Monika Modrzejewska

Publications of Monika Modrzejewska

• The role of hemoglobin variant replacement in retinopathy of prematurity.

  Authors: Wojciech Podraza, Hanna Podraza, Karolina Jezierska, Joanna Szwed, Monika Modrzejewska, Jacek Rudnicki, Agnieszka Kordek, Hanna Domek

  Indian journal of pediatrics. 06/2011; 78(12):1498-502.

  To conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement inTo conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement in adult blood transfusions. A retrospective, observational study of 83 infants born between 23 and 34 wks gestation was conducted. The infants without ROP, with 1 and 2 stage of ROP and with ≥ 3 stage of ROP received Q 28 (12-134); 51 (14-149); 156 (38-244) ml/kg of transfused blood, respectively, and the factor Qt was 1,545 (560-10,045); 3,093 (614-13,419); 11,907 (1,288-20,638) (ml/kg)·day, respectively. For the same groups MCV(35) (mean cell volume at the arbitrary time of the 35(th) wk post-conception) was 92.3 (82.9-110.5); 91.0 (79.3-101.4); 87.1 (80.2-94.8) fl, respectively, and factor P(MCV)/t was 99.5 (89.2-108.8); 96.3 (84.6-106.3); 90.7 (85.3-96.5) fl, respectively. There is high influence on the stage of ROP of the amount of transfused blood and MCV, both with or without the time factor. The statistical differences between P(MCV)/t were more significant than the differences between MCV(35), for different stages of ROP. The influence of the time factor on the statistical differences of MCV but not on the amount of transfused adult blood suggests that HbF - HbA replacement may play a role in ROP development.

• [Cases of congenital eye malformations in children].

  Authors: Monika Modrzejewska, Ewelina Lachowicz, Danuta Karczewicz

  Annales Academiae Medicae Stetinensis. 01/2011; 57(1):17-25.

  The aim of this work was to present a clinical picture of congenital defects in the anterior and posterior segment of the eye and coexisting systemic developmental anomalies in a group of childrenThe aim of this work was to present a clinical picture of congenital defects in the anterior and posterior segment of the eye and coexisting systemic developmental anomalies in a group of children during the infantile period. We performed a retrospective analysis in a group of 1507 infants seen at our outpatient ophthalmology clinic in 2006-2010. Attention was focused on case histories of nine children (0.6%) with congenital defects of the eye. A routine ophthalmologic examination was done and photographs of the anterior and posterior segment of the eye were archived with the Ret - Cam II apparatus. Maternal risk factors during pregnancy and the perinatal period were analyzed, as well as genetic, familial, infectious, traumatic, metabolic, and toxic factors, and drugs which could have contributed to the pathology of the organ of vision. Additionally, congenital polydysplasia was confirmed using ultrasonography, radiography, and imaging techniques (USG, X-ray, MRI). Congenital anomalies of the anterior and posterior segment of the eye were identified in the study group. Abnomalities of the anterior segment of the eye in four infants were in the form of congenital corneal anomalies (keratopathy, microcornea, sclerocornea, congenital mesenchymal dysgenesis), coloboma of the iris, and aniridia. Additionally, ectopic pupil, congenital cataract, aplasia of the lacrimal point, and palpebral coloboma were observed. Developmental anomalies of the posterior segment of the eye in the form of persistent hyperplastic primary vitreous body or primary fetal vasculature syndrome (PHVB or PFVS), choroid coloboma, coloboma of the optic nerve, and optic disc fovea were recognized in eight children. Anomalies of the anterior and posterior segment of the eye were observed in three children and were associated with microphthalmia, nystagmus, and strabismus. Moreover, systemic anomalies coexisting with ophthalmologic defects were confirmed in 6 children. They were seen in the heart (patent ductus arteriosus (PDA), patent foramen ovale (Pfo), atrial septal defect (ASD), nervous system (aplasia of the corpus callosum, hydrocephalus), osteoarticular system (talipes equinovarus, bifurcate rib, butterfly vertebra, dysmorphic splanchnocranium, contracture of the fingers), genitourinary system (cryptorchism, Wilms' tumor, vesicoureteral reflux grade IV), auditory organ (microtia, aplasia of the external auditory meatus, tympanic cavity, and internal ear), and skin (telangiectasia, syndactyly, appendages, and vegetations). Genetic tests revealed one case of an abnormal karyotype (49, XXXXX). Infections, metabolic disorders, and intoxications were excluded as the background for the anomalies. The finding of a congenital eye anomaly should be followed by a search for other systemic anomalies. Developmental anomalies of the eye and other organs will require a multidisciplinary approach to treatment and care.

• [The role of circulating endothelial progenitor cells in the progression of retinopathy of prematurity--a prospective study].

  Authors: Anna Machalińska, Maciej Kotowski, Krzysztof Safranow, Joanna Lewandowska, Monika Modrzejewska, Jacek Rudnicki, Ryszard Czajka, Bogusław Machaliński

  Klinika oczna. 01/2011; 113(7-9):223-7.

