Glaucoma Surgery and Ocular Blood Flow in Colour Doppler Imaging: Is There a Link?

Glaucoma is a common cause of blindness worldwide. This disease is characterised by increased intraocular pressure (IOP) and the concomitant disruption of ocular haemodynamic. Several studies have demonstrated that trabeculectomy is associated with changes in extraocular blood flow. In this study, we reviewed the available evidence on the use of colour Doppler imaging to evaluate and manage patients with open-angle glaucoma. We present the detailed anatomy of ocular blood flow to provide a background for the research findings. We also discuss the physiological foundations of ocular blood flow and detailed flow characteristics of specific extraocular vessels. Finally, we reviewed published studies that analysed the effects of glaucoma surgery on the blood flow parameters of the eye.

Changes to glaucoma surgery patterns during the coronavirus disease 2019 pandemic: a shift towards less invasive procedures

PURPOSE

The aim of the study was to compare the quantity, type of glaucoma surgeries, and the disease stage before and during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This was a retrospective, single-centre consecutive case series that included medical records of patients who underwent glaucoma surgery at the University Hospital in Białystok between 4 September, 2018, and 3 March, 2020 (pre-pandemic group) and compared it with patients treated between 4 March, 2020, and 4 September, 2021 (pandemic group). Adult patients with primary or secondary open-angle or closed-angle glaucoma who underwent surgery were included in this study. Finally, 534 operated eyes (362 and 172 eyes operated on before and during the pandemic, respectively) were examined.

RESULTS

The number of glaucoma surgeries dropped by 50% during the pandemic compared to a similar pre-pandemic period, with a significant difference in the kind of procedure between the two groups (p < 0.001). The most common procedures in the pre-pandemic group were Ex-Press implantation (33.7%) and trabeculectomy (31.5%). Within the pandemic group, half of the eyes underwent trabeculectomy (50.0%), followed by Preserflo microshunt (11.6%), iStent (8.7%), and transscleral cyclophotocoagulation (TSCP) (8.7%). A significant difference in the average intraocular pressure was revealed among patients who qualified for surgery.

CONCLUSION

The COVID-19 pandemic is associated with a decrease in the number of extended antiglaucoma procedures and an increase in the number of short procedures performed, such as TSCP and minimally invasive glaucoma surgery.Key MessagesOur study has shown the negative impact of the COVID-19 pandemic in reducing the number of antiglaucoma procedures.The number of glaucoma surgeries dropped by 50% during the pandemic compared to those in a similar pre-pandemic period, and the type of performed procedures has changed.The COVID-19 pandemic is associated with a decrease in the number of combined antiglaucoma procedures, in opposite: the number of minimally invasive glaucoma surgeries increased due to safety reasons.

First-Generation iStent Bypass Implantation versus ab Externo Canaloplasty Combined with Phacoemulsification in Patients with Primary Open Angle Glaucoma-12-Month Follow-Up

This prospective, non-randomized, interventional clinical study evaluated the efficacy and safety profile of first-generation iStent bypass implantation versus ab externo canaloplasty, both combined with phacoemulsification, in patients with primary open-angle glaucoma (POAG) after 12-month follow-up. A total of 138 patients with POAG and their 138 eyes (69 phaco-iStent and 69 phacocanaloplasty) were included. Postoperatively at 12 months, the mean intraocular pressure (IOP) decreased from 18.44 ± 3.88 to 15.51 ± 2.50 mmHg and from 17.20 ± 4.04 to 14.97 ± 2.37 mmHg in the phaco-iStent (PiS) and phacocanaloplasty (PC) groups, respectively (p = 0.480). In both groups, 35.7% achieved >20% IOP reduction from baseline. A total of 86% and 71.4% of the eyes were medication-free at 12 months in the PiS and PC groups, respectively. In both groups, all eyes showed improvement in best-corrected visual acuity compared with baseline and demonstrated similar safety profiles throughout the 12-month follow-up period. This study showed equal hypotensive effects of PiS and PC. Both procedures significantly reduced the IOP and the requirement for IOP-lowering medications for at least 12 months postoperatively, with no significant differences between the groups.

