Dorota Śpiewak

Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible central vision loss among older adults and is characterized by abnormal macular neovascularization, leading to exudation, hemorrhage, fibrosis, and progressive retinal damage. Advances in multimodal retinal imaging have substantially improved the diagnosis, classification, and management of nAMD. Optical coherence tomography (OCT) enables high-resolution cross-sectional visualization of retinal and choroidal microstructures, facilitating the detection of fluid accumulation, pigment epithelial detachments, fibrovascular tissue, and photoreceptor damage. OCT angiography (OCTA) complements structural imaging by enabling noninvasive visualization of the retinal and choroidal microvasculature and characterizing neovascular architecture without requiring dye injection. This chapter reviews the current clinical spectrum of exudative AMD based on OCT and OCTA findings, including type 1, type 2, type 3, mixed macular neovascularization, and polypoidal choroidal vasculopathy. Characteristic structural and vascular imaging biomarkers, including pigment epithelial detachment, intraretinal and subretinal fluid, prechoroidal clefts, the onion sign, branching vascular networks, vascular loops, and choriocapillaris alterations, are discussed along with their clinical significance and therapeutic implications. Representative OCT and OCTA images demonstrate the morphological diversity of individual lesion subtypes and highlight imaging features that are useful for diagnosis, assessment of disease activity, and monitoring of antivascular endothelial growth factor therapy. A comprehensive understanding of OCT- and OCTA-based biomarkers facilitates accurate differentiation of neovascular phenotypes, improves treatment monitoring, and supports individualized management of patients with nAMD.

Corneal diseases affect a significant proportion of the global population, with younger age groups being particularly vulnerable. In severe cases involving vision loss, standard techniques such as keratoplasty often fail. These cases require more invasive treatment through the implantation of artificial cornea or keratoprostheses. Since the development of the oldest technique for creating and implanting the first keratoprostheses by Strampelli, these devices have experienced major modifications to improve their biocompatibility, function, and long-term viability. As a result, there is currently a wide range of implants and procedures that are available and can be applied according to patient indications and clinical settings. This narrative review attempts to cover the literature on this topic by focusing on (1) recent advances in rigid (Boston Type I and II, osteo-odonto-keratoprosthesis, modified osteo-odonto-keratoprosthesis, and LV Prasad Eye Institute keratoprosthesis) and soft (AlphaCor, CorNeat, and EndoArt) keratoprosthesis designs and (2) more recent studies on innovative biomaterials and techniques that could lead to the fabrication of fully functional biosynthetic corneas with optimal properties. In our review of these materials, we cover the current clinical applications and limitations, as well as future prospects of less invasive and more efficient prostheses that could improve patient outcomes and quality of life.

Background: Post-traumatic corneal wounds that require suturing are quite common; they reduce corneal transparency and cause corneal distortion, leading to corneal astigmatism and higher-order aberrations. Excimer laser treatment can be a potentially beneficial intervention for such wounds. The observation aimed to evaluate the effectiveness of topography-guided custom ablation treatment (TCAT) in patients with corneal injuries. Methods: This observation included three patients with corneal penetrating trauma (full-thickness corneal scar) and one patient with corneal blunt trauma, i.e., a non-penetrating injury with corneal laceration (partial-thickness corneal scar). This cohort study was conducted from July 2021 to August 2023. After first-stage treatment (stabilization of the post-traumatic visual defect confirmed by refraction and topography examination, corneal healing, and improvement of the corneal scar), the patients underwent the second-stage treatment, i.e., TCAT with a 20 to 45 s application of mitomycin C solution to avoid haze induction. After TCAT, the uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCVA) were measured. Refractive astigmatism was assessed using autorefractometry. Topographic astigmatism was analyzed using corneal topography and pachymetry. The root mean square (RMS) of the higher-order aberration was calculated using Zernike coefficients. The patients’ corneal healing and refractive changes were monitored. Results: All patients were monitored for corneal healing and refractive changes and underwent the same second-stage treatment, which utilized TCAT to regularize the corneal surface and reduce higher-order aberrations (HOAs). The UDVA of patients 1, 2, 3 and 4 improved by 3, 7.5, 4 and 6 rows (Snellen chart), respectively. The resultant UDVA was 1.0, 0.9, 0.7 and 1.2, while BCVA was 1.0, 1.2, 1.0, and 1.5, respectively. Conclusions: TCAT regularized the patients’ corneal surfaces and reduced HOAs. We, therefore, conclude that TCAT may be a beneficial second-stage treatment for corneal trauma-induced astigmatism.