  Retinopathy of prematurity (ROP) is the primary cause of visual impairment in preterm infants. There are available data confirming that circulating endothelial progenitor cells (EPCs) are involved inRetinopathy of prematurity (ROP) is the primary cause of visual impairment in preterm infants. There are available data confirming that circulating endothelial progenitor cells (EPCs) are involved in forming the growing network of blood vessels in the developing retina. In this study we sought to explore potential relationship between concentration of circulating bone marrow-derived EPCs and development of ROP in prospective study. The study groups consisted of 90 preterm (23-36 weeks of gestational age), and 52 full-term control infants. EPCs were analyzed in cord blood (CB) and subsequently in peripheral blood (PB) in second and sixth week since delivery. The incidence and stage of ROP was prospectively documented in the preterm infants. EPC concentration in CB was considerably higher in the preterm infants developing ROP. In the preterm infants a noticeable decrease in PB EPC concentration within six weeks of the follow up was found, whereas in full-term infants EPC concentration was maintained at invariable level. Of note, in the sixth week since delivery, EPC concentration in preterm infants with ROP was lower compared to preterm infants without ROP. Increase in CB EPC concentration in preterm infants, including those developing ROP, indicates that the circulating EPC cells contribute to the process of blood vessel formation, and their number in CB reflects the degree of prematurity. Impaired blood vessel formation within retina in the course of ROP may result from decrease in circulating EPC number observed at the sixth week since delivery.

• Chorioretinitis in infants.

  Authors: Monika Modrzejewska, Ewelina Lachowicz, Danuta Karczewicz, Alicja Zdanowska

  Klinika oczna. 01/2011; 113(10-12):352-6.

  The aim of this review is to present cases of chorioretinitis in infants caused by viral and parasitic infections. Four infants with viral chorioretinitis were identified in a routineThe aim of this review is to present cases of chorioretinitis in infants caused by viral and parasitic infections. Four infants with viral chorioretinitis were identified in a routine ophthalmological examination. Laboratory tests towards bacterial, viral and parasitic diseases were performed. Toxoplasmosis, rubella, and CMV infections were diagnosed in clinical and laboratory tests. After a wide spectrum of therapy a total remission of inflammatory process in all the discussed children was observed. Posterior uveitis is an ocular complication which can be connected with viral or parasitic infections in postnatal period. Prematurity, normal delivery, intrauterine transmission, breast feeding, comorbid diseases might be associated with chorioretinitis in infants.

• [Persistent fetal vasculature syndrome--clinical image and diagnostic difficulties].

  Authors: Monika Modrzejewska, Ewelina Lachowicz, Danuta Karczewicz, Ewa Sawińska

  Klinika oczna. 01/2011; 113(10-12):357-63.

  The aim of this review is to present cases of clinically differentiated picture of persistent fetal vasculature syndrome--PFVS (also called persistent hyperplastic primary vitreous body--PHPVB)The aim of this review is to present cases of clinically differentiated picture of persistent fetal vasculature syndrome--PFVS (also called persistent hyperplastic primary vitreous body--PHPVB) observed in group of infants and children. Case records of four children with characteristic changes of posterior form of persistent fetal vasculature syndrome, which were observed on fundus of the eyes, were analyzed retrospectively. Routine ophthalmological examination, genetic, cytogenetic and laboratory tests towards coexisting bacterial, viral and parasitic diseases and congenital anomaly of the eye or chorioretinal neoplastic changes of neonatal period were performed. Ophthalmological changes were archived using Ret-Cam II apparatus (Clarity Medical Systems). Measurement of the axial diameter of the eyes and exclusion coexisting ocular disease by ultrasonography (A-scan US i B-scan US and color Doppler ultrasonography--CDU), were performed. Different clinical image of posterior form of persistent hyperplastic primary vitreous body was observe in ophthalmological examination. Changes such as fibrovascular tissue connecting optic disc (n. II) with ora serrata of the retina coexisting with retinoschisis, retrolental mass or persistent hyaloid artery were observed. Additionally concomitant features in pathological eyes were: iris hypoplasia, corectopia, microphthalmia, congenital cataract, secondary glaucoma, degeneration or retinoschisis and intrvitreous haemorrhage. Strabismus, nystagmus and heart disease in the form of persistent fetal circulation were associated with ophthalmological changes. Inflammatory and genetically determined diseases were excluded in differential diagnosis. The diagnosis of persistent hyperplastic primary vitreous body (PHPVB) was confirmed by characteristic clinical symptoms and results of the additional research. Suggestion of recognition of this syndrome (PHPVB) as well as persistent fetal vasculature syndrome (PFVS) should be implemented diagnostics towards other optic and systemic development defects.

• [Hemodynamic phenomena in retrobulhar and eyeball vessels].

  Authors: Monika Modrzejewska

  Klinika oczna. 01/2011; 113(4-6):180-2.

