Varoniukaitė, Aistė

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 Secondary macular neovascularisation (MNV) following choroidal rupture due to blunt trauma is rare but vision-threatening complication and may result in significant central vision loss up to 5–25% of affected eyes [1]. In this report we describe a case of secondary MNV after blunt trauma in a 16-year-old male, highlighting the clinical course, imaging findings and treatment. Case Presentation A 16-year-old male presented with worsened vision in the right eye (OD) one month after sustaining blunt ocular trauma. Visual acuity (VA) in the OD was 0.08 at presentation. Fundus examination revealed macular hemorrhage and oedema. Subsequent optical coherence tomography (OCT) and OCT angiography confirmed the presence of choroidal rupture and secondary MNV. Intravitreal anti-vascular endothelial growth factor (VEGF) injections with bevacizumab were initiated. Following 3 injections there was a reduction in MNV activity, with complete resolution of the hemorrhage and edema. Mild local retinal pigment epithelium atrophy was noted. VA improved to 0.9, and continued follow-up was recommended. Discussion Choroidal rupture typically results from traumatic injury and represents the most frequent macular finding observed in eyes sustaining blunt ocular trauma [2]. MNV develops due to increased production of VEGF by the retinal pigment epithelium and/or Müller cells in response to localized ischaemia and inflammation [3]. The primary treatment for MNV is intravitreal anti-VEGF [1]. VA at presentation and outcome depend on the rupture location, baseline VA, and the presence of retinal hemorrhage, macular edema or macular holes, with some improvement possible as subretinal hemorrhage and edema resolve [2]. Conclusions Secondary MNV after traumatic choroidal rupture due to blunt trauma particularly in paediatric population is rare but vision-threatening complication. This case highlights the importance of early detection, multimodal imaging, individualised approach and timely intravitreal anti-VEGF therapy that can substantially improve anatomical and functional outcomes.

Introduction Metastatic brain lesions can cause a variety of symptoms. Visual changes might be the first and only complaint [1], therefore, a consistent evaluation and urgent systemic referral is essential in establishing the diagnosis. This case illustrates how ophthalmological examination may be the first sign of an underlying disease. Case Presentation A 62-year-old male with diabetes mellitus and arterial hypertension presented with worsening of vision, flickering, uneven visual perception and diplopia for 3 weeks. Visual acuity was 0.4 in the right eye and 0.7 in the left eye with normal intraocular pressure bilaterally. Fundus examination revealed bilateral optic nerve disc hyperemia and oedema, streak-like hemorrhages, cotton-wool spots, venous congestion and arterial sclerosis. Visual field testing demonstrated left-sided homonymous hemianopia, optical coherence tomography showed peripapillary retinal nerve fiber layer thickening. Emergent computed tomography revealed multiple metastatic brain lesions. With subsequent full systemic examination, the diagnosis of lung adenocarcinoma was made. Discussion Brain metastases are common (25%) complications in systemic malignancies with lungs as one of the most common sites of origin and may present with a variety of visual symptoms depending on anatomical location of metastases [1,2]. Ocular manifestations such as papilledema may be the initial sign of intracranial pathology and need a prompt assessment [1]. This case underlines the importance of recognizing papilledema as potential life-threatening sign of intracranial metastatic disease and the need for multidisciplinary evaluation of the patient. Conclusions Visual disturbances, papilledema and visual field defects can represent as a sign of brain metastases. This case highlights the importance of careful ophthalmological evaluation in patients with atypical visual symptoms, as ocular findings may provide the first clue to an underlying malignant disease.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background and Objectives: Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and a leading cause of blindness among working-age adults. Advanced glycation end products (AGEs) contribute to DR pathogenesis through oxidative stress and inflammation. This study aimed to evaluate the association between AGE levels and DR severity in Lithuanian patients with type 1 (T1D) and type 2 (T2D) diabetes. Materials and Methods: An observational cross-sectional study enrolled 152 patients with T1D and T2D from a tertiary university hospital. AGE values were measured with a non-invasive AGE Reader device. DR severity was assessed through ophthalmological examination. Results: The overall DR prevalence was 54.6%. AGE values increased with the severity of DR, though not significantly between the DR groups (p = 0.386). The mean AGE value was higher in T2D compared with the T1D group (2.429 vs. 2.217, p = 0.011). In T1D, AGE values were higher in the advanced DR group compared with the non-DR patients (2.445 vs. 1.905, p = 0.007), whereas no significant difference was found in the T2D subgroups. In T1D, AGEs correlated positively with both DM duration and higher HbA1c (p < 0.05). Patients with AGE values > 2.35 in T1D and 2.15 in T2D had an increased likelihood of having advanced DR. Patients in the non-DR group had significantly lower AGE values compared to those in the advanced DR group (OR = 0.118, 95% CI 0.025–0.566, p = 0.008). Conclusions: AGEs measured using skin autofluorescence may indicate DR severity in T1D but not in T2D and might not be a suitable standalone risk predictor. DM duration remains a significant determinant of advanced DR, highlighting the importance of early monitoring and timely intervention.

