Publications by authors named "Andrzej Grzybowski"

484 Publications

Ocular Surface Changes Associated with Ophthalmic Surgery.

J Clin Med 2021 Apr 12;10(8). Epub 2021 Apr 12.

Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania.

Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient's satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords "cataract surgery", "phacoemulsification", "refractive surgery", "trabeculectomy", "vitrectomy" in combination with "ocular surface dysfunction", "dry eye disease", and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.
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http://dx.doi.org/10.3390/jcm10081642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069708PMC
April 2021

The Ophthalmology Surgical Competency Assessment Rubric for Intravitreal Injections (ICO-OSCAR:IVI).

J Clin Med 2021 Apr 2;10(7). Epub 2021 Apr 2.

Department of Ophthalmology, University of Warmia and Mazury, 10-561 Olsztyn, Poland.

(1) Background: Intravitreal injections (IVIs) are the most commonly performed intraocular procedure worldwide. Ensuring correct learning is essential to avoid complications. Our purpose was to develop an internationally valid tool to assess skill in performing IVIs. (2) Methods: A panel of six content experts designed a rubric for assessing the IVI procedure by using a modified Dreyfus scale of skill acquisition, dividing it into steps and providing objective behavioral descriptors for each level of skill in each category, following the International Council of Ophthalmology (ICO) guidance. The rubric draft was then critically reviewed by 12 international content experts, and their constructive comments were considered for the final rubric. (3) Results: The Ophthalmology Surgical Competency Assessment Rubric for IVI (ICO-OSCAR:IVI) is the proposed tool for assessing healthcare professionals training to perform IVI. (4) Conclusions: The ICO-OSCAR:IVI is the result of the consensus of an international expert panel. The methodology used for its development provides this rubric with face and content validity. It can be used globally to assess healthcare professionals training to perform IVI, as well as the impact of different teaching methods on performance. Further studies are required to establish intra- and inter-rater reliability, as well as the predictive validity of this tool.
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http://dx.doi.org/10.3390/jcm10071476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038170PMC
April 2021

The 100 most cited papers on retinal detachment: a bibliographic perspective.

Br J Ophthalmol 2021 Mar 30. Epub 2021 Mar 30.

Ophthalmology, Meir Medical Center, Kfar Saba, Israel.

The 100 most cited papers on retinal detachment (RD) were analysed using a bibliographic study. The bibliographic databases of the ISI Web of Knowledge were searched, limited to research articles published between 1965 and 2020 in peer-reviewed journals. The papers were ranked in order of number of citations since publication. Ninety of the 100 most cited papers on RD were published in 12 ophthalmology journals, with 74 of them published in (n=31), (n=23), (n=10) and (n=10); the remaining 10 papers were published in 8 journals from other fields of medical research. All papers in the top 100 were published in English. The 100 most cited papers on RD originated from 12 different countries, with the majority (72 papers) originating from the USA. The 100 identified papers represent a mix of clinical trials and animal/laboratory studies. This bibliographic study provides a unique perspective and insight into some of the most influential contributions in RD understanding and management over the last 55 years.
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http://dx.doi.org/10.1136/bjophthalmol-2020-318015DOI Listing
March 2021

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

Eur J Ophthalmol 2021 Mar 5:1120672121998960. Epub 2021 Mar 5.

School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.
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http://dx.doi.org/10.1177/1120672121998960DOI Listing
March 2021

Response to Letter to the Editor.

Surv Ophthalmol 2021 Feb 26. Epub 2021 Feb 26.

Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA.

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http://dx.doi.org/10.1016/j.survophthal.2021.02.015DOI Listing
February 2021

José Morón was the first to introduce the retinal light photocoagulation.

Acta Ophthalmol 2021 Feb 24. Epub 2021 Feb 24.

Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.

