Phenotype and function of regulatory T cells in Th1- and Th2-mediated inflammatory diseases.

Regulatory T cells (Treg) are critical to the maintenance of immune tolerance, partly by controlling the unwanted activation of effector T cells (Teff) and thereby enhancing the resolution of autoimmune and allergic inflammation. Recent data suggest that Treg can specialize to better control different types of inflammation by using transcriptional machinery which controls differentiation and function of Teff. This thesis addresses questions related to the efficacious use of Treg, notably their ability to adopt distinct phenotypic profiles under different inflammatory contexts and their need to recognize antigen in the inflamed organ. Two differentially mediated mouse disease models were used in this project, namely Th1/Th17-mediated experimental autoimmune encephalomyelitis (EAE) as a model of multiple sclerosis and Th2-mediated allergic airways inflammation (AAI) as a model of asthma. A new model of rMOG-induced AAI was developed to specifically answer the questions on the importance of cell phenotype versus antigen-reactivity for the effective Treg-mediated suppression. It was demonstrated that Treg from the inflamed CNS in EAE had an upregulated expression of Th1 master regulator T-bet and Th1-associated chemokine receptor CXCR3, whereas Treg derived from the inflamed lung in AAI had an increased expression of Th2 master regulator GATA-3, lacked expression of T-bet and displayed decreased levels of CXCR3. This specialized and activated phenotype was restricted to tissue-derived Treg. The importance of appropriate Treg phenotype for effective suppression was suggested by the observed inability of CNS-derived Treg to inhibit AAI. A different Treg subset, TGF-β-induced Treg (iTreg), was shown to express high levels of T-bet and CXCR3, but not GATA-3 upon induction in vitro. iTreg effectively suppressed both Th1 and Th2 types of inflammation and the antigenreactivity was key to this. This thesis demonstrates that Treg are capable of acquiring a distinct phenotype corresponding with a CD4+ T cell response driving inflammatory disease and identifies antigen-reactivity as key to the efficacious suppression of inflammation. It also highlights substantial phenotypic differences between iTreg and naturally-occurring Treg which could be associated with different modes of suppression

Adverse effect of UV radiation on eyes — a review

The aim of this study is to discuss the association between ultraviolet radiation (UVR) and eye diseases. UVR whichreaches the surface of the Earth consists of 95% UVA and 5% of UVB. Both acute and chronic exposure to UVRleads to pathological changes in the eye. There is strong evidence that UVR exposure causes photokeratitis, photoretinitis,climatic droplet keratopathy, cataract, pterygium, squamous cell carcinoma of cornea and conjunctiva,cancer of the eyelids (squamous cell and basal cell carcinoma). Association between UVR and pinguecula, AMD(age-related macular degeneration) and melanoma of the eyeball is ambiguous. UVR exposure occurs all day and allyear long, which is why eye protection is necessary to avoid diseases induced by UVR. In particular childrens’ eyesshould be protected from the sun. Efficient protection is provided by accurate clothing, hats, eyeglasses or contactlenses blocking UV light

How air pollution affects the eyes — a review

The aim of this study is to present scientific reports concerning the influence of air pollution on eyes. Air pollutionis nowadays a common problem. The most significant pollutants are carbon monoxide (CO), nitrogen dioxide(NO2), ozone (O3), sulphur dioxide (SO2), particulate matters — PM10 and PM2.5. The main source of toxins in theair are cars, burning of the fuels and burning of the charcoal in household stoves. Most attention is paid to negativeeffects of air pollution on respiratory system, such as asthma and lung cancer, however, it is worth remembering thatinfluence on the eyes is equally important. Children are especially vulnerable to the harmful effects of air pollution.Anterior segment of the eye is the most exposed. Substances, which are part of the smog have an irritating effecton the surface of the eye, cause disturbances in the tear film and an inflammation. Medical conditions associatedwith increased air pollution are mainly eye irritation, conjunctivitis, dry eye syndrome (DES), meibomian glanddysfunction (MGB) and blepharitis

