Comparison of internal anterior chamber diameter measured with ultrabiomicroscopy with white-to-white distance measured using digital photography in aphakic eyes

PURPOSE

Measuring the anterior chamber diameter (AC) is important both for diagnostics and before ocular surgery. In clinical practice, horizontal AC diameter is usually estimated on the basis of measurements of corneal diameter (so-called white-to-white [WTW] distance). The usual method for selecting an appropriate size for an AC lens is to add 1 mm to WTW measurement. The purpose of this study was to compare AC diameter measured using ultrasound biomicroscopy (UBM) with WTW distance measured using digital photography in aphakic eyes.

METHODS

The data were gathered prospectively from a nonrandomized consecutive series of aphakic patients. The examined group consisted of 23 eyes of 23 adult patients, mean age 71.17 years. WTW diameter was measured in the 3 o'clock and 9 o'clock meridian on a digital photograph. Internal horizontal AC diameter measurements were performed in the 3 o'clock and 9 o'clock meridian with the Sonomed Ultrabiomicroscopy device with a 50-MHz probe.

RESULTS

Mean horizontal WTW diameter measured using digital photographs was 11.65+/-0.38 mm and mean horizontal internal AC diameter measured using UBM was 13.53+/-0.83 mm. A significant difference in mean WTW diameter measured using digital photography and UBM was found (Mann-Whitney U test, p<0.05). There was a significant correlation between these values (Spearman=0.70, p<0.001).

CONCLUSIONS

In order to obtain good and precise measurements of internal AC diameter, a method of direct visualization of the intraocular structures should be used. Despite the limits of a small case series, our results support the use of UBM technique for preoperative evaluation of the internal AC diameter and AC intraocular lens sizing in aphakic eyes.

Comparison of surgically induced astigmatism after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision

PURPOSE

To compare surgically induced astigmatism (SIA) after coaxial 1.8 mm microincision cataract surgery (MICS) and bimanual 1.7 mm MICS calculated with 3 mathematical methods.

SETTING

Department of Ophthalmology, Medical University of Lodz, Lodz, Poland.

METHODS

Study comprised a nonrandomized prospective consecutive series of 58 eyes of 58 patients who had uneventful coaxial MICS with implantation of an Akreos MI60 foldable intraocular lens (IOL) using a 1.8 mm temporal clear corneal incision. Fifty eyes of 50 patients who had uneventful bimanual MICS through a 1.7 mm clear corneal incision for a sleeveless phaco tip and a 1.5 mm side port for an irrigating chopper with implantation of an Acri.Smart 48S foldable IOL served as a comparison group. All surgery was performed by 2 experienced surgeons. Surgically induced astigmatism was calculated using 3 methods.

RESULTS

The patients were examined preoperatively and 2 weeks to 1 month postoperatively. No intraoperative or postoperative complications were seen in any patient. The corrected distance visual acuity improved significantly in both groups after surgery (P<.01); the visual outcomes were not significantly different (P>.05). In vector analysis, the mean SIA was 0.42 +/- 0.29 in the coaxial MICS group and 0.50 +/- 0.24 in the bimanual group; the difference was not statistically significant (P>.05). In vector decomposition, the mean SIA (C90) coaxial MICS group was 0.23 +/- 0.29 in the coaxial MICS group and 0.23 +/- 0.22 in the bimanual MICS group; the difference was not significant. Using the Naeser method, DeltaKP-90 was calculated, amounting to 0.05 +/- 0.44 in the coaxial MICS group and -0.04 +/- 0.42 in the bimanual MICS group; the difference was not significant.

CONCLUSIONS

The amount of SIA induced by bimanual MICS and coaxial MICS phacoemulsification was very small. The bimanual MICS induced a slightly higher degree of SIA; however, according to all methods of SIA analysis, there was no significant difference in the mean SIA induced by both techniques.

