[Clinical advantages of colorimetric exploration in the early diagnosis of glaucomatous neuropathy]. / Intérêt clinique de l'exploration colorimétrique dans le diagnostic précoce de la neuropathie glaucomateuse. Etude préliminaire.

AIM: The purpose of this investigation was to evaluate acquired color vision defects in the early stages of primary glaucoma and in patients at risk for glaucoma. MATERIAL AND METHODS: Patients with primary open-angle glaucoma, normal-tension glaucoma and ocular hypertension were examined with the IF-2 anomaloscope. The Rayleigh equation and the Moreland equation were tested. We studied the relationships between color vision defects and the other tested variables. RESULTS: We found the mean value of the setting range of the Moreland equation significantly increased in all tested groups. Color vision disturbances were found in 57% of eyes with glaucoma and in 31% of eyes with ocular hypertension. We found a positive correlation between the blue-green colour vision defects and the perimetric changes in the glaucomatous eyes. These results indicate a decrease in color discriminating sensitivity in the short wavelength part of the visible spectrum in patients with glaucoma as well as in patients with ocular hypertension. CONCLUSION: Blue-yellow color vision testing with the anomaloscope may serve as an additional test in the early diagnosis of glaucoma but the absence of dyschromatopsia does not exclude the disease.

[Management in preretinal macular hemorrhage. Case report]. / Postepowanie w przedsiatkówkowym krwotoku w okolicy plamkowej. Opis przypadku.

The report presents a method of management in case of clotted premacular haemorrhage in a 46 year-old woman. The used method of treatment proceeded in 2 stages: 1) pars plana, intravitreal injection of 50 mg tissue plasminogen activator (tPA-Actilise), 2) after 24 hours intravitreal 0.5 cc SF6 with air mixture (1:5). Fibrinolytic tPA action and mechanic action of expanding gas caused after argon laser puncture intravitreal haemorrhage dislocation and following its resorption. The almost full visual acuity persisted for over 2 years.

[Removal of inital cataract in high degenerative myopia--selection of surgical technique and planned refractive effect]. / Usuwanie zacmy poczatkowej w oczach z wysoka krótkowzrocznoscia zwyrodnieniowa--wybór techniki operacyjnej i zamierzonego efektu refrakcyjnego.

Visual function deteriorates additionally in high degenerative myopia in consequence of initial cataract causing increase of refractive index and refractive error. This paper presents indications for removal of initial cataract with posterior chamber lens implantation to improve visual acuity, colour perception, contrast sensitivity and to broaden visual field. Particular conditions of cataract surgery in myopic eye, selection criteria of operative technique and anaesthesia, power and diameter of implant and possible postoperative complications are discussed.

[Use of YAG-Selecta laser and argon laser in the treatment of open angle glaucoma]. / Zastosowanie lasera YAG-Selecta i lasera argonowego w leczeniu jaskry otwartego kata.