  The purpose of this review was to evaluate factors connected with blood flow and indices regulating vascular diameter and some parameters influencing retrobulbar circulation such as type of vascularThe purpose of this review was to evaluate factors connected with blood flow and indices regulating vascular diameter and some parameters influencing retrobulbar circulation such as type of vascular resistance, anatomical structure of vascular wall and vessel lumen. Neurogenic and angiogenic factors, rheological blood composition, presence of anatomical and pathological obstructions on blood flow pathway as well as degree of development of collateral circulation pathways--have influence on the volume and blood flow velocity in eyeball. There were discussed bulbar circulation hemodynamics, emphasizing the importance of perfusion pressure. The role of risk factors was underlined for pathological lesions in vessels supplying blood to eyeball and in ophthalmic artery (OA) and its collaterals, in central retinal artery (CRA) as well as posterior ciliary arteries (PCAs), and in venous system carrying away blood from eye. IN CONCLUSION--the results of many studies of retrobulbar blood flow in different types of ophthalmic diseases of the vascular etiopathogenesis indicate that registry of the mean values of blood flow parameters and vascular resistance indices parallel to measurement of blood flow spectrum in OA, CRA, PCAs arteries, might contribute much information to explain or to evaluate nature of pathological changes in retinal and choroidal circulation.

• Circulating stem cell populations in preterm infants: implications for the development of retinopathy of prematurity.

  Authors: Anna Machalinska, Monika Modrzejewska, Maciej Kotowski, Violetta Dziedziejko, Magda Kucia, Milosz Kawa, Krzysztof Safranow, Magdalena Baskiewicz-Masiuk, Anna Modrzejewska, Danuta Karczewicz, Jacek Rudnicki, Boguslaw Machalinski

  Archives of ophthalmology. 10/2010; 128(10):1311-9.

  To investigate the association among different circulating stem cell (SC) populations, the levels of selected growth factors and chemokines regulating SC migration in the peripheral blood, and theTo investigate the association among different circulating stem cell (SC) populations, the levels of selected growth factors and chemokines regulating SC migration in the peripheral blood, and the incidence of retinopathy of prematurity (ROP). We evaluated 88 participants in this study: 29 preterm infants with ROP, 29 preterm infants without ROP, and 30 healthy full-term infants. Peripheral blood samples collected 10 weeks after delivery were analyzed using flow cytometry, immunofluorescence, real-time reverse transcriptase-polymerase chain reaction, and enzyme-linked immunosorbent assay. The following cell populations were analyzed: (1) lin⁻CXCR4(+)CD45⁻ (enriched in very small embryonic-like SCs), (2) lin⁻CXCR4(+)CD45(+) (enriched in hematopoietic SCs), and (3) CD34(+)CD133(+)CD144(+) (early endothelial progenitor cells) [lin indicates lineage]. The concentrations of vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor, and stromal cell-derived factor 1 were measured in the plasma. The very small embryonic-like SCs and early endothelial progenitor cells expressing neural and endothelial markers were significantly increased in the preterm infants. The number of early endothelial progenitor cells in the peripheral blood was significantly greater in the preterm infants with ROP than in the preterm infants without ROP. An accompanying increase in the concentrations of vascular endothelial growth factor and hepatocyte growth factor was found in the peripheral blood of the preterm infants with ROP. No significant associations were found between hematopoietic SCs and ROP or prematurity. The increased number of early endothelial progenitor cells along with elevated levels of vascular endothelial growth factor and hepatocyte growth factor in preterm infants with ROP suggest that circulating vasculogenic factors may play a role in the development and progression of ROP. The increased number of very small embryonic-like SCs in preterm infants suggests that the development of immature tissues and organs, including the retina, may require a contribution of circulating SCs.

• Refractive status and ocular axial length in preterm infants without retinopathy of prematurity with regard to birth weight and gestational age.

  Authors: Monika Modrzejewska, Wilhelm Grzesiak, Danuta Karczewicz, Daniel Zaborski

  Journal of perinatal medicine. 05/2010; 38(3):327-31.

  To obtain ultrasonographic measurements of ocular axial length (AL) in preterm infants without retinopathy of prematurity (ROP) but with different refractive power in regard to birth weight (BW) andTo obtain ultrasonographic measurements of ocular axial length (AL) in preterm infants without retinopathy of prematurity (ROP) but with different refractive power in regard to birth weight (BW) and gestational age (GA). Refraction was measured after cycloplegia (at 6 months of life) in 350 eyes of 180 preterm (non-astigmatic) infants without ROP. Subjects were grouped according to the refractive error: A [above -6.0 dioptres (D)]; B (-3.1 to -6.0 D); C (0 to -3.0 D); D (0.1 to +3.0 D); E (+3.1 to +6.0 D); F (above +6.0 D). The AL measurement was performed by ocular A-scan ultrasound biometry (10 MHz probe). The longest AL was found in group B (20.62 mm) compared to group D and E (19.35, 19.28 mm; P< or =0.01) and group F and A (19.63, 19.39 mm; P< or =0.05). Only regressive correction for BW was statistically significant. Correlations between AL and BW (Rs=0.23) or GA (Rs=0.17) were found only in group E. AL of myopic eyes was significantly longer. In general, hyperopia was positively correlated with BW, whereas correlation between myopia and BW or GA was not found.

