Iwona Grabska-Liberek

Publications of Iwona Grabska-Liberek

• Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma.

  Authors: Jaromir T Wasyluk, Irmina Jankowska-Lech, Barbara Terelak-Borys, Iwona Grabska-Liberek

  Medical science monitor : international medical journal of experimental and clinical research. 02/2012; 18(3):CR195-9.

  We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurementsWe compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18-70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in µm) differ significantly between GDx and all OCT devices. ConCLUSIONS: Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients.

• Intraocular pressure and ocular hemodynamics in patients with primary open-angle glaucoma treated with the combination of morning dosing of bimatoprost and dorzolamide hydrochloride.

  Authors: Andrzej Stankiewicz, Marta Misiuk-Hojło, Iwona Grabska-Liberek, Bożena Romanowska-Dixon, Joanna Wierzbowska, Jaromir Wasyluk, Małgorzata Mulak, Iwona Szuścik, Janusz Sierdziński, Rita Ehrlich, Brent Siesky, Alon Harris

  Acta ophthalmologica. 02/2011; 89(1):e57-63.

  This prospective, multicenter, single-masked study evaluated the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retinal and retrobulbarThis prospective, multicenter, single-masked study evaluated the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retinal and retrobulbar hemodynamics in patients with primary open-angle glaucoma (POAG) treated with morning-dosed bimatoprost 0.03%. Eighty-nine patients (aged, 60.7 ± 11.8 years, range 33-80; 68 women) with POAG received bimatoprost dosed once in the morning for 1 month, after which dorzolamide was added twice daily for 2 months. IOP (Goldmann) and arterial blood pressure (BP) and diurnal ocular perfusion pressures (OPP) were measured every 2 hr for 24 hr. Heidelberg retina flowmetry of the retinal microcirculation was recorded four times daily in 64 patients and colour Doppler imaging of the ophthalmic and central retinal arteries was recorded five times daily in 25 patients. All measurements were taken after the two phases of treatment and compared using anova analysis with Bonferroni adjustment. Mean baseline IOP was 16.5 ± 3.4 mmHg. Mean diurnal IOP with dorzolamide adjunctive therapy (12.9 ± 2.1 mmHg) was significantly lower compared to mean IOP with bimatoprost monotherapy (13.6 ± 2.2 mmHg) (p = 0.03). Adjunctive dorzolamide therapy significantly decreased vascular resistance in the ophthalmic artery (p = 0.02). Mean diastolic BP and OPP were significantly lower after adjunctive therapy. There were no changes in retinal microcirculation between the two phases of treatment. Adjunctive dorzolamide therapy to morning-dosed bimatoprost 0.03% reduced diurnal IOP and vascular resistance in the ophthalmic artery but did not alter retinal circulation in this group of patients with POAG.

• [Complications of intravitreal injections--own experience].

  Authors: Agnieszka Jamrozy-Witkowska, Katarzyna Kowalska, Irmina Jankowska-Lech, Barbara Terelak-Borys, Agnieszka Nowosielska, Iwona Grabska-Liberek

  Klinika oczna. 01/2011; 113(4-6):127-31.

