Optical coherence tomography angiography as a potential tool in differential diagnosis of multiple sclerosis and rheumatic disorders with central nervous system involvement.

PURPOSE: The aim of this study is to analyse whether optical coherence tomography angiography (angio-OCT, OCTA) measurements can be a useful tool to differentiate central nervous system (CNS) involvement in rheumatic disorders (RD) from multiple sclerosis (MS). METHODS: A total of 85 patients- 41 with MS, 21 with RD with CNS involvement and 23 healthy controls were included in the study. All individuals underwent OCTA and the following parameters were measured in each eye separately: average foveal and parafoveal vessel density (VD), average foveal and parafoveal vessel length (VL) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as area, perimeter, and circularity of the foveal avascular zone. RESULTS: OCTA showed a VD reduction in the foveal region of the SCP in eyes of RD patients when compared to MS patients (21.96 ± 3.39 vs.23.88 ± 3.05 (p = 0.003)). There have been no significant differences in any of the assessed parameters that is average VD and total average VL in the foveal area of the SCP as well as of the DCP in the general population comprising healthy controls, MS and RD groups (p > 0.05 for all). CONCLUSIONS: Our results suggest that an OCTA finding of decreased VD in the foveal region of the SCP may be considered as a potentially useful biomarker of RD in comparison with MS patients.

The influence of corneal tunnel length on surgically induced astigmatism after various types of microincision phacoemulsification.

PURPOSE: To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques. METHODS: Patients who underwent a planned phacoemulsification surgery with an implantation of a foldable, acrylic IOL were selected for the study. All surgeries were performed under topical anaesthesia, with the same phaco machine. Group I consisted of 30 eyes of 30 patients after bimanual 1.4 mm microincision cataract surgery (B-MICS). Group II consisted of 30 eyes of 30 patients after coaxial 1.8 mm microincision cataract surgery (C-MICS). Group III consisted of 30 eyes of 30 patients after coaxial 2.4 mm small incision cataract surgery (C-SICS).Best corrected visual acuity, autorefractometry, tonometry, a slit lamp examination and anterior segment OCT were performed preoperatively and 1, 7, 30 and 90 days postoperatively. The temporal peripheral corneal thickness and the chord length of the main incision were measured. Vector method was used to calculate SIA. RESULTS: Mean preoperative BCVA was 0.52 ± 0.19 and it improved to 0.98 ± 0.05 (p < 0.05). Mean corneal tunnel chord length was 1.30 ± 0.16 mm 90 days postoperatively in group I, 1.30 ± 0.19 mm in group II and 1.48 ± 0.22 mm in group III. SIA was 0.54 ± 0.48 mm in group I, 0.45 ± 0.21 mm in group II and 0.62 ± 0.30 mm in group III. There were no correlations between the chord length of the corneal tunnel and SIA calculated with using vector analysis method. CONCLUSIONS: Unlike the incision width, the length of the clear corneal tunnel in small incisions and microinicions, has no significant influence on SIA.

The Role of Optical Coherence Tomography in Differential Diagnosis of Multiple Sclerosis and Autoimmune Connective Tissue Diseases with CNS Involvement.

The purpose of this study was to examine whether application of optical coherence tomography (OCT) measurements can provide a useful biomarker for distinguishing central nervous system (CNS) involvement in autoimmune connective tissue diseases (CTD) from multiple sclerosis (MS). An observational study included non-optic neuritis eyes of 121 individuals: 59 patients with MS, 30 patients with CNS involvement in CTD, and 32 healthy controls. OCT examination was performed in all subjects to measure retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, ganglion cell layer-inner plexiform layer (GCIPL) thickness, and volume of the macula. There was a significant group effect with regard to superior optic disc RNFL, macular RNFL, GCC, and GCIPL thickness, and macular volume. Post-hoc analysis revealed that MS patients have significantly smaller macular volume and thinner superior optic disc RNFL, macular RNFL, GCC, and GCIPL compared to healthy controls. CTD patients have significantly smaller superior optic disc RNFL, GCIPL, and GCC thickness compared to healthy controls. However, no significant group differences were observed between the patient groups (MS vs. CTD) on any outcome. Although a prominent retinal thinning may be a useful biomarker in MS patients, in a general population of individuals with a confirmed CNS involvement the use of OCT is not specific enough to discriminate between MS and autoimmune CTD.