• Ocular circulation in systemic lupus erythematosus.

  Authors: Monika Modrzejewska, Lidia Ostanek, Danuta Bobrowska-Snarska, Danuta Karczewicz, Grazyna Wilk, Marek Brzosko, Alon Harris

  Medical science monitor : international medical journal of experimental and clinical research. 11/2009; 15(11):CR573-8.

  BACKGROUND: Mean vascular resistance in the retrobulbar arteries of SLE patients and the statistical relationship between its parameters and the presence of certain antibodies were determined.BACKGROUND: Mean vascular resistance in the retrobulbar arteries of SLE patients and the statistical relationship between its parameters and the presence of certain antibodies were determined. MATERIAL/METHODS: Forty-three eyes of 43 SLE female patients aged 46.28+/-8.45 years with disease duration of 10.03+/-7.96 years were examined. Physical and ophthalmic examinations with assessments of the immunological markers ANA/IgG-IgM, aCL, anti-beta2GPI, LA, and anti-dsDNA antibodies were performed. color Doppler imaging (CDI) was used in the OA, CRA, LPCA, and MPCA vessels. The vascular resistance indices (RIs) were compared with those of 43 eyes of 43 female controls. Covariance and multiple regression analysis with chi squared, Pearson, Shapiro-Wilk, and Levene tests were used in the statistical analysis (significance levels at p<or=0.01 and p<or=0.05). RESULTS: Significantly increased RIs in the OA, CRA, LPCA, and MPCA were recorded. aCL, abeta2GPI, and LAC correlated significantly with increased RI in the CRA. SLE diagnosis significantly correlated with RI in the OA and PCAs. Significant relationship between age and RI in the CRA and LPCA was detected. CONCLUSIONS: Retrobulbar resistance disturbances were detected in SLE patients by CDI. SLE diagnoses and presence of aPLs antibodies were associated with an increased resistivity index in ophthalmic and retino-choroidal vessels.

• [Evaluation of VEGF and IGF-1 plasma levels in preterm infants--potential correlation with retinopathy of prematurity, clinical implications].

  Authors: Anna Machalińska, Monika Modrzejewska, Violetta Dziedziejko, Maciej Kotowski, Krzysztof Safranow, Aleksandra Herbowska, Danuta Karczewicz

  Klinika oczna. 01/2009; 111(10-12):302-6.

  Insulin-like growth factor-1 plays an important role in fetal growth and development, and its level increases with gestational age. The latest reports show that IGF-1 can directly influence theInsulin-like growth factor-1 plays an important role in fetal growth and development, and its level increases with gestational age. The latest reports show that IGF-1 can directly influence the production of VEGF and regulate the development of blood vessels. Thus, the aim of the study was to evaluate the plasma concentrations of IGF-1 and VEGF as well as analyze their mutual correlation in preterm infants with retinopathy of prematurity (ROP), compared with preterm infants without ROP and full-term babies. To address this issue, peripheral blood samples (PB) were analyzed and collected 10 weeks after delivery from: 25 preterm infants with proliferative stage of retinopathy of prematurity (ROP) and neovascularization (stage 3 or more advanced), 25 preterm infants without ROP, and 25 healthy full-term control infants. Plasma concentrations of VEGF and IGF-1 were measured using high-sensitivity enzyme-linked immunosorbent assay (ELISA) kits. Increased concentrations of VEGF (p < 0.05), were found in the PB of the preterm infants with ROP compared with the preterm babies without retinopathy as well as with the full-term control infants, in whom the lowest levels of the growth factor were observed. The plasma concentrations of IGF-1 in the preterm infants were significantly lower than those of the full-term babies (p < 0.001). After adjustment for gestational age as a independent variable, a tendency to higher concentrations of IGF-1 was observed in the preterm infants with ROP. Disturbances in the interactions of VEGF and IGF-1 at early stages of ROP, leading to uncontrolled increases in their levels in the proliferative phase of disease, can play an important role in the pathogenesis of retinopathy of prematurity.

• Predictive value of color Doppler imaging in an evaluation of retrobulbar blood flow perturbation in young type-1 diabetic patients with regard to dyslipidemia.

  Authors: Monika Modrzejewska, Elzbieta Pieńkowska-Machoy, Wilhelm Grzesiak, Danuta Karczewicz, Grazyna Wilk

  Medical science monitor : international medical journal of experimental and clinical research. 11/2008; 14(10):MT47-52.

