Visual outcomes of posterior chamber intraocular lens intrascleral fixation in the setting of postoperative and posttraumatic aphakia.

BACKGROUND: Several techniques for fixation of the posterior chamber intraocular lens (IOL) have been developed. We evaluate long-term functional outcomes and safety of posterior chamber IOL implantation using Hoffman scleral haptic fixation and sutureless Sharioth technique in patients with posttraumatic and postoperative aphakia. METHODS: This retrospective case-series included 42 eyes operated by one surgeon. The data including demographic data, ocular history, preoperative, early postoperative and final best corrected visual acuity (BCVA), rate of complications as well as postoperative IOL position were collected. The mean follow-up was 14.5 months. Hoffman haptic scleral fixation was performed in 31 eyes, Sharioth technique-in 11 eyes. Aphakia was due to eye trauma (19) or complicated cataract surgery (23). RESULTS: Overall, the final BCVA improved in 26 eyes, did not change in 5 eyes, and worsened in 11 eyes. No significant differences in BCVA were found between groups operated with Hoffman scleral fixation and Sharioth technique. Postoperatively, we noticed two dislocations of IOL fixated using Sharioth technique and none after Hoffman technique. No severe complications were observed. CONCLUSION: Both transscleral fixation techniques are feasible methods of secondary IOL implantation in posttraumatic and postoperative aphakia. with low incidence of complications, however visual outcomes are diverse.

[Anatomical and functional results of pars plana vitrectomy with the internal limiting membrane removal in patients with rhegmatogenous retinal detachment]. / Ocena anatomiczna i funkcjonalna wyników leczenia przedarciowego odwarstwienia siatkówki metoda witrektomii przez czesc plaskqa ciala rzeskowego z usunieciem blony granicznej wewnetrznej.

AIM: To evaluate the benefits of the internal limiting membrane removal in patients with rhegmatogenous retinal detachment who underwent pars plana vitrectomy. MATERIAL AND METHODS: The first study group (B) consisted of 26 patients who underwent vitrectomy with the internal limiting membrane peeling. The second control group (K) consisted of 15 patients, in whom vitrectomy was performed without he internal limiting membrane peeling. Macular detachment was confirmed preoperatively in all patients. Ophthalmic examination was performed 6 months after surgery. This included the best corrected visual acuity for distance and near, M-Charts, fundus examination and spectral domain--optical coherent tomography. RESULTS: The results were statistically analyzed using the Shapiro-Wilk test and the Ch2 test of homogeneity. In the study group (B), the mean postoperative best corrected visual acuity for distance was 0.46, while in the control group (K) it was 0.35 (p = 0.35). The best corrected visual acuity for near in group B was 0.83 and 1.01 (p = 0.63) in group K. Central retinal thickness in group B was 268.64 µm, while in group K it was 335.07 µm (p = 0.20). The statistical analysis revealed significant differences between the two groups regarding the prevalence of defects in the ellipsoidal layer (p = 0.004). They were found to occur more frequently in group K (64.29%) than in group B (20.00%). The prevalence of epiretinal membrane was higher in group K (28.57%) than in group B (3.85%) (p = 0.02). CONCLUSIONS: The internal limiting membrane peeling reduces the risk of secondary epiretinal membrane, restores the ellipsoidal layer integrity and does not affect the visual acuity for distance and near.

M-charts as a tool for quantifying metamorphopsia in age-related macular degeneration treated with the bevacizumab injections.