  PURPOSE: Authors present complications associated with intravitreal injection perfomed in Ophthalmic Clinic CMKP MATERIAL AND METHODS: retrospective study, between January 2006 and July 2009 wePURPOSE: Authors present complications associated with intravitreal injection perfomed in Ophthalmic Clinic CMKP MATERIAL AND METHODS: retrospective study, between January 2006 and July 2009 we performed intravitreal injections with triamcinolone acetonide (Kenalog, 4 mg), ranibizumab (Lucentis, 0.5 mg), bevacizumab (Avastin, 1.25 mg) and pegaptanib (Macugen, 0.3 mg). We treated eyes with age-related macular degeneration, diabetic macular edema, after retinal venous occlusion, with uveitis, Irvine-Gass syndrome, idiopathic juxtafoveolar teleangiectasia and central serous retinopathy. RESULTS: 943 eyes received intravitreal injections. The most common ocular complication was subconjunctival hemorrhage which was seen in 36% cases. Temporary elevated intraocular pressure above 21 mmHg was noticed in 18 eyes (5%) after anti-VEGF agents injections and in 30 eyes (23.4%) after Kenalog injection. Anterior uveitis developed in sixteen cases (1.7%) from the Avastin (5 eyes) and Lucentis (3 eyes) group. Anterior-posterior inflammation occurred in 8 eyes (0.8%), including four eyes (0.4%) with sterile endophthalmitis (3 following bevacizumab and 1 following ranibizumab injection), one eye (0.1%) with pseudoendophthalmitis (after triamcinolone). There were three cases of suspected endophthalmitis (2 following bevacizumab and 1 following triamcinolone injection). The infectious endophthalmitis after triamcinolone injection was culture-proven and revealed Staphylococcus epidermidis. Cataract formation or progression was noted in 34 eyes totally. In Kenalog group progression of cataract was seen in 23.4% of eyes (30 cases) during 2-years of follow-up and in anti-VEGF agents group--in two cases (0.6%) and 2 cases of iatrogenic cataract. Three diabetic patients suffered systemic adverse events: one patient developed renal insufficiency, one patient developed cerebrovascular accidents and one suffered a myocardial infarction resulting in death. Conclusions: Intravitreal injections are associated with a low incidence of serious adverse events. The most common ocular complication was subconjunctival hemorrhage. There was one case of serious complication--the culture-proven infectious endophthalmitis after Kenalog injection. Cataract formation and increase of intraocular pressure were more often observed following intravitreal triamcinolone injection.

• [Changes of the retinal thickness in the macula region in primary open-angle glaucoma patients measured with RTA analyzer].

  Authors: Barbara Polaczek-Krupa, Iwona Grabska-Liberek

  Klinika oczna. 01/2010; 112(1-3):24-8.

  Aim of the study is to determinate retinal thickness in macula region in primary open-angle glaucoma patients and in patients suspected of primary open-angle glaucoma--by using retinal thicknessAim of the study is to determinate retinal thickness in macula region in primary open-angle glaucoma patients and in patients suspected of primary open-angle glaucoma--by using retinal thickness analyzer RTA, as well as evaluation of the applicability of the method in the early diagnosis of primary open-angle glaucoma. Fifty primary open-angle glaucoma patient (95 eyes, average age 43.7 +/- 9.0 years), and 67 patients suspected of primary open-angle glaucoma (128 eyes, average age 43.2 +/- 11.0 years), underwent full ophthalmologic examination and also retinal thickness analysis with RTA analyzer. In particular, foveola average thickness VAV, foveal average thickness FAV, peri-foveal average thickness PFAV and posterior pole average thickness PPAV, were determined. The data were statistically evaluated and compared with those obtained for healthy subjects from the control group. The retinal thickness values in the populations of primary open-angle glaucoma and primary open-angle glaucoma-suspected patients were: VAV 139.0 +/- 20.5 microm i 147.6 +/- 21.2 microm, FAV 149.9 +/- 17.4 microm i 157.1 +/- 18.6 microm, PFAV 173.0 +/- 11.4 microm i 187.3 +/- 15.6 microm oraz PPAV 168.1 +/- 11.3 microm i 182.5 +/- 14.8 microm, respectively. Statistically significant differences between both populations and the population of healthy subjects were observed. The retinal thickness in macula region in primary open-angle glaucoma and in patients suspected of primary open-angle glaucoma was significantly lower than in the population of the healthy subjects. The method can be successfully applied in the early diagnosis of primary open angle glaucoma and be a valuable supplementary examination of the optic nerve disc and peripapillary area.

• [Endophthalmitis following intravitreal triamcinolone acetonid injection--a case report].

  Authors: Agnieszka Jamrozy-Witkowska, Iwona Grabska-Liberek, Katarzyna Kowalska, Jolanta Oficjalska-Młyńczak

  Klinika oczna. 01/2010; 112(1-3):57-60.

  To report a case of acute endophthalmitis following intravitreal triamcinolone acetonide injection. A 54-year-old woman with diabetic macular edema developed endophthalmitis after triamcinoloneTo report a case of acute endophthalmitis following intravitreal triamcinolone acetonide injection. A 54-year-old woman with diabetic macular edema developed endophthalmitis after triamcinolone injection. First she was treated with intravitreal antibiotic injections and next with four surgeries--facovitrectomy, revitrectomy, silicone oil removal and revitrectomy. The initial visual acuity was 0.5. From the vitreous cultured Staphylococcus epidermidis. Depite the intensive medical intervention, the toxic retinal damage occurred and the final visual acuity was hand movement. intravitreal triamcinolone injections can induce bacterial endophthalmitis, which has a devastating effect on the ocular tissues and results in severe loss of vision. The procedure of injection in diabetic and immunocompromised patients should be performed with great care.