INTRODUCTION: The falling success rate of ALT (Argon Laser Trabeculoplasty) has raised the interest in some new laser techniques, such as q-switched Nd:YAG laser trabeculoplasty (Coherent Selecta 7000). The "selective" laser trabeculoplasty destroys melanosomes of pigmented trabecular meshwork cells, sparing adjacent non-pigmented cells and tissues. AIM: Our goal was to establish the IOP lowering effect of selective laser trabeculoplasty (SLT--Selecta Laser Trabeculoplasty) in comparison with ALT. MATERIAL AND METHODS: We have examined 27 patients (10 men, 17 women) aged 35-82, with open angle glaucoma and visual field deterioration despite maximal tolerated topical therapy (21 patients--POAG, 3--NPG, 1--pigmentary glaucoma, 1--pseudoexfoliative glaucoma, 1--juvenile glaucoma). One eye of each patient was randomly chosen for SLT, the other eye underwent ALT. In each method 50 burns were applied in 180 degrees angle with power settings of 600-1000 mW for ALT and energy settings of 0.5-1.4 mJ for SLT. The IOP was measured 1 hour before laser treatment and 1, 2, 24 hours and 3 months after treatment. RESULTS: The mean initial IOP in eyes selected for SLT was significantly higher (21.26 +/- 4.82 mm Hg) than in eyes selected for ALT (20.26 +/- 4.01 mm Hg), t-test: p = 0.037. However, there was no statistically significant difference in the IOP lowering effect between eyes treated with SLT and eyes treated with ALT. The mean IOP drop from the pre-treatment values was -2.85 +/- 4.62 mm Hg after SLT and -2.63 +/- 3.60 mm Hg after ALT (t-test, p = 0.84). All values: 2, 24-hours and 3 months after treatment were significantly lower than pre-treatment values in both groups (t-test, p < 0.03). Only in the 1st hour after SLT the IOP drop was not significant. There was a significant correlation between the amount of pigment on the trabecular meshwork and the IOP fall (U Mann-Whitney test). In SLT group 6 patients (21%) developed mild iritis during 1st day after laser treatment, which disappeared after fluorometholon drop therapy. CONCLUSION: Both methods--SLT and ALT--have equivalent IOP lowering effect in short time observation (3 months). Due to entirely novel mode of Selecta laser action, long term results may show significant differences.

[Pars plana vitrectomy in cases of endophthalmitis non-responding to antibiotic therapy]. / Witrektomia w stanach zapalnych wnetrza galki ocznej opornych na leczenie zachowawcze.

UNLABELLED: The aim of the study is the evaluation of the results of pars plana vitrectomy in the cases of endophthalmitis unresponding to antibiotictherapy. MATERIAL AND METHODS: The procedure of pars plana vitrectomy was carried out in 7 patients treated preoperatively by intraocular injections of antibiotics because of endophthalmitis at Ophthalmological Department of Medical University in Wroclaw in the years 1996-1998. The age of patients was 33-88 years (mean 67). The postoperative follow up was 6 to 28 months. RESULTS: Endophthalmitis resulted in all cases from cataract surgery. The positive microbiological traces were in 4 cases. In 3 cases pathogenic microbes were Staphylococcus epidermidis, in 1 Staphylococcus aureus and Micrococcus. In all patients the symptoms of inflammatory process disappeared after vitrectomy. In 5 patients we achieved the full visual acuity (0.8-1.0), in 1 patient bullous kerathopathy developed and in 1 phthisis bulbi. CONCLUSIONS: Vitrectomy may lead to good functional outcome in 70% of postoperative endophthalmitis.

[Cataract surgery in adults and children with chronic uveitis]. / Chirurgia zacmy u doroslych i dzieci z przewleklym zapaleniem blony naczyniowej.

PURPOSE: To present preoperative strategies and results of cataract surgery in patients with different types of uveitis. PATIENTS AND METHODS: The results of 18 cases of extracapsular cataract extraction with or without intraocular lens implantation were retrospectively analysed. Age of patients ranged from 10 to 71 years (mean age: 35 years). Etiology of uveitis was determined in 10 cases (63%). Preoperative management was determined by the diagnosis of uveitis. The postoperative observation time ranged from 3 years to 6 months (mean: 25 months). RESULTS: Visual acuity improved postoperatively in 17 eyes (96%), and was better than 0.5 in 10 eyes (63%). The reasons for lower visual acuity were: cystoid macular edema in 6 cases (33%), band keratopathy, amblyopia and floaters in the vitreous. CONCLUSIONS: Establishing the diagnosis and controlling the inflammation pre- and postoperatively are the basic conditions for the surgical outcomes in cataract surgery in patients with history of uveitis.

[Limbal stem cell autograft transplantation for persistent epithelial corneal defect after chemical burn of the eye]. / Autogeniczny przeszczep rabkowych komórek pnia w niegojacym sie ubytku nablonka rogówki po oparzeniu chemicznym oka.

