Pupil diameter during cataract surgery after intracameral injection of the first ready-to-use combination of mydriatics and anaesthetic at the beginning of surgery in patients with a preoperative pupil diameter <6 mm

PURPOSE

We evaluated, in a real-life setting, the effect of Mydrane® (ready-to-use combination of tropicamide, phenylephrine hydrochloride and lidocaine, injected into the anterior chamber at the beginning of cataract surgery to induce mydriasis and intraocular anaesthesia) on the pupil diameter during cataract surgery in patients with a preoperative pupil diameter <6 mm after the use of topical mydriatics.

METHODS

We collected and analysed the data of 59 consecutive patients whose pupils dilated to a diameter <6 mm after the administration of mydriatic eye drops during the preoperative visit and who received Mydrane® during cataract surgery.

RESULTS

In the group of 59 patients with a preoperative pupil diameter <6 mm after topical mydriatics, cataract surgery was performed in 36 patients (61.0%) using only Mydrane® to obtain mydriasis, with no additional drug or medical device. The mean pupil diameters in this group (36 of 59) during the preoperative assessment after topical mydriatics and just before capsulorhexis when Mydrane® was injected during surgery were 5.1 ± 0.74 and 6.15 ± 1.14 mm. Additional drugs were used in 23 patients (39%). In this group, the mean pupil diameters after topical mydriatics and just before capsulorhexis using Mydrane® were 4.58 ± 1.06 and 5.6 ± 1.26 mm, respectively.

CONCLUSION

In a real-life setting, the mean pupil diameter achieved during cataract surgery after the intracameral injection of Mydrane® in patients with a preoperative pupil diameter <6 mm was over 1 mm larger than the mean pupil diameter after topical mydriatics, despite the trauma caused by the operation.

Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study

Purpose: To evaluate the effect of Mydrane (contains tropicamide, phenylephrine hydrochloride, and lidocaine hydrochloride) on time needed to induce mydriasis and mydriasis stability during cataract surgery. Methods: This was an observational, non-interventional, multicenter study of patients undergoing cataract surgery who received Mydrane for mydriasis and intraocular anesthesia. The study was conducted at seven ophthalmology departments at university hospitals in Poland. Patients admitted for cataract surgery within a 2-week period were asked to participate in the study. Patients whose pupils dilated to a diameter ≥6 mm after topical mydriatic administration during preoperative examinations were scheduled to receive Mydrane and included in the registry. No additional inclusion criteria were used. Patients' medical histories, examination results, and operative details were recorded. Pupil diameter was measured during surgery. Surgeons were asked to complete a Likert-based survey in parallel. Results: A total of 307 patients were enrolled. The mean pupil diameter was 7.0 ± 1.0 mm before capsulorhexis and 6.9 ± 1.2 mm before lens implementation. A pupil diameter ≥6 mm was achieved in 91.9% and 87.6% of patients before capsulorhexis and lens implantation, respectively. We asked 58 surgeons whether they agreed with the statement "Mydriasis was obtained in a short time after the administration of Mydrane"; the surgeons agreed with this statement after 92.2% (283/307) of surgeries. In addition, after 88.2% of surgeries, the surgeons agreed with the statement "Mydriasis was stable after the administration of Mydrane." Conclusions: Mydriasis was rapidly and stably obtained after Mydrane injection, as demonstrated by pupil diameter measurements during surgery and surgeons' feedback.

The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension

Purpose:

To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension.

Methods:

A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability.

Results:

Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001).

Conclusion:

Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

[The opinion of the Expert Group of the Polish Society of Ophthalmology on using nepafenac in the prevention of postoperative macular edema after cataract surgery in diabetic patients]

Nepafenac is an innovative non-steroidal anti-inflammatory drug used in ophthalmology for the prevention of macular edema after cataract surgery. Along with its anti-inflammatory effect, nepafenac has some unique properties which distinguish it from other non-steroidal anti-inflammatory drugs. It is a prodrug activated to amfenac after it penetrates through the corneal layers to the aqueous humour and the ciliary body. Having electrically neutral molecules of lipophilic properties, nepafenac does not accumulate in the cornea and does not cause its degeneration. Additionally, it quickly achieves higher concentrations in the aqueous humour as compared to other non-steroidal anti-inflammatory drugs. Nepafenac shows high selectivity and activity against COX-2 isoform, the key enzyme implicated in inducing inflammation, which is the main cause of macular edema. Furthermore, nepafenac has the unique scleral and suprachoroidal distribution pathways. Finally, its effect on the intraocular pressure is none to negligible. Nepafenac treatment should be initiated prior to cataract surgery and continued long enough to reduce the risk of late-onset macular edema. The Expert Group of the Polish Society of Ophthalmology consider using nepafenac in the prevention of post­operative macular edema in diabetic patients undergoing cataract surgery as expedient and reasonable. The proposed optimum pre- and postoperative treatment regimen can be modified for individualised therapy.

[Does preservative content affect drug permeability? The permeability analysis in vitro of 3 ophthalmic Latanoprost formulations in a human epithelial cell culture model]

AIM

Comparative permeability analysis of the 3 following Latanoprost formulations intended for ophthalmic use: Xaloptic (Pol­pharma S.A.), Xalatan (Pfizer Europe MA EEIG) and Monoprost (Thea Pharma S.A.) across human corneal epithelium (HCE-T culture model) in vitro.

MATERIAL AND METHODS

Permeability analysis was performed under conditions suitable for latanoprost API (active pharmaceutical ingredient). Statistical analysis of permeability and drug quantity after passing across a cellular membrane was performed using ANOVA test and Tukey’s multiple comparison test (GraphPad Prism 6.00 for Windows, GraphPad Software, La Jolla California, USA

RESULTS

The following differences in permeability were noted between the analyzed drugs: The permeability rates for Xaloptic and Xalatan were 5.49 ± 1.64 x 10-6 cm/s and 4.66 ± 1.13 x 10-6 cm/s, respectively. Xaloptic showed the highest permeability through human corneal epithelium (23.70 ± 1.71 x 10-6 cm/s) and the highest conversion rate (28.13 ± 5.85%). As compared to Xaloptic, Xalatan slight, yet statistically significant differences with the permeability rate of 21.21 ± 1.29 x 10-6 cm/s and a conversion rate of 18.41 ± 2.96%). Monoprost demonstrated the lowest permeability (0.39 ± 0.07 x 10-6 cm/s) and the lowest conversion rate (0.34 ± 0.16%).

CONCLUSION

The differences in permeability and bioavailability between the 3 ophthalmic latanoprost formulations are attributable to the differences in their composition. They are also related to the content of preservative in each preparation.

