[Analysis of 100 cases of retinal detachment treated with conventional surgery in the years 1997-1998]. / Analiza 100 przypadków odwarstwienia siatkówki leczonych konwencjonalnymi metodami w latach 1997-1998.

PURPOSE: The observed increasing number of severe cases of retinal detachment was the ground of the attempt to state the causes of this phenomenon. MATERIAL AND METHODS: Retrospective evaluation of 100 consecutive cases of retinal detachment operated on with conventional methods between September 1997 and October 1998 was performed. The following data were analysed: sex and age of patients, period between the first symptoms and time of diagnosis and surgery. The clinical characteristics of retinal surgery comprise: extent of detachment, macular involving, type and number of breaks, degenerations and PVR. RESULTS: In the majority of cases very severe retinal detachments were observed, including 3-4 quadrants, with large tears or multiple breaks, with PVR B or C. Duration of the detachment ranged from several days in very few cases to several months, on average lasting several weeks. Attachment of the retina was achieved in 80 cases, improvement of the visual acuity in 47. CONCLUSION: Our data indicate the necessity to improve the early diagnosis of retinal detachment and changes predisposing to its development.

[Arteriovenous communication of the retina--case report]. / Polaczenie tetniczo-zylne siatkówki--opis przypadku.

In this paper I have described a rare case of typical arteriovenous communication of the retina (ACVR), also called racemose haemangioma, but with some atypical traits. A case of a young white 22-year-old woman is presented. AVCR was recognised in her left eye, II stage according to Archer's classification, therefore neither intracranial haemangioma nor vascular decompensation of retina was observed. In the standard ophthalmic examination, including automated perymetry and fluorescein angiography, the following phenomena were not seen yet or they were rarely described: pigmented muffs on some changed vessels, mainly nasal location of AVCR, parallel AVCR existed between both great and precapillar vessels and macular changes: yellowish ring surrounded the central fovea. Visual acuity of the affected eye was 1.0 and the patient did not complain about it.

[Risk factors for age-related macular degeneration]. / Czynniki ryzyka zwyrodnienia plamki zwiazanego z wiekiem.

PURPOSE: To present the results of examinations of the risk factors for age-related macular degeneration (AMD) carried out in the last 3 years. MATERIAL AND METHODS: Our clinical material comprised 119 patients, 69 women and 50 men, aged 43-85, mean age 70 years. Using classification according to the worse eye, there were 20 patients with drusen, 27 with atrophic changes and 72 with exudative form and AMD. The following risk factors were evaluated: age, sex, body mass index, history of general medical conditions, cigarette smoking, sun exposure, family history of AMD and ocular conditions such as iris color, lens opacities, hyperopia, gerontoxon and changes in retinal vessels. RESULTS: The significant relationships were found between the development of AMD and the age of patients, as well as between the advanced forms of AMD and the history of cardiovascular diseases and sclerotic changes in retinal vessels, 87% of examined patients have light iris and 52% body mass index above 26. CONCLUSIONS: The studies confirmed the role of age in the development of AMD and indicated cardiovascular disturbances, increased body mass index and light iris as the possible risk factors for AMD that are most worth further studying. The special attention should be also paid to drusen as the risk factor of AMD.

[Conventional methods in retinal detachment surgery]. / Konwencjonalne metody w chirurgii odwarstwienia siatkówki.

PURPOSE: To evaluate the usefulness of conventional methods in retinal detachment (RD) surgery basing on the relationship between factors characterizing clinical picture of the RD, the type and course of surgical procedures and the retinal reattachment. MATERIALS AND METHODS: 252 patients (252 eyes), operated on in the last 5 years in our clinic were enrolled in the studies. There were 120 men and 132 women, aged 9 to 83, mean 53. In all cases scleral buckling procedures with silicone band or sponge and cryocoagulation of the breaks were used. The relationship between retinal reattachment and the following parameters were examined: visual acuity, retinal degenerations, myopia, extent of the detachment, number and kinds of breaks, macular involvement, state of vitreous, PVR, intraocular pressure, extent of scleral buckling, subretinal fluid drainage and intra- or post-operative complications. RESULTS: Retinal reattachment was achieved in 82% of the eyes with one operation and additionally in 7% after reoperation. The significant relationship was found between: visual acuity, intraocular pressure, extent of the detachment, number of breaks, PVR, extent of scleral buckling and retinal reattachment. CONCLUSION: PVR is a significant cause of failure in RD surgery with conventional methods and PVR grade C is the threshold beyond which the percentage of reattachments decreases to about 50%. Value of other risk factors, determining severity of RD is not certain for prognosis. Cerclage with silicone band is a method of choice in the majority of RD with PVR grade B and C. Our observations do not confirm the reports of severe complications caused by cerclage, which might be connected with excessive tightening of the band.

[Value of silicone sponge in retinal detachment surgery]. / Wartosc gabki sylikonowej w operacjach odwarstwienia siatkówki.

