[Cataract surgery in nanophthalmic eyes]. / Phakoemulsifikation bei nanophthalmischen Augen.

PURPOSE: The aim of this study was to determine the prevalence of nanophthalmos among cataract patients and to evaluate intraoperative and postoperative complications in nanophthalmic eyes. PATIENTS AND METHODS: Medical and operating records of all 3287 patients who had undergone clear cornea phacoemulsification cataract surgery with foldable acrylic IOL implantation during a period of two years (January 2009 to December 2010) were retrospectively reviewed. Nanophthalmos was diagnosed according to a shorter axial length than 20 mm, a shallow anterior chamber, hyperopia and scleral thickness greater than 1.7 mm as determined by echography. Before surgery all patients received an intravenous 20 % mannitol solution. RESULTS: From 3287 eyes, six eyes of four patients were identified as nanophthalmic with an axial length below 20 mm and a scleral thickness greater than 1.7 mm. The prevalence of nanophthalmos was 0.18 %. The average hyperopia was + 7.87 D (+ 6.0 to + 9.50). The mean axial length was 19.58 mm (18.94 to 20.00). The mean biometry calculation was 33.16 D (31.5 to 36.0). In all cases no complications were observed during the surgery. In two eyes a mild iritis was observed one day after surgery. During a follow-up of 3 months no further complications occurred. CONCLUSIONS: Surgical manipulation in a narrow and crowded anterior chamber in nanophthalmic eyes with increased vitreous pressure is always a challenge and must be performed by an experienced surgeon. Preoperative examination of scleral thickness and preoperative administration of hyper-osmotic solution for reduction of vitreous pressure are very important to prevent unexpected complications. There was no need for a prophylactic surgical procedure in our patients.

[Ocular symptoms as the initial signs of Wegener's granulomatosis]. / Augensymptome als Initialzeichen von Wegener-Granulomatose.

OBJECTIVE: Wegener's granulomatosis (WG) is a systemic, necrotising, granulomatous vasculitis of unknown aetiology. Ocular involvement is present in up to 60 %. The aim of our study was firstly to evaluate the presence of ophthalmic manifestations as the first sign of WG in patients without obvious systemic manifestations of WG, and secondly to evaluate the clinical manifestation of ocular symptoms as the initial signs of WG. METHODS: The medical records of all patients with a diagnosis of WG examined at the Department of Rheumatology and Immunology during the 5-year period from January 2003 to January 2008 were reviewed. Initial manifestation of WG, initial ocular presentation, biopsy results, laboratory testing results, treatment and the final outcome were determined. Only patients in whom WG was not diagnosed at the time of the ocular symptoms were included in the study. RESULTS: Fifteen patients diagnosed with WG were identified. Six patients (40 %) developed no ocular symptoms before and after WG was diagnosed. Two patients (13.3 %) had a systemic disease first and subsequently developed ocular symptoms. Seven patients (46.7 %) had ocular symptoms as the first signs of WG (necrotising sclerokeratitis in two patients, peripheral ulcerative keratitis in two patients, non-granulomatous uveitis in one patient, anterior necrotising sclerokeratitis and nodular posterior scleritis with serous retinal detachment in one patient, severe retinal and chorioidal vascular occlusions with ischaemic optic disc neuropathy and complete visual loss in one patient). CONCLUSIONS: In nearly 50 % of patients with WG, ocular symptoms were observed as the initial signs before WG was diagnosed. The initial symptoms may be obscure and may vary from one patient to another. Knowledge of the ocular initial symptoms of WG is very important and can contribute to a better prognosis and prevention of visual loss.

[Hyperopia as a risk factor in patients with non-arteritic anterior ischaemic optic neuropathy]. / Weitsichtigkeit als Risikofaktor für Patienten mit nicht arteritischer anteriorer ischämischer Optikusneuropathie.

