Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland

The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A—classic indications and group B—extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss

Imbalance in the levels of angiogenic factors in patients with acute and chronic central serous chorioretinopathy

Background: The pathogenesis of central serous chorioretinopathy (CSC) remains a subject of intensive research. We aimed to determine correlations between plasma levels of selected angiogenic factors and different forms of CSC. Methods: Eighty patients were enrolled in the study including 30 with a chronic form of CSC, 30 with acute CSC, and 20 controls. Presence of active CSC was determined by fluorescein angiography (FA), indocyanine green angiography (ICGA), and swept-source optical coherence tomography (SS-OCT). Plasma concentrations of angiopoietin-1, endostatin, fibroblast growth factor, placental growth factor (PlGF), platelet-derived growth factor (PDGF-AA), thrombospondin-2, vascular endothelial growth factor (VEGF), VEGF-D, and pigment epithelium–derived factor were measured, and the results were compared between groups. Additionally, mean choroidal thickness (CT) was measured in all patients. Results: Levels of angiopoietin-1 (p = 0.008), PlGF (p = 0.045), and PDGF-AA (p = 0.033) differed significantly between the three groups. Compared with the controls, VEGF (p = 0.024), PlGF (p = 0.013), and PDGF-AA (p = 0.012) were downregulated in the whole CSC group, specifically PDGF-AA (p = 0.002) in acute CSC and angiopoietin-1 (p = 0.007) in chronic CSC. An inverse correlation between mean CT and VEGF levels was noted in CSC patients (rho = −0.27, p = 0.044). Conclusions: Downregulated angiopoietin-1, VEGF, PDGF-AA, and PlGF levels may highlight the previously unknown role of the imbalanced levels of proangiogenic and antiangiogenic factors in the pathogenesis of CSC. Moreover, downregulated VEGF levels may suggest that choroidal neovascularization in CSC is associated with arteriogenesis rather than angiogenesis

Laser photocoagulation or intravitreal therapy – dilemma concerning treatment of diabetic macular edema

Leczenie cukrzycowego obrzęku plamki stanowi dla lekarza okulisty wyzwanie terapeutyczne. Jeszcze niedawno główną metodą leczenia tego schorzenia była fotokoagulacja laserowa siatkówki, która zwykle nie prowadziła do znaczącej poprawy widzenia. Współcześnie mamy do dyspozycji skuteczne, ale kosztowne terapie doszklistkowe, w których stosuje się preparaty anty-VEGF i leki sterydowe. Dodatkowo na rynku pojawiły się lasery mikropulsowe niepowodujące uszkodzenia siatkówki. W tym kontekście niezbędne wydają się stworzenie nowego schematu leczenia cukrzycowego obrzęku plamki oraz zmiana sposobu myślenia o roli fotokoagulacji laserowej w tym procesie terapeutycznym.For an ophthalmologist, treatment of diabetic macular edema is a therapeutic challenge. Up to recently, the leading method of treatment of this clinical entity was laser photocoagulation, which in most cases didn’t result in improvement of vision. At present, at our disposal are effective, but expensive, intravitreal therapies by anti-VEGF and steroid medications. Additionally, micropulse lasers, that do not damage the retina, emerged on the market. In this context, it is necessary to create a new algorithm of treatment of diabetic macular edema, as well as change our way of thinking about the role of laser photocoagulation in treating of DME

Risk factors for central serous chorioretinopathy

Central serous chorioretinopathy is a well-described ocular disorder affecting primarily young individuals. As chronic forms of central serous chorioretinopathy are often leading to significant visual impairment, potential risk factors for its development are constantly analyzed in numerous studies. Review of available research shows that predominant risk factors for central serous chorioretinopathy include male gender, steroid intake, pregnancy, Cushing syndrome, chronic or acute stress, maladaptive personal traits, and increased choroidal thickness. Other factors, such as hypertension, gastric ulcer and reflux or genetic predispositions probably increase the risk of central serous chorioretinopathy onset, but its quantification remains the question of debate