Pros and Cons of Immediate Sequential Bilateral Cataract Surgery from a Patient Perspective: A Survey

The aim of the study was to analyze patients' experiences with immediate sequential bilateral cataract surgery (ISBCS). An anonymous survey was sent by post to patients who underwent ISBCS between 1 May 2020 and 30 April 2022. A total of 195 participants completed the survey. Specifically, 94.6% of the respondents were satisfied with the possibility of having both eyes treated during one surgical procedure, 89.7% would choose ISBCS again if offered a choice, and 89.2% would recommend this procedure to their family members. ISBCS provided a subjective benefit for 84.6% of the respondents. The most commonly reported ISBCS-related problems were the necessity to sleep in a supine position (32.8%), inability to read shortly after the surgery (27.7%), having both eyes protected with a dressing (24.6%), and application of eyedrops to both eyes at the same time (17.4%). All patients were able to identify some pros of ISBCS, with the most common being single stay in the operating room (82.6%), lower number of visits to the clinic (62.6%), quick normalization of eyesight (61%), time savings for family members (54.9%), quick adjustment of reading glasses (32.3%), and economical aspects (23.6%). The perception of difficulties associated with ISBCS and the benefits offered by this procedure differed depending on patients' gender, age, marital status, education, place of residence, occupational activity, level of care dependence, and everyday activities. Understanding patients' opinions about ISBCS provides insight into the advantages and disadvantages of this procedure from a broader perspective.

Efficacy and Safety of ab Externo Phaco-Canaloplasty versus First-Generation iStent Bypass Implantation Combined with Phacoemulsification in Patients with Primary Open Angle Glaucoma-Early Results

This study evaluated the early outcomes of the hypotensive efficacy and safety profile of ab externo phaco-canaloplasty versus first-generation iStent bypass implantation combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). In total, 82 patients with POAG comprising 92 eyes were divided into phaco-canaloplasty (Group PC, (n = 47) or iStent combined with phacoemulsification (Group PiS, n = 45) groups. Primary outcome measures were intraocular pressure (IOP) reduction and number of glaucoma medications. Secondary outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (EECD), changes in anterior chamber depth (ACD), and complication rate. The follow-up period was approximately 6 months. Preoperative IOPs were 17.30 (15.00; 19.85) mmHg and 17.50 (15.10; 20.90) mmHg in the PC and PiS groups, respectively (p = 0.876). At the end of the follow-up, IOP decreased to 15.00 (13.00; 16.00) mmHg and 15.00 (14.00; 17.00) mmHg in the PC and PiS groups, respectively (p = 0.438). Medication usage decreased from 2.08 to 0.12 and 1.40 to 0.04 in PC and PiS eyes, respectively. Most patients in both groups were medication-free at 6 months follow-up. After 6 months of observation, EECD in PC and PiS groups decreased from 2309.50 (2032.00; 2533.00) to 1966.50 (1262.00; 2353.50) and 2160.00 (1958.50; 2372.50), to1231.00 (1089.00; 2050.00), respectively (p = 0.037). Pre-surgery BCVA was 0.80 (0.50; 1.00) and 0.60 (0.40; 1.00) in PC and PiS eyes, respectively (p = 0.456). Follow-up BCVA was 0.95 (0.60; 1.00) for PC and 1.00 (1.00; 1.00) for PiS. Hyphema and corneal oedema were noted on the first day post-surgery in both groups. Subsequent complications included a transient increase in IOP in the PC group. Phaco-canaloplasty and iStent bypass implantation combined with phacoemulsification significantly lowered IOP and decreased medication burden. All eyes in both groups maintained or exhibited improved BCVA relative to baseline. Both surgeries had low postoperative complication rates and exhibited comparable safety profiles over 6-month follow-up in patients with POAG.

Corneal Endothelial Cell Loss in Patients After Minimally Invasive Glaucoma Surgery: Current Perspectives

Minimally invasive glaucoma surgery (MIGS) is a rapidly expanding category of surgical glaucoma treatment options that offer a superior safety profile compared with traditional approaches for reducing intraocular pressure. However, MIGS may cause corneal endothelial cell loss; therefore, it has been receiving increasing attention. This systematic review aimed to evaluate and compare the rate and degree of corneal endothelial loss after MIGS. First, this paper presents an overview of the theoretical effectiveness of MIGS, the fundamental aspects regarding the roles of endothelial cells, and the effect of cataract surgery on the quality and count of endothelial cells. Further, we detail the various surgical techniques involved in MIGS, the development of these techniques over the time, and clinical aspects to consider with respect to the endothelial cell count. We discuss in detail the COMPASS-XT study, which was based on data collected over 5 years, reported that withdrawal of the CyPass Micro-Stent (Alcon Laboratories) yielded increased corneal endothelial cell loss. Generally, MIGS procedures are considered safe, with the incidence of complications ranging from 1% to 20% depending on the surgery type; however, there is still need for studies with longer follow-up. Thus, an adequate count of endothelial cells in the central cornea portion is recommended as necessary for candidate patients for MIGS.

