Agnieszka Jamrozy-Witkowska

Publications of Agnieszka Jamrozy-Witkowska

• [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.

• [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.

• [Secondary epithelial cyst of the iris--case report]

  Authors: Agnieszka Jamrozy-Witkowska, Maria Muzyka-Woźniak, Jolanta Oficjalska-Młyńczak, Lukasz Szelepin

  Klinika oczna. 02/2007; 109(10-12):443-5.

  Authors present a case of 33 years old man who developed implantation secondary cyst of the iris, after penetrating trauma in a childhood. He was treated with cyst aspiration and endolaserAuthors present a case of 33 years old man who developed implantation secondary cyst of the iris, after penetrating trauma in a childhood. He was treated with cyst aspiration and endolaser photocoagulation of the cyst base. Postoperatively visual function significantly improved. No recurrence of cyst was observed. Within 6 months cataract developed with pupillary obstruction caused by irydocorneal adhesions, which required reoperation. Authors indicate that management of secondary cyst of the iris may require repeated laser or surgical treatment.

• [Vitrectomy with peeling retinal limiting membrane (ILM) in eyes with diabetic macular edema]

  Authors: Jolanta Oficjalska-Młyńczak, Agnieszka Jamrozy-Witkowska, Maria Muzyka-Woźniak, Anna Turno-Krecicka, Bozena Gołebiowska

  Klinika oczna. 02/2006; 108(7-9):273-7.

  PURPOSE: To evaluate the efficacy of pars plana vitrectomy with retinal internal limiting membrane (ILM) peeling in eyes with diabetic macular edema. MATERIAL AND METHODS: Twenty five eyes of 25PURPOSE: To evaluate the efficacy of pars plana vitrectomy with retinal internal limiting membrane (ILM) peeling in eyes with diabetic macular edema. MATERIAL AND METHODS: Twenty five eyes of 25 patients with diabetic macular edema. All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling and air endotamponde. Preoperatively visual acuity (VA), funduscopic examination and the presence or absence of posterior vitreous detachment, were evaluated. Fluorescein angiography was performed in all patients prior to surgery. Eyes with cystoid macular edema or macular ischaemia were excluded. Postoperative VA, anatomic results, and complications were recorded. The follow-up was 7 to 27 months (mean 17). RESULTS: Intraoperatively, thick posterior hyaloid was found to be attached to the posterior pole in 20 cases. The mean postoperative VA (0.2) was significantly better than the preoperative VA (0.08) (p = 0.0001). VA improved postoperatively in 21 eyes (84%), at least two lines on the Snellen chart in 8 eyes (32%). It remained unchanged in 4 eyes (16%). Confluent hard exudates in fovea were present significantly more frequently in eyes without VA improvement (p = 0.004). The postoperative VA was better in eyes that had not undergone photocoagulation (improvement by 0.14 line) than in others (improvement by 0.11 line) but the difference was non-significant. Reduction of macular exudates was noted in every case in the follow-up over 6 months. Postoperative complication included retinal detachment were treated by re-vitrectomy with oil endotamponade. Cataract has been noted in six eyes. CONCLUSIONS: Vitrectomy including removal of ILM in diabetic macular edema, leads to improvement of visual acuity and long-term stabilization of visual function.

• [Outcome results in macular hole surgery with internal limiting membrane removal]

  Authors: Jolanta Oficjalska-Młyńczak, Agnieszka Jamrozy-Witkowska, Maria Muzyka-Woźniak, Patrycja Krzyzanowska

  Klinika oczna. 02/2005; 107(10-12):650-3.

  PURPOSE: To determine the visual outcome and anatomic closure rate of macular hole surgery using pars plana vitrectomy with internal limiting membrane (ILM) peeling. MATERIAL AND METHODS: Fifty threePURPOSE: To determine the visual outcome and anatomic closure rate of macular hole surgery using pars plana vitrectomy with internal limiting membrane (ILM) peeling. MATERIAL AND METHODS: Fifty three eyes of 52 consecutive patients with a full-thickness idiopathic macular holes (stage 3 or 4). All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling with trypan blue (TB) or indocyanine green (ICG) and gas endo-tamponade with instructions to the patient, to be face down for 4-5 days. Postoperative anatomic results, visual acuity (VA), and complications were recorded. The follow-up was 3 to 22 months. RESULTS: VA improved postoperatively in 45 eyes (84.9%), at least two lines on the Snellen chart in 24 eyes (45.3%). It remained unchanged in 6 eyes (11.3%) and deteriorated in 2 eyes (3.80%). The mean preoperative VA was 0.1 +/- 0.04 and does not differ significantly between stage 3 and 4. The improvement of postoperative VA was statistically significantly better in stage 3, in comparison to stage 4. The anatomical success rate (flat/closed) was 88.7% (47 eyes). There were no differences in VA improvement between TB- or ICG-stained eyes. CONCLUSIONS: 1. Vitrectomy with ILM removal in macular holes provides with meaning improvement in visual acuity. 2. Patients with macular hole in stage 3 have a better prognosis for visual rehabilitation. 3. A kind of dye and preoperative VA do not influence postoperative visual function improvement.