Incidence and functional outcome of phacoemulsification complicated by posterior capsular rupture

PURPOSE

To evaluate retrospectively anatomic and functional results of phacoemulsification with posterior chamber intraocular lens implantation, complicated by intraoperative posterior capsular rupture (PCR).

MATERIAL AND METHODS

Data were gathered from medical records of 930 patients (one thousand eyes), who underwent phacoemulsification. The examined group consisted of 52 eyes of 52 patients, 27 women (52%), and 25 men (48%), 50 to 84 years old (mean age 73.52 +/- 7.8), who underwent phacoemulsification complicated by intraoperative posterior capsular rupture. The control group consisted of 427 patients, including 263 women (61.59%) and 164 men (38.41%), at the age 44 to 93 (mean age 70.3 +/- 10.2), who underwent uncomplicated cataract phacoemulsification. All patients had ophthalmic examination preoperatively, one day postoperatively and 10 to 14 days postoperatively. The evaluated data included: patients' age and gender, pre- and postoperative best corrected visual acuity, intraocular pressure, state of the anterior and posterior segment, early postoperative complications, type of implanted intraocular lens and whether anterior vitrectomy was performed. Nonparametric tests were used for statistical analysis (Wilcoxon signed-ranks test and Mann-Whitney U test).

RESULTS

A statistically significant difference in postoperative BCVA between both groups was found. Mean postoperative BCVA in the PCR group was 0.63 +/- 0.27, whereas mean postoperative BCVA in the reference group was 0.78 +/- 0.18 (p < 0.001). Ten patients in the PCR group (19%), required anterior vitrectomy. In-the-bag implantation was performed in all eyes from the reference group, but it constituted only 31% (16 eyes), of the PCR group. We found that eyes with PCR are 2.6 times more likely to develop other intraoperative complications and early postoperative complications in comparison with controls. In our study eyes with PCR were about 5 times more likely to have a final BCVA worse than 0.5 than eyes from uncomplicated surgery group.

CONCLUSIONS

Eyes with intraoperative PCR during phacoemulsification have a higher risk of reduced BCVA, however, it is possible to achieve good final BCVA in the majority of eyes. Appropriate intraoperative and postoperative management will usually allow to perform a successful procedure with safe placement of an intraocular lens, thus ensuring a relatively favourable outcome.

Analysis of causes of intraocular lens explantations in the material of Department of Ophthalmology, Medical University of Lodz

PURPOSE

Implantation of intraocular lenses (IOLS) has become a standard practice in cataract surgery, however, similar to any other type of surgery, using IOLs is not complication-free and sometimes explantation of intraocular lenses may be necessary. This study was to gather data and analyze causes of intraocular lens explantations, performed in the Department of Ophthalmology, Medical University of Łódź.

MATERIALS AND METHODS

The data were gathered from medical documentation of all patients who underwent intraocular lens removal from January 2003 to July 2006. The examined group consisted of 16 patients (16 eyes): 9 women (fraction 0.56), and 7 men (fraction 0.44), at the age from 21 to 82 years (mean age 62.4 years, SD +/- 15.5). In all patients IOL explantation was performed under local, peribulbar anaesthesia.

RESULTS

Two groups of patients were distinguished: patients who had an anterior chamber lens explanted (3 patients, fraction 0.19) and patients who underwent posterior chamber lens explantation (13 patients, fraction 0.81). Causes of AC IOL explantations were: vaulting of the IOL (1 eye, fraction 0.06), luxation of the IOL to the vitreous cavity (1 eye, fraction 0.06), and painful eyeball after anterior chamber lens implantation (1 eye, fraction 0.06). Causes of PC IOL explantations were: subluxation of the IOL (6 eyes, fraction 0.38), luxation of the lens to the vitreous cavity (3 eyes, fraction 0.19), luxation of the lens to the anterior chamber (1 eye, fraction 0.06), endophthalmitis (2 eyes, fraction 0.13) and incorrect lens power (1 eye, fraction 0.06).