BACKGROUND: This article is aimed to assess quantitatively metamorphopsia using M-charts in patients suffering from wet age-related macular degeneration (AMD) treated with the intravitreal bevacizumab injections and to compare the results with traditional Amsler grid and ocular coherence tomography (OCT). METHODS: Thirty-six patients diagnosed with wet AMD were examined one day before and one month after the intraocular injection of bevacizumab. Horizontal and vertical metamorphopsia scores using M-charts, distance visual acuity, Amsler test and OCT were performed at each visit. Additionally, 23 healthy subjects were examined as a control group. RESULTS: The rate of metamorphopsia detection was 89% with M-charts and 69% with Amsler test. The horizontal metamorphopsia score improved in 22 patients, the vertical metamorphopsia score improved in 16 patients, the Amsler grid results improved in 6 patients, visual acuity improved in 17 patients. There was no correlation between the degree of metamorphopsia and the visual acuity or the central retinal thickness (CRT). The specificity of both the M-charts and Amsler grid was 100%. CONCLUSIONS: The rate of metamorphopsia detection in wet AMD patients was better with M-charts than with Amsler grid. M-charts may be used in the assessment of efficacy of treatment with intravitreal bevacizumab injections as another outcome measure, moreover they can be used even at home for the self-assessment. M-charts provide additional information concerning the visual function, independent of the visual acuity, CRT and morphological changes in OCT.

Presence and distribution of L-kynurenine aminotransferases immunoreactivity in human cataractous lenses.

PURPOSE: To investigate the presence and distribution of l-kynurenine aminotransferases immunoreactivity in human and animal lenses during cataract formation. METHODS: Immunohistochemistry was conducted using polyclonal antibodies against KAT I, KAT II and KAT III on sections of 26 anterior capsules from patients undergoing surgical treatment of anterior subcapsular cataract (ASC) and 22 cataractous lenses from human eyes enucleated because of choroidal malignant melanoma. Additionally, the eyes of 11-month-old DBA/2J mice (6 eyes) were investigated (with KAT I and II). Ten clear human lenses and four BL6 mice lenses were used as controls. Spatial immunoreactivity patterns of enzymes were compared with Periodic Acid - Schiff (PAS)-stained sections. RESULTS: Immunohistochemical analysis revealed presence of KAT I, KAT II and KAT III in extracellular structures of all studied types of cataract in human eyes showing specific pattern of the stain. In cortical cataract, immunoreactivity was observed on cortical lens fibres. In nuclear cataract, KAT II revealed stronger and diffused staining than KAT I. Additionally, both KAT showed more pronounced staining at the edge of small clefts. In normal human lenses, KAT I, II and III, immunoreactivity was not observed. Presence of KAT I and KAT II in the intercellular substance of DBA/2J mice cataract was observed. In BL6 mice lenses without cataract, only weak KAT I and KAT II staining was observed. CONCLUSIONS: Presence of l-kynurenine aminotransferases in extracellular matrix (ECM) during human cataract formation suggests that products of l-kynurenine pathway might be involved in mechanisms of cataractogenesis.

[Optical Coherence Tomography (OCT) examination in patients with central retinal artery occlusion]. / Badanie optycznej koherentnej tomografii (OCT) u chorych z zatorem tetnicy srodkowej siatkówki.

PURPOSE: To present qualitative and quantitative changes in OCT image evolving during time in eyes with central retinal artery occlusion. MATERIAL AND METHODS: Results of OCT examination of 8 patients with central retinal artery occlusion were studied. The patients age ranged from 56 to 81 years (median - 63). The Group consisted of 5 men and 3 women. Follow-up period ranged from 6 o 28 months (median - 14 months). Patients were examined in acute stage of CRAO (1-3 days), 1, 3, 6, 9, 12 and 24 months after CRAO episode. The OCT examination was performed using Cirrus OCT (Zeiss) and macular region analyzed using a standard scanning protocol Macula Thickness: Macular Cube 512x128. RESULTS: In an acute stage of CRAO increased thickness and hyperreflectivity of the inner retinal layers with corresponding hyporeflectivity layer below was detected. During follow-up period thickness of inner retinal layers and total retinal thickness gradually decreased. The other retinal layers presented increased reflectivity over time. After 6 months of observation we observed an atrophy of the retinal layers and lack of fovea profile in all cases. CONCLUSIONS: The SD-OCT examination appears to be a perfect method for the determination of the dynamics of the edematous and atrophic changes evolving after CRAO in the macular area.

