Jacek Robaszkiewicz

Publications of Jacek Robaszkiewicz

• Triple therapy: Phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of Bevacizumab for diffuse diabetic macular edema.

  Authors: Jacek Robaszkiewicz, Katarzyna Chmielewska, Małgorzata Figurska, Joanna Wierzbowska, Andrzej Stankiewicz

  Medical science monitor : international medical journal of experimental and clinical research. 04/2012; 18(4):CR241-251.

  Background: The aim of this study was to evaluate the visual acuity and structural outcomes of combined phacovitrectomy with ILM peeling, retinal endophotocoagulation and use of bevacizumab inBackground: The aim of this study was to evaluate the visual acuity and structural outcomes of combined phacovitrectomy with ILM peeling, retinal endophotocoagulation and use of bevacizumab in patients with diffuse diabetic macular edema (DDME). Material/Methods: In this prospective, nonrandomized, interventional study we included 29 eyes of 26 patients with DDME. The best-corrected visual acuity (BCVA) and central retinal thickness and volume (CRT and CRV) were recorded at 4, 8, 12, and 16 months after surgery. Results: The mean preoperative BCVA was 0.74±0.36 logMAR (0.3-1.5) and improved finally to 0.4±0.24 logMAR (-0.1-1.0) p=0.000006. The mean preoperative CRT in the 1mm zone was 516±184 microm (256-950) and decreased postoperatively at the last control to 237±75 microm (117-489) p=0.000003. The mean preoperative CRV in the 1mm zone was 0.39±0.14 microL (0.19-0.74) and decreased postoperatively at the last control to 0.17±0.06 microL (0.09-0.36) p=0.000003. The mean preoperative CRT in the 6 mm zone was 407±105 microm (279-640) and decreased postoperatively at the last control to 282±40 µm (212-380) p=0.000004. The mean preoperative CRV in the 6 mm zone was 11.4±2.9 microL (7.85-17.93) and decreased postoperatively at the last control to 7.92±1.0 microL (5.62-10.97) p=0.000003. The 23 (79.3%) eyes showed improvement in BCVA ≥0.2 logMAR, 5 (17.2%) eyes improvement or stabilization of BCVA and 1(3.5%) eye deterioration. Preoperative BCVA was a positive factor for prognosis of BCVA at 12th month follow-up (b=0.42; p=0.006), while the negative factors were: previous panretinal photocoagulation (b=-0.24; p=0.04), presence of vitreomacular traction (b=-0.29; p=0.02) and preoperative CRT in the 1000 microm zone (b=-0.24; p=0.07). A greater visual acuity improvement occurred in eyes with worse baseline visual acuity (b=-1.01; p=0.00001). The presentation of vitreomacular traction (b=-0.38; p=0.02), previous panretinal photocoagulation (b=-0.31, p=0.04) and greater preoperative CRT in the 1000 µm zone (b=-0.31; p=0.07) were negative factors for visual improvement. Conclusions: This combined treatment resulted in improvement or stabilization of BCVA and decrease of CRT and CRV. Larger comparative studies are necessary to establish the real impact of this therapeutic approach.

• Severe decrease in visual acuity with choroidal hypoperfusion after photodynamic therapy.

  Authors: Małgorzata Figurska, Joanna Wierzbowska, Jacek Robaszkiewicz

  Medical science monitor : international medical journal of experimental and clinical research. 06/2011; 17(6):CS75-9.