  BACKGROUND: The aim was to examine blood flow velocity and vascular resistance in retrobulbar arteries in young type-1 diabetes (DM-1) patients. Statistical relationships between blood flowBACKGROUND: The aim was to examine blood flow velocity and vascular resistance in retrobulbar arteries in young type-1 diabetes (DM-1) patients. Statistical relationships between blood flow parameters and serum lipid levels (TCH, HDL, LDL, TG, ApoB) were also determined. MATERIAL/METHODS: Fifty-two eyes with diabetic angiopathy were examined (average age: 18.54 years). Color Doppler imaging (CDI) was performed in the ophthalmic (OA), central retinal (CRA), and temporal posterior ciliary (TPCA) arteries. The parameters PSV, EDV, MV, PI, and RI were compared with those of a control group (46 eyes). The Student's t, Shapiro-Wilk, and Mann-Whitney U statistical tests were used (p< or =0.01 and p< or =0.05 were considered significant). RESULTS: Significant decreases in PSV, MV, PI, and RI in the OA, CRA, and TPCA and negative correlations between TCH, LDL, and ApoB and decreased PI and RI in the OA as well as positive correlations between these parameters and EDV in the OA were found. Increased ApoB correlated with decreased PI and RI in the TPCA. There were no significant relationships between TG and HDL and the blood flow parameters. Elevated levels of HbA1c and dyslipidemia were confirmed. CONCLUSIONS: CDI is an effective method for detecting retinochoroidal circulation disorders in the early stage of diabetic angiopathy. The alterations in retrobulbar blood flow were characterized by significant decreases in PSV, MV, and RI in the CRA and PSV, MV, PI, and RI in the TPCA. Dysregulation of TCH, LDL, and ApoB was associated with vascular resistance fluctuation, mainly in the OA.

• [Ocular manifestations in patients with systemic lupus erythematosus and antiphospholipid syndrome]

  Authors: Lidia Ostanek, Monika Modrzejewska, Danuta Bobrowska-Snarska, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:18-23.

  INTRODUCTION: Systemic lupus erythematosus (SLE) is a systemic disease of connective tissue with broad band of symptoms. It could be the reason for many organs and tissues impairment. Changes in eyesINTRODUCTION: Systemic lupus erythematosus (SLE) is a systemic disease of connective tissue with broad band of symptoms. It could be the reason for many organs and tissues impairment. Changes in eyes that occurr in SLE are not frequent, but can lead to severe impairment of sight including blindness. OBJECTIVES: The aim of the work was to asses the frequency of eye changes among patients with SLE and SLE with antiphospholipid syndrome (APS). Another aim was to asses the association between antiphospholipid antibodies and ocular lesions. PATIENTS AND METHODS: There were 75 patients enrolled with SLE, 26 of them ha APS. All of patients had a comprehensive ophthalmological and physical examination. Moreover biochemica analysis including lipid profile and glucose metabolism and serological markers of APS and SLE were performe RESULTS: Thirty-six patients complained of ophthalmologic disturbances (48%), with "dry eyes" being the most common symptom (20 patients). The reduced visual acuity was detected in 17 patients (22.6%). Conjunctivitis was found in 8 patients (10.67%), corneal involvement in 31 (41.3%), and sclera changes in 40 patients (53.3%). Changes in retina were found in 15 (20%) of patients, the most frequent were sub-retinal edema in the region of yellow spot. Changes in yellow spot were found in 8 patients; in 2 of them it was associated with dry degenerative changes, in 6 patients exudates with or without hemorrhages were found. Vascular changes including their lumen diameter were found in 33 patients (44%). In 4 patients there were changes in optical nerve disc. Schirmer's test was pathological in 43 patients (57.3%), but in only 4 patients Sjögren's syndrome was diagnosed. In the group of SLE patients intraocular pressure was significantly higher. The presence of anticardiolipin antibodies IgG class (aCL IgG) was associated with reduced visual acuity. The presence of lupus anticoagulant and anti-beta2, glycoprotein-I antibodies (anti-beta2GPI) was associated with conjunctive involvement. The presence of aCL IgM and anti-beta2GPI was associated with less frequent symptoms of eye dryness. CONCLUSIONS: We found the following significant factors of the occurrence of eye involvement in our series of SLE patients: high activity of disease (conjuctiva, iris, uvea, retina, spot, vessels and optical nerve disc involvement), late diagnosis of SLE (retinopathy and conjuctive involvement), arterial hypertension (reduced visual acuity, cornea involvement, vessels involvement), age (reduced visual acuity, cornea involvement, retinopathy), glucose metabolism disorders (changes in optical nerve disc) and presence of anti-double stranded DNA antibodies (retinopathy).

• [The appearance of refractive errors and eyeballs position disorders in the group of premature babies treated at the Chair and Clinic of Ophthalmology of the Pomeranian Medical University in the years 1999-2005]

  Authors: Monika Modrzejewska, Joanna Kot, Wilhelm Grzesiak, Danuta Karczewicz

  Annales Academiae Medicae Stetinensis. 01/2007; 53(1):57-62.

