Recent Advances in the Diagnosis and Management of Herpetic Keratitis

The chapter is focused on one of the major cause of keratitis - Herpetic keratitis, its epidemiology, natural course, clinical forms, prognosis, diagnosis and treatment. The estimated global incidence of HSV keratitis is roughly 1,5 million, including 40,000 new cases of each year. Patients are usually affected in the early decades of live, therefore the disease has a severe impact on quality of life and quality of vision in young, productive adults. The author describes the detailed corneal characteristics, provides slit lamp photographs, optical coherence tomography scans and confocal microscopy results of different forms of the HSV keratitis: epithelial, stromal, necrotizing and endothelial. The chapter also discusses recent methods of diagnosis based on PCR testing as well as established and future methods of treatment based on the latest research results

Dry Eye Disease: Chronic Ocular Surface Inflammation

Ocular surface inflammation is one of the major features of dry eye disease (DED) according to the definition proposed by the Tear Film and Ocular Surface Society (TFOS) International Dry Eye Workshop (DEWS) in 2007 and 2017. This chapter discusses the potential pathomechanism of the DED vicious cycle and focuses on the role of chronic inflammation and flares in DED pathophysiology. Ocular inflammation may be regarded as both a cause and effect of DED. The current understanding of the mechanism responsible is that the repeating desiccating stress accompanied by hyperosmolarity induces the immune system reaction, leading to the chronic inflammation and apoptosis of ocular surface cells. On the cellular level, there is growing evidence from experimental, animal, and human studies that Th17 lymphocytes play a crucial role in DED pathogenesis. Also, potential methods of anti-inflammatory methods of treatment are discussed, such as eye lubricants, autologous serum eye drops, topical steroids, oral and topical immunomodulation drugs, and N-acetylcysteine (NAC). Understanding the role of inflammation on the cellular and molecular level may lead to improve treatment options for patients. A new approach to DED treatment should be focused to target not only symptoms but also break the pathological dry eye cycle

Non-surgical methods of pain treatment improving the quality of life of patients with endometriosis

Introduction : Endometriosis is a disease that currently affects 10-15% of women of reproductive age worldwide. The main problem of female patients, in addition to infertility, is pain, which varies greatly, significantly reduces the quality of life and affects family, social, sexual and professional life. Pharmacological treatment, which is applied both after the excision of the lesions and in patients who were not eligible for surgery, is an important element of pain therapy. There are also other methods, such as appropriate diet change, supplementation, acupuncture, electrotherapy, which are partially effective. Method : review of the recent literature based on PubMEd ,Google scholar research based on the following keywords : endometriosis treatment, hormonal treatment of endometriosis, quality of life of patients with endometriosis Purpose of work : Comparison of the mode of action and effectiveness of individual non-surgical methods of treating pain in patients with endometriosis

Methods of measuring the iridocorneal angle in tomographic images of the anterior segment of the eye

Introduction: This paper presents the problem of automatic measurement of the iridocorneal angle in tomographic images of the anterior segment of the eye. It includes the results of the comparison of well-known methods for measuring the iridocorneal angle with new methods, proposed in this paper. All these methods concern tomographic image analysis and processing.Material and method: In total, approximately 100'000 tomographic images (from about 6'000 patients) were analysed. They were obtained using two devices: SOCT Copernicus (Optopol Tech. SA, Zawiercie, Poland) and Visante OCT (Carl Zeiss Meditec, Inc, Dublin, California, USA). The patients, aged 12 to 78 years with varying degrees of the iridocorneal angle pathology, were from the region of Silesia, Poland. The images were in DICOM or RAW formats and analysed in the software developed by the authors for the purposes of this study.Results: The results indicate that the measurement method proposed by the authors, which is based on the calculation of the minimum distance between the iris and the cornea in the adopted area, is the most accurate. For this method sensitivity was 0.88, specificity 0.89 and the area under the Receiver Operating Characteristic curve (AUC) was 0.88. The other known methods for measuring the iridocorneal angle gave worse results, that is, for example, for the measurement of the distance between the iris and the cornea AUC = 0.87, sensitivity = 0.86 and specificity = 0.71. For another well-known method of measuring the iridocorneal angle AUC = 0.77, sensitivity = 0.82 and specificity = 0.61.Conclusions: The study proved that the proposed method of measuring the minimum distance between the iris and the cornea within the adopted area is the most effective in the classification of the iridocorneal angle in patients with a high degree of pathology of all the compared measurement methods based on tomographic images. However, it requires fully automated measurement