  Photodynamic therapy (PDT) is considered a selective method of treatment which works in areas of choroidal neovascularization (CNV); however, there are reports of choroidal hypoperfusion after PDT.Photodynamic therapy (PDT) is considered a selective method of treatment which works in areas of choroidal neovascularization (CNV); however, there are reports of choroidal hypoperfusion after PDT. This paper presents a clinical case of choroidal circulation disturbances caused by PDT, accompanied by CNV progression. The patient, a 75-year-old woman, was qualified for PDT in the right eye--first treatment due to progression of occult CNV. Best corrected visual acuity (BCVA) in the right eye at baseline was +0.3 logMAR. After PDT, a rapid decrease in visual acuity to +0.7 logMAR in the right eye was observed, central choroidal hypoperfusion in fluorescein angiography (FA) with subretinal fluid appeared and, as a consequence, progression of neovascular age-related macular degeneration (AMD). After stabilizing the local state through conservative therapy, a decision was made to treat the right eye with intravitreal injections of vascular endothelial growth factor (VEGF) inhibitor. During a 12-month period of observation, 7 doses of ranibizumab were administered. A regression in activity of wet AMD was observed, with visual acuity of +0.6 logMAR. Choroidal circulation disturbance after PDT is possible and has to be taken into account. Sporadically, it can lead to an acute decrease in visual acuity and local state. After stabilization of AF and optical coherence tomography imaging, further treatment of neovascular AMD with intravitreal injections of anti-VEGF agents should be considered.

• [Combined pharmacological-surgical treatment in exudative age-related macular degeneration].

  Authors: Małgorzata Figurska, Jacek Robaszkiewicz, Agnieszka Bogdan-Bandurska

  Klinika oczna. 01/2011; 113(1-3):56-9.

  The aim of this paper is to present the early phase of treating exudative age-releted macular degeneration (AMD)--coexisting witch vitreoretinal pathology--with combined pharmacological-surgicalThe aim of this paper is to present the early phase of treating exudative age-releted macular degeneration (AMD)--coexisting witch vitreoretinal pathology--with combined pharmacological-surgical therapy. Our observation is based on one clinical case of combined therapy: pars planavitrectomy (PPV) and one intravitrealranibizumab injection. Observation is being carried on larger patient group according to the treatment scheme presented In this paper. RESUTS: In this case described combined pharmacological-surgical therapy allowed a significant improvement in visual acuity and closure of choroidal neovascularization (CNV), leakage confirmed by fluorescein angiography (FA) and optical coherence tomography (AMD). The treatment is being continued--another ranibizumab injection according to PRONTO study reinjection criteria. The pathomechanism of exudative AMD and coexistance of vitreoretinal pathology implications confirm reasonability of combined therapy.Due to actual clinical studies: the pharmacological -surgical treatment reduces the number of required intravitreal anti-VEGF agents injections. To confirm this observation we need to perform large randomised clinical studies.

• Future possibilities in glaucoma therapy.

  Authors: Joanna Wierzbowska, Jacek Robaszkiewicz, Małgorzata Figurska, Andrzej Stankiewicz

  Medical science monitor : international medical journal of experimental and clinical research. 11/2010; 16(11):RA252-9.

  Glaucoma is a group of eye diseases causing irreversible optic nerve damage. This review presents 4 elements of future glaucoma treatment strategies: baroprotection, vasoprotection, neuroprotectionGlaucoma is a group of eye diseases causing irreversible optic nerve damage. This review presents 4 elements of future glaucoma treatment strategies: baroprotection, vasoprotection, neuroprotection and gene therapy. New baroprotection includes compounds that alter the actin cytoskeleton (rho-kinase inhibitors, latrunculin, cytochalasin), new drugs that enhance aqueous outflow via the trabecular meshwork (statins, steroid antagonists) and via the uveoscleral route (EP2 agonists, 5-HT2 agonists), as well as new classes of components that suppress aqueous humor formation (cannabinoids). Vasoprotection includes blocking reperfusion injury (NOS-2 inhibitors, endothelin blockers, MMP-9 inhibitors). Concerning neuroprotection antiamyloids antibodies, erythropoietin and caspase inhibitors are discussed. Gene therapy may target various effectors: the trabecular meshwork (cytoskeleton regulatory proteins, miocyllin, MMPs), the ciliary body epithelium (genes modifying aqueous humor production, neuropeptides), the ciliary body cells (MMPs, genes of local PGs biosynthesis, ciliary muscle relaxants), the retinal ganglion cells (neurotrophin genes, anti-apoptotic genes), Müller cells (neurotrophins, GLAST) and conjunctiva (gene of chloramphenicol acetyltransferase, inhibitor p21). Experimental studies on the graft mesenchymal stem cells and mature retinal cells to replace the dead retinal ganglion cells are advanced. Immunotherapy, offering a vaccination, providing protection against loss of retinal ganglion cells, has been investigated.

