Etiology of uveitis in rural and urban areas of mid-eastern Poland.

The aim of this study was to assess and compare the frequencies of uveitis etiology in inhabitants of rural and urban areas of mid-eastern Poland. We reviewed the cases of 563 patients (263 males, 300 females; aged 2-87) with uveitis, treated at the 1st Department of Ophthalmology at the Medical Academy in Lublin and at the District Ophthalmic Hospital in Kielce, Poland, from January 1996-December 2000. Anatomical classification of uveitis was used according to the International Uveitis Study Group and etiological classification including uveitis associated with trauma, infection, systemic disease, non-associated with a systemic disease and masquerade syndromes. Data regarding age, gender, place of residence, anatomical location and etiology of uveitis were obtained. Statistical analyses were performed using Pearson's chi-square test, Spearman's rank correlation test and logistic regression. Etiology of uveitis was established in 70.0% of cases. The most common cause of uveitis was infection. Patients from rural areas were significantly more likely to have uveitis of infectious origin whereas patients from urban areas significantly more likely to have uveitis associated with a systemic disease. In conclusion, the pattern of uveitis in mid-eastern Poland confirms the influence of environmental factors on the etiology of this heterogenous disease.

[Localization of intraocular foreign bodies using computed tomography]. / Zastosowanie tomografii komputerowej (TK) w lokalizacji cial obcych wewnatrzgalkowych.

PURPOSE: To present the evaluation of computed tomography (CT) application for detecting the intraocular foreign bodies. MATERIAL AND METHODS: Sixteen computed tomographies of orbit to localise a foreign body were performed in the 2nd Radiology Department at Lublin University School of Medicine from May 1995 to October 1998. During examination 2 mm computed tomography cuts were taken. In almost all cases fundus examination was not possible because of hazy media (cataract, vitreous haemorrhage, endophthalmitis). Pars plana vitrectomy was applied to remove foreign body in all cases. RESULTS: In 14 cases a foreign body was localised inside the eye (3 of them were embedded in the wall of the eye) and in 2 cases a double perforation was noticed. With pars plana vitrectomy 12 of 14 intraocular foreign bodies were removed. Two foreign bodies deeply embedded in the wall of the eye were left. One of the two foreign bodies after double perforation was removed from the orbit and the second, which was localized deeply in the orbit, was left. CONCLUSION: The localisation of the foreign bodies using the computed tomography is a very accurate and sensitive method, facilitating further surgery.

[Evaluation of astigmatism and blood-aqueous barrier breakdown following procedures in the anterior eye segment]. / Ocena astygmatyzmu oraz zmian przepuszczalnosci bariery krew-ciecz wodnista po operacjach przedniego odcinka galki ocznej.

PURPOSE: The aim of this study was to evaluate the disruption of the blood-aqueous barrier (BAB) and the induced astigmatism following phacoemulsification, trabeculectomy and phacotrabeculectomy. MATERIAL AND METHODS: 141 eyes of patients who underwent different surgical procedures of the anterior segment were examined with the use of computer-assisted videokeratography. All maps were recorded preoperatively, and one and five days after surgery. We also applied a laser flare-meter in 41 eyes in order to quantify aqueous flare following these procedures. RESULTS: The mean surgically-induced astigmatism following conventional trabeculectomy was 2.1 D and 1.4 D one and five days postoperatively, phacoemulsification with sutures 2.7 D and 1.9 D and phacotrabeculectomy 3.0 D and 2.4 D, respectively. Lower values of astigmatism obtained after sutureless phacoemulsification were 0.6 D and 0.3 D one and five days postoperatively, respectively (p < 0.05 vs Phaco+IOL+Trab. group, p < 0.01 vs other groups). It was found that aqueous flare values following phacotrabeculectomy were 58.0 photon counts/milisec.--one day, 39.3--3 days, 24.4--7 days, 20.4--10 days postoperatively. Significantly reduced values were observed after phacoemulsification--27.6 one day after surgery and 17.6--3 days later (p < 0.01 vs Phaco+IOL+Trab.group). CONCLUSIONS: It could be concluded that induced astigmatism and the amount of inflammation were the highest after triple procedure and the lowest after phacoemulsification.