Leki oryginalne i generyczne w okulistyce — bezpieczeństwo i skuteczność terapii

Teoretycznie, lek oryginalny i generyczny nie powinny wykazywać istotnych różnic w praktyce klinicznej. Jednak istnieją liczne publikacje wskazujące na możliwość pogorszenia miejscowego i/lub ogólnego stanu chorego przy zamianie preparatu oryginalnego na preparat generyczny. W przypadku leków odtwórczych brak jest danych dotyczących bezpieczeństwa i skuteczności pochodzących z randomizowanych kontrolowanych badań klinicznych, a procesy produkcyjne leków generycznych i oryginalnych nie są jednolite w różnych firmach. Zmienność pH, substancji pomocniczych, toniczności i wielu innych czynników może mieć poważny wpływ na tolerancję, bezpieczeństwo i skuteczność leków generycznych. Ocena działania tych leków jest szczególnie trudna w odniesieniu do preparatów okulistycznych. W związku z samą specyfiką budowy anatomicznej oka niemożliwe jest wykonywanie niektórych badań farmakokinetycznych in vivo, a na efekt terapeutyczny może mieć wpływ nawet budowa buteleczki, wielkość kropli czy ilość substancji czynnej w jednej kropli

Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

INTRODUCTION. The aim of our study is to describe the anatomical and functional results of pars plana vitrectomy (PPV) among diabetic patients treated due to tractional retinal detachment (TRD) or non-clearing vitreous haemorrhage (VH). MATERIALS AND METHODS. A retrospective analysis was made of clinical data of 45 eyes treated with 23G PPV for TRD (17 eyes) or VH (28 eyes). Preoperative and final visual outcomes and postoperative complications were recorded. The mean follow-up period was 12 months. RESULTS. The postoperative visual acuity (VA) improved significantly in 60% of eyes, but remained unchanged or was worse in 40%. Improvement of VA was more pronounced in the VH group. PPV was performed with silicone oil tamponade in 66.5%, air tamponade in 29%, and gas tamponade in 4.5%. Postoperative complications included: retinal re-detachment (seven eyes), secondary glaucoma (nine eyes), and recurrent VH (two eyes). CONCLUSIONS. PPV is an effective treatment method of complications of severe proliferative diabetic retinopathy inter alia the TRD and VH. Because surgical management of TRD and VH is demanding, anatomical and functional results are limited by complications.

Visual rehabilitation training in a patient with large central scotoma due to Leber’s hereditary optic neuropathy

Background. Leber’s hereditary optic neuropathy (LHON) is a disease associated with pathogenetic mutations of mitochondrial DNA which affects predominantly young adult males and leads to loss of central vision, low visual acuity and unstable fixation. The purpose of this study was to allow the patient to establish the best possible fixation in the best area of retinal sensitivity in LHON patient with central scotoma. Methods. A 17 years old patient with confirmed mitochondrial LHON 11778G > A mutation was included in the study. The patient underwent 16 visual rehabilitation sessions — two for each of 8 weeks using the training module available in the equipment — MAIA microperimeter. Visual acuity and standrad microperimetry examination were performed before and 8 weeks period of training. To measure the fixation stability with MAIA microperimeter, P1, P2 and Bivariate Contour Ellipse Area (BCEA) parameters were used. Results. Visual acuity of the trained better eye was 0.08 at the baseline versus 0.063 after 8 weeks training. Fixation stability parameter was P1-21%, P2-64% at the first session versus P1-60%, P2-90% at the last session. BCEA values 29.2°˛ before and 14.2°˛ after training, respectively. Conclusions. Visual training via microperimetry could potentially be a method that improves the fixation stability in patients with LHON.

Secondary Vitrectomy with Internal Limiting Membrane Plug due to Persistent Full-Thickness Macular Hole OCT-Angiography and Microperimetry Features: Case Series

Purpose. To study the features in OCT-angiography and microperimetry in eyes with persistent full-thickness macular hole (FTMH) closed with the secondary plana vitrectomy (PPV) with autologous internal limiting membrane (ILM) plug. Methods. Secondary PPV was performed with closing the persistent FTMH with ILM plug, C3F8 tamponade, and face-down positioning. Four patients were followed for 6 months with best corrected visual acuity (BCVA) measurement, SD-OCT and OCT-A, and microperimetry. The results were compared with the fellow eye; in two patients, it was the healthy eye, and in two remaining eyes, successfully closed FTMH after primary PPV. Results. ILM flap was integrated in all cases with V-shape of closure, and atrophy was found in one case, with the largest diameter of FTMH. BCVA improved in two cases and remained the same in two cases. In OCT-A, the area of foveal avascular zone (FAZ) was larger, and foveal vessel density (FVDS) was smaller in eyes after secondary PPV in comparison to fellow eyes. In microperimetry, retinal sensitivity was lower in eyes after secondary PPV, and eccentric fixation was found in 2 of 4 patients. Conclusion. Although the anatomical results of repeated surgeries of FTMH with ILM plug are favorable, visual function results may be limited. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. The trial is registered with NCT03701542