The aim of this paper is to describe the possibility of surgical treatment of persistent corneal epithelial defect caused by limbal stem cell deficiency after chemical burn of the eye. Limbal stem cells serve as a proliferative reserve and are responsible for a proper corneal re-epithelialization. Destruction of these cells leads to chronic irritation, epithelial erosions, corneal conjunctivalisation, vascularisation and stromal scarring. Conventional treatment in such cases is ineffective and prognosis for penetrating keratoplasty is very poor. We present a case of persistent epithelial defect after chemical burn that was successfully treated 4 weeks after the injury with limbal stem cell autograft transplantation. The operative technique involved transfer of two free grafts of limbal tissue from the healthy donor eye to the severely burned eye, prepared by superficial dissection of fibrovascular pannus. Three weeks after operation the cornea was completely covered by proper epithelium, stromal vascularisation and opacification was regressed and visual acuity was improved.

[Primary open angle glaucoma,age and age-related cardiovascular disease risk factors]. / Jaskra pierwotna otwartego kata a wiek i zwiazane z nim czynniki ryzyka krazeniowego.

The authors present current opinions about influence of age and different cardiovascular and rheological risk factors on POAG and normal tension glaucoma (NTG), especially in age-related diseases: systemic hypertension and hypotension, nocturnal systemic hypotension, diabetes, obesity and high blood viscosity. The work points out the importance of cooperation between ophthalmologist and specialist of internal medicine in treating patients with POAG and NTG.

[Flash electroretinography and pattern-type visual evoked potentials in early glaucoma]. / Elektroretinogram blyskowy i wzrokowe potencjaly wywolane typu pattern we wczesnej neuropatii jaskrowej.

PURPOSE: The aim of this prospective study was to evaluate diagnostic sensitivity of flash-erg, oscillatory potentials (OPs), and pattern-visual evoked potentials (pVEP) in early glaucoma. MATERIAL AND METHODS: Erg, OPs and pVEP were registered in 416 eyes primary open angle glaucoma (120 eyes), normal tension glaucoma (137), ocular hypertension (74), glaucoma-like discs (86) in age-matched groups, by Tomey 400. RESULTS: There were no statistically significant differences between parameters of flash-erg and pVEP of examined population and control group. Significant reduction in OPs amplitude in NTG patients were found. CONCLUSIONS: Flash erg and pVEP have low diagnostic value in early glaucoma. OPs could be useful in scientific research on pathogenesis of glaucomatous neuropathy.

[Occurrence of nocturnal arterial hypotension in patients with primary open-angle glaucoma and normal tension glaucoma]. / Wystepowanie nocnej hipotonii tetniczej u chorych na jaskre pierwotna otwartego kata i jaskre z normalnym cisnieniem.

PURPOSE: To investigate the nocturnal blood pressure "dip" in patients with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). MATERIAL AND METHODS: 46 patients (36 women and 10 men), including 15 patients with POAG (mean age 49.6 +/- 6.8), 20 patients with NTG (mean age 54.5 +/- 14.1) and 11 control subjects (mean age 43.4 +/- 16.3), were studied. Arterial systolic and diastolic blood pressure and heart rate were measured with automated blood pressure monitor MEDILOG DX in 15 minutes intervals during the day and 30 minutes intervals at night. RESULTS: 30.4% of all examined patients showed the nocturnal "dip" of less than 10% (non-dippers). In 41.4% of patients the blood pressure fell at night by 10-20% (dippers) and in 28.2% of patients by more than 20% (big dippers). The percentage distribution of patients with POAG, NTG and control subjects in non-dippers group was 35%, 36% and 29%; in dippers group: 21%, 53% and 26%; in big dippers group: 46%, 46% and 8% respectively. The nocturnal "dip" was significantly larger in NTG group (max. systolic dip 28% +/- 2.9%, mean systolic dip 17% +/- 4.3%, alpha = 0.05) in comparison with POAG and control group. CONCLUSIONS: Large blood pressure "dips" are observed more frequently in patients with glaucoma than in healthy control subjects. The degree of reduction in blood pressure is significantly larger in NTG patients in comparison with POAG patients and control group.

