Quantitative relationships between transforming growth factor beta mRNA isoforms in congenital and traumatic cataracts.

PURPOSE: The aim of this study was to determine differences in the expression profiles of transforming growth factor (TGF) ß isoforms in the fragments of anterior lens capsules (ALCs) and peripheral blood mononuclear cells (PBMCs) of pediatric patients with congenital and traumatic cataracts. METHODS: Forty children with congenital cataracts (19 girls and 21 boys) and 22 children with traumatic cataracts (six girls and 16 boys) participated in the study. Fragments of ALCs obtained during cataract surgery and whole blood samples were analyzed. Quantification of TGFß1, TGFß2, and TGFß3 mRNA was performed by real-time quantitative reverse transcription (QRT)-PCR using SYBR Green I chemistry. RESULTS: TGFß1, TGFß2, and TGFß3 mRNA was detected in all the studied samples. Significant differences were found for TGFß1 and TGFß2 expression profiles in PBMCs between the patients with congenital and traumatic cataracts. The expression profiles of TGFß isoforms in ALCs did not differ significantly between the groups. CONCLUSIONS: Overexpression of TGFß1 and TGFß2 in the PBMCs of patients with congenital cataracts might indicate that these cytokines are involved in the development of lens opacity.

Etiopathogenesis and management of high myopia. Part II.

High myopia (HM) is defined as refractive error above -6.0 D (-8.0 diopters) with axial eyeball length above 26 mm, and is connected with the process of excessive myopisation. HM is not a homogenous disease. HM is considered to be inherited in 3 different patterns: dominant, autosomal recessive, and X-linked. Many genetic mutations linked to the development of HM have been described, including high grade myopia, and MYP1-16; different patterns of inheritance may reflect different types of HM. Over 150 genetic syndromes are associated with HM. The clinical state of the HM eyeball may also depend on environmental risk factors influencing the progression of refractive error. The complexity of etiopathogenesis makes it difficult to distinguish to what extent the development of HM is related to genetics versus exposure to environmental factors. HM remains a leading cause of visual loss. HM and its complications are considered to be one of the most significant causes of blindness and visual impairment in young, professionally active people, becoming an important social problem. Contemporary data concerning genetic factors, family aggregation, and epidemiological data of visual impairment connected with HM are presented in this paper. Therapeutic options for this refractive error are presented as well.

Etiopathogenesis and management of high-degree myopia. Part I.

High-degree myopia (HM) is defined as a refractive error above -6 D (-8 diopters). An axial eyeball length above 26 mm and is also connected with excessive myopisation. Mechanical stretching and thinning of the choroids may lead to the development of irreversible degenerative changes in the eyeball and visual impairment. HM prevalence varies significantly by geographical area, ranging from 1.7-3.3%, while in highly urban regions of South-East Asia it affects up to 24% of university students. HM is not a homogenous disease. It is considered to be inherited in different patterns: dominant, autosomal recessive, and X-linked. Many genetic mutations linked to HM development have been described and the different patterns of inheritance may reflect different types of HM. Moreover, the clinical state of the HM eyeball may result from both genetic and environmental risk factors influencing the progression of the refractive error. The development and progression of HM is connected with sustained prolonged near work involving accommodation-convergence imbalance leading to retinal blur, the years spent at school, the amount of near work, especially writing and reading, which is related to slight chronic under-accommodation, and improper light stimuli in early childhood. Contemporary definitions of HM, views on etiopathogenesis, excessive axial elongation, and pathological changes within the eyeball in the course of HM leading to visual impairment are presented here. Genetic and environmental risk factors influencing the progression of HM, its significantly different prevalence in various geographical areas, and therapeutic options for the refractive error are also presented.

[Variability of the eyeballs axial length in children with pseudophakia]. / Zmiennosc dlugosci osiowej pseudofakijnych galek ocznych u dzieci.