[Corneal topography of keratoconus]. / Badania topograficzne stozka rogówki.

PURPOSE: The present study was designed to evaluate the topography of a series of keratoconus patients. SUBJECTS AND METHODS: Using a computer-assisted videokeratography (Eye Sys) we determined the topographic findings of 85 eyes of 46 consecutive patients with keratoconus. We analysed some quantitative topographic parameters like: power at the apex, central corneal power, the amount of irregular astigmatism, distance between the apex and the visual axis, difference in central corneal power between the two eyes of the same individual and steepening of the inferior cornea compared with the superior cornea. RESULTS: Keratoconic topographic alterations were classified into two groups. Fifty seven of the cones (71%) could be described as peripheral with steepening of the cornea extending to the limbus. The remaining twenty three eyes (29%) had steepening confined to the central cornea. In many instances corneal topography was characterized by a high degree of nonsuperimposable mirror image symmetry (enantiomorphism) in the location of the topographic alterations between the two eyes of an individual patient. In all patients, irrespective of the topographic pattern, the inferior midperipheral cornea was steeper than superior cornea as quantified by an l-S value. CONCLUSION: Study of the topography in keratoconus using this technique may prove useful for documenting the pattern of involvement of the anterior corneal surface and providing insight into the pathogenesis of this condition.

[Clinical manifestation and diagnosis of ocular borreliosis]. / Obraz kliniczny i diagnostyka boreliozy ukladu wzrokowego.

PURPOSE: To present severe involvements of Borrelia burgdorferi in the etiology of uveitis, optic neuritis and other ocular inflammatory conditions. METHODS: IgM and IgG antibodies for Borrelia burgdorferi were detected by ELISA. Since May 1995 we have examined 78 patients for borreliosis. RESULTS: Borreliosis was diagnosed in 11 patients (4 males, 7 females; aged 7 to 48). 7 persons remembered being bitten by a tick, 3 months to 3 years before the onset of ocular symptoms. All patients had systemic symptoms and signs. Ocular manifestations were as follows: nonspecific chronic conjunctivitis in 4 patients, keratitis in 2, diminished corneal sensation in 1, iritis in 1, intermediate uveitis and perivasculitis in 1, posterior uveitis in 3, retinal haemorrhage in 1, optic neuritis in 1, optic disc oedema in 2, sixth nerve paresis in 1 patient. CONCLUSIONS: We emphasize the importance of performing serological tests for borreliosis in patients with uveitis, inflammatory diseases of unknown etiology, optic neuritis and other neuro-ophthalmic conditions.

[Corneal astigmatism after trabeculectomy]. / Astygmatyzm rogówkowy po trabekulektomii.

PURPOSE: The aim of the present study was to investigate the effect of conventional and mitomycin trabeculectomy on the corneal astigmatism. SUBJECT AND METHODS: Measurements with the use of computer-assisted videokeratography (Eye-Sys) were performed in 34 glaucoma patients who underwent trabeculectomy. Color-coded topography maps were analyzed to obtain astigmatic data. RESULTS: The mean surgically-induced astigmatism in conventional trabeculectomy group was 2.2 D and in the mitomycin group 4.0 D, 1 day post-op, 1.3 D and 3.0 D after 10 days and 0.4 D and 1.1 D after 3 months, respectively. CONCLUSION: There was an apparent correlation between the amount of induced astigmatism and the use of mitomycin. This may be related to the impaired healing process of trabeculectomy wound and lower intraocular pressure in the mitomycin group.

[The value of bacteriologic examination in cataract surgery]. / Wartosc badan bakteriologicznych w chirurgii zacmy.