Regarding the early history of laser, it is generally accepted that the technique of retinal light photocoagulation was first pioneered by Gerd Meyer-Schwickerath in 1949. The renowned German ophthalmologist developed the technique to obtain clinically useful results and is worldwide considered the father of retinal photocoagulation. Nevertheless, we believe that the Spanish ophthalmologist José Morón (Seville, 1918-2000) was really the author of the first known experience of therapeutic photocoagulation of the retina, because he had previously used a similar technique in rabbit and human eyes in 1945 and 1946, respectively. These experiences already appeared in his doctoral dissertation, which was defended in Madrid in 1946, almost three years before the pioneering presentation of Meyer-Schwickerath. Despite this, Morón was permanently forgotten in the history of retinal photocoagulation. We would like to highlight his earlier experimental studies and reclaim the figure of this Spanish ophthalmologist, which deserves international recognition. This case is an example of a common phenomenon that inventors of new ideas are often not cited appropriately.
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http://dx.doi.org/10.1111/aos.14804DOI Listing
February 2021

Early descriptions of vitreous surgery.

Retina 2021 Feb 11. Epub 2021 Feb 11.

Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland Hygeia Clinic, Gdańsk, Poland.

Introduction: Vitreoretinal surgical techniques have evolved during the last decades due to the development and evolution of pars plana vitrectomy. The introduction of modern vitrectomy is credited to Robert Machemer (1933-2009). The aim of this review is to characterize the early developments of vitreous removal.

Methodology: We used the PubMed web platform to search the terms: complications of cataract surgery, vitrectomy, vitreous body, vitreous humor, vitreous humour, vitreous tap, vitreous transplantation. Other publications were also considered as a potential source of information when referenced in relevant articles.

Results: The first description of vitreous removal for treatment of eye disorders dates the 17th century; it was conducted by a Dutch surgeon Anton Nuck (1650-1692) in a case of hydrophthalmia. In English literature the first description of vitrectomy is attributed to the American surgeon John Collins Warren (1778-1856). This method was implemented in the spontaneous dislocation of the crystalline lens. As the fibrillar structure of the vitreous once destroyed could not be regenerated, the researchers aimed to restore the chemical composition of the vitreous. For several decades vitreous transplantation was performed for the treatment of vitreous hemorrhages and retinal detachment.

Conclusion: Although the achievements of vitreoretinal surgery preceding Machemer's inventions are uncommonly reported, they have contributed to the concept and understanding of the treatment modalities.
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http://dx.doi.org/10.1097/IAE.0000000000003149DOI Listing
February 2021

Deep Learning for Anterior Segment Optical Coherence Tomography to Predict the Presence of Plateau Iris.

Transl Vis Sci Technol 2021 Jan 6;10(1). Epub 2021 Jan 6.

Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand.

Purpose: The purpose of this study was to evaluate the diagnostic performance of deep learning (DL) anterior segment optical coherence tomography (AS-OCT) as a plateau iris prediction model.

Design: We used a cross-sectional study of the development and validation of the DL system.

Methods: We conducted a collaboration between a referral eye center and an informative technology department. The study enrolled 179 eyes from 142 patients with primary angle closure disease (PACD). All patients had remaining appositional angle after iridotomy. Each eye was scanned in four quadrants for both AS-OCT and ultrasound biomicroscopy (UBM). A DL algorithm for plateau iris prediction of AS-OCT was developed from training datasets and was validated in test sets. Sensitivity, specificity, and area under the receiver operating characteristics curve (AUC-ROC) of the DL for predicting plateau iris were evaluated, using UBM as a reference standard.

Results: Total paired images of AS-OCT and UBM were from 716 quadrants. Plateau iris was observed with UBM in 276 (38.5%) quadrants. Trainings dataset with data augmentation were used to develop an algorithm from 2500 images, and the test set was validated from 160 images. AUC-ROC was 0.95 (95% confidence interval [CI] = 0.91 to 0.99), sensitivity was 87.9%, and specificity was 97.6%.

Conclusions: DL revealed a high performance in predicting plateau iris on the noncontact AS-OCT images.

Translational Relevance: This work could potentially assist clinicians in more practically detecting this nonpupillary block mechanism of PACD.
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http://dx.doi.org/10.1167/tvst.10.1.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794268PMC
January 2021

Long-term follow-up of cataract surgery in eyes filled with silicone oil.