• The additive effect of dorzolamide hydrochloride (Trusopt) and a morning dose of bimatoprost (Lumigan) on intraocular pressure and retrobulbar blood flow in patients with primary open-angle glaucoma.

  Authors: Andrzej Stankiewicz, Joanna Wierzbowska, Anna Siemiatkowska, Beata Fuksinska, Jacek Robaszkiewicz, Arkadiusz Zegadlo, Rita Ehrlich, Brent Siesky, Alon Harris

  The British journal of ophthalmology. 10/2010; 94(10):1307-11.

  To assess the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retrobulbar haemodynamics in patients with primary open-angle glaucoma (POAG) treatedTo assess the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retrobulbar haemodynamics in patients with primary open-angle glaucoma (POAG) treated with morning-dosed bimatoprost 0.03%. Twenty-five patients with POAG were evaluated in a prospective, single-masked study. After a 1 week run-in period with bimatoprost all patients were treated with bimatoprost dosed once in the morning for 1 month, after which dorzolamide was added twice daily for 2 months. Goldmann applanation IOP, arterial blood pressure (ABP) and heart rate were measured every 2 h for 24 h and diurnal ocular perfusion pressure (OPP) was calculated. Colour Doppler imaging (CDI) of the ophthalmic artery (OA) and the central retinal artery (CRA) was recorded five times daily. All measurements were taken after the two phases of treatment and were compared. The mean baseline IOP was 14.8 ± 3.5 mm Hg. Mean IOP following bimatoprost monotherapy (12.8 ± 2.9 mm Hg) and after 2 months of dorzolamide adjunctive therapy (12.2 ± 2.6 mm Hg) were not statistically significantly different (p=0.544). Only at the 4:00 h time point was IOP significantly reduced using the bimatoprost/dorzolamide combined treatment (p=0.013). The 24 h IOP fluctuations were lower when dorzolamide was added (6.0 ± 2.3 mm Hg vs 4.6 ± 1.5 Hg, p=0.0016). Repeated analysis of variance detected a significant decrease of vascular resistance in the OA (p=0.0167) with adjunctive dorzolamide treatment. The addition of dorzolamide to morning-dosed bimatoprost had an additive hypotensive effect only on the night-time IOP curve at 4:00 h and resulted in a lower IOP fluctuation. Dorzolamide added to bimatoprost may reduce vascular resistance in the OA.

• [Combined surgical and pharmacological treatment of diabetic maculopathy].

  Authors: Jacek Robaszkiewicz, Katarzyna Chmielewska, Joanna Wierzbowska, Małgorzata Figurska, Małgorzata Frontczak-Baniewicz, Andrzej Stankiewicz

  Klinika oczna. 01/2010; 112(1-3):19-23.

  There are at least three avenues of investigation that support the theoretical value of vitrectomy for the treatment of DME, based on (1) vitrectomy with ILM peeling for the relief of traction on theThere are at least three avenues of investigation that support the theoretical value of vitrectomy for the treatment of DME, based on (1) vitrectomy with ILM peeling for the relief of traction on the macula, (2) vitrectomy to improve oxygenation of the macula leading to decreased vascular permeability with subsequent resolution or decrease in DME, and (3) ILM peeling to remove a part of the Müller cell endfeet and the horizontal gliosis. Visual improvement could be due to the induction of a higher overexpression of GFAP at the Müller cells level. It is likely that the proliferation of GFAP-stained gliofibrils, observed in these cells, preserves the blood-retinal barrier, reinforces architectural cohesion, and opposes the installation of the edema. In addition, the search for a specific pharmacological treatment is ongoing on the basis of new findings regarding the involvement of cytokines and growth factors in the formation of macular edema. Vascular endothelial growth factor (VEGF), inhibitors are currently being investigated in clinical studies. However, endogenous VEGF is required for visual function. Growing body evidence indicates that VEGF acts also on nonvascular cells, it plays survival role on Müller cells and photoreceptors. Therefore anti-VEGF therapies should be administered with caution.

