Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study.

PURPOSE: To evaluate the incidence of and factors associated with intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract phacoemulsification. METHODS: In total, 319 eyes of 319 patients who underwent phacoemulsification with implantation of an intraocular lens (IOL) into the posterior chamber were included in this study. Direct injection of epinephrine into the anterior chamber was performed in all cases. The following patient information was collected: gender, age, axial length of the eye, presence of pseudoexfoliation syndrome, glaucoma, diabetes mellitus, hypertension, current use of medications including alpha1 adrenergic receptor antagonists (alpha1-ARAs), finasteride, and benzodiazepines, duration of intake of alpha1-ARAs and finasteride, and duration of the surgery. Patients were classified as IFIS or non-IFIS after the surgery. Univariate and multivariate logistic regression analyses were performed. RESULTS: The overall incidence of IFIS was 9.09% (29/319 eyes). The multivariate analysis revealed that tamsulosin use (P = 0.004), finasteride use (P = 0.014), and increasing age (P = 0.006) were significantly associated with IFIS. Male gender and benzodiazepine use were significantly associated with IFIS in the univariate analysis, but not in the multivariate analysis. The non-selective alpha1-ARA doxazosin was not found to be associated with IFIS. CONCLUSIONS: The findings suggest that finasteride use and aging are risk factors for IFIS and confirm the association of tamsulosin use with IFIS. Further, doxazosin appears to be a relatively safe drug with respect to the occurrence of IFIS.

The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension.

PURPOSE:: To assess tolerability and efficacy following a switch from benzalkonium chloride-latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. METHODS:: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. RESULTS:: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0-10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). CONCLUSION:: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride-latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

Effective treatment of cytomegalovirus retinitis and neuritis with retrobulbar ganciclovir after treosulfan-based autologous bone marrow transplant.

We describe the case of a 16-month-old girl with neuroblastoma and chronic lymphocytopenia due to chemotherapy and treosulfan-containing megatherapy who developed cytomegalovirus retinitis and neuritis. Intravenous ganciclovir and anti-cytomegalovirus immunoglobulin were used with a transient benefit; however, retrobulbar gancyclovir resulted in a complete remission. This report emphasizes the need for close monitoring of viral infections in patients undergoing treosulfan-containing megatherapy, highlighting the immunosuppressive effects of this agent, and indicates the potential use of retrobulbar ganciclovir as the alternative method of drug delivery.

Therapeutic uses of prostaglandin F(2α) analogues in ocular disease and novel synthetic strategies.

The pharmacological management of glaucoma and ocular hypertension has significantly changed over the last 18 years with the introduction of PGF2α analogues, more specifically latanoprost (6), travoprost (8), bimatoprost (10) and tafluprost (12). Prostanoids are currently the first-line medicines among ocular antihypertensive drugs in terms of efficacy, safety, patient compliance and medical economy. Their ability to effectively reduce intraocular pressure with once-per-day dosing, ocular tolerability comparable to timolol and general lack of systemic adverse effects have made them the mainstay of pharmacological therapy for glaucoma and ocular hypertension all over the world. The present review reports a novel, convergent and highly diastereoselective method for the synthesis of PGF2α analogues from the structurally advanced prostaglandin phenylsulfone (5Z)-(+)-15 and new ω-chain synthons. The biochemistry, clinical efficacy and side effects of four commercially available PGF2α analogues, currently used as first-line agents for reducing intraocular pressure in patients with glaucoma or ocular hypertension, are also discussed.

Lid-parallel conjunctival folds (LIPCOF) and dry eye: a multicentre study.

