Rationale: Retinal astrocytic hamartoma (RAH) is a rare benign tumor originating from astrocytic cells located in the neural cell layer of the retina. It is commonly seen in patients with phakomatoses such as tuberous sclerosis complex or neurofibromatosis, rarely as an isolated retinal mass. This lesion is usually asymptomatic; however, these located in the area of the optic nerve, macula, or exhibiting the features of exudation, neovascularization may present visual disturbances and decreased visual acuity. Patient concerns: We present a rare case of a 15-year-old boy, with no significant past medical history, whose cause of visual disturbances turned out to be isolated RAH. Diagnoses: Based on the results of color images of the fundus, fluorescein angiography as well as the analysis of magnetic resonance imaging, the patient was diagnosed with RAH. Interventions: Additionally an B-scan ultrasonography, static and kinetic perimetry were performed. Outcomes: Fundoscopic examination showed a unilateral yellowish, well-circumscribed, mulberry-like lesion with a wide base, located in inferosnasal quadrant, in the vinicity of the optic nerve. The patient underwent neurological, pediatric, and genetic evaluations that excluded other pathological findings or underlying systemic disease. Lessons: The prognosis for RAH is generally good, however, the lesion requires regular ophthalmologic follow-up to rule out the progression of the tumor mass. The patient 7-year follow-up history is without evidence of tumor growth, local or general deterioration of the condition.

Background: This study evaluates changes in the foveal avascular zone (FAZ) area and vessel density in patients with full-thickness macular hole (FTMH) before and after vitrectomy using optical coherence tomography–angiography (OCT-A). Methods: A prospective analysis was conducted on 39 patients diagnosed with FTMH who underwent pars plana vitrectomy. OCT-A imaging was performed preoperatively and at 1 and 3 months postoperatively. Parameters analyzed included FAZ area, superficial (SCP) and deep retinal vessel density (DCP), and central retinal thickness (CRT). Results: Preoperative OCT-A images showed a significant difference in the mean FAZ area between affected and healthy eyes (p < 0.01). However, a significant reduction in superficial capillary plexus (SCP) vessel density was noted after vitrectomy. Visual acuity improved significantly after surgery (p < 0.001), but no significant changes in FAZ or total vessel density were observed postoperatively. Postoperative distance visual acuity (DBCVA) correlated with preoperative macular hole size (p < 0.01). Conclusions: Vitrectomy for FTMH does not significantly alter the FAZ area or DCP vessel density, but does reduce SCP vessel density. OCT-A is a valuable tool for assessing retinal microvascular changes post-vitrectomy.

In kidney transplant recipients (KTRs), uraemia-induced central nervous system damage partly subsides, while the long-lasting exposure to tacrolimus may cause pathologic visual evoked potentials (VEP) findings, which have not been investigated yet. Thus, the aim of the present study was to assess the effect of tacrolimus maintenance treatment on bioelectrical function of optic nerves in stable KTRs. Sixty-five stable KTRs were enrolled, including 30 patients treated with twice-daily (Prograf) and 35 patients treated with prolonged once-daily (Advagraf) tacrolimus formulation. In all patients, pattern and flash VEP measurements were performed. Tacrolimus dosing and exposure were also analyzed. Overall, 129 eyes were analyzed. In pattern VEP, both (1°) and (15′) latencies of P100 waves were significantly longer, whereas (1°) and (15′) amplitudes were lower in the Advagraf group as compared with the Prograf group. Multivariate regression analyses revealed that the use of Advagraf (vs. Prograf) was independently associated with longer (1°) and (15′) P100 latencies and lower corresponding amplitudes, whereas log tacrolimus daily dose was only related to amplitudes in a whole study group. In flash VEP, log tacrolimus trough level was associated with negative changes in P2 wave amplitude irrespective of tacrolimus formulation, whereas its association with P2 latency was observed only in the Prograf group. Both the type of tacrolimus formulation and drug exposure influenced the VEP parameters in stable KTRs.