CONCLUSIONS

In the majority of eyes (n = 13, fraction 0.81) the removed implant was replaced by another intraocular lens, but 3 eyes (fraction 0.19) were left aphakic. We did not observe serious intra- or early postoperative complications which might influence the final result of the operation.

[Evaluation of visual acuity, contrast sensitivity and spherical aberrations in pseudophakic eyes with an intraocular lens]

INTRODUCTION

The use of modern technologies enables constructing and producing perfected intraocular lenses. Recently, aspheric implants have become widely available.

PURPOSE

The purpose of the study was to evaluate functional results, contrast sensitivity in scotopic conditions and spherical aberrations of the optical system of the eye after phacoemulsification with implantation of aspheric intraocular lens.

MATERIALS AND METHODS

The material was gathered prospectively from January until July 2006. The examined group included patients who received aspheric intraocular lenses Adapt AO or AcrySof SN60WF and who previously had received a conventional foldable spherical lens in the fellow eye. The examined group with an intraocular lens Adapt AO consisted of 25 eyes (25 patients) and the examined group with an intraocular lens AcrySof SN60WF consisted of 12 eyes (12 patients). We examined best corrected visual acuity (BCVA) and intraocular pressure. Contrastometry in scotopic conditions and aberrometry were performed. Intraoperative and early postoperative complications were noted. For statistical analysis non-parametric U Mann-Whitney test was used, all calculations were performed for the level of significance alpha = 0.05.

RESULTS

In the examined groups there were no intraoperative and early postoperative complications. In both groups, there was no statistically significant difference in mean postoperative BCVA between eyes with an aspheric implant and eyes with a spherical lens. Assuming the mean contrast sensitivity in eyes with spherical implants as 100%, we observed that in eyes with an aspheric lens it was better nearly by one third. Mean value of spherical aberrations with a pupil diameter of 5mm (Zernike RMS 5 mm) in eyes with an aspheric lens was significantly lower in comparison with eyes with a spherical implant (p < 0.05). Similarly, mean value of higher order spherical aberrations with a pupil diameter of 5 mm (Higher Order Zernike RMS 5 mm), in eyes with an aspheric lens was significantly lower in comparison with eyes with a spherical implant (p < 0.05).

CONCLUSIONS

Using aspheric lenses Adapt AO and AcrySof SN60WF allows for achieving very good functional and anatomic results and it enables to achieve better contrast sensitivity in scotopic conditions, as well as significantly decreases spherical aberrations of the optical system of the eye, in comparison with conventional spherical lenses.

[Comparison of efficacy and safety of cataract phacoemulsification in patients with different degree of nuclear sclerosis]

PURPOSE

To compare the course of surgery and operative outcomes in patients with different stages of nuclear hardness.

MATERIAL AND METHODS

The study comprises 36 patients with hard nucleus cataract (III and IV degree in LOCS scale)--group II and 45 patients with softer types of cataract (I and II degree in LOCS scale)--group I. All patients underwent clear corneal phacoemulsification and foldable intraocular lens implantation. In both groups intraoperative course was assessed and energy with effective phaco time were measured. Visual acuity, intraocular pressure, central corneal thickness and endothelial cell density were estimated preoperatively and one week postoperatively.

RESULTS

Energy and effective phaco time were significantly higher in group II. Mean visual acuity in both groups was 0.8 +/- 0.2. Intraocular pressure, central corneal thickness and endothelium cell loss were not significantly different in both groups. Endothelium cell loss were not significantly correlated with increase of energy or duration of phacoemulsification in any of groups.

CONCLUSIONS

Cataracts with higher stage of nuclear hardness required more energy and effective phaco time to be employed, but it did not influenced significantly postoperative visual acuity, intraocular pressure, central corneal thickness change and loss of endothelial cells.

[Strabismus surgery in pseudophakic patients]

PURPOSE

To analyze the results of strabismus surgery after previous cataract extraction with primary or secondary IOL implantation and to determine predicting factors of squint.