Prolonged hyperglycemia results in the formation and accumulation of complex and heterogeneous groups of compounds - advanced glycation end-products (AGEs) that increase oxidative stress and induce inflammatory reaction, which exacerbate the occurrence and progression of diabetic complications. The project “Integrated model for personalized diabetic retinopathy screening and monitoring using risk-stratification and automated AI-based fundus image analysis – PerDiRe” involved data on type 1 diabetes (T1D) and type 2 diabetes (T2D) patients from four countries - Latvia, Lithuania, Estonia, and Norway, on two consecutive annual visits. The project was funded by EEA-RESEARCH-60 grant. The objective of this substudy was to assess the relationship between AGE levels and diabetic retinopathy (DR) course in patients with diabetes across all four countries. Methods 410 patients with diabetes attended the initial visit, and 226 patients returned for the 1st year follow-up. At both visits, the patients with diabetes underwent full ophthalmological and diabetes-specific clinical examinations. The patients were stratified according to the DR status as follows: no retinopathy, non-proliferative (simple) retinopathy, proliferative retinopathy, and diabetic macular edema. AGEs were measured non-invasively using an AGE Reader device (DiagnOptics Technologies B. V., SN 00010604, Netherlands). AGE z-scores were calculated with the formula: AGE z-scoreZAGE mean-(0. 024*age, yearsC0. 83). Results During the initial visit, 47. 3% (n Z 194) of the patients had some form of DR. By the second visit, 52. 2% (n Z 118) presented with DR (PZ0. 23). 9. 3% of the study subjects experienced progression to a more severe stage of DR (P!0. 05). A significant change in DR severity from first to second visit was found only within the T2D group (P ! 0. 05). During both visits, T2D patients had significantly higher median AGE values and z-scores, compared to T1D (P ! 0. 001). Patients with T1D exhibited a statistically significant increase in median AGE values and z- scores at the second visit compared to the first one (P ! 0. 05 for both measures). Conversely, patients with T2D showed no significant change in either AGE values or AGEs z-scores between the two visits. In both groups combined, marginal means of AGE values and z-scores increased significantly with progression of DR stages during both visits (general linear models’ P ! 0. 001). Conclusions The results indicate a notable change in the distribution of DR stages between the first and second visits, especially in T2D. AGE levels were significantly higher in T2D patients and were directly related to more advanced stages of DR.

Amžinė geltonosios dėmės degeneracija dažniausiai pasireiškia vyresniems nei 50 metų asmenims ir yra viena pagrindinių silpnaregystės bei aklumo priežasčių. Slaugytojų vaidmuo akių ligų priežiūroje yra labai svarbus - nuo prevencijos ir pagalbos diagnozavus ligą iki pacientų sveikatos būklės gerinimo ir gyvenimo kokybės užtikrinimo. Išplėstinės praktikos slaugytojai taip pat svariai prisideda prie pacientų priežiūros ir gydymo koordinavimo.