Our study aimed to assess the anatomical changes in the retina, including the assessment of the reduction of diabetic macular edema (DME) on optical coherence tomography (OCT) and the improvement of retinal microvascular parameters, defined by the reduction of nonperfusion areas on OCT angiography (OCTA) after intravitreal injections of 6 mg faricimab, an anti-VEGF drug used in the treatment of DME. The study included twenty-two patients aged between 61 and 74 years, each of whom received four loading doses of 6 mg faricimab at 1-month intervals, as described in the summary of product characteristics. Hemodynamic parameters were analyzed by OCT angiography before the first intravitreal injection of faricimab and one month after each subsequent injection. The following parameters were analyzed: non-perfusion area (NPA), superficial capillary plexus (SCP) and deep capillary plexus (DCP), outer retinal flow area (ORFA), choriocapillaris flow area (CCFA) and foveal avascular zone (FAZ). Despite differences in the magnitude of improvement and time to improvement from the start of treatment with intravitreal injections of 6 mg faricimab, reductions in DME and improvements in OCTA parameters resulted in increased retinal blood flow and better visual acuity.

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness worldwide and a severe medical and social problem. The steadily increasing number of patients is related to the aging of the population. So far, many factors affecting the development of AMD have been identified, which can be divided into non-modifiable, including genetic factors, age, and sex, and modifiable or environmental factors, such as smoking, poor diet, and hypertension. Early stages of age-related macular degeneration are characterized by fundus drusen and abnormalities in the retinal pigment epithelium. In late stages, geographic atrophy and choroidal neovascularization (CNV) are observed. The treatment of AMD, especially its advanced forms, is very challenging. Intensive research has made it possible to treat advanced stages of the dry form of AMD with pegcetacoplan and avacincaptad pegol, new drugs approved for use in the US. Pegcetacoplan targets the C3 and avacincaptad pegol targets the C5, the pivotal proteins of the complement cascade. The drugs are administered by intravitreal injection. The gold standard for neovascular AMD (nAMD) consists of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs such as bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab. Treatment can be administered according to the fixed, pro-re-nata, and treat-and-extend regimens. The latter seems to have the best effect on improving visual acuity (VA) and the maximum therapeutic benefit. The search continues for the best ways to deliver intravitreal drugs. Current methods include sustained-release implants and hydrogel platforms for drug release, while the most promising future pathways for treating dry and nAMD are stem cell and gene therapy.

Corneal neovascularization can impair vision and result in a poor quality of life. The pathogenesis involves a complex interplay of angiogenic factors, notably vascular endothelial growth factor (VEGF). This review provides a comprehensive overview of potential therapies for corneal neovascularization, covering tissue inhibitors of metalloproteinases (TIMPs), transforming growth factor beta (TGF-β) inhibitors, interleukin-1L receptor antagonist (IL-1 Ra), nitric oxide synthase (NOS) isoforms, galectin-3 inhibitors, retinal pigment epithelium-derived factor (PEDF), platelet-derived growth factor (PDGF) receptor inhibitors, and surgical treatments. Conventional treatments include anti-VEGF therapy and laser interventions, while emerging therapies such as immunosuppressive drugs (cyclosporine and rapamycin) have been explored. Losartan and decorin are potential antifibrotic agents that mitigate TGF-β-induced fibrosis. Ocular nanosystems are innovative drug-delivery platforms that facilitate the targeted release of therapeutic agents. Gene therapies, such as small interfering RNA and antisense oligonucleotides, are promising approaches for selectively inhibiting angiogenesis-related gene expression. Aganirsen is efficacious in reducing the corneal neovascularization area without significant adverse effects. These multifaceted approaches underscore the corneal neovascularization management complexity and highlight ideas for enhancing therapeutic outcomes. Furthermore, the importance of combination therapies and the need for further research to develop specific inhibitors while considering their therapeutic efficacy and potential adverse effects are discussed.

Purpose: The aim of the paper is to present the case of a 53-year-old female patient who, based on the clinical picture and optical coherent tomography of the anterior segment (AS-OCT), was diagnosed with peripheral hypertrophic subepithelial degeneration (PHSD) and underwent surgical treatment in the form of superficial keratectomy with mechanical removal of degenerative plaques. Methods: Analysis of AS-OCT images and corneal tomography based on Scheimpflug images and surgical treatment – superficial keratectomy with mechanical removal of degenerative plaques. Results: Before treatment, the best corrected visual acuity (BCVA) for distance, as assessed by the Snellen chart, was 3/50 c.cor +10.50/-6.50 ax 18° in the right eye (RE) and in the left eye (LE) 5/10 c.cor +10.75/-3.00 ax 48°. Preoperative keratometry performed with the Pentacam device was K1 32.7 D and K2 46.0 D in the OP and K1 42.5 D and K2 44.7 D in the LE. Postoperative BCVA in RE was 5/8 c.cor +3.50/-1.00 ax 120° at 5 months of follow-up and in LE 5/6 c.cor +4.75/-1.00 ax 64° at 3rd month of observation. Postoperative keratometry (Pentacam) in RE K1 was 44.6 D, K2 46.9 D in the 5th month of observation, and in LE K1 45.6 D, K2 46.5 D in the 3rd month of observation. As a result of the treatment, BCVA improved, astigmatism decreased and corneal translucency improved. Conclusions: AS-OCT and Scheimpflug-based corneal tomography are helpful in the diagnosis of PHSD. Superficial keratectomy with mechanical removal of degenerative plaques seems to be an effective treatment for PHSD

