Application of 2RT nanopulse retinal laser in the treatment of diabetic macular edema

W 2013 r. liczba osób z rozpoznaną cukrzycą przekroczyła 382 miliony. Przewiduje się, że do 2035 r. wzrośnie ona trzykrotnie. Jeszcze kilka lat temu w leczeniu cukrzycowego obrzęku plamki stosowano przede wszystkim fotokoagulację laserową, metoda ta jednak bezpowrotnie niszczy tkanki i fotoreceptory. Alternatywą wobec konwencjonalnej laseroterapii siatkówki okazało się zastosowanie lasera 2RT. Pierwsze informacje na temat jego skuteczności pochodzą z 2007 r. Obecnie dostępne są nieliczne doniesienia oceniające skuteczność zabiegów 2RT. Działanie lasera nanosekundowego na plamkę wymaga dalszej obserwacji i wnikliwej randomizowanej oceny.In 2003, there were over 382 million people with diagnosed diabetes worldwide. This number is projected to triple by 2035. Up until a few years ago, the mainstay of diabetic macular edema treatment was laser photocoagulation. However, this treatment method causes irreparable damage to tissues and photoreceptors. As an alternative to conventional retinal laser therapy, 2RT laser was introduced, with the first reports of its effectiveness published in 2007. Currently, there are only a few available studies on 2RT laser efficacy. The effect of nanosecond laser on macular tissues requires further evaluation and thorough, randomized analysis

Current technologies of ocular biometry

Operacja zaćmy jest obecnie najczęściej wykonywaną procedurą chirurgiczną w krajach rozwiniętych. Coraz częściej traktowana jest również jako zabieg refrakcyjny, a zastosowanie soczewek z grupy premium (asferycznych, torycznych, wieloogniskowych) pozwala pacjentowi na uniezależnienie się od korekcji okularowej i uzyskanie dobrej jakości widzenia do wszystkich odległości, nawet jeśli przed zabiegiem występowały starczowzroczność czy astygmatyzm. Wraz z poprawą standardów leczenia operacyjnego zwiększają się również oczekiwania pacjentów. Kluczowe jest uzyskanie jak najlepszej refrakcji pooperacyjnej. W tym celu przed operacją należy dokonać precyzyjnych pomiarów biometrycznych gałki ocznej i wybrać optymalną formułę obliczeniową do kalkulacji mocy wszczepianej soczewki. Celem pracy jest przedstawienie aktualnych metod przeprowadzania badań biometrycznych i najnowszych dostępnych w Polsce aparatów służących do biometrii oraz porównanie ich funkcji. Dokładne zrozumienie zalet i ograniczeń dostępnej na rynku aparatury oraz poznanie podstawowych zasad kalkulacji mocy wszczepianych soczewek pozwoli usprawnić procedury przeprowadzania badań i osiągać optymalne wartości refrakcji pooperacyjnej.Cataract surgery is currently the most frequently performed surgical procedure in developed countries. In some cases it is also regarded as refractive procedure, and the use of premium intraocular lenses (aspheric, toric, multifocal) allows the patient to become spectacle independent. The improvement of surgical treatment results in rising expectations of patients. The key issue is to achieve the desired refractive outcome. Essential for this purpose are precise measurements of the eye, and selection of the optimal IOL calculation formula. The aim of this paper is to present current techniques of ocular biometry and new biometry devices available in Poland, along with a comparison of their functions. Good understanding the advantages and limitations of the current technology allows to perform measurements efficiently and to achieve highly accurate refractive outcomes

Identification of Retinal Biomarkers in Alzheimer's Disease Using Optical Coherence Tomography: Recent Insights, Challenges, and Opportunities

This review will highlight recent insights into measuring retinal structure in Alzheimer's disease (AD). A growing body of evidence indicates that disturbances in retinal blood flow and structure are related to cognitive function, which can severely impair vision. Optical coherence tomography (OCT) is an optical imaging technology that may allow researchers and physicians to gain deeper insights into retinal morphology and clarify the impact of AD on retinal health and function. Direct and noninvasive measurement of retinal morphology using OCT has provided useful diagnostic and therapeutic indications in several central nervous system (CNS) diseases, including AD, multiple sclerosis, and Parkinson disease. Despite several limitations, morphology assessment in the retinal layers is a significant advancement in the understanding of ocular diseases. Nevertheless, additional studies are required to validate the use of OCT in AD and its complications in the eye

Variability of Grading DR Screening Images among Non-Trained Retina Specialists

Poland has never had a widespread diabetic retinopathy (DR) screening program and subsequently has no purpose-trained graders and no established grader training scheme. Herein, we compare the performance and variability of three retinal specialists with no additional DR grading training in assessing images from 335 real-life screening encounters and contrast their performance against IDx-DR, a US Food and Drug Administration (FDA) approved DR screening suite. A total of 1501 fundus images from 670 eyes were assessed by each grader with a final grade on a per-eye level. Unanimous agreement between all graders was achieved for 385 eyes, and 110 patients, out of which 98% had a final grade of no DR. Thirty-six patients had final grades higher than mild DR, out of which only two had no grader disagreements regarding severity. A total of 28 eyes underwent adjudication due to complete grader disagreement. Four patients had discordant grades ranging from no DR to severe DR between the human graders and IDx-DR. Retina specialists achieved kappa scores of 0.52, 0.78, and 0.61. Retina specialists had relatively high grader variability and only a modest concordance with IDx-DR results. Focused training and verification are recommended for any potential DR graders before assessing DR screening images

Mechanism of accommodation assessed by change in precisely registered ocular images associated with concurrent change in auto-refraction

Purpose: Our purpose was to determine the changes in anterior chamber depth (ACD) and central lens thickness (CLT) during pharmacologically induced accommodation. Methods: Following pupillary dilation with phenylephrine 10%, baseline auto-refractions and swept-source optical coherence tomographic biometric images (Zeiss IOLMaster 700) were obtained from the right eyes of 25 subjects aged 19 to 24 years. Pilocarpine 4% and phenylephrine 10% were then instilled into these right eyes. One hour later, auto-refractions and biometric imaging were repeated. Only data from eight of 25 subjects met the following stringent criteria to be included in the study analysis: pre and post-pilocarpine biometric foveal images were registerable, the images of the corneal centers were shifted by ≤100 μm, pupils >5 mm and the pharmacologically induced refractive change was ≥ −7 diopters. Results: The mean auto-refractive accommodative change for the eight included subjects was −12.45 diopters (± 3.45 diopters). The mean change in CLT was 81 μm (± 54 μm) and the mean change in ACD was −145 μm (± 86 μm). Superimposition of the registered pre and post-pilocarpine biometric images of the sagittal sections of the whole eye from each subject demonstrated that the position of the whole lens did not shift either anteriorly, posteriorly or vertically during pharmacologically induced accommodation. Conclusions: A small increase in lens thickness was associated with a large change in accommodative amplitude and no significant change in lens position as predicted by the Schachar theory