MATERIAL AND METHODS

Eight patients with squint deviation after cataract surgery with primary or secondary IOL implantation were enrolled into this study. Each patient had complete ophthalmologic and orthoptic examination. Patients were divided into two groups. Group I consisted of 5 patients with secondary IOL implantation after traumatic cataract surgery, and group II consisted of 3 patients without ocular trauma, with primary IOL implantation. Five patients from both of groups had diplopia after IOL implantation.

RESULTS

Strabismus surgery was performed in all cases. Surgery was combined with preoperative botuline toxin injections and Fresnel prism correction. Two patients were treated with adjustable suture technique. Treatment was successful in all cases. Five patients had no diplopia in primary position, two of them had occasional diplopia in secondary positions, while 3 patients with pour visual acuity achieved only esthetic effect.

CONCLUSIONS

1. Strabismus surgery in patients with pseudophakia is a complicated procedure which can optimize visual alignment, improve binocular vision and reduce diplopia. 2. Patients with diplopia or squint after IOL implantation ought to be informed about the possibility of strabismus surgery, both for diplopia and esthetic effect.

[Estimation of Doppler qualitative blood flow parameters in the eyeball arteries in early pregnancy]

PURPOSE

The study was aimed to evaluate changes in Doppler blood flow indices in the eyeball arteries in women in the early stage of pregnancy compared with non pregnant woman.

MATERIAL AND METHODS

Color Doppler imaging (CDI) of ophthalmic artery, central retinal artery and posterior ciliary arteries was performed in 15 health pregnant women between 6 and 9 weeks of gestation and in 13 non pregnant women.

RESULTS

S/D values were statistically significantly higher in women in early pregnancy, compared with non pregnant woman. In the eyeball arteries, of both pregnant and non pregnant woman, blood flow indices were the highest in the ophthalmic artery, and decline subsequently in the central retinal artery and ciliary posterior arteries.

CONCLUSIONS

Women in early pregnancy had higher values of all blood flow parameters but only values of systolic-diastolic index was statistically significant.

[Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses--long-term results]

PURPOSE

Estimation of long-term results and complications of complex surgical technique, used for the management of luxated crystalline lenses.

MATERIAL AND METHODS

This prospective study involved 29 consecutive patients (31 eyes) with the mean age of 62 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 13 eyes, and scleral-fixated, posterior chamber IOLs in 17 eyes. In one patient with high myopia the lens was not implanted. The follow-up ranged between 9 and 38 months (mean 22.8 months).

RESULTS

No complications were observed during phacofragmentation. Improvement in visual acuity was achieved in 18 cases one week after operation and in 23 patients at last examination. We achieved visual acuity of 4/50--hand movements in 4 cases, 5/16-5/50 in 3 eyes, 5/8-5/12 in 7 and 5/5-5/7 in 17 cases, in last examination. There were no intra-operative complications. Low visual acuity in some cases was due to the presence of postoperative complications or coexisting eye diseases, such as secondary glaucoma, atonic pupil, age related macular degeneration, retinal detachment and macular hole.

CONCLUSIONS

Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses is safe and effective method, providing very good long-term functional results.

[Evaluation of corneal endothelium morphology in diabetic patients]

PURPOSE

To evaluate the influence of diabetes mellitus and type of hipoglicemic therapy on corneal endothelium cell morphology.

MATERIAL AND METHODS

In 68 diabetic patients' eyes with non proliferative diabetic retinopathy (29 males and 39 females), corneal endothelium was studied. Patients age was between 50 and 82 years (mean 63.28). As age-matched control group we analyzed 58 eyes of non diabetic patients. Corneal endothelium density, percentage of corneal endothelium hexagonal cells, average size of corneal endothelium cells and corneal thickness were imaged by non-contact specular microscope TOPCON SP-2000P.