A healthy cornea is a nonvascularized, transparent tissue. It is nourished by diffusion through the tear film, aqueous fluid and neurotrophins supplied by the corneal innervation. The cornea is devoid of both blood and lymphatic vessels, which makes it an immunologi-cally privileged tissue. Corneal neovascularization develops due to an imbalance between angiogenic and anti-angiogenic factors and can lead to a significant decrease in visual acui-ty. It may cause scarring, lipid keratopathy, and corneal edema. The resulting pathological vascularization of the cornea reduces its immune privilege and significantly worsens the prognosis after subsequent penetrating keratoplasty, increasing the risk of rejection of the transplanted flap. Neovascularization is favored by many disease processes, including auto-immune diseases, viral inflammations, mainly herpes and varicella-zoster, and blepharitis [1]. There are several options to treat corneal neovascularization, both pharmacological and surgical. Angiostatic treatment involves inhibiting the growth of new vessels by suppressing inflammatory responses. VEGF inhibitors, steroids, cyclosporine A, and amniotic membrane grafts secured to the cornea work this way. VEGF inhibitors are the agents with the direct and most potent angiostatic effect. Angioregressive treatment, on the other hand, results in the regression of already existing pathological vessels. This therapy is also based on VEGF inhibitors, which, however, have the most potent effect on newly formed and small vessels but are less effective in reducing large-caliber and mature vessels. A more effective method for such vessels is ablation, which involves surgical closure. The most commonly used an-gio-occlusive method is needle diathermy and argon or yellow laser therapy. In advanced corneal neovascularization, corneal transplant surgery may be necessary. It is best performed after pretreatment with anti-VEGF preparations, often continued after corneal transplanta-tion to reduce the risk of transplant rejection [2]. This paper discusses the pathogenesis of corneal neovascularization and the current and future trends in its treatment.

Aim: The primary goal of this study was to evaluate the reduction in non-perfusion area and improvement in blood flow as well as the reduction in retinal edema on optical coherence tomography angiography (OCT-A) in patients with retinal vein occlusion treated with 2 mg intravitreal injections of aflibercept. Material and methods: Fifty eyes of nine patients with central retinal vein occlusion (CRVO) and sixteen patients with branch retinal vein occlusion (BRVO), aged 50 to 75 years, were collectively analyzed as retinal vein occlusion (RVO). The following parameters were analyzed: superficial vessel density (VDSF), deep vessel density (VDD), flow area in the outer retina (FAOR), choriocapillaris flow area (FACC), non-flow area (NFA) and the foveal avascular zone (FAZ). Results: OCT-A revealed a reduction in macular edema. The most significant change in central retinal thickness (CRT) was observed between measurement timepoint “5” and the baseline (46%). The non-flow area was also reduced. Following a significant decrease in superficial vessel density 30 days after the first dose of aflibercept, a non-significant increase was noted at the subsequent timepoints. An increase was also found in deep vessel density and choriocapillaris flow area. Improvements in the above OCT-A parameters resulted in increased retinal blood flow and improved visual acuity. Conclusions: Patients with retinal vein occlusion treated with 2 mg aflibercept exhibited reduced macular edema and FAZ, increased vessel density, improved blood flow, and better visual acuity.

The purpose of the study was to evaluate changes in best corrected visual acuity, central retinal thickness, area and flow in the neovascular membrane and to compare therapeutic outcomes from baseline in patients who received three doses of Beovu (brolucizumab) at three-month follow-up. Material and methods: A prospective observational study conducted at the Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice. Eight patients with exudative form of age-related macular degeneration (AMD) were observed. Results: The mean best corrected visual acuity (BCVA) outcome increased with each subsequent visit. The mean central retinal thickness (CRT) result also improved (decreased) with each subsequent visit, except for the last measurement. A statistically significant change in neovascular membrane area was observed after the first injection. In further treatment, the membrane area underwent changes that were not statistically significant. A statistically significant change in neovascular membrane flow was demonstrated after the first and second injections. Discussion: Our study confirmed the efficacy of brolucizumab in the treatment of patients with exudative AMD in terms of improvements in best corrected visual acuity (BCVA), central retinal thickness (CRT), neovascular membrane area, and neovascular membrane flow area.