The implantation of the scleral-fixated posterior chamber intraocular lens with 9/0 polypropylene sutures - Long-term visual outcomes and complications.

PURPOSE: To analyze long-term visual outcomes and complications of the implantation of a scleralfixated posterior chamber intraocular lens (PC-IOL) in patients with the lack of adequate capsular support, and to verify if the procedure can be performed with 9-0 polypropylene sutures. METHODS: The study was designed as a long-term retrospective analysis. Patients after the implantation of a scleralfixated PC-IOL were evaluated for the best corrected visual acuity (BCVA), intraocular pressure and occurrence of postoperative complications. RESULTS: The analysis included 29 eyes from 28 patients. Indications for the IOL implantation included ocular trauma (89.7%) and previous complicated cataract surgery (10.3%). A postoperative improvement of BCVA was observed in 25 eyes (86.2%). Mean follow-up time was 63.9 months (range 50-83 months). During this time, six patients (21.4%) were diagnosed with glaucoma (21.4%), and retinal detachment was found in one eye (3.4%). A total of six suture breakages were recorded in four eyes from four patients (13.8%); one breakage was precipitated by a trauma, and another five, involving three eyes from three patients, were spontaneous. Mean time to the spontaneous suture breakage was 40.8 months. CONCLUSIONS: Scleral fixation of the PC-IOL provides satisfactory visual outcomes. However, this procedure is associated with a considerable risk of postoperative complications. The incidence of postoperative suture breakage in our series was similar as in previous studies in which the PC-IOL was fixated with 10-0 polypropylene suture. A superiority of 9-0 polypropylene suture needs to be verified in larger series of consecutive patients.

Metamorphopsia before and after full-thickness macular hole surgery.

PURPOSE: We quantified the degree and dynamics of metamorphopsia changes in patients subjected to full-thickness macular hole surgery. MATERIAL/METHODS: This prospective interventional case series included 10 eyes of 10 patients with full-thickness macular hole (mean age 66.2±6.0 years). The patients underwent a complete ophthalmological examination including SD-OCT. The severity of metamorphopsia (expressed as M-score) was evaluated with M-CHARTS. 20-gauge pars plana vitrectomy with trypan blue staining, internal limiting membrane peeling and 20% sulphur hexafluoride tamponade was performed. Time course of metamorphopsia changes and their relation to best corrected visual acuity (BCVA) and OCT parameters were assessed. RESULTS: Significant but not total M-score decrease was observed one month postoperatively (0.72±0.44 vs. 0.50±0.36, z=-2.207, p=0.0353, power=0.26, pre- vs. post-op), with subsequent stabilization (0.41±0.41 three months and 0.37±0.44 six months post-op). The differences between M-score one month, three months and six months postoperatively were not significant. Baseline M-score correlated significantly with postoperative values at three follow-ups (rho=0.853, 0.715, 0.847; p<0.05 for all; power=0.94, 0.58, 0.79). Baseline M-score did not correlate with macular hole dimensions (including basis p=0.154, minimal diameter p=0.051 or height of the border p=0.700). No correlation between M-score and the following parameters was found either pre- or postoperatively: BCVA, central foveal thickness, central subfield macular thickness and central subfield macular volume. CONCLUSIONS: In patients with successfully operated full-thickness macular hole, M-score decreased as early as one month postoperatively and was stable afterwards. The baseline M-score was a prognostic factor for the postoperative M-score. M-score turned out to be independent from BCVA and macular hole dimensions.

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: first clinical experience.

BACKGROUND AND PURPOSE: Recently, a transconjunctival, endoscope-assisted (TEA) approach to the medial intra-orbital space was developed based on cadaver preparations, with an ultimate goal of minimizing disturbances of the anatomic structures of the orbit. However, no report on clinical validation of this promising technique was published thus far. We present our experiences with the TEA approach in two patients. MATERIAL AND METHODS: In emergency conditions, we approached the lateral retrobulbar space of a 42-year-old male through a 180° incision close to the corneal limbus; a scrap of metal, which had perforated the globe and resided at its posterior wall, was removed endoscopically. Moreover, we used the TEA approach to remove a tumor from the upper intraconal space in a 63-year-old woman. RESULTS: In both patients the surgical goal was achieved with no muscle transection and without additional morbidity and complications. CONCLUSIONS: Our experiences with TEA approach suggest that the procedure is clinically feasible, produces no co-morbidity and yields good functional and cosmetic results. As a result, the whole circumference of the retrobulbar space can be conveniently explored.

Ocular haemodynamics in patients with type 2 diabetes and coronary artery disease.

