[Influence of cornea thickness changes after refractive surgery on intraocular pressure measurements]. / Zmiana grubosci rogówki a pomiar cisnienia wewnatrzgalkowego po zabiegach chirurgii refrakcyjnej.

PURPOSE: Assessment of influence of of the cornea thickness decrease on intraocular pressure (IOP) measurements with Goldmann applanation tonometry in patients after refractive surgery procedures (PRK and LASIK). MATERIAL AND METHODS: 80 eyes in 40 patients (pts) qualified for myopia correction with laser surgery were divided into two groups: in Ist group--20 pts (40 eyes)--PRK procedure was performed and in IInd group--40 eyes (20 pts) LASIK was performed. IOP was measured by Goldmann applanation tonometry. The cornea thickness was assessed in its central region with endothelial microscope with pachymetric facility (Cooper Vision). The eyes were evaluated twice: before and 1 month after the procedure. RESULTS: In all eyes after laser surgery procedures IOP was lower because of the decrease of central cornea thickness. CONCLUSIONS: The central cornea thickness is an important factor influencing intraocular pressure measurements with Goldmann applanation tonometry. Refractive surgery procedures leading to the decrease of central cornea thickness result in lower intraocular pressure measurements in applanation tonometry.

[Corneal scars: confocal images as the basis of qualifying for PTK or PK]. / Blizny rogówki--obrazy konfokalne jako podstawa kwalifikacji do fotokeratektomii terapeutycznej (PTK) lub keratoplastyki drazacej (PK).

PURPOSE: The study aimed to evaluate corneal scars of various origin using confocal microscopy in order to qualify patients for phototherapeutic keratectomy or penetrating keratoplasty. MATERIAL AND METHODS: We studied 21 patients with scars of various origins in 28 corneas. The age of patients (9 women and 12 men) ranged from 27 to 47 years (mean 31.8). In 10 patients (17 corneas) scars were caused by superficial or profound inflammatory processes of viral, bacterial or fungal origin. In 7 patients (7 corneas) the causative factor was blunt or lacerating injury (linear and planar) and in 4 patients (4 corneas) scars developed after the removal of foreign bodies. All corneas were examined using a ConfoScan-P4 scanning slit confocal microscope (Tomey). RESULTS: Post-inflammation scars differed in microscopic appearance, depending on the etiology and clinical state, which affected the mode of treatment. Three scars caused by penetrating trauma were qualified for penetrating keratoplasty. Out of 4 scars caused by non-penetrating trauma, 2 were treated by PTK and 2 by penetrating keratoplasty. In patients with impaired vision after the removal of corneal foreign bodies, confocal microscopy revealed focal areas of increased illumination and intracorneal encrustations. CONCLUSIONS: Confocal microscopy enabled us to determine the structure of corneal scar and the depth at which each scar was located, which helped us to choose between PTK and penetrating keratoplasty. The presence or absence of needle-like structures allowed us to detect inflammatory processes within the scar and to evaluate the state of the remaining corneal tissue.

[Familial corneal degeneration in 3 first-degree relatives: a case study]. / Przypadek zwyrodnienia rogówki zaobserwowany u czlonków tej samej rodziny.

UNLABELLED: Corneal degeneration may differently impair visual acuity. Amniotic membrane grafts produce a favourable effect on the corneal structure and therefore they are used in the treatment of severe corneal degenerations. Amniotic membrane grafts can be used to cover conjunctival defects. THE AIM of this paper is to describe 3 cases of severe corneal degeneration manifesting in pseudopterygium in first-degree relatives who were treated with amniotic membrane grafts. MATERIAL AND METHODS: Six eyes in 3 patients (first-degree relatives) were studied. In 3 eyes (2 patients) pathological corneal lesions were removed, the conjunctiva was reconstructed and covered with amniotic membrane grafts. The follow-up period ranged from 9 to 16 months. RESULTS: The results of the above-mentioned procedure were very promising with respect to visual acuity, corneal structure (assessed by confocal microscopy) and alleviation of symptoms. CONCLUSIONS: Amniotic membrane grafts constitute a promising method for the treatment of severe familial corneal degeneration manifesting in pseudopterygium.