PURPOSE: The aim of the study is to evaluate the dynamics of axial elongation of pseudophakic eyes and changes in refraction pseudophakic eyes in children after monocular or binocular cataract surgery. MATERIAL AND METHODS: the observations of 79 children (158 eyes) aged from 4 to 18 years (mean 9.7 +/- 0.55) after cataract surgery were conducted. The examined group consisted of 105 pseudophakic eyes, the comparative group consisted of 53 eyes without surgery in the same observed group of children. Moreover, the patients were evaluated in the following group: moncular - binocular cataract, primary or secondary IOL implantation, the age in groups were between 4-7 and between 8-18 years. Analysis statistically: STATGRAPHICS and SIMSTAT programs, p (alpha) = 0.05. RESULTS: In the examined group (105 eyes) the mean follow-up time was 4.2 years (+/- 0.3), the average age of patients was 9.7 years (+/- 0.7). Improvement of visual acuity was achieved mean 0.5 in 52.4% post operative eyes observed, myopic shift was -0.7D (+/- 0.52). The anatomic eyeball length increased up to 0.5mm (+/- 0.27). The average age of patients of the control group was 9.7 years (+/- 0.83), follow-up 4.3 years (+/- 0.44), visual acuity 0.8 (+/- 0.03). Mean elongation of the axial length was 0.56 mm(+/- 0.26), mean refraction of the eyeball was +0.38 D (+/- 0.54). The difference of the changes of refraction between examined and control group was statistically significant. The comparison of final refraction in optical pathway (p = 0.32) and the growth of anatomic eyeball length (p = 0.14), proved no significant differences in the group with monocular and binocular IOL. The comparative analysis of final refraction in optical pathway (p1 = 0.36), and the growth of anatomic eyeball length (p2 = 0.26) in the group with primary or secondary IOL and in the younger or older children (p1 = 0.52; p = 0.98) in the both groups, did not significantly differ. CONCLUSIONS: The dynamics of axial elongation of pseudophakic and phakic eyes in children is similar. The myopic shift of pseufophakic eyes is bigger than in phakic eyes. It should be undertaken in calculation of the refractive power of intraocular lenses.

[Vernal keratoconjunctivitis in children]. / Wiosenne zapalenie rogówek i spojówek u dzieci.

PURPOSE: To evaluate the course of palpebral type of vernal keratoconjunctivitis (VKC) and relation of the number of recurrences per year, to patients age and to estimate the frequency of irreversible corneal transparency changes and visual acuity decrease. MATERIAL AND METHODS: There were 34 eyes of 17 children, 13 boys (76.4%) included 2 brothers and 4 girls. The age of patients was from 5 to 14 years, mean 9.1. All patients were hospitalized because of pathological corneal changes. Follow up from 2 to 13 years (mean 8.4). The number of recurrences ranged from 2 to 5 per year and there was not correlation between age of children and frequency of episodes. RESULTS: We have observed punctate keratopathy (79.14% of cases) and corneal ulcers (26.5% of cases). In 25 eyes of 13 patients cryocoagulation and/or excision of giant palpebral papillae were done. Visual acuity ranged from 0.01 to 1.0 and mean value before treatment was 0.879 +/- 0.09 and after 0.884 +/- 0.10. The difference was not statistically significant (p = 0.878). CONCLUSIONS: (1) The course of VKC is recurrent, the number of recurrences per year does not depend on the age of patients, but is correlated with giant papillae of palpebral conjunctiva presence. (2) Large papillae should be excised, in order to make the healing of cornea quicker. (3) Permanent visual function decreasing is not frequent because partial leucoma is localized at the periphery of cornea.

[Diode laser in secondary glaucoma in children--long-term results]. / Zastosowanie lasera diodowego w jaskrze wtórnej u dzieci-- obserwacje dlugoterminowe.