Introduction: Neurotoxicity, including optic nerve injury, is one of the most common adverse effects of tacrolimus, the principal calcineurin inhibitor used after kidney transplantation (KTx). The electrophysiologic measurements of both pattern visual evoked potentials (PVEP) and flash visual evoked potentials (FVEP) are valuable when drug-induced optic neuropathy is suspected. Objectives: To determine whether VEP measurement is a sensitive and repeatable method for monitoring tacrolimus neurotoxicity. Material and methods: This prospective study focused on 35 patients (20 M, 15F, 69 eyes, mean age 43 ± 11 years) who were at a median of 3.0 (IQR, 2.2–3.7) months after KTx at the time of the initial VEP evaluation and were treated with tacrolimus since KTx. The follow-up VEP examination was done after a median of 24 (22–27) months (both VEP measurements followed the ISCEV standards). The P100 wave latency and amplitude for the 1° and 15’ PVEP simulations, and the P2 wave latency and amplitude for the FVEP were analyzed. Results: For the 1° checks, the P100 wave latency and amplitude values were significantly worse in the follow-up examination compared to the early post-transplant time-point. Independent associations between FVEP parameters and the tacrolimus blood trough level were observed in the follow-up examination but not at the early post-transplant period. The P2 wave latency correlated with the tacrolimus trough level only in patients treated with the twice-daily, but not the once-daily, tacrolimus formulation. The brain derived neurotrophic factor (BDNF) level correlated with the P100 (15’) latency (R = 0.499; p = 0.005) and the P2 latency (R = 0.409; p = 0.025) only in patients treated with the once-daily, but not the twice-daily, tacrolimus formulation. Conclusion: The observations in this study may support the rationale for the use of VEP measurements as non-invasive monitoring of subclinical tacrolimus neurotoxicity.

Wprowadzenie: Blefaroplastyka to zabieg chirurgiczny polegający na korekcie lub rekonstrukcji powiek górnych lub dolnych. Głównym celem wykonywania tych procedur jest zniwelowanie oznak starzenia się występujących w okolicy okołooczodołowej oraz poprawienie wyglądu nieestetycznych powiek. Plastyka powiek znajduje również zastosowanie w korekcji schorzeń o podłożu okulistyczno-funkcjonalnym. Celem niniejszego przeglądu jest opisanie najczęstszych powikłań po blefaroplastyce powiek górnych lub dolnych, analiza przyczyn powikłań oraz zaproponowanie metod zapobiegania im oraz ich korekcji.Przegląd: Ważne jest zrozumienie, w jaki sposób i dlaczego dochodzi do powikłań po plastyce powiek. Większość powikłań pooperacyjnych należy do jednej z czterech kategorii: (1) niedokładna ocena przedoperacyjna, (2) niewłaściwa technika chirurgiczna, (3) zła ocena sytuacji śródoperacyjnej, (4) powikłania idiopatyczne. Do powikłań towarzyszących tego typu zabiegom należą: krwawienie, infekcje, urazy rogówki, podwójne widzenie, niedomykanie powiek (lagophthalmos), opadanie powieki (ptosis), uszkodzenie gruczołu łzowego, zespół suchego oka, asymetryczna linia załamania powieki, pozostały nadmiar skóry i tkanki podskórnej, deformacje bruzdy powiekowej, canthal webbing oraz oparzenia.Wnioski: Blefaroplastyka, mimo że jest jednym z najczęściej wykonywanych zabiegów chirurgii plastycznej na świecie, nie należy do najłatwiejszych procedur. Wiąże się z licznymi powikłaniami, które mogą znacząco wpłynąć na ostateczny wynik operacji, a nawet na jakość życia pacjenta. Znajomość wszystkich możliwych powikłań oraz metod zapobiegania im jest kluczowa dla każdego chirurga, który chce osiągać dobre wyniki pooperacyjne.