Intraocular lens power calculations in eyes with pseudoexfoliation syndrome.

To compare refractive outcomes after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes and to investigate the accuracy of 3 intraocular lens (IOL) calculation formulas in these eyes. In this prospective comparative study 42 eyes (PEX group) and 38 eyes (control group) of 80 patients were included. The follow-up was 3 months. The refractive prediction error (RPE), mean absolute error (MAE), median absolute error (MedAE) and the percentages of eyes within ± 0.25 D, ± 0.5 D, ± 1.0 D and ± 2.0 D of prediction error were calculated. Three IOL calculation formulas (SRK/T, Barrett Universal II and Hill-RBF) were evaluated. PEX produced statistically significantly higher mean absolute errors and lower percentages of eyes within ± 0.5 D than control eyes in all investigated IOL calculation formulas. There were no statistically significant differences in the median absolute errors between the 3 formulas in either PEX or control eyes. Refractive outcomes after cataract surgery are statistically significantly worse in PEX than in control eyes. All three IOL calculation formulas produced similar results in both PEX and control eyes.Trial registration: ClinicalTrials.gov registration number NCT04783909.

Limbal Approach Phacovitrectomy to Treat Cataract with Clinically Significant Asteroid Hyalosis-Presentation of the Technique and Preliminary Results.

PURPOSE: To assess preliminarily the efficacy and safety of a relatively new surgical modification of phacovitrectomy in eyes with cataract and visually significant asteroid hyalosis (AH). MATERIALS AND METHODS: Prospective, noncomparative, interventional case series of six eyes of six patients (mean age 75.6 years; 1 woman, 5 men) with cataract and visually significant AH treated with a novel surgical technique-a phacoemulsification with anterior vitrectomy through posterior capsulorhexis and intraocular lens (IOL) implantation. Main outcome measures were: best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, complications. Mean follow-up was 39.17 ± 4.31 months. RESULTS: The mean BCVA (Snellen) improved from 0.26 ± 0.18 to 0.73 ± 0.33 at the end of the follow-up. IOP was in the normal range, and no problems with IOL fixation were observed at the end of the follow-up. No post-operative complications, retinal detachment, retinal tears, macular edema or prolonged inflammation were observed. CONCLUSIONS: The presented new surgical technique seems to be a safe and efficacious method to treat cataract with visually significant asteroid hyalosis.

Predictive Value of Bleb Vascularity after Mitomycin C Augmented Trabeculectomy.

BACKGROUND: To evaluate the relationship between bleb vascularity and surgical outcome one year after mitomycin C (MMC) augmented trabeculectomy. METHODS: This was a prospective study of 51 eyes of 44 patients after MMC-augmented primary trabeculectomy with follow-up of 12 months. The total vessel area of a bleb was measured with ImageJ software on color photographs of the bleb on day 1 and 14, then months 1, 3, 6 and 12 after trabeculectomy. Blebs were classified clinically as successful (intraocular pressure (IOP) ≤ 18 mmHg and a >30% reduction in IOP without antiglaucoma medications or additional surgical interventions) or failed. Linear regression analysis was performed to determine the correlation of bleb vascularity with IOP and outcome. RESULTS: At 1 year, 40 eyes (78.4%) were classified as successful and 11 eyes (21.6%) as failed. The mean bleb vascularity at 1, 3 and 12 months after surgery was significantly higher in failed blebs (16.31% vs. 13.01%, p = 0.005, 14.93% vs. 10.15%, p = 0.001, 8.99% vs. 6.37%, p = 0.011, respectively). There were no significant differences in mean bleb vascularity at 1 and 14 days postoperatively in successful and failed blebs. The results revealed a significant association between vessel area at 1 and 3 months after trabeculectomy with IOP at 6 months postoperatively (p = 0.005 and p = 0.009, respectively). CONCLUSIONS: In this prospective study, we demonstrated a strong relationship between bleb vascularity and the surgical outcomes of trabeculectomy. Vascularity of the filtering bleb during early postoperative period was not correlated with IOP or success of trabeculectomy at one year. Increased bleb vascularity 1, 3 and 12 months after trabeculectomy appears to predict surgical failure at 1 year after trabeculectomy.

Phacotrabeculectomy using collagen matrix implant (Ologen® ) versus mitomycin C: a prospective randomized controlled trial.

PURPOSE: To compare the efficacy and safety of collagen matrix implant (Ologen® ; OLO) with mitomycin C (MMC) in phacotrabeculectomy. METHODS: Prospective, single-centre, nonblinded, randomized controlled trial. A total of 53 eyes of 45 patients were enrolled in the study protocol with 27 eyes randomly assigned to OLO and 26 to MMC. The follow-up was 12 months. The primary outcome measure was mean change from baseline intraocular pressure (IOP) in both groups after 12 months. The secondary outcome measures were cumulative success rates at 12 months with Kaplan-Meier analysis, change in number of medications, change in best corrected visual acuity (BCVA), and bleb morphology assessed using Moorfields Bleb Grading System and anterior segment swept-source optical coherence tomography. RESULTS: The mean IOP decreased from 26.4 ± 6.1 mmHg to 13.7 ± 3.8 in the OLO group and from 23.4 ± 3.6 mmHg to 13.3 ± 2.8 in the MMC group at 1 year without significant intergroup differences. At 1 year, the overall success rates were 92.6% and 92.3% in the OLO and MMC groups, respectively. There were no significant differences in the overall success rates, BCVA, number of medications, morphology of the filtering blebs and rate of complications at the end of the follow-up. CONCLUSION: Ologen (OLO) provides similar surgical outcomes in phacotrabeculectomy compared with adjunctive MMC. It may be a new, safe and effective alternative to MMC for combined phacoemulsification and trabeculectomy surgery.

