Correlation of spectral optical coherence tomography with fluorescein and indocyanine green angiography in multiple evanescent white dot syndrome.

AIMS: To determine the spatial location of lesions in multiple evanescent white dot syndrome (MEWDS) with the aid of spectral optical coherence topography (SOCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA). METHODS: A novel method of three-dimensional SOCT data analysis called reflectivity maps was introduced. The reflectivity maps display the distribution of a back-reflected intensity taken only from individual retinal layers located at specific distance from the reference plane. Reflectivity maps of the inner retina, the junction between photoreceptor inner and outer segments (IS/OS), retinal pigment epithelium and choroid of the patient with MEWDS were created and correlated with FA and ICGA. RESULTS: During the acute stage of MEWDS, the reflectivity map of the IS/OS junction displayed areas of reduced reflectivity that showed a strong positive correlation with hypofluorescent ICGA spots and a weaker but positive correlation with hyperfluorescent FA dots. SOCT examination did not reveal any pathological changes involving either any other retinal layers or the inner choroid. CONCLUSION: Disseminated disruptions of the IS/OS junction seen on SOCT cross-sectional images in the acute stage of MEWDS form the pattern of spots that can be correlated with those revealed by ICGA. This suggests that hypofluorescent ICGA spots indicate alternations in the retinal pigment epithelium-photoreceptor complex and do not represent inflammatory choroidal lesions.

Retinal imaging by spectral optical coherence tomography.

PURPOSE: To demonstrate applicability of high speed spectral optical coherence tomography (SOCT) method for imaging retinal pathologies in clinical conditions. METHODS: SOCT was performed in 67 eyes with different macular diseases. Examinations were carried out with the prototype SOCT instrument constructed in the Institute of Physics, Nicolaus Copernicus University, Torun, Poland. A broadband superluminescent diode was used as a light source. RESULTS: The disturbances of retinal layer structure concerning mainly outer segments of photoreceptors were observed in case of central serous chorioretinopathy and choroidal neovascularization in age-related macular degeneration. Large drusen were often related to significant changes of outer nuclear layer thickness and reflectivity. CONCLUSIONS: SOCT detects small disturbances of the retinal structure and helps to precisely determine layers involved in different pathologies.

Long-term evaluation of endothelial cell loss after phacoemulsification.

PURPOSE: To check whether three months' follow-up is sufficient to determine endothelial cell loss after cataract surgery and whether this value depends on preoperative central endothelial cell density. METHODS: A two-year prospective assessment of central endothelial cell density was done in 60 eyes after phacoemulsification. In 30 eyes a 3.5 mm corneal incision closed with a single crossed suture was made, and the other 30 had a 3.5 mm scleral tunnel no-stitch incision. Central endothelial cell density was measured before surgery and 1, 3, 6 months and 2 years after. RESULTS: The mean rate of endothelial cell loss even two years after surgery was significantly higher than the physiological rate, amounting to 0.9% per year. There was no correlation between preoperative central endothelial cell density and postoperative cell loss. CONCLUSIONS: Even two years' follow-up is not sufficient to establish the total endothelial cell loss after cataract surgery. The amount of cell loss does not depend on the preoperative density.

[Evaluation of the surface of the new intraocular lenses in the scanning electron microscope]. / Ocena powierzchni nowych soczewek wewnatrzgalkowych w elektronowym mikroskopie skaningowym.

PURPOSE: To evaluate the surface of the new PC IOLs commercially available in Poland in 2000. MATERIAL AND METHODS: Representative samples of new posterior chamber IOLs produced by 6 different companies (Alcon, Lensita, Medicontur, Opsia, Rayner, Storz), 5 of each, underwent surface examination with Novoscan 30 scanning electron microscope. RESULTS: Although, in general, smooth surface of optic and haptic parts were observed, three samples with irregularities were found. CONCLUSIONS: Comparing to previous evaluation performed in 1994, significant improvement in quality of IOLs surface was noted. No considerable differences in this field between above mentioned producers were observed.

[Retrospective evaluation of PC IOL power after extracapsular cataract extraction]. / Retrospektywna ocena mocy soczewki wszczepionej podczas zewnatrztorebkowego wydobycia zacmy.

PURPOSE: Retrospective evaluation of PC IOL power calculation accuracy and comparison of the refractive errors after ECCE resulted from different methods of calculation. MATERIAL AND METHODS: The PC IOL power in 100 eyes with senile cataract without significant refractive errors, was calculated using SRK II formula with two different biometers and based on primary refraction. The final IOL power was established by surgeon based on all mentioned calculations (surgeon choice). Half a year after surgery the refractive error was measured. The proper IOL power, which did not require additional correction, was calculated (ideal lens). RESULTS: 48 eyes did not require any distance correction. In 44 eyes small hyperopia (to +2.0 D) appeared and in 8 eyes myopia (to -1.5 D). The smallest error was made in cases where we implanted lenses according to surgeon choice. The average power of ideal lens was 20.32 D. We observed statistically significant difference between both ultrasound biometers. CONCLUSIONS: The most accurate results were achieved in cases where IOL power was chosen by the surgeon based on SRK II formula and primary refraction. Possible source of errors can be inadequate indications of biometers.