AIMS: The study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye. METHODS: At 12 centres in 11 countries, 272 eyes of 272 dry eye patients (75 men, 197 women) were examined. Their mean age was 52.7±16.2 years. The LIPCOF were graded according to the method of Höh et al. The tear film break-up time (BUT) was measured, and fluorescein staining and the Schirmer 1 test were performed. The subjective symptoms were evaluated by 16 questions. RESULTS: The LIPCOF score demonstrated significant positive correlations with age, dry eye disease severity and fluorescein staining (r>0.2, p<0.001), and negative correlations with BUT and results of the Schirmer 1 test (r<-0.2, p<0.001). The LIPCOF score exhibited a significant correlation with the overall subjective symptoms (r=0.250, p<0.001). The sensitivity and specificity of LIPCOF grading for discriminating between normal and dry eyes were best with the cut-off between LIPCOF degrees 1 and 2. CONCLUSIONS: The displayed medium sensitivity and specificity, and good positive predictive value of the LIPCOF test support the use of LIPCOF grading as a simple, quick and non-invasive dry eye screening tool.

Pulsatile ocular blood flow in subjects with sleep apnoea syndrome.

INTRODUCTION: The aim of the study was to determine the correlation between pulsatile ocular blood flow (POBF) and sleep apnoea syndrome (SAS). MATERIAL AND METHODS: Patients were recruited from those who underwent polysomnography in the "Sleep Unit" of the physiology department (Medical University, Lodz, Poland). A total of 52 Caucasian patients, 34 with SAS and 18 age- and gender-matched controls, were included in the study. Comprehensive ophthalmic examination included the pulsatile ocular blood flow (POBF) measurements, disc analysis with Heidelberg Retina Tomograph II and Oculus Centerfield computerized perimetry as well as the best visual acuity, a slit lamp and indirect ophthalmoscopic evaluation of anterior and posterior segments and applanation tonometry. RESULTS: The observed prevalence of glaucoma in SAS patients was 5.9% (2 of 34). The mean values of POBF were 1069.21 ±235.94 µl/min in the SAS group and 1061.78 ±174.63 µl/min in the control group. The study revealed that the differences of mean POBF between the SAS patients and the control group were not statistically significant: Mann-Whitney U-test p > 0.05. No correlations were found between sleep apnoea syndrome and mean intraocular pressure (IOP), mean retinal nerve fibre layer (RNFL) thickness and visual field mean defect (MD). CONCLUSIONS: No correlation was found between pulsatile ocular blood flow and sleep apnoea syndrome. Although some previous studies found an association between IOP, MD, RNFL thickness and sleep apnoea syndrome, our study did not confirm that. However, a high prevalence of glaucoma was found among SAS patients in Poland.

Hydroxypropyl-guar gellable lubricant eye drops for dry eye treatment.

BACKGROUND: Dry eye is a medical problem of epidemic proportions, especially among the elderly in developed countries. The treatment of dry eye is still largely inadequate because there is no way of permanently restoring normal tear function and secretion at present. At present, virtually all therapeutic regimens include tear supplements; however, their main drawbacks are the need for frequent instillation, inadequate ocular surface protection and limited mode of action, focusing on rewetting only. OBJECTIVE: A new gellable lubricant eye drop (Systane lubricant eye drops, Alcon) has been designed using the novel concept of a pH-sensitive hydroxypropyl-guar component that prevents surface desiccation, reduces friction and acts as a mucomimetic. The purpose of this review is to consider this topical therapy and its properties. METHODS: Currently published data on Systane is reviewed, putting an accent on its novel multiple modality of action. RESULTS/CONCLUSION: By being pH sensitive, Systane adapts its viscosity to the ocular surface pH, which tends to be higher in dry eye. It becomes more viscous when the eye is drier, thus, providing better ocular surface protection. In addition, its characteristics reduce ocular surface friction, which is another factor that exacerbates dry eye symptoms. Data published so far show that it is also well tolerated by the patient, thus, significantly reducing dry eye symptoms and improving the patient's quality of life. By implementing this novel approach, Systane has contributed significantly to dry eye treatment.

The differential diagnosis of red eye: a survey of medical practitioners from Eastern Europe and the Middle East.