[Central retinal sensitivity assessment with microperimetry in patients with primary open angle glaucoma]

INTRODUCTION

Visual field defects in glaucomatous patients found in perimetry are analysed using increasingly more sophisticated methods. One of these methods is microperimetry, which enables detecting the progression of changes in particular central retinal quadrants in eyes with primary open angle glaucoma, especially at early stages of the disease.

MATERIAL AND METHODS

99 eyes of 57 patients--men and women aged 40 to 65 years--were enrolled in the study. Retinal sensitivity in the central perimacular, 12-degree area divided into four quadrants (temporal, nasal, superior and inferior) plus the fovea was assessed with microperimetry. The mean visual field defects in particular areas were compared and analysed using the ANOVA rank Kruskal-Wallis test.

RESULTS

The biggest defect in the visual field was found in both superior quadrants. Only slightly milder defects were demonstrated within the fovea. The defects were the least pronounced within the inferior temporal and nasal quadrants.

CONCLUSIONS

Microperimetry enables detection and appreciation of changes in sensitivity of individual central retinal quadrants, which is of significance in the diagnosis of early glaucoma.

Age-related macular degeneration and changes in the extracellular matrix

Age-related macular degeneration (AMD) is the leading cause of permanent, irreversible, central blindness (scotoma in the central visual field that makes reading and writing impossible, stereoscopic vision, recognition of colors and details) in patients over the age of 50 years in European and North America countries, and an important role is attributed to disorders in the regulation of the extracellular matrix (ECM). The main aim of this article is to present the crucial processes that occur on the level of Bruch’s membrane, with special consideration of the metalloproteinase substrates, metalloproteinase, and tissue inhibitor of metalloproteinase (TIMP).

A comprehensive review of the literature was performed through MEDLINE and PubMed searches, covering the years 2005–2012, using the following keywords: AMD, extracellular matrix, metalloproteinases, tissue inhibitors of metalloproteinases, Bruch’s membrane, collagen, elastin.

In the pathogenesis of AMD, a significant role is played by collagen type I and type IV; elastin; fibulin-3, -5, and -6; matrix metalloproteinase (MMP)-2, MMP-9, MMP-14, and MMP-1; and TIMP-3. Other important mechanisms include: ARMS2 and HTR1 proteins, the complement system, the urokinase plasminogen activator system, and pro-renin receptor activation.

Continuous rebuilding of the extracellular matrix occurs in both early and advanced AMD, simultaneously with the dysfunction of retinal pigment epithelium (RPE) cells and endothelial cells. The pathological degradation or accumulation of ECM structural components are caused by impairment or hyperactivity of specific MMPs/TIMPs complexes, and is also endangered by the influence of other mechanisms connected with both genetic and environmental factors.

The influence of elastin degradation products, glucose and atorvastatin on metalloproteinase-1, -2, -9 and tissue inhibitor of metalloproteinases-1, -2, -3 expression in human retinal pigment epithelial cells

PURPOSE

Hyperglycemia and increased concentrations of elastin degradation products (EDPs) are common findings in patients with diabetes, atherosclerosis and hypertension. The aim of this study was to assess the influence of high glucose, EDPs and atorvastatin on MMP-1, MMP-2, MMP-9 and TIMP1-3 gene expression in human retinal pigment epithelial cells (HRPE) in vitro.

METHOD

HRPE were cultured for 24 hours with the substances being tested (glucose, EDPs), alone or in combination. Additionally, the cells were treated with atorvastatin in two different concentrations (1 or 10 μM). After incubation, total cellular RNA was extracted and used for gene expression evaluation. Gene expression was measured using the real-time RT-PCR technique.

RESULTS

Glucose, EDPs and atorvastatin had no impact on TIMP-1 and TIMP-3 expression. HRPE cells treated with glucose or EDPs with the addition of atorvastatin had a statistically significant decrease of TIMP-2 expression; glucose alone decreased MMP-1 expression. Atorvastatin decreased expression of all assessed genes, except TIMP-1 and TIMP-3 in a dose-dependent manner.

CONCLUSIONS

Our results confirm the importance of MMPs and TIMPs in retinal vascular biology. Atorvastatin-induced MMPs gene expression can deeply affect extracellular matrix turnover, which may play an important role in the progression of ocular diseases.

The influence of elastin degradation products, glucose and atorvastatin on metalloproteinase-1, -2, -9 and tissue inhibitor of metalloproteinases-1, -2, -3 expression in human retinal pigment epithelial cells

Hyperglycemia and increased concentrations of elastin degradation products (EDPs) are common findings in patients with diabetes, atherosclerosis and hypertension. The aim of this study was to assess the influence of high glucose, EDPs and atorvastatin on MMP-1, MMP-2, MMP-9 and TIMP1-3 gene expression in human retinal pigment epithelial cells (HRPE) in vitro. HRPE were cultured for 24 hours with the substances being tested (glucose, EDPs), alone or in combination. Additionally, the cells were treated with atorvastatin in two different concentrations (1 or 10 μM). After incubation, total cellular RNA was extracted and used for gene expression evaluation. Gene expression was measured using the real-time RT-PCR technique. Glucose, EDPs and atorvastatin had no impact on TIMP-1 and TIMP-3 expression. HRPE cells treated with glucose or EDPs with the addition of atorvastatin had a statistically significant decrease of TIMP-2 expression; glucose alone decreased MMP-1 expression. Atorvastatin decreased expression of all assessed genes, except TIMP-1 and TIMP-3 in a dose-dependent manner. Our results confirm the importance of MMPs and TIMPs in retinal vascular biology. Atorvastatin-induced MMPs gene expression can deeply affect extracellular matrix turnover, which may play an important role in the progression of ocular diseases.

Ophthalmic transplantology: posterior segment of the eye--part II

Background

Transplants of the retina are among the new strategies being used in the treatment of genetic and degenerative macular diseases. Moreover, various cell cultures are being tested to treat retinal disorders.

Material/Methods

Literature dated from 2004 to 2011 was comprehensively examined via Medline and PubMed searches for the following terms: auto-, homo-, heterologous transplantation, retina, stem cells, cultivated cells.

Results

Tissue and cell therapy of retinal diseases are reviewed, including full-thickness retina/retinal pigment epithelium (RPE)/choroid graft; full and partial thickness RPE/choroid complex grafts; RPE/Bruch membrane complex graft; and RPE, iris pigment epithelium and stem cell grafts. Recommendations for transplants, as well as the benefits and weaknesses of specific techniques in retina transplants, are discussed.

Conclusions

Auto- and allogenic transplants of a full or partial thickness retina/RPE/Bruch membrane/choroid complex represent an alternative treatment offered to patients with some macular diseases. Stem cell transplantation to reconstruct and regenerate the macula requires further biomolecular and animal research studies.