• Combined therapy in exudative age-related macular degeneration.

  Authors: Małgorzata Figurska, Joanna Wierzbowska, Jacek Robaszkiewicz

  Klinika oczna. 01/2010; 112(7-9):223-9.

  Therapeutic options in active exudative age-related macular degeneration (AMD) are following means used to destroy the choroidal neovascularization (CNV) lesion: laser photocoagulation, radiotherapy,Therapeutic options in active exudative age-related macular degeneration (AMD) are following means used to destroy the choroidal neovascularization (CNV) lesion: laser photocoagulation, radiotherapy, transpupillary thermotherapy, photodynamic therapy (POT) or removal of neovascular membrane through vitreoretinal surgery. Another possibility is to suppress the development of neovasculanization through intravitreal administration of anti-VEGF agents: ranibizumab, bevacizumab (off-label), sodium pegaptanib or steroids (off-label). The aim of this paper is to present the early phase of treating exudative AMO with combined therapy: photodynamic therapy with intravitreal ranibizumab injection. Our observation is based on three clinical cases. Observations are being carried out on larger patient groups according to the treatment scheme presented in this paper. In the three cases described one POT procedure and the saturation phase of three ranibizumab injections allowed a significant improvement in visual acuity and closure of CNV leakage confirmed by fluorescein angiography (FA) and optical coherence tomography (OCT). Treatment is being continued according to AMO activity: next POT in case of leakage in FA, another ranibizumab injection according to PRONTO study reinjection criteria. The pathomechanism of exudative AMB confirms reasonability of combined treatment. Considering the stages of neovascularization in exudative AMO. VEGF inhibition combined with POT has a synergistic action and increases the effectiveness of both therapies alone. L.arge clinical studies (FOCUS) show that combined therapy reduces the number or required POT procedures. In combined therapy modification of POT parameters should be considered: reduction of energy and laser exposure time.

• Optical coherence tomography in imaging of macular diseases.

  Authors: Małgorzata Figurska, Jacek Robaszkiewicz, Joanna Wierzbowska

  Klinika oczna. 01/2010; 112(4-6):138-46.

  OCT (opitcal coherence tomography), is a diagnostic method that enables the analysis of the retinal structures by means of high-resolution tomographic cross-sections of the retina. WhereasOCT (opitcal coherence tomography), is a diagnostic method that enables the analysis of the retinal structures by means of high-resolution tomographic cross-sections of the retina. Whereas fluorescein and indocyanine angiography allow visualization of the retinal epithelium layer and chorioretinal vessels, OCT may help in diagnosing and monitoring the condition of many internal retinal layers. Ultrasound B-mode examinations have a resolution of about 150 microm while OCT provides a resolution of 10 microm. OCT makes it possible to detect and measure morphological changes, retinal thickness, retinal volume, thickness of retinal nerve fiber layer and various parameters of the optic disc. We use OCT in the analysis of the retinal structures in various pathologies such as macular holes and pseudo-holes, epiretinal membranes, macular edemas of various origins, including vasooclusive disease and diabetic macular edema, lesions of vitreoretinal interface and vitreoretinal traction, serous and hemorrhagic detachments of the retina and of pigment epithelium, age related macular degeneration, diabetic retinopathy, glaucoma. OCT is an examination that is fast, sensitive, reproducible, non-invasive, non-contact and easy to perform and interpret for a retinologist. The aim of this article is to present OCT principles and techniques as well as OCT interpretation and images of most common retinal diseases: age related macular degeneration--dry and wet form, retinal angiomatous proliferation (RAP), central serous chorioretinopathy, epiretinal membranes, macular holes, diabetic retinopathy.

