[Multifocal electroretinogram]

The paper presents current state of knowledge regarding multifocal electroretinography (mfERG). The theoretical basis of this technique, procedure, methods and examples of use in clinical diagnostics are presented.

[Epidemiology of cataract in clinical material of Department of Ophthalmology, Medical University of Lódź]

PURPOSE

Analysis of some epidemiological features of patients operated for senile and presenile cataract at our department in years: 1992, 1994, 1997, 2000 and 2002.

MATERIAL AND METHODS

In the analyzed years 4385 patients (1594 males and 2791 females) aged from 36 to 97 years were operated. The age of patients, sex, duration of cataract symptoms before surgery, preoperative visual acuity, type of cataract, place of living and coexistence of diabetes or high myopia, were taken into consideration.

RESULTS

The mean age of patients was 70.4. A statistically significant difference between mean age in 1997 (69.7), and 2000 (71.6) and 2002 (71.4) was found. Women tended to be operated on 2 years later than men (mean age for women--71.1, mean age for men--69.1). 16% of patients suffered from diabetes, and 6.7% had high myopia. Senile cataract affected people with high myopia at earlier age (mean--67.3 years). 67.5% of patients were of big town origin, 13% came from small towns and 19% were from the country. Patients from big towns were operated in higher age (mean--72.4 years) than patients from small cities (mean--69.9 years), and from country (mean--70.2 years) and had better visual acuity (mean--0.20) than patients from small towns (mean--0.16) and from country (mean--0.13). Preoperative visual acuity in the range 0.4-1.0 was found in 0.4% of patients in 1992, and in 28% in 2002. The visual acuity <0.1 was found in 77.5% of patients in 1992 and in 45% of patients in 2002.

CONCLUSIONS

Mean age of patients operated for cataract is increasing and there is a tendency of performing operations in cases with better visual acuity. Women suffer from cataract later than men. People of country origin were operated at earlier age with worse visual acuity comparing to patients coming from towns. Senile cataract affects people with high myopia at earlier age.

[Analysis of the causes of enucleations performed at the Department of Ophthalmology of the Medical University of Lódź]

PURPOSE

To gather and analyse the data about causes of enucleations, which were performed in the Department of Ophthalmology, Medical University of Lódź.

MATERIAL AND METHODS

The data were based on case histories. The whole examined group consisted of 57 patients, who had an enucleation surgery done in the period from June 1999 to June 2003. The analyzed data included: clinical diagnosis, visual acuity, intraocular pressure, results of histopathology examination and results of diagnostic imaging examinations.

RESULTS

The most frequent causes of enucleations were: intraocular tumors (fraction 0.51 of the whole group), painful blind eyes (fraction 0.33), endophthalmitis (fraction 0.12) and ocular traumas (fraction 0.04).

CONCLUSIONS

Despite significant advances in ophthalmology in recent years, enucleation remains a method of treatment. The main indications for this type of surgery are: intraocular tumors, painful blind eyes, severe endophthalmitis and some cases of ocular trauma.

[Using a botuline toxin diagnostic test in a case of bilateral stilling--Türk--Duane (STD) syndrome found during preparation for cataract surgery]

PURPOSE

The presentation of complex procedures in preoperative diagnosis, allowing the evaluation of reaction of a patient with bilateral STD syndrome, to a potential change in the long-lasting ocular motility disturbances and corrective head position.

MATERIAL AND METHODS

The botuline toxin was injected into the medial rectus muscle of the eye with greater motility disturbance in convergent strabismus. It was discovered during preparation for cataract surgery in a 45 years old female with STD Syndrome I type. Due to reduced visual acuity the diagnosis of binocular vision were performed after bilateral cataract surgery. We were afraid that the fixed sensory status of the patient would change, and therefore we performed botuline injections. Strabismus angle, ocular motility and diplopia were assessed and compared.