RESULTS

The mean corneal endothelium cell density was: 2467 cells/mm2 in diabetic patients, and 2573 cells/mm2 in control group. The mean percentage of corneal endothelium hexagonal cells was: 55.3% in diabetic patients treated with insulin and 52.9% in diabetic patients treated with oral antidiabetic drugs, and 54.4% in the control group. The mean size of corneal endothelium cells was: 414.6 microm2 in diabetic patients, and 395.9 microm2 in the control group. The mean corneal thickness was: 0.556 mm in diabetic patients and 0.545 mm in the control group.

CONCLUSIONS

Corneal endothelium was thicker in diabetic patients than in non diabetic patients. The duration of diabetes mellitus had no influence on corneal endothelium cell morphology. Diabetic patients treated with oral antidiabetic drugs had larger percentage of hexagonal cells than those treated with insulin.

[Retinal capillary blood flow in exudative age-related macular degeneration]

PURPOSE

The purpose of this study was to evaluate retinal capillary blood flow in patients with exudative AMD.

MATERIAL AND METHODS

Twenty patients with exudative AMD and twenty four patients age-matched control subjects, were included into the study. Retinal capillary blood flow was evaluated with Heidelberg Retinal Flowmeter (HRF), measurements were taken in two macular regions. The total mean flow and mean velocity were calculated usingthe technique of automatic full field perfusion image analysis (AFFPIA). The U Mann-Whitney test was used for statistical analysis.

RESULTS

Patients with exudative AMD revealed slightly lower retinal blood flow than control subjects in area I and in area II. In the AMD group total mean flow values were: 295.75 AU/ 303.85 AU, while in the control group were: 302.37 AU/ 304.42 AU. The mean velocity values were: 1.48 AU/ 1.42 AU in AMD patients and: 1.49 AU/ 1.52 AU in control group. The differences did not reach the statistical significance.

CONCLUSIONS

The study results showed no changes in retinal capillary blood flow in patients with exudative AMD comparing to normal subjects.

[Pathomorphology of membranes appearing in proliferative vitreoretinopathies]

Immunohistochemical techniques were used to investigate the cell content of epiretinal membranes occuring in proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR). Ten epiretinal membranes were obtained during surgery from eyes with PVR and five from eyes with PDR. This material was studied histopathologically and immunohistochemically. Retinal pigment epithelial cells, glial cells, macrophages, T lymphocytes and type IV collagen were identified in these membranes. The findings indicate that the cells mentioned possess a potential role in creating vitreoretinal membranes in PVR and PDR.

[Proliferative vitreoretinopathy--selected issues concerning morphology and pathophysiology]

Based on the literature review the article presents state of the art knowledge on creation, structure and pathophysiology of membranes occurring in PVR. Additionally selected clinical risk factors are discussed.

[Results of bimanual phacoemulsification with intraocular lens implantation through the micro incision]

PURPOSE

To evaluate the postoperative results of bimanual, cold phacoemulsification with foldable lens implantation through 1.7 mm incision.

MATERIAL AND METHODS

Thirty four bimanual cold phacoemulsifications with Acri. Smart (AcriTec) IOL implantation through 1.7 mm incision were performed in the Department of Ophthalmology, Medical University of Lódź, between March and May 2004. In the group of 34 patients, 24 were women and 10 were men. The mean age of patients was 67 years (range between 42 and 77). Preoperative visual acuity ranged from 0.5/50 to 5/10. Mean visual acuity was 0.3. Preoperative astigmatism ranged from 0.15 to 2.3 diopters (mean 0.7). Preoperatively, nuclear density was estimated according to LOCS III classification. Twenty patients (59%) had 1 to 3 nuclear density, and 14 (41%) had 4 to 6 nuclear density. All surgeries were performed with Oertli machine using the burst mode with a sleeveless phaco tip. Postoperative examinations were conducted on the 1st and the 7th day, and I month after the surgery. Visual acuity, astigmatism, status of the cornea and IOL centration were evaluated.