Social media and the possibility of depressive states in young adults

Social media (SM) is now a popular place for content creation and a means of communication between young adults. Their increasing participation in our lives means that they replace us face to face contacts (FTF), which can affect our mental health. The above changes in communication habits may correlate with the occurrence of depressive states and a sense of social isolation. The aim of the study is to analyze the relationship between the use of MS and the occurrence of depressive states in young adults on the basis of selected literature. The topic of emotional support and a sense of social isolation will also be discussed. PubMed and Google Scholar databases were used to select the appropriate literature, and only research was used.  The cited studies on the use of MS and depression showed that people who spent the most time on social media showed an increased risk of experiencing a depressed mood. Another study analyzed the likelihood of depression depending on the method of emotional support. The comparison of emotional support in FTF (face to face) communication with the support obtained through MS showed that the possibility of depressive symptoms was lower for FTF communication and higher for the second method, respectively. The use of social media among young adults contributes to an increased risk of depression, perceived social isolation and reduced emotional support. Moreover, it has been proven that addiction to MS positively correlates with the presence of depressive symptoms

Bacterial Keratitis

Bacterial keratitis is a disease prevalent in the underdeveloped and developing worlds and is a significant cause of vision-threatening keratitis across the globe. Early and exact diagnosis, accurate treatment, and regular follow-up are key determinants of success in these cases and allow to prevent serious complications and ensure optimal patient outcomes. This chapter provides a comprehensive overview of the causes, symptoms, diagnosis, and management of bacterial keratitis. The importance of accurate diagnosis based on culture of corneal scraping, and smear examinations, as well as with the use of diagnostic tools, such as confocal microscopy is highlighted. Treatment options, including medical treatment and surgical interventions, are discussed in detail. Moreover, the chapter provides insights into the latest research and developments including new treatments. It also highlights the need for ongoing monitoring, regular follow-up, and good compliance between patient and doctor to ensure optimal patient outcomes. The patient must be educated to avoid risk factors. The superficial ulcer usually responds well to medical management, whereas deeper non-resolving ulcers require therapeutic penetrating keratoplasty for globe salvage. Overall, this chapter serves as an important resource for clinicians, researchers, and healthcare professionals, providing valuable information on the diagnosis and management of bacterial keratitis

Selected parameters of the corneal deformation in the Corvis tonometer

Introduction: Contemporary ophthalmology knows many methods of measuring intraocular pressure, namely the methods of non-contact and impression applanation tonometry. In non-contact applanation tonometers, e.g. the Corvis, the corneal flattening is caused by an air puff. Image registration of the corneal deflection performed by a tonometer enables to determine other interesting biomechanical parameters of the eye, which are not available in the tonometer. The measurement of new selected parameters is presented in this paper. Material and method: Images with an M x N x I resolution of 200 x 576 x 140 pixels were acquired from the Corvis device in the source recording format *.cst. A total of 13'400 2D images of patients examined routinely in the Clinical Department of Ophthalmology, in District Railway Hospital in Katowice, Poland, were analysed in accordance with the Declaration of Helsinki. A new method has been proposed for the analysis of corneal deflection images in the Corvis tonometer with the use of the Canny edge detection method, mathematical morphology methods and context free operations. Results: The resulting image analysis tool allows determination of the response of the cornea and the entire eyeball to an air puff. The paper presents the method that enables the measurement of the amplitude of curvature changes in the frequency range from 150 to 500 Hz and automatic designation of the eyeball movement direction. The analysis of these data resulted in 3 new features of dynamics of the eye reaction to an air puff. Classification of these features enabled to propose 4 classes of deformation. The proposed algorithm allows to obtain reproducible results fully automatically at a time of 5 s per patient using the Core i5 CPU M460 @ 2.5GHz 4GB of RAM. Conclusions: The paper presents the possibility of using a profiled algorithm of image analysis, proposed by the authors, to measure additional cornea deformation parameters. The new tool enables automatic measurement of the additional new parameters when using the Corvis tonometer. A detailed clinical examination based on this method will be presented in subsequent paper

