The Impact of Chronic Heart Failure on Retinal Vessel Density Assessed by Optical Coherence Tomography Angiography in Children with Dilated Cardiomyopathy.

(1) Introduction: The aim of this study is to assess retinal vessel density (VD) in the superficial capillary plexus layer (SP) and deep capillary plexus layer (DP) in children with chronic heart failure (CHF) in the course of dilated cardiomyopathy (DCM) using optical coherence tomography angiography (OCTA). (2) Methods: Thirty children with CHF due to DCM lasting more than six months, with an enlarged left ventricle and impaired left ventricular systolic function (left ventricular ejection fraction (LVEF) ≤ 55%), were enrolled to have both their eyes assessed for this study. Mean age of the children was 9.9 ± 3.57 years. The control group consisted of an additional 30 children without CHF (mean age 11.27 ± 3.33 years) matched for age and gender against the study group. All participants underwent transthoracic echocardiography to measure LVEF using Simpson method. Blood serum was tested for N-terminal-pro-brain natriuretic peptide (NT-proBNP) marker value. All children underwent OCTA with evaluation of the foveal avascular zone (FAZ), whole superficial vessel density (wsVD), foveal superficial vessel density (fsVD), parafoveal superficial vessel density (psVD), whole deep vessel density (wdVD), foveal deep vessel density (fdVD), parafoveal deep vessel density (pdVD), whole thickness (WT), foveal thickness (FT), and parafoveal thickness (PFT). (3) Results: Retinal VD in SP was significantly lower in children with CHF as compared to the controls. The following SP parameters in the study group were statistically significantly lower than these same measurements for the control group. Details, with study group findings quantified first, include wsVD (46.2% vs. 49.83%, p < 0.05), fsVD (18.07% vs. 24.15%, p < 0.05), and psVD (49.24% vs. 52.51%, p < 0.05). The WT (311.03 micrometers (µm) vs. 323.55 µm, p < 0.05), FT (244.57 µm vs. 256.98 µm, p < 0.05), and PFT (320.63 µm vs. 332.02 µm, p < 0.05). No significant differences in DP retinal VD were found between the two groups. No statistically significant differences in the FAZ were found. The fsVD and FT were correlated with biometry and the age of the study participants. There was a correlation between FAZ and FT (p < 0.001). There were no correlations between retinal VD in both plexuses and refractive error, sex, NT-proBNP, and LVEF. (4) Conclusions: In children with CHF in the course of DCM as compared to the control group, significantly decreased retinal VD in SP was observed. The results of our study indicate that measurements of the OCTA may be a useful diagnostic method in children with chronic heart failure, but it is necessary to conduct further studies in larger groups of participants and long-term observation of these patients.

Choroidal thickness changes in children with chronic heart failure due to dilated cardiomyopathy.

PURPOSE: To evaluate choroidal thickness (CTh) in children with chronic heart failure (CHF) secondary to dilated cardiomyopathy (DCM) using spectral domain optical coherence tomography (SD-OCT) and to compare their values to those of healthy children. METHODS: Sixty eyes of thirty children (mean age 9.9 ± 3.57 years) with chronic heart failure (left ventricular ejection fraction, LVEF ≤ 55%) due to DCM lasting for over 6 months were prospectively enrolled. The control group consisted of 30 age- (mean age 10.16 ± 3.42 years) and sex-matched healthy children. All participants underwent transthoracic echocardiography with LVEF measured using the Simpson method and had the blood serum level of N-terminal-pro-brain natriuretic peptide marker (NT-proBNP) determined. All children underwent SD-OCT and had subfoveal choroidal thickness (SFCTh) and CTh measured at 1500 µm (µm) nasally, temporally, superiorly and inferiorly from the fovea in both eyes by two investigators. RESULTS: CTh at all locations was statistically significantly lower in children with DCM compared to the control group. Mean CTh in the group with CHF compared to the control group were (304.03 vs. 369.72 µm, p < 0.05) at the subfoveal location, (245.87 vs. 284 µm, p < 0.05) 1500 µm nasally from the fovea, (291.5 vs. 355.95 µm, p < 0.05) 1500 µm temporally from the fovea, (303.98 vs. 357.58 µm, p < 0.05) 1500 µm superiorly from the fovea and (290.92 vs. 344.96 µm, p < 0.05) 1500 µm inferiorly from the fovea. The average difference CTh between the study groups ranged from 38.13 to 65.69 µm at individual locations. In both groups, CTh was the thickest at subfoveal location (304.03 vs. 369.72 µm, p < 0.05) and the thinnest was 1500 µm nasally from the fovea (262.37 vs. 336.87 µm, p < 0.05). There was no correlation between CTh and age, gender, biometry and refractive error. No correlation was found between CTh and LVEF and NT-proBNP. CONCLUSION: Patients with CHF due to DCM had a thinner CTh at all measured locations. The results of our research indicate that CHF affects CTh and this parameter may be very helpful in monitoring the clinical course of the disease in children with DCM.

Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome.

BACKGROUND: Cohen syndrome (Q87.8;ORPHA:193; OMIM#216550) is an autosomal recessive inherited genetic disorder caused by mutation in the VPS13B/COH1 gene. It is characterized by variable clinical symptoms such as deformity of the head, face, hands and feet, eye abnormalities, abdominal obesity, neutropenia and nonprogressive intellectual disability. The typical lesions in the eyeball in Cohen syndrome include high myopia, retinal dystrophy, strabismus, maculopathy and lens subluxation. The present study describes the coexistence of bilateral macular edema with pale optic disc in a patient with a homozygous deletion in the VPS13B/COH1 gene. MATERIAL AND METHODS: A 6-year-old Caucasian girl with facial dysmorphism, microcephaly, prominent upper incisors, narrow hands with slender fingers, congenital heart defect and ophthalmic symptoms was subjected to genetic testing. The genetic evaluation revealed a homozygous deletion on the long arm of chromosome 8 encompassing 20-25 exons of the VPS13 gene, as confirmed by Cohen syndrome. She underwent a full ophthalmological examination with the assessment of slit lamp examination of anterior segment and fundoscopy, refraction error, biometry, central corneal thickness and additionally electroretinography, optical coherence tomography and fundus photography. RESULTS: In the ophthalmologic examination, the girl had bilateral astigmatism accompanied by myopia and a marked reduction in central corneal thickness. Fundus examination showed pale optic nerve discs and "salt and pepper" retinopathy. Bilateral cystic macular edema was revealed in handheld optical coherence tomography. Electroretinography showed a reduced response amplitude of cones and rods. CONCLUSION: In a patient with high myopia, macular edema, pale optic disc and facial dysmorphism, Cohen syndrome should be considered in the differential diagnosis. The severity of individual clinical features in patients with Cohen syndrome varies. It can be assumed that the type of mutation affects the occurrence and severity of individual symptoms.

Investigating Ganglion Cell Complex Thickness in Children with Chronic Heart Failure due to Dilated Cardiomyopathy.

PURPOSE: To assess ganglion cell complex (GCC) thickness in children with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM) using optical coherence tomography (OCT). METHODS: Sixty eyes of 30 patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM) and 60 eyes of 30 age- and sex-matched healthy volunteers (control group) were enrolled. The mean age of the patients and controls was 9.9 ± 3.57 (range 5-17) years and 10.08 ± 3.41 (range 4-16) years, respectively. All patients underwent a complete ophthalmic assessment and OCT imaging using RTVue XR Avanti (Optovue). The following OCT-based parameters were analysed: average ganglion cell complex thickness (avgGCC), superior ganglion cell complex thickness (supGCC), inferior ganglion cell complex thickness (infGCC), global loss of volume (GLV) and focal loss of volume (FLV). RESULTS: There were no significant differences in avgGCC (98.13 µm vs. 99.96 µm, p = 0.21), supGCC (97.17 µm vs. 99.29 µm, p = 0.13), infGCC (99.03 µm vs. 100.71 µm, p = 0.25), FVL (0.49% vs. 0.4%, p = 0.25) and GVL (2.1% vs. 1.3%, p = 0.09) between patients with chronic heart failure due to dilated cardiomyopathy and healthy children. There was no correlation between avgGCC, supGCC, infGCC, FLV, GLV and ocular biometry, refractive errors or age. There was no correlation between avgGCC, supGCC, infGCC, FLV, GLV and NT-proBNP or LVEF. There were no significant differences in the studied parameters between the sexes. There were no significant differences in the studied parameters between the left and right eye. CONCLUSION: Our study seems to be the first to analyse ganglion cell complex in paediatric patients with dilated cardiomyopathy. We have demonstrated no changes in the ganglion cell complex thickness parameters in children with chronic heart failure due dilated cardiomyopathy, as compared to their healthy peers.

[Ocular findings in Nijmegen breakage syndrome]. / Objawy okulistyczne w przebiegu zespolu Nijmegen.