Int J Ophthalmol 2021 18;14(1):72-75. Epub 2021 Jan 18.

Department of Ophthalmology, Medical University of Gdańsk, Gdańsk 80-952, Poland.

Aim: To evaluate the refractive and long-term outcome of eyes filled with silicone oil (SO) undergoing phacoemulsification cataract surgery (PCS).

Methods: This retrospective study evaluated patients with SO tamponade who were scheduled for PCS.

Results: Subjects (=26) were followed for 29.5±13.9mo after cataract surgery. The median spherical equivalent refraction (SER) was +5.3 D [interquartile range (IQR) +2.9 to +6.7] before PCS, and +3.4 D (IQR +2.0 to +4.4) after PCS. Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes (57.7%). In 13 eyes assessment of refraction after SO-removal was possible, and showed a myopic shift of -4.6 D (IQR -2.9 to -7.3) in the SER. After SO removal, 5 of the 13 eyes (38.5%) were within ±1.0 D of the target refraction, while 9 out of the 13 eyes (69.2%) were within ±2.0 D.

Conclusion: In our study, the refraction after PCS for eyes filled with SO manifested low predictability, as did the myopic shift following SO removal. A significant percentage of the eyes that underwent SO administration required a long-term tamponade.
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http://dx.doi.org/10.18240/ijo.2021.01.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790668PMC
January 2021

Should We Expect the Rise of Nd:YAG Laser Capsulotomies in the Future?

Am J Ophthalmol 2021 02 12;222:A1-A2. Epub 2021 Jan 12.

Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland; Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

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http://dx.doi.org/10.1016/j.ajo.2020.12.035DOI Listing
February 2021

Angle alpha as predictor for improving patient satisfaction with multifocal intraocular lenses?

Graefes Arch Clin Exp Ophthalmol 2021 Mar 4;259(3):563-565. Epub 2021 Jan 4.

Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany.

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http://dx.doi.org/10.1007/s00417-020-05053-4DOI Listing
March 2021

Longitudinal Screening for Diabetic Retinopathy in a Nationwide Screening Program: Comparing Deep Learning and Human Graders.

J Diabetes Res 2020 15;2020:8839376. Epub 2020 Dec 15.

Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand.

Objective: To evaluate diabetic retinopathy (DR) screening via deep learning (DL) and trained human graders (HG) in a longitudinal cohort, as case spectrum shifts based on treatment referral and new-onset DR.

Methods: We randomly selected patients with diabetes screened twice, two years apart within a nationwide screening program. The reference standard was established via adjudication by retina specialists. Each patient's color fundus photographs were graded, and a patient was considered as having sight-threatening DR (STDR) if the worse eye had severe nonproliferative DR, proliferative DR, or diabetic macular edema. We compared DR screening via two modalities: DL and HG. For each modality, we simulated treatment referral by excluding patients with detected STDR from the second screening using that modality.

Results: There were 5,738 patients (12.3% STDR) in the first screening. DL and HG captured different numbers of STDR cases, and after simulated referral and excluding ungradable cases, 4,148 and 4,263 patients remained in the second screening, respectively. The STDR prevalence at the second screening was 5.1% and 6.8% for DL- and HG-based screening, respectively. Along with the prevalence decrease, the sensitivity for both modalities decreased from the first to the second screening (DL: from 95% to 90%, = 0.008; HG: from 74% to 57%, < 0.001). At both the first and second screenings, the rate of false negatives for the DL was a fifth that of HG (0.5-0.6% vs. 2.9-3.2%).

Conclusion: On 2-year longitudinal follow-up of a DR screening cohort, STDR prevalence decreased for both DL- and HG-based screening. Follow-up screenings in longitudinal DR screening can be more difficult and induce lower sensitivity for both DL and HG, though the false negative rate was substantially lower for DL. Our data may be useful for health-economics analyses of longitudinal screening settings.
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http://dx.doi.org/10.1155/2020/8839376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758133PMC
December 2020

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020.

Ann Transl Med 2020 Nov;8(22):1554

Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.