RESULTS

The reduction of strabismus angle was achieved with no diplopia. The patient no longer needed the corrective head position, with binocular vision present while looking straight ahead. Also, a slight improvement was obtained in the abduction motility of the eye to which botuline toxin was injected.

CONCLUSION

Preoperative diagnostic botuline toxin injection into the rectus medial muscle of the eye with greater motility disturbance, gives an effect of strabismus reduction. This allows for further decisions of whether, and what type of surgical treatment should be performed.

Congenital blepharoptosis: Part II. Visual disorders coexisting with congenital blepharoptosis

A retrospective ophthalmic analysis 44 of 118 patients with congenital blepharoptosis aged from 2 to 48, who underwent surgical correction at the Department of Plastic Surgery of Lódź between 1977 and 2001, was reviewed. Patients with congenital blepharoptosis were investigated by ophthalmologists in the pre and postoperative period, and their medical ophthalmological notes were also analysed. The aim of this study was to assess the presence, type, and severity of visual disorders coexisting with ptosis. We found in 42 patients (95%) ophthalmologic disorders, of which we noted amblyopia in 19, astigmatism in 30, anisometropia in 5, and strabismus in 30 cases.

Congenital blepharoptosis: Part I. Evaluation of the results of surgical treatment for congenital blepharoptosis

A retrospective clinical analysis of 69 of 118 patients with congenital blepharoptosis aged from 2 to 48, who underwent surgical corrections at the Department of Plastic Surgery of Lódź between 1977 and 2001, was reviewed. Included cases were analysed on the base of the type of primary defect, degree of ptosis, and surgical method. The aim of this study was to estimate aesthetic and functional results of surgical treatment in 39 patients corrected by Mustarde's modified method, in 17 by Mustarde's method, in 7 by Everbusch's method, in 4 by Blascovic's method, and in 2 by frontalis suspension. Comparable acceptable results of Mustarde's modified and Mustarde's method were achieved. Postoperatively 13 patients (18.8%) exhibited lagophthalmos.

[Removal of luxated crystalline lenses by intravitreal phaco-emulsification]

PURPOSE

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

MATERIAL AND METHODS

Between May 2001 and February 2002, ten patients (ten eyes) were treated for crystalline lens luxation. There were 4 females and 6 males in this group, their age ranged between 46 and 78 years (average 63 years). In all cases, the surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection and crystalline lens phacoemulsification in the vitreous cavity. Simultaneously, anterior chamber IOLs were implanted in 8 eyes, and scleral-fixation, posterior chamber IOLs in 2 eyes. The follow-up ranged between 1 and 9 months (mean 2.7 months).

RESULTS

All dislocated lenses were successfully removed. No complications occurred during phacofragmentation. We achieved improvement in visual acuity in 5 cases, while good pre-operative visual acuity (with aphakic correction) did not change postoperatively in remaining 5 eyes. The mean preoperative visual acuity was 0.52 (0.1-1.0), and it was 0.75 (0.2-1.0) postoperatively. In 9 cases very good visual acuity (6/6-6/12) was achieved. There were no serious complications. In the first postoperative days transient hypotonia and Descemet's membrane folds were observed in 8 eyes, fibrinous reaction in the anterior chamber in one eye, and dispersed blood in the vitreous cavity in 2 eyes.

CONCLUSION

The management of luxated lenses using the described method is safe. Very good functional results and lack of severe complications are very encouraging. Additional cases with a longer follow-up study are necessary to support our opinion.

[A study of human lens epithelial cells by light and electron microscopy and by immunohistochemistry in different types of cataracts]

PURPOSE

To evaluate the characteristics of cataract changes in lens epithelial cells (LECs), in different types of human cataract.

MATERIAL AND METHODS

Anterior capsules for the study were obtained from patients with different types of cataracts during extracapsular cataract extraction, or phacoemulsification using continuous curvilinear capsulorhexis. LECs attached to the anterior capsules were analyzed for morphological changes by light and electron microscopy, and for cellular characteristics by immunohistochemistry. The reactivity to cytokeratins 5,6,8,17 and 19 (arker for epithelial cells) and to vimentin (arker for mesenchymal cells) was determined.