BACKGROUND: The aim of this study was to review the refractive errors of non-arteritic anterior ischaemic optic neuropathy (NAION) patients, especially with regard to hyperopia as an additional risk for NAION. PATIENTS AND METHODS: The medical records of detailed ophthalmic examinations of 45 patients with acute NAION who were admitted to our department between January 1, 2002 and January 1, 2007 were reviewed retrospectively. Refractive errors were measured with an autorefractometer. The spherical equivalent (sum of sphere and cylinder) was used as a measure of refractive error. RESULTS: The majority of eyes (32 of 45) were hyperopic (71.1 %) The average degree of hyperopia was + 1.86 D. Six of 45 patients (13.3 %) were myopic. The average degree of myopia was -0.87 D. CONCLUSION: Our results suggest that hyperopia could be a predisposing factor for NAION. Since there is no reliable and effective treatment for NAION, measures to avoid ischaemic optic neuropathy have priority. Patients with moderate hyperopia should receive a detailed eye examination with emphasis placed on recognition and management of other possible risk factors to minimise the risk for NAION. Prevention of possible risk factors is the only way to avoid this severe complication and to prevent the involvement of the fellow eye.

[Optical coherence tomography findings in hemodialysis patients]. / Optische Kohärenztomografie bei hämodialysierten Patienten.

BACKGROUND: The aim of the present prospective study was to compare retinal thickness between normal healthy subjects and chronic renal failure patients treated with maintenance hemodialysis (HD) as well as to determine whether there was any correlation between age and duration of HD treatment. PATIENTS AND METHODS: A total of 24 eyes of 12 HD patients and 32 eyes of 16 controls underwent optical coherence tomographic scanning (OCT) in the central disc of 6000 mum in diameter. RESULTS: The mean retinal thickness was measured in the inner temporal, superior, nasal and inferior quadrants. There was a highly significant difference in the inner quadrants between controls and HD patients (p < 0.005). The mean retinal thickness was also measured in all outer quadrants. The differences between HD patients and controls were highly significant (p < 0.005). The average reduction in retinal thickness in HD patients compared to the controls in the inner quadrants was 7.9% or 22 microm (279.0 in controls, 257.0 in HD patients) and 7.3% or 17.7 microm in the outer quadrants (244.5 in controls, 226.8 in HD patients). The average reduction in all quadrants was 7.7% or 20.1 microm (262 in controls, 241.9 in HD patients). The differences between HD patients and controls were highly significant in all quadrants (p < 0.001). No differences in foveal thickness between controls and HD patients were found. The reduction of retinal thickness was correlated with the age of HD patients, but not with the duration of HD treatment. CONCLUSION: OCT revealed a significant reduction of retinal thickness in HD patients. The reduction was significant in all quadrants and was correlated to the age of HD patients. No differences in foveal retinal thickness were found.

[Traumatic wound dehiscence following penetrating keratoplasty]. / Traumatische Wunddehiszenz nach perforierender Keratoplastik.

BACKGROUND AND PURPOSE: Blunt ocular trauma to a corneal transplanted eye represents a higher risk for wound rupture at the donor-recipient interface. We have evaluated the causes, clinical characteristics, treatment and outcome, particularly the graft's clarity, in patients with traumatic wound dehiscence after penetrating keratoplasty. METHODS: Between March 1996 and April 2006, over a period of 10 years, 4 patients who had previously undergone successful penetrating keratoplasty and subsequently sustained traumatic wound dehiscence were treated at our department. All eyes underwent primary wound closure with interrupted 10-0 nylon sutures. RESULTS: Over the 10-year period, the incidence of traumatic wound dehiscence in which penetrating keratoplasty was performed was 2.35 % (4 of 170 patients). The ages of our patients at the time of injury were 6, 76, 78 and 39 years. The interval between penetrating keratoplasty and trauma varied from 12 through 16 and 17 to 30 months. All corneal dehiscences occurred at the graft-host junction. All dehiscences were at the temporal-superior quadrant (4 of 4 eyes) and at superior-nasal and temporal quadrants in 3 of 4 eyes. Two eyes that were pseudophakic had lost their implants and required anterior vitrectomy. In one of these patients (a 76-year-old women) delayed-onset expulsive choroidal haemorrhage occurred at the end of surgical repair. Visual outcome was correlated with the force of trauma, previous eye conditions and complications during surgery. All of the resutured grafts retained clarity. CONCLUSION: Traumatic wound dehiscence is a serious and not uncommon complication following penetrating keratoplasty. Despite severe trauma, graft transparency was achieved in all cases and there was no need for regrafting.

[Changing indications for penetrating keratoplasty over a 20-year period, 1985-2004]. / Veränderungen der Indikationen für die perforierende Keratoplastik über 20 Jahre, 1985-2004.