Comparative study of anterior eye segment measurements with spectral swept-source and time-domain optical coherence tomography in eyes with corneal dystrophies

Purpose. To compare anterior eye segment measurements and morphology obtained with two optical coherence tomography systems (TD OCT, SS OCT) in eyes with corneal dystrophies (CDs). Methods. Fifty healthy volunteers (50 eyes) and 54 patients (96 eyes) diagnosed with CD (epithelial basement membrane dystrophy, EBMD = 12 eyes; Thiel-Behnke CD = 6 eyes; lattice CD TGFBI type = 15 eyes; granular CD type 1 = 7 eyes, granular CD type 2 = 2 eyes; macular CD = 23 eyes; and Fuchs endothelial CD = 31 eyes) were recruited for the study. Automated and manual central corneal thickness (aCCT, mCCT), anterior chamber depth (ACD), and nasal and temporal trabecular iris angle (nTIA, tTIA) were measured and compared with Bland-Altman plots. Results. Good agreement between the TD and SS OCT measurements was demonstrated for mCCT and aCCT in normal individuals and for mCCT in the CDs group. The ACD, nTIA, and tTIA measurements differed significantly in both groups. TBCD, LCD, and FECD caused increased CCT. MCD caused significant corneal thinning. FECD affected all analyzed parameters. Conclusions. Better agreement between SS OCT and TD OCT measurements was demonstrated in normal individuals compared to the CDs group. OCT provides comprehensive corneal deposits analysis and demonstrates the association of CD with CCT, ACD, and TIA measurements

Trehalose protects the corneal epithelium in alcohol delamination: a structural and ultrastructural study

During laser subepithelial keratomilieusis (LASEK) the corneal epithelium undergoes to peculiar morphological changes owing to the dilute alcohol used to facilitate its mechanical separation from the stroma. As it was shown that trehalose, a non-reducing disaccharide of glucose, protects corneal epithelial cells from drying [1] and is effective in the treatment of experimental [2] and of human dry eye [3], aim of the present work was to evaluate the advantages of a pretreatment with trehalose to improve the structural and ultrastructural features of the corneal epithelium. Twelve patients undergoing LASEK were consecutively included in the study and treated as follows: topical anesthesia with oxybuprocaine hydrochloride 0.4 %, 20% ethanol in distilled water for 25 seconds followed by Merocel wetting, treatment with hypotonic BSS in distilled water, lifting of the epithelial flap with a beaver blade, excimer laser treatment (0.8 mm flying spot), reposition of the epithelial flap, BSS wash of the entire surface, application of a contact lens for 5-7 days. The right eyes of each patient were pretreated, together with the anesthetic, with 3% trehalose eye drops, whilst the left eyes were used as controls. Small parts of the epithelium were collected with a forceps at the end of the epithelial reposition and were processed for light and transmission electron microscopy. From the micrographs obtained with both techniques a morphometric analysis was also performed. In the controls, the corneal epithelium showed flat superficial cells with well-preserved apical microfolds, wing cells with intracellular vesicles and slightly dilated intercellular spaces, and irregularly shaped basal cells filled with vesicle, separated by wide spaces. In the trehalose-treated epithelium superficial cells showed normal shape, regular apical microfolds and well-preserved intercellular borders; wing cells had a well evident cytoskeleton, sometimes apparently double nuclei and normal intercellular borders, glued by desmosomes. The basal cells demonstrated polygonal shape, round nuclei and evident intracytoplasmic vesicles. The morphometric analysis carried out on the height and on the number of the layers of the corneal epithelium demonstrated in the trehalose-treated group values significantly lower than the control group. Similarly, basal hemidesmosomes were more numerous in the trehalose-treated group when compared to the control group. The morphological changes of the corneal epithelium during LASEK represent a simple and reproducible experimental model to evaluate the antagonists of an acute stress, such as the alcohol delamination. Our results demonstrate that trehalose administration before LASEK is able to maintain better morphological and morphometric features when compared to the control cornea