[Ophthalmological complications associated with clinically significant carotid stenosis]. / Objawy oczne towarzyszace klinicznie znaczacemu zwezeniu tetnicy szyjnej.

The aim of the study was to show ocular manifestations in carotid artery occlusive disease, with pathogenesis, diagnostic and therapeutic abilities of this changes. Carotid arteries are the main route by which the blood is supplied to the cerebrum and eyes. Clinical significant carotid artery stenosis is mainly caused by atherosclerosis. Most frequent neurological symptoms are transient ischemic attacks (TIA) and temporary visual loss (amaurosos fugax) are most common ocular symptoms. Other ocular pathologies in fundus examination are retinal embolies, retinal vein occlusion, anterior ischemic optic neuropathy, ocular ischemic syndrome or glaucoma. Most dangerous complications are stroke, blindness, or even patients death. Besides clinical examination the diagnosis is usually confirmed by carotid artery color Doppler ultrasound, magnetic resonance angiography and retinal fluorescein angiography. It is important to refer a patient with suspected or confirmed significant carotid artery stenosis for appropriate evaluation and treatment to a endovascular surgeon.

Vitamin D receptor binding to DNA is altered without the change in its expression in human renal clear cell cancer.

Vitamin D co-regulates cell proliferation, differentiation and apoptosis, the processes that are disturbed in cancer tissues. It acts through the vitamin D nuclear receptor (VDR) that binds to DNA in the regulatory sequences of the target genes. As the kidney is one of the key organs for vitamin D metabolism and action, we analyzed VDR expression and its DNA binding activity in human renal clear cell cancer. 24 tumors, 24 controls that were excised from the opposite pole of the same kidney and 7 controls originating from kidneys without cancer were examined. Independently of tumor grading neither Northern blots nor immunoblotting demonstrated statistically significant differences of the mean VDR mRNA and protein amounts, respectively, in the cancer as compared to both control types. In contrast, the amount of VDR-DNA complexes was lower in 52.2% of the tumors in comparison to their corresponding controls. After normalization against VDR receptor protein amount in 34.8% of the tumors VDR-DNA binding was at least 3-4 times weaker than in the controls. However, the expression of vitamin D-dependent P21 gene on the mRNA level was not decreased in these cancers. It remains to be elucidated if altered VDR function due to its impaired binding to DNA contributes to the process of tumorigenesis, and what potential vitamin D-dependent mechanisms are involved in this process.

[Low-symptomatic pheochromocytoma]. / Guz chromochlonny o skapoobjawowym przebiegu klinicznym.

We present the patient with 1-month history of mild hypertension, who was admitted to our department with suspicion of coronary heart disease. He had family history of hypertension and coronary heart disease, hyperlipidaemia and he has been smoker for several years. During the diagnostic exertion test chest pain together with an unusual high blood pressure was found (240/140 mmHg). The results of catecholamines and their metabolites in 24-urine collection, abdominal ultrasonography and NMR revealed pheochromocytoma in the left adrenal gland, which was removed successfully. Particular clinical examination allowed to include the patient to the group with low-symptomatic pheochromocytoma. Abdominal USG, which had been done prior to the exertion test, didn't reveal any incidental tumor in the adrenal glands. The abnormal hypertensive reaction during exertion test was the main decision of the urine catecholamines and their metabolites determination. Pheochromocytoma should be included to the differential diagnosis in all patients with chest pain and high blood pressure during diagnostic exertion test.

Functionally impaired TR mutants are present in thyroid papillary cancer.

TRs are transcription factors that regulate cell proliferation, differentiation, and apoptosis. They are cellular homologs of the transcriptionally inactive viral oncogene v-erbA. We tested the hypothesis that the functions of TRs could be impaired in cancer tissues as a result of aberrant expression and/or somatic mutations. As a model system, we selected human thyroid papillary cancer, in which the most common abnormalities, RET/papillary thyroid cancer rearrangements (fusion of RET kinase domain to the activating domains of other genes), were found in 40--45% of cases. We found that the mean expression levels of TR beta mRNA and TR alpha mRNA were significantly lower, whereas the protein levels of TR beta 1 and TR alpha 1 were higher in cancer tissues than in healthy thyroid. Sequencing of TR beta 1 and TR alpha 1 cDNAs, cloned from 16 papillary cancers, revealed that mutations affected receptor amino acid sequences in 93.75% and 62.5% of cases, respectively. In contrast, no mutations were found in healthy thyroid controls, and only 11.11% and 22.22% of thyroid adenomas had such TR beta 1 or TR alpha 1 mutations, respectively. The majority of the mutated TRs lost their trans-activation function and exhibited dominant negative activity. These findings suggest a possible role for mutated thyroid hormone receptors in the tumorigenesis of human papillary thyroid carcinoma.