Threshold Values of Myopic Anisometropia Causing Loss of Stereopsis

Purpose. The aim of the study was to determine the threshold values of myopic anisometropia that lead to the loss of stereoacuity in most of patients. Materials and Methods. Forty healthy subjects were included in the study. The inclusion criteria were as follows: lack of any functional or morphological ophthalmological disorders, or detectable damage to the visual system, anisometropia equal or less than 0.25 D in a spherical equivalent, and full stereoscopic vision for near and for distance. Myopic anisometropia was evoked by placing different focusing lenses in front of the right eye of the subject in the trial frame. Stereoscopic vision was assessed with the use of the Titmus test (dots) (Stereo Fly Test Stereo Optical Co. Inc.) for near and the Randot test for distance (Distance Randot Stereotest Stereo Optical Co. Inc.). Results. The threshold values for different types of myopic anisometropia for the loss of stereopsis in more than 50% of patients were determined. For near, this value was 3 D for sphere and “against the rule astigmatism” and 4 D for “with the rule astigmatism”. For distance, the values were 2 D for sphere and “against the rule astigmatism” and 3 D for “with the rule astigmatism.” Conclusions. Myopic anisometropia of more than 2 D can cause a significant impairment of binocular vision. Stereoacuity at distance is more sensitive to myopic anisometropia than stereoacuity at near. Myopic anisometropia involving “against the rule” astigmatism potentially affects binocularity more than anisometropia with regular astigmatism. A prompt correction of anisometropia of more than 2 D is needed in children to prevent the development of amblyopia

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Objective: intravitreal therapy for macular edema (ME) is a common clinical approach to treating most retinal vascular diseases; however, it generates high costs and requires multiple follow-up visits. Combining intravitreal anti–vascular endothelial growth factor (VEGF) or steroid therapy with subthreshold diode micropulse laser (SDM) application could potentially reduce the burden of numerous intravitreal injections. This review sought to explore whether this combination treatment is effective in the course of ME secondary to retinal vascular disease, and in particular, determine whether it is comparable or superior to intravitreal therapy alone. Materials and methods: the following terms and Boolean operators were used to search the PubMed literature database: subthreshold micropulse laser, subthreshold diode micropulse OR micropulse laser treatment AND anti-VEGF, anti-VEGF treatment, intravitreal steroids, OR combined therapy.This analysis included all studies discussing the combination of SDM and intravitreal anti-VEGF or steroid treatment. Results: the search revealed nine studies that met the inclusion criteria, including five comparing combined treatment and anti-VEGF treatment alone, four covering diabetic ME, and one covering ME secondary to branch retinal vein occlusion. All of these five studies suggested that combination therapy results in fewer intravitreal injections than anti-VEGF monotherapy with non-inferior functional and morphological outcomes. The remaining four studies report functional and morphological improvements after combined treatment; however, SDM alone was never superior to intravitreal-alone or combined treatment. There were substantial differences in treatment protocols and inclusion criteria between the studies. Conclusions: the available material was too scarce to provide a reliable assessment of the effects of combined therapy and its relation to intravitreal monotherapy in the treatment of ME secondary to retinal vascular disease. One assumption of note is that it is possible that SDM plus anti-VEGF might require fewer intravitreal injections than anti-VEGF monotherapy with equally good functional and morphological results. However, further randomized research is required to confirm this thesis

Increase in Central Retinal Edema after Subthreshold Diode Micropulse Laser Treatment of Chronic Central Serous Chorioretinopathy

Purpose. Subthreshold diode micropulse laser (SDM) treatment is believed to be safe method of treating clinical entities involving retinal edema. We present a case of serous edematous reaction of the retina to SDM treatment. Methods. Case report. Results. A patient with chronic central serous chorioretinopathy (CSCR) was treated with SDM Yellow multispot laser. Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%. The follow-up visit two days after treatment revealed significant central retinal edema and subretinal fluid. Fundus autofluorescence image showed thermal reaction from the RPE in the form of small spots of hyperfluorescence corresponding to the laser multispot pattern used for treatment. Retinal edema resolved after topical bromfenac and single intravitreal bevacizumab injection. Slight pigmentary reaction from the RPE persisted. Conclusion. In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration

The position of fluorescein angiography among modern imaging techniques in ophthalmology – part I

Angiografia fluoresceinowa siatkówki jest jednym z najstarszych badań obrazowych w okulistyce. Wraz z wprowadzeniem optycznej koherentnej tomografii do codziennej praktyki klinicznej zmieniły się również wskazania do wykonywania angiografii fluoresceinowej. W prezentowanej pracy omówiono współczesne zastosowania angiografii fluoresceinowej w diagnostyce schorzeń siatkówki oraz wymieniono główne wskazania do jej wykonania. Badanie to jest porównywane z optyczną koherentną tomografią oraz angiografią OCT. Autor wskazuje także główne kierunki rozwoju techniki angiograficznej.Fluorescein angiography is one of the oldest forms of imaging in ophthalmology. However, with the advent of optical coherence tomography in everyday clinical practice, indications for performing fluorescein angiography have significantly changed. In the following paper, modern application of fluorescein angiography in diagnostics of retinal diseases has been outlined as well as main recommendations for its performance. It has been compared with optical coherence tomography and OCT angiography. Author presents main directions for development of this technique

The position of fluorescein angiography among modern imaging techniques in ophthalmology – part II

Angiografia fluoresceinowa siatkówki jest jednym z najstarszych badań obrazowych w okulistyce. Wraz z wprowadzeniem optycznej koherentnej tomografii do codziennej praktyki klinicznej zmieniły się również wskazania do wykonywania angiografii fluoresceinowej. W prezentowanej pracy omówiono współczesne zastosowania angiografii fluoresceinowej w diagnostyce schorzeń siatkówki oraz wymieniono główne wskazania do jej wykonania. Badanie to porównywane jest z optyczną koherentną tomografią oraz angiografią OCT. Autor wskazuje również główne kierunki rozwoju techniki angiograficznej.Fluorescein angiography is one of the oldest forms of imaging in ophthalmology. However, with the advent of optical coherence tomography in everyday clinical practice, indications for performing fluorescein angiography have significantly changed. In the following paper, modern application of fluorescein angiography in diagnostics of retinal diseases has been outlined as well as main recommendations for its performance. It has been compared with optical coherence tomography and OCT angiography. Author presents main directions for development of this technique

Adjustable Versus Nonadjustable Sutures in Strabismus Surgery—Who Benefits the Most?

Background: Adjustable sutures have been used in strabismus surgery for more than 40 years, but controversy remains regarding their application. This review sought to analyze studies comparing the efficacy of adjustable sutures (AS) and nonadjustable sutures (NAS) in the treatment of different ocular deviations. Materials and Methods: The PubMed literature database was searched using the keywords ‘adjustable sutures’ and ‘strabismus surgery’, yielding a total of 209 results. Only comparative studies were extracted, and the results were divided into three categories: Adult comitant strabismus, childhood comitant strabismus, and paretic/restrictive strabismus. Results: The search revealed eleven comparative studies on AS versus NAS in adult strabismus, including only one randomized controlled trial. Five of these studies analyzed just the postoperative success rate, three studies analyzed just the reoperation rate, two studies analyzed both the postoperative success and reoperation rates, and one study evaluated achievement of the postoperative target angle. Three of seven studies analyzing postoperative success reported the statically significant superiority of AS over NAS, while four of five studies analyzing reoperation rate indicated a significantly smaller percentage of reoperations with the use of AS. The study covering postoperative target angle as an outcome favored the AS technique. Separately, the search revealed three comparative studies on AS versus NAS in childhood strabismus, one of which reported a statistically significant advantage with AS. Only four comparative studies on AS versus NAS in paretic or restrictive strabismus were found; all showed a tendency for better results with the use of AS but not in a statistically significant fashion. Overall, out of 18 studies analyzed in this review, 17 suggested better clinical results followed the application of AS versus NAS; however, only a minority had statistically significant results. Conclusion: The analysis of available research failed to support AS as the preferable surgery technique over NAS in cases of simple and predictive strabismus. Further research is needed to more precisely determine the group of patients able to benefit the most from AS