Joanna Kobylarz

Publications of Joanna Kobylarz

• 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.

• [Results of combined chemotherapy and local ophtalmic therapy for intraocular retinoblastoma].

  Authors: Walentyna Balwierz, Danuta Pietrys, Bozena Romanowska-Dixon, Joanna Kobylarz, Katarzyna Pawińska-Wasikowska, Angelina Moryl-Bujakowska

  Przegla̧d lekarski. 01/2010; 67(6):404-8.

  Until recently chemotherapy was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (uveal extension, orbital extension, neoplastic infiltrates of the opticUntil recently chemotherapy was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (uveal extension, orbital extension, neoplastic infiltrates of the optic nerve at resection line, intracranial metastasis, generalized disease). Recent experience has proved that use of chemotherapy for intraocular retinoblastoma before local treatment (so called "chemoreduction") has allowed not only to decrease number of enucleations and indications for external beam irradiation or limit the extension of local therapy, but also increase chances for vision preservation and decrease the risk of severe complications. Seventy five children (with 106 involved eyes) aged 0.2 - 106 months with intraocular retinoblastoma diagnosed between January 1996 and June 2009 were the subject of this study. Among 106 involved eyes, in 70 (66%) the V stage according to Reese-Ellsworth classification (R-E) was established. Enucleation before chemotherapy was necessary in 9 (8.5%) cases, and in 22 more children the eye had to be removed after 1-2 courses of chemotherapy. In 68 remaining children (with 70 involved eyes) VEC (vincristine, etoposide, carboplatin) chemotherapy combined with delayed local therapy (cryotherapy, photocoagulation, brachytherapy) was employed. Out of 84 eyes treated by combined methods eye enucleation could be avoided in 47 (67%), including 18 (90%), 13 (87%) and 16 (46%) qualified to R-E group I-II, III-IV and V, respectively. First-line chemotherapy combined with the local treatment should be standard treatment for intraocular retinoblastoma groups I - IV. More effective therapy is required for R-E eye group V cases.

• [Signs of retinoblastoma].

  Authors: Joanna Kobylarz, Anna Napora-Krawiec, Małgorzata Anzel, Dawid Kulec, Anna Michalik-Wójcik, Bozena Romanowska-Dixon

  Przegla̧d lekarski. 01/2009; 66(11):937-9.

  Retrospective analysis of retinoblastoma symptoms in patients treated in Ophthalmological Clinic in Krakow. A retrospective chart review was conducted of 293 retinoblastoma patients from our centerRetrospective analysis of retinoblastoma symptoms in patients treated in Ophthalmological Clinic in Krakow. A retrospective chart review was conducted of 293 retinoblastoma patients from our center (1969-2008). A total of 170 (58%) of 293 patients presented with leukocoria, 81 (27.6%) patients had strabismus, 22 (7.5%) had atypical sings, 12 (4.1%) was detected by chance. Eight (2.8%) patients who had a family history of retinoblastoma and were clinically screened for retinal tumors from birth were diagnosed younger. We recommend routine dilated fundoscopic examination by an ophthalmologist for early detection of retinoblastoma before leukocoria and strabismus.

• [Ocular outcomes in 3-year-old premature infants with retinopathy treated with cryotherapy and laser photocoagulation].

  Authors: Joanna Kobylarz, Dawid Kulec, Anna Michalik-Wójcik, Anna Napora-Krawiec, Małgorzata Anzel, Bozena Romanowska-Dixon

  Przegla̧d lekarski. 01/2009; 66(11):940-3.

  The aim of the study was to compare functional and structural outcomes in 3-year-old premature children treated in acute phase of retinopathy of prematurity with diode laser photocoagulation andThe aim of the study was to compare functional and structural outcomes in 3-year-old premature children treated in acute phase of retinopathy of prematurity with diode laser photocoagulation and cryotherapy. We examined 106 premature children aged 3 years, treated for retinopathy of prematurity, by transpupillary diode laser photocoagulation (group II) or cryotherapy (group I). Functional (visual acuity using Snellen charts or preferential looking test - Teller acuity Card) and structural (anterior segment slit lamp and indirect Fison fundus examination) outcome and cycloplegic refraction using 1% Tropicamide were examined in all children. Favorable functional results occurred in 81.9% of eyes in patients after cryotherapy and in 83.9% of eyes in patients after diode laser photocoagulation. Structural outcome was favorable in 90.1% of eyes treated with cryotherapy and in 95.3% of eyes treated with diode laser photocoagulation. Diode laser photocoagulation appliance in retinopathy of prematurity treatment allows to obtain better functional and structural outcomes than cryotherapy.