Indocyanine green angiography in chronic central serous chorioretinopathy

BACKGROUND

Central serous chorioretinopathy (CSC) is a condition that originates from alterations of the choroidal circulation. The aim of this paper was to evaluate the use of indocyanine green angiography (ICGA) in patients with chronic CSC.

MATERIAL/METHODS

The analysis included 17 patients (34 eyes) with chronic CSC in at least 1 eye. The eye examination included: distance and near visual acuity, biomicroscopy, applanation tonometry, fundus examination, colored and red-free fundus photography, evaluation of autofluorescence, optical coherence tomography, and fluorescein and indocyanine green angiography.

RESULTS

In 34 eyes (100%) involved in the ICGA study the results revealed zones of transient increased choroidal vessels permeability. In 18 eyes (52.9%) choroidal changes were accompanied by a focal serous pigment epithelial detachment. In 4 eyes (11.8%) of 3 patients' the ICGA examination confirmed the presence of occult choroidal neovascularization (CNV). In the patient with bilateral diffuse retinal pigment epitheliopathy, CNV was present in 1 eye, in the patient with unilateral chronic CSC it was also present in 1 eye, and in the third patient with bilateral chronic CSC it was detected in both eyes.

CONCLUSIONS

ICGA is a very useful examination that enables ophthalmologists to visualize choroidal changes due to chronic CSC, as well as to diagnose occult CNV in chronic CSC.

Ophthalmic transplantology: anterior segment of the eye - part I

Background

Transplantology is a quickly developing field of ophthalmology. It currently is able to treat many inherited, degenerative, inflammatory, traumatic, and cancerous diseases. This review outlines recent concepts and methods of treating ocular diseases with tissue and cell grafts. Ocular transplants related to the anterior part of the eye, including the conjunctiva and the cornea, are reviewed in Part 1.

Material/Methods

The scientific literature dated from January 2005 to July 2011 was thoroughly searched using Medline and PubMed. Publications dated 2009, 2010, and 2011 were analyzed in detail. Search terms were as follows: auto-, homo-, heterologous transplantation, eyeball, ocular adnexa, anterior segment of the eye, cornea, lamellar keratoplasty, stem cells, cultured cells. Further data were found at the website of the Eye Bank Association of America.

Results

Nearly all tissues of the anterior segment of the eye (the conjunctiva, sclera, eye muscles, and cornea) are transplanted. Because of the recent significant progress in the field, cornea transplantation was analyzed in more detail, specifically procedures such as limbus grafts and anterior and posterior lamellar keratoplasty. Indications, advantages, and drawbacks of the transplant techniques were also reviewed.

Conclusions

Recent progress in the field of cornea transplants allows treatment at the level of the endothelium and the use of cultured limbal epithelial stem cell grafts. However, compared with previous techniques, modern and multilayered transplant techniques of the cornea require much more expertise and longer training of the surgeon, as well as expensive and technologically advanced equipment. The availability of donor tissue is still the main limitation affecting all transplants. Therefore, cell culturing techniques such as stem cells, as well as artificial cornea projects, seem to be very promising.

Results of the AcrySof Toric intraocular lenses implantation

BACKGROUND

The expectations of post-removal cataract surgery patients are extremely high, and best vision acuity is expected. The best refractive results are influenced by two factors - cataract surgical removal and the corneal astigmatism correction. Currently, the two most often applied corneal astigmatism removal methods are laser surgery and toric intraocular lens implantation, with the latter method being both more stable and more reversible. This study aimed to estimate the surgical astigmatism correction efficiency after AcrySof Toric intraocular lens implantation in patients with corneal astigmatism.

MATERIAL/METHODS

We used the AcrySof Toric IOL 1-part hydrophobic acrylic lenses. The retrospective research covered 30 eyeballs in 28 cataract and corneal astigmatism patients, with the AcrySof Toric lens implanted by one surgeon.

RESULTS

In our test group 92.31% of post-surgical patients (phacoemulsification and toric lenses implantation) gained the best uncorrected visual acuity, range 0.6-1.0; and in 7.69% of patients the acuity was 0.4-0.6. Lens rotation was examined three weeks after the surgical procedure and a 3.24 ± 3.41 degree axial displacement was observed; however, this lens rotation was clinically unimportant. Based on the analysis of post-surgical results, the corneal astigmatism was 84.2% lower than before the procedure.

CONCLUSIONS

We noticed clinically and statistically important vision acuity improvement in the corneal astigmatism patients. The patients' high satisfaction was conditioned by proper pre-surgery qualification. Astigmatism correction by cataract removal surgery is a safe and effective surgical solution. In the future, we expect the use of toric intraocular lenses will become widespread and significant.

Influence of rheological factors on the development of primary open angle glaucoma

The aim of this study was to compare our non published investigation on the effect of rheological factors on the development of primary open angle glaucoma (POAG)--to literature data. POAG is a chronic eye disease characterised by a slowly progressive neuropathy of the optic nerve with typical anatomical and functional lesions and is associated with specific visual field defects.

Needle aspiration with surgical excision of an epithelial posttraumatic iris cyst--a case report

Background

The aim of this study was to report on epithelial posttraumatic iris cyst that was successfully treated with needle aspiration and surgical excision with surrounding iris tissue.

Case Report

A 30-year-old women was treated for a large fluid-filled cyst in the anterior chamber of the left eye; 25 years before, she had an open globe injury. She observed deterioration of her visual acuity 1 year before her visit to our clinic. During ophthalmological examination, an iris cyst was diagnosed. As a result, she had Nd: YAG laser puncture of the cyst in the left eye, performed 5 months before she came to our clinic. After a short time of decompression, the cyst rapidly grew in size (2/3 of the anterior chamber), and her visual acuity was getting worse due to an aggressive growth of the iris cyst. Visual acuity was 0.06. Needle aspiration with surgical excision of the cyst with surrounding iris tissue was performed. Histopathologic examination confirmed an epithelial cyst. At the 1-year follow-up, there was no evidence of recurrence of the iris cyst, and BCVA was 0.2.

Conclusions

This case report provides evidence that needle aspiration with surgical excision of iris cyst seems to be an effective treatment method of this complication.

[Optical coherence tomography in the imaging of the iridocorneal angle]

Anterior segment optical coherence tomography (AS OCT), enables visualization and measurements of the anterior segment of the eye. In particular, it is a valuable tool in the imaging of the iridocorneal angle. In this paper, we reviewed parameters used for analysis of the iridocorneal angle in AS OCT and compared changes of these parameters after cataract surgery, laser iridotomy and illumination. Special attention was paid to changes of such quantitative parameters as TISA (trabecular-iris space area), AOD (angle opening distance), and ARA (angle recess area).