[Recurrent pterygium: removal and plastic procedure with the use of amniotic membrane: a case history]. / Nawracajacy skrzydlik--usuniecie i plastyka z zastosowaniem blony owodniowej--opis przypadku.

AIM: Pterygium is the primitive degenerative and hyperplastic pathology of the conjunctiva. The origin and nature of the primary pterygium lesion is still not fully understood. Surgery is used as a treatment for primary and recurrent pterygium. The surgical techniques applied range from simple surgical removal to complex procedures comprising the treatment of the optical zone and the repair of the conjunctiva. Conjunctival reconstruction may be carried out with free graft of the amniotic membrane. MATERIAL AND METHODS: The paper presents a case history of a patient with 18-fold pterygium removal during the period of last 6 years. The mean recurrence time during the last 2 years ranged between 2-3 months. The pterygium was again removed, and conjunctivoplasty was performed using amniotic membrane. The paper presents the steps of the surgery and the patient's postoperative course. The clinical state and subjective symptoms improved in the postoperative period. The follow-up time was 6 months. RESULTS: The amniotic membrane graft for pterygium surgery is useful for recurrent pterygium in achieving a lower recurrence rate, quicker rehabilitation and agreeable cosmetic result.

[Complicated cataract: Part II: complicated cataract in glaucoma. Part II: Complicated cataract in retinal degenerative disorders]. / Zacma wiklajaca. Czesc II--Zacma wiklajaca w jaskrze. Czesc III--Zacma wiklajaca procesy zwyrodnieniowe siatkówki.

The paper shows pathognomonique cases of complicated cataracts concerning the prognostic aspects of surgical treatment. The article presents surgical methods of treating patients with secondary cataract in high myopia and glaucoma. Modern diagnostic methods are discussed, how to choose the safest surgical technique and to reach the desired postoperative refraction. More effective ways of cataract surgery in patients with glaucoma and in high myopia are suggested.

[Complicated cataract. Part I: complicated cataract in uveitic patients]. / Zacma wiklajaca. Czesc I--Zacma wiklajaca zapalenia blony naczyniowej.

The paper shows pathognomonique cases of complicated cataracts concerning the prognostic aspects of surgical treatment. The article presents methods of treatment in cases with uveitic cataract. Modern diagnostic methods are discussed, how to choose the safest surgical technique and to reach the desired postoperative refraction. More effective ways of cataract surgery in uveitis patients are proposed.

[Assessment of cornea thickness in patients after refractive surgery]. / Ocena grubosci rogówki po zabiegach laserowej chirurgii refrakcyjnej.

PURPOSE: To assess changes of central cornea thickness after Excimer laser procedures--photorefractive keratectomy (PRK) and in situ keratomileusis (LASIK). MATERIAL AND METHODS: In 80 eyes of 40 patients the Excimer laser procedure was performed. Patients were divided into 2 groups: the 1st after PRK and the 2nd after LASIK procedure. Pachymetric measurements of cornea were performed before and 6 months after procedure. RESULTS: In both groups the thickness of the cornea was significantly lower after procedure. In the 2nd group the changes were greater. CONCLUSION: Excimer laser refractive surgery produces significant decrease in cornea thickness. The change in corneal thickness correlates with the change in spherical equivalent refraction.

[The state of anterior eye segment after posterior chamber intraocular lens implantation with transscleral fixation]. / Stan przedniego odcinka galki ocznej z soczewka tylnokomorowa mocowana do twardówki.

PURPOSE: The aim of the study was to evaluate the state of anterior eye segment in postoperative period after PC-IOL transscleral fixation. MATERIAL AND METHODS: The material comprised 31 eyes in 31 patients, (11 women and 20 men), aged 20-80 years (average 61 years), who underwent the primary or secondary PC-IOL implantation with transscleral fixation. The examination was performed 10 to 14 months (average 12 months) after surgery. The clinical state of the corneas was evaluated using endothelial and confocal microscopy. The position of the IOL, its location and symmetry were evaluated with ultrasound biomicroscopy. RESULTS: The visual acuity ranged from 0.1 to 1.0. In 20 eyes (64%) the position of PC-IOL was correct. In the rest of cases the inappropriate position of implants was observed. The decrease of endothelial cells density was 13% in eyes with primary implantation and 7% in cases with secondary implantation of IOL. In the corneal endothelium, there were features of pleomorfism and polymegatism; in a few cases some deposits were observed. CONCLUSION: The implantation of posterior chamber intraocular lenses with transscleral fixation is recommended for some cases of primary or secondary problems with capsule support. The PC-IOL implantation with transscleral fixation can be the alternative method for the anterior IOL implantation.