UNLABELLED: This paper presents effectiveness and safety of transscleral contact cyclophotocoagulation with diode laser (TSCPC) in secondary glaucoma in children. Fifteen eyes of 15 children at the age from 4 to 18 years were examined. Majority of patients was aphakic after congenital and traumatic cataract extraction. Microphtalmus, nystagmus and dysgenesis mesodermalis was observed. Eleven eyes had undergone at least one previous trabeculectomy, 9 eyes -cyclokrioaplication and 4 eyes perforate diathermy. In all patients diode laser transscleral cyclophotocoagulation has been performed. The number of procedures per one eye, intraocular pressure (IOP), visual acuity and complications after TSCPC was estimated. Follow-up ranged from 3 to 5 years, mean 4.13 years. TSCPC was performed once in 3 eyes, twice in 6 eyes, three times in 4 eyes and four times in 2 eyes, mean 2.33 procedures per eye. Before the treatment mean IOP was 34.0 mmHg. Decreasing of IOP was observed in 73.3% of eyes. The final mean postoperative IOP was 20.07 mmHg. Visual acuity before operation ranged from no light perception to 0.0001, mean 0.0081. After TSCPC no light perception was noted in 2 eyes. Visual acuity recovered in 1 eye. Mean Length of the eye globe before treatment was 24.48 mm. No changes of length after cyclophotocoagulation were noted. CONCLUSIONS: cyclophotocoagulation by diode laser is a useful therapy for the treatment of secondary pediatric glaucomas with uncontrolled IOP in the long term.

[Central corneal thickness and intraocular pressure in the youth]. / Grubosc centralnej czesci rogówki a pomiary cisnienia wewnatrzgalkowego u mlodziezy.

PURPOSE: To estimate the central corneal thickness in young patients and to evaluate the relationship between the intraocular pressure (IOP) and pachometry. PATIENTS AND METHODS: Eighty eyes of 40 children at the age from 9-18 years, mean 13.75 were examined. The applanation tonometry, pachometry, refraction and examination of corneal diameter were done. To statistical purpose t-Student test was used alpha = 0.05. RESULTS: IOP ranged from 12 to 24 mmHg, in 32 eyes was above 17 mmHg, mean 20.2 +/- 1.46 mmHg (I group) and in 48 eyeballs ranged from 12 to 17 mmHg, mean 15.6 +/- 0.96 mmHg (II group), p = 0. In the I group pachometry was from 480 to 591 microm, mean 542 +/- 11.1 and in the II group from 451 to 570 microm mean 521.7 +/- 9.39 p = 0.006. Mean refractive error in the I group was -0.4 D (from -5.0 to +4.0 D) and in the II group mean -0.8 (from -6.25 to +4.75), p = 0.45. In the both groups corneal diameter was from 11.5 to 12.5 mm. Comparing eyeballs of patients at similar age, refraction and corneal diameter, it was shown that central corneal thickness in the group with higher IOP was statistically significantly bigger than in the group II. CONCLUSION: Measuring IOP in children we have to take into account the corneal thickness.

[Heparin-surface-modified PMMA intraocular lenses in children in early and late follow-up]. / Wszczepy soczewek heparynizowanych u dzieci we wczesnym i póznym okresie obserwacji.

PURPOSE: To compare anatomical and functional state of eyeballs after congenital cataract extraction and heparin-surface-modified PMMA (HSM-PMMA) or PMMA implanted lenses and to conclude, which type of implants is more advantageous in young patients. MATERIALS AND METHODS: 42 eyes of 30 children at the age of 3-16 years with congenital or developmental cataract after extraction and IOL implantation: I group--HSM-PMMA lenses in 24 eyes, and PMMA lenses in 18 eyes--II group. Mean age in the I group was 6 years and in the II group 8 years, p = 0.07. The presence of cellular and pigment deposits on the IOL surface as a sign of postoperative inflammation was examined by slit-lamp within 1 month after surgery. We have compared the results of visual acuity (V/A), corneal endothelium cell density and posterior capsule state. The examination were done in the short-term follow-up mean 14.1 months (4-24 months) in the I group and mean 32.1 months (16-48 months) in the II group. In the long-term follow-up mean 38 months (30-44 months) in the I group, and mean 56.1 months (40-72 months) in the II group. RESULTS: Within first month after operation cellular and pigment deposits on the IOL surface were seen more often in the II group, p = 0.03. Best corrected V/A was comparable in both groups in the short-term and the long-term follow-up. At last visit, mean value of V/A was 0.54 (I group) and 0.42 (II group), p = 0.37. There was no significant difference between central corneal endothelial cell density in both groups: before (2893 +/- 261/mm2 and 2821 +/- 217/mm2, p = 0.143) and after operation (2371 +/- 202/mm2 and 2361 +/- 299/mm2, p = 0.428). In the short-term follow-up, but not longer than within first 12 months after surgery the frequency of clinically significant posterior capsule opacification (PCO) was less in the HSM-PMMA group (8%), than in the PMMA group (33%), p = 0.006. In the long-term follow-up there was no statistically significant difference in PCO appearance between these groups (44% and 50%, p = 0.27). CONCLUSIONS: Heparin-surface-modified intraocular lenses reduced postoperative inflammation and delayed the incidence of PCO in children. Heparin-surface-modified intraocular lenses are more advantageous, than PMMA lenses in young patients.