[Optic disc drusen--case report]. / Druzy tarczy nerwu wzrokowego--opis przypadku.

A case of giant optic disc drusen is presented. Diagnostic difficulties and a role of fluorescein angiography, CT and static perimetry in diagnosing these alterations are described.

[Clear lens extraction in high myopia]. / Usuniecie soczewki przezroczystej w wysokiej krótkowzrocznosci.

PURPOSE: To evaluate effectiveness and safety of clear lens extraction in high myopia. MATERIAL AND METHODS: 39 eyes of 26 patients had clear lens extraction and implantation of PC IOL. The mean preoperative spherical equivalent was -17.0 D sph, mean follow-up was 19.4 months. IOL calculations were performed using SRK II formula for target refraction -2.0 or -3.0 D sph. RESULTS: The mean postoperative spherical equivalent was -3.3 D sph. The best corrected visual acuity improved in 84.6% of eyes. The percentage of eyes achieving BCVA 0.5 or better increased from 23% preoperatively to 59% postoperatively. In 7 eyes (18%) posterior capsule opacification occurred. Two years after the surgery in one eye retinal detachment appeared, which was successfully treated. CONCLUSION: Clear lens extraction with PC IOL implantation in high myopia gives good results with low number of complications.

Intraocular lens movement and accommodation in eyes of young patients.

PURPOSE: To evaluate the position of posterior chamber intraocular lenses (PC IOLs) at distance and near and the amplitude of pseudoaccommodation in young eyes. SETTING: Department of Ophthalmology, University School of Medical Sciences, Bydgoszcz, Poland. METHODS: This study comprised 45 eyes of 38 patients aged 12 to 19 years who had removal of congenital cataract with implantation of a PC IOL. During the follow-up, the refractive error ranged between -1.00 and +1.00 diopter (D), and near visual acuity was 0.75 or 0.50 (Snellen) without additional correction. The position of the PC IOL was measured by A-mode ultrasound at distance and near. Pseudoaccommodation amplitude was calculated using Gullstrand's near-point rule. RESULTS: Mean anterior movement of the IOL was 0.42 mm at near. Mean pseudoaccommodation amplitude was 4.50 D. The correlation between these values was significant (P <.01). CONCLUSION: The movement of PC IOLs in young patients may be one reason they attain good near vision without additional correction.

[Tuberous sclerosis--case report]. / Stwardnienie guzowate--opis przypadku.

A case of 37-year-old man with tuberous sclerosis is presented. Classic triad (Vogt) which consists of mental handicap, epilepsy and adenoma sebaceum around a nose and cheeks was observed. Ophthalmoscopy showed bilateral retinal astrocytomas with mulberrylike appearance. During 6 years follow-up small progression of ocular changes (findings) was noticed. CT and NMR of the head, ultrasound of the eye fluorescein and ICG angiography are presented.

[Secondary posterior chamber intraocular lens implantation without scleral fixation]. / Wtórne wszczepy tylnokomorowe bez fiksacji twardówkowej.

AIM: Retrospective evaluation of results of secondary PC IOL implantation without scleral fixation. MATERIAL AND METHODS: 29 eyes of 21 patients including 8 children underwent secondary PC IOL implantation into the sulcus. In all these eyes there was partially or completely preserved posterior capsule. RESULTS: Final postoperative visual acuity of 20/40 or better was achieved in 82.7% of the eyes with PC IOL. CONCLUSION: Secondary PC IOL implants give good anatomical and functional results.

[Intraocular refractive surgery]. / Wewnatrzgalkowa chirurgia refrakcyjna.

The aim of this paper was presentation of current opinions about intraocular refractive surgery. The implantation of Baikoff and Worst-Fechner lenses to anterior chamber and usage of refractive PC IOL is described. The extraction of clear lens in high ametropia and implantation of PC IOLs of adequate power was also presented. The paper is illustrated by own material.

The influence of retinal detachment surgery on perioperative blood fibrinolysis.

