Correction of high myopia with different phakic anterior chamber intraocular lenses: ICARE angle-supported lens and Verisyse iris-claw lens.

PURPOSE: To evaluate the efficacy, predictability and safety of implanting two models of anterior chamber IOLs for high myopia. Comparison of the refractive results between two groups of patients implanted with different IOLs. MATERIALS AND METHODS: Forty eyes were implanted with phakic IOLs. The ICARE myopia lens was implanted in 20 eyes of 12 patients with preoperative myopia that ranged from -21.875 to -10.0. The mean patients' age was 30 years. The Verisyse IOL was implanted in 20 eyes of 12 patients with spherical equivalent of the refractive error from -21.625 to -10.375D, and the mean patients' age was 32.25 years. The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up period was 12 months. RESULTS: Twelve months after surgery, the mean refractive error (SE) was -0.19D (100% of eyes were within +/-1.0D of the target refraction) in the ICARE group, and -0.86D (95% of eyes were within +/-1.0D of the target refraction) in the Verisyse group. The postoperative refraction remained stable during the entire follow-up period. The mean uncorrected visual acuity was 0.7 in the ICARE group, and 0.69 in the Verisyse group 1 year postoperatively. There was no loss in visual acuity 1 year after surgery in the ICARE implanted eyes, one patient in the Verisyse group lost 1 line of BCVA as compared to the preoperative state. Mean endothelial cell density loss was 6.12% and 6.79% in the ICARE and Verisyse groups, respectively. There were no statistically significant differences regarding the analyzed outcome parameters between the two study groups. CONCLUSION: The implantation of both anterior chamber phakic intraocular lenses to correct high myopia resulted in a stable and predictable refractive outcome. Efficacy and safety of surgery for both implanted lens models are very high.

[Ranibizumab for treatment of exudative age-related macular degeneration--own experience]. / Zastosowanie ranibizumabu w leczeniu wysiekowego AMD--doswiadczenia wlasne.

UNLABELLED: It is commonly agreed nowadays that one of the key elements of neovascular age-related macular degeneration (AMO) pathogenesis is deregulation of the angiogenesis factors. Treatment of subfoveal choroidal neovascularizations (CNV) in course of AMD was limited to photodynamic therapy with verteporfin (PDT). The new approach to CNV treatment is to discover and eliminate factors, which directly induce CNV development. Extended studies have allowed to employ inhibitors of vascular endothelial growth factor (VEGF) for a treatment of neovascular AMD. Numerous of anti-VEGF compounds are still under developing in pre-clinical or phase-1/2 clinical studies whereas 2 of them have completed phase 3 of clinical trials. The newest compound that was launched on drug market is ranibizumab (Lucentis). Ranibizumab is a recombinant humanized IgG1 isotype, monoclonal antibody fragment designed for intravitreal use. Ranibizumab binds to and inhibits the biologic activity of human vascular endothelial growth factor A (VEGF-A). It has been proved on the base of MARINA and ANCHOR clinical trials that treatment ranibizumab is effective and save for patients treated for CNV secondary to AMD. PURPOSE: Interventional case series. MATERIAL AND METHODS: 67 eyes of 67 patients with all angiographic subtypes of wet AMD were treated with 0.5 mg of intravitreal ranibizumab, injected monthly for first 3 doses. Next doses were injected according to specified re-treatment criteria as assessed in monthly follow-up. RESULTS: Mean change in visual acuity (VA) was +12.4 ETDRS letters. Percent of patient losing less than 15 ETDRS letters was 93.2%. Percent of patient gaining VA more than 3 ETDRS letters was 43.4%. CONCLUSIONS: Intravitreal ranibizumab is effective in treatment of CNV due to AMD. A significant number of patients have improved theirs VA. Implementation of anti-VEGF therapy for treatment of ocular diseases gave a new hope for patient that previously couldn't be treated with any of method.

[Non-penetrating deep sclerectomy in the treatment of advanced cases of open angle glaucoma]. / Zastosowanie nieprzenikajacej sklerektomii glebokiej w leczeniu zaawansowanych postaci jaskry pierwotnej otwartego kata przesaczania.