RESULTS

The consecutive degenerative changes were observed in most of the cells: multilayered cells, nuclei of abnormal diameters and shapes, vacuolation of nuclei and cytoplasm. LECs were immunohistochemically positive for cytokeratin and vimentin, or only for vimentin in all types of cataract. Some of LECs showed morphological and immunohistochemical characteristics of mesenchymal cells.

CONCLUSIONS

Lens epithelial cells show similar degenerative changes in different types of cataract and may have the ability to transdifferentiate into mesenchymal cells.

[Massive choroidal hemorrhage as a late trabeculectomy complication ]

The purpose of this paper was to present the case of an unusual late complication of filtering glaucoma surgery. A massive choroidal hemorrhage occurred 5 years after trabeculectomy and extracapsular cataract extraction. The diagnosis was confirmed by MRI examination. Improvement in choroidal status and in visual acuity (from hand motions to 6/12 with aphakic correction of 12 diopters) was observed during three weeks of medication. The retina and the choroid remained attached during two years of observation.

[Advancements in diagnosis and surgical treatment of strabismus in adolescent and adults]

PURPOSE

To present complete process of pre-operative strabismus diagnosis, which can be used for prediction of post-operative diplopia in adolescents and adults.

MATERIAL AND METHODS

The study involved three patients, who were qualified for the surgical treatment of strabismus. Complete pre-operative diagnosis predicting potential post-operative diplopia was performed in all patients. The prismatic test for diplopia, hyperfunctional muscle botuline toxin injection, and prism correction were performed

RESULTS

Regarding the results of tests, two patients were qualified for surgical treatment. None of them suffered from diplopia after this treatment. The third patient in pre-operative tests showed unacceptably high risk of intolerable diplopia.

CONCLUSIONS

Post-operative diplopia in adolescents and adults represents a serious problem, especially in susceptible patients. Accurate and complete pre-operative diagnosis allows for risk reduction in post-operative diplopia. The predictive test for post-operative diplopia, botuline toxin injection and prism correction in isolation are not always able, to give a reliable indication, as to the sensory status following strabismus surgery. A combination of the three above mentioned techniques give more reliable diagnosis. For patients, who can possibly suffer from post-operative diplopia, the adjustable suture technique should be applied.

[Simultaneous bilateral cataract surgery with PC IOL implantation]

PURPOSE

To evaluate results of simultaneous bilateral extracapsular cataract extraction with PC IOL implantation and to discuss indications for such treatment.

MATERIAL AND METHODS

Simultaneous bilateral cataract surgery was performed in 3 patients: 56-year-old woman with Little's syndrome, 75-year-old woman with Parkinson's disease and 29-year-old mentally handicapped man. All patients required general anesthesia because of the general state of health. All patients were treated topically with broad-spectrum antibiotic drops before the surgery. Simultaneous bilateral surgery was performed as two separate operations. After successful completion of surgery of the first eye, the gloves, drapes and gowns were changed and the new set of instruments and irrigation solution was used.

RESULTS

The visual acuity improved in all eyes after surgery, and it was 6/6 in both eyes in patients 1 and 3, whereas it was 6/8 and 6/60 in patient 2, due to glaucomatous optic nerve atrophy. There were no intra- or postoperative complications.

CONCLUSIONS

Simultaneous bilateral cataract surgery is a safe procedure if all special conditions are fulfilled. It is specially indicated in patients requiring general anesthesia. Patients are not at risk of the second general anesthesia and achieve earlier visual binocular rehabilitation. Extracapsular cataract extraction with PC IOL implantation was performed in all eyes. The excision of fibrotic anterior lens capsule was necessary before the aspiration of cortical material in 2 eyes with congenital cataracts. The corneal incision and plastic surgery of the iris was done in the eye, which had undergone iridencleisis. In the other eye of the same women cutting and suturing of the iris was performed because of posterior synechiae and very narrow pupil.