Diet, Oxidative Stress, and Blood Serum Nutrients in Various Types of Glaucoma: A Systematic Review

Glaucoma is one of the most common causes of irreversible vision loss worldwide. It is an insidious disease with a multifactorial pathogenesis. Despite progress in treatment methods, prevention and lifestyle modifications may be useful in slowing the progression of this disease. This systematic review aimed to evaluate the influence of diet, oxidative stress, and disturbances in blood serum levels of nutrients on the incidence and severity of glaucoma based on scientific reports on the role of nutrition in the pathogenesis and course of glaucoma. This paper presents an analysis of the above issues; however, further research is required to develop this topic. Future clinical trials are needed to assess the influence of nutrition and to develop nutritional management strategies for patients with glaucoma.

Evaluation of the Effect of the First Generation iStent on Corneal Endothelial Cell Loss-A Match Case-Control Study

Glaucoma is the leading cause of irreversible blindness worldwide. The only proven factor in slowing the progression of glaucomatous neuropathy is lower intraocular pressure (IOP), which can be achieved with pharmacology, laser therapy, or surgery. However, these treatments are associated with various adverse effects, including corneal endothelial cell loss (CECL). In recent years, several novel surgeries for reducing the IOP, collectively referred to as minimally invasive glaucoma surgery (MIGS), have been developed, one of which is the iStent. However, the long-term effects of such surgeries remain unknown. We compared a group of patients with open-angle glaucoma and cataract who underwent phacoemulsification alone with a group of patients with similar demographic and clinical characteristics who underwent simultaneous phacoemulsification and iStent implantation. Overall, 26 eyes of 22 subjects who underwent a combined phacoemulsification-iStent procedure and 26 eyes of 24 subjects who underwent cataract surgery were included. Before surgery, endothelial cells accounted to 2228.65 ± 474.99 in iStent group and 2253.96 ± 404.76 in the control group (p = 0.836). After surgery, their number declined to 1389.77 ± 433.26 and 1475.31 ± 556.45, respectively (p = 0.509). There was no statistically significant difference in CECL between the two groups 18–24 months after surgery, despite increased manipulation in the anterior chamber and the presence of an implant in the trabecular meshwork in those with an iStent implant. Thus, iStent bypass implantation is a safe treatment in terms of CECL for mild-to-moderate open-angle glaucoma.

Impact of the COVID-19 pandemic on ophthalmic specialist training in Poland

The aim of this study was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on ophthalmology residency training in Poland. An anonymous self-administered online survey involving polish ophthalmology residents was conducted between February 15 and 28, 2021. Of the 126 residents who completed the survey, 88.9% (n = 112) and 89.7% (n = 113) felt that the COVID-19 pandemic had negatively impacted their surgical training and overall training programs, respectively. Trainees providing care to patients with COVID-19 and female trainees indicated a greater negative impact of the pandemic on the implementation of the specialization program (p = 0.008 and p = 0.015, respectively) and on the acquisition of practical skills (p = 0.014 and p = 0.021, respectively). Approximately 94% (n = 118) of the residents surveyed participated in virtual training during the pandemic, and 99.2% (n = 124) positively assessed the content and usefulness of online teaching in everyday clinical practice. The most common platforms used for online meetings were Zoom (62.7%, n = 79) and Microsoft Teams (50.8%, n = 64). Approximately 79% (n = 99) of residents believed that, after the pandemic is over, at least some of the training courses and conferences should be conducted online. In addition, 13.5% (n = 17) of residents reported that they would like to undergo training and specialization courses in virtual form only after the pandemic is over. In summary, the present findings indicate that the COVID-19 pandemic negatively impacted the implementation of the ophthalmology specialization program in Poland, with the greatest impact on surgical training. Trainees providing care to patients with COVID-19 are more likely to negatively assess the impact of the pandemic on the training process. Replacing traditional training with virtual methods was positively received by residents and considered very useful, and most residents reported a desire to maintain virtual training in ophthalmology in the future.