The debate on role of 'simultaneous bilateral cataract surgery' (SBCS) continues. The world population has exponentially increased during last fifty years and average human lifespan has increased by a decade during the last century. This translates to ever increasing geriatric population with its inherent problem of preventable blindness because of cataract formation in the elderly. We are adding to the backlog of cataract surgeries not only in the 'developing world' but also in the 'developed world.' Times demand that we reconsider our old fashioned approach of staggering bilateral cataract surgeries. Serious, but a potential, risk of simultaneous bilateral infection/endophthalmitis has been the biggest deterrent in acceptance of SBCS as a routine procedure. The opponents of SBCS strongly believe in this argument that has not been documented when strictly followed the recommendations regarding separate procedures of each eye. The advantages of reducing the ever-increasing backlog of preventable/treatable blindness, faster visual recovery, economic benefits to patients as well as health care providers, lesser risk of amblyopia in pediatric population, and decreased risk of as serious a complication as death by exposure to general anesthesia in pediatric and adult population, etc. outweigh the disadvantages of SBCS when compared with 'delayed bilateral cataract surgery' (DBCS). SBCS is favored over DBCS in pediatric population and in uncooperative, mentally retarded and physically disabled adults needing general anesthesia to reduce the risks and complications of general anesthesia. Considering such factors and review of available literature strongly support that SBCS has a definite role where indicated, under certain circumstances, and in certain select group of patients in both developing as well as developed countries.
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http://dx.doi.org/10.21037/atm-20-3490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729368PMC
November 2020

The history of cataract surgery: from couching to phacoemulsification.

Ann Transl Med 2020 Nov;8(22):1551

Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.

Where and when cataract surgery started have been a mystery. Indian tradition and the Persian author Zarrin-Dast attributed the procedure to the Indians, while pseudo-Galen suggested an Egyptian origin. Certain idiosyncratic practices are common to early Greek and Sanskrit descriptions of cataract couching, e.g., the requirement for maturity of the cataract, the preference for patients of intermediate ages, comparison of some eyes to glass, rubbing the eye, having a wide portion of the couching instrument shaft, pars-plana puncture with avoidance of the vein, and immediate vision testing. In ancient Greece and India, the words describing the color of a healthy blue eye (glaukos and nīla, respectively) could also characterize a poorly-seeing eye not curable by surgery. In both regions, the lens (or pupillary region) was compared to a lentil, and colored entoptic phenomena were noted. The sitting posture of the patient, ocular convergence towards the nose, the more systematized integration of the humoral theory with cataract surgery, and possibly blowing on the eye and putting cotton on the eye are all consistent with an Indian origin for the procedure. On the other hand, the emphasis on surgical ambidexterity could suggest an origin close to the Mediterranean. Thus, the question of where cataract surgery started has not been resolved. Various authors have suggested that multiple types of cataract surgery were practiced in the ancient and medieval periods: (I) couching, (II) discission (division), (III) aspiration through a tube, (IV) extraction through a limbal incision, and (V) expulsion of lens remnants around an embedded probe. We review the evidence in favor (and against) each of these types of surgery.
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http://dx.doi.org/10.21037/atm-2019-rcs-04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729313PMC
November 2020

Intraocular vision-improving devices in age-related macular degeneration.

Ann Transl Med 2020 Nov;8(22):1549

Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Age-related macular degeneration (AMD) is a leading cause of blindness, especially in western countries, and will substantially burden society and the world's health care system. Patients with late AMD often accompany a progressive loss of central vision, which will heavily influence the quality of life and associated with increased risk of functional disability. The principal visual rehabilitation methods with low-vision magnifiers, such as hand or stand magnifiers, spectacles, and closed-circuit television, were cumbersome to use and cosmetically burdensome. Therefore, the development of intraocular vision-improving devices has become an attractive alternative to extraocular visual aids, and better life quality improvement has been reached among AMD patients. To evaluate each device's safety and efficacy based on current research, we searched the Cochrane Library, PubMed using pre-reported search terms and keywords combined with both Mesh term and text words. We explored randomized clinical controlled trials, cohort studies, and case serial reports and summarizes three aspects: visual outcomes, safety outcome, and quality of life outcomes. There are four types of devices recommended for AMD patients illustrating in this article: an implantable miniature telescope (IMT), IOL-VIP System, EyeMax Mono, and Scharioth macula lens (SML). There is no doubt that these technological advancements would bring new hope for AMD patients. However, the lack of randomized controls, limited follow-up duration, and various visual acuity (VA) measurements in different studies would be difficult than IOL devices.
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http://dx.doi.org/10.21037/atm-20-5851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729333PMC
November 2020

Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update.