BACKGROUND/AIMS: To assess the relationship between ocular blood flow parameters and diabetic retinopathy and coronary artery disease in diabetic patients. METHODS: 56 patients participated in the study. Colour Doppler imaging was used to assess the peak systolic and end-diastolic blood velocities as well as resistivity index in the ophthalmic, central retinal and posterior ciliary arteries. The diagnosis of coronary artery disease was based on the coronary angiogram. RESULTS: As compared to controls, the peak systolic and end-diastolic blood velocities in all three evaluated vessels were significantly lower in the case of diabetic patients with coronary artery disease. Diabetic patients without coronary artery disease showed only decreased end-diastolic velocity values in the ophthalmic artery compared with the controls. Among diabetic patients, coronary artery disease was related to lower peak systolic and end-diastolic velocities in the central retinal artery and peak systolic velocities in the short posterior ciliary arteries. Diabetic retinopathy was significantly associated with a further decrease in end-diastolic blood velocity and an increase in resistivity index in the central retinal artery. CONCLUSIONS: (1) Flow disturbances within the ocular blood vessels of patients with type 2 diabetes were associated with atherogenic changes of coronary arteries. (2) In patients with type 2 diabetes and concomitant coronary artery disease, impaired blood flow within the ophthalmic and short posterior ciliary arteries was not related to diabetic retinopathy, but diabetic retinopathy was related to additional blood flow impairment within the central retinal artery.

[Acute phacomorphic glaucoma in patient with diabetes mellitus type 1--case report]. / Ostra jaskra fakomorficzna u pacjenta z cukrzyca typu 1.--opis przypadku.

Diabetes mellitus contributes to an earlier and a quicker development of opacities of the lens and worsening of the vision in affected people, in comparison with healthy people in similar age. The main source of energy in the human lens is glucose, which is metabolised through the glycolytic process. When the level of glucose increases in blood, its content also increases in aqueous humour and in the lens. It causes a saturation of the glycolytic process and the activation of the sorbitol pathway with participation of aldose reductase. The accumulation of sorbits responsible for the growth of osmotic pressure inside the lens, inflow of water and gradual swelling of its fibres. In extreme cases a swelling of the lens can even lead to occurrence of cataracta intumescens and secondary glaucoma. The primary treatment of cataracta intumescens is to remove lens surgicaly, preferably after lowering intraocular pressure. In that report is presented a particular case of such, fulminating course of ophthalmological complications in patient with diabetes mellitus type 1.

[Anterior capsule contraction syndrome after cataract phacoemulsification surgery]. / Zespól obkurczania torebki przedniej soczewki po operacjach fakoemulsyfikacji zacmy.

Cataract facoemulsification with continuous anterior capsulorhexis and foldable intraocular lens implantation into the capsular bag has become basic, standard method in cataract surgery and curvilinear capsulorhexis s the most common technique for opening the anterior lens capsule. The opening, made during the operation, within several months of postoperative evolution gradually constricts and in extreme cases it may even close completely. That course of healing is not desirable because of evoking a noted impairment of vision. Decreasing in the anterior capsule opening is observed mostly in eyes with weakened lens zonules. It happens in high myopia, retinitis pigmentosa, diabetes mellitus, retinopathia diabetica, pseudoexfoliation syndrome, uveitis and people of well advanced age. Inspired by observation of a particular, quite drastic case of capsule contraction syndrome, we attempted to analyze the causes, pathogenesis, risk factors, clinical course, prevention and treatment of options for that syndrome.

The expressions of Fas and caspase-3 in human glaucomatous optic nerve axons.

BACKGROUND: Glaucoma is a chronic neurodegeneration of the optic nerve and one of the leading causes of vision loss in the world among the aging. Recent data suggest an important role for Fas receptor- and caspase-3-mediated apoptosis in the pathophysiology of glaucoma. In this study, Fas receptor and caspase-3 immunoexpression in the optic nerve axons of eyeballs with absolute glaucoma and eyes enucleated following extensive trauma were compared. MATERIAL/METHODS: A series of 25 eyeballs were examined and enucleated during the period of 1994-2005. Seventeen eyeballs were removed from patients with absolute glaucoma who suffered from severe ophthalmalgia and 8 eyeballs were enucleated because of extensive injury on the day of injury or one day thereafter. The samples were obtained from the retrolaminar region of the optic nerve head and evaluated histopathologically. Immunohistochemistry was performed using polyclonal antibodies and the LSAB technique to determine Fas and caspase-3 expression. RESULTS: The percentages of positive Fas receptor and caspase-3 immunohistochemical staining were higher in the axons with absolute glaucoma than in the trauma group (p=0.0084 for Fas, p=0.0322 for caspase-3). CONCLUSIONS: The results indicate that the apoptosis markers Fas receptor and caspase-3 might play a significant role in glaucoma neuropathy at the stage of absolute glaucoma.

