis in a male breast cancer.

  Authors: Piotr Oleksy, Arkadiusz Pogrzebielski, Izabella Karska-Basta, Bozena Romanowska-Dixon

  Klinika oczna. 01/2010; 112(10-12):311-3.

  We present a case of male patient under therapy due to breast cancer with choroid metastasis and exudative retinal detachment in right eye. A 59 years old male patient was referred with diagnosis ofWe present a case of male patient under therapy due to breast cancer with choroid metastasis and exudative retinal detachment in right eye. A 59 years old male patient was referred with diagnosis of intraocular tumor in right eye Three years ago radical right-side mastectomy was performed (T2N1M0). The medical history revealed that the patient was under chemo- and hormontherapy due to right breast cancer with lungs, liver and mediastinum metastases. Based on the ophthalmological examination the diagnosis of intraocular tumor was established--choroidal metastasis with exudative retinal detachment. Due to tumor size and general dissemination external beam irradiation of tumor was performed. The majority of choroidal metastases in males are secondary to lung carcinoma, however in differential diagnosis it is necessary to consider also rare cases of breast carcinoma metastases. Treatment strategy should be considered individual depending on size, localization, presence of metastases to other organs and general condition of the patient.

• [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.

• [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.

• [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.

• [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.

• 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.

• [Diffuse atrophy of the choroid--a case report]

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

  Klinika oczna. 02/2007; 109(4-6):216-9.

  PURPOSE: The authors present a case of the 66-year-old female patient suffering from the diffuse atrophy of the choroid. MATERIAL AND METHODS: The 66-year-old woman was referred to thePURPOSE: The authors present a case of the 66-year-old female patient suffering from the diffuse atrophy of the choroid. MATERIAL AND METHODS: The 66-year-old woman was referred to the Ophthalmological Clinic in Krakow with the diagnosis of choroideremia. The patient developed central vision problems (mainly in the left eye) and night blindness. We performed following investigations: distance and near visual acuity with Snellen charts, Amsler grid test, the investigation of the anterior and posterior segments of both eyes, and the fluorescein angiography as well as the infrared photo of the fundus. The assessment of ornithine serum level was performed. RESULTS: The ophthalmological examination revealed: the distance visual acuity in the RE=0.5, and in the LE=0.25. The near visual acuity in the RE=0.5, in the LE=0.75. The Amsler grid test in the RE showed no pathology but in the LE revealed in the nasal aspect of the central visual field a relative scotoma. Fundoscopy, fluorescein angiography and infrared imaging revealed the broad patch form atrophy of the RPE and choriocapillaris within the whole fundus and also within the macula. The serum level of ornithine was within the normal limits. CONCLUSIONS: Based on the results of performed investigations the definitive diagnosis of a very rare dystrophy--a diffuse atrophy of the choroid was established.

• [Serum antiretinal antibodies (ARA) in patients with choroidal melanoma--preliminary report]

  Authors: Agnieszka Kubicka-Trzaska, Izabella Karska-Basta, Katarzyna Krukierek-Małec

  Klinika oczna. 02/2005; 107(10-12):642-5.

  PURPOSE: To estimate serum antiretinal antibodies (ARA) in patients with choroidal melanoma after therapy in 3 months follow-up period. MATERIAL AND METHODS: 24 patients at the age 37-72 years (mean:PURPOSE: To estimate serum antiretinal antibodies (ARA) in patients with choroidal melanoma after therapy in 3 months follow-up period. MATERIAL AND METHODS: 24 patients at the age 37-72 years (mean: 57.8 years) with choroidal melanoma were examined. In all cases routine ophthalmic examination with A- and B-scan ultrasonography and fluorescein angiography were performed. In some subjects also indocyanine green angiography was performed. Ruthenium-106 plaques were used in 16 cases, in 5 cases treatment with Iodine-125 plaques was performed. Three patients underwent enucleation. In all cases ARA were determined in a serum dilution 1:10 by indirect immunofluorescence test on normal monkey retina as a substrate and FITC-labeled anti-human IgA, IgG, IgM serum (Euroimmun--Germany). ARA were scored before and within 3 months, after the therapy was performed. RESULTS: Before treatment ARA were present in 15 patients (62.5%) with choroidal melanoma in serum dilution 1:10. In a control group ARA were present in 3 cases (12.5%) in serum dilution 1:10. After therapy within 3 months follow-up period ARA occurred in serum of further 7 patients, all treated with Ruthenium-106 plaques. Fluorescence of outer retinal segments was present in 7 cases, while serum of remaining 15 patients demonstrated positive reaction within the whole tissue. Indirect immunofluorescence test on normal monkey retina revealed in 11 patients the presence of other autoantibodies; antinuclear and antinucleolar antibodies, reacting with nuclei of inner and outer nuclear layers of retina. CONCLUSIONS: The presence of ARA in serum of patients with choroidal melanoma before therapy may be a result of autoimmune reaction against the tumor tissue. The detection of ARA in serum after plaque therapy may be associated with reaction due to tumor irradiation. The appearance of other serum autoantibodies in patients with choroidal melanoma may indicate at more advanced and generalized process.