Dominika Wróbel-Dudzińska

Background: Glaucoma is an optic neuropathy characterized by progressive retinal ganglion cells degeneration and associated visual field defects. Although elevated intraocular pressure is a major risk factor, glaucoma can also develop in individuals with statistically normal intraocular pressure, implying alternative mechanisms such as neurotrophins deprivation and primary lateral geniculate nucleus injury. These mechanisms may suggest a neurodegenerative aspect of the disease. Methods: In this study, we evaluated 15 patients with bilateral early-stage normal-tension glaucoma, 10 with bilateral early-stage high-tension glaucoma, and 15 age-matched controls. All participants underwent standard ophthalmic examinations, including visual field testing and retinal nerve fiber layer assessment. High-resolution brain imaging was performed on a 7 Tesla MRI scanner. Volumes of the lateral geniculate nucleus and additional brain structures were quantified using ITK-SNAP and FreeSurfer. Results: Lateral geniculate nucleus volumes were significantly reduced in both normal-tension glaucoma and high-tension glaucoma groups compared to controls for left side, with no significant difference between normal-tension glaucoma and high-tension glaucoma. Average lateral geniculate nucleus volume was significantly lower in the normal-tension glaucoma group relative to controls, but not in high-tension glaucoma. Pearson correlation showed moderate positive associations between lateral geniculate nucleus volume and average retinal nerve fiber layer thickness when all participants were analyzed together, but no significant correlations were observed within individual groups. No significant differences in total brain volume or cortical structures (e.g., primary and secondary visual cortices) were observed among the three groups. Although certain non-visual regions, such as entorhinal cortex and fusiform gyrus, exhibited subtle alterations suggestive of early neurodegenerative processes, these differences did not reach statistical significance. Nevertheless, these findings may justify further investigation in larger cohorts to explore their potential as early indicators of neurodegeneration in glaucoma. Conclusion: These findings indicate that the impact of glaucoma might not be limited to the optic nerve but could also involve alterations in central visual and non-visual pathways. The use of 7 Tesla MRI showed promise in detecting early structural changes, highlighting the importance of further developing advanced imaging techniques. This could help expand the clinical use of ultra-high-field MRI, enhancing diagnosis and understanding of glaucoma.

Keratoconus is a progressive disease that requires precise and rapid diagnosis, as well as the initiation of treatment, to prevent serious and permanent visual impairment. This article presents a comparison of 3D convolutional neural network models for the diagnosis of keratoconus based on...

The ocular surface is a structure crucial to maintaining eye health and proper vision. Unfortunately, ocular surface diseases functioning as chronic epithelial defects, inflammation, impaired healing, require immediate regenerative repair treatment that can restore tissue integrity and function. Conventional therapies, such as artificial tears and topical anti-inflammatory agents, principally provide symptomatic relief without addressing the underlying biological deficits, thus leading to incomplete or delayed recovery. Therefore, blood derivatives have emerged as a promising bioactive therapy that not only lubricates but also actively promotes regeneration through the delivery of cytokines, growth factors, and vitamins naturally present in blood. Due to their properties mimicking the components of natural tears, autologous origin, biocompatibility and capacity to enhance tissue repair, they have emerged as a cornerstone in regenerative medicine. Therefore, the purpose of this review was to compare the evolution, positive aspects, and drawbacks, in order to demonstrate the molecular mechanism of action and the therapeutic efficacy of different blood derivates at treating ocular surface disease. Over time, these biologic preparations have evolved from the use of simple traditional serum-based derivatives to more advanced platelet-rich products, underscoring the evolving understanding of platelet-driven molecular and cellular mechanisms in tissue regeneration. Despite their widespread use, we would like to highlight the current limitations related to the lack of standardized preparation protocols, variability in composition, and evidence-based integration into clinical practice. Finally, this review highlights contemporary research trends and depicts future directions advancing the field. Key priorities include the establishment of standardized, reproducible preparation protocols; the development of next-generation platelet-derived concentrates and biomaterials; and the integration of multi-omics technologies to achieve comprehensive profiling of their biological and therapeutic activity. Moving toward methodological standardization and the execution of well-designed, high-quality comparative clinical trials will be essential to reinforce the scientific foundation, enhance translational potential, and ensure the clinical reliability of blood-derived therapies in modern regenerative medicine.

