The role of inflammation in the progression of ocular surface damage in children following allogeneic haematopoietic cell transplantation.

The aim of the study was to evaluate HLA-DR expression and cellular morphology of the conjunctival epithelium cells in children who underwent haematopoietic cell transplantation, and to assess the relation between HLA-DR expression and cellular morphology. Impression cytology with staining was used to visualize epithelium cells, whereas immunohistochemistry was applied to assess HLA-DR expression. Elevated HLA-DR expression and increased cytological abnormalities were observed in the study group when compared to the controls. An increase in HLA-DR expression was accompanied by a decrease in the number of eyes with normal epithelium morphology together with the increase in squamous metaplasia features. We can conclude that inflammation of conjunctiva can follow stem cell allotransplantation. Ocular surface inflammation may lead to squamous metaplasia of the conjunctiva.

[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.

[Pars plana vitrectomy in treatment of ocular toxocariasis complications--case report]. / Pars plana witrektomia w leczeniu powiklan ocznej postaci toksokarozy--opis przypadku.

Ocular toxocariasis in adults may cause serious diagnostic and therapeutic problems. We describe a case of a 54-year-old farmer who developed peripheral granuloma with dense connective tissue strands joined to the disc. The diagnosis was confirmed by high ELISA titers in the serum and vitreous body. We performed pars plana vitrectomy with epiretinal membrane removal and laser photocoagulation of the inferior retina, obtaining improvement of visual acuity. After a few weeks the patient returned with central retinal detachment and macular hole. After the second vitrectomy with use of silicon oil we obtained reattachment of the retina but without functional improvement.

[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.

[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.

[Tissue plasminogen activator in treatment of fibrinous membranes after cataract surgery]. / Tkankowy aktywator plazminogenu w leczeniu blon wlóknikowych po operacji zacmy.

UNLABELLED: The aim of our study is estimation of the efficacy of recombinant tissue plasminogen activator for the treatment of fibrinous membranes following cataract extraction. PATIENTS AND METHODS: The fibrinous membranes were formed, despite conventional antiinflammatory therapy, in 17 eyes after ECCE with IOL and in 3 eyes after ECCE without IOL. We injected the solution of recombinant tissue plasminogen activator-Actilyse (Boehringer Ingelheim) into the anterior chamber of 20 eyes after cataract surgery. Simultaneously, topical corticosteroid and cycloplegic therapy was continued. Routine follow-up included slit lamp examination, ophthalmoscopy and intraocular pressure measurement. RESULTS: Injection of the solution of tissue plasminogen activator into anterior chamber of 20 eyes resulted in complete dissolution of the fibrinous membranes in 18 eyes within 1 day. In 7 eyes, within a few days after injection, fibrinous membrane recurred. In four of this cases durable effect of fibrin dissolution was obtained after multiple tPA injections. Finally, expectable stable result was obtained in 15 of 20 eyes. CONCLUSIONS: Results of our study confirm high efficacy of recombinant tissue plasminogen activator in the treatment of fibrinous membranes after cataract surgery. Short term follow-up and small number of cases motivates further continuation of observation.

[Incidence of and treatment outcome for diabetic maculopathy--material from the Eye Clinic in Wrocçaw in 1991-1994]. / Czestosc wystepowania i wyniki leczenia makulopatii cukrzycowej--material Kliniki Okulistyki we Wroclawiu w latach 1991-1994.

PURPOSE: To evaluate the incidence of ME, its characteristics, and results of its treatment with laser coagulation. MATERIAL AND METHODS: In the analysed group there were 478 subjects with diabetes mellitus--84 with a diagnosis before 30 years of age and 394 with a diagnosis at 30 years of age or older. In the older-onset group there were 64% taking insulin. Mean age of the group was 61 years and mean period of duration of diabetes was 16 years. The methods of ophthalmological examination included stereoophthalmoscopy and fluorescein angiography. In 845 examined eyes there were 832 eyes with mild-to-severe nonproliferative and moderate-to-high risk proliferative diabetic retinopathy. RESULTS: The incidence of macular edema was 81.6%. These data suggest high incidence of macular edema and its high severity (V < 0.2 = 47%) over the 15-years period of duration of diabetes. Treatment included focal coagulation, macular grid and PRK performed with argon laser. CONCLUSION: The results of laser coagulation demonstrated that focal photocoagulation was effective in reducing the risk of moderate visual loss. When macular edema was more severe, macular grid before scatter (panretinal) photocoagulation for proliferative retinopathy decreased the frequency of persistent ME.

[Panretinal photocoagulation with argon laser--material from the Eye Clinic in Wroclaw in 1991-1994]. / Fotokoagulacja obwodu siatkówki laserem argonowym w retinopatii cukrzycowej--material Kliniki Okulistyki we Wroclawiu w latach 1991-1994.

PURPOSE: To evaluate the results of PRK performed between 1990 and 1994 in Wroclaw University Eye Clinic. MATERIALS AND METHODS: PRK was performed in 630 eyes with: (1) PDR--451 immediately treated eyes (moderate PDR--184 eyes, with "high-risk" characteristics--227 eyes, PDR advanced--after cryopexion--40 eyes); (2) severe NPDR--119 eyes (with PDR in fellow eye or with ME) and (3) less severe DR--60 eyes treated with immediate or delayed, full or mild scatter coagulation (with macular edema, both eye moderate NPDR, other systemic risk factors). Follow-up treatment: Additional scatter or local photocoagulation was performed in 34 cases increasing activity of neovascularisation or increase in frequency/extend of vitreous hemorrhage. RESULTS: In a period 3 to 36 months of follow-up (mean period = 25 months) in the group of 451 eyes with PDR 28.2% of eyes showed visual improvement, 48.3% of eyes showed no change and 23.5% of eyes worsened. In the group of 119 eyes with severe NPRD 75.6% showed visual improvement and 24.4% showed no change. In the group of 60 eyes with less severe DR 27.8% showed improvement, 36.7% showed no change and 35.5% worsened. CONCLUSION: Our results are relatively good and in agreement with other studies.

[Use of soft contact lenses in the Riley-Day syndrome in a small child]. / Zastosowanie miekkich soczewek kontaktowych w zespole Riley-Day u malego dziecka.

We present the observation of a boy treated in our Ophthalmological Department in Wroclaw from the age of 6 months up to 6 years for the serious keratitis with ulceration. We diagnosed Riley-Day syndrome with regard to many associated pathological features. The efficacy of the local treatment improved after application of soft contact lenses.