[Correlations between morphologic measurements of the optic disc using planimetric tests and changes in the visual field in patients with glaucoma]. / Wspólzaleznosc pomiedzy cechami morfologicznymi tarczy nerwu wzrokowego badanymi planimetrycznie a zmianami w polu widzenia u chorych na jaskre.

PURPOSE: To evaluate the relationships between planimetrical measurements of the optic disc and visual field indices in primary open-angle glaucoma patients and glaucoma suspects. MATERIALS AND METHODS: Materials consisted of 64 patients (128 eyes) divided into two groups: glaucoma suspects without any treatment (30 patients, 60 eyes) and early open-angle glaucoma patients already medically treated (34 patients, 68 eyes). All the patients underwent the full, computerized, planimetrical analysis of the optic disc. A special attention was paid to the neuroretinal rim measurements. Visual field examination was performed with automated perimeter Octopus 101 using test dG2. Results were analysed with the use of "Interzeag Peridata" software. RESULTS: We found the statistically significant correlations between neuroretinal rim area and visual field parameters in the glaucoma group. The highest relationship concerned mean defect and compound index of the field. There were no such correlations in glaucoma suspects. Cup/disc ratio correlated more weakly with visual field than neuroretinal rim area. We also analysed mean and extreme values of the neuroretinal rim area in groups of different depth and configuration of visual field defects. CONCLUSIONS: Neuroretinal rim area is a more valuable planimetrical parameter in optic disc analysis than cup/disc ratio. It is also an important factor affecting the visual field, but probably not the only one. There is a significant correlation between visual field quantitative parameters and neuroretinal rim area in primary open-angle glaucoma patients, but in glaucoma suspects that is not true. Digital planimetry proved to be a valuable tool for optic disc biomorphometry and it seems to be an objective method for detecting development of structural changes in glaucoma.

[Coexistence of migraine and glaucoma-like visual field defects]. / Wspólistnienie migreny i jaskropodobnych zmian w polu widzenia.

PURPOSE: Functional and morphological evaluation of the optic nerve heads in patients suffering from migraine. MATERIAL AND METHODS: 21 patients--13 women and 8 men (mean age 40 +/- 10) with neurologically confirmed diagnosis of common and classic migraine were examined. The headache history was obtained by standard questions. The patients suffered from migraine from 2 to 30 years and the frequency of attacks was from < 10 to > 100/year. Ophthalmologic examination involved evaluation of visual acuity, anterior segment, irido-corneal angle, retina and optic disc. In all cases optic disc photography, diurnal tension curve and two central visual field examinations with Octopus 101 programm G2 were performed. RESULTS: In all cases IOP was normal (< 21 mm Hg). In 4 eyes (2 patients) there was early glaucomatous-like damage of the optic disc, without visual field defect. In most of these patients the optic nerve head looked normal, in part of them slightly pale. In 28% patients glaucomatous-like visual field defects were found (MD-3.9 dB to 6.6 dB). There was statistically significant relationship between increase of MD and frequency of migraine attacks (Mann-Withney U test, a = 0.05). CONCLUSIONS: Static perimetry of the central visual field has high diagnostic value in ocular vasospastic syndrome. Functional dysregulation of the optic nerve head circulation in patients with migraine might be involved in the pathogenesis of normal-tension glaucoma.

[Bilateral isolated posterior scleritis]. / Obustronne, izolowane zapalenie tylnej czesci twardówki.

