Electro-oculogram in patients with neurofibromatosis type 1.

PURPOSE: The electro-oculogram (EOG) is a powerful test to evaluate the functional status of the retinal pigment epithelium (RPE). Clinically detectable changes of the RPE desribed in neurofibromatosis type 1 (NF-1) patients include combined hamartoma of the retina/RPE and congenital hypertrophy of the RPE. The goal of this study was to determine whether the function of RPE as measured by EOG is also changed in individuals with NF-1. PATIENTS: Studies were undertaken in 20 patients with clinically diagnosed NF-1 and compared to 16 normal healthy controls. METHODS: Standard EOG and flash ERG recordings were performed in accordance with International Society for Clinical Electrophysiology of Vision (ISCEV) standards. RESULTS: In NF-1 patients the Arden indexes of the EOG test were significantly higher primarily due to the lower values of dark troughs. Supernormal EOGs were present in 60% of NF-1 patients in comparison to the control group mean +2 SD. No one patient showed so high abnormalities during flash ERG examination. CONCLUSIONS: Dysfunction of the RPE may be characteristic feature of individuals with NF- 1.

[Assessment of foveal function in eyes of patients with exudative age-related macular degeneration before and after argon laser treatment]. / Ocena funkcji dolka w oczach z wysiekowa postacia zwyrodnienia plamki zwiazanego z wiekiem pacjentów przed i po leczeniu laserem argonowym.

PURPOSE: 1. Can foveal cone electroretinogram (FCERG) be a useful diagnostic test in evaluation of efficacy of argon laser treatment in eyes with exudative (wet) age-related macular degeneration (AMD)? 2. Comparison of FCERG with visual acuity, static perimetry and fluorescein angiography results. MATERIAL AND METHODS: FCERGs were recorded from 30 eyes with mean visual acuity 0.6 (Snellen Table) of 20 patients (mean age: 61 years) with wet AMD. The fovea was stimulated with 5-degree flickering light spot (f = 31.25 Hz), surrounded by a 20-degree annulus of intensive steady retinali illuminance. FCERGs were recorded and analysed in amplitude according to the computer-aided method recently put in practice in our laboratory. FCERGs were obtained twice for each AMD patients: before and 3 months after argon laser treatment. Electrophysiological data were also compared with the results of fluorescein angiography, visual acuity and static perimetry. RESULTS: In the group of patients with wet AMD, significant increase of FCERG amplitude (p < 0.001) after laser treatment was obtained in group I (33% of analysed eyes) and there were mainly patients with extrafoveal choroidal neovascularisation (CNV). Significant decrease of FCERG amplitude (p < 0.01) was obtained in group II (67% of analysed eyes). These were mainly patients with subfoveal CNV and also with extrafoveal CNV. In both groups after laser treatment we did not receive significant changes in visual acuity and macular perimetric mean sensitivity. CONCLUSIONS: These findings suggest that foveal cone ERG can be a useful, independent from fluorescein angiography, test for objective evaluation of efficacy of argon laser treatment in patients with wet AMD, opposite to visual acuity and static perimetry (macula threshold) examinations. FCERG probably indicates patients with better or worse prognosis.

[Negative-type flash electroretinogram]. / Negatywny elektroretinogram blyskowy.

The authors explain the entity of the negative-type flash electroretinogram (negative ERG), its morphology and origin. They also describe some retinal diseases and syndromes with this type of ERG. On the basis of the literature and own experiences the authors emphasize its diagnostic and prognostic value.

[Oscillatory potentials in electroretinographic evaluation of retinal function in insulin-dependent diabetics without retinopathy]. / Potencjaly oscylacyjne w elektroretinograficznej ocenie funkcji siatkówki u pacjentów z cukrzyca insulinozalezna bez objawów retinopatii.

PURPOSE: Can oscillatory potentials be a useful method for detection of retinal dysfunction in insulin-dependent diabetics without retinopathy? MATERIAL AND METHODS: In this study scotopic oscillatory potentials (OPs) were obtained in 35 subjects (70 eyes) with insulin-dependent diabetes without retinopathy (mean disease duration--5 years) and in 15 healthy subjects (30 eyes). This examination was performed according to the recommendations of the International Society of Clinical Electrophysiology of Vision (ISCEV). The oscillatory potentials were extracted from the maximal combined response by high-pass filtering. We analysed amplitude and peak-latencies of the first three electroretinographic oscillatory potentials O1, O2, O3, index of wavelets [sum of amplitudes (O1 + O2 + O3)] and compared with the results of the control group. RESULTS: In group of patients with insulin-dependent diabetes without retinopathy, we received statistically significant reduction of amplitude O1 (p < 0.003) and index of wavelets (p < 0.04). Reduced amplitude O1 was obtained in 10%, index of wavelets in 31.4% of analysed eyes. We didn't observe statistically significant changes in amplitudes O2, O3 and latencies O1, O2, O3. CONCLUSIONS: Our results suggest that retinal dysfunction is present in insulin-dependent diabetics without retinopathy 5 years after onset of the disease. The sum of amplitudes (O1 + O2 + O3) was the most sensitive parameter of retinal abnormalities. It seems reasonable to have more frequent ophthalmological examination of the diabetics with abnormal oscillatory potentials.