[Mode of delivery and eye diseases]. / Poród a schorzenia narzadu wzroku.

There are many controversies among ophthalmologists and obstetricians regarding indications for caesarean section due to preexisting eye diseases. Many ophthalmologists still believe myopia, retinal detachment, glaucoma or diabetic retinopathy to be indications for a caesarean section. There is a discrepancy between clinical practice and evidence-based medicine, as none of the published trials have reported any retinal changes after vaginal delivery This report provides information on the influence of physiological changes on eye diseases during the final stage of the delivery. We conclude that an eye disease is not an indication for a caesarean section.

[Novelty of vital dyes in ophthalmic surgery]. / Zastosowanie nowych barwników w chirurgii okulistycznej.

The aim of this paper is to present recent developments in the area of novelty of vital dyes in intraocular surgery. The authors present the advantages and disadvantages of several vital dyes currently used in ophthalmic surgery. Vital dyes are used to allow better intraoperative visualization of both the anterior and posterior segments. Indocyanine green and trypan blue are the most frequently used and the most efficacious dyes for staining the important anatomic areas but often are associated with significant side effects. These dyes are used in cataract and vitreo-retinal surgery. Other dyes including rhodamine 6G, E68, bromophenol blue, light green and Chicago blue are still under preclinical assessment.

Invasive cervical cancer during pregnancy: laparoscopic nodal evaluation before oncologic treatment delay.

INTRODUCTION: Cervical cancer is the most frequently encountered malignancy during pregnancy. Presence of nodal metastasis is the most important negative prognostic factor and its assessment represents a crucial parameter to decide if pregnancy can safely continue. We describe the results of 18 pregnant patients with cervical cancer who had their nodal status proved by means of laparoscopy. MATERIAL AND METHODS: Eighteen patients with cervical cancer who underwent laparoscopic pelvic lymphadenectomy during pregnancy at Charité-University Berlin and Friedrich-Schiller-University Jena between 1999 and 2010 were analyzed retrospectively. RESULTS: The mean age at diagnosis was 32 years (26-40) and gestational age between 6 and 23 weeks of pregnancy. The following FIGO stages of cervical cancer were treated: 1a1 for two women, 1a2 for one woman, 1b1 for thirteen women, 1b2 for one woman and 2a for one woman. The histological type was squamous carcinoma in nine cases and adenocarcinoma also in nine cases. All laparoscopic procedures were successfully completed; there was no surgery-associated mortality, morbidity, or conversion to laparotomy. Additionally, there were no complications for either mother or child related to the general anesthesia. The mean number of lymph nodes removed was 17 (6-46). Definitive cancer treatment was delayed for fourteen out of eighteen patients until delivery with an average delay interval of 17 (9-28) weeks. Lymph nodes were positive in 16% of the cases (3/18) and these patients received immediate cancer treatment. One patient decided to interrupt the gestation before delivery despite negative lymph nodes. Fourteen patients reached fetal maturity and gave birth to healthy babies by caesarean section. All patients are alive without evidence of disease at a mean follow-up time of 38 (5-128) months. CONCLUSION: Laparoscopic pelvic lymphadenectomy during pregnancy is feasible and safe. Results suggest that in patients with cervical cancer complicated by pregnancy a planned delay of oncologic treatment can be a safe option after tumor metastasis to lymph nodes has been histopathologically ruled out.

Percutaneous intragastric catheter (PIC) for administration of an unpalatable substance to large animals.