Quantitative analysis of transforming growth factor beta isoforms mRNA in the human corneal epithelium

TGF-beta is an important mediator of cell growth, differentiation, and proliferation and plays a significant role in both normal and pathological corneal tissue. However, the quantitative relations between TGF-beta1, -beta2 and -beta3 isoforms in human cornea still remain unclear. Therefore, the aim of this study was to determine the gene expression profile of TGF-betas in order to evaluate quantitative relations between the examined transcripts in human corneal epithelium. Transcriptional activity of TGF-beta1, 2, 3, GAPDH and beta-actin genes was estimated on the basis of mRNA copy number per 1 microg of total RNA using the real-time QRT-PCR technique with the SYBR Green I chemistry. Specificity of RT-PCR reaction was confirmed by determination of the characteristic melting temperature for each amplimer. Additionally, the RT-PCR products were separated on 6% polyacrylamide gels and visualized with silver salts. Expression of all TGF-beta genes for the corneal epithelium was determined. Comparable analysis of mRNA copies/1 mug of total RNA for each TGF-beta isoform showed that: TGF-beta1 > TGF-beta2; TGF-beta3 > TGF-beta2; TGF-beta1 = TGF-beta3 (ANOVA test P < 0.0001; post-hoc Tukey's test: TGF-beta1 and TGF-beta2, P = 0.0306; TGF-beta3 and TGF-beta2, P = 0.0045; TGF-beta1 and TGF-beta3 NS). We found different expression of the TGF-beta1, -2 and -3 isoforms in the human corneal epithelium. Such differential expression of TGF-betas suggests that each of them may play a specific role in corneal tissue.

Correlations in some pathogenetic factors and values of hemorheological parameters in age-related macular degeneration

The aim of this study was to correlate some pathogenetic factor with the hemorheological parameters in ills with age-related macular degeneration. The studies were performed on 52 patients suffering from AMD. The control group consisted of 42 healthy persons. Blood samples were taken from patients immediately after ophthalmological examination from antecubital vein and anticoagulated with K3EDTA. The symptoms of macular degeneration were drusen; changes in retinal pigmentation, areolar atrophy, neovascularization. Blood viscosity measurements were performed with use of cone-plate Brookfield viscometer at sheer rate 150 s(-1) and plasma viscosity with capillary Ubbelohde's viscometer. Fibrinogen concentration has been measured according to Clauss method, and level of triglycerides was measured using coupled enzymatic reactions. Haematocrit level was measured with the help of micromethod. The viscosity of whole blood, corrected viscosity and plasma viscosity were respectively 6.9%, 14.6% and 15.7% higher in the patient group than in the control group, while fibrinogen-plasma factor was 16% higher. Aggregation amplitude and time t(1/2) were 89.3% and 28.6% lower in AMD group. Erythrocyte deformability was 18% lower. The aggregation index was 7.6% higher in the AMD group then in the control group. Summing up in people suffering from AMD rheological disturbances is observed increased blood and plasma viscosity.

[Posterior chamber phacic intraocular lens implantation in patients with medium or high myopia--own experiments]

PURPOSE

To evaluate the results of the PCPIOL implantation (Posterior Chamber Phacic Intaocular Lens) in patients with medium or high myopia.

MATERIAL AND METHODS

The posterior chamber phacic lenses were implanted by means of an 3.2 mm (or smaller) incision in a clear cornea. The studied group consisted of 6 patients (4 women and 2 men; age range 28-45 years). Mean preoperative spherical equivalent was from -10.0 to 17.0 D. Preoperative uncorrected visual acuity was worse than 0.04 in all the eyes. Preoperative spectacle corrected visual acuity was 0.42 or better.

RESULTS

4 patients after the posterior chamber phacic lens implantation gained full visual acuity without spectacle correction, the remaining 2 achieved postoperative visual acuity equal to preoperative best spectacle-corrected visual acuity.

CONCLUSIONS

The posterior chamber phacic intraocular lens implantation is an effective, safe, reversible procedure and it offers an alternative to laser refractive surgery.

[Retinal ganglion cells death in glaucoma--mechanism and potential treatment. Part I]

Glaucoma is a kind of optic neuropathy where selective retinal ganglion cell loss is the major hallmark. Frequently glaucoma is associated with elevated intraocular pressure, but this condition is neither necessary nor sufficient for onset and progression of the disease. The exact mechanism of ganglion cell death in glaucoma and fully effective treatment of glaucomatous neuropathy still remain unknown. This article is a review of the recent researches relevant to IOP independent risk factors, mechanisms of RGC death and modern potential therapeutic strategies in glaucoma. Part one includes review of blood flow changes, neurotrophic factors deprivation and apoptotic dysregulation findings in glaucoma.

[Phacoemulsification of subluxated lens with capsular tension ring implantation]

PURPOSE

To evaluate long term results of phacoemulsification with PC IOL and capsular tension ring (CTR) implantation in lens subluxation.

MATERIAL AND METHODS

The study comprised of 134 patients--146 eyes with subluxated lens. In all cases phacoemulsification with PC IOL and CTR implantation was performed.

RESULTS

No intaroperative complications has occured. Postoperative complications included: inflammation in the anterior chamber in 3 eyes (2.1%), retinal detachment in 2 eyes (1.4%). In all cases there was no PC IOL decentration.

CONCLUSIONS

(1) CTR facilitates phacoemulsification with PC IOL implantation in lens subluxation. (2) Phacoemulsification of subluxated lens with PC IOL and CTR implantation seems to be safe and effective procedure.

[Retinal ganglion cells death in glaucoma--mechanism and potential treatment. Part II]

Glaucoma is a kind of optic neuropathy where selective retinal ganglion cell loss is the major hallmark. Frequently glaucoma is associated with elevated intraocular pressure, but this condition is neither necessary nor sufficient for onset and progression of the disease. The exact mechanism(s) of ganglion cell death in glaucoma and fully effective treatment of glaucomatous neuropathy still remain unknown. This article reviews the recent researches relevant to IOP-independent risk factors, mechanisms of RGC death and modern potential therapeutic strategies in glaucoma. Part two includes review of ionic derangements, reactive oxygen species cytotoxicity, role of nitric oxide and immunity disorder findings in glaucoma.

[Phacoemulsification of subluxated opacified lens in pseudoexfoliation glaucoma patients, performed with the use of a capsular tension ring and iris retractors]

PURPOSE

To evaluate results of phacoemulsification of subluxated lens in patients suffering from pseudoexfoliation-related cataract and glaucoma, performed with the use of a capsular tension ring (CTR) and iris retractors and implantation of artificial intracapsular lens.

PATIENTS AND METHODS

The retrospective covered 15 patients (15 eyes) at the average age of 75 years, with a subluxated, cloudy lens and pseudoexfoliation glaucoma with IV PEX. Due to poor mydriasis resulting from the course of the pseudoexfoliation syndrome, it was necessary with all the patients to apply iris retractors in order to enlarge the pupil. The opacified lens were removed by means of phacoemulsification. In order to provide additional peripheral support and to maintain the artificial lens in the central position after the surgery, a tension ring was implanted into the lenticular capsule. A foldable intraocular lens was implanted inside the capsule.