The Impact of Three Waves of the COVID-19 Pandemic on the Characteristics of Primary Rhegmatogenous Retinal Detachments at a Tertiary Referral Centre

Purpose

This study assessed the effect of three waves of the COVID-19 pandemic primarily on the number and timing of referrals due to rhegmatogenous retinal detachment (RRD) and secondarily on the demographic or clinical characteristics of patients.

Patients and Methods

A retrospective single-centre analysis of medical records included 247 eyes from 247 patients who underwent primary RRD repair with (phaco) vitrectomy between January 1, 2019, and May 31, 2021.

Results

The percentage of referrals due to primary RRD during the first year of pandemic (March 2020–February 2021) was 16.5% (p=0.179) lower than a year earlier. The percentage of referrals during the first, second and third wave of the pandemic was 48.4%, 18.5% and 26.1% (p=0.029, 0.475, 0.343) lower than in the corresponding months of 2019. A rebound effect was observed only after the first wave. The numbers of referrals in April and May 2021 were similar as in the corresponding months of 2019. No significant differences were observed in the demographic and clinical characteristics of patients admitted before and during the COVID-19 pandemic, other than a tendency towards a higher representation of women, younger persons, longer duration of symptoms but better visual acuity in the latter group. Silicone oil tamponade was used more frequently during the pandemic than before.

Conclusion

In this study, the COVID-19 pandemic affected the number and timing of referrals due to RRD and the clinical but not demographic characteristics of the patients. The effect lessened with the duration of the pandemic. Previously raised concerns regarding the delay in RRD referrals may no longer be valid during a potential fourth wave of the pandemic. The impact of the pandemic’s waves should be analysed separately, as such an approach provides a better insight into the fluctuations in the number of referrals due to RRD than a year-to-year comparison.

Posterior Capsule Opacification: A Review of Experimental Studies

Posterior capsule opacification (PCO) is the most common complication of cataract surgery. It causes a gradual deterioration of visual acuity, which would otherwise improve after a successful procedure. Despite recent advances in ophthalmology, this complication has not been eradicated, and the incidence of PCO can be as high as 10%. This article reviews the literature concerning the pathomechanism of PCO and examines the biochemical pathways involved in its formation and methods to prevent this complication. We also review the reported tests performed in cell cultures under laboratory conditions and in experimental animal models and in ex vivo human lens capsules. Finally, we describe research involving human eyes in the clinical setting and pharmacological methods that may reduce the frequency of PCO. Due to the multifactorial etiology of PCO, in vitro studies make it possible to assess the factors contributing to its complications and search for new therapeutic targets. Not all pathways involved in cell proliferation, migration, and contraction of the lens capsule are reproducible in laboratory conditions; moreover, PCO in humans and laboratory animals may be additionally stimulated by various degrees of postoperative reactions depending on the course of surgery. Therefore, further studies are necessary.

Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review

Cataract surgery is one of the most frequently performed surgical procedures worldwide. Patients usually experience strong negative emotions, such as fear and anxiety. A systematic review of the recent literature regarding the emotional states experienced during cataract surgery under local anaesthesia was performed based on the PubMed and Scopus databases. The objective of this review was to determine the causes and frequency of fear and anxiety, as well as methods for improving intraoperative experience and supporting the patient prior to surgery. Anxiety is mainly caused by fear of the surgery itself, fright of pain, and loss of vision. Abstaining and visual sensations experienced during cataract surgery also increased the preoperative anxiety. Women and hypochondriacs showed higher levels of anxiety. The greatest intensity of negative emotions occurred on the day of the cataract surgery. Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. In order to reduce patients’ negative experiences, pharmacological sedation, preoperative education and counselling, manual massage immediately before surgery, and listening to music during surgery are used. Taking this information into consideration allows the introduction of effective methods of eliminating the patient’s negative feelings in connection with cataract surgery, which leads to an improvement in the results of the operation and an increase in the patients’ sense of satisfaction and quality of life.