[Implantation of posterior chamber lenses with trans-scleral fixation]. / Wszczepy soczewek tylnokomorowych mocowanych do twardówki.

PURPOSE: The aim of this study is the presentation of our experiences in implantations of posterior chamber lenses with transscleral fixation. MATERIAL AND METHODS: The surgery was performed in 66 patients (66 eyes) using modified technique described by Lindquist et al. Primary implantations were performed in 53% subjects, in the remaining secondary implantations. RESULTS: After surgery we achieved visual acuity improvement in 80.3%, good visual acuity (0.5-1.0) in 68.4% of subjects. The main postoperative complications were: deformation of the pupil and decompensation of corneal endothelium. CONCLUSIONS: Implantation of posterior chamber lenses with transscleral fixation is preferable (alternatively for anterior chamber lenses) in young patients as well as in subjects with glaucoma, elevated intraocular pressure, iris coloboma and corneal problems.

[Ventilation using the laryngeal mask and intubation tube during general anesthesia for ophthalmic surgery]. / Wentylacja przez maske krtaniowa i rurke intubacyjna podczas znieczulenia ogólnego w okulistyce.

PURPOSE: The aim of the investigation was to compare efficacy of using for airway maintainance and controlled ventilation the laryngeal mask versus orotracheal intubation. MATERIALS AND METHODS: We carried outs this examination in the group of 50 patient of both sex scheduled for elective operations in ophthalmic surgery. All participants were of I or II class of perioperative risk according to ASA scale. We tried to estimate efficacy of using laryngeal mask versus orotracheal intubation during anaesthesia with controlled ventilation. We examined capillary blood hemoglobin saturation, carbon dioxide pressure in end-tidal expired gas and peak inspiratory pressure while laryngeal mask or orotracheal tube was applied. RESULTS: We found no differences of clinical importance in both group of patients in the range of measured parameters. CONCLUSION: We conclude that ventilation with the laryngeal mask inserted is safe and effective providing that patients are carefully selected.

[Foveal electroretinogram: its application in the diagnosis of macular diseases. Preliminary report]. / Elektroretinogram dolkowy--zastosowanie w diagnostyce chorób plamki. Doniesienie wstepne.

PURPOSE: To present difficult method of recording and analysis of the Foveal Cone Electroretinogram (FCERG, a type of focal ERG) for evaluation of foveal cone function in healthy subjects and patients with different macular diseases. The FCERG signal is of great importance in diagnosis of these diseases because the full-field ERG is dominated by the extrafoveal cones activity. MATERIAL AND METHODS: In this study FCERGs were obtained in 90 healthy subjects (90 normal eyes), several with known macular diseases and subjects with optic neuritis and suspected maculopathy. The fovea was stimulated with a 5-degree flickering light spot surrounded by a 20-degree annulus of steady retinal illuminace. The stimulus was applied to the eye with the use of a hand-held stimulator-ophthalmoscope. FCERG signals were analysed by means of Fast Fourier Transformation method. RESULTS: Mean FCERG amplitudes, phase and standard deviation (SD) values were established in 3 control groups of different age. There was in decrease in amplitude of FCERGs with age, which is a agreement with literature data. In this study significant abnormalities of the FCERG recordings are illustrated in some cases of known macular diseases. CONCLUSION: Our preliminary clinical investigations manifest the value of the FCERGs in objective evaluations of macular diseases undetectable with conventional electroretinography.

[The significance and interpretation of the electrophysiological and psychophysiological analyses in the diagnosis of glaucoma]. / Znaczenie i interpretacja badan elektrofizjologicznych i psychologicznych w diagnostyce jaskry.

The goal of this paper is to discuss and indicate which electrophysiological and psychophysical tests are useful for diagnosis and monitoring of glaucoma patients. In diagnosis of glaucoma, among electrophysiological methods, the authors perform mainly transient and steady-state pattern electroretinogram (PERG). Steady-state as well as transient PERG have the best sensitivity and specificity in diagnosis of this disease even in its early stages. Pattern visual evoked potentials (PVEPs) are less sensitive and specific, that is why this examination is rare in practical use. The authors describe the method of PERG, discuss most frequent mistakes in the method and interpretation of the obtained results. Among psychophysical tests the authors emphasize the significance of short-wave-length perimetry (blue-on-yellow) and standard static perimetry in early diagnosis of glaucoma. On the basis of literature, the authors present also other psychophysical methods, which can be applied in diagnosis of glaucoma.