[Iron deposits in cornea in confocal microscope]. / Zlogi zelaza w rogówce w mikroskopie konfokalnym.

PURPOSE: The study aimed to evaluate the iron deposits in corneas in confocal microscope. MATERIAL AND METHODS: The material comprised 16 eyes which underwent photorefractive keratectomy (PRK) procedure. The structure of corneas was evaluated between 3-10 years after PRK. The visual acuity after PRK was the same as the best corrected visual acuity before the procedure. The structure of corneas was evaluated in vivo using scanning slit confocal microscopy. The confocal images of corneas in patients after PRK were compared with confocal corneal images of patients with corneal scars (2 eyes), keratoconus (2 eyes), after radial keratotomy (RK) (2 eyes) and healthy patients. RESULTS: Within the central part of corneal epithelium and anterior part of stroma, the clusters of iron deposits were observed. They were round and produced different shapes. In the paracentral and peripheral part of corneas the subepithelial nerve plexus was detected. Beneath, the pattern of keratocytic nuclei, characteristic for state after PRK, was detected. In patients with corneal scars, keratoconus and after RK, the same clusters of deposits were detected. In cases of corneal scars, additionally high reflectivity of corneal structure was observed. CONCLUSIONS: The iron deposits in corneal structure arise in epithelium and anterior part of corneal stroma. The iron deposits which produce different shapes have no influence on visual acuity.

[Treatment of corneal ulcerations with use of the amniotic membrane]. / Leczenie owrzodzen rogówki z zastosowaniem blony owodniowej.

UNLABELLED: Corneal ulcerations may cause complications such as, for example, the loss of transparency, descemetocele or perforation of the cornea. Widely used therapies do not always bring expected results. Recently the amniotic membrane has been applied for the treatment of corneal ulceration. PURPOSE: The purpose of the present study was to evaluate the efficacy of the amniotic membrane suturing over the locations of corneal ulcers. MATERIAL AND METHODS: The amniotic membrane was sutured over the locations of corneal ulcers in 9 eyes of 9 patients suffering from ulcers which did not regress with traditional therapeutic methods. After meticulous debridement of the ulcer floor and border area the amniotic membrane was sutured to the cornea with a single 10.0 Nylon suture (around the ulcer area), and additionally suture were fixed to the sclera. Following the procedure contact lenses were placed over the area for protection. The observation period was 6 months. Follow-up examinations were performed regularly during the first seven postoperative days, then after 2, 4 and 12 weeks; the final follow-up took place 6 months after the procedure. RESULTS: In all patients we observed healing of the corneal defect, improvement of visual acuity and regression of the active inflammatory process. After this procedure the subjective symptoms subsided. CONCLUSION: The amniotic membrane can be used for the treatment of corneal ulceration of various etiology.

[Structural changes in the cornea after LASIK-u during the early postoperative period]. / Zmiany struktury istoty wlasciwej rogówki po LASIK-u we wczesnym okresie pooperacyjnym.

PURPOSE: The study aimed to evaluate in vivo the corneal structure after refractive surgery and monitor morphologic and morphometric changes in the post-operative period. MATERIAL AND METHODS: The study included 35 eyes (25 patients) who underwent LASIK correction of myopia. The structure of the cornea was evaluated in vivo using a scanning slit confocal microscope. Each cornea was examined before, 2, 4 and 8 weeks after procedure. The keratocyte density was evaluated morphometrically in the anterior and posterior corneal stroma. RESULTS: Before surgery the keratocyte density in the anterior stroma ranged from 900 to 1200/mm2, while in the posterior stroma it ranged from 600 to 950/mm2. 8 weeks after LASIK the keratocyte density in anterior stroma ranged from 695 to 1048/mm2 and in posterior stroma from 565 to 935/mm2. CONCLUSIONS: After LASIK the keratocyte density decreases in anterior stroma while in posterior stoma it is constant.

