Jarosław Kocięcki

Background: Cystic fibrosis (CF) is a systemic genetic disorder characterized by chronic inflammation, hypoxia, and metabolic imbalance that may affect neural and microvascular structures. While previous studies have evaluated superficial optic nerve head (ONH) parameters in CF, deep ONH structures, particularly the lamina cribrosa (LC), remain insufficiently explored. This study aimed to assess both superficial and deep ONH morphology in adults with CF using swept-source optical coherence tomography (SS-OCT). Methods: This observational case–control study included 34 CF individuals and 34 age- and sex-matched healthy controls. CF patients were examined at baseline and after 12–18 months of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy. All participants underwent comprehensive ophthalmic examination and SS-OCT imaging. Assessed parameters included peripapillary retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT), and lamina cribrosa depth (LCD). Between-group comparisons were performed using ANCOVA adjusted for axial length (AL) and IOP. Results: After adjustment for AL and IOP, total RNFL thickness did not differ significantly between the CF group and controls (F(1,92) = 0.363, p = 0.548). However, CF patients demonstrated significantly reduced central LCT (170.2 µm [95% CI 162.2–178.2] vs. 214.6 µm [95% CI 208.6–220.7]; F(1,91) = 72.205, p < 0.001) without markedly altered LCD (425.5 µm [95% CI 390.4–454.2] vs. 354.7 µm [95% CI 329.6–379.8]; F(1,94) = 10.090, p = 0.099) compared with controls. Intraocular pressure was also higher in CF patients (17.50 mmHg [95% CI 16.60–18.41] vs. 15.87 mmHg [95% CI 15.19–16.55]; F(1,83) = 7.660, p = 0.007). Longitudinally, total RNFL thickness decreased from 106.5 µm (IQR 15.25) to 102.0 µm (IQR 15.5) following therapy (z = 3.488, p < 0.001), while LCT (p = 0.364) and LCD (p = 0.660) remained stable. Conclusions: CF is associated with significant alterations in deep ONH structures, characterized by thinner LC, independent of ocular biometry. In contrast, superficial RNFL differences appear to be largely influenced by AL. LC parameters, particularly LCT, may represent potential structural markers of systemic involvement in CF, pending further validation.

Background and Clinical Significance: Susac syndrome is a rare autoimmune-mediated microangiopathy characterized by the triad of encephalopathy, branch retinal artery occlusion (BRAO), and sensorineural hearing loss. Due to its variable onset and protean manifestations, the syndrome is frequently misdiagnosed, potentially leading to delayed treatment and irreversible organ damage. Ocular involvement is common and often provides the first diagnostic clue. Multimodal imaging, particularly fluorescein angiography (FA) and optical coherence tomography (OCT) as well as optical coherence tomography angiography (OCT-A), enables the detection of both acute and chronic ischemic retinal changes. Their complementary application yields critical insights into disease activity, supports monitoring of relapses, and guides therapeutic strategies. Case Presentation: We describe two patients with Susac syndrome presenting with distinct ocular and neurological features. A 43-year-old male developed recurrent BRAOs in both eyes, documented by FA, OCT, and OCT-A, with preserved best-corrected visual acuity (BCVA) of 0.00 logMAR in both eyes (OU). OCT demonstrated progressive thinning of the retinal nerve fiber layer (RNFL) and inner retinal layers, consistent with sequelae of microinfarctions, while FA revealed focal arteriolar wall hyperfluorescence. Immunosuppressive therapy with corticosteroids and mycophenolate mofetil stabilized his condition. A 31-year-old female with a history of migraine and encephalopathy showed thinning of the RNFL and ganglion cell layer (GCL) with macular atrophy on OCT. FA demonstrated peripheral arteriolar wall hyperfluorescence and microaneurysms. Despite these structural alterations, visual acuity remained unaffected. Serial imaging initially demonstrated mild progression on OCT and OCT-A, followed by disease stabilization under systemic immunosuppressive therapy. Conclusions: These cases highlight the pivotal role of multimodal imaging in the early recognition and long-term monitoring of Susac syndrome. OCT provides a detailed assessment of retinal microinfarctions and chronic atrophy, while FA remains indispensable for detecting vascular leakage and disease activity. The complementary use of OCT, OCT-A, and FA enhances diagnostic accuracy, facilitates timely therapeutic interventions, and supports individualized management. Regular ophthalmological monitoring, including advanced imaging modalities, should be considered an essential component of care in Susac syndrome.

Background: To evaluate functional and anatomical outcomesof cataract surgery in neovascular age-related macular neovascularization (nAMD) eyes receiving anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections in modified pro re nata (PRN) regimen. Materials and Methods: Sixty eyes of 60 nAMD patients, including 41 women (68.3%) and 19 men (31.7%) in an average age of 77.35 ± 6.41 years, under treatment with intravitreal aflibercept injections in modified PRN regimen with no signs of macular neovascularization (MNV) activity during two consecutive visits were included in this prospective, observational study. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), as well as the number of anti-VEGF injections were monitored six months before and after phacoemulsification with intraocular lens (IOL) implantation. Further, the change of the abovementioned parameters was assessed during the six-month follow-up period for CRT and the number of injections, while the BCVA was monitored for 54 months. Results: BCVA measured on the first day after surgery (0.17 ± 0.19 logMAR) as well as in the six-month post-surgery (0.13 ± 0.16 logMAR) significantly improved compared to preop values (0.42 ± 0.20 logMAR). BCVA remains stable during the observational period. We found that both differences were statistically significant (p < 0.01). The mean CRT and the mean number of injections did not differ between the six-month pre- and post-surgical periods. Conclusions: We showed the beneficial effect of phacoemulsification in nAMD patients treated with anti-VEGF agents on visual outcomes in the short and long term. Cataract surgery in nAMD eyes treated with anti-VEGF injections does not increase the frequency of anti-VEGF injections and does not cause deterioration of the macular status.