Ann Transl Med 2020 Nov;8(22):1548

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Improved surgical techniques have led to an increase in the number of outpatient ophthalmic procedures. In spite of decreased surgical times and overall improved outcomes, endophthalmitis remains one of the most severe complications of ophthalmic surgery. Although there are well known risk factors for postoperative endophthalmitis, some prophylaxis strategies remain controversial. A category of noninfectious postoperative inflammation, known as toxic anterior segment syndrome (TASS), is a rare but important complication of cataract surgery. While several worldwide outbreaks of TASS have occurred, it is challenging to identify an etiology in order to reduce the risk of further cases. Endophthalmitis and TASS cannot be prevented completely, but their rates may be decreased through risk reduction strategies supported by peer-reviewed evidence. This review highlights the current evidence in the prevention strategies for postoperative endophthalmitis and TASS.
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http://dx.doi.org/10.21037/atm-2019-rcs-02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729369PMC
November 2020

A narrative review of intraocular lens opacifications: update 2020.

Ann Transl Med 2020 Nov;8(22):1547

Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

The opacifications of intraocular lenses (IOLs) can significantly impact patients visual quality. Despite the identification of specific risk factors, manufacturing changes, opacifications are not eliminated. Likewise, more attention in recent studies was paid to possible new risk factors, however one of the most important purposes of the studies remains opacifications effect on visual performance, which could be disturbed in different aspects. The aim of this review is to discuss the main risk factors of IOLs opacification in particular IOL types, and its impact on vision quality. Different risk factors were discussed in the study, including the material of IOLs, the impact of the breakdown of blood-aqueous barrier (BAB), and certain surgeries that can be associated with opacification formation. Glistenings occur more often in a hydrophobic material, however, the changes in water content of the IOLs can significantly reduce the formation of glistenings. The studies showed a significant effect of intraocular injection of exogenous air or gas during Descemet-stripping endothelial keratoplasty, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, and pars plana vitrectomy on calcification formation. It raises a concern, as the incidence of these surgeries is increasing. Visual acuity decreases significantly after the calcification in IOLs occurs, and it usually causes IOLs exchange. However, disability glare seems to be more affected in patients with IOLs, which were affected by glistenings than visual acuity. Disability glare is associated with increased levels of straylight, which was widely evaluated in recent studies and it was reported to be a susceptible measurement to detect the presence of IOLs pathology. For future researches, it should be noticed that disability glare and straylight are more appropriate in evaluating IOLs opacification effect on visual quality than visual acuity. While reviewing the main risk factors of IOLs opacifications particular attention must be paid on calcification occurrence in hydrophilic acrylic IOLs after surgeries with intraocular injection of exogenous air or gas.
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http://dx.doi.org/10.21037/atm-20-4207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729367PMC
November 2020

A narrative review of intraoperative floppy iris syndrome: an update 2020.

Ann Transl Med 2020 Nov;8(22):1546

Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China.

