[Does acetylsalicylic acid and vitamin K antagonists are risk factors of macular degeneration related with age?]. / Czy kwas acetylosalicylowy i antagonisci witaminy K sa czynnikami ryzyka wystapienia zwyrodnienia plamki zóltej zwiazanego z wiekiem?

AIM: The aim of this study was to evaluate the effects of chronic use of acetylsalicylic acid (ASA) and vitamin K antagonists (VKA) on the incidence of age related macular degeneration (AMD). MATERIALS AND METHODS: The study included 292 individuals (187 women, 105 men, aged 45-94 (mean 73.2 ± 10.2 years). All individuals completed a survey and underwent a full eye examination. Patients were divided into four groups according to the presence or absence of degenerative changes at the bottom of an eye: group D - 80 patients with drusen (23 men and 57 women), 27,4% of studied population, group GA - 25 patients with geographic atrophy (10 men, 15 women), 8,56% of studied population, group CNV - 52 patients with neovascular form of AMD (28 men, 24 women), 17,81% of studied population, group Z - 135 healthy people (44 men, 91 women), 46,23% of studied population. Among study group 79 patients (27,1%) used aspirin, 32 people (11%) used vitamin K antagonists (acenocoumarol or warfarin), 181 people (61,9%) didn't use any drug. RESULTS: Patients from D and CNV group took ASA and VKA more often than patients from GA and Z group. The percentages were: in a group Z - 30,37%, in group D - 46,25%, in group GA - 32%, in group CNV - 48,08% (p=0,0407). There was no relationship between belonging to a group and use of ASA (p=0,3169). A statistically significant relationship between belonging to a group and use of VKA was discovered. The number of people using VKA in group D and CNV was statistically significantly higher than in the healthy control group and percentage were as follows: in group Z - 8,15%, in group D - 17,5%, in group GA 0%, in group CNV - 13,46% (p=0,0159). Patient groups differed statistically significantly due to age (p=0,0043), sex (p=0,0197), family history of macular diseases (p <0,0001), smoking (p=0,011), prevalence of hypercholesterolemia (p=0,0437), ischemic heart disease (p= 0,0173). The consumption of fish at least once a week and eating fruits and vegetables more often than once a day was associated with a reduced incidence of AMD p=0,0009, p=0,0003. Patients without AMD assessed their quality of life at a higher level than people with AMD (p<0,0001). ASA and VKA intake was found not to be an independent risk factor for AMD. Positive family history was an independent risk factor for AMD in all groups. Also age ≥75, fish consumption > 1 week, male gender were independent risk factors for AMD in specified groups. CONCLUSIONS: Patients with drusen and exudative form of AMD took ASA and VKA more often than healthy people and patients with geographic atrophy. ASA or VKA intake was found not to be an independent risk factor for AMD. Positive family history was an independent risk factor for AMD in all groups. In selected groups: age ≥75, male gender and reduced consumption of fish was found to be an independent risk factor for AMD. Number of people taking ASA and VKA is increasing and further studies are needed to assess their impact on the organ of vision.

[Orbital trauma inflicted by a butcher's knife without any injury of the eyeball]. / Uraz oczodolu bez zranienia galki ocznej zadany nozem rzezniczym.

We present a 25 year old man, who suffered from an apparently serious orbital injury inflicted by a butcher's knife during a fight. The knife perforated the upper lid of the right eye, and than penetrated the orbita along its medial wall into the right maxillary sinus, the ethmoid sinus, finally reaching the left maxillary sinus. The eye bulb, as well as the optic nerve and the muscles remained intact. A major hemorrhage from the nasal cavity, which occurred immediately after the extraction of the knife, was managed successfully by means of anterior and posterior nasal packing. Intranasal synechias developed in the days following the injury, leading to obstruction of the nasal cavities. The synechias were later almost entirely eliminated through appropriate treatment, leaving the patient with practically no complications of this dramatic injury.