[Embolic central retinal artery occlusion as a complication of percutaneous coronary angioplasty--case report]. / Zator tetnicy srodkowej siatkówki jako powiklanie przezskórnej angioplastyki wiencowej--opis przypadku.

Procedures of the percutaneous coronary intervention are more often carried out in patients with coronary heart disease (CHD) because they are not very invasive and very effective. Even though a lot of procedures of this type are carried out, reports on the ophthalmic complications connected to them,are rarely found. The authors present the case of the 78-years-old patient in whom disturbances of the right eye vision occurred after coronary angiography combined with angioplasty of the narrowed artery with stent implantation. Ophthalmic examination revealed features of the central retinal artery occlusion. Even though an immediate treatment was applied, the function of the right eye was not improved. When general condition of the patient was normalized, the diagnosis was confirmed by the Color Doppler ultrasonography in the vessels supplying eye. The photographic documentation was prepared. The literature data indicate the necessity of immediate diagnosis of even mild vision disturbances in the course of and after the percutaneous coronary intervention because only an immediate treatment can protect the patient from a permanent vision decrease, due to the embolism of the retinal vessels.

[An application of Color Doppler ultrasonography in evaluate of brachytherapy in patients with uveal melanomas]. / Zastosowanie kolorowej ultrasonografii dopplerowskiej do oceny skutecznosci brachyterapii u pacjentów z czerniakiem blony naczyniowej.

UNLABELLED: Uveal melanomas, even those of big size, are recently more readily treated conservatively, with radiotherapy, though the efficiency of this treatment has not been yet established. PURPOSE: Of the study was the assessment of the usefulness of Color Doppler (CD) or Power Doppler (PD) examination in monitoring the effectiveness of brachytherapy in the management of melanomas. MATERIAL AND METHODS: Examination was performed in 15 patients, who were treated because of medium size or large uveal melanomas, with plaque radiation (brachytherapy). CD/PD examination of blood flow within the tumor, with the use of SonoVue contrast agent in several cases, was performed before institution of the therapy and two times after the treatment, as follow-up. RESULTS: Regression of the tumor and gradual atrophy of its neovascularisation was observed in all the examined patients. The enhancement of Color Doppler imaging with contrast agent helps in making decision to further therapeutic options as complex situation. CONCLUSIONS: Color and Power Doppler ultrasonography is a helpful method in monitoring the effectiveness of brachytherapy in patients with uveal melanomas.

[The influence of pregnancy on progression of diabetic retinopathy]. / Wplyw ciazy na progresje retinopatii cukrzycowej.

PURPOSE: Pregnancy is considered an important risk factor of the development and progression of diabetic retinopathy (DR). The aim of the study was to assess whether retinal changes tend to progress during pregnancy in women with type 1 diabetes. MATERIAL AND METHODS: 136 women with type 1 diabetes were enrolled to this 3 years prospective study. The patients were divided according to White's scale into the following classes: B (n=76), C (n=34), D (n=24), R (n=2). Before conception and during pregnancy the patients were treated with intensive insulin therapy to achieve optimal metabolic control. Ophthalmic examination was performed before planned conception, in each trimester of the pregnancy and after delivery. RESULTS: No pathologies were discovered with fundoscopy in all the women belonging to class B, in 22 women from class C and in 4 women from class D. No progression of diabetic retinopathy was observed during the entire period of observation in 12 women from class C and in 20 from class D with nonproliferative DR in the first examination. In 3 women from class C progression of DR were observed in the second trimester with partial improvement after delivery. Visual acuity in these patients also deteriorated. Proliferative DR diagnosed in 2 patients from class R at the beginning of the observation, progressed during the pregnancy to diminish after delivery. CONCLUSIONS: Pregnancy does not influence significantly the progression of pre-existing diabetic retinopathy, provided that proper metabolic control is achieved and patients are subject to systematic ophthalmological control.

[Assessment of blood flow in the ocular circulation in type 2 diabetes patients with Color Doppler imaging]. / Ocena przeplywu krwi metoda Color Doppler w naczyniach galki ocznej u pacjentów z cukrzyca typu 2.