Intraoperative floppy iris syndrome (IFIS) is characterized by intraoperative floppiness or billowing of the iris, progressive miosis, and iris prolapse through the surgical wounds. It was originally reported about fifteen years ago, which was later identified to be closely associated with tamsulosin, the most commonly used α1 adrenoceptor antagonist for benign prostatic hyperplasia (BPH). A variety of risk factors, including age, gender, hypertension, axial length of the eye, 5α-reductase inhibitors, other α adrenoceptor antagonist and neuromodulators, have been connected with IFIS. If IFIS occurs during phacoemulsification surgery, complications such as corneal endothelial loss, iris trauma, posterior capsule rupture (PCR), high intraocular pressure and vitreous loss are significantly increased. Therefore, preoperative evaluation of high-risk patients and appropriate intraoperative intervention is crucial to avoid severe complications. This review summarizes the pathogenesis and clinical features of classic IFIS, and provides some clinical pearls to ophthalmologists that may help identify, prevent or reduce IFIS associated complications. Additionally, from the perspective of clinical occurrence of IFIS, there are some recommendations for urologists as well. In conclusion, both ophthalmologists and urologists should be aware of this special clinical situation and communicate with each other about their own fields. A multidisciplinary interaction is of importance to simplify potentially complicated clinical issues.
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http://dx.doi.org/10.21037/atm-20-3214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729334PMC
November 2020

Effect of cataract surgery on quality of life for patients with severe vision impairment due to age-related macular degeneration.

Ann Transl Med 2020 Nov;8(22):1543

Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.

Background: To determine whether patients with severe vision impairment due to advanced age-related macular degeneration (AMD) benefit from bilateral cataract surgery in terms of vision-related quality of life (QoL).

Methods: A prospective interventional single-center study. Ten patients with severe vision impairment due to advanced bilateral AMD were included. The preoperative corrected distance visual acuity (CDVA) was ≥1.0/≥1.0 LogMAR units on Snellen chart and <20/<20 points on Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Patients were not on active treatment for wet AMD as the treatment was expected to have no effect or benefit. The patients were scheduled for immediate sequential bilateral cataract surgery, with target refraction emmetropia (SN60WF, Alcon). Vision-related QoL was measured with National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) preoperatively, at 3 months and 1 year.

Results: The mean age of the patients was 82.5±6.2 years. The mean NEI VFQ-25 overall composite score changed from 44.0±7.1 preoperatively to 54.9±13.7 at 3 months and to 56.9±15.6 at 1 year (P=0.045, Friedman test). During the 1-year follow-up, there was an improvement in the subscale scores indicating difficulty with peripheral vision, mental health symptoms, and role difficulties due to vision (P<0.05 for all, Wilcoxon sign-rank test).

Conclusions: Cataract surgery may improve the vision-related QoL in patients with severe vision impairment due to bilateral advanced AMD.
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http://dx.doi.org/10.21037/atm-2020-965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729353PMC
November 2020

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience.

Ann Transl Med 2020 Nov;8(22):1541

Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.

Background: To evaluate the learning-curve in performing cataract surgery with respect to developments in technology and different teaching strategies by comparing the incidence of capsular bag-related complications to operator experience.

Methods: A review of the registry of 14,520 cataract surgeries carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, from August 8, 2009 to July 31, 2017.

Results: We identified 144 cases with posterior capsule rupture and/or loss of capsular bag support (incidence 0.99% of all surgeries). The mean age of patients was 76.9±9.1 years and gender distribution ratio 29:71 male:female. Pseudoexfoliation syndrome (PXF; incidence 21%) and small pupil (incidence 14%) were over-represented in complication eyes, especially at the beginning of the study. Capsular bag-related complication rates were reported in 0.36% of surgeries for senior and 7.03% for resident surgeons at the beginning of the study, compared to 0.32% and 1.32%, respectively, at the end of the study. Best-corrected visual acuity at the final post-operative visit was 0.61±0.16 decimals at the beginning of the study, and 0.81±0.19 decimals at the end of the study. The mean number of post-operative visits was 4.3±2.7 and did not show trend over the study period.

Conclusions: Real-world evidence suggests PXF and small pupil as significant risk factors in cataract surgery. A gradual decline in the rate complications was noted with increasing surgical experience, also among residents over the follow-up period.
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http://dx.doi.org/10.21037/atm-20-845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729371PMC
November 2020

Recent developments in cataract surgery.

Ann Transl Med 2020 Nov;8(22):1540

Professor of Ophthalmology, Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznan, Poland.

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http://dx.doi.org/10.21037/atm-2020-rcs-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729366PMC
November 2020

Peter the Great and sexually transmitted diseases.