BACKGROUND: The aim of the study was to determine the changing indications for penetrating keratoplasty (PK) over the 20 years from 1.1.1985 through 31.12.2004 at our Ophthalmology Department as well as to identify additional surgical interventions. PATIENTS AND METHODS: Medical records of all 268 patients (290 eyes) who underwent PK at our Ophthalmology Department Teaching Hospital Maribor over the 20-year period (1985-2004) were reviewed retrospectively. All PK were divided into two groups: the first group comprised 121 eyes operated in the first 10 years (1985-1994) and the second one comprised those operated in the last 10 years (1995-2004). RESULTS: During the period of 20 years (1984-2004), the most common indication for PK was aphakic/pseudophakic bullous keratopathy (23.1 %). Keratoconus was the second most common indication for PK (21.7 %), followed by corneal scars (21.4 %). In the first 10 years of the study (1985 to 1994) the most common indications were corneal scars (28.9 %), keratoconus (22.3 %) and corneal dystrophy (19.8 %). Over the second 10 years (1995 to 2004) the three most common indications were bullous keratopathy (29 %), keratoconus (21.3 %) and corneal scars (16.9 %). There was a dramatic increase in the number of PK for failed corneal transplants, from 3.3 % in the first to 12.4 % in the second period (+ 275.8 %) and for bullous keratopathy (+ 94.6 %) as well as a decrease for corneal scarring (-41.5 %) and corneal dystrophy (-40.4 %). Additional surgical interventions increased from 21.5 % in the first 10 years to 28.4 % (+ 32.1 %) in the second 10 years. CONCLUSIONS: Bullous keratopathy was the leading indication for PK during the last 10 years (1994-2005). Keratoconus was the second leading indication in both 10 year periods. Regrafting showed a significant increasing trend in the last 10 years.

[Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma]. / Die Vorhersagefaktoren einer erfolgreichen selektiven Lasertrabekuloplastik bei Offenwinkelglaukom.

BACKGROUND: The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). PATIENTS AND METHODS: In 122 eyes suffering from OAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pretreatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined. RESULTS: The mean follow-up time was 43.4 months (SD: 25.6). The mean pretreatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation (r = -0.234; p = 0.01), diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy. CONCLUSION: SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.

[Changes of retinal light sensitivity after YAG-laser capsulotomy]. / Veränderungen der Lichtunterschiedsempfindlichkeit (LUE) der Netzhaut nach der YAG-Laser-Kapsulotomie.

BACKGROUND: The aim of this prospective study was firstly to investigate the changes of retinal light sensitivity of the central visual field in patients with posterior capsule opacification (PCO) after YAG-laser capsulotomy and secondly to determine the correlation between changes in retinal light sensitivity and patient's age and the diameter of posterior laser capsulotomy. PATIENTS AND METHODS: Our study includes 25 eyes (25 patients) with PCO after phacoemulsification and intraocular lens implantation. In all patients YAG-laser capsulotomy was performed. In all patients, a threshold visual field analysis was carried out with the C 30 - 2 programme of the automated Humphrey Field Analyzer before and one month after the procedure. RESULTS: In all patients a significant improvement of visual acuity was observed one month after capsulotomy (p = 0,00003). One month after YAG-laser treatment, a significant improvement of retinal light sensitivity in the central visual field was also observed. The average MD (mean deviation) before the procedure was - 6.05 db (+/- 3.2, max. - 11.7, min. + 2.17) and after the procedure - 3.61 db (+/- 3.7, max. - 10.87, min. + 0.71). Before laser capsulotomy obvious areas of reduced retinal sensitivity in 19 of 25 eyes (76 %) were found with MD p values of less than 5 %. One month after the procedure the MD p values were less than 5 % only in 8 eyes (32 %). The improvement in MD was statistically significant (p = 0,0002). No correlation was established between the improvement of retinal light sensitivity and patient's age or the size of the capsulotomy. CONCLUSIONS: Our study shows that the improvement of retinal light sensitivity is significant after YAG-laser capsulotomy and not depends on patient age or capsulotomy size.

[Repair of an extensive corneoscleral perforation in a case of ocular rosacea with a keratoplasty]. / Behandlung einer umfangreichen Korneoskleraperforation bei okulärer Rosacea mit der Keratoplastik.