  INTRODUCTION: Retinopathy of prematurity (ROP) is a disease of the retina and the vitreous body present in children prematurely born. In the groups of babies with retinopathy of prematurity as wellINTRODUCTION: Retinopathy of prematurity (ROP) is a disease of the retina and the vitreous body present in children prematurely born. In the groups of babies with retinopathy of prematurity as well as among in the group of babies without pathological lesions, however, with retinal immaturity, occurrence of complications in the form of refractive errors and abnormality in the eyeballs position can be observed. The aim of the study was to analyze the frequency of occurrence of hypermetropia, myopia, astigmatism and eyeballs position disorders in the form of strabismus and nystagmus in premature babies. MATERIAL AND METHODS: The study material consisted of 1052 newborns treated in the Outpatient Clinic of Ophthalmology for Premature Infants in Szczecin, between 1999-2005. Refractive errors were estimated, after cycloplegic retinoscopy (0.5% Tropicamidum and 2.5% Phenylephryni hydrochloridum). Refractive errors were recognized when hypermetropia was > or = +3.0 D, myopia > or = -0.5 D, astigmatism > or = 1.0 Dcyl. Among 65 babies of the analyzed group laser treatment of the retina was applied, the rest of the 987 infants were observed or have underwent a conservative treatment. The studied group of premature babies has been divided into the following subgroups: Group I--conservatively treated babies (n = 987), group II--diode laser treated babies (n = 65). The statistic analysis of refractive errors was done on the basis of Statistica v.7.1 [StatSoft, Inc. (2005). Statistica (data analysis system), version 7.1.]. The incidence of refractive errors was described with the help of chi-square test. RESULTS: Refractive errors were recognized among 695 babies (70.49%) from group I and in 49 babies (75.39%) from group II. In the group of 987 infants whom were not treated with laser but conservatively a more frequent occurrence ofhypermetropia and astigmatism was observed--655 babies (66.33%) and 202 (20.46%) respectively. Myopia was most common in the laser treated group of babies: 19 patients (29.23%). In this group astigmatism was present in 9 babies (13.84%). Eyeballs position disorders in the form of strabismus and nystagmus were more common in the group of babies treated with laser (29.23% and 9.23%) comparing with conservatively treated babies (10.63% and 1.63%) respectively. CONCLUSIONS: Hypermetropia and astigmatism could be more often observed in the group of premature babies in whom pathological ocular fundus lesions or a low stage of advancement of retinopathy of prematurity susceptible to self-regression were not recognized. Myopia was more often identified in the group of babies with an active stage of retinopathy of prematurity as well as in those in whom laser treatment was required. Eyeballs position disorders in the form of strabismus and nystagmus were more frequent in the group of babies with an active stage of retinopathy of prematurity in whom diode laser treatment was applied.

• Assessment of blood flow velocity in eyeball arteries in multiple sclerosis patients with past retrobulbar optic neuritis in color Doppler ultrasonography.

  Authors: Monika Modrzejewska, Danuta Karczewicz, Grazyna Wilk

  Klinika oczna. 01/2007; 109(4-6):183-6.

  PURPOSE: The aim of the study was to evaluate blood flow velocity in eyeball arteries in affected and unaffected eyes in patients with past retrobulbar optic neuritis in the course of multiplePURPOSE: The aim of the study was to evaluate blood flow velocity in eyeball arteries in affected and unaffected eyes in patients with past retrobulbar optic neuritis in the course of multiple sclerosis (MS). MATERIAL AND METHODS: Evaluation of blood flow velocity in 16 eyes of 16 patients with unilateral retrobulbar optic neuritis was performed in ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA). In the arteries the following parameters have been assessed: peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), indicators of peripheral vascular resistance such as Gosling Index (PI) and Pourcelot Index (RI). The obtained values have been compared to values of blood flow in the same arteries of the control group. Using Shapiro-Wilk test, mode of distribution of each parameter was analyzed. The statistic analysis has been done between group of affected eyeballs (group 1) and control group and between group of unaffected eyeballs (group 2) in multiple sclerosis patients and control group (13 individual, 26 eyes), regarding the age. The assessment was performed with the assistance of t-Student test, and in case of lack of normal distribution, by U Mann-Whitney test. Statistically significant difference was established when p value was below 0.05 (p < or = 0.05). RESULTS: Among the analyzed parameters of blood flow velocity, statistically significant disturbances in the examined eyeball arteries were found. The most significant disturbances of blood flow were found in CRA and SPCA. The affected parameters were: diminished MV velocity in OA; PSV, MV, RI in CRA and PSV, EDV, MV and RI indices in SPCA. The similar blood flow velocity disturbances were also found in unaffected eyeball arteries. CONCLUSIONS: In MS patients with past optic neuritis disturbances of ocular circulation can be observed. The statistically significant diminishing blood flow velocity parameters and vascular resistance indices in eyeball arteries may indicate alterations of blood flow. Lowering of systolic and mean velocities and resistance indices of blood flow are most expressed in CRA and SPCA. Reduction in blood flow parameters in the examined arteries occur both, in the eyes previously affected by past optic neuritis and in contra lateral, unaffected eyes.