Background: This study aims to present the clinical outcomes, safety profile, and mid-term results of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with failed trabeculectomy. Methods: The studied group consisted of 62 patients after failed trabeculectomy. All patients underwent GATT, as a standalone procedure or in combination with cataract surgery (Phaco-GATT), between 2021 and 2023 and had at least 12 months of follow-up. The patients were examined at 1 day, 7 days, 1 month, 3 months, 6 months, and 12 months after surgery, with evaluation of visual acuity, intraocular pressure (IOP), number of antiglaucoma drops, and possible surgical complications. Results: The mean IOP before surgery was 37.22 ± 9.07 mmHg, and after the GATT procedure, it significantly decreased to 15.91 ± 5.28 mmHg at the 12-month follow-up. A comparison of patients with one or more previous antiglaucoma procedures showed no differences. A comparison of the degrees of successful canulating and deroofing of Schlemm’s canal revealed no statistical significance concerning IOP values or the number of medications. When comparing the IOP between the patients after standalone GATT and Phaco-GATT, a tendency for higher IOP values in the latter group was observed. In 21 (33.3%) patients, hyphema affecting visual acuity was observed early after surgery, which resolved spontaneously. Six patients (9.7%) needed additional surgery to obtain the target pressure. Conclusions: GATT is an effective and safe IOP-lowering surgical option in open-angle glaucoma patients with failed trabeculectomy.

The ocular surface plays a key role in maintaining corneal transparency and protecting the visual organ from external factors. One of the threats to its integrity is the use of topical ophthalmic preparations containing phosphates, which – when the epithelium is damaged – can lead to the formation of calcium phosphate deposits and the development of band keratopathy. The aim of this article is to present the role of phosphates as excipients in eye drops, their mechanism of action, potential toxicity, and the risks associated with their long-term use. Special attention is given to the conditions that promote corneal calcification and the negative impact of phosphates on epithelial healing and regeneration processes. The article emphasizes the need to raise awareness among physicians and patients about the potential adverse effects of phosphates and the necessity for caution in their use, particularly in individuals with a compromised ocular surface.

Objectives: The aim was to present the complicated diagnostic and therapeutic process of atypical, painless keratitis caused by a cosmopolitan protozoan of the genus Acanthamoeba. Methods: This Case Report describes a medical case involving a 48-year-old woman who occasionally wears soft contact lenses and was referred to our hospital for treatment due to deteriorating visual acuity in her left eye. The diagnostic process included the isolation of amoebae from corneal scrapings and the morphological and molecular identification of the etiological agent of the infection. Results: After examination, painless atypical keratitis was diagnosed, initially considered recurrent herpetic keratitis. However, antiviral treatment did not bring about any improvement. Further observation revealed a dense, central, annular infiltrate on the periphery of the cornea. Despite treatment, the corneal infiltrate did not improve and the patient required therapeutic penetrating keratoplasty. Ultimately, the patient underwent combined surgery: corneal transplantation with cataract phacoemulsification and intraocular lens implantation. The postoperative course was uneventful. Conclusions: Acanthamoeba keratitis should be included in the differential diagnosis of keratitis, even in the absence of its characteristic feature of severe ocular pain, especially in contact lens wearers and patients who have had herpetic keratitis. Infection of the cornea with the Herpes simplex type 1 virus causes nerve degeneration, which probably translates into a painless course of Acanthamoeba castellanii infection.

Introduction: The report discusses the management of ocular surface complications in the late phase of toxic epidermal necrolysis, with an emphasis on strategies to mitigate these debilitating consequences. Case Report: A 75-year-old male presented with severe ocular complications, including...

Purpose: The aim of the study was to compare the difference in composition between 100% autologous serum (AS) and 100% platelet-rich plasma (PRP) eye drops and assess their impact on the clinical outcomes after the treatment of severe dry eye (DE) in primary Sjogren Syndrome patients (pSS). Materials and Methods: This is an interventional, non-randomized, comparative, three-month study. 22 patients with severe DE in pSS were treated with 100% AS (22 eyes) and 100% PRP (22 eyes) eye drops 5 times per day in monotherapy mode. The quantifications of growth factors (GFs) such as fibroblast growth factor (FGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), nerve growth factor (NGF), transforming growth factor (TGF-b), insulin-like growth factor (IGF), fibronectin, and substance p in hemoderivates were done. The main outcome measures were: Ocular Surface Disease Index (OSDI), Best Corrected Visual Acuity (BCVA), the Schirmer test, tear break-up time (TBUT), corneal and conjunctival staining according to the Oxford scale, conjunctival hyperaemia, and Meibomian gland parameters. The results were compared at baseline, 1 month, and 3 months following the treatment. The clinical results were correlated with the concentration of GFs in the biological tear substitutes. Results: Significant differences were observed in the concentration of FGF (4.42 ± 0.86 vs. 15.96 ± 7.63, p < 0.0001), EGF (4.98 ± 0.97 vs. 39.06 ± 20.18, p < 0.0001), fibronectin (929.6 ± 111.5 vs. 823.64 ± 98.49, p = 0.0005), VEGF (175.45 ± 65.93 vs. 717.35 ± 488.15, p < 0.0001), PDGF AB (619.6 ± 117.30 vs. 349.66 ± 79.82, p < 0.0001), NGF (85.22 ± 23.49 vs. 8.29 ± 9.06, p < 0.0001), PDGF (935.38 ± 434.26 vs. 126.66 ± 54.41, p < 0.0001), substance p (112.58 ± 27.28 vs. 127.51 ± 26.56, p = 0.0125) in PRP compared to AS. The level of TGF-β was undoubtedly higher in AS than in PRP (1031.37 ± 330.23 vs. 726.03 ± 298.95, p = 0.0004). No significant differences between AS and PRP were observed in the concentration of IGF. Therapy with blood products relieved the signs and symptoms in pSS DE patients. There was a statistically significant improvement in BCVA, the Schirmer test, TBUT, Meibomian gland parameters, and the reduction of the OSDI scores, Oxford staining, and conjunctiva hyperaemia in each of the groups. However, the clinical changes were more significant in the PRP group. There were numerous correlations between the level of GFs and the mean change in clinical outcomes. No adverse events were reported. Conclusions: Despite the fact that blood derivatives differ in composition, they seem to be effective and safe in the treatment of severe DE in pSS patients. The signs and symptoms of DE were reduced in both groups, but only the mean change in OSDI was statistically significant. A greater reduction in OSDI scores was observed in the PRP group. The obtained results and the composition of haemoderivates may indicate the superiority of PRP in relieving the symptoms of DE in pSS patients compared to AS.

