Late ophthalmological assessment of patients with subarachnoid hemorrhage and clipping of cerebral aneurysm

PURPOSE

To estimate prospectively late ocular manifestations in patients after aneurysmal subarachnoid hemorrhage (SAH) treated with aneurysm clipping.

METHODS

Forty-six patients (12 men and 34 women), 23-69 years of age, were included in this study. A conventional ophthalmological examination, visual evoked potentials (VEPs), and static perimetry were performed on all patients. The mean interval between the onset of SAH and the aforementioned examination was 1.9 ± 1.3 years (range 0.5-5 years). The following were compared between patients with affected and non-affected visual fields as well as between those with normal and abnormal VEPs: sex, age, time from SAH to surgery, Hunt and Hess scale, Glasgow Coma Scale, Glasgow Outcome Scale, grading of SAH according to the Fisher scale, and the size and site of aneurysm.

RESULTS

Visual field defects were found in 23 patients (50%). In all of these patients, both eyes were affected. The most frequent type of visual field defects were: constricted field (47.8%), multiple peripheral foci (26.1%), and superior field defect (17.4%). There was no significant relationship between the analyzed factors and the occurrence of visual field defects, although statistical significance was almost observed in respect to the Fisher scale (p = 0.055). Deterioration in VEPs was observed in nine patients (19.6%). In the group of patients with abnormal VEPs, the time from onset of SAH to surgery was 2.6 ± 1.8 days, whereas in the group of patients with normal VEPs this time amounted to 6.4 ± 2.4 days (p = 0.02). In patients with no changes in VEPs, the mean Fisher score was significantly higher than in the group with abnormal VEPs (2.8 ± 0.6 vs 2.0 ± 0.4 respectively, p = 0.04).

CONCLUSION

Visual field defects and VEP deterioration are frequent late ocular manifestations of SAH treated with aneurysm clipping. Damage to the visual pathway correlates with the severity of SAH and timing of aneurysmal surgery.

[Clinical characteristics of penetrating ocular injuries with intraocular foreign body. Part I. Pathogenesis and clinical features]

Intraocular foreign bodies (IOFBs), are the major cause of penetrating ocular trauma and the most serious problem is the resulting impairment of visual function. In this paper, based on published reports and their clinical experience, authors discuss questions of pathogenesis, epidemiology and clinical features of IOFB injuries. Special attention was paid on primary and secondary complications, which include mechanical lesions of the ocular tissues, metallosis and endophthalmitis.

[Clinical characteristics of penetrating ocular injuries with intraocular foreign body. Part II. Diagnostics and treatment]

Ocular trauma remains a major cause of blindness, particularly in the working-age population. Intraocular foreign bodies (IOFBs ), frequently accompany penetrating ocular injuries and can lead to increased ocular morbidity. In this paper, based on published reports and their authors clinical experience, we discuss questions of advantages and disadvantages of three imaging methods (radiology, ultrasound and tomography), and evaluate the value of these methods in the diagnosis of IOFBs. Authors discuss also management options in patients with IOFB injuries and describe techniques of primary surgical repair and foreign body removal, especially pars plana vitrectomy.

[Early changes in the visual system connected with brain's aneurysm rupture]

PURPOSE

To evaluate frequency and type of early changes in the visual system connected with brain's aneurysm rupture.

MATERIAL AND METHODS

45 patient, 34 women and 11 men, with subarachnoid hemorrhage (SAH) after brain's aneurysm rupture were enclosed in this study. To identify aneurysm, cerebral angiography as well as CT or MR angiography were applied. Conventional ophthalmologic examination and Doppler sonography of the retrobulbar vessels were performed in all patients before and two or three days after neurosurgical procedure.

RESULTS

The mean age of patients with SAH was 47.6 years. Female/male ratio was 3:1. The most common site of aneurysm was at the origin of the middle cerebral artery (37.8%), or anterior communicating artery (28.9%). In 73.3% of patients aneurysm were asymptomatic at diagnosis. The rest patients had some prodromal symptoms, including ocular signs (wide pupil, opressive feeling on the globe, diplopia or visual disturbances), in 15% of one's. Sudden headache (80%), was the most characteristic symptom of brain aneurysm rupture. In 20% the first sign of SAH was loss of consciousness. Papilledema and intraocular hemorrhages occurred in 25 patients (55.6%), and wide pupil in 4 person (8.9%). Among patients with hemorrhagic changes 3 person (6.7%), had Terson syndrome.