PURPOSE: The purpose of the paper was to examine the efficacy of non-penetrating deep sclerectomy (NPDS) with sodium hyaluronate implants and mitomycin C in the treatment of advanced cases of open angle glaucoma. MATERIAL AND METHODS: Thirty-five eyes of 35 patients with medically uncontrolled advanced open angle glaucoma were retrospectively analyzed. Visual acuity and intraocular pressure measurement were performed before and after surgery at 1 and 7 days and 1, 6 and 12 months. Visual field was analyzed before and 12 months after surgery. RESULTS: The mean preoperative intraocular pressure was 27+/-3.1 mm Hg and 18.1+/-1.5 at 12 month after surgery (p<0.05). Visual acuity decreased more than two rows on Snellen chart in 4 patients. Visual field analysis shows mean defect MD--17+/-5.2 before surgery and 20.1+/-6.2 after 12 month of follow up (p>0.05). Complete success rate defined as an IOP lower than 21 mmHg without medications was 51%. In 3 eyes we performed needling and in 8 goniopuncture. Postoperative complications included hyphaema in 3 eyes, choroidal detachment in 1 eye, bleb fibrosis in 2 eyes. CONCLUSIONS: 1. Deep sclerectomy with SK-GEL implant and antimetabolites provided good reasonable control of intraocular pressure. 2. In uncomplicated cases it let us achieve stabilization of the visual field.

[Laser therapy in the treatment of glaucoma]. / Zastosowanie laseroterapii w leczeniu jaskry.

PURPOSE: The paper is presenting the possibility of laser surgery in the treatment of glaucoma, new operations, and laser equipment. In the treatment of primary open angle glaucoma, argon laser was replaced by diode laser with continuous wave and in recent years by Nd:YAG Q switch, second harmonic 532 nm. This laser allows ophthalmologists for selective photoablation of cells with pigment in trabeculum without thermal effect. The introduction of fibers to transport energy let us increase accuracy and efficacy of laser therapy. Application of excimer lasers 308 nm enables to perform trabeculectomy by internal (ELT) and deep sclerectomy. After NPDS we sometimes have to use Q switch Nd:YAG for goniopuncture, to prolong filtration function of trabeculum--Descemet membrane. In primary angle closure glaucoma the most often laser treatment is iridotomy and gonioplasty. Laser cyclodestructive procedures almost completely eliminated cyclodiathermy and cyclokriotherapy, which were performed so far. The main cyclophotocoagulative procedures are contact transscleral cyclophotocogulation, transpupillary cyclophotocoagulation and intraocular cyclophotocoagulation. CONCLUSIONS: 1. The introduction of lasers enables safer, quicker and more effective antiglaucoma operations. 2. New laser equipment increases efficacy of so far performed laser surgery. 3. Laser surgery allows for the resignation of patients hospitalization and thereby enables to decrease the cost of treatment, and to increase the comfort of patients.

Transscleral cyclophotocoagulation in the treatment of secondary glaucoma.

BACKGROUND: The purpose of this study was to evaluate the results obtained by using transscleral cyclophotocoagulation (TSCPC) in the treatment of refractory secondary glaucoma. Our study attempted to assess the functional effects of TSCPC in different types of secondary glaucoma. MATERIAL/METHODS: We studied 83 eyes in 81 patients: 52 men and 29 women, aged 9-88 years old (mean 52.8+/-21.85). Contact transscleral cyclophotocoagulation was performed with an OcuLight SLx photocoagulator using a G probe. The follow-up period was 12 months. All the eyes were photographed for documentation of details. RESULTS: The mean intraocular pressure (IOP) significantly decreased, from 46+/-12 mmHg at baseline to 18+/-6.4 mmHg (p<0.05) at the end of the 12-month observation period. Average visual acuity showed no statistically significant changes. The number of TSCPC procedures ranged from 1 to 4. The number of anti-glaucoma drugs decreased from 2.8+/-0.9 to 1.9+/-0.9 (p<0.05). The T/E coefficient was the lowest in pediatric secondary glaucoma (p<0.05). Most of the severe complications developed in neovascular glaucoma (p<0.05). CONCLUSIONS: Contact transscleral cyclophotocoagulation effectively decreases intraocular pressure and the number of anti-glaucoma medications and also alleviates pain in the majority of patients with severe secondary glaucoma. Patients with neovascular glaucoma are at the highest risk of severe complications following TSCPC. TSCPC was the least effective in patients with refractory pediatric glaucoma. Since there is a risk of photocoagulative damage to the sclera and conjunctiva, areas of hyperpigmentation, hemorrhage and scleral thinning should be avoided.

[Frequency of neovascular lesion types in wet age-related macular degeneration]. / Czestosc wystepowania róznych postaci neowaskularyzacji podsiatkówkowych w przebiegu wysiekowego zwyrodnienia plamki zwiazanego z wiekiem.