UNLABELLED: Nijmegen Breakage Syndrome (NBS) is a genomic instability disease caused by inherited mutations in the NBN/NBS1 gene. The clinical symptoms of NBS are: primary microcephaly, characteristic facial appearance, recurring respiratory tract infections caused by immune deficiency and extremely high risk of cancer development at early age. PURPOSE: The aim of the study was to assess the vision organ in patients with NBS. MATERIAL AND METHODS: Ophthalmological examination of 10 NBS patients was performed. The visual acuity, refractive errors, anterior and posterior segment of the eye ball test, tonometry and biometry were assessed. RESULTS: Serious pathology of the sight organ in the study group were found, including upward slanting of the palpebral fissures, reduced visual acuity, small eyes, small cornea diameter, lens opacity, refractive errors. CONCLUSIONS: The patients with Nijmegen breakage syndrome have significant sight organ abnormalities. These pathologies require long-term ophthalmologic care.

[Posterior chamber intraocular lens implantation with one-point scleral fixation in children in long time observation]. / Implantacja sztucznej soczewki wewnatrzgalkowej tylnokomorowej z zastosowaniem jednopunktowej fiksacji sródtwardówkowej u dzieci w dlugim okresie obserwacji.

MATERIAL AND METHODS: The study included 31 eyes in 31 children in age between 4 and 12 years. One - point suture fixation of PC IOL to the sclera was performed primary, because of partial loss of the posterior capsule support. Poly-propylene suture 10-0 was used for IOL fixation. Rigid PMMA lenses and acrylic were sutured to the edge of incision. The ends of the propylene suture were buried between the 2 edges of the sclera-corneal incision. Incision was closed with 8-0 nylon. Average time of observation was 8.4 years. RESULTS: Postoperative visual acuity was significantly improved after surgery in each case. Postoperative complications were minimal and not sight-threatening. CONCLUSIONS: This modified technique scleral-fixation of PC IOL implantation in some cases despite defective capsular support, can make up the effective method of surgical treatment without risk of IOL dislocation.

[Clinical ocular manifestation of Patau's syndrom (trisomy 13)--own observations]. / Oczne objawy kliniczne w zespole Pataua (trisomia 13.)--obserwacje wlasne.

PURPOSE: The purpose of the article is to present the clinical abnormalities of Patau's syndrome (trisomy13). MATERIAL AND METHODS: Examination was performed on 18 months old girl with trisomy13 in which we noted characteristic malformations in ocular system. The patient underwent cataract surgery and intraocular lens implantation in right eye. In this case the diagnosis of trisomy 13 was confirmed by karyotype. RESULTS: Inferonasal iris colobomas, anterior-posterior form of persistent hyperplastic primary vitreus (PHPV), persistent tunica vasculosa lentis (PTVL), coloboma of the lens and cataract in right eye were found. Cataract surgery was performed with good results. Systemic abnormalities included heart defect, brain defect, cleft palate, small head, dysplastic ears, mental retardation, epilepsy and increased muscle tone. CONCLUSIONS: The child with the presence of inferonosal iris colobomas and cataract and with other systemic and dysmorfic findings, should have kariotype examination to look for trisomy 13.

Orbital tumor as an initial manifestation of Wegener's granulomatosis in children: a series of four cases.

BACKGROUND: Wegener's granulomatosis (WG) is a rare idiopathic disease in which small and medium-sized arteries are affected by necrotizing granulomatous inflammation. It is associated with a triad of pulmonary (cavitating granulomatous lesions with hemoptysis, cough, and dyspnea), renal (glomerulonephritis with hematuria, proteinuria), and head (otitis media, recurrent sinusitis, eye or orbital involvement) manifestations. CASE REPORT: Four children aged 7-11 years diagnosed with WG between 1995-2008 initially presented with unilateral proptosis and ptosis due to orbital tumor. CT or MRI, orbital lesion biopsy, and laboratory tests (ERS, CRP, ANCA) were part of the diagnostic workup. The diagnoses were based on correlation between clinical presentation and diagnostic findings. All four patients had orbital lesions on contrast-enhanced CT and MRI. Two had lesions of the temporal pyramid. Orbital tumor biopsies showed granulomatous lesions in two patients, necrotizing vasculitis with leukocytoclasia in three, and an orbital pseudotumor in one. ESR and CRP were positive in all. ANCA positivity was variable (c-ANCA did not allow WG diagnosis or there were atypical ANCAs). All had blood and protein in the urine, but only one had advanced renal involvement. All were treated with oral steroid and immunosuppression; remission was successful. CONCLUSIONS: WG is often more difficult to diagnose in children than in adults due to frequent absence of its signature features. The absence of the classic triad and atypical laboratory or biopsy findings do not exclude a diagnosis of WG. Orbital demonstration helps achieve early diagnosis and treatment of this potentially fatal rheumatologic disease.