• Müller glial cells--the mediators of vascular disorders with vitreomacular interface pathology in diabetic maculopathy.

  Authors: Jacek Robaszkiewicz, Katarzyna Chmielewska, Małgorzata Figurska, Joanna Wierzbowska, Andrzej Stankiewicz

  Klinika oczna. 01/2010; 112(10-12):328-32.

  The key to identifying the type of diabetic maculopathy is determining the status of posterior vitreous adhesion. In the pathological state, the breakdown of the internal and external blood-retinaThe key to identifying the type of diabetic maculopathy is determining the status of posterior vitreous adhesion. In the pathological state, the breakdown of the internal and external blood-retina barrier is evident, however the mechanism is usually complex. The common denominator for these disorders are Müller glial cells, which mediate in maintaining the blood-retina barrier by linking the vessels, neurons and the vitreous in anatomical network and into functional dependence. The breakdown of the blood-retina barrier results in proliferation of Müller cells. Molecular changes in these cells increase endothelial barrier properties, but also induce pathological processes on the vitreo-retinal junction, resulting in increased adhesiveness of the collagen fibers of vitreous to retinal internal limiting membrane. The ability of Müller cells to reactive gliosis is influenced by the healthy functioning of the retinal pigment epithelium, which is a source of trophic factors necessary for appropriate Müller cells morphogenesis. Vitrectomy with the removal of ILM eliminates the vitreofoveal interface pathology, additionally provoking reactive gliosis within the macula. Intraoperative use of anti-VEGF supports short-term tightness of the blood-retina barrier in the perioperative neuralgic period. In the future, supplying astrocytes may be a strategy that will allow not only the inhibition of pathological neovascularization but also the restoration of the physiological network of capillaries in avascular retina areas. The delivery of recombinant PEDF allows for the recovery of Müller cells, and thus creates the conditions favourable for the survival of nerve cells in loss of retinal homeostasis.

• Safety of ranibizumab therapy in wet AMD and the role of vascular endothelial growth factors in physiological angiogenesis.

  Authors: Małgorzata Figurska, Jacek Robaszkiewicz, Joanna Wierzbowska

  Klinika oczna. 01/2010; 112(4-6):147-50.

  Vascular endothelial growth factor - A (VEGF-A), is a major factor implicated in choroidal neovascularisation (CNV) and therefore a target for therapeutic agents in wet age related macularVascular endothelial growth factor - A (VEGF-A), is a major factor implicated in choroidal neovascularisation (CNV) and therefore a target for therapeutic agents in wet age related macular degeneration (AMD). Ranibiuzumab (Lucentis) blocks all active isoforms of VEGF-A and the products of their degradation. It penetrates through all layers of the retina in order to reach the target tissue. It is quickly removed from the system and it is characterised by low level of immunogenicity. The essence of angiogenesis is formation of new vessels by branching and expansion of already existing ones. Angiogenesis is an important physiological process that takes place during the healing of wounds, reconstruction of hypoxic injury and reproduction. However some diseases such as cancer, arthritis, diabetes and neovascular AMD are associated with persistent unregulated angiogenesis. There is an important question whether binding vascular-endothelial growth factors in wet AMD therapies using ranibizumab is correlated with the increase of the incidence of systematic adverse effects (AEs), such as cardiovascular episodes or thrombosis. The aim of this article is to present ranibizumab as a safe drug in treating wet AMD patients. Even though the concentration of Lucentis administered in a dose of 0.3 or 0.5 mg into the vitreous body in the organism is very low, the incidence of AEs during the anti-VEGF therapy was traced. In MARINA and ANCHOR studies, occurrence of possible AEs was observed. No statistically significant differences were shown in the AEs frequency between the patients treated with ranibizumab and the control group, and in correlation with the general population of patients suffering from wet AMD.