Pars plana vitrectomy and transscleral fixation of black diaphragm intraocular lens for the management of traumatic aniridia

BACKGROUND AND OBJECTIVES

Partial or complete aniridia occurring after severe ocular trauma is a difficult therapeutic problem. Diaphragm intraocular lenses were developed for the correction of aniridia, but the safety and efficacy of implanting such lenses are not well established in traumatic cases because of very few reports, and the small number of cases studied.

PATIENTS AND METHODS

Six patients, 4 men and 2 women with a mean age of 44 years, were treated for traumatic aniridia using pars plana vitrectomy and transscleral fixation of a black diaphragm intraocular lens. Total aniridia was observed in 3 eyes and partial aniridia in 3 eyes. Four eyes were aphakic and severe lens subluxation was seen in 2 eyes. Vitreous hemorrhage coexisted in 2 patients and bacterial endophthalmitis was present in 1 patient. Follow-up time ranged between 4 and 39 months (mean, 23 months).

RESULTS

Best-corrected visual acuity improved in 5 patients and 1 remained unchanged. Good visual acuity (20/20 - 20/40) was achieved in all cases and all lenses were well-centered. No severe complications were noted. Three of 6 patients required glaucoma topical medications pre- and postoperatively achieving good intraocular pressure control.

CONCLUSION

The management of traumatic aniridia using pars plana vitrectomy and implantation of scleral fixation black diaphragm intraocular lenses seem to be safe. Very good functional results and lack of severe complications are encouraging. Additional cases with a longer follow-up study are necessary to support our opinion.

[Treatment of dislocated lenses in patients with Marfan's syndrome using vitrectomy and intraocular lenses]

PURPOSE

To evaluate results of surgical complex treatment of lens dislocation in Marfan syndrome cases.

MATERIAL AND METHODS

Nineteen eyes of 13 patients were operatively treated for lens dislocation. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in 5 eyes and with an intracapsular method in 14 eyes. The scleral fixation technique was used for primary posterior chamber intraocular lens implantation in 18 eyes, and one eye remained aphakic. Time of observation ranged between 6 and 71 months (mean 3.5 years).

RESULTS

All eyes achieved improvement in visual acuity or good preoperative visual acuity was maintained. The vision between 6/6 and 6/8 was achieved in 14 patients. There were no serious intraoperative or early postoperative complications. Retinal detachment appeared in two eyes in a long observation time and it was successfully operatively treated. The not good visual results were due to amblyopia (n = 2), complications of retinal detachment surgery (n = 2) and glaucomatous optic disc atrophy coexisting with macular degeneration (n = 1).

CONCLUSIONS

Pars plana vitrectomy and primary scleral-fixated IOL implantation gives quick and good visual rehabilitation in adult patients with Marfan's syndrome. The described surgical method is complex and need a prolonged operative time, but gives very good functional results and very few complications.

[Refraction changes after cataract extraction with IOL implantation in the eyes with previous performed vitrectomy]

PURPOSE

To determine differences between the predicted and postoperative refraction after cataract extraction with intraocular lens implantation in the eyes, which previous underwent vitrectomy.

MATERIAL AND METHODS

Fifty three eyes of 52 patients underwent the analysis: twenty five in group I, nineteen in group II and nine eyes with previous scleral buckling in group III. All the eyes had ECCE and IOL with PMMA implantation after vitrectomy. In groups II and. III silicone oil tamponade was used and removed before cataract extraction. Thirty eyes of the control group K underwent cataract surgery and IOL implantation alone. The IOL power calculation was performed with SRK II formula. The predicted and postoperative refractions were compared. The follow-up was minimum 4 months (on average 15 +/- 12.71 months).