Cystic fibrosis (CF), also known as mucoviscidosis, is the most common autosomal recessive genetic disease in the Caucasian population, with an estimated frequency of 1:2000–3000 live births. CF results from the mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene localized in the long arm of chromosome 7. The product of CFTR gene expression is CFTR protein, an adenosine triphosphate (ATP)-binding cassette (ABC) transporter that regulates the transport of chloride ions (Cl⁻) across the apical cell membrane. Primary manifestations of CF include chronic lung and pancreas function impairment secondary to the production of thick, sticky mucus resulting from dehydrated secretions. It is well known that CF can cause both anterior and posterior ocular abnormalities. Conjunctival and corneal xerosis and dry eye disease symptoms are the most characteristic manifestations in the anterior segment. In contrast, the most typical anatomical and functional changes relating to the posterior segment of the eye include defects in the retinal nerve fiber layer (RNFL), vascular abnormalities, and visual disturbances, such as reduced contrast sensitivity and abnormal dark adaptation. However, the complete background of ophthalmic manifestations in the course of CF has yet to be discovered. This review summarizes the current knowledge regarding ocular changes in cystic fibrosis.

Anti-vascular endothelial growth factor (VEGF) drugs are widely used in modern ophthalmology, especially in treating macular disorders like age-related macular degeneration or diabetic macular edema. Protocols for such treatments include repeated administration of intravitreal injections, with the volume of drug injected into the vitreous chamber seemingly high enough to cause an increase in intraocular pressure. Hence, questions might arise if such therapeutic approaches are safe for ocular tissue. Moreover, anti-VEGF compounds may theoretically harm the retinal nerve fibers due to the inhibition of VEGF and its neuroprotective effects. Thus, this manuscript aims to review the literature regarding studies evaluating the retinal nerve fiber layer (RNFL) in eyes receiving anti-VEGF treatment due to age-related macular degeneration. The RNFL was chosen as a subject of this review, as it is the innermost retinal layer exposed to the direct action of intravitreally administered drugs. The results of the available studies remain inconclusive. Most researchers seem to confirm the safety of the anti-VEGF treatment in wet age-related macular degeneration, at least regarding the retinal nerve fiber layer. However, some authors noticed that the influence of anti-VEGFs on RNFL could become apparent after more than thirty injections. Nonetheless, the authors of all studies agree that further, long-term observations are needed to help clinicians understand the effect of anti-VEGF treatment on the dynamics of changes in the thickness of retinal nerve fibers in patients with the wet form of age-related macular degeneration.

Optical coherence tomography (OCT) is a non-invasive, easily accessible imaging technique that enables diagnosing several retinal diseases at various stages of development. This review discusses early OCT findings as non-invasive imaging biomarkers for predicting the future development of selected retinal diseases, with emphasis on age-related macular degeneration, macular telangiectasia, and drug-induced maculopathies. Practitioners, by being able to predict the development of many conditions and start treatment at the earliest stage, may thus achieve better treatment outcomes.

Preoperative corneal astigmatism higher than 1 D is present in up to 30–47% of eyes with cataracts. Proper correction of astigmatism, apart from the adequately determined spherical power of the artificial intraocular lens (IOL), is the main factor ensuring the desired result of the procedure manifested as postoperative spectacle’s independence, visual function, and as a result – patient satisfaction. Toric IOL implantation allows simultaneous cataract removal and correction of corneal astigmatism during one surgical procedure. Since the introduction of toric IOLs, more rotationally stable lenses allowing for better refractive performance have been introduced to clinical practice. EnVista® is an acrylic toric IOL (enVista® MX60T; Bausch and Lomb Inc., Rochester, NY, USA), which was introduced in 2018, and currently is one of the most used toric IOLs in clinical practice worldwide. Rotational stability, apart from adequately selected spherical and toric IOL equivalents, is the most crucial parameter determining the benefits of using a toric lens because it is estimated that for every 1° of rotation of the toric IOL from the target axis, the correction of astigmatism is reduced by 3.5%; therefore a significant change of position in the postoperative period may require another surgical intervention. In this review, based on published research, we summarized the rotational stability of the enVista® lens compared to the other toric IOLs available on the market.

Carotid arteriosclerosis is the main cause of the stroke but it can also lead to ophthalmic symptoms. In this article, we aim to present four patients. All of them had hemodynamically significant but asymptomatic unilateral carotid stenosis and underwent internal carotid endarterectomy. Postoperatively, their visual function improved. Mean deviation in perimetry and values of amplitudes in pattern visual evoked potentials increased. Two patients improved visual acuity; in the other two, it remained stable.

W ostatnim czasie, ze względu na większe zapotrzebowanie na korekcję prezbiopii, obserwujemy zwiększenie różnorodności soczewek wewnątrzgałkowych klasy premium, które są stosowane podczas operacji zaćmy. Wśród soczewek wewnątrzgałkowych klasy premium znajdują się soczewki wieloogniskowe, soczewki EDOF oraz niedawno opracowane ulepszone soczewki jednoogniskowe lub jednoogniskowe plus. W artykule omówiono charakterystykę soczewek jednoogniskowych plus oraz soczewek EDOF, podstawy techniki ulepszonej monowizji, a także ogólne zasady kwalifikacji pacjenta do wszczepienia tego typu soczewek.