• [Autonomic nervous system and primary open angle glaucoma--pathogenetic and clinical correlations]

  Authors: Joanna Wierzbowska, Robert Wierzbowski, Andrzej Stankiewicz, Jacek Robaszkiewicz

  Klinika oczna. 02/2009; 111(1-3):75-9.

  Primary open angle glaucoma is linked to autonomic nervous system dysfunction. In a review the role of autonomic nervous system as an important determinant of systemic hemodynamic parameters such asPrimary open angle glaucoma is linked to autonomic nervous system dysfunction. In a review the role of autonomic nervous system as an important determinant of systemic hemodynamic parameters such as heart rate and blood pressure, was presented. Human circadian clock and its impact on autonomic nervous system was emphasized. Finally some autonomic function tests and therapeutical implications were described.

• The impact of common classes of topical antiglaucoma medications on central corneal thickness--own observations.

  Authors: Joanna Wierzbowska, Anita Łagocka, Anna Siemiatkowska, Jacek Robaszkiewicz, Andrzej Stankiewicz, Janusz Sierdziński

  Klinika oczna. 01/2009; 111(10-12):323-6.

  To investigate the influence of common classes of topical antiglaucoma medications used either in monotherapy or combined therapy on CCT. In a retrospective study 487 eyes from consecutive 260To investigate the influence of common classes of topical antiglaucoma medications used either in monotherapy or combined therapy on CCT. In a retrospective study 487 eyes from consecutive 260 patients (148 F/112 M) with open angle glaucoma were examined. Depending on the topical treatment they were classified into 7 groups: A/PGA (n=212), B/BB (n= 54), C/CAI (n=36), D/PGA + CAI (n=25) E/PGA + BB (n=23) F/BB + CAI (n=54), G/ non-treated (n=83). The CCT was measured using ultrasound pachymetry Tomey AL-2000. The central corneal power was measured with the Topcon keratometer. ANOVA analyses were used for statistical analysis. There were no statistically significant differences between CCT of all groups (F = 1.06, p = 0.3931); the lowest values were in the eyes treated with PGA + BB (535.9 microm SD 31.4) and the highest in the eyes treated with PGA + CAI (571.3 microm SD 46.3). The Mean CCT in group A was 550.4 microm (SD 40.8), group B 552.5 microm (SD 34.7), group C 562.6 microm (SD 40.2), group D 571.3 microm (SD 46.3), group E 535.9 microm (SD 31.4), group F 559.5 microm (SD 32.5), group F 557.5 microm (SD 42.2). There were no statistically significant differences between CCT of eyes treated with different PGA. The highest CCT was found in the eyes treated with bimatoprost (554.4 microm SD 46.0) and the lowest in the eyes treated with latanoprost (546.4 microm SD 37.7). In this study CCT appears not to differ in eyes treated with different classes of antiglaucoma medications either in monotherapy or combined therapy. CCT appears not to differ in eyes treated with different prostaglandin and prostamide anal logs. CCT of treated glaucoma eyes does not differ from CCT of untreated glaucoma eyes.

• [Role of the retinal pigment epithelium (RPE) in the pathogenesis and treatment of diabetic macular edema (DME)]

  Authors: Katarzyna Chmielewska, Jacek Robaszkiewicz, Mariusz Kosatka

  Klinika oczna. 02/2008; 110(7-9):318-20.