A survey amongst ophthalmologists and general medical practitioners from nine countries in Eastern Europe and the Middle East was conducted to estimate the percentage of patients presenting with a red eye and to examine differential diagnosis and treatment. Practitioners recorded brief details of every patient seen and detailed information concerning signs and symptoms, differential diagnosis and treatment for all patients presenting with a red eye during 20 consecutive days in the period between May and September 2004. Red eyes accounted for approximately 15% of consultations with ophthalmologists and almost 6% with general medical practitioners. Allergic conjunctivitis was the most common diagnosis (35%), followed by dry eye (25%) and bacterial conjunctivitis (24%). General medical practitioners were far more likely to prescribe a combination topical antibiotic and steroid preparation than ophthalmologists. This survey illustrates that red eye remains a very important problem for both ophthalmologists and general medical practitioners. Identification of dry eye as a common cause of red eye symptoms and more appropriate treatment of dry eye, allergic conjunctivitis and viral conjunctivitis are key messages to emerge.

[Antibiotic resistance of conjunctival bacterial flora in children]. / Antybiotykoopornosc szczepów bakteryjnych worka spojówkowego u dzieci.

PURPOSE: To evaluate conjunctival bacterial flora in children and its resistance to the most frequently antibiotics used by the ophthalmologists in Poland. MATERIAL AND METHODS: Bacterial conjuntival cultures obtained in 593 children without ocular infections. RESULTS AND CONCLUSIONS: Pathogenic bacterial isolates were identified in 26.3% children. Most frequently isolated were Gram-positive cocci (70.5%). Significant resistance of Gram-positive cocci to aminoglicosides (5% to 65%) was observed. Emerging resistance to fluoroquinolones, especially of coagulase-negative staphylococci (in 21%), was also observed.

[Central corneal thickness measurements in children]. / Badania grubosci rogówki w róznych okresach zycia u dzieci.

PURPOSE: To evaluate central corneal thickness in children. MATERIAL AND METHODS: Central corneal thickness was measured with the use of ultrasound pachymeter in 360 children aged 0-14 years. RESULTS: Mean central corneal thickness was 537 microm after the birth and 567 microm in the age of 14 years. Wide differences between minimum and maximum recorded values were observed (410-650 microm) in first 2 years of life, and 420-640 microm in years 2-14. CONCLUSIONS: 1. Mean central corneal thickness in children (even in small one's) does not differ significantly from adults and does not change with age. 2. Great differences between minimum and maximum recorded values were observed in children (especially in first two years of life), exceeding the range in adults. 3. IOP measurements in children should be corrected according to the results of central corneal thickness.

[Central corneal thickness in children with congenital glaucoma]. / Grubosc rogówki w jaskrze wrodzonej u dzieci.

PURPOSE: To evaluate central corneal thickness in children with congenital glaucoma. MATERIAL AND METHODS: Central corneal thickness was measured with the use of ultrasound pachymeter in 49 eyes of 30 children, with congenital glaucoma aged 0-12 years. RESULTS: Mean central corneal thickness was 462 microm. Very wide differences between minimum and maximum recorded values were observed (380-780 microm). Three groups of patients could be distinguished: with very thin cornea of 380-450 microm (73% children), with normal corneal thickness of about 550 microm (15%) and with very thick cornea of 680-780 microm (12% patients). CONCLUSIONS: 1. Mean central corneal thickness in children with congenital glaucoma is significantly thinner than in healthy children in the same age and in adult patients with glaucoma. A very wide differences between minimum and maximum recorded values, are observed in these patients. 2. The results of applanation tonometric measurements are underestimated in most cases or less frequently overestimated. 3. The measurements of central corneal thickness should be performed in every patient with congenital glaucoma to correct the IOP values.

[IOL calculations in cataract operations in children]. / Obliczenie mocy soczewek wewnatrzgalkowych w operacjach zacmy u dzieci.

The rapid growth of the eye must be accounted for, when calculating the dioptric power of the IOL before cataract surgery in children. Therefore in the paper, changes in axial length of the eye, refractive power of the cornea and dioptric power of IOL for correction of aphakia in children aged 0-14 years were measured. Basing on the obtained data, the guidelines for the choice of IOL in different age of children were worked up. Between 1 and 2 years the power of the IOL should be undercorrected by 20%, at 2 to 4 years by 15% and at 4 to 8 years by 10%.