A case of 44-year-old man is presented with no simultaneous bilateral posterior scleritis with amelanotic chorioidal mass initially diagnosed as intraocular tumor. The patient showed the features of nodular posterior scleritis without associated systemic disease. The case presented symptoms of severe eye pain, unilateral proptosis, hyperemia and dilatation of scleral, episcleral and conjunctival vessels. Diagnosis was made on the basis of B-scan ultrasonography. Differential diagnosis excluded melanoma malignum chorioideae, orbital cellulitis, Graves ophthalmopathy, orbital cellulitis, cavernous sinus thrombosis and carotid-cavernous fistula. The patient did not respond well to systemic steroids given in high doses and during slow tapering at the dosage of 30 mg prednisone once per day the symptom of uveal effusion syndrome occurred. After 10 months of steroid therapy the signs of disease like mild hyperemia and tenderness were still present. The adjunction of cyclosporin improved the disease and caused the remission.

[Results of screening for primary glaucoma from data in materials from the Medical Diagnostic Center DOLMED in Wroclaw]. / Wyniki badan przesiewowych w kierunku jaskry pierwotnej w materiale Dolnoslaskiego Centrum Diagnostyki Medycznej DOLMED we Wroclawiu.

PURPOSE: The aim of this study was to estimate the prevalence of morphological signs of glaucomatous optic neuropathy (GON) and IOP > 21 mm Hg in adult population. MATERIAL AND METHODS: The retrospective epidemiologic study of 11,989 persons (mean age 37.7 years +/- 11.6) was based on data of Medical Diagnostic Center DOLMED in Wroclaw. IOP was measured by air-push tonometer and optic disc was estimated in direct ophthalmoscopy. RESULTS: GON was found in 0.92% and IOP > 21 mm Hg in 30.81% of the examined population. About 50% of GON was found in the group with normal IOP. The positive correlation was proved between GON and age. Mean IOP and prevalence of GON was not significantly different between the sexes and between right and left eyes. CONCLUSION: Screening of primary glaucoma should be based on stereoscopic examination of optic disc. High values of IOP should be verified. Raised IOP should be estimated as a risk factor of POAG.

[Investigations correlating age and selected vascular risk factors in primary glaucoma based on screening data the Medical Diagnostics Center DOLMED in Wroclaw]. / Badania korelacji wieku i wybranych krazeniowych czynników ryzyka z cechami jaskry pierwotnej na podstawie wyników badan przesiewowych przeprowadzonych w Dolnoslaskim Centrum Diagnostyki Medycznej DOLMED we Wroclawiu.

AIM: The purpose of the study was to investigate the associations of glaucomatous optic neuropathy (GON) features and level of IOP with age and selected cardiovascular risk factors: systolic and diastolic blood pressure (BPs and BPd), heart rate, hematocrit and cholesterol level, diabetes, body mass index. MATERIAL AND METHODS: The retrospective study of 11,989 persons (mean age 37.7 years +/- 11.6) was based on data of Medical Diagnostic Center DOLMED in Wroclaw. All data were analysed statistically. RESULTS: Positive statistically significant correlation was found between BPs, BPd, cholesterol level and GON. Significant differences were proved in the BPs/IOP and BPd/IOP rations and the groups with and without GON. Mean IOP was higher in the group with GON. Positive relationship was found between cardiovascular risk factors and IOP level. There was no positive correlation between level of IOP and age of the analysed group.

[Current theory on mechanical damage in glaucomatous optic neuropathy]. / Wspólczesne rozumienie teorii mechanicznego uszkodzenia nerwu wzrokowego w jaskrze.

The paper presents the contemporary interpretation of mechanically theory of glaucomatous optic neuropathy (GON). The authors explained influence of high intraocular pressure on morphology of lamina cribrosa in vivo and in vitro experiments, extracellular matrix of the optic nerve, retinal ganglion cells and nerve fibers within the optic nerve head.

[Comparative analysis of changes in the visual field in primary open-angle glaucoma and glaucoma with normal tension]. / Porównawcza analiza zmian w polu widzenia w jaskrze pierwotnej otwartego kata oraz w jaskrze z normalnym cisnieniem.