[Changes in corneal structure observed with confocal microscopy during Fuchs endothelial dystrophy]. / Zmiany struktury rogówki obrazowane w mikroskopii konfokalnej w przebiegu dystrofii Fuchsa.

PURPOSE: The study aimed to in vivo evaluate corneal structure in Fuchs' dystrophy. MATERIAL AND METHODS: Forty-two eyes of 21 patients (11 women and 10 men) aged 34-80 (mean 60.8) were studied. Sixteen patients presented clinical symptoms. The cornea was examined using a Confoscan P4 scanning slit confocal microscope (Tomey). Before examination, the cornea was anesthetized with 0.5% propacaine (Alcaine, Alcon) in order to inhibit the corneopalpebral reflex. A 40x microscope objective was covered with a drop of polyarylic acid gel (Vidisic, Mann Pharma) and then it was moved horizontally close to the patient's cornea and the examination was carried out. RESULTS: In the early stage of Fuchs dystrophy, slit biomicroscopy revealed fine dark spots within the corneal endothelium, while in the advanced stage the cornea had the appearance of beaten metal. On confocal microscopy, there were diffused hyporeflective areas in the early-stage disease. The endothelial cells located beyond these areas were pleomorphic and polymegathic. In the late stage we observed diffused hyporeflective areas surrounded by hyperreflective endothelial cells, which could not be analyzed separately. Within the corneal stroma, the collagen fibers were blurred and the background illumination was increased. In the posterior part of the stroma, dark bands were seen. The epithelium contained cystic structures (blisters). The membranes of the basal cells were thickened and the background illumination was increased. CONCLUSIONS: Confocal microscopy allows to diagnose Fuchs dystrophy and visualize endothelial cells within the swollen cornea.

[Correction of myopia with LASIK--two year observation]. / Korekcja krótkowzrocznosci metoda LASIK--dwuletnie obserwacje.

PURPOSE: The purpose of this study was to evaluate the clinical results of correction of moderate and high myopia as well as myopic astigmatism with LASIK. MATERIAL AND METHODS: 112 randomly selected eyes (79 patients) were analyzed after LASIK. In this group there were 55 women and 24 men aged 17 to 50 (mean 34.9). The eyes were divided into two groups (the first: between -8.0 D to -14.75 D; the second: between -15.0 D to -23.0 D). The follow-up time was 24 months. The effectiveness of this method was evaluated on the basis of the best visual acuity without correction after LASIK procedure compared to the best visual acuity with correction before LASIK. The course of the healing process, the state of cornea and subjective symptoms were also evaluated. RESULTS: One week after the operation (after LASIK) a statistically significant decrease of mean visual acuity was observed. In group I after 2 weeks the mean visual acuity was in the same range of values compared with the visual acuity before the operation. In the next period no statistically significant were observed differences. In group II after 2, 4, and 12 weeks the mean visual acuity was equalized in comparison with the mean visual acuity before correction. After 6, 12 and 24 months statistically significant improvement of visual acuity was observed. CONCLUSION: On the basis of our own observations we can say that LASIK is an effective and safe method of myopia and myopic astigmatism correction.

[New generation of excimer laser--Asclepion Meditec MEL 70 G-Scan]. / Nowa generacja lasera excimerowego--MEL 70 G-Scan firmy Asclepion-Meditec.

The new Asclepion-Meditec MEL 70 G-Scan represents a breakthrough in surgical application of excimer laser. The laser uses the latest generation of flying spot system which utilizes a SafeScan algorithm (patent pending) to avoid corneal surface irregularities. The system utilizes a Gaussian beam profile. In cases where the cornea has regular surface, the conventional excimer laser PRK or LASIK method will provide good results. If the cornea shows an irregular surface shape, custom-tailored, topography-based ablation, which has been adapted to the corneal irregularity, should provide better results. Asclepion-Meditec have added a TSA (Tissue saving Algorithm) module to TOSCA (Topography Supported Customized Ablations) software for carrying out topography-guided corrections. This module automatically minimises the tissue removal when calculating the correction program. MEL 70 G-Scan allows to treat all forms of refractive errors, myopia and myopic astigmatism -24 D sph, -12 D cyl, hyperopia and hyperopic astigmatism +16 D sph, +8 D cyl, mixtus and irregular astigmatism.