[Intraocular lens implantation in developmental lens disorders in children]. / Implantacja sztucznej soczewki wewnatrzgalkowej w anomaliach rozwojowych soczewki u dzieci.

The pediatric cataract surgery in eyes with developmental disorders, stay with still considerable challenge. At children, the lasting vision development extorts necessity quick settlement of refraction defect formed after operation. The intraocular lens old boy with cataract in microspherophakia and 12 years old boy with cataract in lens with coloboma. One-piece flexible and rigid PMMA intraocular lens was placed with success at posterior chamber without scleral fixations and without using capsular tension ring in this cases. After 3 years of observation there were no decentration or dislocation of intraocular lens in both children. Authors concluded that in some cases posterior chamber intraocular lens implantation despite defective zonular or capsular support, can make up the effective method of surgical treatment without risk of early dislocation.

[Subluxation of scleral-fixated PC IOL caused by polypropylene suture degradation--case report]. / Przemieszczenie soczewki z fiksacjq sródtwardówkowa w wyniku degradacji szwu polipropylenowego--opis przypadku.

The purpose of the study is to evaluate factors related to late-onset of lens subluxation in transscleral sutured posterior chamber IOL. We report a child, which required surgical treatment for dislocation of a scleral-sutured PC IOL. 11 years earlier the secondary lens implantation with scleral fixation was performed in 4 years old boy. The first surgical procedure included an anterior victrectomy and suturing a single- piece PMMA IOL under the scleral flaps with a 10-0 polipropylene suture. The second--included explantation of the dislocated lens. Optic and scanning electron microscopy was used to analyze the surface of the explanted remnants of the breakage suture. Microscopic findings indicate that the late suture breakage and subluxation of suture-fixated PC IOL was due to the degradation of polypropylene suture.

[Ocular changes in course of Mycohacterium tuberculosis infection--own observations]. / Zmiany w narzadzie wzroku w przebiegu zakazenia pratkiem gruzlicy--obserwacje wlasne.

Ocular tuberculosis occurs rarely and causes many diagnostic difficulties. The aim of this paper is to provide an analysis of diagnostic problems of ocular changes as a consequence of Mycobacterium tuberculosis infection in children. Between 2006 and 2007 there were 7 children at the age 8 to 16 years old, treated in Ophthalmic Department. The infection or contact with Mycobacterium tuberculosis was diagnosed through the range of examination. Diagnosis of tuberculosis included chest radiography, computed tomography of lungs, tuberculin skin test and bronchoscopy. Gastric and bronchial aspirates were used for bacterial and genetic investigations. In eyes with ocular tuberculosis there were various intraocular changes. The most common clinical presentation occurred by intermediate uveitis, posterior uveitis and optic neuritis. 5 children were treated with antituberculous drugs, 2 children were observed without treatment. Examination and treatment of ocular tuberculosis required cooperation with specialists of pulmonary diseases.

Pupillary block glaucoma in child with persistent hyperplastic primary vitreus--case report.

PURPOSE: The purpose of this paper is to present the case of a patient with PHPV, in whom the complication in a form of pupillary block glaucoma was observed as a result of idiopathic and complete lens dislocation into the anterior chamber. MATERIAL AND METHODS: Examination was performed on 3 months old boy with grey pupilla reflex, noted from the birth, in the right eye. Microphthalmia, subcapsular cataract and anterior-posterior form of PHPV was found in that eye. The patient was qualified to surgical treatment. Before the appointed time of operation the increased intraocular pressure and significant globe enlargement were noted. The reason of that was pupillary block caused by lens dislocation into the anterior chamber. One-step surgical procedure: trabeculectomy, lensectomy and cutting out the retrolenticular fibrous membrane, was performed in urgent course. RESULTS: Performed complicated and difficult surgical treatment resulted in normalizing IOP and created good conditions for vision rehabilitation for the child. Postoperatively the detachment of the choroid was noted as a transient complication. CONCLUSIONS: In this case luxated lens and pupillary block was caused by constriction of retrolenticular fibrous membrane. Early surgical intervention is necessary to prevent progressive pathologic changes in eyes with this developmental disorder and to obtain the best possible visual results.

