[Corneal scars: confocal images as the basis of qualifying for PTK or PK]. / Blizny rogówki--obrazy konfokalne jako podstawa kwalifikacji do fotokeratektomii terapeutycznej (PTK) lub keratoplastyki drazacej (PK).

PURPOSE: The study aimed to evaluate corneal scars of various origin using confocal microscopy in order to qualify patients for phototherapeutic keratectomy or penetrating keratoplasty. MATERIAL AND METHODS: We studied 21 patients with scars of various origins in 28 corneas. The age of patients (9 women and 12 men) ranged from 27 to 47 years (mean 31.8). In 10 patients (17 corneas) scars were caused by superficial or profound inflammatory processes of viral, bacterial or fungal origin. In 7 patients (7 corneas) the causative factor was blunt or lacerating injury (linear and planar) and in 4 patients (4 corneas) scars developed after the removal of foreign bodies. All corneas were examined using a ConfoScan-P4 scanning slit confocal microscope (Tomey). RESULTS: Post-inflammation scars differed in microscopic appearance, depending on the etiology and clinical state, which affected the mode of treatment. Three scars caused by penetrating trauma were qualified for penetrating keratoplasty. Out of 4 scars caused by non-penetrating trauma, 2 were treated by PTK and 2 by penetrating keratoplasty. In patients with impaired vision after the removal of corneal foreign bodies, confocal microscopy revealed focal areas of increased illumination and intracorneal encrustations. CONCLUSIONS: Confocal microscopy enabled us to determine the structure of corneal scar and the depth at which each scar was located, which helped us to choose between PTK and penetrating keratoplasty. The presence or absence of needle-like structures allowed us to detect inflammatory processes within the scar and to evaluate the state of the remaining corneal tissue.

[Complicated cataract: Part II: complicated cataract in glaucoma. Part II: Complicated cataract in retinal degenerative disorders]. / Zacma wiklajaca. Czesc II--Zacma wiklajaca w jaskrze. Czesc III--Zacma wiklajaca procesy zwyrodnieniowe siatkówki.

The paper shows pathognomonique cases of complicated cataracts concerning the prognostic aspects of surgical treatment. The article presents surgical methods of treating patients with secondary cataract in high myopia and glaucoma. Modern diagnostic methods are discussed, how to choose the safest surgical technique and to reach the desired postoperative refraction. More effective ways of cataract surgery in patients with glaucoma and in high myopia are suggested.

[Complicated cataract. Part I: complicated cataract in uveitic patients]. / Zacma wiklajaca. Czesc I--Zacma wiklajaca zapalenia blony naczyniowej.

The paper shows pathognomonique cases of complicated cataracts concerning the prognostic aspects of surgical treatment. The article presents methods of treatment in cases with uveitic cataract. Modern diagnostic methods are discussed, how to choose the safest surgical technique and to reach the desired postoperative refraction. More effective ways of cataract surgery in uveitis patients are proposed.

[Treatment of corneal ulcerations with use of the amniotic membrane]. / Leczenie owrzodzen rogówki z zastosowaniem blony owodniowej.

UNLABELLED: Corneal ulcerations may cause complications such as, for example, the loss of transparency, descemetocele or perforation of the cornea. Widely used therapies do not always bring expected results. Recently the amniotic membrane has been applied for the treatment of corneal ulceration. PURPOSE: The purpose of the present study was to evaluate the efficacy of the amniotic membrane suturing over the locations of corneal ulcers. MATERIAL AND METHODS: The amniotic membrane was sutured over the locations of corneal ulcers in 9 eyes of 9 patients suffering from ulcers which did not regress with traditional therapeutic methods. After meticulous debridement of the ulcer floor and border area the amniotic membrane was sutured to the cornea with a single 10.0 Nylon suture (around the ulcer area), and additionally suture were fixed to the sclera. Following the procedure contact lenses were placed over the area for protection. The observation period was 6 months. Follow-up examinations were performed regularly during the first seven postoperative days, then after 2, 4 and 12 weeks; the final follow-up took place 6 months after the procedure. RESULTS: In all patients we observed healing of the corneal defect, improvement of visual acuity and regression of the active inflammatory process. After this procedure the subjective symptoms subsided. CONCLUSION: The amniotic membrane can be used for the treatment of corneal ulceration of various etiology.

