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.

Effects of retinal detachment surgery on protein C antigen level.

BACKGROUND: The purpose of the study was to evaluate perioperative changes in protein C antigen (PC Ag) in patients undergoing retinal detachment surgery under general or local anesthesia. MATERIAL AND METHODS: Prospective study of 39 patients: 27 patients, 14 male, 13 female, age from 15 to 78 (mean: 50.8, SD=18.6), undergoing retinal detachment surgery (encirclement with scleral buckling) performed under general anesthesia (group A), and 12 patients, 5 male, 7 female, age from 25 to 78 (mean: 52.9, SD=19.2), operated under local anesthesia (group B). Patients with venous or arterial disease or other factors which could affect the evaluated parameters were excluded from the study. Blood samples were collected from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after the completion of the operation but before the termination of anesthesia, and after surgery (on the 1st and 4th day). The PC Ag concentration was measured in the citrate plasma of the patients studied, utilizing a commercially available enzyme-linked immunosorbent assay. RESULTS: In both groups, the pattern of changes in perioperative PC antigen was similar. A trend towards moderately lower intraoperative levels of PC Ag could be observed. In both groups, PC Ag concentration increased on the first postoperative day, but a significant change was noted only in general anesthesia group. CONCLUSIONS: Retinal detachment surgery evokes a less than statistically significant decrease in intraoperative PC antigen levels in systemic circulation, and these changes are not affected by the type of anesthesia. An increase in PC Ag was observed on the 1st postoperative day, but this was statistically significant only in the general anesthesia group.

Fibrinolytic response to retinal detachment surgery under general or local anesthesia.

PURPOSE: To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery under general or local anesthesia. PATIENTS: Prospective study of 81 patients (43 male, 38 female), aged from 15 to 82 (mean 50.7 SD = 17.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia (group A), and 14 patients (6 male, 8 female) aged from 15 to 78 (mean 52.9, SD =19.8) years, operated under local anesthesia (group B). Excluded were patients with venous or arterial disease or other factors that could change the parameters investigated. METHODS: Blood was sampled from a cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and after the operation (on days 1 and 4). In patients' citrated plasma, tissue plasminogen activator antigen (t-PA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and activity (PAI-1), fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured. RESULTS. The pattern of changes in perioperative fibrinolytic activity was similar in both groups. Intraoperative levels of FDP were significantly higher and ELT shorter than preoperatively. In both groups t-PA Ag concentration was significantly increased on the first postoperative day. There were no changes in PAI-1 in both groups. Postoperatively, the FDP concentration was reduced and ELT prolonged. CONCLUSIONS: Retinal detachment surgery induces intraoperative activation of fibrinolysis in the systemic circulation regardless of the type of anesthesia.

Von Willebrand factor in subretinal fluid.

PURPOSE: To measure the vWF antigen concentration (vWF Ag) in subretinal fluid (SRF) and blood plasma. METHODS: Prospective study of 30 patients, aged from 15 to 78 years (mean 52.7 years), undergoing retinal detachment surgery. Excluded were patients with venous or arterial disease or any other factors that could affect the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. VWF in plasma and in SRF and its relation to patients' age, sex, the duration and extent of retinal detachment, number of retinal tears, and cryopexy application were evaluated. RESULTS: The median level of vWFAg in 30 samples of SRF was 6.3%. The median level of vWF Ag in blood plasma was 70.34%. The levels of vWF Ag in SRF were significantly lower than in blood plasma (p<0.00001). We found no correlation between the vWF Ag concentration in plasma or in SRF and sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and the use of cryopexy. CONCLUSIONS: Determination of vWF Ag showed that this factor in SRF is unrelated to patients', sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and use of cryopexy.

[Pseudophakic retinal detachment from personal material]. / Odwarstwienie siatkówki w oczach pseudofakijnych w materiale wlasnym.

PURPOSE: To analyse retinal detachment in pseudophakic eyes. MATERIAL AND METHODS: Analysis of 23 pseudophakic patients with retinal detachment operated at the Department of Ophthalmology in Bydgoszcz in the period from 1996 to 1998. The following factors were evaluated: time interval to retinal detachment surgery from the date of cataract surgery, intraoperative complications during the cataract extraction, state of posterior capsule, type and location of retinal tears, extension of retinal detachment, anatomical and functional results and state of fellow eye. RESULTS: Retinal detachment occurred in 65.2% pseudophakic eyes in the period shorter than 3 years after cataract extraction and IOL implantation and in 34.8% more than 5 years after this operation. In 17.4% pseudophakic eyes posterior capsula was ruptured intraoperatively, in 17.4% YAG capsulotomy and in 4.3% surgical capsulotomy were performed. In 56.5% eyes posterior capsula was intact. CONCLUSIONS: Our results suggest possibility of the occurrence of delayed retinal detachment in pseudophakic eyes. The rupture of posterior capsule is not the only risk factor for this disease.