• [Evaluation of retinal thickness in macular region in diabetic patients with RTA analyzer]

  Authors: Barbara Polaczek-Krupa, Iwona Grabska-Liberek, Barbara Terelak-Borys

  Klinika oczna. 02/2009; 111(4-6):119-21.

  PURPOSE: Aim of the study is an evaluation of the anatomic state of retina in the macular region in diabetic patients with various stages of retinopathy by using RTA analyzer, and an assessment ofPURPOSE: Aim of the study is an evaluation of the anatomic state of retina in the macular region in diabetic patients with various stages of retinopathy by using RTA analyzer, and an assessment of applicability of this method in early diagnosis of diabetic macular edema. MATERIAL AND METHODS: Forty diabetic patients (68 eyes) underwent full ophthalmologic examination and also retinal thickness analysis with RTA analyzer. In particular, foveal average thickness FAV and posterior pole average thickness PPAV were determined. The data were statistically evaluated. RESULTS: Both FAV and PPAV are strongly correlated with the eyeground state and increased with increasing the severity of retinopathy and macular edema. The patients with minimal and mild nonproliferative retinopathy without any visible macular edema showed an increased retinal thickness when compared both with diabetic patients without any retinopathy and with control patients. The thickness was however lower than that in patients with diabetic macular edema. CONCLUSIONS: The eyes with minimal and mild nonproliferative diabetic retinopathy without any visible macular edema should be examined by some independent methods, like RTA. The method can be recommended for screening the macular edema in diabetic patients.

• [Evaluation of retinal thickness in the macula region in a population of healthy subjects by using the retinal thickness analyzer RTA]

  Authors: Barbara Polaczek-Krupa, Iwona Grabska-Liberek

  Klinika oczna. 01/2009; 111(7-9):217-20.

  PURPOSE: The Aim of this study is an evaluation of retina thickness in macula region in healthy subjects, by using retina thickness analyzer RTA and determination of gender and age relationships ofPURPOSE: The Aim of this study is an evaluation of retina thickness in macula region in healthy subjects, by using retina thickness analyzer RTA and determination of gender and age relationships of the retina thickness. MATERIAL AND METHODS: Eighty healthy subjects (155 eyes), 24 to 70 years old (average age 45.7 years), underwent full ophthalmologic examination and also retinal thickness analysis with RTA analyzer. In particular, foveola average thickness VAV, foveal average thickness FAV, peri-foveal average thickness PFAV and posterior pole average thickness PPAV, were determined. The data were statistically evaluated. RESULTS: Average values of VAV (163.6 +/- 21.7 microm), FAV (172.4 +/- 19.0 microm), PFAV (199.2 +/- 14.2 microm) and PPAV (194.5 +/- 12.8 microm), were determined. No statistically significant differences between male and female groups and between right and left eyes were found. The retinal thickness increased slightly with age but the regression analysis revealed no significant linear correlation between any of the parameter values and age. CONCLUSION: The retinal thickness in macula region in Polish healthy subjects did not differ substantially from the world literature data.

• [Application of retinal nerves fiber layer examination--GDx in patients with multiple sclerosis]

  Authors: Irmina Jankowska-Lech, Barbara Terelak-Borys, Iwona Grabska-Liberek, Jaromir Wasyluk, Witold Palasik

  Klinika oczna. 02/2008; 110(1-3):28-30.