[Evaluation of the visual apparatus in children and teenagers with pseudophakic eyes]. / Ocena narzadu wzroku u dzieci i mlodziezy w oczach pseudofakijnych.

UNLABELLED: The aim of the work is to evaluate the ocular functions in children and teenagers after IOL implantation. MATERIAL AND METHODS: The study included 51 eyes in 47 patients aged 6-20 years. IOL implantation was performed simultaneously with congenital or traumatic cataract surgery and in aphakia. RESULTS: The visual acuity 5/50-5/5 was achieved in 73.3% of eyes after congenital cataract surgery, in 76.5% of eyes after traumatic cataract surgery, and in 31% of aphakic eyes before implantation.

[The examination of healthy human corneas with confocal microscope]. / Obserwacje przyzyciowe prawidlowych ludzkich rogówek przy uzyciu mikroskopu konfokalnego.

PURPOSE: The aim of this study was to observe the normal human corneas in vivo, using the Scanning Slit Confocal Microscope "Confoscan P4" (Tomey). MATERIALS AND METHODS: 50 corneas of 25 patients, aged 18 to 45 (mean 26), 10 women and 15 men were examined by means of the Confocal Slit Scanning Microscope. Obtained results were analysed in relation to patients' age and sex. The comparison of right and left cornea in each patient was performed. The structure of the epithelium, stromal keratocytes in the anterior, middle and rear part of the stroma, the pattern of the nerve plexus, the appearance of Bowman's and Descement's membranes and the condition of the endothelium were observed. RESULTS: In the analyzed group of patients there were no differences in the findings between the right and left eye. No age and sex related changes were observed. CONCLUSION: Confocal Scanning Microscope allows for real-time, noninvasive observation of the human corneal cell structure in vivo and is capable of evaluation of corneal morphology and physiology.

[Comparison of the mean deviation of retinal sensitivity in the static perimetry threshold test with biomorphometric parameters of the optic disc in eyes with glaucoma]. / Porównanie wartosci sredniego odchylenia progu czulosci siatkówki w tescie progowym perymetrii statycznej z wybranymi parametrami biomorfometrycznymi tarczy nerwu wzrokowego w oczach z jaskra prosta.

The aim of the study is to evaluate results of mean deviation of retinal sensitivity obtained in static perimetry threshold test in glaucoma simplex eyes and to compare them with some biomorphometric parameters of the optic disc measured with scanning laser ophthalmoscope. The analysis was performed with the results obtained in 50 glaucomatous eyes with the disease lasting 4 to 15 years. The mean values of mean deviation, cup to disc ratio, mean cup depth and neuroretinal rim area were 6.71, 0.459, 0.031 and 1.464, respectively. The best correlation coefficient value (0.847) was found between mean deviation and neuroretinal rim area. The results confirm the importance of neuroretinal rim area value in evaluation of optic disc in glaucoma cases.

A fluorophotometric study of corneal endothelium after trabeculectomy using different concentrations of Mitomycin-C.