RESULTS

The postoperative refractions were significantly shifted toward myopia than it was predicted--1.41 +/- 1.21 D in group I, -0.81 +/- 2.11 D in group II and -3.03 +/- 1.49 D in group III. In the control group K the difference was--0.07 +/- 0.91.

CONCLUSIONS

Myopic shift of postoperative refraction after cataract surgery should be considered, when calculating the IOL power in the eye after vitreoretinal procedures.

[Secondary glaucoma in patients with lens subluxation or luxation]

AIM

To estimate the frequency of secondary glaucoma appearance and the influence of surgical treatment on intraocular pressure (IOP) in patients with posterior lens dislocation.

MATERIAL AND METHODS

The study concerned 152 patients (57 females and 95 males, age range: 19 to 91 years, mean--58 years). Secondary glaucoma was found in 62 patients (41%). Trauma was the cause of lens dislocation in 81% of these cases, while it was the cause in only 69% of cases in the whole material. Pars plana vitrectomy with limbal intracapsular lens extraction or lentectomy were performed in all cases. In 24 cases perfluorocarbon liquid was used. Scleral fixation PC IOLs were implanted in 85 eyes (group A), AC IOLs in 27 eyes (group B), and 40 eyes remained aphakic (group C). The follow-up time ranged from 6 months to 5 years, mean 22 months.

RESULTS

Raised IOP was found preoperatively in 46 cases (30.3%). It was raised in 21 (24.7%) eyes in group A (24-60 mm Hg, mean 37.1 mm Hg), and it has normalized postoperatively in 14 eyes, while topical medication was necessary in 7 remaining cases. In group B raised IOP (26-60 mm Hg, mean 41.4 mm Hg) was found preoperatively in 8 (29.6%) eyes. It has normalized postoperatively in 5 eyes, while topical medication was necessary in 3 eyes. The respective values in group C were: 17 (42.5%), 24-80 mm Hg, mean 43.2 mm Hg. In 7 eyes IOP was normal after surgery, 10 patients required topical treatment, and in 3 of these cases trabeculectomy had to be performed. In 16 eyes with normal preoperative IOP it has raised postoperatively in different periods of time (from 1 week to 6 months).

CONCLUSIONS

Secondary glaucoma is a frequent complication of the posterior lens dislocation, and it is more often related with traumatic cases. The dislocated lens removal with the use of vitrectomy causes IOP normalization in most of the cases. The periodical examination of IOP is necessary after the dislocated lens removal also in cases with normal preoperative IOP, because secondary glaucoma may appear in different time after surgery.

[Implantation of black diaphragm intraocular lenses in congenital and traumatic aniridia]

PURPOSE

To evaluate the safety and efficacy of the black diaphragm intraocular lens (IOL) implantation for the treatment of congenital and traumatic aniridia.

MATERIAL AND METHODS

Seven black diaphragmatic IOLs were implanted in the eyes of 6 patients between 1997 and 1998. There were 5 males and 1 female. The mean age of them was 42.8 years (range: 22-54 years). Follow-up ranged from 9 to 20 months (mean: 14.2 months). Traumatic aniridia was present in 4 eyes and congenital aniridia in 3 eyes. Pars plana vitrectomy was combined with the simple outside-in method of scleral fixation of IOLs in 6 cases. Three of these eyes were aphakic (all with traumatic aniridia) and in 3 eyes (two congenital cases, one traumatic case) subluxated lens was simultaneously removed. In one case of congenital aniridia with mature cataract, ECCE and ciliary sulcus implantation without scleral fixation were performed.

RESULTS

There were very few complications. Ciliary sulcus bleeding appeared in 2 cases during scleral fixation. Transient post-operative corneal oedema was observed in 2 eyes, raised intraocular pressure in 3 eyes, and dispersed blood in vitreous cavity in 2 eyes. All IOLs were well centred. The improvement in best corrected visual acuity was achieved in 5 cases, while good pre-operative best corrected visual acuity was maintained in 2 cases.