We studied an easy and reliable technique for administration of an unpalatable substance to large animals. There were three groups of pigs: group I (n = 6) received 1 g ethanol/kg body weight per day orally with water for 24 days, group II (n = 6) received 2 g ethanol/kg orally with water for 24 days and 4 g ethanol/kg via percutaneous intragastric catheter (PIC) for the next 24 days, group III (n = 6) received 6 g ethanol/kg via PIC for 72 days. The catheter was placed after insufflation of the stomach using an orogastric tube. PIC was successfully placed in each pig. No complications occurred during placement. The total amount of the administrated dose was assimilated each time. PIC is a safe, effective, well tolerated, and precise method of administering ethanol that is inexpensive and easy to perform. Ethanol administration via PIC is a convenient and effective mean of exposing animals to high levels of alcohol on a long-term basis.

Vaginal robot-assisted radical hysterectomy (VRARH) after laparoscopic staging: feasibility and operative results.

BACKGROUND: To describe a technique of vaginal robot-assisted radical hysterectomy (VRARH) that utilizes the advantages of a robotic system and eliminates the manipulation of cancer tissue. METHODS: A prospective study was performed for VRARH using the da Vinci robotic surgical system in 12 patients. The procedure was indicated in patients with cervical cancer stage FIGO IB1 after laparoscopic lymphadenectomy. A tumour-adapted vaginal cuff was created transvaginally. RESULTS: All operations were completed with minimal blood loss (mean 123 ml). The mean operative time including para-aortic lympadenectomy was 356 min, the vaginal cuff creation took 43 min and the radical robotic resection 68 min. No uterine manipulator was used. There were no bladder or bowel complications and no conversion to standard laparoscopy or laparotomy. CONCLUSIONS: The VRARH technique combines the advantages of the vaginal route and robotic laparoscopic surgery: tumour contamination is avoided and complications are minimized. This procedure could be superior to techniques described previously.

Robotic assistance in gynecological oncology.

PURPOSE OF REVIEW: The da Vinci robot has proved to be the most advanced surgical system in gynecology. In this review we evaluated the possibilities of applying robotic assistance to improve gynecological endoscopic oncological surgery. RECENT FINDINGS: A literature survey on robotic-assisted gynecological oncology clearly supports the use of the da Vinci surgical system in laparoscopic oncological surgery. Robotic precision in tumor excision, easier intracorporal suturing and favorable ergonomics for the surgeon make the da Vinci robot particularly suitable for performing complex laparoscopic microinvasive surgical operations in gynecological oncology. SUMMARY: Robotic surgery combines the advantages of open surgery and endoscopic surgery. In our opinion, robotic surgery may lead to better results than conventional laparoscopic surgery, particularly in the field of gynecological oncology. However, this opinion has yet to be confirmed by randomized studies.

[Decrease of the postoperative inflammatory reaction during pars plana vitrectomy (PPV) after administration of triamcinolone acetonide]. / Zmniejszenie pooperacyjnego odczynu zapalnego wskutek zastosowania octanu triamcynolonu podczas witrektomii pars plana.

PURPOSE: To prospectively evaluate the effect on postoperative inflammatory reaction and recovery after application of triamcinolone acetonide (TA) during pars plana vitrectomy (PPV), to visualize the vitreous. MATERIAL AND METHODS: Pars plana vitrectomy (PPV) was performed in 45 patients (21 males, 24 females) (29 with retinal detachment, 6 with macular hole, 1 with cystoid macular edema, 3 with diabetic retinopathy, 3 with vitreous haemorrhage, 1 with preretinal membrane, 1 with PVR and 1 with lens luxation). After surgical separation of the posterior vitreous and removal of any visible epiretinal membrane, TA was injected over the posterior pole. For the control group we used 15 patients (10 with retinal detachment, 2 with macular hole, 1 with preretinal membrane, 1 with lens luxation and 1 with vitreous haemorrhage) (10 males, 5 females) treated with PPV but without TA administration. To evaluate the degree of postoperative inflammation and to monitor the dynamics of the blood-aqueous barrier disruption, the laser flare cell meter (Kowa FM-500) was used. RESULTS: Tyndalometric mean values in the control group of eyes recorded 1 day after PPV were 32.41 +/- 6.1 ph/ msec while values in TA-treated group were significantly lower (20.26 +/- 2.4, p < 0.02). 10 days after surgery in TA group results were still significantly lower as compared to the control group (16.4 +/- 2.6 vs 32.5 +/- 9.6, p < 0.005). As observed 6 weeks after PPV, tyndalometric recordings in TA-treated group remained lower as those observed in the control group (16.1 +/- 3.1 vs 32.0 +/- 8.1, p < 0.01). CONCLUSIONS: The eyes which received TA-assisted PPV showed significantly less breakdown of the blood-ocular barrier than those with routine PPV. Intraoperative administration TA facilitates postoperative recovery after surgery lowering the inflammatory reaction.