RESULTS

The observation period was 12 months. The average visual acuity prior the surgery was 0.18+/-0.2, while after a year after the surgery it was 0.56+/-0.32 (p<0.001). Besides, the intraocular pressure was observed to decrease from 18.2+/-5.02 mm Hg before the surgery to 15.8+/-0.84 mmHg (p<0.001) after the surgery. The anti-glaucoma medication ratio was also reduced from 2.1 to 1.3 in the post-surgery period. Inflammatory reaction of the anterior chamber was observed in 7 eyes.

CONCLUSIONS

Application of a CTR and iris retractors during a surgery of cataract in patients with subluxated opacified lens considerably facilitates the implantation procedure of an artificial lens into the capsule, and it allows to improve the visual acuity and stabilize the intraocular pressure while reducing the quantity of the applied anti-glaucoma drugs.

[Evaluation stereometric parameters of the optic nerve head in the III and IV stage of pseudoexfoliation syndrome]

PURPOSE

Pseudoexfoliation syndrome (PEX) often coexists with glaucomatous optic nerve head damage. Confocal scanning laser tomography Heidelberg Retina Tomograph (HRT) is the most competent and accurate technique of monitoring of glaucomatous optic nerve head damage. Our aim was to determine correlation between stage of PEX and glaucomatous optic nerve head damage, by using HRT system.

MATERIAL AND METHODS

Two groups of patients underwent examination. The examined PEX-group with 35 eyes with III stage and 35 eyes with IV stage of PEX. The control group (POAG patients) of 44 eyes. Stereometric parameters Disc Area, Cup Area, Cup/Disc Area Ratio, Rim Area, Height Variation Contour, Cup Volume, Rim Volume, Mean Cup Depth, Max Cup Depth, Cup Shape Measure, Mean RNFL Thickness, RNFL Cross Section Area were obtained by HRT.

RESULTS

No statistical differences were noted between III and IV stage of PEX for DA, HVC, RV, Mean RNFL Thickness and RNFL Cross Section Area parameters. Between III stage of PEX and control group no statistical differences were confirmed for HVC. Between IV stage of PEX and control group no statistical differences have respect to: CSM, Mean RNFL Thickness and RNFL Cross Section Area stereometric parameters.

CONCLUSIONS

IV stage of PEX syndrome is the serious risk for glaucomatous neuropathy and requires precise monitoring.

[Frequency doubling perimetry in diagnosis of early glaucomatous optic nerve fiber damage]

PURPOSE

The comparative evaluation results of frequency doubling technology (FDT) in healthy subjects, in patients with glaucoma suspected and glaucoma, as well as analysis influences of selected risk factors onset, and progression of glaucoma (age, gender, intraocular pressure, refractive errors, circulation system disease, diabetes mellitus, vasospastic vascular disease) on FDT-parameters.

MATERIAL AND METHODS

Sixty four patients (128 eyes), in age between 13-80, with refraction error from -14.5 to +6.5 D sph and average intraocular pressure 19.8 +/- SEM were included in this study. All patients were previously diagnosed towards glaucoma. The visual field testing with help of FDT Visual Field Instrument were made at least triple at all patients, with capitalize on the THR N-30 threshold program. Global indices: mean deviation (MD) and pattern standard deviation (PSD) and numerical value of mean retinal sensitivity for central visual field 5 degree sector (mean sensitivity to central 5 degrees--MS 5 degrees) come in comparative analysis. All data were analyzed by chi2 and Kruskal-Wallis tests.

RESULTS

Comparative analysis examined groups of healthy persons, patients with glaucoma suspect and glaucoma, it proves statistically significant difference between MD, PSD and MS 5 degrees. Statistically no significant difference between PSD and MS 5 degrees at groups of healthy and glaucoma suspect patients was detected. In glaucoma group there did not reveal an influence on selected risk factors on FDT parameters. However, in glaucoma suspect group revealed an influence on most risk factors on perimetry parameters.

CONCLUSIONS

FDT is useful for detection of glaucomatous nerve fiber damage. There should be taken precautions of interpretation FDT results at glaucoma suspect patients.

[Phacotrabeculectomy in patients with cataract and chronic open angle glaucoma, and patients with cataract and pseudoexfoliation glaucoma]

PURPOSE

To compare the results obtained after phacotrabeculectomy followed by implantation of an intracapsular lens in patients with cataract and chronic open angle glaucoma, and patients with cataract and pseudoexfoliation open angle glaucoma.

MATERIAL AND METHODS

The retrospective study covered 55 eyes with cataract and glaucoma. In 28 eyes, chronic open angle glaucoma was diagnosed, and in 27--pseudoexfoliation glaucoma. In all cases, phacoemulsification of the opacified lens was carried out, a foldable intraocular lens was implanted in the capsule, and the trabeculum was removed by means of a punch. Visual acuity, intraocular pressure and the ratio of applied anti-glaucoma drugs were subject to the assessment.

RESULTS

The observation period was 12 months. Within the COAG patient group, the average visual acuity prior to the surgery was 0.2+/-0.24, and after one year from the surgery it increased to 0.82+/-0.22. For PEX glaucoma patients, the values were respectively 0.3+/-0.25 before the surgery and 0.75+/-0.29 a year after it. Considerable reduction of the intraocular pressure was also achieved: in the COAG patients--from 19.51+/-3.8 mm Hg to 16.6+/-1.6 mm Hg, and in PEX glaucoma patients--from 22.28+/-5.18 mm Hg to 17.6+/-2.33 mm Hg one year after the surgery. Also, the quantity of anti-glaucoma drugs applied in the study groups was significantly reduced. The anti-glaucoma drug ratio in the COAG patients dropped from 1.8 to 0 after the surgery, and in the PEX glaucoma patients--from 2.3 to 0.3.

CONCLUSIONS

Phacotrabeculectomy is an efficient and safe surgical method, to be recommended for patients both with primary open angle glaucoma and with pseudoexfoliation glaucoma.

[Phacoemulsification in patients with cataract and pseudoexfoliation syndrome--own experience]

The aim of the study was the assesment of effectivness of phacoemulsification procedure in patients with cataract and pseudoexfoliation syndrome. Analysed group consisted of 72 eyes (8 patients), age 53 - 93 years with PEX and 50 eyes (50 patients), age 49-82 without PEX. All cases have performed the phacoemulsification with implantation of artificial posterior chamber lens using small incision procedure. In more than 50% of patients marked postoperative improvement of visual acuity up to 0,6. Year after operation significant decrease of intrabulbar pressure was observed. We conclude that phacoemulsification in cataract treatment is an efficient and save procedure with improvement of patient's visual acuity and with low number of postoperative complications.