CONCLUSIONS

Female gender seem to increase the risk for intracranial aneurysm formation. Among symptoms, which are presenting manifestations of brain's aneurysm, ocular signs play the important role. Brain's aneurysm rupture is always connected with severe neurological symptoms. More than half of patients with SAH after intracranial aneurysm rupture have fundal hemorrhagic changes in fundus.

[Posterior ischemic optic neuropathy following bilateral radical dissection of cervical lymph nodes]

Visual loss is a rare and potentially devastating complication of surgery under general anesthesia. We present a case of blindness after simultaneous bilateral neck dissection and discuss the perioperative circumstances and the possible causes. We also compare and contrast other such cases described in the literature and remind the clinical criteria for the diagnosis of perioperative type of posterior ischemic optic neuropathy.

[Endoscopic surgery of the orbit]

Thanks to continuous improvement of instrumentarium, methods of imaging and intraoperative neuronavigation, endoscopic techniques are increasingly used for management of intraorbital pathologies. The aim of the study was to present, basing on own experience, the virtues and limitations of endoscopic transnasal surgery in the diagnosis and treatment of orbital pathologies. This article contains a review of endoscopic treatment of lacrimal duct stenosis, evacuation of inflammatory lesions and benign tumors penetrating the orbit from the adjacent sinuses, management of primary intraorbital tumors, Graves-Basedov orbitopathy and posttraumatic lesions of the optic nerves. Both own experience and data from the relevant literature indicate that intraorbital inflammatory lesions can nowadays be effectively treated by means of endoscopy whereas purely endoscopic removal of intraorbital tumor still remains rare because is technically demanding and requires high experience in this type of surgery. In case of malignancies endoscopy may be used for diagnostic purposes and/or as a method supporting conventional external surgical approaches.

Blood flow disturbances in the central retinal artery in patients with traumatic optic neuropathy

BACKGROUND

Traumatic optic neuropathy (TON) is a serious sequel of head trauma, leading even to loss of vision. Experimental studies suggest that vascular factors contribute to the pathogenesis of TON. Thus the purpose of this study was to explore associations between blood flow Doppler parameters in the central retinal artery (CRA) and optic nerve function in patients after closed head trauma.

MATERIAL/METHODS

Blood flow was evaluated by color-coded duplex sonography (CCDS) in the CRA of 72 consecutive patients (57 males and 15 females, mean age: 40+/-14.5, range: 15-77 years) with a diagnosis of traumatic optic neuropathy. Of the 101 affected eyes, optic nerve atrophy was found in 87 whereas the optic disc had normal appearance in the remaining 14 eyes.

RESULTS

Both peak-systolic velocity (PSV) and end-diastolic velocity (EDV) in the eyes with TON were significantly lower (26% and 20%, respectively, p<0.01) than those in age- and gender-matched healthy subjects. A statistically significant decrease in PSV was also noted in the CRA of the contralateral unaffected eye (9%, p<0.05). A statistically significant positive association was found between blood flow velocities in the CRA and visual acuity (p<0.01) after controlling for sex, side of symptoms, and blood pressure.

CONCLUSIONS

Blood flow is significantly decreased in the central retinal artery of the affected eye and slightly in the unaffected eye in patients with traumatic optic neuropathy. Hemodynamic disturbances within the central retinal artery concur with functional nerve impairment.

[Late complications after penetrating ocular injuries caused by intraocular and intraorbital foreign bodies]

PURPOSE

To evaluate late complications in patients with penetrating ocular injuries caused by intraocular or intraorbital foreign bodies (IOFBs).

MATERIAL AND METHODS

We reviewed 58 posttraumatic patients with IOFBs removed by external electromagnet or intraocular forceps. The patients underwent a follow-up examinations at 1 to 7 years after trauma. We noted final visual acuity, frequency and type of complications and following surgical treatment.

RESULTS

Final visual acuity of 5/50 or more was obtained in 65.5% of patients. Ocular complications were found in 50 patients (86.2%). The most frequent consequence of past trauma was corneal scar (58.6%), cataract (44.8%), and retinal detachment (20.7%). 37 patients (63.7%), required the next surgical interventions. 23 patients 139.6%), underwent posttraumatic cataract extraction, 9 (15.5%)--pars plana vitrectomy for retinal detachment or vitreoretinal proliferations, 5 (8.6%)--scleral buckling procedure, 3 (5.2%)--antiglaucoma surgery, and 2 (3.4%)--enucleation.