[Observation of the cornea with confocal microscopy after Nd:YAG laser capsulotomy]. / Obserwacja rogówek w mikroskopii konfokalnej po zabiegach kapsulotomii laserem Nd:YAG.

PURPOSE: The purpose of the study was to evaluate the influence of Nd:YAG capsulotomy on the cornea structure assessed by scanning slit confocal microscopy. MATERIAL AND METHODS: 14 eyes in 14 patients after Nd:YAG laser capsulotomy performed 6-34 months after extracapsular cataract extraction with PCIOL implantation were observed. Structure of cornea layers was evaluated before the procedure, then 3 hours and 7 days after the laser exposition using confocal microscope. RESULTS: Initial evaluation showed degenerative changes in subepithelial plexus; 3 hours after the procedure excessive exfoliation of superficial epithelial cells was observed. No significant changes were registered 7 days after the procedure. CONCLUSION: No significant changes were found in the confocal microscopy images of cornea after Nd:YAG capsulotomy.

[Eight year results of excimer laser correction for irregular astigmatism by linear excimer laser photoablations of the cornea in cases of keratoconus]. / Osmioletnie wyniki korekcji astygmatyzmu nieregularnego metoda linijnych fotoablacji laserem excimerowym w przypadkach stozka rogówki.

PURPOSE: The purpose of this study was to evaluate changes of the corneal curvature as a result of linear incisions with excimer laser and also to evaluate durability of the achieved effect, including the changes in visual acuity, topographic maps of the corneal curvature and keratometric changes at the location of keratoconus 2, 4, 8, 16, 24 weeks postoperatively. MATERIAL AND METHODS: At the First Department and Clinic of Ophthalmology, Silesian Medical School in Katowice, 294 patients went through ophthalmological examinations. 164 patients (187 eyes) with the III degree of keratoconus according to the Amsler scale, including 69 women (77 eyes) and 95 men (110 eyes), were classified for the excimer laser surgery with the method of linear, corneal incisions with MEL-60 (Aesculap-Meditec). The eyes did not tolerate contact lenses at all or because of peripheral location of the keratoconus. The patients were from 16 to 60 years of age (the mean age was 27.9 years). RESULTS: According to the statistical results, there were no difference between the effects of treatment between men and women. Correlation between the results of the surgery and the patients age showed that the latter did not have any effect on the final result. Lack of correlation between the height of the absolute corneal curvature at the keratoconus and the achieved change after the surgery was reported, thus changes of the corneal curvature parameters do not depend on its parameters before the surgical procedure. Absolute visual acuity of patients was improving and reached maximally 0.252 of the unit. As a result of the single surgery, the maximum change of keratometric values was 4.949 D, and the minimum was 3.611 D. In the case of the secondary surgery, the maximum keratometric value at the axis of the incision was 8.55 D and the minimum one was 7.101 D. CONCLUSION: To sum up, we can say that the favourable effect of decreasing the irregular corneal astigmatism with the method of linear laser fotoablations was maintained throughout the whole observation period, which allowed to shift in time planned corneal transplantation.

[Correction of irregular astigmatism using excimer laser MEL 70 G-Scan with the TOSCA program--introductory report]. / Korekcja niezbornosci nieregularnej przy uzyciu lasera excimerowego MEL 70 G-Scan z programem TOSCA--doniesienie wstepne.