Antithrombin III activity in subretinal fluid.

PURPOSE: To evaluate antithrombin III (AT III) activity in subretinal fluid (SRF) and blood plasma. METHODS: Prospective study of 32 patients, aged from 20 to 77 years (mean 53.8 years), undergoing retinal detachment surgery. Patients with vein or arterial disease or any other factors that could affect the parameters evaluated were excluded. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. AT III activity in citrated plasma and in SRF and its relations to patients' age, sex, duration and extent of retinal detachment and degenerative changes of the retina, were evaluated. RESULTS: The median level of AT III activity in 32 SRF samples was 16.5% (lower quartile 8.5% and upper quartile 23%). The mean level of AT III activity in plasma was 105% (SD 24%). AT III levels in SRF were significantly lower than in plasma (p < 0.0001). We found no correlation between AT III activity in SRF and plasma, and age, sex, the degree of myopia, the duration and extent of retinal detachment, or retinal degenerative changes. CONCLUSIONS: In this study we detected AT III activity in all 32 SRF samples.

Alterations in antithrombin III activity and other blood coagulation parameters after retinal detachment surgery.

PURPOSE: To evaluate perioperative changes in blood coagulation in patients undergoing retinal detachment surgery. MATERIALS: Prospective study of 56 patients, aged from 19 to 82 (mean +/- S.D. 53 +/- 16.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia. Excluded were patients with venous or arterial disease and any other factors that could affect the parameters under consideration. METHODS: Blood was sampled from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and on days 1 and 4 after the operation. We measured antithrombin III activity (AT III), platelet count, fibrinogen concentration, activated partial thromboplastin time (aPTT) and prothrombin time (PT). RESULTS: Intraoperative AT III activity and platelet count were significantly lower, aPTT was shortened and PT prolonged, although all values remained within the normal range. These results indicate moderate activation of coagulation during retinal detachment surgery. On the first postoperative day coagulation activity was reduced, with increases in AT III activity, fibrinogen concentration and platelet count and prolongation of aPTT. CONCLUSIONS: During retinal detachment surgery there is moderate activation of coagulation in the systemic circulation.

[Thrombin-antithrombin III complexes in plasma and subretinal fluid in patients with perforated retinal detachment]. / Kompleksy trombina-antytrombina III w osoczu i plynie podsiatkówkowym u chorych z przedarciowym odwarstwieniem siatkówki.

PURPOSE: To study the thrombin generation in plasma and subretinal fluid (SRF) by evaluation of thrombin-antithrombin III complexes (TAT) and antithrombin III (AT III) activity in patients with rhegmatogenous retinal detachment. MATERIAL AND METHODS: Prospective study of 54 patients subjected to retinal detachment surgery. Patients with vein or arterial disease and with other factors which could change evaluated parameters were excluded. Subretinal fluid samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein to natrium citrate solution (9:1) immediately after induction of anaesthesia but before surgery. TAT concentration in citrate plasma and in SRF was assessed in 22 patients aged from 15 to 78 years (mean: 49.5 years). AT III activity in blood plasma and SRF was measured in 32 patients aged from 20 to 77 years (mean: 53.8). The correlations between the TAT concentration in SRF were evaluated as well as AT III activity in SRF, and age, sex of patients, the duration and extent of retinal detachment, number of retinal tears and the cryopexy application. RESULTS: The median value of TAT concentration in citrate plasma was 9.08 micrograms/l (interquartile range: 59.3 micrograms/l). In 20 cases out of 22 eyes studied TAT levels were higher than 60 micrograms/l. The mean level of AT III activity in blood plasma was 105% (SD: 24.0%). The median level of AT III activity in 32 samples of SRF was 16.5% (interquartile range: 14.5%). The levels of AT III in SRF were significantly lower than AT III values in blood plasma (p < 0.001). We found no correlation between the levels of AT III activity in plasma and AT III activity in SRF nor between TAT concentration, AT III activity in SRF and sex, age of patients, the degree of myopia, the duration and extent of retinal detachment, nor retinal degenerative changes and cryopexy application. CONCLUSION: Our study revealed high TAT concentration and AT III activity and in all studied samples of SRF disclosing the signs of thrombin generation in SRF.

[Hemangioma racemosum of retina: a case report]. / Naczyniak krwionosny groniasty siatkówki--opis przypadku.