RESULTS

No intraoperative complications were observed. All 34 patients maintained corneal transparency with no signs of thermal damage around the wound. Visual acuity improved in all cases. Mean visual acuity in 33 patients who had no coexisting ocular diseases I month after surgery was 0.98 and the mean induced astigmatism was 0.2 diopters. In all cases IOLs were very well centred.

CONCLUSIONS

Bimanual phacoemulsification is a very safe method allowing to minimise corneal incision. Using Acri. Smart IOLs, the induced astigmatism is very small, almost imperceptible to patients.

Management of bilateral ectopia lentis et pupillae syndrome

A 52-year-old patient presented with signs clinically consistent with ectopia lentis et pupillae syndrome. The patient was treated successfully with vitrectomy, dislocated lens removal using perfluorocarbon liquid and phacofragmentation in the vitreous cavity, pupil reconstruction, and scleral-fixated intraocular lens implantation in both eyes. Despite the fact that the surgery was successful in technical terms, the final visual outcome was not as good as expected. This was caused by the optic nerve atrophy resulting from long-lasting glaucoma. Nevertheless, the described surgical techniques may be considered an effective method of treatment in cases of ectopia lentis et pupillae syndrome.

[Multifocal oscillatory potentials (mfOPs) in patients with central retinal vein occlusion]

PURPOSE

To evaluate usefulness of multifocal oscillatory potentials (mfOPs) in diagnostics in patients with retinal vein occlusions.

MATERIAL AND METHODS

The Visual Evoked Imaging System (VERIS, version 4.9) was used to stimulate the visual system to elicit mfOPs from 103 areas subtending the central 70-80 degrees of the retina in three patients with central or branch retinal vein occlusions. Two stimulating conditions were used. For each subject, the mean first- and second-order kernel responses from occlusion area, were analyzed and compared with the fellow eye and control subjects results.

RESULTS

In retinal areas without circulatory disturbances in fluorescein angiography all mfOPs components were present. In a patient with branch retinal vein occlusion in the area without capillary perfusion mfOPs responses were not detectable.

CONCLUSIONS

The mfOPs are in a large extent dependent on a proper retinal circulation. The recording of mfOPs may be useful in clinical diagnosis, to asses circulatory disturbances in internal layers of the retina and in differentiation of ischemic from non ischemic retinal vein occlusions.

Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses

PURPOSE

To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results.

SETTING

Department of Ophthalmology, Medical University of Lodz, Lodz, Poland.

METHODS

This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral-fixated posterior chamber IOLs in 20 eyes. The follow-up mean was 5.2 month (range 1 to 16 months).

RESULTS

No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 +/- 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 +/- 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral-fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication.

CONCLUSION

Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.

[Retinal capillary blood flow in nonexudative age-related macular degeneration]

PURPOSE

The purpose of this study was to evaluate retinal capillary blood flow in patients with nonexudative age-related macular degeneration.

MATERIAL AND METHODS

Twenty five patients with nonexudative age-related macular degeneration and twenty five age-matched control subjects were enrolled into the study. Full ophthalmological examination and fluorescein angiography were performed. Retinal blood flow was evaluated with the Heidelberg Retina Flowmeter. Total mean flow and mean velocity were calculated using the technique of automatic full field perfusion image analysis

RESULTS

Patients with nonexudative age-related macular degeneration revealed statistically significant lower retinal blood flow than control subjects. In AMD group total mean flow values were 266.89 / 272.21 AU, while in control group were: 1.498 / 1.509 AU. Mean velocity values were: 1.315 / 1.329 AU in AMD patients and: 1.498 / 1.509 AU in controls.

CONCLUSIONS

The study results showed reduced capillary retinal blood flow in patients with age-related macular degeneration compared to normal subjects. This retinal microcirculation impairment suggests more generalized perfusion defect involving both, choroidal and retinal blood flow.