PURPOSE: The purpose of this study was to evaluate changes of the corneal curvature as a result of excimer laser ablation using the TOSCA and TSA system. MATERIAL AND METHODS: At the First Department and Clinic of Ophthalmology, Silesian Medical School in Katowice, 8 patients (8 eyes) with the II and III degree of keratoconus according to the Amsler scale, including 4 women (4 eyes) and 4 men (4 eyes), were classified for the excimer laser surgery with the method of PRK with TOSCA program and TSA system with MEL 70 G-Scan (Asclepion-Meditec). The eyes did not tolerate contact lenses at all or because of peripheral location of the keratoconus. The patients were from 18 to 42 years of age (the mean age was 25.8 years). The observation period was 4 weeks. RESULTS: According to the statistical results lack of correlation between the height of the absolute corneal curvature at the keratoconus and the achieved change after the surgery was reported. The improvement of patients absolute visual acuity was improving and reached 0.2 of the unit. CONCLUSION: To sum up, we can say that the favourable effect of decreasing the irregular corneal astigmatism with the method of laser fotoablations with topography-controlled system was maintained throughout the whole observation period, which probably allowed to shift in time planned corneal transplantation.

[The significance of computer video-keratography in refractory surgery of the cornea]. / Znaczenie komputerowej wideokeratografii w chirurgii refrakcyjnej rogówki.

In this review authors explain the meaning of CVK in refractive surgery; before the procedure and in the postoperative period. A special attention is paid to the postoperative complications.

[The alterations in corneal structure at III/IV stage of keratoconus by means of confocal microscopy and ultrasound biomicroscopy before penetrating keratoplasty]. / Zmiany struktury rogówki w III/IV stopniu stozka rogówki obrazowane badaniami mikroskopii konfokalnej i biomikroskopii ultradzwiekowej przed przeszczepem drazacym.

PURPOSE: The aim of the study was in-real time observation and morphological evaluation of the human corneas at III/IV stage of keratoconus, using the scanning slit confocal microscope Confoscan P4 and ultrasound biomicroscopy--UBM. MATERIAL AND METHODS: The patients with keratoconus were examined according to the Amsler scale. The material consisted of 12 corneas of 11 patients (8 men, 3 women), where assessment of the corneal structure was performed with the confocal microscope ConfoScan P4 (Tomey) and ultrasound biomicroscopy--UBM Model 840 (Humphrey Instruments). The comparison of different corneal regions (central and peripheral) was evaluated. RESULTS: The confocal microscopy and UBM revealed thinning of the layers of the corneal structure and pathological changes in the central area, especially at IV stage of keratoconus. The desquamating superficial cells were elongated, arranged around the apex of the cornea. Below the Bowman's membrane a considerable disarrangement of collagen fibers reflected by bright background illumination was observed. In the posterior part of the stroma the folds were detected. The examination of the cornea showed thickening in the peripheral part, central detachment of the Descemet's membrane and the endothelium from the posterior surface of the cornea. The thickness of the cornea varied from 0.201 to 0.384 mm in the central part and 0.675 to 0.740 mm in the peripheral area. CONCLUSION: Confocal scanning microscopy combined with ultrasound biomicroscopy enables the cornea to be examined in vivo. It can be used to localize pathological changes in individual corneal layers and to assess their extent.

[Results of radial keratotomy and photorefractive keratectomy in patients' assessment]. / Wyniki keratotomii radialnej i fotokeratektomii refrakcyjnej w ocenie pacjentów.

PURPOSE: The aim of the study is the presentation of RK and PRK results in patients' assessment. MATERIAL AND METHODS: Questionnaire forms were sent to 100 patients after RK and 120 after PRK between 12 and 24 months after surgery. Preoperative refractive error in both groups was similar: -6.76 D sph in RK group and(--)-6.25 D sph in PRK group. Questionnaire forms consisted of 12 questions about the decision of operation, its course, possible complications and results. RESULTS: 76 (76%) patients after RK and 94 (78.25%) after PRK answered the questionnaires. 96% of patients after RK and 98.9% after PRK were satisfied with achieved results. 56.4% of PRK and 29% of RK patients answered that healing was painful and very painful. 57% of patients after RK and 49% after PRK complained of complications after surgery (fluctuations of vision, glares). Majority of patients in both groups would accept the procedure again. CONCLUSIONS: Both RK and PRK were positively assessed by the patients, however slightly higher level of satisfaction was in PRK group. There were also fewer complications in this group.