[Implantation of Ahmed-type valve in the treatment of glaucoma, following penetrating keratoplasty]

PURPOSE

To evaluate the outcomes of Ahmed glaucoma valve implantation for therapy of glaucoma after penetrating keratoplasty.

MATERIAL AND METHODS

17 Ahmed glaucoma valve implants were placed in 17 eyes with glaucoma after penetrating keratoplasty. The follow up was 1 year. V.A., IOP and index medication were observed before and 1 year after surgery.

RESULTS

The mean preoperative IOP was 29.1 mmHg (+/-6.5) with average medication 2.65 +/- 0.5, 1 year after surgery the mean IOP decreased to 18.4 mmHg +/- 4.7 with 0.7 +/- 0.8 medication. The tube implant successfully controlled glaucoma in 13 eyes (73.5%) at 1 year. The corneal grafts remain clear in 11 eyes (64.7%).

CONCLUSIONS

Implantation of Ahmed glaucoma valve successfully controlled IOP in difficult cases of glaucoma after penetrating keratoplasty.

[Confocal laser scanning tomography (HRT) in diagnosis and monitoring glaucomatous optic nerve damage in primary open angle glaucoma]

PURPOSE

The aim of this study was to estimate HRT usefulness in quantitative evaluation of structural glaucomatous optic nerve head damage and in monitoring this atrophy in POAG patients and normal subjects, during 18-monthly follow up.

MATERIAL AND METHODS

130 eyes of 84 patients with primary open angle glaucoma, 52 women (79 eyes) and 32 men (51 eyes) in age 45-70 (mean = 54.69 yrs) and 96 eyes of 48 normal subjects, 33 women (66 eyes) and 15 men (30 eyes) in age 40-70 (mean=51.90 yrs). The ONH-stereometric parameters were examined using confocal laser scanning tomography--HRT (version 2.01).

RESULTS

All of ONH stereometric parameters (except: HVC) statistically significant distinguish glaucoma and normal eyes. The most marked of ONH-parameters are: C/D area ratio, CA, CSM, RA, RV, Mean cup depth, CV, Max cup depth, Mean RNFL thickness, RNFL-csa and DA. Statistically significant changes of all ONH stereometric parameters in primary open angle glaucoma were found during follow up (except: HVC, CV and CSM).

CONCLUSIONS

HRT is precise method for ONH-parameters evaluation. All of ONH-stereometric parameters (except HVC) are good markers of quantitative ONH-glaucomatous damage. HRT is valuable and precise method of quantitative monitoring progression of glaucomatous neuropathy.

[The estimation of efficacy of the phacotrabeculectomy procedure in patient with cataract and pseudoexfoliation glaucoma]

PURPOSE

The aim of the study was the estimation of phacotrabeculectomy effectiveness in patient with pseudoexfoliation syndrome.

MATERIAL AND METHODS

The analyzed group consisted of 72 eyes of 65 patients in the range of 61-92 years old. 32 patients have phacoemulsification procedure (gr. I) and 40 patients have performed the procedure of the phacotrabeculectomy (gr. II).

RESULTS

In 60% of the eyes marked postoperative improvement of visual acuity to more than 0.6 was observed. We noticed significant decrease of mean intraocular pressure (from 22.45 mmHg-17.88 mmHg), only in group II.

CONCLUSIONS

We have concluded that the polyprocedular operation of phacotrabeculectomy in cataract with pseudoexfolation syndrome is an efficient procedure lowering mean intraocular pressure and improving visual acuity.

[Non-proliferative diabetic retinopathy and red blood cell aggregation]

The pathogenesis of diabetic retinopathy is not clear, but it is generally agreed, that in addition to vascular components hemorheological disturbances can play a role in the impairment of microvascular flow. The aim of this study was to correlate the severity of retinopathy in diabetic patients with red blood aggregation and some parameters of aggregation. The study was carried out on 52 patients suffering from type 2 diabetes mellitus with non-proliferative retinopathy--25 men and 27 women (mean age 63.8 +/- 6.5 years) and 43 healthy--20 men and 23 women (mean age 55.5 +/- 9.6 years). The fundus appearance of patients showed non-proliferative diabetic retinopathy. Red blood cell aggregation was determined by LORCA aggregometer. Aggregation index (AI), disaggregation shear rate (gamma(p)), time to the half of the disaggregation (t1/2), time constant of fast component in syllectogram (T1), time constant of slow component (T2) and amplitude (total extent of aggregation Am) were measured. In diabetics with non-proliferative retinopathy we observed the increase of AI (66.5 +/- 7.2 vs 59.4 +/- 5.8; p < 0.001), decrease of Am (19.8 +/- 3.3 vs 21.2 +/- 2.7; p < 0.05), decrease of T1 (2.4 +/- 0.5 vs 2.75 +/- 0.42; p < 0.005), increase of T2 (27.6 +/- 4.7 vs 25.75 +/- 4.11; p < 0.05), decrease of t1/2 (1.98 +/- 0.72 vs 2.7 +/- 0.77; p < 0.001) and increase of gamma(p) (215.6 +/- 23.3 vs 98.1 +/- 8.7; p < 0.001). The parameters of erythrocytes aggregation were correlated with intensification of diabetic retinopathy symptoms. Our results show the importance of red blood cell aggregation parameters in the development of diabetic microangiopathy.

Correlations between the severity of retinopathy in diabetic patients and whole blood and plasma viscosity

The aim of this study was to correlate the severity of retinopathy in diabetic patients with the whole blood and plasma viscosity. The studies were performed on 52 patients suffering from type II diabetes mellitus with non-proliferative retinopathy (25 men and 27 females, mean age of patients 64+/-6.5 years). The mean duration of diabetes treatment was 13.7 years. The control group consisted of 43 healthy persons (20 men and 23 women, the mean age of controls was 55.9+/-9.2 years). Blood samples were taken from patients immediately after ophthalmological examination from anticubital vein and anticoagulated with K2EDTA. The symptoms of retinopathy were: macular edemas, microaneurysms, hard and soft exudates and hemorrhagic focuses. The severity of particular signs of retinopathy was expressed in a three point scale. The total number of rank points was correlated with blood and plasma viscosity, moreover with eyes acuity. Blood viscosity measurements were performed with the use of cone-plate Brookfield's viscometer at shear rate 150 s(-1), and plasma viscosity with capillary Ubbelohd's viscometer. Besides the viscometric examinations hematocrit, fibrinogen, blood morphology, total cholesterol concentration, LDL-cholesterol, HDL-cholesterol, triglycerides, blood glucose concentration and glycosylated hemoglobin were examined. The whole blood viscosity, the corrected blood viscosity adjusted to 45% of hematocrit were significantly higher in diabetics (p<0.001). The whole blood relative viscosity was also significantly elevated in diabetic patients (p<0.002). The correlation between visual acuity and rank point of retinopathy severity was negative (r= -0.91, p<0.001). The retinopathy severity was positively correlated with whole blood and plasma viscosity (r=0.51; p<0.001 and r=0.4; p<0.005, respectively).