Medial patellofemoral ligament reconstruction in children: A comparative randomized short-term study of fascia lata allograft and gracilis tendon autograft reconstruction.

BACKGROUND: Many surgical procedures have been described to treat recurrent patellar dislocation, but none of these techniques has been successful in all patients. The goal of the study was to evaluate the results of medial patellofemoral ligament reconstruction in children. Two operative procedures were evaluated; a fascia lata allograft and an autologous gracilis graft. METHODS: Forty-four children (27 girls and 17 boys) between 13 and 17 years of age with unilateral recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction. Patients were operated in two orthopedic centers. The 1st group contained 22 patients and surgery was performed using a fascia lata allograft. In the 2nd group of patients which also contained 22 children and autologous gracilis graft was used. The mean age of the patients was 14.9 years and the mean follow-up was 24 months. Preoperatively, all patients were evaluated clinically (Kujala score questionnaire) and radiologically. The same evaluation was used 18 to 30 months postoperatively to estimate the results of our treatment. RESULTS: In 1st group of children operated with cadaver allografts, the Kujala score significantly improved from 73.91 points preoperatively to 94.50 points postoperatively (P < .001). The average duration of operating procedure was 1 hour and 35 minutes. As shown by subjective symptoms, the results in 95% of patients were rated as good or very good. All children returned to full activity. Similar results were obtained in patients in 2nd group, where MPFL was reconstructed with ipsilateral gracilis tendon. Kujala score increased from 70.77 points preoperatively to 94.32 postoperatively (P < .001). Our results were estimated as good or very good in 93% of patients. All patients that were operated returned to full activity. However, median duration of operation was longer and lasted 1 hour and 55 minutes. CONCLUSIONS: Both techniques were effective in the short-term (18-30 months) in treatment of recurrent patellar dislocation. The use of cadaver allograft spares the hamstring muscles and reduces the time of surgery. Therefore, such study appears to be useful because it provides valuable information that would help to guide treatment of this condition in children. Level of evidence II-2.

The influence of concomitant medial wall fracture on the results of orbital floor reconstruction.

INTRODUCTION: Up to 35% of orbital floor fractures extend to the medial wall. This results in restriction of both abduction and adduction, leading to horizontal diplopia. The greater the defect, the more pronounced the enophthalmos. AIM OF THE STUDY: The aim of the study was to determine the influence of concomitant medial wall defects on enophthalmos and diplopia, and the influence of intraoperative revision on the results of surgical reconstruction in patients with orbital floor fracture. MATERIAL AND METHODS: 78 cases of orbital floor fracture, with or without concomitant medial wall defect, were retrospectively analyzed. Reconstruction surgeries were performed in a similar fashion, but with variation in the alloplastic materials used. Careful investigation of the area was performed during the surgery. RESULTS: Patients with associated medial wall defects had significantly more pronounced enophthalmos than those with isolated floor fracture, with no such difference after the orbital reconstruction. Postoperative vertical diplopia was more common in patients with an associated medial defect. CONCLUSIONS: Associated medial wall defect leads to more severe enophthalmos at presentation. However, if the medial aspect of the orbital wall is revised properly, postoperative outcomes are not inferior to those in cases of isolated floor fracture.

Bilateral congenital torticollis: a case report with 25 years of follow-up.

Unilateral congenital sternocleidomastoid muscle (SCM) contracture causing torticollis is well known. Although the unilateral muscular torticollis is quite often recognized, a bilateral contracture of SCM muscle is very rare. A review of the literature showed only three cases of bilateral congenital torticollis reported over the last two decades. We present a case report of a boy with congenital bilateral torticollis with 25 years of follow-up. Bilateral tenotomies of the right SCM were performed and the child was immobilized in Schanz's cervical orthosis. Three months after operative procedure, the physical examination indicated an increasing contracture of the left SCM with time. A similar operative procedure was applied to the left SCM. The follow-up examinations showed good wound healing and a positive outcome. Bilateral congenital muscular torticollis is a very rare form of muscle skeletal disorder. We describe a surgical treatment of such deformation that ended with a satisfactory result confirmed through a 25-year follow-up.