[Optic nerve disc in unilateral myopia in children]. / Obraz tarczy nerwu wzrokowego w krótkowzrocznosci jednostronnej u dzieci.

PURPOSE: The evaluation of biomorphometric parameters of optic nerve head of the eyes in myopic anisometropia, to state if glaucoma similar changes described in adults were present. MATERIAL AND METHODS: 17 children, 14 girls and 3 boys at the age from 7-18 years, mean 12.6 years with unilateral myopia of mean value 8.6 D. The parameters of optic nerve disc: total contour area (TCA), cup/disc ratio (C/D), neuroretinal rim area (Rim), volume of neuroretinal rim (Vol. A), cup volume (Vol. B), maximum slope (MSL) and average slope angle (ASL) were examined using laser scanning ophthalmoscope in the TopSS system of Laser Diagnostic Technologies Inc. The I group consists of myopic eyes, in the II group there were emmetropic eyes of the same children. RESULTS: Refraction in the I group ranged from -4.5 to -12 D, mean -8.6 D, in the II group from 0 to + 1.0 D, mean 0.07 D. The mean axial length of eyeballs was 25.57 SD 1.9 mm in the I and 22.47 SD 1.09 mm in II group--the difference was significant. There was not statistically significant difference between TCA in the I (mean 1.19 SD 0.75 mm2) and II group (mean 2.13 SD 0.49 mm2). Mean C/D ratio and cup volume were significantly smaller in myopic (C/D 0.23 SD 0.16 Vol. B -0.06 SD 0.05) than in emmetropic eyes (C/D 0.33 SD 0.11 mm3, Vol. B -0.18 SD 0.14 mm3). CONCLUSIONS: Optic nerve disc images in myopic and glaucomatous eyes in children are different. Smaller optic disc cup in myopic than in emmetropic eyes can show, that children myopic eyeballs enlarged without nerve fibers atrophy.

[Image of optic nerve disc with laser scanning tomography and results of static perimetry in children with juvenile glaucoma]. / Obraz tarczy nerwu wzrokowego w skaningowej tomografii laserowej a wyniki perymetrii statycznej u dzieci z jaskra mlodziencza.

UNLABELLED: The aim of our research was to estimate the correlation between optic nerve head parameters examined with laser scanning ophthalmoscope and results of central, visual field (MD and PSD) in the youth and the evaluation the role of this correlation in juvenile glaucoma early diagnosis. MATERIAL: Three groups of patients. Group I consisted of 32 eyes (16 children) with juvenile glaucoma in which trabeculectomy was performed. There were 72 eyes of 32 children with glaucoma juvenile suspect in the group II. Control group (III) contained 20 eyes of 10 children without glaucoma. The age of patients ranged from 9 to 18 years. The mean intraocular pressure was 16 mmHg in the I group, 18 mmHg in the II group and 15.6 mmHg in the III group. Simple Regression Analysis of mean values of biomorphometric parameters of optic nerve head for Mean Defect of central visual field was used in all three groups. RESULTS: The statistically significant correlation between Vol. B and MD was observed in the I group. There was no such correlation in the II group, but correlation between Av. Sl. and MD was presented. In the III group mean value of MD was the smallest one and correlated with Vol. B. Statistically significant correlation between mean values of PSD and Vol. B was observed in the I and II group, between PSD and Vol. A in group III. CONCLUSION: There was the correlation between optic nerve head parameters and mean deviation of retinal sensitivity of central visual field in the youth. This examination can be helpful in early diagnosis of primary juvenile glaucoma.