CONCLUSION

Elevated blood and plasma viscosity may play an additional and significant role in the development of diabetic retinopathy.

A unique case of primary corneal melanoma

PURPOSE

To report a unique case of primary corneal melanoma.

METHODS

A 59-year-old white woman underwent keratectomy to remove a pigmented rapidly enlarging growth on the corner of her left eye. The specimen was submitted for histopathologic examination.

RESULTS

Ophthalmic examination disclosed no association with limbal or conjunctival melanocytic abnormalities. Histopathologic studies demonstrated nodular malignant melanoma.

CONCLUSION

Possible development of primary corneal melanoma should be considered in diagnosing all cases with a past history of corneal melanin pigmentation.

[Surgical correction of astigmatism after wedge resection keratoplasty]

PURPOSE

To analyse the results of astigmatism correction after keratoplasty using wedge resection technique.

MATERIAL AND METHODS

Eleven patients underwent a wedge resection for postkeratoplasty astigmatism. The average postoperative astigmatism was 13.9 diopters (range 11.0 to 17.0 D). Among the patients there were 5 women and 6 men, aged 25 to 70 years. All of the grafts were in static phase, after suture removal. The indications for keratoplasty were: keratoconus--8, pseudophakic and aphakic corneal edema--3. The follow-up period after wedge resection was 6 to 24 months. The astigmatism was evaluated by videokeratometer (ORC Masterviue Ultra).

RESULTS

Postoperatively, the average astigmatism was 7.25 D by 6 months, 8.1 D by 12 months, 8.45 D by 24 months. The visual acuity corrected with spectacles was 0.2 to 1.0. 8 patients (72.7%) gained better visual acuity. Complications included: 1) growing vessels through the wound, 2) delay of epithelization.

CONCLUSION

Wedge resection is an effective technique for managing postkeratoplasty high astigmatism.

[A grid pattern type of photocoagulation in treatment of diabetic maculopathy--personal experience]

PURPOSE

The aim of the present study was the evaluation of visual outcome of 425 eyes in 283 patients treated by focal and grid pattern photocoagulation for clinically significant macular edema according to the recommendations of the Early Treatment Diabetic Retinopathy Study (ETDRS).

MATERIAL AND METHODS

On the basis of baseline status of macula, eyes were classified into three groups: group I--eyes treated by focal photocoagulation (39 eyes), group II--eyes treated by focal photocoagulation and/or modified grid (84 eyes), group III--eyes treated by focal photocoagulation and/or grid pattern (302 eyes). Eligibility criteria for this retrospective study included a diagnosis of clinically significant macular edema according to the ETDRS scale. The baseline examination for all patients presented in this review included: the best corrected visual acuity (VA), slit lamp with contact lens indirect ophthalmoscopy, fundus color photography and fluorescein angiography. All patients were treated with argon green by grid with Nidek 2300 laser. Modified grid or focal photocoagulation according to the ETDRS recommendations were performed. Patients with proliferative diabetic retinopathy (PDR) were transferred to panretinal photocoagulation (PRP) after treatment of maculopathy. Development of VA from the baseline to last checkup in treated eyes was reported and compared. Follow-up ranged widely from 6 to 45 months.

RESULTS

General stabilization was achieved in 51.3%, improvement in 10.1% and deterioration in 38.6% of eyes. The best results were achieved after selective and focal and/or modified grid treatment: in the Ist group stabilization of VA was achieved in 43.6% and improvement in 41% of eyes; in the IInd group: stabilization in 60.7% and improvement in 21.4% were stated; in the IIIrd group: stabilization in 49.7% and improvement only in 3.0%. In 164 (38.6%) cases supplemental treatment was administered.

CONCLUSION

Photocoagulation has proved effective in the treatment of diabetic clinically significant macular edema.

[Valve implants of glaucoma pressure regulator for refractory glaucoma: own experience]

PURPOSE

To present our experiences in valve implantation for refractory glaucoma.

MATERIAL AND METHODS

From October 1993 to December 1996 implantations of Glaucoma Pressure Regulator Optimed were performed in 7 eyes of 7 patients. There were 4 men and 3 women aged from 32 to 65 years. There were 3 eyes with neovascular glaucoma due to diabetes mellitus, 2 eyes with posttraumatic glaucoma, including 1 case after keratoplasty, 1 eye with postkeratoplasty glaucoma and 1 eye with aphakic glaucoma. Preoperative IOPs ranged from 33 to 61 mm Hg (mean 37.6 +/- 7.2 mm Hg).

RESULTS

Success was considered an IOP of less than 22 mm Hg without medication (complete success) or with medication (qualified success) without additional filtering surgery. Postoperative success was obtained in 4 out of 7 eyes after follow-up period of 37.4 +/- 17.08 months (range 16-39 months). Early complications were hyphema (1 patient, 14.3%), blockage of intracameral portion of the tube (1 patient, 14.3%), hypertony (1 patient, 14.3%). Late complications were: external conjunctival bleb failure (2 patients, 28.6%), blockage of intracameral portion of tube by fibrovascular tissue (1 patient, 14.3%).

CONCLUSION

Our experiences confirm that the valve implant is still today an alternative surgical procedure for controlling IOP in eyes with refractory glaucoma that have visual potential.

[Polymorphism of the chymase gene and development of retinopathy in type 2 diabetic patients]

Diabetic retinopathy is one of the major causes of blindness in developed countries. Among the factors involved in development of retinopathy genetic factors related to the generation of angiotensin II are mentioned. Recently was described that tissue chymase enzyme is the alternative trait for angiotensin II formulation. The aim of the study was assessment of association of CMA/B hCC polymorphism of chymase gene with the development and progression of diabetic retinopathy. The study was conduced in 587 type 2 diabetic patients with diabetes duration longer than 10 years. Mean age 62.8 +/- 8.58, mean duration 16.7 +/- 5.66, HbA1c 8.23 +/- 1.71, BMI 29.1 +/- 4.91. Ophthalmological examination was performed to determine the presence of retinopathy. Next polymorphism CMA/B hCC chymase gene by PCR method was assessed. Gene distribution was estimated by chi-square test. In the whole examined group no significant changes of gene distribution was found. However, in female group without retinopathy the tendency to lower incidence of GG genotype was observed (p = 0.06). When assessed the female group without retinopathy despite 15 years duration of diabetes frequency decrease of GG genotype was significant (p = 0.04). According to the results we conclude that CMA/B hCC chymase gene polymorphism is associated with the presence of diabetic retinopathy. Association is expressed by decreased frequency of GG genotype in female group without retinopathy.