PURPOSE: To report a case of haemangioma racemosum, a rare congenital disease. PATIENT: Female patient, aged 17, with unilateral decrease of visual acuity. Examination showed retinal arteriovenous malformations. Fluorescein angiography demonstrated variably sized arteriovenous communications, tortuosity and dilatation of the malformed vessels as well as normal vessels. CONCLUSION: The reported case shows the difficulties that may be encountered in differentiating haemangioma racemosum from hemangiomas associated with other disorders. A complete physical examination and angiography are essential in distinguishing difficult cases.

[Corneal endothelial cell density and corneal thickness after laser trabeculoplasty]. / Gestosc komórek sródblonka rogówki i jej grubosc po trabekuloplastyce laserowej.

PURPOSE: The evaluation of the influence of laser trabeculoplasty on the corneal thickness and central endothelial cell density. MATERIAL AND METHODS: Corneal thickness and central endothelial cell density were measured before and 3 months after laser treatment. Patients were divided into 2 groups with different energy applied: 550-800 mW and 850-1100 mW. RESULTS: Differences of corneal thickness and central endothelial cell density were not statistically significant neither within nor between the groups. CONCLUSION: Laser trabeculoplasty performed with energy up to 1100 mW has no influence on corneal thickness and central endothelial cell density.

[Effect of vaccination programs on the incidence of idiopathic optic neuritis]. / Znaczenie podstawowych szczepien ochronnych dla zachorowalnosci na samoistna postac zapalenia nerwu wzrokowego.

UNLABELLED: To evaluate the influence of vaccination programs on the incidence of idiopathic optic neuritis. MATERIAL: 359 questionnaired patients with idiopathic optic neuritis hospitalized in the Department of Ophthalmology in Bydgoszcz and in the province of Bydgoszcz in the period from 1978 to 1997. Control group included 264 persons with no history of optic neuritis. RESULTS: Vaccinated persons were significantly (p = 0.01) rarely affected by this disease. CONCLUSION: The study revealed the positive correlation between lack of vaccination (according to vaccination program) and the incidence of idiopathic optic neuritis.

Changes in axial length after retinal detachment surgery.

PURPOSE: To evaluate changes in axial length and corneal curvature after an encircling procedure combined with segmental buckling. MATERIALS AND METHODS: We prospectively analysed cases with rhegmatogenous retinal detachment treated with an encircling band and scleral buckling surgery, comparing the pre-and postoperative ultrasonographic measurements of axial length and corneal curvature, and patients' age and sex in relation to the axial length of the eyeballs. We studied 74 patients (25 female, 49 male, aged 14-78 years, mean 46.7 years), who underwent retinal detachment surgery in 1995 and 1996. RESULTS: Axial eye length was significantly increased by surgery (median 0.77 mm one month after surgery). One year after treatment the elongation of the eye had decreased by 0.20 mm. The average increase of corneal curvature was 0.22 D one month after surgery, and 0.43 D at one year. The distribution of axial length showed a significant preponderance of eyes with a longer axial length among males. CONCLUSIONS: Encircling with a scleral buckling procedure with moderate indentation causes axial elongation of the eye.

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.

[Evaluation of the use of intravitreal air in retinal detachment surgery]. / Ocena zastosowania endotamponady powietrzem w chirurgii odwarstwienia siatkówki.

PURPOSE: To analyse the effects and complications after the use of intravitreal air in retinal surgery. MATERIAL AND METHODS: 185 patients (89 female, 96 male, aged from 12 to 81 years) with retinal detachment treated in the Department of Ophthalmology in Bydgoszcz in the period from 1992 to 1997, in whom intravitreal air was used. Patients with breaks lying above the 5 and 7 o'clock meridians were included in the treatment with intravitreal air. Follow-up period was from 6 months to 5 years. RESULTS: In 94% of cases the treatment was successful. In 2.7% the transient rise of intraocular pressure was noted. CONCLUSION: The use of intravitreal air in retinal surgery is an effective, safe, easy to perform, cheap and commonly available method used in retinal detachment surgery.

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.

Fibrinolytic activity of subretinal fluid after cryopexy.