[Evaluation of results of combined pars plana vitrectomy and cataract removal]

PURPOSE

Cataract often coexists with pathologies of the vitreous body. Moreover, after several months after vitrectomy, the lens becomes opaque. Lens opacities interfere with appropriate visualisation of the vitreous chamber and the eye fundus, which makes performing vitreoretinal procedures difficult. For this reason, in such patients, a combined procedure of pars plana vitrectomy and cataract extraction can be considered. This is retrospective analysis of the indications and results of combined cataract extraction and pars plana vitrectomy.

MATERIAL AND METHODS

The data were based on case histories of patients who underwent combined cataract extraction and pars plana vitrectomy in the years 2001 - 2003, in the Department of Ophthalmology, Medical University of Lódź. The evaluated data included: diagnosis, pre- and postoperative best corrected visual acuity, intraocular pressure, pre- and postoperative state of the anterior and posterior segment of the eye and the employed surgical techniques.

RESULTS

The examined group consisted of 40 patients (40 eyes), including 20 men and 20 women, at the age from 13 to 76 years old (mean 55.7, SD+/-14.6). The indications to vitrectomy were: vitreous haemorrhage, retinal detachment, vitreoretinal proliferations, intraocular foreign body, persistent hyaloid artery and endophthalmitis. Phacoemulsification was the most often used method of cataract extraction (34 people, 85%). In three patients cataract was removed by classical extracapsular cataract extraction (ECCE), and in further 3 patients bimanual aspiration was used. In terms of anatomical results, therapeutic success was achieved in 35 cases (87,5%). Improvement of visual acuity was observed in 28 people (70%), unchanged visual acuity in 10 people (25%), and a decrease in visual acuity in 2 patients (5%). Improvement of visual acuity at least 2 lines on Snellen's chart was achieved in 20 patients (50%).

[Color Doppler imaging of the retrobulbar circulation in non-exudative and exudative age-related macular degeneration]

PURPOSE

To study ocular perfusion in the ophthalmic artery, central retinal artery, nasal and temporal posterior ciliary : arteries in non-exudative and exudative age-related macular degeneration.

MATERIAL AND METHODS

Twenty five subjects with non-exudative age-related macular degeneration were compared to twenty five subjects with exudative age-related macular degeneration and to twenty five age-matched control subjects. Color Doppler imaging measured peak systolic velocity (PSV) and end diastolic velocity (EDV) in the ophthalmic artery, central retinal artery, nasal and temporal posterior ciliary arteries of one eye. The resistivity index (RI) and the pulsatility index (PI) were calculated.

RESULTS

There were statistically significant differences between: subjects with non-exudative age-related macular degeneration and subjects with exudative age-related macular degeneration in EDV, RI and PI in the ophthalmic artery and PSV in the temporal posterior ciliary artery, subjects with non-exudative age-related macular degeneration and control subjects in RI in central retinal artery, subjects with non-exudative age-related macular degeneration and control subjects in RI and PI in nasal posterior ciliary artery, subjects with exudative age-related macular degeneration and control subjects in PI in nasal posterior ciliary artery.

CONCLUSIONS

The study results showed reduced ocular blood flow in patients with non-exudative age-related macular degeneration compared to patients with exudative age-related macular degeneration and to control subjects. The higher RI in central retinal artery in non-exudative age-related macular degeneration compared to control subjects, suggest there may be a more generalized perfusion abnormality beyond the choroid.

[Surgically induced astigmatism after cataract phacoemulsification]

PURPOSE

To evaluate the astigmatic effect after phacoemulsification depending on size and location of incision.

MATERIAL AND METHODS

Three groups of 30 patients each: In 1st group with scleral tunnel incision enlarged to 6 mm with continuous cross-like suture at 12 o'clock; In 2nd group with 3.2 mm scleral incision without suture at 12 o'clock; In 3rd group with 3.2 mm superotemporal incision in clear cornea, no suture. Postoperative astigmatism was examined by keratometry after 1 day, 1 week and 1 and 3 months post surgery. Surgically induced astigmatism was calculated by polar values method.