Lincoff's development of silicone sponge and substitution cryosurgery for diathermy in the mid-1960s, was the beginning of the minimized surgery for retinal detachment, limited to the surgery of the breaks. The aim of this paper is to present our experiences with these kinds of operations, with special attention to the complications causing the necessity of removing the sponge. Our studies concerned the patients who underwent retinal detachment surgery, in the Ophthalmological Clinic in Cracow in the years 1983-1992, using scleral buckling procedures with silicone sponge. In 152 cases circumferential and in 36 radial local scleral buckling procedures were performed; in 30 cases local buckling was added to encirclement with silicone band. The complications, attributed to the sponge, were observed in 9.7% of cases. Anterior segment inflammatory reactions, often sterile were found in 15 eyes, in 7 of them it was necessary to remove the sponge. In 13 eyes the sponge was removed on account of its extrusion. In none of the cases removal of the sponge influenced the retinal attachment. Our studies confirmed, that silicone sponge is a very good material for scleral buckling procedures.

[Drainage of subretinal fluid in our clinical studies]. / Drenaz plynu podsiatkówkowego w swietle wlasnych badan.

The studies comprised 531 patients (544 eyes) who underwent retinal detachment surgery in the Ophthalmological Clinic in Cracow, in the years 1983-1992. Drainage of subretinal fluid was performed in 54.6% of the eyes and in this group attachment of the retina was achieved in 72.4% of cases; in the group of patients with nondrainage operations it was 74.5%. Intraocular haemorrhages, the only complications, which may be attributed to the drainage of subretinal fluid were found in 18.9% of eyes with drainage and in 8.1% without; this difference was statistically significant (p < 0.01). Statistically significant relationship (p < 0.01) was also found between subretinal fluid drainage and severity of the retinal detachment. The results showed that there were no significant relationships between drainage of subretinal fluid and the results of surgery and that it is indicated first of all in severe cases of retinal detachment in which method of choice is an encirclement procedure.

[Relationship between results of retinal detachment surgery and method of attachment]. / Zaleznosc miedzy wynikami leczenia operacyjnego odwarstwienia siatkówki a rodzajem blokady otworów.

Basing on the clinical material of the years 1984-1991 the authors have compared the results of retinal detachment surgery in two groups of patients, depending on the method of adhesion. Diathermy was used in 182 eyes (group I) and cryosurgery in 274 (group II). Retinal attachment was achieved in 69% of the eyes in group I and in 74% in group II. Inadequate closing of the breaks was the cause of failure in 22.8% of the cases in group I and in 30.6% in group II. Various changes of the macula were observed in 31% of the eyes in group I and in 24.5% in group II. Statistically significant relationships were found between method of adhesion and: development of PVR (p < 0.05), appearance of pigmentary changes in the eye ground (p < 0.01) and cicatrization of the breaks (p < 0.01). Stronger cicatrization was observed after cryosurgery as well as the pigmentary changes in the fundus which have not influenced the results. The studies revealed that no significant differences depending on the method of adhesion were found in results of retinal detachment surgery.

[A case of Stickler's syndrome]. / Przypadek zespolu Stickler'a.

The authors presented a case of Stickler's syndrome diagnosed in 56-year-old woman referred to the clinic because of cataract in both eyes. After surgery typical vitreo-retinal changes mainly extensive lattice degenerations, pigmentary lesions and preretinal membranes in vitreous were found. Orofacial and musculoskeletal abnormalities confirmed diagnosis.

[Use of photocoagulation during surgery for retinal detachment]. / Zastosowanie fotokoagulacji w operacjach odwarstwienia siatkówki.

On the basis of a 10-years clinical material comprising 95 eyes operated for retinal detachment in the Department of Ophthalmology in Krakow the authors evaluated the usefulness of xenon and laser coagulation as a method complementing the blockade of the retinal holes. It had been used in 18 p.c. of all operated eyes attaining in this group of cases the re-apposition of the retina in 61 p.c. The efficacy of the coagulation depended on the adherence of the retina and showed itself as formation during the surgery of visible foci and the development of a distinct, pigmented scar. There were no complications connected with photocoagulation as well the xenon as the laser one; all this encourages to employ both these methods.

[Late results of surgical treatment of retinal detachment by the cerclage method using a silicone band]. / Odlegle wyniki leczenia operacyjnego odwarstwienia siatkówki metoda opierscienienia tasma sylikonowa.

Presented are the results of control examination performed in 121 patients in the period of 3 to 8 years after retinal detachment operation by the silicone band encircling method. Evaluated were: the anatomical reattachment, function of the eye and the cosmetic effect. The retina reattached in 63.2 p.c. of eyes. The visual acuity for far was at least 0.1 in over one half (55 p.c.) of eyes and for near 2.0 or more in 78.5 p.c. Among the persons examined by means of Amsler's test and Panel D-15 test a correct response was attained by -- respectively -- 44.7 p.c. and 76.1 p.c. of the examinees. A very good cosmetic effect was achieved in 44.9 p.c. and a good one in 47.2 p.c. of eyes.