Intraoperative floppy iris syndrome ­ epidemiology and clinical assessment.

Purpose: To assess the incidence, and to identify medications and clinical features associated with intraoperative floppy iris syndrome in patients undergoing cataract surgery. Material and methods: The non-randomized, observational, prospective study was performed in 616 eyes (610 patients) after cataract surgery to determine the incidence of intraoperative floppy iris syndrome and the medications associated with its higher prevalence. We used a slit lamp adapted optical coherence tomography to evaluate anterior segment of 155 eyes (154 patients), measuring pupil diameter before and after the use of mydriatics and assessing the pre-dilated iris thickness at the dilator and sphincter muscle region. Results: The overall incidence of intraoperative floppy iris syndrome was 4% (25/616 eyes). The highest prevalence of intraoperative floppy iris syndrome was shown in patients exposed to tamsulosin (39%). Pupil diameter in mm before and after mydriasis was significantly smaller in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (pre-dilated ­ 1.85 ± 0.43 vs. 2.16 ± 0.37; p < 0.01; dilated ­ 5.04 ± 1.01 vs. 5.70 ± 0.87; p < 0.01). The thickness of the iris in sphincter muscle region in µm was similar in patients with and without intraoperative floppy iris syndrome (520.3 ± 76.1 vs. 520.6 ± 72.4; p > 0.05). Significantly thinner iris in dilator muscle region was found in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (409.9 ± 55.7 vs. 448.6 ± 55.8; p < 0.05). The presence of intraoperative floppy iris syndrome was correlated with a higher risk of intraoperative complications. Conclusions: Patients with intraoperative floppy iris syndrome have decreased pupil diameter and a thinner iris in dilator muscle region. Slit lamp optical coherence tomography is a useful device to preoperatively detect clinical features associated with intraoperative floppy iris syndrome. These findings may warn the surgeon of potential intra-operative difficulties. Slowa kluczowe: zespól sródoperacyjnie wiotkiej teczówki (IFIS), epidemiologia, operacja zacmy, optyczna koherentna tomografia skojarzona z lampa szczelinowa (sl-OCT).

Prospective analysis of outcomes of cataract phacoemulsification with the implantation of the Crystalens accommodative intraocular lens. / Prospektywna ocena wyników fakoemulsyfikacji zacmy z wszczepieniem wewnatrzgalkowej soczewki akomodacyjnej Crystalens.

Objectives: To evaluate visual outcomes after bilateral implantation of Crystalens accommodative intraocular lenses. Material and methods: The study group consisted of 20 patients (40 eyes) who underwent uneventful phacoemulsification through a 2.8 mm wide clear corneal incision followed by the implantation of an accommodative intraocular lens Crystalens HD or Crystalens AO. Uncorrected visual acuity, best corrected visual acuity, distance corrected intermediate visual acuity, distance corrected near visual acuity, best near visual acuity 1, 3, 6, 12 months postoperatively were evaluated. Distance visual acuity was measured with Snellen test. Near (40 cm) and intermediate (80 cm) visual acuity were measured with Jeager test. Results: The mean uncorrected distance visual acuity was 0.94 and 0.89 at month 1. and 12., respectively. The distance corrected intermediate visual acuity was 0.9 and 0.86 at month 1. and 12., respectively. The distance corrected near visual acuity was J1 in 10% and J3 in 50% of patients at month 1. It was J1 in 10% and J3 in 55% of patients at month 12. Conclusions: Crystalens intraocular lens implantation in our patients enabled them to achieve good distance, near and intermediate visual acuity. The majority of patients did not require spectacle correction for distance and near (87.5% and 65%, respectively). The achieved results did not differ significantly at months 1., 6., and 12. postoperatively.

The effect of corneal tunnel length in patients after standard phacoemulsification through a 2.75 mm incision on surgically induced astigmatism, corneal thickness and endothelial cell density.

