Stanislovaitienė, Daiva

Subhialoidinė kraujosruva - tai reta, tačiau regai pavojinga būklė, galinti pasireikšti nėštumo laikotarpiu dėl Valsalvos retinopatijos. Staigus intratorakalinio arba intraabdominalinio spaudimo padidėjimas gali sukelti tinklainės kapiliarų plyšimą ir kraujo susikaupimą geltonosios dėmės srityje. Aprašomas 27 metų moters subhialoidinės kraujosruvos atvejis, pasireiškęs 33 nėštumo savaitę po vėmimo epizodo. Laiku atlikus Nd:YAG lazerinę hialoidotomiją, rega reikšmingai pagerėjo. Gimdymo taktika parinkta individualiai, įvertinus pakartotinio kraujavimo riziką.

Introduction Subhyaloid hemorrhage (SH) is an accumulation of blood between the vitreous body and the retina, typically presenting with sudden deterioration of vision.[1] Most common cause is Valsalva retinopathy (VR), caused by acute intrathoracic or intra-abdominal pressure rise.[1,3] The risk increases during pregnancy due to changes in blood flow and venous pressure.[5,6] Case Presentation A 27-year-old woman at 33 weeks of gestation developed nausea during an eyelash extension procedure. After vomiting, she noted sudden central vision loss in the left eye, preserving only peripheral vision. Examination on 2025-08-27 showed: visual acuity (VA) of the right eye (OD) = 1.0; VA of the left eye (OS) = finger counting at 10 cm; intraocular pressure OD = 15.3 mmHg; OS = 16.3 mmHg. Anterior segments were unremarkable. Fundoscopy revealed a SH in the macular area of OS. Nd:YAG laser hyaloidotomy (7.0 mJ, N1) was performed. Follow-up one week later showed: vision slightly improved, though foggy and blurred. VA OS = 0.1. Vitreous hemorrhage present, subhyaloid blood partially resorbed. 2025-09-23 follow-up showed: significant subjective improvement; VA OS = 0.7; vitreous hemorrhage decreased; residual hemorrhagic borders remained. Recommendations: follow-up in 2 - 3 months. Cesarean delivery was recommended to avoid recurrence induced by strong Valsalva maneuvers during vaginal delivery. Discussion SH is an uncommon but vision-threatening condition, most frequently observed in younger patients and triggered by a sudden rise in intrathoracic or intraabdominal pressure. A vomiting episode, as in our case, is a well-documented predisposing factor for VR in the literature. [1,3] Nd:YAG laser hyaloidotomy is an effective treatment option, especially when performed within 3 - 4 weeks of symptom onset. [2] Recent data indicates that both delivery modes - vaginal and cesarean delivery are considered safe. However, the decision should be individualized, as literature recommendations apply when SH has had sufficient time to resolve, while in our case delivery planning was required while the hemorrhage was still only partially resorbed. [4] Conclusions This case highlights the importance of timely diagnosis and appropriate treatment of SH during pregnancy. The choice of delivery method must be individualized, based on the risk of bleeding and the ophthalmological condition.

Introduction Metallic corneal foreign bodies are common and may lead to serious complications, including corneal ulceration or, rarely, full-thickness perforation. [1] Spontaneous iris prolapse at the perforation site, though uncommon, is vision-threatening. [2] This case illustrates such progression and the value of timely diagnosis and conservative management. Case Presentation A 66-year-old man presented with a one-week history of progressive blurred vision in the right eye after rubbing it. On examination, visual acuity (VA) was 0.03 (0.1 corrected), intraocular pressure 8 mmHg. Ocular ultrasonography showed a superior choroidal detachment with vitreous opacities, while computed tomography was unremarkable. Slit-lamp exam revealed a paracentral corneal opacity with rust deposits from a prior metallic foreign body. Fluorescein pooling and a positive Seidel test indicated a small corneal perforation, with iris tamponade at the wound. The anterior chamber was shallow laterally, the pupil was irregular and drawn to 9 o’clock, but remained reactive. The fundus view was hazy due to vitreous opacities. A therapeutic contact lens was applied, and topical levofloxacin and cyclopentolate were started along with systemic antibiotics and antiinflammatory therapy. After 24 hours, VA improved to 0.1 (0.4 corrected), and ultrasonography showed a flat superior choroidal detachment. The anterior chamber reformed and he was discharged with VA 0.3 (0.7 pinhole), a clear cornea, and the perforation sealed by iris tamponade. The anterior chamber remained shallow but stable, and mild diffuse lens opacities persisted. Discussion Metallic corneal foreign bodies usually resolve after removal, but rare complications like fullthickness perforation can occur. [3] Spontaneous iris prolapse may act as a temporary autologous tamponade, as in our case, allowing conservative management with a therapeutic contact lens. Careful monitoring is essential to ensure healing and prevent secondary complications, such as infection or persistent leakage. [2] Conclusions This case shows that spontaneous iris prolapse does not always require surgical intervention. Conservative management with a healing lens can be effective, but vigilant follow-up is critical to preserve corneal integrity and visual function.