  PURPOSE: The purpose of our study is to evaluate retinal fiber layer thickness with scanning polarymetry laser (GDx), in patients suffering from SM with or without optic nerve symptoms. MultiplePURPOSE: The purpose of our study is to evaluate retinal fiber layer thickness with scanning polarymetry laser (GDx), in patients suffering from SM with or without optic nerve symptoms. Multiple sclerosis proceeds to neurodegenerative changes and commonly appears with retrobulbar optic nerve damage. Examination of retinal nerves fiber layer examination with scanning laser polarymetry (GDx) enables to perform quantitative evaluation of retinal nerves fiber layer thickness within the area around the optic nerve disc. It finds application in diagnosis and monitoring of glaucoma, however its usefulness as a tool evaluating optic nerve in multiple sclerosis, has not been proved yet. MATERIALS AND METHODS: Subjects diagnosed with multiple sclerosis (SM) were divided into 2 groups. First group was comprised of subjects, who suffered from at least one episode of retrobulbar neuritis, in at least one eye. Second group was made up of 8 subjects with no history of retrobulbar neuritis. Retinal nerves fiber layer thickness was measured with scanning polarymetry laser (GDx). RESULTS: Symptoms of retinal nerves fiber layer damage, were discovered with GDx significantly more common in first group (70% vs 18.75% accordingly). CONCLUSIONS: Moreover, we stated that evaluation with scanning polarymetry laser might be precious method in discovering retinal nerves fiber layer damage in the course of multiple sclerosis. Presence of defects in retinal nerves fiber layer in patients suffering from multiple sclerosis with no history of retrobulbar neuritis may suggest subclinical damage of optic nerve.

• [Evaluation of the applicability of selected methods in glaucoma diagnosis in a patient with optic disc drusen. Case report]

  Authors: Iwona Grabska-Liberek, Barbara Polaczek-Krupa, Irmina Jankowska-Lech

  Klinika oczna. 02/2008; 110(1-3):88-91.

  PURPOSE: The aim of the study is an evaluation of applicability of selected test in glaucoma diagnosis in a patient with optic disc drusen. MATERIAL AND METHODS: The authors describe a case of aPURPOSE: The aim of the study is an evaluation of applicability of selected test in glaucoma diagnosis in a patient with optic disc drusen. MATERIAL AND METHODS: The authors describe a case of a patient examined for glaucoma because of an increased intraocular pressure and deterioration of vision. The optic disc drusen were found in the patient by ophthalmoscopy and confirmed by ultrasonography. The patient was examined by the scanning laser ophthalmoscopy HRT, scanning laser polarymetry GDX, retina thickness analysis RTA and determination of the visual field. RESULTS: Results of diagnostic studies were presented in the paper. The scanning laser ophthalmoscopy did not evidence any presence of glaucomatous cup in the optic nerve head. The scanning laser polarymetry showed extensive losses in nerve fiber layer of retina and the retinal thickness analysis showed a reduction of the retina thickness in the posterior pole. Study of the vision field evidenced the relative and absolute scotomas. CONCLUSIONS: The results show a necessity for careful evaluation of the glaucoma examination results in patients with drusen in the optic nerve head, because of a high similarity of abnormalities produced by both diseases.

• [Glaucoma neuropathy and neuropathy in multiple sclerosis--common elements of pathogenesis?]

  Authors: Irmina Jankowska-Lech, Barbara Terelak-Borys, Iwona Grabska-Liberek, Witold Palasik

  Klinika oczna. 02/2007; 109(7-9):317-20.

  The optic neuropathy in multiple sclerosis and glaucoma neuropathy are very common ophthalmological diseases. Multiple sclerosis /MS/ is the chronic inflammatory central nervous systemThe optic neuropathy in multiple sclerosis and glaucoma neuropathy are very common ophthalmological diseases. Multiple sclerosis /MS/ is the chronic inflammatory central nervous system demyelinisation disease with an autoimmunological ethiology. The last investigation of multiple sclerosis indicate the molecular and cellular autoimmunisation aspects. Te role of vasoactive factors is underlines in its pathogenesis which also suggests the common elements of glaucoma and MS pathogenesis. The over expressed vasoconstrictive mechanisms in both diseases can conduct to optic nerve injury. The aim of this study is evaluation of the optic disc morphological changes in sclerosis multiplex patients /MS/ with or without neuritis optica in anamnesis in glaucoma "remodeling" aspects. MATERIAL AND METHODS: We present two patients with coexsist sclerosis multiplex and glaucoma neuropathy, which underwent retrobulbar neuritis. CONCLUSION: Coexistance of glaucoma neuropathy and multiple sclerosis neuropathy may indicate common elements of glaucoma and SM pathogenesis. The authors recommend precise morphological optic disc evaluation in multiple sclerosis patients because glaucoma neuropathy may appear.

• [Choeroidal vasculopathy detected by indocyanine green angiography in diabetic patients]

  Authors: Irmina Jankowska-Lech, Barbara Terelak, Iwona Grabska-Liberek

  Klinika oczna. 02/2007; 109(10-12):413-7.