RESULTS

After 3 months observation the lowest mean postoperative corneal astigmatism was achieved in group III. The SIA was 0.71 in group III, 1.08 in group I and 0.95 in group II. The differences between group III and groups I, II were statistically significant.

CONCLUSIONS

Surgically induced astigmatism can be minimized with incision in clear cornea and no suture.

[The influence of viscoelastic's maintenance in the anterior chamber on early results and complications after trabeculectomy]

PURPOSE

The evaluation of intraocular pressure and number of complications in the early postoperative period in patients after trabeculectomy with viscoelastic agent used to recreate the anterior chamber at the end of procedure.

MATERIAL AND METHODS

Between November 2001 and February 2002, in 56 patients (58 eyes) with primary open-angle glaucoma trabeculectomy was performed. Patients were divided into two groups. Trabeculectomy was performed with leaving the viscoelastic agent (Provisc) in the anterior chamber at the end of surgery in 29 eyes of 28 patients (Group A), while in 28 patients (29 eyes) the anterior chamber was filled with Ringer solution (Group B). Preoperative IOP in group A ranged from 19 to 48 mmHg, mean--28.41 mmHg. In group B it ranged between 19 and 41 mmHg, mean--25.07 mmHg. The follow-up time was 1 month in every case.

RESULTS

The mean IOP on the first, fifth, 14th and 30th day after surgery was 14.0 mmHg, 13.2 mmHg, 12.03 mmHg and 11.76 mmHg respectively in group A, while in group B corresponding values were: 9.0 mmHg, 8.97 mmHg, 8.83 mmHg and 8.9 mmHg. The shallowing of anterior chamber and choroidal detachment were observed in 4 eyes (13.8%) in group A and in 8 eyes (27.6%) in group B postoperatively. The increased IOP during first days after surgery was observed in 3 cases (10.3%) in group A.

CONCLUSIONS

The viscoelastic agent left in the anterior chamber at the end of trabeculectomy significantly decreases the frequency of anterior chamber shallowing and choroidal detachment and reduces number of cases with hypotony.

[Intraocular pressure in early postoperative period after cataract phacoemulsification]

PURPOSE

The purpose of this study was to investigate the pattern of intraocular pressure (IOP) change after phacoemulsification and its bearing on timing of postoperative review.

MATERIAL AND METHODS

31 eyes of 31 consecutive patients having uneventful phacoemulsification were included in this study. The IOP was measured by Goldmann applanation tonometry preoperatively and 1-3 hours, 1 day and 1 week postoperatively. The relationship between these measurements' readings were examined.

RESULTS

31 patients completed the study. The IOP checked next day was significantly correlated with the IOP preoperatively.

CONCLUSION

After phacoemulsification with OIL implantation the decrease in IOP was observed in first three postoperative hours in comparison with preoperative values and it was followed by an increase on the first postoperative day. It decreased again after a week reaching values lower than preoperatively. Only in few cases (10%) a transient intraocular hypertension (23-26 mmHg) appeared on the first postoperative day.

[Long-term results of trabeculectomy in patients with open angle and angle-closure glaucoma]

PURPOSE

To provide data on the long-term results of trabeculectomy performed in open angle and in chronic angle-closure glaucoma.

MATERIAL AND METHODS

Fifty nine eyes of 51 patients, underwent trabeculectomy from 1992 to 1994 in the Department of Ophthalmology, Medical University of Lodz. The follow up was minimum 10 years. Such pre- and postoperative measurements, as: visual acuity, intraocular pressure (IOP), visual field and the use of hypotensive medications, were evaluated.

RESULTS

Successful IOP control was obtained in 91%. After 10-years follow-up the average IOP was 15 mmHg. The decrease in visual acuity was found in 25% of eyes, caused mainly by cataract. In 71% of eyes (10 years after surgery) additional topical medication was required.

CONCLUSIONS

Trabeculectomy is effective and very often performed surgery in glaucoma.