[Analysis of the changes in the causes of blindness and significant vision loss among children and young adults born between 1974 and 2004]. / Analiza zimian przyczyn slepoty i znacznego pogorszenia widzenia u dzieci i mlodziezy urodzonych w latach 1974-2004.

INTRODUCTION: Visual impairment develops serious medical, psychological, social and economical problems. Thus, of most importance is improvement in prophylaxis, early diagnosis and treatment. THE AIM of this paper is to define the reasons of blindness and significant loss of vision in children and youths in Poland, and changes in them among children and youths under the age of 24, born between 1974-2004, with classification by age. SUBJECT AND METHOD: Included in the study were the records of 2,518 children and youths under the age of 24, associates of the Polski Zwiazek Niewidomych (PZN, Polish Association of the Blind); these were analyzed for the prevalence of each cause of vision loss. There were two groups. The first group were files of 1,504 students and pupils in the institutions for blind and visually impaired children, and the archives of PZN, describing the members who joined it between year 1974 and 1998. The second, comparative group, was based on files of 1,014 children and students, who joined PZN between year 1999 and 2004. Each group was also analysed within different age groups. RESULTS: The most important causes of visual impairment are: optic nerve atrophy, retinopathy of prematurity (ROP), high myopia, congenital cataract and retinal degradations. Changes in them between 1998-2004 introduce a percentage growth of optic nerve atrophy from 21.66% to 25.41% and decrement in vision degrading stages of ROP from 14.14% to 10.71%, in development disorders from 8.09% to 7.10%. There is an alarming growth in congenital toxoplasmosis percentage, from 1.06% to 2.39%, and of congenital cataract, from 3.02% to 4.47%. High myopia among the visually impaired remains at the same level. There is a big growth in the percentage of heavy (bilateral) injuries, which cause significant vision loss. Less often, the cause of serious vision damage are uveitis, secondary glaucoma and toxocariasis. CONCLUSIONS: The study conducted between 1998-2004 revealed changes in the causes of blindness and significantly vision loss in children and youths under the age of 24, as compared to a similar study conducted between 1974-1998. There is constant increase of the optic nerve atrophy as a cause of vision loss, and decrease among vision impairments caused by vision damaging stages of ROP. Cataract and congenital abnormalities are more frequent among youngest children. Cortical blindness, formerly rarely diagnosed, is becoming a significant factor. The results of our study, describing the changes in blindness and significant vision loss factors, should provide a proper rationale for developing a strategy for control of visual impairment in children and youths.

[Cataract in children--not only an ophthalmological problem]. / Zacma u dzieci--problem nie tylko okulistyczny.

Cataract is an opacity of the lens that leads to loss of vision and even blindness. It is responsible for 10.7-14% of the children who are blind. The etiology of cataract is unknown. Cataract in children can be congenital or acquired, unilateral or bilateral. Unilateral congenital cataract is an important cause of amblyopia and strabismus. Cataract can occur as an isolated disorder or as coexisting problem with other diseases. Differential diagnostics requires a number of tests regarding the patient and his relatives. The management should be complex including prophylaxis, diagnosis and treatment. The treatment is predominantly surgical with ocular rehabilitation following. In some cases, for example in some inborn errors of metabolism early prophylactic procedure and specialistic paediatric treatment are needed.

[Modern methods of cataract surgery in children]. / Wspólczesne metody leczenia operacyjnego zacmy u dzieci.

Cataract continues to be one of the most important causes of blindness in children in spite of the fact that surgical treatment prevents visual disturbances. Management of cataract in infants and very young children is more complex than treatment in adults. The choice of appropriate timing of surgery, modern surgical technique, appropriate methods of paediatric aphakic rehabilitation, and management of the general disorder which may cause the cataract are of utmost importance for good visual results in children. Automation introduced in surgery and intraocular lenses have helped to achieve better anatomic conditions and functional outcome of cataract surgery in children.

[Evaluation of the results of treatment orbital rhabdomyosarcoma in children]. / Ocena wyników leczenia miesaka miesni prazkowanych oczodolu u dzieci.