BACKGROUND: A 58-year-old female patient with rosacea and a 7year history of eye trouble presented with a spontaneous corneoscleral perforation of the left eye. METHODS: The persisting ocular hypotonia with retinal folds made a closure of the leakage area necessary. Covering with a corneal transplant was chosen from among several possibilities available for the repair of eye-surface defects. The involved parts of the sclera and cornea were removed in a diameter of 7 mm. RESULTS AND CONCLUSIONS: The almost 6-year postoperative course with virtually no problems confirmed the keratoplasty as being effective therapy also in the case of perforation in rosacea scleroperikeratitis.

[Long-term follow-up of selective laser trabeculoplasty in primary open-angle glaucoma]. / Langfristige Nachbeobachtung der selektiven Lasertrabekuloplastik bei primärem Offenwinkelglaukom.

BACKGROUND: Our aim was to investigate the outcomes of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study. PATIENTS AND METHODS: In 90 eyes suffering from POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66 and 72 months after. A failure was defined as an IOP reduction of less than 20 % of the pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged. RESULTS: The mean follow-up time was 41.2 months (SD 20.0). The mean pretreatment IOP was 22.4 mmHg (SD 2.3). At one month of follow-up, the mean IOP reduction was 5.0 mmHg (SD 2.3) or 22.3 % and at 6 months 5.2 mmHg (SD 2.4) or 23.2 %. At 12 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.4) or 24.0 % and at 24 months 5.8 mmHg (SD 2.3) or 25.5 %. At 36 months of follow-up, the mean IOP reduction was 5.7 mmHg (SD 2.1) or 25.1 % and at 48 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 1.9) or 23.1 %. At 60 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 2.0) or 22.6 % and at the end of 72 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.3) or 22.8 %. The success rate after 12 months determined by Kaplan-Meier survival analysis was 94 %, after 24 months 85 %, after 36 months 74 %, after 48 months 68 % and after 72 months 59 %. CONCLUSION: SLT is an effective procedure offering an additional therapy option for the treatment of POAG, but the effect diminishes over time.

[Pseudomonas-keratoconjunctivitis in a contact lens wearer, the therapy and keratoplasty á chaud]. / Pseudomonas--Keratokonjunktivitis bei einer Kontaktlinsenträgerin, Therapie und Keratoplastik á chaud.

BACKGROUND: Eye infections in contact lens wearers can cause severe complications. Especially dangerous is Pseudomonas aeruginosa. PATIENT: A 18-year-old patient who received her first soft contact lens from a optician two years ago without an ophthalmological examination, will be presented. At the time of an excursion to Paris in August 2004 she suffered from a purulent secretion on her right eye. In a pharmacy she bought medicinal herbal eye drops first. Then after three days a physician prescribed her Tobramycin eye drops 4 times per day and Chloramphenicol ointment at bedtime. At that time the visual acuity (VA) of the infected eye was already very bad. Two days later we performed the first ophthalmological examination at our Ophthalmological Department. RESULTS: The clinical finding was typical for a Pseudomonas infection: mucopurulent secretion, corneal ring abscess with stromal necrosis and hypopyon. The VA was only light perception. Immediately, a topical and systemic antibiotic therapy was prescribed (grade III by W. Behrens-Baumann). A conjunctival smear was sterile. For the microbiological examination the corneal scraping, the contact lens and storing solution were also taken and Pseudomonas aeruginosa and Klebsiella spp. were isolated. One month after the first presentation of the patient at our Department we performed a keratoplasty á chaud (diameter 8.0 mm). 1 year later the corneal graft is clear and the VA is 0.6 - 0.7 cc. CONCLUSIONS: The contact lens fitting lies worldwide in different hands and could be done by an ophthalmologist, an optometrist or an optician. The changes of the cornea and conjunctiva made by contact lenses can have different causes. Especially dangerous are metabolic-hypoxic corneal changes and infections. Therefore, an ophthalmological check-up, particularly after contact lens fitting done by an non-physician, is very important and necessary.

[The outcome of phacoemulsification in eyes after filtering glaucoma surgery]. / Ergebnisse nach Phakoemulsifikation in Augen nach filtrierender Glaukomoperation.

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.

[The surprising finding and removal of a large plastic foreign body through the corneal wound from the vitreous cavity with good outcome]. / Der überraschende Fund und die Entfernung eines riesigen Kunststoff-Fremdkörpers durch die Hornhautwunde aus dem Glaskörperraum mit gutem Endergebnis.