Introduction Severe arterial hypertension (AH) in young adults is uncommon yet associated with progressive organ damage. Hypertensive retinopathy indicates systemic microvascular injury and may reveal previously undiagnosed hypertension.[1,2] This case highlights rapid organ damage in a young woman and emphasizes early diagnosis and blood pressure (BP) control. Case Presentation A 27-year-old woman reported episodic blurred vision in the right eye, with visual acuity remaining 1.0 in both eyes. The patient had a two-year history of migraine with visual impairment during severe headache episodes. Ophthalmologic examination revealed bilateral optic disc edema, arteriolar narrowing, venous stasis, macular hard exudates with a partial macular star in the left eye, and serous retinal detachments in both eyes. Optical coherence tomography showed bilateral subretinal fluid and retinal pigment epithelium detachment. Fluorescein angiography demonstrated diffuse vascular leakage and optic disc hyperfluorescence. In the hospital, incidentally measured arterial BP was markedly elevated, reaching 223/150 mmHg. The patient was diagnosed with acute kidney injury, indicated by elevated creatinine and pathological albuminuria. Renal ultrasonography revealed parenchymal thickening and an elevated resistive index. Twenty-four-hour BP monitoring showed uncontrolled BP. Treatment included four antihypertensive drugs and a loop diuretic. AH etiology is unclear. Secondary causes are under investigation, including endocrine, renal, neurologic, and cardiologic evaluation. Discussion This case demonstrates that uncontrolled secondary AH can lead to multi-organ damage in young patients.[1] Retinal vessels are highly sensitive to BP changes, resulting in grade IV hypertensive retinopathy according to the Keith–Wagener–Barker classification, characterized by optic disc edema.[2] Such fundoscopic findings reflect systemic microvascular injury and hypertension-induced organ damage, including acute renal impairment.[2,3] Severe fundoscopic changes may regress with effective BP control.[2] Conclusions Severe hypertension in young adults may remain clinically silent until advanced organ damage occurs, with hypertensive retinopathy as the first or only clinical sign. Therefore, hypertensive disorders should be suspected even in young patients.

Ageing changes are heterogenous, with substantial variation in health impacts of ageing across populations, individuals and tissues [Grimbly MJ, et al. BMJ Open Ophth 2024;9:e001794. doi:10.1136/bmjophth-2024-001794]. Biological ageing markers have emerged to better represent the ageing process and predict the risk of diseases. Retinal age is an imaging-based biomarker for biological age assessment from retinal fundus photographs. Accelerated ageing, or Retinal age gap (RAG) – the difference between calculated retinal age and chronological age, provides a valuable metric for quantifying the risk of vascular, neurodegenerative, metabolic diseases and even assessing the risk of mortality. However, an undisclosed controversy remains whether generated retinal age models are accurate predictors of biological age. Moreover, further clinical trials exploring their applicability across diverse healthy populations are warrant. We aimed to determine the accuracy of retinal age prediction models and evaluate their ability to reflect age-related parameters from retinal images exploring their estimation to chronological age of healthy Lithuanian population subjects. Color fundus images from 92 patients were analyzed for age prediction, allocating 80% of patients (n = 74) for training and 20% (n = 18) for validation. Images were split into training and validation sets at the patient level to avoid data leakage. Each patient contributed 8 images, except for one patient who had 6 images, resulting in a total of 734 fundus images included in the analysis. Preliminary experiments using grayscale OCTA images resulted in insufficient prediction performance, therefore the analysis focused exclusively on color fundus data. A convolutional neural network based on EfficientNet-B2 was adapted for regression by replacing the classification head with a single linear output unit predicting normalized age values. EfficientNet-B2 was selected based on findings from our previous study, in which several convolutional and transformer-based architectures were compared for classifying fundus images of healthy versus pathological images. The evaluated models in-