PURPOSE: The purpose was to determine the effect of the corneal tunnel length in the 2.75 mm wide clear corneal incision, created during phacoemulsification on surgically induced astigmatism, central corneal thickness and corneal endothelial cell loss. MATERIAL AND METHODS: The study comprised 27 eyes (27 patients) who underwent phacoemulsification through 2.75 mm temporal clear corneal incision. Patients were examined preoperatively, 1 day, 7 days and 1 month postoperatively. Exclusion criteria were: previous intraocular surgery, corneal disorders and previous ocular trauma. Best corrected distance visual acuity, keratometry, slit-lamp examination, anterior segment optical coherence tomography and corneal endothelial cell density measurement were performed. Surgically induced astigmatism was calculated with vector method. Statistical analysis was done using non-parametric tests: Wilcoxon test, Mann-Whitney U test and Spearmann correlation coefficient. RESULTS: Mean best-corrected distance visual acuity was 0.30±0.24 preoperatively and 0.94 ± 0.18 postoperatively (p<0.05). Mean corneal incision length 1 day postoperatively was 1.84±0.36 mm. Surgically induced astigmatism was 0.51 ± 0.41 D one month postoperatively. Clear corneal incision length and surgically induced astigmatism were positively correlated (p<0.05). Mean central corneal thickness was 0.51 ± 0.05mm preoperatively, 0.56± 0.09 mm one day and 0.51 ±0.05 mm one month postoperatively (p <0.05). Clear corneal incision length and central corneal thickness 30 days postoperatively were not corrdlated (p=0.27). Mean corneal endothelial cell density was 2483?417 cells/mm² preoperatively and 2325 ± 410 cells/mm² postoperatively. The difference was significant (p<0.05). Clear corneal incision length and corneal endothelial cell loss were not correlated (p>0.05). CONCLUSIONS: The results suggest that the length of the 2.75 mm clear corneal incision influences the surgically induced astigmatism, but it doesn't influence the central corneal thickness and corneal endothelial cell loss. Shorter clear corneal incisions induce smaller surgically induced astigmatism in comparison with longer incisions of the same width and localization. Unequivocal confirmation.of the influence of clear corneal incision length on surgically induced astigmatism requires further investigation on a larger group of patients. Using laser techniques could help, as it would enable to examine patients in groups with different predefined clear corneal incision lengths.

Visual outcomes, binocular vision and subjective accommodation after Crystalens HD accommodating intraocular lens implantation. / [Ocena ostrosci wzroku, widzenia obuocznego i subiektywnej akomodacji po wszczepieniu soczewek akomodacyjnych Crystalens HD].

Objective: To evaluate visual acuity, binocular vision and subjective accommodation in patients after Crystalens HD accommodating intraocular lenses (IOLs) or monofocal IOLs implantation. Material and methods: 75 consecutive patients (aged 48 to 75 years) after bilateral cataract surgery with acrylic monofocal IOL (n = 36) or single-optic accommodating IOL (Crystalens HD) (n = 19) implantation and healthy presbyopic population (n = 20) were enrolled. Presence of asthenopic symptoms, diplopia and spectacle dependence was assessed. Orthoptic status, prism bar and amblyoscopic motor fusion, Frisby Near Stereotest, TNO and Titmus tests were performed. Convergence and subjective accommodation were evaluated using Krimsky-Prince rule. Results: Asthenopic symptoms were present respectively in 36.1%, 15.8% and 35.0% of patients and spectacle dependency was reported by 86.1%, 21.1% and 85.0% of patients in subsequent groups. Negative fusional distance vergence means were 9.53 ± 5.53, 8.05 ± 3.66, 6.65 ± 5.33 respectively (p = .039). Negative fusional near vergence means were 26.53 ± 11.39, 28.68 ± 11.70, 20.75 ± 12.60 in subsequent groups (p = .001). Mean subjective right eye/ left eye accommodation was 5.01 ± 1.47/ 4.86 ± 1.72, 6.29 ± 2.33/ 6.02 ± 1.90, 4.13 ± 0.89/ 4.22 ± 1.3 respectively (p = .009). There were no statistically significant differences between groups in positive fusional vergence, stereoacuity and near point of convergence. Conclusions: Bilateral accommodating IOL implantation provided full binocular vision in the majority of patients. Spectacle dependence and asthenopic symptoms were less frequent in patients with accommodating IOLs. Accommodating IOLs provided significantly better useful accommodation than monofocal IOLs.