The aim of the study was to determine the corneal endothelial permeability coefficient (Pac) in subjects after trabeculectomies using different concentrations of Mitomycin-C (MMC). MMC, a highly toxic drug, is not without drawbacks and complications such as corneal damage. To ascertain a possible relationship between a level of endothelial permeability (Pac) and concentrations of MMC used, we performed, in a prospective study, trabeculectomies in cases of primary open-angle glaucoma (POAG), younger than 50 years, with either concentrations of 0.5 mg/ml of MMC (group 1: 11 eyes) or 0.2 mg/ml of MMC (group 2: 10 eyes). Group 3 consisted of 8 patients after a typical trabeculectomy without MMC and served as a control group (8 eyes). In all groups, before surgery and again 1, 3 and 6 months after surgery, corneal endothelial permeability (Pac) was determined by using anterior segment fluorophotometry (Fluorotron Master). The thickness of the cornea (CT) was measured with a DGH Technology ultrasonic pachymeter. One month after surgery the mean values of Pac were statistically significantly higher in groups 1 and 2 (group 1: 4.78 x 10(-4) cm/min, group 2: 4.67 x 10(-4) cm/min) in comparison with the control group (group 3: 3.37 x 10(-4) cm/min), but the differences between groups 1 and 2 were not statistically significant (p = 0.05). Six months after operation the mean values of Pac in all groups were normalized. In eyes that underwent trabeculectomy with MMC, higher concentrations of MMC were likely to have a transient adverse effect on corneal endothelial permeability. In light of the resulting toxic intraocular effect of MMC, the damage in the function of the corneal endothelial barrier is greater with greater concentrations of MMC.

[Axial and para-axial fluorophotometry in optic neuropathies]. / Osiowa i paraosiowa fluorofotometria w neuropatiach nerwu wzrokowego.

PURPOSE: To investigate optic neuropathies, with normal results in fluorescein fundus angiography, by axial and paraaxial fluorophotometry (a type of topographic vitreous fluorophotometry) in order to determine differences examined in the amount of fluorescein leakage in macular and optic disc. MATERIAL AND METHODS: We studied 12 eyes with unilateral idiopathic retrobulbar inflammatory optic neuropathy and 4 eyes with unilateral posterior ischaemic optic neuropathy during the acute phase: control group consisted of 5 healthy eyes. After 3-4 months, in final stage of optic neuropathies, in which primary atrophy of optic disc developed (6 eyes), fluorophotometric examinations were repeated. All cases of control group underwent axial and paraaxial fluorophotometry. Complete ophthalmic, physical and neurological examinations were performed. RESULTS: The mean fluorophotometric values of PVPR (posterior vitreous penetratio-ratio) for f-scans (foveal) were lower than for t-scans (PVPRf < PVPRt) in all neuropathies during the acute phase but all values of PVPR were higher than in control eyes. In late phase of the neuropathies in which primary atrophy of optic disc developed we found a trend: PVPRt < PVPRf, but all values of PVPR were lower than in control eyes. We noticed increased permeability of the blood-ocular barrier and difference between fluorophotometric readings for optic disc directions (t-paraaxial scans) and for foveal directions (f-axial scans) in optic neuropathies during the acute phase, when the findings on ophthalmoscopic and fluorescein fundus angiography were normal.

[Fluorometric estimation of corneal endothelium functions in emmetropic and myopic eyes in pseudophakia]. / Ocena fluorofotometryczna funkcji sródblonka rogówki oka normowzrocznego i krótkowzrocznego w pseudofakii.

The aim of the study was to calculate the corneal endothelial permeability (Pac) before, one week, and one month after planned extracapsular cataract extraction and intraocular posterior chamber lens implantation in two groups with axial myopes (8 eyes) and normal eyes (6 eyes): in patients aged 60-75 years. Patients with minimal endothelial disorders have been found to have abnormal endothelial permeabilities. Each operated eye was submitted to fluorophotometry of the anterior segment with measurement of corneal endothelial permeability (Fluorotron Master, Coherent), the day before surgery, 1 week and 1 month afterwards. The measuring of cornea thickness measurement and endothelial cell counting was done by specular microscopy with pachymeter. Corneal permeability clearly increased 1 week after surgery in both groups; 1 months after surgery Pac was normalized in both groups, except for all pseudophakic myopic eyes (axial length: 25-27 mm) with longer surgical procedures (> 20 min), those associated with a greater increase in corneal endothelial permeability. No changes in corneal thickness and endothelial cell density were noted as a result of surgery. Myopic eye with longer surgical procedures was found as a risk factor for an increase in corneal endothelial permeability.