  Pigment epithelium-derived factor (PEDF) has recently been shown to be the most potent inhibitor of angiogenesis in the mammalian eye, suggesting that loss of PEDF is involved in the pathogenesis ofPigment epithelium-derived factor (PEDF) has recently been shown to be the most potent inhibitor of angiogenesis in the mammalian eye, suggesting that loss of PEDF is involved in the pathogenesis of proliferative diabetic retinopathy. However, a protective role for PEDF in pericyte loss requires elucidation. Present studies suggest that PEDF proteins could protect against advanced glycation end product (AGE), which induce injury in retinal pericytes. Substitution of PEDF proteins may be a promising strategy in the treatment of patients with early diabetic retinopathy. Therefore, injury of RPE is the basic condition, not only of the progress of neovascularization, but initiation of early diabetic microangiopathy and macular edema as well. Recently new intravitreal drugs being used in the treatment of eye diseases with increased level of VEGE. Intravitreally administered a human, monoclonal anti-VEGF agent acts only as symptomatic treatment. It does not eliminate hypoxia and requires repeated administration. It is worth emphasizing, that VEGF functions are not limited to active angiogenesis, but also seems to require the maintenance and differentiation of mature blood vessels, such as the choriocapillaris. Therefore, delivery of these anti-VEGF treatments needs to be specific to sites of neovascularization or limited to a short duration, to prevent disruption of the normal vasculature. The effective method, which preserves RPE, improves oxygenation and release traction on the macula, leading to decreased permeability with subsequent resolution in DME, is pars plana vitrectomy with ILM peeling. There are several investigations that support the theoretical value of vitrectomy for the treatment of DME. Intraoperative administration of anti-VEGF agent and corticosteroids may additionally improve results of operative treatment.

• [Internal limiting membrane removal. Mechanical and fluid membranectomy]

  Authors: Jacek Robaszkiewicz, Ewa Wójcik

  Klinika oczna. 02/2006; 108(10-12):464-6.

  The purpose of this study is presentation of some surgical methods used during the removal of internal limiting membrane of retina, or its complex with epiretinal membrane. At the beginning, theThe purpose of this study is presentation of some surgical methods used during the removal of internal limiting membrane of retina, or its complex with epiretinal membrane. At the beginning, the procedure was reserved only for difficult cases so in such conditions we can hardly expect very good results. Removing of epiretinal membranes became more common of late twenty years and macular surgery began to comprise greater percentage of vitreoretinal surgeries. Indications for the type of this procedure were significantly enhanced, as well.

• [25 gauge technology in vitrectomy: pro and con]

  Authors: Jacek Robaszkiewicz, Ewa Wójcik

  Klinika oczna. 02/2006; 108(10-12):467-70.

  In the article authors present new technology of performing vitrectomy.During the surgery w e used tools twice lesser in diameter than in traditional method. Main indications for its use are: macularIn the article authors present new technology of performing vitrectomy.During the surgery w e used tools twice lesser in diameter than in traditional method. Main indications for its use are: macular hole (stage II, III and IV), idiopatic epiretinal membrane (cellophane maculopathy, macular pucker), secondary epiretinal membrane, vitreotraction macular syndrome, endophthalmitis, haemophthalmia, traction retinal detachment, diabetic macular edema, proliferative diabetic retinopathy, giant retinal tears, radial optic neurotomy, sheathotomy. At present, the best alternative is one day surgery. witrektomia 25 gauge, chirurgia szklistkowo-siatk6wkowa, bezszwowa witrektomia. 25 gauge vitrectomy, vitreoretinal surgery, sutureless vitrectomy.

• [Immediate vitrectomy as a method of choice in the treatment of endophthalmitis]

  Authors: Andrzej Stankiewicz, Jacek Robaszkiewicz, Mariusz Kosatka

  Klinika oczna. 02/2005; 107(4-6):256-9.

  This study is evaluation of the results of surgical treatment in case of postoperative endophthalmitis. The results of 16 pars plana vitrectomies in 16 patients with clinical evidences ofThis study is evaluation of the results of surgical treatment in case of postoperative endophthalmitis. The results of 16 pars plana vitrectomies in 16 patients with clinical evidences of postoperative endophthalmitis were analyzed. Successful management of postoperative endophthalmitis depends on timely diagnosis and institution of appropriate therapy.