Objectives (oral/poster only) Ocular trauma is the leading cause of monocular blindness worldwide. The aim of this study is to identify clinical outcomes of close globe ocular injuries (CGI). Materials and methods (oral/poster only) The medical records of all adult patients treated for CGI at a hospital of LUHS KC, Ophthalmology Department, during the year 2021, were retrospectively reviewed. Data analysis included sex, age, trauma cause, type, initial and final results of an ophthalmological examination. Visual acuity (VA) was assessed according to the Snellen decimal system. Eye injuries were classified by Birmingham Eye Trauma Terminology and Ocular Trauma Classification System. Data was analysed using SPSS version 27. The mean, standard deviation, Fisher’s exact test and the Spearman correlation coefficient (R) were used. A P-value <0.05 was considered statistically significant. Results (oral/poster only) Out of 37 cases, 34 (91,9%) were male and 3 (8,1%) were female in a ratio of 11,3:1. The mean age was 47 years (±2). The majority of CGI were caused by blunt objects (21 cases, 56,8%). The most common blunt object was a blunt work tool (4 cases, 20%) and a car traffic accident (3 cases, 15%). Ocular contusion (24 cases, 66,7%), partial thickness corneal wound (13 cases, 36,1%), hyphema (19 cases, 52,8%) and corneal erosions (6 cases, 16,7%) were the most common presentations of CGI. The most common initial (11 cases, 29,7%) and final (18 cases, 48,6%) VA was grade 1 (VA ≥0,5). The grade 4 initial VA (1/∞-0,02) was significantly more common in CGI caused by a sharp object compared to a blunt object (p=0,005). Good (18 cases, 48,6%) visual outcome was the most common outcome of CGI. There was a statistically significant correlation between the grade of initial and final VA (R=0,753, p<0,001). Conclusions CGI had good visual outcome as they were more likely to have grade 1 final VA.

Introduction Among eye injuries, open globe injury (OGI) is the most common, accounting for 44% of all eye trauma. It is defined as a full-thickness defect in the cornea and/or sclera (1). Severe OGI causes significant visual impairment and lifelong consequences with serious socioeconomic impact (2).Consequently, prevention and prompt management are essential to prevent vision loss (3). Aim To identify clinical outcomes of OGIs. Methods The medical records of all adult patients treated for OGI, at the Ophthalmology Department of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, during the year 2021were retrospectively reviewed. Included features in the data analysis with SPSS 27 were sex, age, trauma cause, type and location of the injury, initial and final results of an ophthalmologic examination. Visual acuity (VA) was assessed according to the Snellen decimal system and eye injuries were classified by the Birmingham Eye Trauma Terminology and Ocular Trauma Classification System. Mean, standard deviation (SD), the chi-square (χ2) criteria, z-test and the Spearman correlation coefficient (r) were calculated. A P-value <0.05 was considered statistically significant. Results Of the 69 cases included in the study, 57 (82.6%) were male and 12 (17.4%) were female, yielding a male to female ratio of 4.75:1. The mean age was 48 (±2) years. In the age group of 66 years and older, females suffered from OGI significantly more often than males (p=0,001). The highest percentage of OGI were caused by sharp objects (60 cases, 87%), followed by blunt objects (9 cases, 13%). The most common sharp objects were a metal shaving (25 cases, 41.7%) and as harp wooden stick (9 cases, 15%). The most frequently reported blunt objects were an impact from a trip-and-fall accident (4 cases, 44,4%) and a punch or a kick (3 cases, 33,3%). Full thickness corneal wound (36 cases, 52,2%), corneal injury with intraocular foreign body (22 cases, 31,9%), hyphema (20 cases, 29%), traumatic cataract (19 cases, 27,5%) and iris prolapse (16 cases, 23,2%) were the most common presentations of an OGI. The majority of wounds were in zone I (43 cases, 68,3%). The most common initial VA was grade 4 (VA 1/∞ - 0,02) (27 cases, 39,1%)and final VA - grade 4 (VA 1/∞ - 0,02; 16 cases, 25,4%) and grade 3 (VA 0,03-0,1; 15 cases,23,8%). There was a statistically significant correlation between the grade of initial and final VA (r=0,776, p<0,001). Satisfactory (25 cases, 39,7%) and bad (23 cases, 36,5%) visual outcomes were the most common outcomes of OGI. Conclusions Presenting clinical characteristics of OGIs were mostly full-thickness corneal wound, corneal injury with intraocular foreign body, hyphema, traumatic cataract and iris prolapse. The initial VA was mostly grade 4. There was a strong direct correlation between the grade of initial and final VA. Since OGIs were more likely to have either grade 3 or 4 final VA, resulting visual outcomes were satisfactory or bad.