[Three dimensional analysis of the optic disc with scanning laser tomography]. / Trójwymiarowa analiza tarczy nerwu wzrokowego za pomoca skaningowej tomografii laserowej.

The aim the study was to evaluate the optic disc's topography, to compare it with conventional photographs and with defect of the visual field in glaucomatous patients. We performed our study in 18 glaucomatous and 19 healthy control subjects with laser topographic scanning ophthalmoscope (TopSS, Laser Diagnostic Technologies Inc.) and compared the results with those in the photographic method. Defect of the visual field was assessed with "Octopus 1-2-3" using the GL programme GL. A topographic image of the cup area in control subjects and the neuroretinal rim area in glaucomatous subjects obtained with TopSS was smaller than in the photographic method (p < 0.05 and p < 0.01 respectively). Mean values of cup volume in control and glaucomatous subjects were 0.222 mm3 (SD = 0.011) and 0.619 mm3 (SD = 0.021) respectively. A correlation between the optic disc parameters obtained in TopSS examinations and the mean defect of the visual field was statistically significant in glaucomatous patients. Topographic results of optic disc obtained by TopSS allow for an accurate assessment of optic nerve damage.

Corneal endothelial permeability in protection glaucoma filter bleb with tissue plasminogen activator.

After glaucoma filtering surgery subconjunctival injection of human recombinant tissue plasminogen activator may promote the function of glaucoma filter bleb and increase outflow facility. It can also increase postoperative complications, such as corneal damage. The aim of our research was to determine corneal endothelial permeability (Pac) in subjects with glaucoma filter bleb protected by a plasminogen activator (Actilyse, Boehringer) when haemorrhagic clots obstructing a glaucoma filtering site had occurred. Two weeks, three months and six months after goniotrephining with scleral cover, in groups with and without subconjunctival injection of 25 mg human tissue plasminogen activator, Pac was calculated. In both groups, no significant differences in the level of Pac measured by fluorophotometry were found.

[Intraoperative support of trabeculectomy with mitomycin]. / Sródoperacyjne wspomaganie trabekulektomii mitomycyna.

The authors evaluated the efficacy of pharmacological support of trabeculectomy by intraoperative application of mitomycin. It was used in selected cases, those of high risk glaucoma as regards to poor surgical effect, in concentrations 0.2 mg/ml and 0.5 mg/ml. There were 32 eyes with following types of secondary glaucoma: neovascular glaucoma in diabetes, glaucoma in aphakic and pseudophakic eyes and simple glaucoma in the eyes after uneffective trabeculectomy. Normalization of the intraocular pressure was achieved in 21 eyes (65.6%). The 1.5-year follow-up revealed that with higher concentrations of mitomycin normalization of the pressure was more frequent lait there occurred more complications than with lower concentrations. Long-lasting hypotony is a difficult complication.

[The influence of retinal argon laser photocoagulation on results of vitreous fluorophotometry in patients with diabetic retinopathy]. / Wplyw fotokoagulacji siatkówki laserem argonowym na wyniki pomiarów fluorofotometrycznych u chorych z retinopatia cukrzycowa.

The authors performed vitreous fluorophotometry in 16 cases of diabetic retinopathy before and after argon laser focal coagulation of retina. They have found rising tendency of the permeability of the blood-retinal barrier during the two months after laser treatment, which depended on its intensity.

[Influence of steroidal and nonsteroidal anti-inflammatory drugs on post-operative blood-aqueous barrier in pseudophakia]. / Wplyw sterydowych i niesterydowych leków przeciwzapalnych na pooperacyjna bariere krew-ciecz wodnista w pseudofakii.