PURPOSE: Color Doppler assessment of blood flow in ocular circulation in type 2 diabetes patients. MATERIAL AND METHODS: Total of 56 patients were included in the study and divided into 3 groups: group I--control group, group II--type 2 diabetes patients without diabetic retinopathy, group III--type 2 diabetes patients with nonproliferative diabetic retinopathy. USG Color Doppler method was used in all patients to assess peak systolic blood velocity (PSV), end-diastolic blood velocity (ESV) and resistivity index (RI) in the following arteries: ophthalmic artery (OA), central retinal artery (CRA), short posterior ciliary artery (SPCA). In addition several clinical parameters including age, diabetes duration, blood pressure, body mass index (BMI) and blood glucose level with empty stomach were statistically analyzed. RESULTS: Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in ophthalmic artery (OA) in diabetic patients were significantly lower in comparison to the control group. Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in central retinal artery (CRA) were significantly lower only in patients with diabetic retinopathy. In short posterior ciliary arteries (SPCA) only peak systolic blood velocity (PSV) was decreased in patients with diabetic retinopathy. Average age of patients was significantly higher in the group with diabetic retinopathy. Diabetes duration was significantly longer in group III in comparison to group II. CONCLUSIONS: Color Doppler imaging method is useful for assessing blood flow in ocular circulation. Blood flow in ophthalmic artery is decreased in patients with diabetes. Reduction of blood flow in central retinal artery and short posterior ciliary arteries can be significant in the development of diabetic retinopathy.

[Morphological parameters of the optic disc in patients with primary open angle glaucoma and low myopia]. / Parametry morfologiczne tarczy nerwu wzrokowego u pacjentów z jaskra pierwotna otwartego kata i krótkowzrocznoscia niskiego stopnia.

PURPOSE: To compare the morphological parameters of the optic disc in patients with low myopia and primary open angle glaucoma (POAG) and in patients with glaucoma without refractive errors. MATERIAL AND METHODS: 53 patients, aged 33-88 (56.2 +/- 11.9) with POAG were qualified for our study. The group was divided into two: first group consisted of 14 patients--11 women and 3 men, aged 41-83 (58.2 +/- 10.9) comprising 28 eye balls with low myopia (-0.5 Dsph to -3.5 Dsph) and POAG. The second group consisted of 38 patients: 24 women and 14 men, aged 33-80 (51.0 +/- 13.4) comprising 71 eye balls including 43 emetropic eyes, 26 eyes with hyperopia (+0.5 Dsph to +3.0 Dsph) and 2 eyes with astigmatism. All patients demonstrated early changes in visual field 1-2 stage due to the Aulhom classification. The measurements of the morphological parameters of the optic disc were made with confocal scanning laser ophthalmoscopy using Heidelberg Retina Tomograph--HRT II with glaucoma software. We analyzed the following parameters: optic disc area, cup area, rim area, cup/disc ratio, linear c/d ratio, mean cup depth, maximum cup depth. The statistical analysis was made using Kolomogarow-Smirnow test. RESULTS: All analyzed parameters were higher in patients with low myopia and POAG than in patients with only POAG. The results in both groups were different but still no statistically significant. CONCLUSIONS: Low myopia has an influence on the optic disc morphology in patients with POAG.

[Loss of heterozygosity at microsatellite marker localised near the metalloproteinase gene in patients with PEX syndrome]. / Utrata heterozygotycznosci w markerze mikrosatelitarnym zlokalizowanym w poblizu genu metaloproteinazy u chorych z zespolem pseudoeksfoliacji.

PURPOSE: The aim of the study was to evaluate the possible occurrence of loss of heterozygosity (LOH) at microsatellite marker localised near the area for metalloproteinase gene in the anterior capsule, lens nucleus, iris and trabeculum samples taken from patients with pseudoexfoliation syndrome (PEX). MATERIAL AND METHODS: In our study we examined 19 patients (12 women and 7 men) with PEX syndrome who underwent surgical treatment for glaucoma, cataract or both at the same time. The mean age was 75.5 +/- 4.7, range 64-86. Specimens of the iris, anterior capsule, trabeculum and lens nucleus were taken to evaluate the possible occurrence of LOH at microsatellite marker D7S820 with fluorescent multiplex PCR method. RESULTS: LOH was displayed in 44% specimens of anterior capsule, 33% of iris specimen. In lens nucleus and trabeculum specimen LOH did not occur. CONCLUSIONS: The high frequency of LOH in PEX patients at locus D7S820 suggests that genetic factors may be involved in the etiology and pathogenesis of PEX.

[Non-penetrating deep sclerectomy with SK-GEL implant in the patients with pseudoexfoliation glaucoma]. / Gleboka nieperforujaca sklerektomia z wszczepem sródtwardówkowym typu SK-GEL u chorych na jaskre pseudoeksfoliacyjna.