[Possibilities of spontaneous regression in active phase of ROP]. / Mozliwosci samoistnej regresji zmian w fazie czynnej retinopatii wczesniaków.

PURPOSE: To evaluate the possibilities of spontaneous regression of changes in the retina and vitreous in active stage 1-5 retinopathy in prematurity. MATERIAL AND METHODS: 168 premature infants with active stages 1-3 and 91 with stages 4-5 ROP, was observed by the author in years 1995-2002. RESULTS: Spontaneous regression of changes in the retina and vitreous was observed in 85% of children with stage 1, in 56% in stage 2 and in 25% in stage 3. In stage 3 regression occurred in 35% in stage 3 A, in 18% in 3 B and in 12% in stage 3 C. With changes in zone III regression can be expected in 95%, in zone II in 45% and in zone I in 6%. Spontaneous reattachment of the retina was observed in 27% of children with stage 4A, in 15% with stage 4B and only in 6% in stage 5. CONCLUSIONS: Considering the occurrence of spontaneous regression, laser therapy should be performed in every stage, if changes are observed in zone I and in every case of stage 3 B and 3 C.

[Results of treatment of retinal detachment in active stage-5 retinopathy of prematurity]. / Ocena wyników leczenia odwarstwienia siatkówki w przebiegu 5. stadium fazy czynnej retinopatii wczesniaków.

PURPOSE: To evaluate the surgical and functional results of encircling scleral buckling in treatment of active stage 5 retinopathy of prematurity. MATERIAL AND METHODS: 68 premature infants (121 eyes) with active stage 5 ROP operated with the use of the modified encircling buckling technique. The surgical and functional results were compared with the results observed in 91 unoperated children with active stage 5 ROP. RESULTS: In the operated group total retinal reattachment was observed in 52% and partial reattachment in 24.5% of premature infants. The surgery failed to reattach the retina in 23.5%. Visual acuity was: no light perception in 56.1%, light perception to 0.02 in 24.5% and 0.02 to 0.2 in 19.4% of children. In unoperated group spontaneous reattachment was observed in 6% of infants and visual acuity was: no light perception in 76%, light perception in 20% and finger counting in 4% of them. CONCLUSION: The obtained results indicate, that modified encircling buckling can be an effective treatment in reattaching the retina in stage 5 ROP although useful vision can be obtained in only 20% of operated children.

[Treatment of retinal detachment of the course of retinopathy of prematurity]. / Leczenie odwarstwienia siatkówki w przebiegu retinopatii wczesniaków.

Cryo- and laser therapy of stage 3 have reduced, but not eliminated the occurrence of retinal detachment in stages 4a, 4b and 5 of ROP. In this disease the treatment of these stages is still the greatest challenge to the ophthalmologist. Therefore, the aim of this paper is to present our up-to-date possibilities of treatment of different kinds of retinal detachments in ROP, including segmental scleral buckling, encircling scleral buckling, scleral resection, vitrectomy and its modifications in ROP. Guidelines of surgery of retinal detachment in active stage 4 and 5 of retinopathy of prematurity have been described.

[Evaluation of the visual function in employees working with computers]. / Ocena wybranych funkcji widzenia u osób pracujacych z komputerami.

PURPOSE: To evaluate the effects of long-term work with computer monitor on the accommodation, convergence, stereopsis, near and distant visual acuity. MATERIAL AND METHODS: The studies of the accommodation, convergence, stereopsis, near and distant visual acuity have been performed in 50 employees working with the computer 6.5 hours daily, 5-6 days weekly and 5 to 12 years. The same studies have been performed in 50 white-collar workers, who had no contact with the computer in their work. RESULTS: No changes in the accommodation, convergence, stereopsis, near and distant visual acuity have been found in the employees in both studies groups. CONCLUSION: Long-term work with the computer monitor does not cause changes in the visual function of the employees. Reported changes are probably cause by the visual fatigue associated with the near work, and not by the direct influence of the computer monitor.