CONCLUSIONS

Penetrating ocular injuries caused by IOFBs were often complicated with corneal scar, cataract and retinal detachment. More than 2/3rd of patients required subsequent surgical interventions.

[The latest world standards in the diagnosis of multiple sclerosis]

The diagnosis of multiple sclerosis (MS) one of the major causes of neurologic-based disability in young adults, is challenging because of the heterogeneity of signs and symptoms, many of which are not specific to MS, and because there is no single test to verify MS. During the last 40 years, the diagnosis of multiple sclerosis has been aided by increasing knowledge of the natural history and pathophysiology of the disease and by technologic advances in clinical, laboratory and radiologic testing. This report describes the evolution of MS diagnostic guidelines for physician in clinical practice with a focus on recent recommended criteria from the year 2005, called "Revised McDonald Criteria".

[Internuclear ophthalmoplegia--causes, symptoms and management]

Internuclear ophthalmoplegia (INO) is a disorder of eye movements caused by a lesion in an area of the brain called the medial longitudinal fasciculus (MLF). The most common causes of INO are multiple sclerosis and brainstem infarction. Other causes include head trauma, brainstem and fourth ventricular tumors, Arnold-Chiari malformation, infection, hydrocephalus, and lupus erythematosus. Internuclear ophthalmoplegia is clinically characterized by total or partial failure to adduct one eye in lateral gaze and a monocular nystagmus of the abducting eye. It may be unilateral and bilateral. The method of choice for diagnostic imaging of MLF lesion in patients with INO is magnetic resonance. In this article authors present current opinion about pathogenesis, clinical symptoms, and management in patients with inter nuclear ophthalmoplegia.

[Perioperative posterior ischemic optic neuropathy--pathogenesis and clinical characteristics]

Posterior ischemic optic neuropathy (PION) is an uncommon cause of perioperative visual loss. It has been most frequently reported after spinal surgery and radical neck dissection. This type of PION occurs in the setting of profound hypotension and severe anemia during the perioperative period. The visual loss, which typically presents immediately after surgery, is often bilateral and profound with count fingers vision or worse. The examination findings are consistent with an optic neuropathy, however the optic disc is normal. Diagnosis of PION can be made only after other causes of the optic neuropathy have been excluded. The prognosis for visual recovery is generally poor. Although correction of hemodynamic derangements may be beneficial, no treatment has proven to be effective.

[Intraocular and intraorbital foreign bodies characteristics in patients with penetrating ocular injury]

PURPOSE

To determine clinical features of intraocular and intraorbital foreign body (IOFB) injuries.

MATERIAL AND METHODS

62 patients with IOFB injury were retrospectively reviewed. Data on age, sex, activity at the time of injury, initial visual acuity and presenting clinical features were recorded. Special attention was paid on foreign bodies characteristics. Factors analyzed included: material, quantity and size of IOFB, site of entrance wound and final IOFB location.

RESULTS

The mean patient age was 38.1 years. All but one patient were male. Hammering and chiselling were the most common activities at the time of injury. 93.5% of patients had single IOFB. Metallic foreign body comprised 85.5% of all cases. The average IOFB size was 3.9 x 15.1 mm. 83.9% of IOFBs were located inside the globe, among them: 46.1% in the anterior segment; 44.2% in the vitreous and the rest in the posterior part of globe. The most frequent entrance wound site was cornea (59.7%). Initial visual acuity was worse or equal 5/50 in 50% of the cases. Patients with greater size of IOFB had worse initial visual acuity. The most common clinical features, presenting at the time of injury, were corneal wound (64.5%), lens lesion (33.9%), endophthalmitis (29%) and vitreous hemorrhage (25.8%).

CONCLUSIONS

The majority of patients with IOFB injury were young male. Tool-related activities, particularly hammering, were more likely to cause of IOFB injuries. Single metallic foreign body occurred much more frequently. Cornea was the most frequent site of entrance wound. The vitreous and the anterior segment were the most common final location of IOFB. Increasing IOFB size was associated with worse initial visual acuity. IOFB injury has been found to be associated with a lot number of the ocular tissues lesions.

[Internuclear ophthalmoplegia in course of multiple sclerosis and head trauma. Presentation of 2 cases]

Internuclear ophthalmoplegia (INO) is produced by a lesion in the brainstem involving the medial longitudinal fasciculus (MLF), between the oculomotor and abducens nuclei. This lesion is mostly causes by multiple sclerosis, and only rarely by head injury. INO is a common cause for diplopia in clinical practice. Authors present 2 cases of unilateral internuclear ophthalmoplegia as an isolated sequels of multiple sclerosis and head trauma. They discuss patho-mechanism and diagnostic problems, especially magnetic resonance imaging of MLF lesion.