The aim of this study was to evaluate the nailfold videocapillaroscopic examination results from patients with pseudoexfoliative glaucoma (XFG) and to assess the relationship between the results of this examination and the patient’s clinical status in the XFG group. Material and Methods: The studied group consisted of 39 Caucasian patients with XFG and 32 patients in a control group. The patients were classified into two subgroups: the hypertensive pseudoexfoliative glaucoma (hXFG) subgroup and the normotensive pseudoexfoliative glaucoma (nXFG) subgroup. The nailfold videocapillaroscopy (NVC) was performed on all participants. The results of each NVC were classified as having a normal or abnormal pattern. Results: There was no statistical difference between the results of an abnormal NVC pattern in the study group vs. the control group (p = 0.8773). Microhemorrhages were shown in 30.0% of patients with nXFG vs. the control group (6.25%) (p = 0.0520). Microhemorrhages tended to be more frequent in the XFG group (p = 0.1221). A prevalent number of tortuous capillaries was observed in hXFG patients with advanced glaucomatous neuropathy. Dilatation in the capillaries and microbleedings were observed in the group of patients with lower IOP values. Tortuosity in the capillaries was significantly more frequent in PEXG patients (XFG vs. control: p = 0.0386). No relationships between the results of NVC and age, c/d, BCVA, time of treatment, and visual field defect were found. Conclusions: Specific features of NVC examination differentiate nXFG from hXFG patients. Some capillaroscopic features may correlate with the patient’s clinical status of XFG.

Purpose: To evaluate long-term efficacy, safety, and spectacle independence after the treatment of hyperopic presbyopia with pseudophakic mini-monovision using standard monofocal intraocular lenses (IOLs) after bilateral cataract surgery. Setting: Private practice in Barcelona, Spain. Design: Retrospective, noncomparative case series. Methods: Patients with hyperopic presbyopia underwent bilateral cataract surgery with pseudophakic mini-monovision using standard monofocal IOLs between 2008 and 2018. Main outcomes analyzed were uncorrected distance visual acuity (UDVA), uncorrected near distance visual acuity (UNVA), and rates of spectacle independence at postoperative day 1 (POD1), months 1, 6 and 12, and at 5 and 10 years (Y10) postoperatively. Results: The study enrolled 463 patients. Both UDVA and UNVA significantly improved postoperatively (P < .05). The mean binocular UDVA improved from 0.47 ± 0.3 logMAR preoperatively to 0.096 ± 0.14 at POD1 to 0.16 ± 0.2 at Y10 (P = .0033). The binocular UNVA was 0.05 logMAR at Y10, whereas in preoperative visits, all patients needed spectacles. The mean UDVA for the dominant eye ≤0.20 logMAR was achieved in 84.29% at the Y10. Self-reported and measured complete spectacle independence for near vision was achieved in 79.61% of patients at POD1 and 71.92% at Y10 postoperatively. For distance, respectively, in 86.29% of patients at POD1 and 78.43% at Y10. The achieved results were stable. No serious events were reported, as well as no photic phenomena. Conclusions: Pseudophakic mini-monovision in hyperopic presbyopes is a safe, effective, and low-cost approach for the long-term correction of presbyopia. It significantly reduces spectacle dependence and fulfils patients' expectations after bilateral cataract surgery.