PURPOSE: To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery. MATERIAL: Prospective study of 56 patients (30 male, 26 female), aged from 19 to 82 (mean: 53, SD = 16.8) years, subjected to retinal detachment surgery (encirclement with scleral buckling) performed under general anaesthesia. Excluded were patients with vein or arterial disease and with other factors which could change evaluated parameters. METHOD: Blood was sampled from cubital vein one day before surgery, immediately after induction of anaesthesia but before surgery, immediately after the completion of the operation but before the termination of anaesthesia and after operation (on the 1(st) and 4(th) day). In the citrate plasma of patients studied, tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1), plasmin-alpha(2)-antiplasmin (PAP) complexes, fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured. RESULTS: In the group studied intraoperative values of t-PA Ag, PAP and FDP were significantly higher, PAI-1 Ag concentration decreased and ELT was reduced. These results indicate a significant activation of fibrinolysis during the retinal detachment surgery. On the first postoperative day the fibrinolytic activity was reduced (decrease in t-PA Ag and FDP concentration and prolongation of ELT). CONCLUSION: During retinal detachment surgery the patients reveal activation of fibrinolysis in systemic circulation.

Intraocular lens implantation in children and youth.

PURPOSE: To evaluate the safety and the effectiveness posterior chamber intraocular lenses (PCIOLs) in children and youth with cataract. METHODS: Retrospective study of operative and postoperative results was based on 146 eyes in 125 children ages 6 to 18 years (mean: 11.7 years) who underwent extracapsular cataract extraction with IOL implantation in the period from 1986 to 1996. Follow up was 1 to 10 years. OUTCOME MEASURE: Best corrected distance and near visual acuity, operative complications, and early and late postoperative complications. Exclusion criteria were uveitis, retinal detachment, prior glaucoma, and systemic diseases. RESULTS: Early postoperative complications were observed in 12.3% of cases including iritis in 7.5%, and transient corneal edema in 3.4% of eyes. Posterior capsule opacification requiring capsulotomy was needed in 81.5% of eyes after 8.5 years. YAG laser capsulotomy was performed in 68.1% and surgical intervention in 26.8% of cases. In 5.1% of the cases, both techniques were used. In 74.7% of patients, best corrected visual acuity of 0.5 or better was achieved. The mean postoperative spherical equivalent was +0.35 diopters (D, SD 1.35). Spectacle-corrected near visual acuity of 0.5 on the Snellen chart was obtained in 82.8% of eyes. CONCLUSION: IOL implantation in children older than 6 years appears to be an efficacious, satisfactory, and safe procedure in the management of pediatric cataract.

[Comparative evaluation of visual acuity after cataract extraction with monofocal, bifocal or progressive lenses implantation]. / Ocena porównawcza ostrosci wzroku po operacji zacmy z wszczepem soczewek tylnokomorowych jednoogniskowych, dwuogniskowych i progresywnych.

PURPOSE: Evaluation which of the lenses: monofocal, bifocal or progressive, assure the best visual acuity in patients. MATERIAL AND METHODS: 86 patients aged from 21 to 84 years were operated. Monofocal lenses were implanted in 30 cases, bifocal in 32 and progressive in 24 cases. RESULTS: In 90% of patients with monofocal lenses and over 90% of patients in the remaining groups full uncorrected or corrected distance visual acuity was achieved. In groups with bifocal and progressive lenses full near visual acuity without correction, or with the same correction as for distance, was achieved by respectively 65.5% and 75% of patients. CONCLUSIONS: In all three groups very good distance visual acuity was achieved. The best near visual acuity is assured by progressive lenses, in lower degree by bifocal lenses.

[Post-steroid elevations of intraocular pressure in patient after radial keratotomy]. / Posteroidowe zwyzki cisnienia wewnatrzgalkowego u osób po keratotomii radialnej.

PURPOSE: The evaluation of frequency and amplitude of IOP elevations in patients after RK who were administrated topically dexamethasone. MATERIAL AND METHODS: RK was carried out in 90 eyes (55 patients). All these patients had been treated topically with 0.1% dexamethasone (Maxitrol, Alcon) since the first day after surgery till the period of 3 months in lowering doses. IOP was measured using air-puff tonometer (Reichert, USA) before surgery and on 1, 2, 3, 14, 30, 50, 90 day after RK. In case of IOP elevations the measurements were made more often. RESULTS: The mean IOP before surgery was 14.88 +/- 2.86 mm Hg for women and 16.14 +/- 2.83 mm Hg for men. In the period of 3 months after RK maximum IOP increased significantly both for women (mean: 21.46 +/- 7.51 mm Hg) and men (mean: 26.14 +/- 8.87 mm Hg). IOP higher than 25 mm Hg was observed in 35 eyes (37.7%). These IOP elevations were observed more often in men than women but this difference was not statistically significant. There was no correlation between frequency of IOP elevations and preoperative refractive error or the age of patients. CONCLUSIONS: The usage of steroids after RK requires careful monitoring of IOP. This subject needs further studies to answer if these IOP elevations can damage eye functions.