[Modern neurosurgical techniques to remove intraorbital foreign bodies--report of two cases]

To indicate the usefulness of modern neurosurgical techniques to remove intraorbital foreign bodies, not removed during primary ophthalmological surgical intervention. PATIENT 1: A 29-year-old man, struck with a bottle, with a piece of glass located at the top of the right orbit. During the primary ophthalmological intervention--orbitotomy accessed through the conjunctiva of the fornix of the upper eyelid and the second cut through the wound in the eyelid--the foreign body was not removed. The patient was moved to the Department of Neurosurgery, where 3 days after the injury the 30 mm x 7 mm piece of glass was successfully removed with the aid of neuronavigation system. The surgical approach was through a cut in the right eyebrow and the foreign body was found to be located in the back-top part of the orbit. PATIENT 2: A 30-year-old man, hit with a piece of wood, with an organic foreign body (wood), located in the mid-lower and medial part of the right orbit. During the primary ophthalmological operation--orbitotomy accessed through the conjunctiva of the fornix of the lower eyelid--the foreign body was not removed. The patient was moved to the Department of Neurosurgery, where the surgeon unsuccesfuly attempted to remove the foreign body through the wound in the conjunctiva of the fornix of the lower eyelid with the aid of neuronavigation. In this situation the endoscopic technique with access through the nose was used. The mid part of the medial orbit wall was removed and partially fragmented piece of wood was located with the use of the neuronavigation. The foreign body was located in the middle part of the orbit, near the medial wall. It was removed in four pieces measuring: 8 mm x 3 mm, 8 mm x 4 mm, 15 mm x 5 mm, 18 mm x 6 mm.

Refraction and the axial length of the eyeball in patients with the optic disc drusen

PURPOSE

The aim of the study was to demonstrate the relationship between the optic disc drusen (ODD) and the axial length of the eyeball as well as refractive error.

MATERIAL AND METHODS

We examined prospectively 40 patients with ODD, 18 men and 22 women, age range from 34 to 69 years. All subjects underwent full ophthalmic examination, visual field testing and color-coded duplex sonography of the ocular vessels. Refraction was determined with an autorefractometer (Topcon RM-8000B) and further refined subjectively. Spherical equivalent refraction was calculated as the spherical dioptre plus one half of the cylindrical dioptre. Axial lengths were measured with a Sonomed ultrasound scanner model E-Z Scan AB5500.

RESULTS

Clinical signs were observed in 65% of the eyes with drusen, among them, 38% had symptoms of visual acuity loss and all had visual fields defects. There were 21 eyes (18 eyes with and 3 without drusen), with a recorded refractive error. Significant differences in hyperopia were observed between the eyes with and without drusen (p = 0.048). The rate of occurrence of myopia did not differ significantly between affected and unaffected eyes (p = 0.06). The mean spherical equivalent refraction and axial dimensions of the eye differed significantly among the groups of eyes with and without drusen (p < 0.05). Significant differences in mean values of peak-systolic and end-diastolic velocities (p < 0.001) as well as in the resistivity index (p = 0.047) were observed between eyes with and without drusen.

CONCLUSIONS

The optic disc drusen are often associated with shorter and hyperopic eyes. This anatomical conditions and vascular factors may contribute to pathogenesis of drusen.

[Endoscopic dacryocystorhinostomy in patients with postsaccal stenosis of lacrimal duct]

Dynamic development of the endoscopic treatment of the lacrimal duct obstruction has been observed for the last 20 years. Various causes of the tear outflow disorders, different levels of lacrlmal duct blockage may require different surgical approach and sometimes additional modern equipment. THE AIM of the study was to present the results of treatment of possibly uniform group of patients with lacrimal duct obstruction in whom the same method of endoscopic surgery was applied.

MATERIAL AND METHOD

16 patients with postsuccal level of obstruction were qualified for the study. All of them were treated endoscopically with mucosal flap formation. Patients in whom synechiae in the upper part of the sac or at the orifice of common canalicullus were found during the procedure were excluded from the study, as well as the patients with Wagener's granulomatosis and posttraumatic form of lacrimal obstruction.

RESULTS

Release of epiphora and proper patency of lacrimal system corroborated by irrigation test was achieved in 14 (87,5%) patients of the studied group. In 2 (12,5%) patients recurrence of symptoms was observed. In both cases too small osteotomy and lack of surgical technique precision were the cause of failure. No major complications in the studied group were observed.