• [Use of automatic alignment and combining adjacent images in fundus imaging]

  Authors: Tomasz Licznerski, Agnieszka Jamrozy-Witkowska, Marek Cwirko, Dariusz Kosz

  Klinika oczna. 02/2005; 107(4-6):205-8.

  The paper presents a method for automatic alignment and combining adjacent images of the fundus. Presented algorithm is based on specific arrangement of the vessels in the fundus. A correlationThe paper presents a method for automatic alignment and combining adjacent images of the fundus. Presented algorithm is based on specific arrangement of the vessels in the fundus. A correlation function is used to the adjacent images with extracted net of the vessels. An optimum location of the images is found by applying successive approximations method. An angle of rotation and shift of the combining images are taken into an account during this search. The paper shows also the examples of application of the method in fundus imaging.

• [Vitrectomy for idiopathic and secondary preretinal macular membrane]

  Authors: Jolanta Oficjalska-Młyńczak, Agnieszka Jamrozy-Witkowska

  Klinika oczna. 02/2004; 106(1-2):35-8.

  PURPOSE: To evaluate the results of pars plana vitrectomy and membrane stripping for idiopathic and secondary preretinal macular membrane (PMM). MATERIAL AND METHODS: Twenty one consecutive subjectsPURPOSE: To evaluate the results of pars plana vitrectomy and membrane stripping for idiopathic and secondary preretinal macular membrane (PMM). MATERIAL AND METHODS: Twenty one consecutive subjects (21 eyes) ranging in age from 40 to 78 (mean 66.9) with PMM underwent vitrectomy and membrane peeling. 17 cases had membranes that were considered idiopathic, and 4 cases were associated with other disorders: 3 occurred after successful retinal reattachment surgery, 1--after laserotherapy in the course of diabetic retinopathy. Visual acuity (VA), Amsler grid, and postoperative complications were assessed. The follow-up was 1 to 22 months, mean 5.7. RESULTS: Visual acuity improved postoperatively in 15 eyes (71.4%), at least two lines on the Snellen chart in 8 eyes (38.1%), entirely in patients with idiopathic PMM. It remained unchanged in 3 eyes (14.3%) and deteriorated in 3 eyes (14.3%). Eyes with transparent membrane showed greater visual improvement than opaque ones. The preoperative Amsler test was positive in 15 patients (71.4%), postoperatively--in 4 cases (19%). 2 idiopathic cases with VA of 0.7 showed postoperatively VA of 1.0. Complications included retinal detachment in 2 eyes (1 in idiopathic and 1 in secondary PMM), and development of nuclear sclerotic cataract in 2 eyes. At 6 months of follow-up, a residual membrane formation in 1 cases appeared. Macular pseudohole was observed in 1 eye with no impact on visual results. CONCLUSIONS: 1. Vitrectomy with membrane peeling for preretinal macular membrane provides improvement in visual acuity and reduces metamorphopsia 2. Thin, cellophane-like appearance of the membrane gives a better prognosis of visual function improvement.

• [Vitrectomy in treatment of ocular tuberculosis--case report]

  Authors: Jolanta Oficjalska-Młyńczak, Maria Muzyka-Woźniak, Anna Turno-Krecicka, Agnieszka Jamrozy-Witkowska

  Klinika oczna. 02/2004; 106(3 Suppl):530-1.

  The authors present a case of ocular tuberculosis in otherwise healthy young men, diagnosed with positive tuberculin test and positive PCR for Mycobacterium tuberculosis in conjunctiva and vitreousThe authors present a case of ocular tuberculosis in otherwise healthy young men, diagnosed with positive tuberculin test and positive PCR for Mycobacterium tuberculosis in conjunctiva and vitreous samples. An early vitrectomy and typical systemic treatment (tuberculostatic drugs) resulted in regression of the disease.