Regenerative capacity differs between micro- and macrovesicular hepatic steatosis.

INTRODUCTION: Independent of etiology, the hepatic microvesicular steatosis has a worse prognosis compared with macrovesicular steatosis. Proliferation compensates for apoptosis and reflects regenerative mechanisms following liver injury. It is unknown whether these two types of fatty liver have differences in regenerative capacity and apoptosis, which could have an impact on their prognosis. METHODS: Two groups of pigs were studied for 72 days under a protein-deficient diet. One group received only protein-deficient diet (n=6), the other was treated in addition to the diet with 6g ethanol/kg/day by means of a percutaneous intragastric catheter (n=6). The rate of proliferating and apoptotic hepatocytes was determined, respectively, by proliferation cell nuclear antigen (PCNA) and ISEL/TUNEL staining for apoptosis in liver biopsies with similar steatosis grade in pigs with micro- or macrovesicular fatty liver. RESULTS: The ethanol-treated group developed microvesicular steatosis, the other group developed macrovesicular steatosis. Proliferation index was significantly increased in macrovesicular in comparison with microvesicular steatosis (p<0.05). Apoptosis rate was similar in both groups. CONCLUSIONS: Regeneration, but not apoptosis rate differs between micro- and macrovesicular steatosis. The reduced regenerative capacity in microvesicular steatosis may contribute to the worse prognosis of this subtype of fatty liver disease.

[Assessment of the macula function by static perimetry, microperimetry and rarebit perimetry in patients suffering from dry age related macular degeneration]. / Ocena funkcji plamki za pomoca perymetrii statycznej, mikroperymetrii oraz perymetrii "rarebit" u chorych z postacia sucha AMD.

PURPOSE: To compare the visual field results obtained by static perimetry, microperimetry and rabbit perimetry in patients suffering from dry age related macular degeneration (AMD). MATERIAL AND METHODS: Fifteen eyes with dry AMD (hard or soft macula drusen and RPE disorders) were enrolled into the study. Static perimetry was performed using M2 macula program included in Octopus 101 instrument. Microperimetry was performed using macula program (14-2 threshold, 10dB) within 10 degrees of the central visual field. The fovea program within 4 degrees was used while performing rarebit perimetry. RESULTS: The mean sensitivity was significantly lower (p<0.001) during microperimetry (13.5 dB) comparing to static perimetry (26.7 dB). The mean deviation was significantly higher (p<0.001) during microperimetry (-6.32 dB) comparing to static perimetry (-3.11 dB). The fixation was unstable in 47% and eccentric in 40% while performing microperimetry. The median of the "mean hit rate" in rarebit perimetry was 90% (range 40-100%). The mean examination duration was 6.5 min. in static perimetry, 10.6 min. in microperimetry and 5,5 min. in rarebit perimetry (p<0.001). Sensitivity was 30%, 53% and 93% respectively. CONCLUSIONS: The visual field defects obtained by microperimetry were more pronounced than those obtained by static perimetry. Microperimetry was the most sensitive procedure although the most time-consuming. Microperimetry enables the control of the fixation position and stability, that is not possible using the remaining methods. Rarebit perimetry revealed slight reduction of the integrity of neural architecture of the retina. Microperimetry and rarebit perimetry provide more information in regard to the visual function than static perimetry, thus are the valuable method in the diagnosis of dry AMD.