[Evaluation of endothelial cells after the usage of gentamycin in irrigation-aspiration fluid during extracapsular cataract extraction]. / Ocena komórek sródblonka rogówki po zastosowaniu gentamycyny w plynie irygacyjno-aspiracyjnym podczas zewnatrztorebkowego usuniecia zacmy.

PURPOSE: Assessment of the density of endothelial cells after usage of gentamicin in irrigation-aspiration fluid. MATERIAL AND METHODS: 60 patients subjected to extracapsular cataract extraction with intraocular lens implantation. In 30 eyes irrigation was performed with Ringer fluid (group I) and in 30 eyes Ringer fluid with gentamicin (group II) 4 mg gentamicin were added to 500 ml of Ringer fluid obtaining the concentration 8 micrograms/ml. Evaluation of endothelial cells density was carried before operation, 1 month and 6 months after. RESULTS: Percentage endothelial cells loss in group I was 7.8% 1 month postoperatively and 14.5% 6 months after operation and in group II 8.5% and 14.87%, respectively. CONCLUSION: Gentamicin added to irrigation-aspiration fluid doesn't cause enhanced endothelial cells loss during extracapsular cataract extraction.

[Comparative evaluation of corneal endothelial cells after extracapsular cataract extraction with PMMA and heparin-surface modified lens implantation]. / Ocena porównawcza komórek sródblonka rogówki po zewnatrztorebkowym usunieciu zacmy z wszczepem soczewek z PMMA i heparynizowanych.

PURPOSE: Comparison of endothelial cells density in eyes after PMMA and heparin-surface-modified lenses (HSfM1) implantation. MATERIAL AND METHODS: 58 patients (26 male and 32 female) aged from 36 to 89 years. In 30 patients PMMA lenses produced by Pharmacia, Storz and Alcon and in 28 HSM (Pharmacia) lenses were implanted, after ECCE. RESULTS: Percentage loss of endothelial cells in eyes with PMMA lenses was 8.61% after month and 13.56% 6 months post-operatively. In eyes with HSM lenses endothelial cell loss was 8.44% and 13.55% respectively. CONCLUSION: Loss of corneal endothelial cells in eyes with PMMA lenses is almost the same in eyes with HSM lenses.

[The use of indocyanine green angiography in diagnosis of occult choroidal neovascularization in age-related macular degeneration]. / Zastosowanie angiografii indocyjaninowej do wykrywania ukrytej neowaskularyzacji podsiatkówkowej w starczym zwyrodnieniu plamki.

PURPOSE: To determine whether scanning laser ophthalmoscopy (SLO) indocyanine green (ICG) angiography may be useful in detecting occult or ill-defined choroidal neovascularization (CNV). MATERIAL AND METHODS: ICG angiography using SLO was performed in 28 patients (29 eyes). Indication for this examination was occult or ill-defined CNV on fluorescein angiography. RESULTS: Well-defined hyperfluorescent lesions on ICG angiography were found in 16 eyes (55.2%). Three morphological types of CNV were noted: plaque (82.8%), focal spots (10.4%), combination lesions (3.4%). In one case no manifestations of CNV were observed in ICG angiography (3.4%). In 4 eyes (13.8%) we performed successful laseroterapy of CNV. CONCLUSIONS: ICG angiography performed using SLO is a valuable tool in determining borders of occult and ill-defined CNV.

[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.

[The effect of diclofenac sodium and indomethacin used locally for maintenance of pupillary dilatation during cataract surgery]. / Wplyw diklofenaku sodu i indometacyny stosowanych miejscowo na szerokosc zrenicy podczas operacji zacmy.

PURPOSE: One of the important points in extracapsular cataract extraction with posterior chamber intraocular lens implantation is to maintain mydriasis during the intervention. In this study we compared the efficacy of two topical nonsteroidal anti-inflammatory drugs: diclofenac sodium (Naclof) and indomethacin used before cataract surgery to inhibit surgically induced miosis. METHODS: Sixty-four patients were operated (ECCE with IOL) by three experienced surgeons. All patients received dilatating drops and nonsteroidal anti-inflammatory drugs every 30 minutes in five doses beginning 2.5 hours before surgery. 32 patients received diclofenac sodium and 32 patients indomethacin. Pupil diameters were measured three times: first--just before the initial limbal incision, second--at the end of cortical aspiration and the last after implantation of an intraocular lens. RESULTS: In both groups the surgical manipulations induced a decrease in pupil diameter but more in the group treated with indomethacin. CONCLUSIONS: Diclofenac sodium appeared to be more potent than indomethacin in maintaining intraoperative mydriasis during cataract surgery.