• [The use of ultrasonographic techniques for the diagnosis of retinopathy of prematurity]

  Authors: Monika Modrzejewska

  Annales Academiae Medicae Stetinensis. 02/2006; 52(2):83-8; discussion 88.

  INTRODUCTION: Ultrasonographic techniques are commonly used for the imaging of various tissue structures and organs, including the eyeball and orbit. The non-invasive ultrasound imaging is safe forINTRODUCTION: Ultrasonographic techniques are commonly used for the imaging of various tissue structures and organs, including the eyeball and orbit. The non-invasive ultrasound imaging is safe for the patient and may be repeated after a short time unlike in the case of other radiological techniques. In pediatric ophthalmology, ultrasonography plays a major role as an auxiliary examination for the diagnosis of various intraocular diseases, pathologies of the retina and choroid, and retrobulbar conditions. Ultrasonography is of major importance in diagnosing eye disorders associated with opacity preventing visual inspection of the posterior eye segment. METHODS: Among ultrasonographic techniques in pediatric ophthalmology the most frequently used are B-scan, A-scan, and Doppler ultrasonography. Because of the resolution of ultrasonographic methods in comparison to radiological techniques, they play an important role in monitoring the dynamics of pathological processes in retinopathy of prematurity (ROP). Other radiological methods such as CT, MRI or subtractive angiography do not offer a detailed view of retinal attachment or vitreo-retinal proliferation. CONCLUSION: Ultrasonography as an auxiliary examination at subsequent stages of ROP helps to document the changes and in case of corneal opacity connected with progression of vitreo-retinal abnormalities is the basis for the diagnosis.

• [The results of panphotocoagulation laser treatment in retinopathy of prematurity in the West Pomeranian Region in 2003-2005 years]

  Authors: Monika Modrzejewska, Ewa Tomala, Danuta Karczewicz, Jacek Rudnicki, Beata Czeszyńska, Jacek Patalan

  Klinika oczna. 02/2006; 108(10-12):409-12.

  PURPOSE: ROP--retinopathy of prematurity is a disease of the retina and the vitreous body of premature infants, especially born before 28 weeks of intrauterine life (71%), rare till 33 weeks ofPURPOSE: ROP--retinopathy of prematurity is a disease of the retina and the vitreous body of premature infants, especially born before 28 weeks of intrauterine life (71%), rare till 33 weeks of pregnancy (7.6%). The pathogenesis is involved with damage of immature vessels of the retina. The disease seems to self-regress in 80%. According to stage of changes of the retina there could be some complications of the organ of vision like: refractive errors, disturbances of eyeball movement, poor vision or even blindness (19.01%). ROP is now second (after atrophy of the optic nerve) cause of blindness in children (3). Aim of our study was the analysis of the results of laser-treatment in ROP in West Pomeranian region in years 2003-2005 and estimation of the risk factors of advanced stages of ROP. MATERIAL AND METHODS: Since January 2003 to June 2005 in Outpatients Clinic for Premature Infants of the Ophthalmology Department of The West Pomeranian Medical University in Szczecin we have examined 708 children. 40 premature infants (78 eyes) were treated with panphotocoagulation of the retina because of advanced ROP We have used the Ocu-Lights SL laser, manufactured by Iris Medical. RESULTS: Laser treatment caused regression of ROP in 88.5% of children. In 11.5% the progression of ROP caused secondary retina detachment. CONCLUSIONS: Respiratory failure, anemia, infections and multi-organ inflammations increase the risk of ROP Good results of laser treatment depend of beginning of the therapy in the right stage of ROP On the final results of treatment could have got the influence both: immaturity of the child and the showed risk of factors.

• [The detachment of retina as possible complication after BCG vaccination during HOP--description of case]

  Authors: Monika Modrzejewska, Danuta Karczewicz, Agnieszka Kordek, Jacek Rudnicki, Ryszard Czajka

  Klinika oczna. 02/2006; 108(10-12):446-9.

  PURPOSE: The authors described the rare case of the progression of changes in the retina of child in course of retinopathy of prematurity. It happened after finished laser-treatment and fullPURPOSE: The authors described the rare case of the progression of changes in the retina of child in course of retinopathy of prematurity. It happened after finished laser-treatment and full regression of changes of the retina. It seems that BCG vaccination done in 3-th month of life could reactivate the disease of the retina which caused total retina detachment of both eyes. MATERIAL AND METHODS: The ophthalmologic examination included: indirect ophthalmoscopy using Fisson ophthalmoscope, slit-lamp examination and USG B-mode examination, using USG Echo Scan 3300 Oculus with the head 10 MHz--performed during all control visits. RESULTS: The regular ophthalmologic examination enabled estimation of the dynamic of changes in the retina and correctness of treatment. In author's opinion, the secondary retina detachment in 3-th month of life could be associated with reaction post BCG vaccination. CONCLUSIONS: Probably secondary inflammation after BCG vaccination could be the reason of reactivation of earlier treated with good results ROP Possible vision complications should incline to take special ophthalmologic care of premature infants from high risk group (very low mass of the body or fetal immaturity). Decision of changing time of BCG vaccination in such group should be made by attending physician.