CONCLUSIONS

Diaphragmatic IOL can be fixated to the sclera in cases without capsular support or it can be implanted into ciliary sulcus after ECCE. Reconstruction of 5 mm pupil and intraocular correction of aphakia enable good visual rehabilitation of patients. The combined procedure of pars plana vitrectomy and scleral fixation of diaphragmatic lens is safe and effective in traumatic and congenital aniridia.

[Intraocular lens implantation in traumatic cataract]

PURPOSE

The evaluation of postoperative results and complications after traumatic cataract extraction with intraocular lens implantation.

MATERIAL AND METHODS

Forty two eyes of 41 patients (31 male and 10 female) aged from 10 to 66 years (mean 37.8) with traumatic cataract were the subject of our study. They were operated on between 1996 and 1997. A penetrating injury in 33 eyes (78.6%) and blunt trauma in 9 eyes (21.4%) caused the cataract. The interval between trauma and cataract surgery ranged from 1 day to 40 years. The mean follow up was 13.5 months. Despite of cataract corneal scars, pupil deformations, posterior and anterior synechiae were observed in most of the eyes. Extracapsular cataract extraction was performed in all cases. Posterior chamber IOLs were implanted in 33 eyes. Anterior vitrectomy and anterior chamber IOL implantation was performed in 9 eyes due to the lack of capsular support.

RESULTS

Very good or good visual acuity (5/5-5/16) was achieved in 71.4% of cases. Low visual acuity (below 5/50) was observed in 6 eyes (14.3%) because of severe damage to the retina, optic nerve atrophy or amblyopia. Fibrin reaction in anterior chamber (30.9%), hyphaema (19%) and haemophtalmus (4.8%) were the most severe postoperative complications.

CONCLUSIONS

An intraocular lens implantation in traumatic cataract, despite many postoperative complications, enables most of the patients to achieve satisfactory and useful vision. Patients with severe posterior segment damage do not benefit functionally from cataract surgery.

[The use of perfluorocarbon liquid in the surgical removal of lenses luxated to the vitreous cavity]

BACKGROUND

Removal of lenses dislocated to the vitreous cavity can be hazardous. The use of perfluorocarbon liquids during pars plana vitrectomy may reduce the risk of intraoperative and postoperative complications. We report our experience in using this surgical technique.

MATERIAL AND METHODS

The authors describe a series of 14 patients in whom a posteriorly dislocated crystalline (11 eyes) or intraocular (3 eyes) lens was successfully removed with the use of perfluorodecalin through the limbal incision. Simultaneously, posterior chamber, scleral fixation IOLs were implanted in 10 cases and anterior chamber IOL in one case. In one patient AC IOL was implanted secondarily.

RESULTS

With a minimum follow-up of one month (average, 8 months), the visual acuity improved in 4 eyes, remained the same in 10, and worsened in one eye. Very good visual acuity (5/5-5/10) was achieved in 86% of patients. Complications were not frequent and not severe despite one case of retinal detachment.

CONCLUSIONS

Application of pars plana vitrectomy and the use of liquid perfluorocarbon allow for the safe management of eyes with luxated lenses.

[Corneal sensitivity in patients undergoing extracapsular cataract extraction with posterior chamber intraocular lens implantation]

PURPOSE

To evaluate pre- and postoperative corneal sensitivity in patients undergoing ECCE with PC IOL implantation.

SETTING

Department of Ophthalmology, Medical University of Lódź.

MATERIAL AND METHODS

One hundred and twenty patients (age range: 33-92 years) were examined for corneal sensitivity with electroaesthesiometer before surgery and after 4, 14 days, and 3, 6 months postoperatively. The measurements were performed in 5 different locations of the cornea in each case. In 41% of patients we found coexisting diseases such as glaucoma, myopia, diabetes and other.