CONCLUSIONS

Endoscopic dcryocystorhinostomy Is low traumatic and effective procedure of surgical treatment of lacrimal duct obstruction. The success is determined by high precision of surgical technique.

[Visual field defects in the optic disc drusen]

PURPOSE

To evaluate the visual field defects in patients with visible and buried optic disc drusen.

MATERIAL AND METHODS

40 patients (22 women and 18 men, mean age 49.8 years) with optic disc drusen were studied prospectively for clinical and electrophysiological evidence of impaired optic nerve function. Visual acuity, colour perception, presence of an afferent pupillary defect, visual evoked potentials (VEP), and visual field were analyzed. The visual field defects were classified by their predominant pattern. Statistical analysis was performed using a chi-squared test and the Fisher exact test.

RESULTS

The visual field defects were found in 63.2% of eyes with optic disc drusen. The two most common pattern of visual field loss were enlargement of blind spot and nerve fiber bundle defects. 76.3% of eyes with visible optic disc drusen had abnormal visual fields compared with 46.5% of eyes with buried drusen, p = 0.011. Results of electrophysiological studies showed abnormal VEPs in 44.7% of eyes with visible drusen an in 20% of eyes with buried drusen, p = 0.032.

CONCLUSION

Visual field loss are the most common visual symptoms in the optic disc drusen. Visual field defects in eyes with visible drusen are more frequent than in eyes with buried drusen. Changes in perimetry are strongly associated with visual acuity loss and abnormal VEP.

[Giant cell arteritis--case report]

Giant cell arteritis is a systemic disease of unknown origin. Vasculitis involves large and medium-sized vessels. Frequent clinical manifestations include characteristic headache in the temporal area, jaw or tongue claudication, apathy, fatigue, weight loss. The incidence of ocular involvement is reported in up to 70% patients. The most common and serious ophthalmic presentation is arteritic anterior ischemic optic neuropathy, which can lead to irreversible visual loss. Only early and aggressive steroid therapy may prevent this dangerous complication. The authors presented a case of a 68-years-old woman with giant cell arteritis. The main visual manifestation of this disease was anterior ischemic optic neuropathy.

[The influence of the pseudoexfoliation syndrome on cataract development]

Pseudoexfoliation syndrome (PEX) is a chronic, systemic, connective tissue disease. Its hallmark is the accumulation of an abnormal, amyloid-like material in the anterior segment tissues of the eye. PEX is one of the risk factors in the development of lens opacification. The aim of the paper is a presentation of the current knowledge on the relationship between pseudoexfoliation syndrome and cataract. Special attention is paid to pathogenetic and epidemiologic factors.

Risk factors of massive suprachoroidal hemorrhage during extracapsular cataract extraction surgery

PURPOSE

To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery.

METHODS

The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test.

RESULTS

The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction.

CONCLUSIONS

Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.

[Ischemic optic neuropathy. Pathogenesis, clinical features, diagnostics and treatment]

Ischemic optic neuropathy is a common cause of visual loss in the older population. This disease is classified into anterior and posterior type according to the location the lesions. The anterior type is due to transient nonperfusion or hypoperfusion of the ciliary circulation in the optic nerve head. The etiology of this disease is multifactorial. The most important risk factors for developing anterior ischemic optic neuropathy (AION) include hypertension, nocturnal hypotension, diabetes mellitus, atherosclerosis and small cup in the optic disc. AION presents with sudden painless loss of vision, pale edema of the optic disc, afferent papillary defect and visual field defects, typically in lower quadrants. Posterior ischemic optic neuropathy (PION) is a rare condition and diagnosis of it usually is made only after other causes of a retrobulbar optic neuropathy have been excluded. There are three distinct subtype of PION: perioperative, arteritic and nonarteritic. They are characterized by acute visual loss, variable visual field defects, relative afferent pupillary defect and normal optic disc.

[Simultaneous bilateral cataract surgery--advantages and disadvantages]

During the past decade, advances in techniques and technology led to major changes in cataract surgical practice patterns. In this progression towards ever faster eye rehabilitation after surgery, simultaneous bilateral cataract surgery (SBCS) may be the next and ultimate step. It is not routinely performed: however, there are certain situations in which SBCS might be beneficial to the patients. It has been considered a good option in patients who have significant cataract in both eyes and are not good candidates for having anesthesia and surgery twice. The question is, if the benefits by bilateral surgery justify the risk of simultaneous complications, in particular endophthalmitis. In this perspective we present the clinical, social and economic advantages and disadvantages of such surgical procedures.