BACKGROUND: Presented is a patient whose history showed that during a hammer-blow on a piece of iron something had flown into his left eye. Clinical investigation revealed a 9-mm long, horizontal, paracentrally located, penetrating corneal wound. Temporally in the same region the iris was torn in its entire width. The lens appeared opaque and seemed to be cut in two parts. Radiological investigation revealed no foreign body. METHODS: The operative treatment presented a surprise: the white piece, which had been considered to be a part of the traumatic cataract, was actually the edge of a large plastic foreign body lying in the vitreous cavity. The exciting and complicated procedure of removing this 12 x 9 x 2 mm large foreign body through the corneal wound as well as the reconstruction of the anterior segment of the eye are demonstrated. RESULTS: Seven months after the injury the corneal wound is very tender, the corneal sutures have not been removed, and the retina of the aphakic eye is undamaged. Visual acuity with a contact lens is 0.6 - 0.7. CONCLUSIONS: Operative treatment of patients with a penetrating eye injury is always demanding and difficult and requires a lot of experience. Particularly in apparently hopeless cases, an optimum primary care is of greatest importance.

[Cause and repair of a corneoscleral fistula in two patients]. / Ursache und Behandlung einer korneoskleralen Fistel bei 2 Patienten.

BACKGROUND: A slowly progressing bulbar hypotension with maculopathy in a male patient as well as an endophthalmitis in a female patient both required surgical repair of posttraumatic leaks. PATIENTS AND METHODS: In a 32-year-old male patient, a filtration bleb leak occurred 4 months after a penetrating stab wound in the corneoscleral region. Persistent bulbar hypotension demanded microsurgical revision, revealing a 1 x 1 mm scleral defect. The leakage area was close to the limbus. In a 75-year-old female patient, signs of endophthalmitis occurred 4 years after extracapsular cataract extraction with posterior intraocular lens implantation. The place of entry of the inflammation was a 1 x 3 mm subconjunctival fistula in the corneoscleral scar. In both cases the leakage areas were repaired by an autologous 4 x 4 mm scleral graft obtained from the pars plana region in the same eye. RESULTS: The postoperative course was without complications, the intraocular pressure was back to normal within a few days in both cases. Two weeks after surgical repair in the first patient, normal ocular fundus and normal visual acuity were observed. In both cases complete and permanent leakage closure was achieved. CONCLUSIONS: There are various surgical possibilities for the repair of scleral defects. Patching the defects with autologous scleral grafts has several advantages. Dissection of the graft in the pars plana region is relatively simple. The graft comprising 30% of the scleral thickness is sufficiently firm and supple and there is no danger of infection transmission or of rejection.

[Siderosis bulbi. Is it still a problem?]. / Siderosis bulbi. Noch immer ein Problem?

BACKGROUND: Siderosis bulbi (SB) is caused by un-removed intraocular iron-containing foreign bodies. Our retrospective study was designed to establish the number of patients treated for SB at our ophthalmology department within the past 10 years, and to find out why SB occurred. PATIENTS AND METHODS: Retrospectively, we analyzed the documentation of every patient treated at our department for ocular injury due to an intraocular metal foreign body between 1.1.1992 and 1.1.2002. Particular attention was focussed on the documentation of patients exhibiting symptoms of SB. RESULTS: During this period of time, 48 eyes with an intraocular iron-containing foreign body were treated operatively. In 45 cases, the foreign body was removed within 3 days after injury without any symptoms of SB. Of these, three patients (6.2%) came so late for treatment that various clinical signs of SB were already present. CONCLUSIONS: There are three major reasons for the development of SB: some patients do not come for an examination because there is no discomfort, the second reason is that the medical treatment at the first visit was too superficial and thirdly a small foreign body may also be overlooked due to deficient or inappropriate methods of examination. Therefore, sporadic cases of SB are still to be expected in the future.

Postoperative inflammation after cataract surgery in patients with rheumatoid arthritis.

The purpose of the present study was to assess the influence of preoperative activity of rheumatoid arthritis (RA) on early postoperative anterior chamber inflammation after phacoemulsification and intraocular lens implantation. Twenty-three eyes in 18 patients were included in our study. On the first postoperative day, anterior chamber inflammation was observed in 11 eyes (47.8%). Five days after surgery, we found postoperative inflammation only in 1 eye (4.3%). Keratic precipitates were observed in 1 eye (4.3%) on the second postoperative day. We found no correlation between the extent of anterior chamber inflammation and the preoperative activity of RA. Postoperative anterior chamber inflammation was also not associated with the medical management of RA.