[Midazolam administered orally as premedication in children in the ophthalmology department]. / Midazolam stosowany doustnie w premedykaczji dzieci w oddziale okulistycznym.

The aim of research was using midazolam for preoperational medication in children undergoing diagnostic and minor surgical procedures in ophthalmic surgery and estimation of its properties for deep sedation. We used midazolam in children of both sex, from 2 to 10 years of age. All the patients were considered as I or II grade of ASA scale of perioperational risk. Patients were given midazolam orally at dose 0.5 mg per kg of body weight. Sedation degree was assessed according to Addenbrooke's Hospital Scale of Sedation as well as to changes in systolic (SAP) and diastolic (DAP) arterial pressure, pulse oximetry of capillary blood (SpO2) and heart rate (HR). Sedation in all children subjected to the trial was good and optimal conditions to perform the procedures were achieved. We found the level of sedation satisfactory and safe. Measurement of SAP, DAP, SpO2 and HR revealed stability of circulation in the whole perioperative period. We found the sedative properties of midazolam as excellent in the described range of age and useful for the diagnostics and surgery respectively.

[Clinical examinations in Usher's syndrome]. / Badania kliniczne w zespole Ushera.

In this paper we are showing the results of clinical examinations in the family in which three siblings had the following symptoms: congenital deafness and nyctalopia. Clinical examinations including genetic counseling, audiometry, caloric test, Flash ERG, perimetry, computer tomography revealed total deafness, no vestibular function, and an advanced stage of retinitis pigmentosa. On the basis of clinical results, we determined the correct diagnosis: autosomal recessive Usher's syndrome-type 1. Diagnosis of the syndrome enables qualification of prognosis, complications, possibility of treatment and the risk of having the disease in the next generations. Early identification of the presence of Usher's syndrome can help in the formulation of an appropriate educational and training program. It seems purposeful that all patients with hearing loss should be examined by ophthalmologists.

[Electrophysiologic tests for diagnosis of congenital night blindness]. / Badania elektrofizjologiczne w diagnostyce wrodzonej slepoty nocnej.

UNLABELLED: Electrophysiological study in diagnosis of congenital stationary night blindness. MATERIAL AND METHODS: The goal of this study was to describe a family with X-linked congenital stationary night blindness (CSNB) in which 3 brothers had similar symptoms: night blindness, reduced visual acuity and "negative" type of Flash ERG. RESULTS: Electrophysiological study permitted to differentiate CSNB from generalized progressive retinal degeneration, what has a prognostic value for these patients.

[Surgery for retinal detachment in the years 1989-1994]. / Leczenie operacyjne odwarstwien siatkówki w latach 1989-1994.

PURPOSE: Evaluation of early and long-term results of retinal detachments operated in the recent years. MATERIAL AND METHODS: 99 eyes of 98 patients were examined. The conventional methods of retinal detachment surgery have been applied, mostly (above 75%) encirclement with subretinal fluid drainage. RESULTS: Anatomical reattachment was applied in 81.8% of cases, but after follow-up, meanly 2.5 years this percent was 66.2% in the majority of cases functional results were also good; in 18.5% of the eyes with anatomical reatachment visual acuity did not improve. CONCLUSION: Encirclement of the eyeball with subretinal fluid drainage is the basic and the most useful method of surgical treatment in most cases of retinal detachment.

[Surgical methods in patients with cataract and myopia]. / Postepowanie chirurgiczne u chorych z zacma i krótkowzrocznoscia.

PURPOSE: To present own experiences in cataract surgery in myopic eyes. METHODS: 72 eyes of patients, aged 41-84, with 4-year follow-up were analysed. According to the degree of myopia, the patients were divided into 3 groups: MP up to -4.0 D (29 eyes), mp from -4.25 D to -8.0 D (27 eyes) and MP > -8.0 D (16 eyes). Extracapsular cataract extraction was performed in 55 eyes (76.4%) and intracapsular in 11 (15.2%). Posterior IOLS were implanted in 30 eyes (41.6%), anterior IOLS (including 4 secondary ones) in 26 (36.1%) and 16 eyes (22.2%) were operated on without IOLS implantation. RESULTS: Good visual acuity (> 0.5) was achieved in 73.6% of cases, useful visual acuity (> 0.1) in 89%. The results as well as the postoperative complications were compared with the control group of non-myopic eyes. Glaucoma was observed in 18% of myopic eyes and in 10% of non-myopic but it was not significant. CONCLUSION: The safest method of cataract surgery in myopic eyes is extracapsular extraction with posterior IOL implantation. These eyes should be operated on by very experienced surgeons.