The purpose of our study was to compare the incidence of intrabulbar infections following cataract extraction and its correlation with the results of preoperative bacterial cultures. We examined 2344 patients who were operated on from 1st January 1993 to 31st December 1994 in our hospital. Patients were divided into 3 groups. In the first group surgery, was performed only in cases where preoperative cultures were negative, in the second group conjunctival cultures were prepared just before surgery. In the third group no preoperative cultures were prepared. Additionally in the second and the third group one drop of 5% Betadine solution was administered to the conjunctival sack just before surgery. We conclude that negative preoperative conjunctival cultures did not prevent from postoperative infections of the eye. After resigning of preoperative bacterial cultures the incidence of intrabulbar infections following cataract surgery did not increase in our study.

[Use of the laser-flare meter for early diagnosis of corneal graft rejection and for monitoring therapy]. / Zastosowanie tyndalometrii laserowej do wczesnego rozpoznawania odrzutu przeszczepu rogówki oraz do monitorowania leczenia.

AIM: The purpose of this study was to noninvasively quantify, with the use of a laser-flare meter, the alterations of the blood-aqueous barrier following penetrating keratoplasty. This could objectively indicate the disruption of this barrier in eyes with early allograft rejection, possibly even before the manifestation of the clinical signs, and would help to monitor the efficacy of the treatment. MATERIAL AND METHODS: We used the laser flare-meter (Kowa FM-500) to investigate alterations of the blood-aqueous barrier following uncomplicated penetrating keratoplasty (PK) and in corneal allograft rejection. Examination was performed in 53 eyes of 50 patients after uncomplicated PK (7 days to 12 months after PK), in 20 normal control eyes and in 8 patients with acute allograft rejection before and during the treatment. The treatment consisted of systemic and topical administration of steroids and in some cases additionally topical immunosuppressants. RESULTS: Mean flare values in the control eyes were 3.9 +/- 1.0 photon counts/ms. During the first two weeks after uncomplicated keratoplasty they were significantly increased (18.2 +/- 5.8) but were postoperatively slowly decreasing in time, nearly reaching the control values within 6-12 months. They were considerably higher in eyes with acute allograft rejection (34.0 +/- 13.1), but gradually diminished to 8.1 +/- 1.2 after successful treatment. CONCLUSIONS: The application of laser flaremetry is useful in the follow-up of patients after perforating keratoplasty, especially after high risk grafts. The method helps to detect quantitatively early allograft rejection and is beneficial in monitoring the effectiveness of the treatment.

[Changes of some physicochemical parameters of gas exchange in aqueous humor of rabbits during treatment of experimental uveitis]. / Zmiany w wartosciach parametrów fizykochemicznych przemiany gazowej plynu komory przedniej oka królików w leczeniu doswiadczalnie wywolanego zapalenia blony naczyniowej.

PURPOSE: To evaluate the usefulness of some parameters of the aqueous humor: pH, pO2 (oxygen pressure), pCO2 (carbon dioxide pressure) and HCO3- concentration in the diagnosis of uveitis. Changes of these parameters following conventional treatment and cryotherapy have also been investigated. MATERIAL AND METHOD: We used 40 grey rabbits (weighing 2.5-3.0 kg). Uveitis was evoked by intravitreal injection of 5 mg of animal albumin. Cryotherapy was performed by transconjunctival, quintuple cryoapplication (30 s) over ciliary body. Samples of aqueous humor were collected 6, 12, 24 and 48 hours after albumin injection. pH, pO2, pCO2 values and HCO3- concentration were determined using Astrup microanalyser. RESULTS: Parameters of aqueous humor, especially pH, pCO2 and HCO3- turned out to be fairly sensitive indicators reflecting the natural history of experimental uveitis. Cryotherapy characteristically modulates the pH, pCO2 and HCO3- values in the anterior chamber. CONCLUSIONS: We came to the conclusion that monitoring of these parameters may give some important information about the intensity of the course of uveitis and the influence of the treatment. Normalisation of the values usually parallels clinical improvement.