• [The comparative analysis of changes in optic disc morphology after trabeculectomy, measured by scanning laser tomography]

  Authors: Patrycja Krzyzanowska, Agnieszka Jamrozy-Witkowska, Magdalena Koziorowska

  Klinika oczna. 01/2002; 104(2):122-7.

  PURPOSE: The aim of this study was to investigate and estimate quantitative changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (Heidelberg Engineering, HRTPURPOSE: The aim of this study was to investigate and estimate quantitative changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (Heidelberg Engineering, HRT Software 2.01). MATERIAL AND METHODS: The eyes of 42 consecutive patients (34 women and 8 men) undergoing trabeculectomy at the Department of Ophthalmology, Wroclaw Medical University, were enrolled into the study. Quantitative analysis of the optic nerve head parameters by scanning laser tomography were performed, as well as automated perimetry, before and after surgery. Post operative HRT images were obtained at 2-3 weeks, 4-6 months, 9-12 months and > 12 months after surgery. RESULTS: Forty one patients (97.6%) have obtained postoperatively IOP reduction greater than 30%. Two weeks after trabeculectomy seven HRT parameters showed statistically significant improvement: CA, CV, RA, RV, mean cup depth, CSM. Approximately 5 months after surgery only 2 parameters (mean cup depth & CSM) were statistically changed, as well as 12 months after surgery (mean and max cup depth), which cannot be explained by postoperative disc edema. A corresponding change was also noted in the visual field. There was no statistically significant association between optic disc morphology as measured by HRT and the degree of intraocular pressure reduction. CONCLUSION: All patients showing a 30% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. Further studies are required to provide information, to what extent the change in optic disc topography is dependent on the duration of elevated intraocular pressure or advanced stage of glaucomatous optic neuropathy.

• [Evaluation analysis of blood flow of peripapillary area in glaucoma patients using scanning laser Doppler flowmetry]

  Authors: Maria Hanna Nizankowska, Agnieszka Jamrozy-Witkowska, Magdalena Asejczyk

  Klinika oczna. 01/2002; 104(3-4):201-6.

  PURPOSE: To evaluate capillary blood flow and velocity in retinal peripapillary area in primary open angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PEXG) and agePURPOSE: To evaluate capillary blood flow and velocity in retinal peripapillary area in primary open angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PEXG) and age matched control group (C) using scanning laser Doppler flowmetry (Heildelberg Retina Flowmeter). MATERIAL AND METHOD: One randomly selected eye of 17 POAG patients (mean age 59.3 +/- 2.6), 18 NTG patients (mean age 56.4 +/- 2.4), 17 PEXG patients (63.3 +/- 2.8) and 15 healthy subjects (mean age 55.8 +/- 3.8) underwent examination with scanning laser Doppler flowmetry. The measurements were performed at the superior and inferior temporal peripapillary retinal area. The measured parameters were capillary blood flow and velocity of the moving erythrocytes. Each image was analysed using the program AFFPIA. This software calculates the hemodynamic parameter flow of each pixel. Comparison of value obtained from patients and control participants were made using Student's t test. RESULTS: Scanning laser Doppler flowmetry results showed a significant reduction in blood flow at the superior and inferior temporal peripapillary area in POAG and NTG patients compared to control group (p < 0.04). The POAG and NTG patients had also significantly decreased velocity at the inferior temporal peripapillary retinal area compared to control group. No statistical difference was found between blood flow and velocity in POAG compared with NTG. When compared with the control participants, patients with PEXG showed significant decreases in the mean blood flow at the inferior temporal quadrant (p < 0.05), while the differences in the mean flow and velocity at the superior quadrant between those groups were not statistically significant. CONCLUSIONS: Our findings indicate a reduction in ocular blood flow at the temporal peripapillary retinal area in patients with POAG and NTG compared to age matched control participants. The peripapillary retinal microcirculation is not significantly altered in patients with PEXG compare with POAG and JNC. The blood flow parameters in the capillaries are lower in JNC retinas, the difference however is not significant. Further clinical investigation is required having groups homogeneous with respect to stage of glaucoma and controlled for factors known to effect perfusion pressure.