Introduction Ocular injury is an important cause of visual impairment worldwide. Severe trauma may result in permanent blindness and even the loss of an eyeball (1). The global annual incidence of eye injuries is estimated to be around 55 million (2). It continues to be of major public health importance and indicate the need to be further investigated (3). Aim To compare visual outcomes of open and close globe ocular trauma. Methods The medical records of all adult patients treated for ocular trauma at the Ophthalmology Department of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, during the year 2021 were retrospectively reviewed. The information retrieved included sex, age, trauma cause, type and location of the injury, initial and final results of an ophthalmological examination. Visual acuity (VA) was assessed according to the Snellen decimal system. Eye injuries were classified by Birmingham Eye Trauma Terminology and Ocular Trauma Classification System. Mean, standard deviations (SD), the chi-square (χ2) criteria, z-test and the Spearman correlation coefficient (r) were used. We set the level of statistical significance at p <0.05. All statistical analyses were performed using IBM SPSS Statistics 27. Results Out of 106 cases, 91 were males (85.8%) and 15 were females (14.2%) with a ratio of 6:1. Their age ranged from 18 to 93 years (mean ± SD = 47.4 ± 1,6 years). This study found 69 cases (65.1%) of open globe injuries (OGIs) and 37 cases (34.9%) of close globe injuries (CGIs). The most frequent mechanism of injury (MOI) was a sharp object (76 cases, 71.7%), followed by a blunt object (30 cases, 28.3%). A sharp object was significantly more common MOI in OGIs compared to CGIs (p<0.01). Similarly, blunt object was significantly more frequent in CGIs compared to OGIs (p<0.01). It appeared that significantly more common presentation of OGIs compared to CGIs was traumatic cataract (p=0.009), while ocular contusion (p<0.001), ocular hypertension (p=0.001), hyphema (p=0.010) and lens dislocation (p=0.023) were significantly more frequent in CGIs than in OGIs. There was a statistically significant correlation between the grade of the initial and the final VA in all cases together (r=0.779, p<0.001) and by OGIs (R=0.776,p<0.001) and CGIs (R=0.753, p<0.001) separately. Good visual outcome was significantly more often in CGIs than in OGIs (p=0.008). Meanwhile, bad visual outcome was found to be significantly more often in OGIs compared to CGIs (p=0.037). Conclusions Significantly more common presenting clinical characteristic of OGIs was traumatic cataract, while ocular contusion, ocular hypertension, hyphema and lens dislocation were significantly more frequent in CGIs. This study observed a strong direct correlation between the grade of the initial and the final VA. A good visual outcome was significantly more often in CGIs and a bad visual outcome - in OGIs.

Tyrimo tikslas. Nustatyti uždarojo ir atvirojo tipo akių traumų klinikines baigtis. Metodai. Atliktas retrospektyvusis tyrimas, išanalizuotos 106 atvirojo ir uždarojo tipo akių traumas patyrusių pacientų gydymo stacionare asmens sveikatos istorijos. Rezultatai ir išvados. Uždarojo tipo akių traumų galutinis regos aštrumas buvo geresnis nei patyrusiųjų atvirojo tipo akių traumas. Akies obuolio sumušimą, kai nėra reliatyviojo aferentinio vyzdžio defekto ir gerą pradinį regos aštrumą galime vertinti kaip palankius akių traumų prognozės veiksnius, nes šiais atvejais nustatytas geras galutinis regos aštrumas.

Tyrimo tikslas. Apžvelgti mokslinę literatūrą apie Stargardto ligos patogenezę, simptomatiką, diagnostikos ir gydymo galimybes. Tyrimo metodai. Literatūros apžvalga atlikta remiantis mokslinėmis publikacijomis, atrinktomis naudojantis Google Scholar, PubMed paieškos sistemomis. Naudoti raktažodžiai paieškai: Stargardt disease, macular dystrophy, inherited macular degeneration. Rezultatai. Stargardto ligą dažniausiai lemia mutacijos ABCA4, ELOVL4 ir PROM1 genuose. Sutrinka metabolinis regos ciklas ir kaupiasi lipofuscino pigmentai fotoreceptoriuose bei tinklainės pigmentiniame epitelyje. Dėl aktyvuotos komplemento sistemos ir vykstančio oksidacinio streso žūva tiek fotoreceptoriai, tiek tinklainės pigmentinio epitelio ląstelės, kas lemia regos silpnėjimą. Simptomai dažniausiai atsiranda tarpinės ir vėlyvosios paauglystės laikotarpiu. Diagnostika yra kompleksinė, susidedanti iš rutininio oftalmologinio ir genetinio ištyrimo. Optinės koherentinės tomografijos tyrime stebimas išorinių tinklainės sluoksnių plonėjimas, tinklainės pigmentinio epitelio atrofija. Nors veiksmingo patogenetinio gydymo nėra, bet modifikuoti vitamino A preparatai, veikiantys medžiagų metabolizmo ciklą, jau yra prieinami. Genų terapija šiuo melu yra preklinikinėse mokslinių tyrimų stadijose, o kamieninių ląstelių terapija peržengė klinikinių tyrimų stadiją, kas teikia vilčių, jog bus atrastas veiksmingas ligos gydymas. Išvados. Stargardto ligą gali sukelti įvykusios mutacijos skirtinguose genuose, priklausomai nuo dominantinio arba recesyvinio paveldimumo. Pagrindiniai simptomai: progresuojantis abipusis centrinio matymo praradimas - sumažėjęs regos aštrumas, niktalopija, fotofobija, dischromatopsija. Liga diagnozuojama tiriant pacientą oftalmologiniu bei genetiniu būdais. Veiksmingo patogenetinio gydymo nėra.