[Efficiency of laser trabeculotomy in open-angle glaucoma]. / Skutecznosc trabekulopunkcji laserowej w jaskrze otwartego kata.

Results of Nd: YAG laser trabeculotomy performed in 71 eyes of 48 patients with open-angle glaucoma are presented. There were 25 females and 23 males, aged 15-86 years (mean age 67 years). The follow-up was 0.5-1.5 years. Normalization of the intraocular pressure was achieved in 90% of cases and outflow facility was improved in 87.3%. Deterioration of visual acuity was observed in 2.8% of eyes. In 4.2% the procedure was complicated by anterior chamber haemorrhages. The authors discuss principles, indications and techniques of Nd:YAG laser trabeculotomy and compare their results with those of others.

[Laser capsulotomy in cases of posterior capsule opacity in pseudophakia, aphakia and traumatic cataracts]. / Kapsulotomia laserowa w przypadkach zmetnienia tylnej torebki soczewki w pseudofakii, afakii oraz w zacmach pourazowych.

The results of Nd:YAG laser capsulotomy performed in 94 eyes of 90 patients (48 males and 42 females) are presented. Visual acuity 0.5 and better was achieved in 58.4% of cases. The authors discussed the techniques of the operations and some possible complications.

[Remarks on iris complications caused by intraocular lens implantation based on our own experiences]. / Uwagi na temat powiklan teczówkowych wywolanych wszczepieniem sztucznej soczewki na podstawie doswiadczen wlasnych.

Of 346 cataract extractions with IOLs implantation (184 anterior and 162 posterior chamber) in 98 eyes iris complications were observed. They were: pigment dispersion syndrome and iris-tuck-syndrome, the latter caused by the pressure of the haptic part of the lens. In our material these complications were observed more often after posterior chamber IOLs than in anterior ones. However, the consequences of the complications were more serious and had worse prognosis in anterior chamber IOLs. The authors compared their results with literature.

[Implantation of intraocular lens in anterior and posterior chamber from our clinical material]. / Wszczepy sztucznych soczewek przednioi tylnokomorowych w materiale wlasnym.

The authors presented results of 346 cataract extraction with IOL implantation--in 184 eyes anterior and in 162 posterior chamber. The follow-up ranged from 3 months to 6 years (mean 1.6 year). In 80.6% of cases, visual acuity after surgery was 0.6-1.0. Corneal astigmatismus 2.5-5.0 D was found in 31.2% of the eyes. The authors analysed early and late complications, taking into account the differences between anterior and posterior chamber IOLs implantation.

[Modification of Bagolini's registration method of normal macular and perimacular electroretinography in normal and selected cases of central retinal diseases]. / Modyfikacja metody Bagoliniego rejestracji elektroretinogramu plamkowego i przyplamkowego w normie i w wybranych przypadkach schorzen centralnej czesci siatkówki.

The authors applied the modified method of Bagolini's et al., who were the first to make use of the technique based on standard stimulation of "pattern" type for simultaneous macular and perimacular ERG registration. UTAS E-1000 system was applied for stimulation and registration of bioelectrical signals. 26 eyes in 16 healthy patients, aged 18 to 41 years (mean 29.5), have been examined. The anterior and posterior segment of all examined eyes was not changed, function of both eyes was normal. The mean values of macular and perimacular potentials and M/P value, that is proportion of macular and perimacular potential and standard deviations have been determined. The examples of pathologically changed macular and perimacular potentials in some diseases of central retina have been presented.

[Attempts at treating pigmented iris tumors with argon laser]. / Próby leczenia barwnikowych guzów teczówki laserem argonowym.

4 cases of flat pigmentary iris tumours, spreading out, in three cases, into anterior chamber angle are presented. The lack of patient's consent to surgery made histopathological diagnosis impossible and limited the choice of method of treatment. The several stage photocoagulation with argon laser was performed. The treatment resulted in cicatrization with atrophy of pathological tissue and the structure of iris itself. During follow-up (2-5 years) the growth of tumors was regressed and all patients were in good condition.

[Laser trabeculoplasty in open-angle glaucoma treatment--long term results of treatment]. / Trabekuloplastyka laserowa w jaskrze otwartego kata-odlegle wyniki leczenia.

The authors present the results of open-angle glaucoma treatment, in the cases where laser trabeculoplasty was the basic treatment. The follow-up of 53 treated patients (72 eyes) was approximately a little more than 3 years. The stabilization of the basic eye functions, i.e. the visual acuity in 76.4% and the visual field in 84.7% of the cases, was obtained. As a result of the treatment, a decrease of intraocular pressure below 21 mm Hg was obtained in 84.7% of the cases whereas the outflow facility factor c > 0.15 was observed in 72.2% of the examined eyes. The low outflow facility factor is one of the causes of the failures.