PURPOSE: The aim of this study was to evaluate the effectiveness of non-penetrating deep sclerectomy with SK-GEL implant in the patients with pseudoexfoliation glaucoma. MATERIAL AND METHODS: Non-penetrating deep sclerectomy with SK-GEL implant was performed in 5 eyes of 5 patients aged 65 to 78 (mean age 73 years +/- 5.4). Pseudoexfoliation glaucoma was recognized in all patients. In spite of the intensive pharmacological and laser treatment, sufficient reduction of an intraocular pressure was not obtained. The intraocular pressure before the surgery ranged between 24 and 43.4 mmHg (mean 31 mmHg +/- 7.6). Follow-up period lasted from 36 to 53 days (mean 46 days +/- 7.7). RESULTS: After the surgery, reduction of the intraocular pressure was observed in all subjects. At the moment of discharge from hospital the intraocular pressure ranged from 12 to 26 mmHg (mean 19.6 mmHg +/- 5.12), and at the last control appointment--from 14 to 16 mmHg (mean 14.9 mmHg +/- 0.72). CONCLUSIONS: Non-penetrating deep sclerectomy with SK-GEL implant can be taken into consideration, while planning glaucoma surgery in the patients with pseudoexfoliation syndrome.

[Tumor angiogensis in uveal melanoma. Role of vascular endothelial growth factor (VEGF)]. / Angiogeneza w nowotworach barwnikowych blony naczyniowej oka. Rola naczyniowo-sródblonkowego czynnika wzrostu (VEGF).

Neoplastic angiogenesis, as a process of forming new blood vessels, plays an important role in progression of cancer tumors and dissemination of metastases. New vessels can be formed in cancer tissue due to mutations of certain genes and under the influence of hypoxia. The process is mediated by locally delivered specific angiogenetic factors. Vascular endothelial growth factor (VEGF) plays a crucial role in stimulation of the vascular endothelial cells to their proliferation and migration. Intensity of neoplastic angiogenesis determines the rate and extent of tumor expansion, thus may heavily influence the outcome.

Loss of heterozygosity in patients with pseudoexfoliation syndrome.

PURPOSE: The purpose of the study was to evaluate the possible occurrence of loss of heterozygosity (LOH) in the anterior capsule, lens nucleus, iris, and trabeculum samples taken from patients with pseudoexfoliation syndrome (PEX). Loss of heterozygosity in a microsatellite marker locus indicates that the neighboring gene may be inactivated. Previous attempts to find a gene defect that might be responsible for pseudoexfoliation glaucoma have been unsuccessful. METHODS: Specimens of the anterior capsule, the lens nucleus, the iris, the trabeculum, and reference blood samples were collected from 19 PEX patients. Fluorescent multiplex PCR was used to amplify the microsatellite markers located on chromosomes 2, 4, 7, 12, 18, 19, and 21. RESULTS: LOH was found in 58% of the iris specimens and 50% of the anterior capsule specimens collected from PEX patients. The highest incidence of LOH was observed at the marker D7S820. CONCLUSIONS: It is possible, that genetic factors may be involved in the etiology and pathogenesis of PEX.

[Genetic instability in human malignant uveal melanomas]. / Niestabilnosc genetyczna w guzach barwnikowych blony naczyniowej oka.

PURPOSE: The aim of the study was evaluation of genetic changes: loss of heterozygosity (LOH) and microsatellite instability (MSI) in the genome of cells of the uveal melanoma. MATERIAL AND METHODS: The incidence of MSI and LOH in cells of uveal melanomas was examined in tissue specimens obtained at surgical resection of the tumour in 14 patients. The results were related to respective MSI and LOH incidence in the genome of peripheral blood cells of the same patients. DNA was isolated with organic extraction. The fluorescent multiplex polymerase chain reaction (PCR) was used to amplify microsatellite loci included in commercially available human identification kits. Phenotyping was performed with the use of ABI Prism 310 Genetic Analyzer. RESULTS: MSI and LOH was found in 6 of 14 cases of uveal melanoma, manifested at one or more loci. MSI was present in chromosomes 3, 11 and 16. LOH was detected in chromosomes: 2, 3, 8, 13, 16 and 19. Genetic instability of the LOH/MSI type was detected in 3 patients with long anamnesis and large tumor infiltrating retrobulbar structures (pT4 feature). Two patients died within a year because of generalized cancer disease. CONCLUSIONS: 1 Loss of heterozygosity and microsatellite instability is present in uveal melanomas. 2. Genetic instability of LOH/MSI type associates with advanced size of tumour and progression of neoplastic disease.