Comparison of auditory sensations in patients who underwent cataract phacoemulsification surgery in the first and second eye

To compare subjective auditory sensations of patients during the first and second eye cataract surgeries. Consecutive patients who underwent phacoemulsification of the first eye (group I) and second eye (group II) completed questionnaires designed to evaluate their auditory sensations in the operating room including background music, sound of working equipment, staff conversations, and surgeon's voice. This study included 124 patients in group I and 76 patients in group II. Patients most often heard nursing staff's conversations (91.9% and 96%, respectively, p > 0.05), surgeon's voice (87.9% and 86.8%, respectively, p > 0.05), and music (70.9% and 75%, respectively, p > 0.05). Music was the most pleasant experience (78.2% and 78.9%, respectively, p > 0.05). The sound of the working phacoemulsifier was the most undesirable sound (20.2% and 15.8%, respectively, p > 0.05). Patients in group II more often indicated that none of the sounds required elimination (69.7% and 52.6%, respectively, p = 0.013) or that staff conversations should be eliminated (13.2% and 3.1%, respectively, p = 0.005). The most desirable sounds during phacoemulsification include music and the surgeon's voice regarding the procedure. The most unpleasant sound was that that of phacoemulsifier. The commonest sounds to be eliminated in groups I and II included those of equipment and staff conversations.

Subjective Opinions of Patients About Step-by-Step Cataract Surgery Preparation

Purpose

We analyzed the subjective feelings and opinions of patients regarding modified cataract phacoemulsification procedures.

Patients and Methods

A consecutive case series of patients undergoing phacoemulsification of cataracts, who completed questionnaires designed by the authors to evaluate their subjective opinions about hospital admission, medical examination, and intraoperative procedures carried out at the operating theater.

Results

Two hundred patients (82 men and 118 women) were included in the study. Subjects aged ≥65 years more often than younger respondents presented negative opinions about hospital admission procedures (15% vs. 2.5%, p=0.032) and were less satisfied with physicians’ explanations about the matter of phacoemulsification (71.3% vs. 92.5%, p=0.004), type of artificial lens to be implanted (43.8% vs. 85%, p<0.001), and potential complications (69.4% vs. 95%, p<0.001). The most unpleasant intraoperative experiences included venipuncture (35.5%), artificial lens implantation (30.5%), and peeling off of a sterile surgical drape (24%).

Conclusion

Persons aged ≥65 years presented with negative opinions about routine procedures related to phacoemulsification. Older age seems to be associated with less tolerance to time-consuming bureaucratic procedures and a lesser understanding of the specific stages of the surgery. Older patients should be notified in advance about all routine procedures to be carried out and provided with a rationale for these activities.

Trial Registration

The study was registered on clinicaltrials. gov (NCT04327856).

A prospective, randomised study of the effect of fixation sutures during phacotrabeculectomy on intraocular pressure and incidence of ptosis

We investigated the effects of different intraoperative eyeball fixation techniques (superior rectus muscle suture [MS] and traction suture at the corneal limbus [CS]), on intraocular pressure (IOP) and the incidence of ptosis after phacotrabeculectomy. Forty-one eyes with different glaucoma types which qualified for phacotrabeculectomy were included. Twenty-three and eighteen patients were included in the CS and MS groups, respectively. The IOP, best-corrected visual acuity (BCVA), and margin reflex distance were assessed preoperatively and 3, 6, and 12 months post-operatively. Preoperatively, the mean IOPs (± standard deviation) in the CS and MS groups were 23.6 ± 7.3 mmHg and 24.3 ± 6.6 mmHg (p > 0.05), respectively. At 3 and 6 months post-surgery, the mean IOPs were significantly lower in the CS group than in the MS group: 13.9 ± 3.0 mmHg vs. 17.7 ± 3.5 mmHg (p = 0.001), and 13.9 ± 4.9 mmHg vs. 17.2 ± 3.5 mmHg (p = 0.005), respectively (mean difference: 3.9, 95% confidence interval 1.7–6.1). At 12 months, the mean postoperative IOPs were 15.2 ± 3.5 mmHg and 14.9 ± 3.6 mmHg in the CS and MS groups, respectively (p > 0.05). At 6 months, the BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; the difference was non-significant 12 months post-surgery (0.78 ± 0.32 vs. 0.74 ± 0.30, p = 0.553). Postoperative ptosis was observed in 4 (17%) and zero patients in the CS and MS groups, respectively, but the difference was not statistically significant (p = 0.118). The study was not powered sufficiently to detect statistically significant changes in exploratory endpoints. The study was not powered sufficiently to detect statistically significant differences between groups in exploratory endpoints.

