Team of the Clinic of Ophthalmology of the Medical Centre of Postgraduate Education presents further issues, which we cope with in every day practice. The principal subject of this bulletin is a diabetes mellitus, which is currently defined by WHO as the epidemic of the 21^st century.

The paper regarding epidemiology and pathogenesis of the diabetes mellitus has summarized recent statistical data related to morbidity and incidence of the diabetes mellitus. Differences in pathogenesis of type 1 and type 2 diabetes mellitus were presented as well as recent reports regarding role of the cytokines in the development of insulin resistance. The authors emphasize influence of the genetic and environmental factors in the development of this disease. One of the most significant problems related to the diabetes mellitus is the diabetic retinopathy. Content of a presented article describes its pathogenesis in details and it helps to understand this issue.

Within the study conducted in the Clinic of Ophthalmology of the Medical Centre of Postgraduate Education we conducted diagnostics of the diabetic macular edema in forty patients with diabetes mellitus using RTA ( retinal thickness analyzer). The authors emphasized non-invasive nature of the exam, simple operation of the device and easy evaluation of the exam results. For these reasons, the method may play an important role as the screening towards the macular edema in patients with diabetes. It has been established that the retina in the area of the fovea and in the area of the posterior pole is statistically significantly thicker in the group of patients with diabetes than it is in the control group.

The angiography and the optical coherence tomography are the exams, which are necessary in the diagnostics of the diabetic lesions in the eye fundus, which is the subject of presented paper. These are techniques that allow evaluation of the retino-choroidal circulation. The basis for observed angiographic lesions in the diabetic retinopathy includes so called microangiopathy [microvascular disease], loss of the pericytes, thickening of the vascular basement membrane, proliferation of the endothelial cells and changes in blood composition – erythrocytes and platelets. The angiography allows defining type of the diabetic retinopathy, evaluating advancement, efficacy of used therapy, evaluating diabetic maculopathy. Introducing the optical coherence tomography – OCT as non-contact, non-invasive imaging method was the beginning of the new era in the diagnostics and treatment of the retinal diseases. OCT also provides the high sensitivity in detection of the clinically significant macular edema amounted to 89% and specificity – 96%.

The article regarding laser therapy describes photocoagulation, which is necessary in treatment of the diabetic reticulopathy and complications of the proliferative reticulopathy. The pan retinal photocoagulation allows stopping or obtaining regression of the vascular neoplasia in the retina, the optic disc or the iris. We use focal photocoagulation in the clinically significant macular edema and it includes guided photocoagulation of the microaneurysms in the macula. The grid photocoagulation is conducted in the diffuse diabetic macular edema. At the same time, the authors indicate that efficacy of the laser therapy in the diabetes depends on suitable control of the general parameters by a patient.

Diabetic complications constitute the problem, which is going to be observed by the practicing ophthalmologists more and more often due to increasing incidence of the diabetes, especially of type 2. The paper on this subject presents results of the most recent studies regarding the role of the pro-inflammatory cytokines, including VEGF, in the pathogenesis of the diabetic macular edema development. Due to this knowledge it was possible to introduce therapy with the inhibitors of the VEGF isoform A. Treatment with anti –VEGF preparations provides a chance not only to stop the progression of the disease, but also to improve visual acuity. At the same time, the authors of the article underline that drug administration via intravitreal injections is a safe procedure, which is responsible for insignificant number of complications.

Administration of the triamcinolone acetate in the form of injections into the vitreous chamber or under the Tenon´s capsule is one of the diabetic maculopathy treatment methods. In reference to this subject, the authors of the paper described adverse effects following the use of this form of therapy. The most frequent adverse effect is an increase in the intraocular pressure. The most severe complication is endophthalmitis, which includes sterile, pseudoinfective or infective inflammatory process. Complications, which occur more rarely, include the retinal detachment and the vitreous hemorrhage.

The next paper, which relates to endophthalmitis as a complication of the cataract surgery, indicates the problem of the most severe complications following the procedure, which may result in severe visual impairment. The paper summarizes the most important facts regarding pathogenesis of the infection, risk factors, clinical picture and diagnostics of the disease. The authors also presented the most recent guidelines related to parasurgical preventive treatment. Results of the most recent studies were analyzed in case of therapeutic management after occurrence of complication.

Choroiditis is one of the most frequently occurring problems, which the ophthalmologist observes in every day practice. The essence of the issue becomes more complicated if symptoms of the choroiditis occur in pregnant patient. This problem was discussed in the paper presented by physicians from the Clinic of Ophthalmology of the Medical Centre of Postgraduate Education. The authors presented the role of the immunological modulation phenomenon in course of the inflammatory process. Reports, study results, and observations in pregnant patient, who were diagnosed with the choroiditis, were discussed. The risk related to potential teratogenic action of the used treatment was indicated. The drugs, which may be used safely within the pregnancy, were listed.

Dr. hab. med. Iwona Grabska-Liberek