PURPOSE: To measure the tissue plasminogen activator antigen (t-PA Ag) content and plasminogen activator inhibitor type 1 (PAI-1) activity of SRF and blood. METHODS: 22 patients aged from 20 to 77 years (median: 57.3 years), were studied, undergoing retinal detachment surgery. Excluded were patients with vein or arterial disease and any other factors that could change the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery, after cryopexy. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. T-PA Ag concentration and PAI-1 activity in subretinal fluid and citrated plasma and their relation to patients' age and sex, the duration and extent of retinal detachment, and degenerative changes of the retina were assessed. RESULTS: The median t-PA Ag concentration in 22 samples of SRF was 6.7 ng/ml (interquartile range 3.6 ng/ml) and PAI-1 activity 14.0 IU/ml (interquartile range 7.5 IU/ml). The median levels of t-PA Ag and PAI in plasma were respectively 10.7 ng/ml (interquartile range 8.6 ng/ml) and 15.7 IU/ml (interquartile range 12.2 IU/ml). There were no differences between the t-PA Ag concentration and PAI-1 activity in SRF and blood. We found no correlation between the levels of t-PA Ag and PAI-1 activity in SRF and age, sex, the degree of myopia, the duration and extent of retinal detachment, or retinal degenerative changes. CONCLUSIONS: The parameters of the fibrinolytic cascade studied here indicated the presence of high levels of t-PA Ag and PAI-1 activity in SRF.

[Fibrinolytic system and a central retinal vein thrombosis]. / Uklad fibrynolityczny a zakrzep zyly srodkowej siatkówki.

On the basis of literature review the role of fibrinolysis in the pathogenesis of central retinal vein thrombosis is presented. It has been proved by many authors that fibrinolytic activity is depressed in patients with vascular thrombosis, due to increased levels of fibrinolytic inhibitors mainly plasminogen activator inhibitor (PAI 1), and/or decreased levels of tissue plasmogen activator (t-PA). Low levels of t-PA and increased levels of PAI-1 have been found in states of special risk of thrombosis: obesity, diabetes mellitus, postoperative states, rheumatoid arthritis, malignancies and other diseases such as Behcet's syndrome. In pregnancy susceptibility to thrombosis follows the presence in blood of PAI-2, an inhibitor of plasminogen activators secreted by the placenta. Therapy is based on the use of anticoagulants (e.g. heparin) and thrombolytic agents (e.g. streptokinase).

Intraocular lens implantation in myopic eyes.

PURPOSE: To assess the results of posterior chamber lens implantation in myopic eyes with cataract. METHODS: Retrospective study of postoperative results ranging from 4 to 89 months (mean 35 months) in 54 myopic patients (62 eyes with axial length of 26 mm or more) who had undergone PC IOL implantation in the Department of Ophthalmology, Medical Academy of Bydgoszcz, Poland. OUTCOME MEASURE: Best corrected distance and near visual acuity, operative complications, early and late postoperative complications. RESULTS: in 95% of patients with eye length 26-28 mm visual acuity of 0.5 or more was achieved. The mean postoperative spherical equivalent was -0.8 D. Posterior capsule opacification which required Nd: YAG capsulotomy developed in 19% of eyes, on average after one year of follow-up. No complications such as retinal detachment, glaucoma or corneal dystrophy were observed. CONCLUSIONS: PC IOL implantation in myopic eyes with cataract appears to be an efficacious, satisfactory and safe procedure.

[The efficacy of repeated laser trabeculoplasy]. / Skutecznosc wielokrotnej trabekuloplastyki laserowej.

PURPOSE: The evaluation of the results of repeated laser trabeculoplasty. MATERIAL AND METHODS: Retrospective analysis of cases with open angle glaucoma in eyes with uncontrolled intraocular pressure was carried out. The studied group comprised eyes which had shown a significant and prolonged (for at least 12 months) hypotensive response to initial laser trabeculoplasty. 20 patients (26 eyes) were analyzed. The follow-up period lasted from 12 to 59 months. RESULTS: 91% of eyes demonstrated a sustained and favourable response--intraocular pressure decrease of 5.6 mmHg to 17 mmHg (mean 9.6 mmHg). No significant immediate postoperative pressure increases were observed. CONCLUSION: Our results show the effectiveness of repeated laser trabeculoplasty in the treatment of chosen types of glaucoma.

[Structured abstracting of scientific medical publications]. / Streszczenia strukturalne naukowych publikacji medycznych.

Abstracts play an important role in medical literature as the carriers of synthetic information. Their significance grows as computerized data bases are in use in which whole information should comprise no more than 250 words. Critical appraisal the abstracts' standard resulted in a proposal for data presentation divided into significant parts (structured abstracts). The abstract of an original clinical trial should contain description of the objective, design, setting, patients, intervention, main outcome measures, results and conclusions. The abstract of the review article should provide information about the purpose, data identification, study selection, data extraction, results of data synthesis and conclusions. This form obliges the authors to precise, logical formulation draws out the essential aspects of the work, facilitates literature review, and critical appraisal.