Clin Dermatol 2020 Sep - Oct;38(5):598-603. Epub 2019 Sep 12.

Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland. Electronic address:

Shortly after syphilis appeared in Europe at the time of Columbus' voyage to the New World, the big pox, as it was often known, became a serious issue in Russia for diagnosis, treatment, and prevention. Members of the Russian royal family were made aware of the disease from adolescence onward. Czar Peter the Great had many sexual contacts and could have contracted any number of sexually transmitted diseases (STDs) that were quite common in his era. Nevertheless, contributions analyzed from available sources by his contemporary doctors, and later from medical analyses, reveal no evidence that he had contracted syphilis or any other STD. Most likely, he died from acute renal failure due to urinary tract obstruction.
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http://dx.doi.org/10.1016/j.clindermatol.2019.09.002DOI Listing
January 2021

Alfred Biesiadecki (1839-1889) and his place in the history of dermatology.

Clin Dermatol 2020 Sep - Oct;38(5):591-597. Epub 2020 Apr 8.

Institute for Research in Ophthalmology, Poznan, Poland. Electronic address:

Modern dermatology, as a separate branch of medicine, came into being in the 19th century. Alfred Biesiadecki was an outstanding anatomic pathologist and the pioneer in the histopathologic examination of the skin. Biesiadecki was the first to describe the exact distribution of lymphatic vessels in the skin. He dealt with the histopathologic mechanisms of dermatitis and skin grafts, and his work was the forerunner of studies of neoplasms in the skin vasculature. His scientific achievements secured him a prominent place in the history of dermatology in Europe and around the globe. The present work outlines a biography of Alfred Biesiadecki and his most important studies of both dermatology and other branches of medicine.
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http://dx.doi.org/10.1016/j.clindermatol.2020.04.004DOI Listing
January 2021

Re: Niffenegger et al: Treatment of Secondary Full-Thickness Macular Holes with Topical Therapy.

Ophthalmol Retina 2020 12;4(12):e13

Ophthalmic Clinic "Jasne Blonia," Łódź, Poland.

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http://dx.doi.org/10.1016/j.oret.2020.07.024DOI Listing
December 2020

Functional Assessment of Outer and Middle Macular Layers in Multiple Sclerosis.

J Clin Med 2020 Nov 22;9(11). Epub 2020 Nov 22.

IRCCS-Fondazione Bietti, Via Livenza 1, 00198 Rome, Italy.

The involvement of macular preganglionic elements' function, during the neurodegenerative process of multiple sclerosis (MS), is controversial. In this case-control observational and retrospective study, we assessed multifocal electroretinogram (mfERG) responses from 41 healthy Controls, 41 relapsing-remitting MS patients without optic neuritis (ON) (MS-noON Group) and 47 MS patients with ON: 27 with full recovery of high-contrast best corrected visual acuity (BCVA) (MS-ON-G Group) and 20 with poor recovery (between 0.2 and 1 LogMAR) of BCVA, (MS-ON-P Group). In the latter Group, Sd-OCT macular volumes and thicknesses of whole and inner and outer retina were measured. MfERG N1 and P1 implicit times (ITs), and N1-P1 response amplitude densities (RADs), were measured from concentric rings (R) with increasing foveal eccentricity: 0-5° (R1), 5-10° (R2), 10-15° (R3), 15-20° (R4), 20-25° (R5), and from retinal sectors (superior, nasal, inferior and temporal) between 0-15° and 0-25°. In the MS-ON-P Group, mean mfERG RADs detected from R1 (0-5°) and from the central nasal sector (0-15°) were significantly reduced ( < 0.01) with respect to those of the Control, MS-noON and MS-ON-G Groups. No other significant differences between Groups for any mfERG parameters were found. All Sd-OCT measurements, apart from the inner retina macular volume in the central 1 mm, were significantly reduced in MS-ON-P patients compared to Controls. The functional impairment in the MS-ON-P Group was associated but not correlated with structural changes of the outer and inner retinal layers in corresponding retinal Areas and Sectors. Our results suggest that in MS, exclusively after ON with poor recovery of BCVA, the neurodegenerative process can induce dysfunctional mechanisms involving photoreceptors and bipolar cells of the fovea and of the more central nasal macular area.
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http://dx.doi.org/10.3390/jcm9113766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700336PMC
November 2020

Authors' Response.