  PURPOSE: The aim of the study was to evaluate choroidal circulation in the posterior pole of the eye in diabetic patients with nonproliferative retinopathy. MATERIAL AND METHODS: AngiographicPURPOSE: The aim of the study was to evaluate choroidal circulation in the posterior pole of the eye in diabetic patients with nonproliferative retinopathy. MATERIAL AND METHODS: Angiographic evaluation of choroids in the posterior pole were performed in diabetic patients with clinically detectable diabetic retinal changes in the Department of Ophthalmology, Medical Center of Postgraduate Education in Warsaw from December 2002 to December 2004, using HRA-system (Heidelberg Engineering, Germany). HRA-system allows to perform simultaneous fluoresceine (FA) and indocyanine green (ICGA) angiography. RESULTS: Simultaneous ICGA and fluorescein angiography pictures were evaluated. Choroidal abnormalities were defined as ICGA findings not detectable by FA. In ICGA we observed hypo- and hyperfluorescent areas or spots in different phases of the examination which proved break-down of outer blood-retinal barrier, retinal pigment epithelial oedema, increased permeability of choriocapillaries and chorioidal microaneurysms. CONCLUSIONS: 1. FA discloses only a part of vascular pathology in posterior pole of the eye in the course of diabetes. 2. ICGA may be useful as adjunctive to FA in the evaluation of the choroidal vascular changes in diabetic eyes. 3. Choroidal vessels changes may play role in the development of diabetic retinopathy.

• [Application of retinal thickness analyzer (RTA) in diagnosis and treatment monitoring in retinal diseases]

  Authors: Barbara Polaczek-Krupa, Iwona Grabska-Liberek

  Klinika oczna. 02/2006; 108(10-12):452-6.

  The aim of the study was to evaluate the applicability of retinal thickness measurements using the Retinal thickness analyzer (RTA) in diagnosis and monitoring treatment of a variety of eye diseases.The aim of the study was to evaluate the applicability of retinal thickness measurements using the Retinal thickness analyzer (RTA) in diagnosis and monitoring treatment of a variety of eye diseases. MATERIAL AND METHODS: Patients with various retinal diseases (diabetic macular edema, branch retinal vein occlusion, age-related macular degeneration, and primary open-angle glaucoma), were examined for retinal thickness in the posterior pole using the Retinal thickness analyzer. A laser light beam of a 543 nm wave length was projected on the retina and scanned across 3x3 mm retinal area. Five scans covered the 200 area of the fundus. The images of the particular intersections were digitally recorded and the results were presented as colour maps and diagrams. RESULTS: The examination carried out with Retinal thickness analyzer showed the retinal thickening in patients with diabetic macular edema and branch retinal vein occlusion. Leakage from subfoveal choroidal neovascular membranes resulted also in retinal edema and thickening. Fluorescein and indocyanine green angiography confirmed the diagnosis. Evaluation of the retinal nerve fibre layer in patient with primary open angle glaucoma, confirmed a thinning of the retina in the region of posterior pole. CONCLUSIONS: The scanning Retinal thickness analyzer provides an essential information useful in diagnosis and monitoring treatment of retina diseases in the macula region.

• [Risk factors for encapsulated filtering bleb after trabeculectomy--own experience]

  Authors: Jerzy Szaflik, Anna Kamińska, Krzysztof Cieślik, Iwona Grabska-Liberek

  Klinika oczna. 02/2004; 106(1-2 Suppl):179-81.

  The aim of the study was to evaluate the incidence of encapsulated filtering bleb at patients after trabeculectomy. We analyzed risk factors, prognosis and treatment in cases of this complication.The aim of the study was to evaluate the incidence of encapsulated filtering bleb at patients after trabeculectomy. We analyzed risk factors, prognosis and treatment in cases of this complication. All 857 cases of trabeculectomies performed in Department of Ophthalmology of Medical University of Warsaw in years 2001-2003 were included in the study. Twenty two cases (2.5% of all trabeculectomies) of encapsulated filtering bleb were analyzed. Twenty patients (91%) underwent surgery procedure and two patients (9%) were treated medically. The encapsulated filtering blebs occurred mainly in patients after previous ocular surgery, in eyes with episodes of earlier ocular inflammation and in patients treated with many antiglaucoma drops.