Corneal collagen cross-linking (CXL) is a therapeutic intervention that utilizes riboflavin photochemical activation with ultraviolet-A (UV-A) light to induce covalent cross-links within the stromal corneal fibers, effectively increasing corneal biomechanical stability and halting the progressive ectasia. The method was introduced in the late 1990s in Germany at the University of Dresden. The cross-linking method using the Avedro system (Waltham, MA, USA) was approved by the US Food and Drug Administration (FDA) on 18 April 2016, based on three prospective, multicenter, randomized clinical trials for keratoconus and other corneal ectasias. Recent innovations in CXL include a range of new treatment protocols and methods, which have been introduced to further enhance the clinical effectiveness, efficiency, and safety of CXL. These modifications encompass approaches like transepithelial or epithelium-on CXL (TE-CXL or epi-on CXL), accelerated CXL (ACXL), pulsed CXL (PL-CXL), transepithelial iontophoresis-assisted crosslinking (I-CXL), diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL), slit-lamp CXL, and CXL plus (combined) methods. This review synthesizes findings on currently used modifications of the cross-linking method, the effectiveness, and directions of development of this currently dominant surgical method of treating corneal ectasia. This review concentrates on the long-term follow-up data, based on publications ranging from 1998 up to 2023.

Ocular toxoplasmosis (OT), a global health concern due to the protozoan T. gondii, disproportionately affects immunocompromised individuals, causing severe eye infections and potential vision loss. This review aims to evaluate current treatment options, highlighting challenges in managing both congenital and acquired forms of the infection. Our analysis synthesizes findings from 21 recent studies and a key specialty textbook, selected through systematic searches on databases including PubMed and ScienceDirect, focusing on treatments developed since 2018 to ensure relevance in the field of OT management. While diagnosis relies heavily on clinical assessments, advanced imaging like optical coherence tomography and fluorescein angiography, as well as serological and PCR testing, have improved detection. Treatment primarily involves antiparasitic and antibacterial drugs, yet standard protocols, such as pyrimethamine and sulfadiazine combinations, often fail due to severe side effects and high recurrence rates. The emergence of drug-resistant strains complicates therapy, underscoring the necessity for novel treatment approaches. Recent advancements suggest potential in mitochondrial inhibitors and histone deacetylase inhibitors, yet further research is essential to minimize toxicity and enhance specificity. OT management is hindered by the complexity of its clinical presentation and the suboptimal efficacy of traditional treatments. Personalized treatment strategies, considering patient history and local drug availability, are critical for improving outcomes in those afflicted by this debilitating infection.

Diagnosis of malignant glaucoma presents a challenge due to subtle symptoms in early stages of the disease, making increased intraocular pressure a pivotal indicator, often accompanied by inflammation and corneal edema. Diagnostic modalities, including ultrasound biomicroscopy and anterior segment optical coherence tomography, play crucial roles in visualizing anatomical changes in the ciliary body and anterior chamber. The classic slit lamp examination, complemented by tonometry, remains a fundamental diagnostic tool. A stepwise therapeutic approach is essential, beginning with pharmacological interventions aimed at intraocular pressure reduction and subsequent restoration of the anterior chamber configuration. The first stage of treatment is pharmacotherapy. Laser therapies, such as iridotomy and Nd:YAG laser treatment, address angle closure. In resistant cases, a surgical approach, such as irydo-zonulo-hialoidotomy may be considered.

This paper discusses scleritis in the course of systemic autoimmune diseases such as rheumatoid arthritis, nodular arteritis and granulomatosis with vasculitis. In addition, treatment suggestions based on the available literature are presented. Patients with scleritis resulting from an underlying disease should be twardiagnosed as soon as possible and given appropriate and effective treatment. Untreated or poorly treated scleritis or underlying disease can lead to severe damage to ocular tissues, loss of vision and eventually even blindness. A meticulous medical history, detailed ophthalmic examination and a series of targeted investigations as part of a multidisciplinary approach to detect any systemic disease are important in the management of scleritis. Rheumatoid arthritis remains the most common systemic rheumatic disease and the most common systemic condition associated with scleritis.

Therapeutic options in inflammatory glaucoma, both pharmacological and surgical methods, have been presented in this paper. Main goals of pharmacotherapy are: controlling inflammation and reducing intraocular pressure. Anti-inflammatory drugs primarily include topical glucocorticosteroids but also nonsteroidal anti-inflammatorydrugs and immunomodulatory therapy. Elevated intraocular pressure is treated with β-blockers, carbonic anhydrase inhibirozpotors, prostaglandin analogues and α2-adrenergic receptor agonists. If pharmacological treatment does not produce the desired results, surgical treatment must be considered. Due to the risk of reactivation of inflammation, it is recommended that it be performed 3 months after the inflammation has healed. Currently, trabeculectomy remains the gold standard. Among the invasive treatment techniques, we discuss trabeculectomy with the use of mitomycin C, micro-hook trabeculectomy, laser therapy, glaucoma drainage implants, deep sclerectomy and viscocanalostomy.

Wprowadzenie: W ostatnich latach stożek rogówki stał się często diagnozowanym schorzeniem okulistycznym, charakteryzującym się postępującym ścieńczeniem obszaru centralnego lub paracentralnego rogówki. Standardową metodą terapeutyczną jest cross-linking rogówki (CXL), który oferuje różnorodne techniki leczenia dostosowane do zaawansowania choroby. Celem niniejszego przeglądu jest zebranie i omówienie najczęściej stosowanych metod CXL w sposób, który ułatwi lekarzom dobór najbardziej odpowiedniego planu terapeutycznego, uwzględniającego indywidualne potrzeby pacjenta.Metody przeglądu: Niniejszy przegląd opiera się na 42 artykułach starannie wybranych z ogólnodostępnych źródeł, z wykorzystaniem baz danych PubMed i Google Scholar. Wyszukiwanie obejmowało postępowanie terapeutyczne w CXL zarówno u dorosłych, jak i u dzieci. Przegląd literatury obejmuje publikacje z lat 2003–2024.Stan wiedzy: CXL jest uważany za podstawową strategię terapeutyczną w leczeniu stożka rogówki. Liczne badania wskazują, że metoda ta jest bardzo skuteczna u pacjentów cierpiących na to schorzenie.Wnioski: Przegląd ocenia różne metody CXL. W metodzie przeznabłonkowego CXL (transepithelial cross-linking – TE-CXL) zachowuje się warstwę nabłonka, co zmniejsza ryzyko powikłań pooperacyjnych i umożliwia leczenie cieńszych rogówek oraz zaawansowanego stożka rogówki. Chociaż wspomniana metoda jest bezpieczniejsza, mniej bolesna i sprzyja szybszemu powrotowi do zdrowia, jej skuteczność może być ograniczona przez niewystarczającą penetrację ryboflawiny. Z kolei CXL z usunięciem nabłonka (epithelium-off – epi-off), zwłaszcza protokół drezdeński, pozostaje złotym standardem, choć niesie za sobą ryzyko powikłań, takich jak ból. Praca podkreśla potrzebę równoważenia bezpieczeństwa i skuteczności przy wyborze metod CXL, przy jednoczesnym uznaniu, że wszystkie metody są skuteczne w hamowaniu postępu stożka rogówki.