Clinical Features of Iris Cysts in Long-Term Follow-Up

This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.

Comparison of Subjective Preoperative Experiences of Patients Before First- or Second-Eye Cataract Surgeries

Purpose

To compare the subjective preoperative experiences of patients undergoing their first- or second-cataract surgeries.

Patients and Methods

Consecutive patients undergoing phacoemulsification were asked to complete postoperative questionnaires evaluating their subjective preoperative experiences, including their emotional state, decision-making process, and opinions on the admission and examination processes, medical interviews, and quality of service. The obtained data were compared between patients undergoing their first (group I)- or second (group II)-cataract surgeries.

Results

Two hundred patients (group I, 124; group II, 76) were included in the evaluation. Presurgical anxiety was more prevalent in group I than in group II (55.7% vs 34.2%, P = 0.005). Fear was the major trigger for reconsidering the decision to undergo surgery, with 29% and 13.2% of patients in groups I and II, respectively, considering abandoning the operation (P = 0.016). The preoperative medical examination was reported to be sufficiently accurate by 66.1% and 80.3% of patients in groups I and II, respectively (P = 0.047), while 28.2% and 21% of patients in groups I and II, respectively, did not understand the information presented about possible complications of surgery (P = 0.039). Administration of eyedrops before surgery was uncomfortable for 71.4% and 68.4% of patients in groups I and II, respectively (P = 0.553), while 22.6% and 9.2% of patients in groups I and II, respectively, found repeated administration of drops to be highly uncomfortable (P = 0.026).

Conclusion

Patients experienced greater anxiety before their first-cataract surgery than before their second-cataract surgery. Moreover, many patients from both groups did not understand the medical information provided by doctors regarding the surgery and its possible complications. The most unpleasant stage of preparation for cataract surgery was repeated administration of eyedrops.

Trial Registration

The study was registered on clinicaltrial.gov under the number NCT04327856.

Limitations of Color Doppler Sonography in the Imaging of Ocular Vessels

PURPOSE

To describe a case where detection of blood flow in the central retinal artery and the central retinal vein was limited by an artifact evoked by the optic disc drusen. METHODS Case report.

RESULTS

During color Doppler sonography, examination of optic disc drusen may generate an artifact--the so-called twinkling artifact--which can simulate blood flow and make evaluation of the central retinal vessels impossible.

CONCLUSIONS

Twinkling artifact does not allow evaluation of color Doppler sonography in the imaging of ocular vessels.

Early Intraocular Complications of Subarachnoid Haemorrhage after Aneurysm Rupture

The aim of this study was to identify factors predisposing for early intraocular complications of aneurysmal subarachnoid haemorrhage (SAH). The authors analysed 96 selected cases of aneurysmal SAH. Forty patients (42%) demonstrated abnormal fundus findings, including disc swelling (13.5%), retinal haemorrhages (23%), and vitreous haemorrhage (5%). The incidence of intraocular pathologies was significantly higher in patients who lost consciousness at the onset of SAH, were admitted with high scores of the Hunt-Hess and Fisher scales and low score of the Glasgow Coma Scale, as well as in those with arterial hypertension, more sizable aneurysm, and older.

Nutritional optic neuropathy

Nutritional optic neuropathy (aka deficiency optic neuropathy) is a dysfunction of the optic nerve resulting from improper dietary content of certain nutrients essential for normal functioning of the nerve fibers. Most commonly, it results from folic acid and vitamin B complex deficiency associated with malnutrition or poor dietary habits, incorrectly applied vegetarian diet, or chronic alcohol abuse. Obese patients after bariatric surgery constitute another risk group of optic neuropathy. Nutritional optic neuropathy is characterized by painless, gradually progressing, bilateral and symmetrical decrease in visual acuity, which can be accompanied by the color vision dysfunction. Progression of the neuropathy is associated with optic nerve atrophy, manifesting as complete disc pallor. Treatment of nutritional neuropathy includes dietary supplementation, aimed at compensating for the deficient nutrients. The treatment is mostly based on folic acid, vitamin B complex, and protein replacement, as well as eliminating risk factors of neuropathy. Early treatment commencement, prior to irreversible optic nerve atrophy, is a prerequisite of effective treatment. We would like to highlight this problem by presenting the case of a young woman in whom chronic use "water-based" diet resulted in anemia and bilateral nutritional optic neuropathy.