Fluorophotometric evaluation of the tightness of blood-aqueous barrier was made in 2 groups of patients who underwent cataract surgery with IOLs implantation. The first group was treated with nonsteroidal (Naclof, Tolectin) and the second with steroidal (Dexamethasone, Hydrocortisone) anti-inflammatory drugs. Fluorophotometry of the anterior segment of the eye was performed for the quantitative examination of the inflammatory reaction. The leakage of fluorescein through the blood-aqueous barrier was evaluated and compared with the fellow, non-operated eye. The individual leakage coefficient, calculated according to Sanders, was lower in the group of patients treated with nonsteroidal drugs but the differences were not statistically significant. The results suggest that nonsteroidal drugs could be as efficient or even more efficient in the treatment of inflammatory reaction after cataract surgery with IOLs implantation.

Axial and para-axial fluorophotometry in diabetic macular edema.

The vitreous fluorophotometric examinations were used in nonproliferative diabetic retinopathy to recognize early diabetic macular edema. Thanks to additional fixation light, axial and para-axial fluorophotometry in patients with nonproliferative diabetic retinopathy was achieved (Fluorotron Master, Coherent). The angle of deviation from the foveal scan (f) was 10 degrees in temporal (t) and nasal (n) directions. In case of non clinically significant macular edema, the posterior vitreous penetration ratio (PVPR) in the foveal scan (f) was significantly higher (p < 0.05) than in the other results (trend PVPRt < PVPRf > PVPRn).

[Blood-retinal barrier and visual field in retinitis pigmentosa]. / Bariera krew-siatkówka i pole widzenia w zwyrodnieniu barwnikowym siatkówki.

The aim of the research was to determine, with new-generation fluorometer (Fluorotron Master), the factor of fluorescein leakage into the vitreous and to reveal, with the static perimeter (Humphrey's), the quantitative parameter of the visual field in retinal pigmentary dystrophy. The factor of fluorescein leakage into the vitreous was almost ten times higher in retinal pigmentary dystrophy and it indicated the damage of blood-retina barrier. The correlation between the factor of fluorescein leakage into the vitreous and the degree of visual field defect has not been found.

[Refractive surgery of the cornea. II. Operations with excimer laser]. / Chirurgia refrakcyjna rogówki. II. Operacje laserem excimer.

Discussed are the possibilities of application of excimer laser for the correction of myopia, astigmatism and hypermetropia, based on personal material and survey of the literature. The results obtained hitherto submit a considerable hope for utilization of the presented method in the future.

[Keratoprosthesis from a personal collection 15-year old material]. / Keratoprotezowanie w 15-letnim materiale wlasnym.

The study presents the analysis of a 15-years material concerning the keratoprosthesis in severe corneal leukoma of various aetiology. The material comprises 82 cases of corneal leukoma of the 5th category (hopeless leukoma) caused in the majority of cases by chemical burns as well as post-inflammatory leukoma, on the background of pemphigus, after opacified corneal grafting. The authors discuss the characteristic complications of keratoprosthesis and present their personal results.

Axial and para-axial fluorophotometry in glaucoma simplex.

In this fluorophotometric study, in 25 eyes with middle advanced stages of glaucoma simplex (visual field defects ranged from 500 dB to 800 dB) and treated with topical antiglaucomatous agents, the posterior vitreous penetration ratio (PVPR) was compared with that from normal subjects. Vitreous fluorophotometry (Fluorotron Master, Coherent) was used to measure posterior vitreous fluorescein concentration. Due to additional fixation light in horizontal plane, three scans were taken along the following directions: temporal (t), foveal (f), nasal (n). The angle of deviation from the foveal scan was 15 degrees in each direction. The average values of posterior vitreous penetration ratio in group of patients with glaucoma were higher in comparison with those in healthy subjects. In both groups the PVPR was significantly lower in nasal (n) scan (optic disc area) in comparison with temporal (t) or foveal (f) scans (p < 0.05).