Central retinal artery occlusion (CRAO) - case report

Central retinal artery occlusion (CRAO) is an ophthalmic emergency, most commonly caused by an embolism, usually from the carotid arteries. It can be considered as an acute stroke of the eye, and is an ocular analogue of cerebral stroke. The incidence of CRAO is estimated to be 1 in 100 000 people. Risk factors include hypertension, carotid atherosclerosis, structural cardiac pathology, coronary heart disease, cerebral vascular accident, and diabetes mellitus. CRAO usually presents with a sudden, painless loss of vision. 52 - year old male was admitted to the Ophthalmology ER, reporting a painless monocular vision loss in a right eye for two days. After such a long time from the occurrence of symptoms, there weren’t any possible treatment methods for this patient, besides preventing future embolic events. Ophthalmological examination showed only a light perception in a right eye and vision in the left eye was 1.0. Patient was diagnosed to identify risk factors of CRAO: hypertension, hypercholesterolemia, atherosclerosis or thrombophilia. He was qualified for a careful observation for the atherosclerotic risk factors and educated, that in case of occurrence of the similar symptoms, he needs to report to a Ophthalmologist immediately. Currently, there are two main types of treating an acute non-arteritic CRAO: the first: ‘standard’, non-invasive method, and the second: using the thrombolytics deployed intravenously or intra-arterially. Unfortunately, they couldn’t be used to treat described patient, since he has already been in a late phase of CRAO

The popularity and usability of mobile applications for women and expecting mothers

Introduction and purpose: There are many applications for women, including those planning to conceive, being pregnant or having a small child. These applications have various functions, among others: menstrual cycle control, information about fetal development, labor contractions counting or lifestyle advice. Aim of the study was to assess the popularity, usability, most frequently used functions and expectations of users in relation to mobile applications designed for period tracking, for pregnant women and for parents. Material and methods: The study was conducted in the form of a self-prepared, anonymous survey shared on social media. Results: 522 correctly completed questionnaires were analysed. The main sources of knowledge about pregnancy and motherhood were: Internet (90.4%) and doctor (73.5%). 78.7% of participating women used period tracking applications. The most useful functions were: date of period (94.7%), fertile days and ovulation (86.4%) and menstrual cycle regularity (58,2%). 86.6% of women used pregnancy tracker applications. The most useful features were: information about week of pregnancy (98.5%), child development (95.3%) and countdown to childbirth (83%). Using application during pregnancy: 74.8% of women felt more aware and 68.6% enjoyed the expectation time more. Parenting applications were the least popular - only 25% of respondents used them. Conclusions: Thanks to the mobile applications, women can be more aware and better prepared for planning pregnancy and motherhood. Encouraging them to use the applications can bring many benefits in a doctor-patient relationships, provided that the information contained therein is properly constructed

Clinical outcomes of primary vitrectomy in pseudophakic retinal detachment

PURPOSE. To evaluate the efficacy of primary pars plana vitrectomy (PPV) for rhematogenous retinal detachment (RD) in pseudophakic eyes. MATERIALS AND METHODS. The medical records of 63 patients who had undergone PPV after phacoemulsification were reviewed retrospectively. The mean follow-up period was 10 months. Statistical analysis evaluated functional and anatomical results as well as general (diabetes, hypertension) and ocular (myopia, glaucoma, floppy iris syndrome, intraoperative complications during cataract surgery, YAG capsulotomy) conditions. RESULTS. The median period from cataract surgery to RD onset was 15 months. Retinal attachment was achieved in 92% of eyes. The final visual acuities were improved significantly from 1.7 logMAR to 0.7 logMAR. Silicon oil was used as a tamponade in 38 eyes and SF6 gas in 25 eyes. Better functional results were achieved with SF6 gas tamponade. No intraoperative complications were reported. Most of the patients were males (71%). Statistical analysis revealed that general and ocular conditions did not influence functional results. CONCLUSIONS. Primary PPV, especially with gas as a tamponade, is an effective procedure in the surgical treatment of pseudophakic RD. The advantages include good anatomical and functional outcomes and low complication rate. Neither clinical nor surgical factors have been identified as responsible for the visual outcomes