[Anterior ischemic optic neuropathy associated with giant cell arteritis. Case report]

Giant cell arteritis is a systemic vasculitis that affects large- and medium sized arteries. The most common ophthalmic manifestation of this disease is anterior ischemic optic neuropathy, leading to acute, painless visual loss in one or both eyes. It is caused by ischemia of the optic nerve head, which is mainly supplied by the short posterior ciliary arteries. Early diagnosis is the key to correct management and prevention of visual loss in the second eye. The treatment of choice for arteritic ischemic optic neuropathy is high dose of systemic corticosteroids. Only such treatment may prevent blindness. The authors presented a case of a 62 years man with anterior ischemic neuropathy in one eye, which was diagnosed as arteritic form caused by giant cell arteritis. The correct diagnosis was based on typical clinical signs of ischemic changes in the optic nerve head and diagnostic criteria for giant cell arteritis, advocated by American College of Rheumatologists.

[Pseudoexfoliation syndrome in patients scheduled for cataract surgery]

PURPOSE

We present the results of a prospective investigation into the frequency of pseudoexfoliation syndrome (XFS), age, sex, intraocular pressure (IOP) and the type of lens opacity in patients scheduled for cataract surgery.

MATERIAL AND METHODS

A series of 1000 consecutive patients (604 females and 396 males in the age from 26 to 97 years), who were admitted for cataract surgery to the Department of Ophthalmology of Medical University in Bialystok, were studied. All eyes were examined with a slit-lamp biomicroscope before and after mydriasis with 1% tropicamide and 10% phenylephrine to find out the exfoliation. The type of cataract was classified as mainly nuclear, cortical, posterior subcapsular, mixed, mature or hypermature. Glaucoma was defined as IOP > or =21 mmHg with optic disc and/or visual field changes indicative of glaucoma.

RESULTS

Exfoliation material was detected in 82 patients (8.2%). The mean age of patients with XFS (77.1 +/- 9.3 years) was significantly more than that of those without XFS (65.6 +/- 11.2 years), p < 0.01. The prevalence of XFS significantly increased with advancing age. Mature cataract and nuclear sclerosis predominated in eyes with XFS (32.9% and 24.4%, respectively) compared to those without XFS (24.6% and 14.2%), p < 0.05. Posterior subcapsular cataract was less common in eyes with exfoliation (9.7%) than in eyes without it (39.1%), p < 0.001. The mean preoperative intraocular pressure was higher in eyes with XFS (17.8 +/- 3.2 mmHg), than in those without XFS (15.2 +/- 3.8 mmHg), p < 0.01. Glaucoma was found in 28 of 82 eyes with pseudoexfoliation syndrome (34.1%).

CONCLUSIONS

The pseudoexfoliation syndrome occurred much more frequently in elderly persons. PEX has been found to be associated with higher mean intraocular pressure, glaucoma, mature and nuclear cataract. Posterior subcapsular cataract was less common in patients with PEX.

[Application of Color Doppler ultrasonography in the evaluation of the blood flow in the ocular vessels in patients with anterior ischemic optic neuropathy--the preliminary report]

PURPOSE

Anterior ischemic optic neuropathy (AION) is one of the most common causes of acute loss vision in the middle-aged and elderly persons. It occurs due to hypoperfusion in the short posterior ciliary arteries supplying the optic nerve head. The aim of our study was evaluation of the usefulness of colour Doppler ultrasonography in diagnostics of AION.

MATERIAL AND METHODS

Color Doppler imaging of the ophthalmic artery, central retinal artery and posterior ciliary arteries were performed in 10 patients with clinically evident AION. The peak-systolic velocity (PSV), end-systolic velocity (EDV) and resistance index (RI) were measured.

RESULTS

No significant differences in the mean values of PSV, EDV and RI of ophthalmic arteries and posterior ciliary arteries between the affected and non-affected eyes were found. Reduction of mean flow velocities as well as significantly increased resistance index were observed in the central retinal artery in eyes with AION.

CONCLUSIONS

The Color Doppler findings in the ciliary arteries do not reflect the ischemic changes in patients with AION. It is probably due to anatomical limitation of this method in evaluation of the blood flow in posterior ciliary arteries supplying the optic nerve head. Abnormal blood flow parameters in the central retinal artery are secondary changes due to optic disc oedema.