PURPOSE: To compare the pattern and the depth of visual field defects of POAG and NTG patients. MATERIALS AND METHODS: The visual fields in two groups of POAG and NTG patients, each counting 25 eyes, were analysed statistically. All eyes were tested at least twice, employing full threshold G2 test of Octopus 101 (Interzeag) automatic perimeter. The tests with the highest reliability level were included. The analysis was performed using Peridata (Interzeag) statistical package. Mean values of mean defect (MD), corrected loss variance (CLV) and compound index (CI) for each group were acquired. Furthermore, main values of MD for upper and lower hemifield, quadrants and 10 degrees concentric rings, were obtained. The differences between the two groups were tested for the statistical significance. RESULTS: Values of all three above parameters (MD, CLV i CI) were significantly lower in the group of eyes with POAG as compared with those with NTG. In both groups mean MD was higher in the upper hemifield, but the upper/lower hemifield ratio was significantly higher in the POAG group (1.50) as compared with NTG group (1.05). In POAG group the highest mean MD was found in the upper-temporal quadrant whereas in NTG group the lower-nasal quadrant was the most affected. In both groups the highest values of mean MD were found in the outer ring between 20 degrees and 30 degrees of visual field but the difference between the centre and periphery was considerably lower in NTG group. CONCLUSIONS: The results support the opinion that there exist differences between the patterns of visual field changes in POAG and NTG. The loss tends to be more diffuse in POAG, showing deeper defects in the periphery and stronger tendency to affect the upper hemifield.

[Evaluation of acquired color vision defects by means of the two equation method in primary open-angle glaucoma with normal pressure and in patients from the risk group]. / Ocena nabytych zaburzen widzenia barw metoda dwóch równan metamerycznych w jaskrze pierwotnej otwartego kata, jaskrze z normalnym cisnieniem oraz u osób z grupy ryzyka.

PURPOSE: To evaluate acquired color vision defects in glaucoma patients and glaucoma suspects. MATERIAL AND METHODS: 52 subjects (102 eyes) divided into four groups (with primary open angle glaucoma, normal tension glaucoma, ocular hypertension and with glaucoma-like optic disc) were examined with the IF-2 All-Color Anomaloscope. In all cases both the red-green equation of Rayleigh and the blue-green equation of Moreland were tested and three variables were determined: setting (matching) range (SR), calculated mid point (matching mid point) (CMP) and anomalous quotient (AQ) as compared to control group. RESULTS: No significant changes were found in the variables of the Rayleigh equation. However, in the blue-green equation SR was significantly enlarged in all tested groups and CMP was significantly shifted towards the short wavelength end of the match in first three groups. These results indicate a diminution of the color discriminating sensitivity in the short wavelength half of the visible spectrum and diminution of the blue cone sensitivity in glaucoma patients as well as in ocular hypertension (p < 0.001). In patients with glaucoma-like optic disc the setting range was enlarged in less degree (p < 0.01) without changes in the remaining variables (p > 0.05) what may be indicative of early stage of disease before the perimetric changes. CONCLUSION: Blue-green colour vision testing with the anomaloscope may serve as an additional test in the diagnostics of glaucoma. Glaucoma suspects with blue colour vision disturbances require the most careful investigation and if need be the recommendation of early treatment.

[The role of hemodynamic conditions in the posterior eye segment on genesis and development of glaucomatous neuropathy]. / Rola warunków hemodynamicznych w obrebie tylnego odcinka oka w powstawaniu i rozwoju neuropatii jaskrowej.

The contemporary literature has widely described the role of insufficiency of blood flow in glaucomatous damage. The paper presents the blood supply of the optic nerve head and the role of systemic and nocturnal hypotension, vasospasmus syndrome, carotide artery disease, location of the wathershed zone in relation to the optic disc and the effects of defective autoregulation of blood flow in glaucoma. The implications of vascular risk factors in glaucoma for its prognostics and management are discussed.