[The evaluation of the usefulness of phacotrabeculectomy as the only surgery for glaucoma and cataract patients]

PURPOSE

To evaluate IOP changes after phacotrabeculectomy.

MATERIAL AND METHODS

24 glaucoma patients (27 eyes) with coexistence of cataract. Age: 56-79 years. Mean IOP level before surgery: 23.2 +/- 2.4 mm Hg. In all cases phacotrabeculectomy was performed. Follow-up ranged from 3 to 12 months.

RESULTS

IOP decrease after surgery was achieved: mean decrease 7.1 +/- 2.3 mm Hg after 3 months and 5.5 +/- 2.4 mm Hg, and 4.1 +/- 2.1 mm Hg after 6 and 12 months, respectively.

CONCLUSION

Phacotrabeculectomy combines all advantages of phacoemulsification and creates perspective for IOP normalization.

[Keratectomy for a malignant melanoma of the cornea]

PURPOSE

To present the possibility of malignant melanoma treatment of the cornea using keratectomy.

MATERIAL AND METHODS

A 59-year old woman with a primary malignant melanoma of the cornea. Visual acuity before surgery 0.2. Malignant melanoma was removed using keratectomy. Follow-up 18 months.

RESULTS

Satisfactory cosmetic result and visual acuity 1.0 was obtained. In 18 months follow-up no local or general symptoms of tumor recurrence are observed.

CONCLUSION

Keratectomy should be considered as an alternative treatment for primary malignant melanoma of the cornea.

[Glaucoma after penetrating keratoplasty in the material of the ocular department of the Mountain Hospital in Sosnowiec]

PURPOSE

To evaluate the necessity of antiglaucoma therapy in patients after penetrating keratoplasty (PK).

MATERIAL AND METHODS

An analysis of 537 penetrating keratoplasties performed in our department was undertaken. Incidence of glaucoma after penetrating keratoplasty procedure, necessity of pharmacological antiglaucoma treatment as well as the kind of surgical procedure and its influence on the graft transparency were estimated.

RESULTS

The incidence of post keratoplasty glaucoma was 11.2% (60/537). 42 patients required pharmacological treatment (42/60) and the remaining 18 required surgery. 12 trabeculectomies, 6 drainage devices procedures and 1 cyclokrytherapy were performed and stabilization of intraocular pressure was obtained. 14 of the grafts treated surgically lost their transparency.

CONCLUSIONS

Multiple surgical treatment of post-penetrating keratoplasty glaucoma, despite the stabilisation of the intraocular pressure, may lead to loss of graft transparency in most cases.

[Trans-sclerally fixated PC-IOLs: six year of investigations]

PURPOSE

To present the results of PC IOLs transscleral fixation to the ciliary sulcus in six years follow-up.

MATERIAL AND METHODS

152 eyes in 3 groups: 15 eyes with primary fixations of PC IOLs, 92 eyes with secondary fixations of PC IOLs and 45 eyes with secondary fixations of PC IOLs combined with penetrating keratoplasty.

RESULTS

Postoperative corrected visual acuity was 0.5 or better in 32.2% of cases, the most common complications in our material was CME (9.9%), lens tilt (4.6%) and increase of IOP (3.95%).

CONCLUSION

Transscleral fixation of PC IOLs offers good visual outcome with relatively low rate of complications and is recommended in cases with inadequate posterior capsule support.

[Diagnostic-therapeutic procedures in ocular sarcoidosis]

The authors present diagnostic and therapeutic procedure in patients with ocular sarcoidosis.

[Symptomatic eye changes during the course of sarcoidosis]

The authors present ocular changes observed in sarcoidosis. The most frequent features are: symptoms of dry eye and uveitis. Frequency of ocular manifestations leads to the conclusion that ophthalmic examinations ought to be routine procedure at sarcoid patients.

[Evaluation of the usefulness of the laryngeal mask for general anesthesia in eye microsurgery--preliminary results]

PURPOSE

This prospective study was designed to compare intraocular pressure changes and haemodynamic response to insertion of either a laryngeal mask or an orotracheal tube during general anaesthesia for cataract surgery.

MATERIAL AND METHODS

The effect of techniques (tracheal tube-TT, laryngeal mask airway-LMA) securing a clear upper airway on the heart rate changes (HR), arterial pressure (SAP, DAP), oxygen saturation (SpO2), end-tidal carbon-dioxide pressure (Et-CO2), intraocular pressure (IOP) and the incidence of coughing, stridor and sore throat was analysed in 60 patients undergoing cataract surgery during general anaesthesia.

RESULTS

The mean values for HR, SAP, DAP and IOP measured before and after induction of anaesthesia were not different in both groups. After securing a clear airway, mean HR increased in TT group to 95.5/min and decreased to 75.7/min in LMA group. SAP increased in TT group to 131 mmHg, DAP to 82.6 mmHg, whilst in LMA group both values decreased to 98.6 mmHG and 66.3 mmHg, respectively. The significant difference in IOP values was observed after intubation or using laryngeal mask. In TT group, intraocular pressure increased to 15 mmHg in healthy eye and to 13.6 mmHg in ill eye whilst there was a decrease in LMA group to 5.5 and 7.43 mmHg, respectively. Furthermore, a greater incidence of such complications as coughing, stridor and sore throat in TT group was observed.

CONCLUSION

The results show that using LMA in microsurgery during general anaesthesia is more advantageous and safer for patients in comparison with tracheal intubation.

[Treatment of idiopathic blepharospasm with botulinum toxin A]

The preparations of botulinum toxin A--Botox and Porton were injected into the orbicular muscle of eye in 18 patients with idiopathic blepharospasm or Meige's syndrome. Improvement was achieved in 17 patients; in 10 injections should be repeated after about 8 weeks. Minor side effects declined after several days. Injection of botulinum toxin could be effective in this disease, otherwise hard to cure.

[Methods of preventing opacification in the posterior lens capsule after extracapsular cataract extraction]

The methods of extracapsular cataract extraction generated some problems connected with postoperative opacification of the posterior capsule. The authors present clinical and experimental methods applied nowadays, intended to prevent these opacifications from forming.

[Changes of the retinal pigmented layer in familial polyposis of the colon]

Ophthalmoscopic examinations were performed in 96 patients with polyps or another disturbances of the colon, among them 3 cases suffered a histopathologically confirmed familial polyposis of the colon. All 3 cases of the familial polyposis exhibited in the ophthalmological examination pathological changes of the retinal pigment epithelium of both eyes.