Surv Ophthalmol 2021 Mar-Apr;66(2):409. Epub 2020 Nov 23.

Department of Ophthalmology Mayo Clinic Florida, Jacksonville Florida, USA. Electronic address:

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http://dx.doi.org/10.1016/j.survophthal.2020.11.003DOI Listing
November 2020

Choroidal thickness after phacoemulsification: nonrandomized comparison of postoperative topical ketorolac vs dexamethasone vs combination of ketorolac-dexamethasone eyedrops.

J Cataract Refract Surg 2021 Jan;47(1):46-52

From the Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran (Ghiasian, Aghdam, Azizi, Abdolalizadeh, Ghasemi Falavarjani); Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran (Janani); Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland (Grzybowski); Institute for Research in Ophthalmology, Poznan, Poland (Grzybowski).

Purpose: To compare the effect of topical dexamethasone vs ketorolac vs combined dexamethasone-ketorolac after phacoemulsification on choroidal thickness (CT).

Setting: Tertiary university-based hospital.

Design: Prospective nonrandomized comparative case series.

Methods: Ninety-two eyes of 92 patients were assigned to the 3 groups after uneventful phacoemulsification: Group 1, dexamethasone; Group 2, ketorolac; Group 3, combined dexamethasone-ketorolac applied topically. CT at subfoveal (SFCT), nasal, and temporal as primary and central retinal thickness (CRT) as secondary outcomes were measured preoperatively and at 1 month, 3 months, and 6 months postoperatively using enhanced depth-imaging optical coherence tomography.

Results: Preoperative CT was similar between the groups (all P > .05). The groups differed in pattern of changes in nasal and temporal CT (both P < .001) although their changes of CRT (P = .13) and SFCT (P = .55) over time were similar. The mean of SFCT at 1 month, 3 months, and 6 months was significantly higher than baseline in dexamethasone (P < .001 for all follow-ups) and combined (P < .001 for both 1 month and 3 months and P = .03 for 6 months) groups, whereas it was not statistically significant in the ketorolac group (P = .07). There was an increase in the nasal and temporal CT in 3 groups, persisted at 6 months in dexamethasone (both P < .001) and ketorolac (both P < .001) groups, whereas the change was not statistically significant at 6 months in the combined group. Choroidal thickness measurements were performed in 31 eyes of 31 patients in group 1, 29 eyes of 29 patients in group 2, and 32 eyes of 32 patients in group 3.

Conclusions: Dexamethasone and combined groups had statistically significant changes of SFCT after phacoemulsification; however, the ketorolac group did not. The pattern of SFCT changes was similar between 3 groups.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000477DOI Listing
January 2021

Interplay between reactive oxygen species and autophagy in the course of age-related macular degeneration.

EXCLI J 2020 25;19:1353-1371. Epub 2020 Sep 25.

Department of Ophthalmolgy, Medical Faculty, University of Warmia and Mazury, Olsztyn, Poland.

Pathological biomolecules such as lipofuscin, methylglyoxal-modified proteins (the major precursors of advanced glycationend products), misfolding protein deposits and dysfunctional mitochondria are source of oxidative stress and act as strong autophagic stimulators in age-related macular degeneration. Disturbed autophagy accelerates progression of the disease, since it leads to retinal cells' death and activates inflammation by the interplay with the NLRP3 inflammasome complex. Vascular dysfunction and hypoxia, as well as circulating autoantibodies against autophagy regulators (anti-S100A9, anti-ANXA5, and anti-HSPA8, A9 and B4) compromise an autophagy-mediated mechanism as well. Metformin, the autophagic stimulator, may act as a senostatic drug to inhibit the senescent phenotype in the age-related macular degeneration. PGC-1α , Sirt1 and AMPK represent new therapeutic targets for interventions in this disease.
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http://dx.doi.org/10.17179/excli2020-2915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658465PMC
September 2020