RESULTS

Corneal sensitivity decreased postoperatively. The lowest mean value was observed 3 months after surgery. It increased after next 3 months, but was still lower than preoperatively. The preoperative sensitivity was lower in the group of patients with coexisting diseases, while its postoperative decrease was relatively smaller.

[Secondary intraocular lens implantation]

PURPOSE

To analyse results of secondary intraocular lens implantation in aphakic eyes.

MATERIAL AND METHODS

Sixty five eyes of 63 patients (23 females and 40 males) had secondary intraocular lens (IOL) implantation, from December 1996 to April 1997. Follow-up was from 1 to 21 months. An anterior chamber lens was used in 51 eyes (78.5%) and a posterior chamber lens in 14 eyes (21.5%); these included 6 cases of trans-scleral fixated lenses. The most common reason for secondary implantation was to relieve the discomfort caused by spectacles or contact lenses.

RESULTS

Final postoperative visual acuity of 20/40 or better was achieved in 77% of the eyes. The most common postoperative complications were: pupil deformation, transient corneal edema and hyphema. One eye developed endophthalmitis requiring pars plana vitrectomy and one eye had cystoid macular edema.

[Astigmatism after extracapsular cataract extraction with intraocular posterior lens implantation]

PURPOSE

To evaluate early and late astigmatism appearing after extracapsular cataract extraction with PC IOL implantation.

MATERIAL AND METHODS

Astigmatism was examined in one hundred consecutive patients before operation and one week, 6 months and 12 months postoperatively.

RESULTS

During the first week after surgery most patients (82%) had with the rule astigmatism, which decreased gradually from 3.95 D cyl (mean value) to 0.08 D cyl after a year. Against the rule astigmatism was present in 14% of cases and increased from 2.40 D cyl (mean value) to 3.07 D cyl in the same period of time. On the last examination 35% of patients didn't use any astigmatic correction.

CONCLUSIONS

Traditional ECCE with PC IOLs causes postoperative astigmatism in most patients. Majority of them has with the rule astigmatism, which decreases gradually during the first postoperative year and may change into against the rule astigmatism.

[Cataract surgery with intraocular lens implantation in cyclopia patients]

PURPOSE

To analyse results and complications of cataract surgery with IOL implantation in monopic patients.

MATERIAL AND METHODS

41 monopic patients underwent cataract surgery with IOL implantation during the period of 1995-1997. The follow up time ranged from 3 to 28 months (mean 16 months).

RESULTS

Intraoperatively there were 2 cases of posterior capsule tears with vitreous loss. Postoperatively, transient hypertonia in 4 eyes, Descemet's membrane folds in 15 eyes, and fibrinous reaction in anterior chamber in 2 eyes were observed. 71% of patients achieved visual acuity of 5/5-5/12.

CONCLUSION

Monopia should not be considered as a contraindication for IOL implantation, although special attention should be paid to choosing the proper time of operation, which should be performed extremely carefully by an experienced surgeon.

Pars plana vitrectomy, lensectomy, or extraction in transscleral intraocular lens fixation for the management of dislocated lenses in a family with Marfan's syndrome

BACKGROUND AND OBJECTIVES

Congenital lens subluxation may be a difficult therapeutic problem. Surgical treatment options include iris manipulation or lens decision, aspiration, intracapsular or extracapsular extraction, and lensectomy through the pars plana. It is not established which kind of aphakic correction is the most appropriate in these cases.

PATIENTS AND METHODS

A father and his two sons with Marfan's syndrome were operatively treated for lens dislocation in both eyes. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in three eyes and with an intracapsular method in three eyes. The outside-in scleral fixation technique was used for primary posterior chamber intraocular lens (PC IOL) implantation in all cases.

RESULTS

All eyes achieved good visual acuity (20/20-20/25). Time of observation ranged between 8 and 20 months. There were no intraoperative or post-operative complications.

CONCLUSION

Pars plana vitrectomy and primary scleral-fixated IOL implantation is a safe procedure and gives good visual rehabilitation in adult patients with Marfan's syndrome.