• [Retinopathy of prematurity--pathogenesis and prevalence]

  Authors: Monika Modrzejewska

  Annales Academiae Medicae Stetinensis. 02/2006; 52(1):67-72; discussion 72.

  INTRODUCTION: Retinopathy of prematurity (ROP) is a retinal disease in premature newborns. The etiology of this disease is complex and not fully understood. For many years, ROP was the main cause ofINTRODUCTION: Retinopathy of prematurity (ROP) is a retinal disease in premature newborns. The etiology of this disease is complex and not fully understood. For many years, ROP was the main cause of blindness and impairment of visual acuity in prematurely born children in Poland. Progress in neonatal medicine helps save the life of increasingly more neonates with extremely low birthweight but at the same time ROP is observed more often. Today, ROP has grown to the chief problem in contemporary pediatric ophthalmology. Therefore, it is crucial from the medical and economic point of view to understand, prevent, and manage ROP. CONCLUSIONS: The present study focuses on the epidemiology, etiology, and pathogenesis of ROP. Information on ophthalmologic screening in Poland is also provided.

• [Retinopathy of prematurity: clinical findings and current opinions on diagnosis and treatment]

  Authors: Monika Modrzejewska

  Annales Academiae Medicae Stetinensis. 02/2006; 52(1):73-8; discussion 78.

  INTRODUCTION: Retinopathy of prematurity (ROP) is an ophthalmologic condition which may lead to blindness if compounded by other risk factors. Since many years, ROP is among the main causes ofINTRODUCTION: Retinopathy of prematurity (ROP) is an ophthalmologic condition which may lead to blindness if compounded by other risk factors. Since many years, ROP is among the main causes of impaired visual acuity and blindness in Polish children. Therefore, the understanding of this disease, progress in diagnostics, and improved methods of treatment will contribute to a better prognosis in ROP. Nowadays, diode laser photocoagulation and cryotherapy are modalities used in ophthalmology centers at specific clinical stages of ROP. When performed at the right time, these procedures offer promising results in the re-attachment of the retina and restoration of vision. Interventions for the most advanced vaso-retinal changes are rare because of a poor outcome. Early detection of vascular and retinal changes during ROP is burdened by some technical difficulties. Therefore, classification of findings in ROP should be done by ophthalmologists specialized in this area. The role of the neonatologist is also important, particularly when it comes to awareness of the parents as to the treatment needed by their prematurely born child. Laser photocoagulation, cryotherapy, and surgery undertaken in ROP may lead to ophthalmologic complications, with refraction errors and eyeball mobility disorders being the most common. Consequently, it is important for the child to undergo regular ophthalmologic examinations.

• [Posterior capsule opacification as a complication of the posterior chamber intraocular lens implantation]

  Authors: Danuta Karczewicz, Elzbieta Pieńkowska-Machoy, Monika Modrzejewska, Jolanta Gronkowska, Zofia Sylwestrzak

  Klinika oczna. 02/2004; 106(1-2):19-22.

  PURPOSE: The aim of the study was to evaluate factors possibly effecting the posterior capsule opacification (PCO), after extra-capsular cataract extraction with the posterior chamber intra-ocularPURPOSE: The aim of the study was to evaluate factors possibly effecting the posterior capsule opacification (PCO), after extra-capsular cataract extraction with the posterior chamber intra-ocular lens (IOL) implantation. Age of patients, refractive errors, technique of cataract extraction, intra- and postoperative complications and coexisting diseases were taken into consideration. In 1992-98 posterior laser Nd:YAG capsulotomy was performed in 222 eyes of 222 patients (134 women and 88 men) previously operated in 1st and IInd Eye Clinic. PCO occurred in 5.8% patients, who underwent cataract extraction in this period, in 5.7% patients operated with phacoemulsification method and in 5.8% patients where extra-capsular cataract extraction with nucleus expulsion was performed. PCO was diagnosed in 12.7% patients at the age below 30, in 17% aged 31-40, in 7.8% aged 41-55 and in 5.1% patients older than 55 years. Among the patients, who developed PCO, in 6.3% myopia was present, in 8% primary open angle glaucoma, 16.6% were treated for diabetes mellitus. In 7.6% eyes the intra-operative cortical clean up was not efficient. CONCLUSION: PCO occurred in young patients (under 40) twice as often as in the other groups of age. Technique of cataract extraction had an influence on the incidence of PCO as well.