Age-related macular degeneration (AMD) is the most common cause of legal blindness among the urbanized world. Neovascular type of the disease which is responsible for majority of severe vision loss in course of AMD has received few years ago a new treatment modality--photodynamic therapy (PDT) with verteporfin (Visudyne). Efficacy of PDT depends on angiographic feature of chorioneovascularization (CNV). There are three main types of CNV: predominantly classic, minimally classic and occult with no classic CNV. No population studies on prevalence of these types are available. We analyzed fluorescein angiography (FA) performed in Eye Clinic of Silesian School of Medicine in Katowice, Poland. FA were performed between January 2002 and March 2004. 2942 cases of CNV due to AMD was identified and their type was stated. Statistical assessment of CNV types frequency was executed. CNV location and size was defined as well. Visual acuity data from patients medical history was used for deeper analysis.

[Pterygium: allergic etiology?]. / Skrzydlik--etiologia alergiczna?

Pterygium is a wedge-shaped fibrovascular growth of conjunctiva that extends onto the cornea. The etiopathogenesis of pterygium is still not fully elucidated. Exposure to ultraviolet light is suggested as one of the most important factors contributing to pterygium development. However, other factors including allergens, harmful chemical substances, wind, dust and pollens also may contribute to its development. The aim of the study was to evaluate the influence of immune reactions on the pathogenesis of pterygium.

[Correction of high myopia with anterior chamber angle-supported phakic intraocular lenses--own results]. / Chirurgiczna korekcja wad refrakcji metoda wszczepów wewnatrzgalkowych--wyniki wlasne.

PURPOSE: To evaluate the early results: predictability, efficacy and safety of implanting new model of anterior chamber IOL for high myopia. MATERIAL AND METHODS: ICARE myopia lens (Corneal) was implanted in 20 eyes of 12 patients with preoperative myopia that ranged from -10 D to 23.5 D. Mean patient age was 32.3 years. The follow-up period was 6 months. The desired outcome was emmetropia. RESULTS: Eighteen eyes (85%) had a postoperative refraction at the last follow-up examination in a range +/- 1.0 D of emmetropia. The postoperative refraction remained stable during the entire follow-up period. Mean visual acuity before surgery, corrected with spectacle improved from 0.5 to 0.68 postoperatively without glasses in 3 months time. There was no loss in visual acuity after operation. We didn't encounter major complications. Mean endothelial cell density reduction was 3.2% in our 3 months study. CONCLUSIONS: Implantation of ICARE myopia lens to correct high myopia resulted in a stable and predictable refractive outcome. Further investigation is necessary to evaluate long-term stability and safety of this procedure.

[Photodynamic therapy in age-related macular degeneration--results of one year observation]. / Terapia fotodynamiczna w starczym zwyrodnieniu plamki--obserwacja roczna.

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin in reducing the vision loss and progression of choroidal neovascularization (CNV) in patients with subfoveal CNV due to age-related macular degeneration (AMD). MATERIALS AND METHODS: 46 eyes of 46 patients with subfoveal, predominantly classic CNV caused by AMD and best-corrected visual acuity of 5/50 to 5/10 were treated with photodynamic therapy with verteporfin (Visudyne, CIBA Vision). Verteporfin was administered via intravenous infusion over 10 minutes. Fifteen minutes after the start of the infusion, a diode laser light at 689 nm (Opal Photoactivator, Coherent) was delivered over 83 seconds. Visual acuity and fluorescein angiography were performed before and after the treatment at 7 days and 1, 3, 6, 9 and 12 months after the initial-treatment. Retreatment in the same manner was applied if at follow-up examination fluorescein leakage from CNV was seen. Outcomes were compared with those of control group which consisted of 38 eyes of 38 patients of the same condition of the disease, not treated with any method. RESULTS: The lost of visual acuity was significantly reduced in the verteporfin--treated eyes compared--with controls. At the 12 month 73.91% eyes of PDT group versus 36.84% of control group (p < 0.001) lost fewer than 3 Snellen lines. The vision loss appeared to be more rapid in first 6 months of the study. During the study growth of CNV was diminished in PDT group compared with control group. CONCLUSIONS: Results show, that photodynamic therapy may be an effective method of treatment for predominantly classic subfoveal choroidal neovascularization caused by AMD. Further studies are needed to find the best modes of PDT procedure.

[New methods of treatment of age-related macular degeneration. Photodynamic therapy. Part I]. / Nowe metody leczenia starczego zwyrodnienia plamki. Terapia fotodynamiczna. Czesc I.

Neovascular form of Age-related Macular Degeneration is the leading cause of blindness in developed countries. There is un urgent need for the effective treatment. In the recent years a number of treatment methods has been investigated. Photodynamic Therapy (PDT) with verteporfin appears to be an exciting approach to treatment which may provide a major breakthrough. The benefits of PDT with verteporfin were proved in randomized clinical trials--Treatment of Age-related Macular Degeneration With Photodynamic Therapy (TAP) study.