Ophthalmic manifestation of skull base metastasis from breast cancer

Background

There is a vast discrepancy between the incidence of skull base metastases reported in vivo and at autopsy. Asymptomatic character or unspecific symptoms make the diagnosis difficult, particularly in patients with no history of cancer. Our case illustrates a skull base metastasis from breast cancer, detected in a diagnostic process initiated by ophthalmologic examination.

Case Report

We report the case of a 53-year-old woman complaining of ptosis and diplopia, with concomitant loss of skin sensation within the right half of the forehead, and without any other worrisome symptoms or signs. Ophthalmic examination revealed impairment in eye movements, slight proptosis and corneal hypoesthesia on the right side, with normal pupillary light reflexes. The anterior and posterior segments of the eye were normal. Based on CT and MRI, an extensive tumor was detected, infiltrating the right orbit and the frontotemporal region of the skull base, and producing edema of the adjacent aspects of the brain. Aside from partial palsy of the oculomotor nerve and the ophthalmic division of the trigeminal nerve, no abnormalities were found on neurological examination. Explorative craniotomy and histopathological findings revealed a skull base metastasis from breast cancer.

Conclusions

Diplopia, ptosis, proptosis, and ophthalmic nerve sensory loss may be the only manifestation of a skull base metastasis. Careful ophthalmologic examination is crucial in early detection of this life-threatening condition.

Exophthalmos as a first manifestation of the systemic spread of small cell lung cancer

Small cell lung cancer is characterized by rapid growth and early metastases. The most frequent locations of the secondary lesions include adrenal glands, brain, liver, and skeleton. On initial diagnosis, up to 70% of patients with small cell lung cancer have metastases. Metastases to the eye or orbit developed approximately 0.7-12% of patients with lung cancer. Clinical signs and symptoms of orbital metastases may include exophthalmos, diplopia, pain, limited ocular motility, blurred vision, swollen eyelid, conjunctival hyperemia and edema, increased ocular pressure and papilledema. Here, we report a rare case of exophthalmos as the first manifestation of a metastatic tumor of orbit due to small cell lung cancer.

Left-sided hemianopia as an unrecognized symptom of brain tumor and head injury

Homonymous hemianopia (HH) is a visual field defect characterized by the involvement of two right or left halves of the visual field in both eyes. Patients with HH complain of difficulties with reading and scanning scenes in sufficiently rapid fashion to make sense of things as a whole. Some of these patients are not aware of their visual field defect. We report two cases of left-sided hemianopia in which visual field defects were detected "quite" accidentally. In the case of the first patient, revealing HH facilitated the detection of brain tumor and its treatment. In the case of the other patient, identifying HH, which was caused by a head injury, and making the patient aware of this fact, prevented potential harmful consequences associated with driving a car by a person with severe deficits in cognitive visual functions. homonymous hemianopia, brain tumor, head trauma.

Homonymous hemianopsia

Homonymous hemianopia (HH) is a visual field defect involving either two right or the two left halves of the visual field of both eye. It results from the damage of the visual pathway in its suprachiasmatic part. The causes of HH include stroke, brain tumors, head injuries, neurosurgical procedures, multiple sclerosis and miscellaneous conditions. HH result in a severe visual impairment and affect a variety of cognitive visual functions. Patients with HH frequently have difficulties with reading and scanning scenes in sufficiently rapid fashion to make sense of things as a whole. They stumble, fall or knock objects in their surroundings, since they cannot see them and they are frequent surprised that somebody or something suddenly appeared in their visual field. The prognosis of visual field deficit recovery is highly variable and depends on the cause and severity of brain nd optic pathway injury. The fundamental method in the management of HH patients is rehabilitation. Rehabilitation techniques used in HH include three groups of methods: optical therapies, eye movement-based therapies, and visual field restitution therapies.

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.