[Intravitreal bevacizumab (Avastin) iniections for neovascular age-related macular degeneration (AMD)--preliminary results]. / Doszklistkowe iniekcje bevacizumabu (Avastin) w leczeniu wysiekowej formy zwyrodnienia plamki zwiazanego z wiekiem (AMD)--doniesienie wstepne.

PURPOSE: To evaluate effects of intravitreal bevacizumab on visual acuity and angiographic lesions characteristics in patients with neovascular AMD and to report safety of such treatement. MATERIAL AND METHODS: 32 patients with confirmed choroidal neovascularisation (CNV) and AMD were treated. Patients received 2 intravitreal bevacizumabu (1.25 mg) iniections on 1-3 months basis. Control ophthalmic evaluations included visual acuity measurements with EDTRS charts, intraocular pressure measurements, complete ophthalmic examination in slit lamp, fluorescein angiography and blond pressure measurements. RESULTS: In 18 patients (56%) visual acuity improvement at a mean 3 lines on EDTRS charts was observed, in 9 patients (28%) visual acuity did not change and in 5 (16%) cases decreased visual acuity (about 1,5 lines in EDTRS charts) was noted. Mean follow-up period was 3 months after second injection. In most study eyes fluorescein angiography revealed a marked reduction in leakage from CNV. Apart from one case with endophthalmitis symptoms after second bevacizumab injection, we did not observed systemic or ocular adverse effects of the applied treatment. CONCLUSIONS: Short-term results suggest that intravitreal bevacizumab is relatively safe form of AMD treatement and is associated with improvement in visual acuity and reduction in angiographic leakage in most patients with neovascular AMD. Further evaluation of the long-term effectiveness of this treatment is warranted.

Retinopathy of prematurity: A refresher for obstetricians.

Advances in neonatal care improved the survival of many preterm infants, but also increased the incidence of retinopathy of prematurity (ROP). Numerous risk factors have been associated with the development of ROP, the most important of which are: low birth weight, early gestational age at delivery, and duration of oxygen therapy. Screening premature infants is a critical factor for any prevention and treatment protocol. The Retinopathy of Prematurity Subcommittee of the American Academy of Ophthalmology (AAO) and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) have developed guidelines that assist practicing physicians in managing children with ROP. A portion of these guidelines is particularly applicable to practicing obstetricians who, along with the pediatricians, are often the primary physicians for the affected families. The aim of this paper is to present a comprehensive overview of the epidemiology, etiology, manifestations, prevention, and management of ROP. In the last section, the authors present guidelines for practicing obstetricians that incorporate the most recent recommendations of ophthalmic and pediatric thought leaders.

The paradox of old maternal age in multiple pregnancies.

The study of multiple gestations in older mothers has been furthered by the analyses of large data sets published in recent years. These initial analyses are counterintuitive in that the obstetric and neonatal outcomes of the older mothers (>40 years) are better than those of their younger counterparts (aged 25-29). Currently, it is not clear if older mothers of multiples are advantaged or younger mothers of multiples are disadvantaged. It seems reasonable, however, to conclude that pregnancy after age 40 represents a new obstetric entity, one in which many women will have twins or triplets as a result of assisted reproductive technologies. Further study in this area is clearly warranted, preferably using databases that combine maternal and neonatal data.

Defining the high-risk nature of triplet pregnancies.

Triplet pregnancies are by nature rare. Assisted reproductive technologies have multiplied their rate of occurrence in the last two decades. Whether spontaneous or induced, triplet pregnancies present obstetric and neonatal-and then often lifelong-medical problems severalfold more often than singletons, or even twins. The major cause of problems for triplet gestations stems from preterm delivery and low birth weight.