Aims/Purpose: Advanced glycation end products (AGEs) are proteins or lipids that become glycated as a result to exposure to sugars and diabetes (DM) can accelerate its usually slow accumulation. Higher levels of AGEs are associated with microvascular complications as diabetic retinopathy (DR). AGEs can be measured in human skin using ultra‐violet light to excite autofluorescence. The purpose of this study was to determine the association between AGEs levels and DR severity. Methods: A total of 152 patients were enrolled. DR severity was determined by an ophthalmologist. AGEs concentrations were measured with non‐invasive AGE Reader device. Results: 69 men and 83 women with type 1 (50.7%) and type 2 (49.3%) diabetes were included in the analysis. Age median was 51.85 (min.18, max. 85) years with duration of diabetes 15.99 ± 11.18 years. Mean HbA1C was 8.34 ± 1.99%. 43.7% had no signs of DR, 40.4% had non‐proliferative DR (NPDR), 15.9% – proliferative DR (PDR). Age and HbA1C did not differ between different severity DR groups (p = 0.081 and p = 0.196). AGEs concentration increases with age (r = 0.498, p < 0.001) and duration of diabetes (r = 0.308, p < 0.001). Mean concentration of AGEs were higher in type 2 DM group (p = 0.015). The concentration of AGEs did not differ between DR groups (p = 0.473), thought in type 1 DM subgroup mean concentration of AGEs was higher in PDR patients compared to no DR patients (1.89 vs. 2.43, p = 0.006), whereas no significant difference was found between type 2 DM patients in different DR groups (p = 0.343). There was no significant correlation between HbA1C and AGEs concentration (p = 0246) in all DM patients, but in type 1 DM, AGEs concentration significantly increases with higher HbA1C values (r = 0.309, p = 0.007), but not significantly in type 2 DM (p = 0.282). Conclusions: The levels of AGEs might have association with the severity of DR in type 1 diabetes, but not type 2. More investigations regarding the association of AGEs and DR severity should be performed.

PURPOSE

To assess the first real-world outcomes of faricimab in previously treated eyes of treatment-resistant neovascular age-related macular degeneration (nAMD) patients in a tertiary university hospital in Lithuania.

SETTING / VENUE

Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics.

METHODS

A retrospective review of all patients treated with faricimab for nAMD from September 2023 to February 2024 was performed. All of the patients were previously treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (IVTI) and treatment-resistant. The data collected: background demographics, treatment history regarding the type of anti-VEGF agent, number of IVTI, treatment intervals, best corrected visual acuity (BCVA) in decimal, central subfield thickness (CST) in microns (µ), sub/intra retinal fluid (SRF/IRF) and adverse events.

RESULTS

25 eyes (20 patients) were included with mean of 2.52±1.19 faricimab IVTI. Mean age was 77.08±10.67 years (min. 55, max.91), 17 were women (58.6%) and 8 men (27.6%). Patients received in total a mean of 30.6±17.44 anti-VEGF IVTI every 8.68±1.22 weeks (min. 6.18, max.11.57) prior to switching to faricimab. In 2022 the mean number of IVTI was 5.50±1.64, in 2021 – 5.36±1.33. Most were treated with either aflibercept and bevacizumab combination (34.5%) or ranibizumab and bevacizumab combination (37.9%). The mean BCVA did not significantly improve from 0.35±0.34 before switching to faricimab to 0.37±0.29 4 weeks after the first faricimab IVTI (p>0.05). After one IVTI of faricimab all eyed demonstrated reduction in CST with the mean CST significantly decreasing from 317.54±89.24 µ to 265.76±48.39 µ in 4 weeks (p=0.001). Prior to switching to faricimab 8 eyes (33.33%) had IRF, 9 eyes (37.50%) SRF, 5 eyes (20.84%) both IRF and SRF and 2 eyes were dry (8.33%) (n=24). After the first faricimab IVTI after 4 weeks a complete dryness was observed in 8 eyes (40%), IRF in 5 eyes (25%), SRF in 6 eyes (30%), both IRF and SRF in 1 eye (5%) (n=20) respectively. No intraocular inflammation cases were registered.

CONCLUSIONS

Real-world first experience of faricimab IVTI in Lithuania demonstrated significant reduction in CST even in treatment-resistant nAMD patients. More patients were completely dry after 4 weeks of the switching to faricimab which may in future reduce the number of visits, prolong treatment intervals, and maintain dry macula. Larger number of patients and longer follow-up period are needed for further evaluation, but the need of possibility to switch the patients for better anatomical and possibly visual outcomes is vital in the future disease management of nAMD in Lithuania.