• [Vitrectomy--absolute indication in case of intraocular foreign body localized in vitreous cavity or within vitreo-retinal interface]

  Authors: Jacek Robaszkiewicz, Agnieszka Nowosielska, Ewa Wójcik

  Klinika oczna. 02/2005; 107(4-6):326-9.

  Ocular trauma is the leading cause of visual loss in young adults. Open globe injuries with intraocular foreign bodies are an important part of this group, and in general an early surgery isOcular trauma is the leading cause of visual loss in young adults. Open globe injuries with intraocular foreign bodies are an important part of this group, and in general an early surgery is required, in order to preserve the visual acuity and the eye globe. Primary surgical repair and foreign body removal may be performed using external magnet or vitrectomy. Based on published reports and our clinical experience we think that vitrectomy is safer procedure, giving better chance for good postoperative visual outcome.

• [The influence of spontaneous posterior vitreous detachment in resolution of diabetic macular edema in NIDDM]

  Authors: Agnieszka Nowosielska, Jacek Robaszkiewicz, Ewa Graczyńska, Wojciech Czarnecki, Andrzej Stankiewicz

  Klinika oczna. 02/2003; 105(6):355-61.

  PURPOSE: To establish the influence of posterior vitreous detachment on development and resolution of diabetic macular edema in NIDDM. To asses the posterior vitreous detachment role in argon laserPURPOSE: To establish the influence of posterior vitreous detachment on development and resolution of diabetic macular edema in NIDDM. To asses the posterior vitreous detachment role in argon laser treatment of diabetic macular edema. MATERIAL AND METHODS: Retrospective study. RESULTS: 68 eyes of 36 patients were involved into the study, 52 eyes (76.5%) with macular edema and 16 eyes (23.5%) without macular edema. Posterior vitreous detachment (PVD) was present in 62.5% of cases without macular edema, and only 30.77% of cases had macular edema. Laser treatment applied in accordance to general standards cased resolution of macular edema in all cases with posterior vitreous detachment. In group with no spontaneous posterior vitreous detachment, macular edema resolved only in 19.23% of cases. CONCLUSIONS: Diabetic macular edema is less common in eyes with spontaneous posterior vitreous detachment. This observation shows, that not only vascular factor but also vitreo-macular tractions are responsible for macular pathology in diabetic macular edema. The efficacy of standard argon laser treatment depends also on vitreo-macular relation--presence of PVD, and is more sufficient in eyes with posterior vitreous detachment.

• [Vitrectomy in diabetic macular edema]

  Authors: Agnieszka Nowosielska, Jacek Robaszkiewicz, Ewa Graczyńska, Wojciech Czarnecki, Andrzej Stankiewicz

  Klinika oczna. 02/2003; 105(6):421-4.

  Macular edema remains one of the important therapeutic issues. Vitero-macular tractions are said, to be the cause of persistent, non responding to laser treatment diabetic macular edema. SurgicalMacular edema remains one of the important therapeutic issues. Vitero-macular tractions are said, to be the cause of persistent, non responding to laser treatment diabetic macular edema. Surgical removal of these tractions is used in treatment of non resolving macular edema. However, vitrectomy in treatment of diabetic macular edema remains the experimental, method requiring further studying.

• [Non-arteritic anterior ischemic optic neuropathy--case reports]

  Authors: Krystyna Kazimierczuk, Aldona Wilk, Jacek Robaszkiewicz

  Klinika oczna. 02/2003; 105(3-4):187-91.

  Nonarteritic anterior ischaemic optic neuropathy usually caused by hypertension, diabetes and hypercholesterolaemia is quite a common disease. Within its symptoms two are the most important: deep andNonarteritic anterior ischaemic optic neuropathy usually caused by hypertension, diabetes and hypercholesterolaemia is quite a common disease. Within its symptoms two are the most important: deep and often not reversible visual aquity loss and visual field defects. The decrease of visual aquity may be the first sign of systemic illness, which is noticed by a patient. In many cases the correct diagnosis and anti-oedematous, anti-inflammatory and vascular treatment may improve their visual function and general condition.