• [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.

• 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.

• [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.

• [Diode laser photocoagulation for retinopathy of prematurity--outcomes in one-year observation]

  Authors: Joanna Kobylarz, Anna Piwowarczyk, Bozena Romanowska-Dixon

  Klinika oczna. 02/2006; 108(1-3):36-8.

  PURPOSE: To evaluate structural and functional outcomes in one-year old patients, treated for retinopathy of prematurity (ROP) with transpupillary diode laser photocoagulation. MATERIALS AND METHODS:PURPOSE: To evaluate structural and functional outcomes in one-year old patients, treated for retinopathy of prematurity (ROP) with transpupillary diode laser photocoagulation. MATERIALS AND METHODS: 58 children (116 eyes) 12 months old, after treatment for ROP with diode laser photocoagulation, were examined. Both, functional outcome (visual acuity--basing on the examination with Teller Acuity Card Procedure), and structural outcome were evaluated. The cycloplegic refraction was examined in all cases. RESULTS: We have found good functional outcome in 81.9%, and good structural outcomes in 96.5% of examined eyes. 64.6% of eyes had hyperopic refractive error, and 31% were myopic. CONCLUSIONS: Diode laser photocoagulation is an effective method of treatment for ROP.

• [Results of 10 years observation of organ of sight in prematurity]

  Authors: Anna Kubatko-Zielińska, Joanna Kobylarz, Anna Piwowarczyk, Bozena Romanowska-Dixon

  Klinika oczna. 02/2006; 108(1-3):43-5.

  PURPOSE: (1) To compare the incidence of refractive errors and the orthoptic condition in ten-year-old children, born prematurely and treated with cryotherapy versus children, whom did not apply suchPURPOSE: (1) To compare the incidence of refractive errors and the orthoptic condition in ten-year-old children, born prematurely and treated with cryotherapy versus children, whom did not apply such a procedure. (2) To estimate condition of the extraocular muscles. MATERIAL AND METHODS: A group of 60 prematurely born children was divided into 2 subgroups: I--30 children treated with cryotherapy, II--30 no treatment was applied. All the children had anterior segment, fundus and visual acuity examined. Refraction following cycloplegia was evaluated. Visual acuity and orthoptic status was assessed. RESULTS: In the group of prematurely born children who had retinopathy in the infantile age and were treated with cryotherapy, refractive errors were frequently observed. In over half of those children squint or impaired eye movement were found. In the group of children who required no cryotherapy the percentage of those with refractive errors was similar. CONCLUSIONS: In prematurely born children with retinopathy refractive errors and squint occur quite often. Prematurely born children should be subject to ophthalmologic follow-up throughout their childhood.

• [Results of combined chemoreduction and local treatment for intraocular retinoblastoma]

  Authors: Joanna Kobylarz, Anna Piwowarczyk, Bozena Romanowska-Dixon, Walentyna Balwierz, Agnieszka Dłuzniewska

  Klinika oczna. 02/2006; 108(1-3):55-9.

  PURPOSE: Of this study was to evaluate the results of combined treatment for intraocular retinoblastoma. MATERIALS AND METHODS: We examined 23 children (32 eyes), 14 with unilateral and 9 withPURPOSE: Of this study was to evaluate the results of combined treatment for intraocular retinoblastoma. MATERIALS AND METHODS: We examined 23 children (32 eyes), 14 with unilateral and 9 with bilateral disease. 53% of eyes had the stage V of the disease, according to Reese-Ellsworth. RESULTS: In I-III group according to R-E, it was possible to save more than 90% of eyes. In group IV-V we saved 20% of eyes. CONCLUSIONS: Chemoreduction combined with local treatment is an optimal method of treatment for retinoblastoma, especially in I-III group.