PURPOSE: To estimate the state of the vision organ in the children treated for orbital rhabdomyosarcoma. Rhabdomyosarcoma (RMS) is the most common primary malignant orbital tumor in children. RMS usually manifest clinically as rapidly progressive exophthalmus and displacement of the globe. The diagnosis is based on biopsy, CT and MR images. The treatment includes radiation, chemotherapy, and surgery. MATERIAL AND METHODS: The retrospective review of data of 14 children between 0 and 11 years old with rhabdomyosarcmoa of orbit. After a biopsy, with precedent CT or MRI, all patients were treated with chemotherapy including or not including radiotherapy. RESULTS: 3 children died, orbital exentaration was necessary because of tumor recurrence in 3 cases, 8 children remained healthy (without recurrent disease). CONCLUSIONS: Fast diagnosis using CT, MRI and the result of biopsy, have a positive influence on the effect of neoplastic treatment and prognosis.

[Secondary intraocular lens implantation in children]. / Wtórne wszczepy sztucznych soczewek wewnatrzgalkowych u dzieci.

PURPOSE: We describe a technique for secondary intraocular lens implantation in the ciliary sulcus in patients with congenital cataract or with primary aphakia. MATERIAL AND METHODS: Secondary intraocular lens implantation was performed in 119 eyes of 74 children. The average age at this procedure was 6.8 (range 22 months to 10 years), whereas the average age at primary cataract surgery was 18 weeks (range 7 weeks to 19 months). The average follow-up was 5.7 years. All eyes received a PMMA IOL. The sites of IOL fixation was ciliary sulcus. All patients had cataract extraction (lensectomy) via the pars plana, leaving in situ peripheral collarette of capsular bag to enable secondary lens implantation. RESULTS: Complications included IOL dislocation in five eyes, visual axis opacification in four, pupillary capture in one eye. CONCLUSIONS: Secondary IOL implantation in the ciliary sulcus is a safe and effective method to correct aphakia in pediatric patients with adequate capsular support. This surgical procedure is associated with a low rate of complications.

[Morphology of secondary cataract membrane in child post congenital cataract surgery--case report]. / Morfologia blony zacmy wtórnej u dziecka po operacji zacmy wrodzonej--opis przypadku.

In younger children it is advantageous to perform cataract surgery with posterior capsulectomy and anterior vitrectomy to prevent secondary cataract formation. In many cases after surgery lens epithelial cells grow on the posterior lens capsule, and on the anterior surface of the vitreous. Authors report a case of secondary cataract in 6 years old girl post pars plana lensectomy and anterior vitrectomy in both eyes. They performed secondary posterior chamber IOL implantation and examined the fibrous tissue resection (secondary cataract), from the left eye - histological and immunohistochemical tests. This examination with H&E staining revealed the presence of fibroblast-like cells. The lens epithelial cells probably underwent epithelial-mesenchymal transformation and in some cases can create secondary cataract.

[Transsclerally fixated intraocular artificial lenses in children--analysis of long-term postoperative complications]. / Fiksacja sródtwardówkowa sztucznych soczewek wewnqtrzgalkowych u dzieci--analiza odleglych powiklan pooperacyjnych.

PURPOSE: To report the long-term surgical complications of transscleral sutured intraocular lens implantation in children. MATERIAL AND METHODS: Surgical procedure was performed in 10 children (17 eyes) with ectopia lentis, and in 16 children (21 eyes) with aphakia between July 1995 and December 1998. The mean age of implantation was 8.1 years (range 4 to 17). The Lewis method ab externo was used to suture 1-piece PMMA IOL in all cases. Average follow-up was 9.1 years (range 8 to 11 years). RESULTS: After operation in long time observations, we noted retinal detachment in 1 eye (post trauma), suture break and IOL dislocation in 3 eyes, suture erosion through the scleral flap in 4 eyes, suture erosion through the flap and conjuctiva in 2 eyes, IOL decentraction in 3 eyes, IOL tilt in 6 eyes, glaucoma in 2 eyes, anterior uveitis in 2 eyes. Four eyes exhibited episodes of iris capture of the IOL optic. There were no endophthalmitis in this group of patients. CONCLUSIONS: The analysis showed that long follow up and complications was associated with scleral fixation included exposure of the scleral suture and the suture break, not with retinal detachment and endophthalmitis.

[Spontaneous bilateral posterior capsule rupture in child--case report]. / Samoistne obustronne uszkodzenie tylnej torebki soczewki u dziecka--opis przypadku.

Isolated posterior capsule rupture without penetrating injury has rarely been reported. Posterior capsule tears can be preexisting, spontaneous or intrasurgical. Authors report a case of progressing bilateral cataract in 3 months old boy, caused by posterior capsule rupture. Rapidly developing cataract with intumescent lens material in vitreous cavity required surgical procedure: pars plana lensectomy and vitrectomy in both eyes.