[Primary congenital glaucoma. Long-term success after goniotrepanation with scleral flap]. / Primäres kongenitales Glaukom. Langzeiterfolg nach primärer Goniotrepanation mit Skleradeckel.

BACKGROUND: The long-term success of primary goniotrephining with scleral flap was evaluated in the treatment of primary congenital glaucoma. PATIENTS AND METHODS: Retrospective analysis was carried out in 31 eyes of 18 patients with primary congenital glaucoma (mean follow-up 63 months, range 10-161). Surgical success was defined by an intraocular pressure less than 18 mmHg without medication, stabilization, or reduction in horizontal corneal diameter and stabilization or reversal of disc cupping. Surgical complications were also noted. RESULTS: In 25 eyes control of the glaucoma was achieved with a single goniotrephining procedure (80.6% success rate). In 31 eyes control was achieved with two goniotrephinings (100% success rate). No serious surgical complications were noted. CONCLUSIONS: Primary goniotrephining with scleral flap is a successful and safe method of primary congenital glaucoma treatment.

Bilateral eye injury caused by a high-pressure water jet from a fire hose.

We present a case of bilateral eye injury caused by a high-pressure water jet from a fire hose. Eye injury secondary to high-pressure water jets are relatively rare, but invariably result in severe damage to all ocular structures. A 51-year-old woman was admitted to our ophthalmologic department for treatment following a direct hit in the face by a water jet from a fire hose from a distance of about one meter. The patient had bilateral extensive eyelid edema and ecchymosis, conjunctival chemosis with hemorrhage, vitreous hemorrhages in the right eye and iridodialysis with hyphema in the left eye, a transient decrease in intraocular pressure, bilateral superior commotio retinae with macular edema, and bilateral impairment of vision. The patient was treated with topical corticosteroids. Four months later she was re-admitted to our department for surgical repair of iridodialysis in the left eye. Iridodialysis had affected the entire superior nasal portion of the iris, and the pupil was displaced downward temporally. The iris partly obscured the visual axis. After surgical repair the visual axis was free. At a follow-up examination two years later, the ocular findings were the same. The best corrected visual acuity was 0.1 in the right eye and 0.3 in the left eye. Visual impairment was a consequence of permanent posttraumatic posterior fundus changes, particularly of the macula in both eyes. Intraocular pressure was within normal limits in both eyes. Injuries caused by high-pressure water jets are usually bilateral. The injuries are mainly confined to the lower anterior portions of the eye (Bell's phenomenon). Our patient had bent forward during the accident, therefore the central and upper chorioretinal portions were also affected. Such injuries usually cause severe damage to the anterior and posterior portions of the eyes and greatly reduce visual acuity in both eyes. Because of the risk of late complications (cataract, glaucoma, retinal detachment), long-term follow-up is recommended in such patients.

Surgical repair of Descemet's membrane detachment.

The aim of the study was to demonstrate a successful repair of Descemet membrane detachment (DMD). A 73-year-old woman with pseudoexfoliative glaucoma underwent phacoemulsification with flexible posterior chamber intraocular lens implantation. Because of inadequate pupillary dilatation flexible iris retractors were used. Four days after cataract surgery, a large DMD was recognized. One day later, the patient underwent surgical repair. Three long full-thickness 10-0 nylon sutures were used to fixate DM to the cornea. The next day, DM was completely attached and the cornea was clear. Final best-corrected visual acuity was 0.9. Iris retractors may increase the risk of DMD because the iris is more anterior to the cornea. Bimanual manipulation is recommended to avoid accidental separation. No clinical case of DMD repair has been previously reported, associated with flexible iris retractors and phacoemulsification. To achieve good visual results in extensive DMD we recommend early surgical treatment.

Indirect traumatic optic neuropathy--two case report.

The aim of the study was to evaluate the treatment of indirect traumatic optic neuropathy (ITON). ITON is defined as traumatic loss of vision that occurs without external or initial ophthalmoscopic evidence of injury to the eye or its nerve. The optimal management of ITON remains controversial. History, clinical findings and treatment of two cases of ITON with high-dose corticosteroids are described. Improvement of visual acuity after treatment with high-dose corticosteroids was achieved in both cases. The treatment is evaluated in comparison to endorsed treatment modalities found in literature. We concluded that was clinically reasonable to decide to treat or not to treat the indirect optic neuropathy on an individual patient basis.