Treatment outcomes of pars plana vitrectomy in patients with Benson's disease.

Introduction: In Benson's disease (scintillatio albescens or asteroid hyalosis) slight, white condensations of phospholipids are seen in the vitreous. In advanced stages, the decrease of visual acuity or subjective discomfort of vision may follow due to floaters. The pars plana vitrectomy is the treatment of choice in these patients. Purpose: To evaluate surgical treatment outcomes in Bensons' disease. Material and methods: The research was carried out in a group of patients with Benson's disease, who had undergone 23G or 25G pars plana vitrectomy in 2012­2014. The evaluated data included: diagnosis, the pre- and postoperative best corrected visual acuity as well as the pre- and postoperative ocular ultrasound (B scans). The study group consisted of 7 patients (8 eyes), including 5 men and 2 women, at the age of 66 to 82 years (mean age of 74 years). Results: In 5 patients with concomitant cataract, combined procedures of phacoemulsification and pars plana vitrectomy were performed. In one patient, pars plana vitrectomy was done first followed by phacoemulsification with intraocular lens implantation at a later date. In two cases, only pars plana vitrectomy was performed. All patients were examined 7 days postoperatively and the follow up period ranged from 1 month to 1 year (mean follow up duration of 8 months). Visual acuity and subjective comfort of vision improved in all cases. Conclusions: Pars plana vitrectomy enables improvement of visual acuity and subjective comfort of vision in patients with Benson's disease. It was confirmed in both subgroups, i.e. in patients who underwent both pars plana vitrectomy and phacoemulsification with intraocular lens implantation, and those in whom only vitrectomy was performed

Phacoemulsification with implantation of Morcher aniridia capsular rings for postoperative atonic pupil after iridencleisis--case report.

INTRODUCION: Large iris defets, anirdia or wide atonic pupil may cause disturbing photoptic phenomena my require surgical treatment. In acquired iris defects, ophthalmologists have a relatively wide choice of therapeutic strategies, which depend on the size and etiology of the defect and the comorbidities. The goal of treatment is to restore iris diaphragm and to reconstruct the pupil in order to prevent glare and to increase the quality of perceived image. CASE REPORT: We present a case of cataract and unilateral wide, atonic pupil in a patient 39 years after iridencleisis, who complained of intense glare in the left eye and photophobia ever since. The patient was successfully treated by phacoemulsification through a 2.75 mm clear corneal incision with implantation of two black Morcher aniridia capsular rings. The patient experienced a significant improvement in her subjective quality of vision and a constant glare that she had been experiencing for years resolved. CONCLUSION: The presented case indicates that Morcher aniridia capsular rings may be a good tool instrument to assist the surgeon in cases of cataract concomitant with wide and atonic pupil. Using these rings reduces glare and improves the subjective quality of patients' vision.

The influence of a prolonged interoperative period on binocular vision after bilateral cataract extractions.

PURPOSE: To evaluate the influence of the extent of the interoperative period on binocular vision function in patients after consecutive bilateral cataract extractions and intraocular lens implantation. METHODS: The study included patients operated due to bilateral cataract. Presence of asthenopic symptoms, distance and near squint angle, fusional amplitudes, stereopsis, and convergence were evaluated. Preoperative, interoperative, and postoperative differences in best-corrected visual acuity between eyes were also noted. Multivariate analysis was conducted in order to establish the relation between the interoperative period and binocular status. RESULTS: The study included 104 patients (74 female, 30 male, mean age 69.9 years, range 32-88). Mean interoperative period was 20.3 ± 12.9 months, range 1.5-47.7. Prolongation of the interoperative interval had a significant negative impact on stereopsis measured by TNO (R2 = 0.215, p = 0.001) and Randot (R2 = 0.179, p = 0.001) stereotests, as well as for near point of convergence (R2 = 0.09, p = 0.002). It was also related, but not independently, to reduction in fusional amplitudes, mainly for distance (R2 = 0.18, p = 0.001 for divergence and R2 = 0.12, p = 0.001 for convergence). Asthenopic symptoms were reported by 17 (16.3%) patients. The incidence of exophoria was significantly (p = 0.002) higher in patients with an interoperative interval longer than 24 months. CONCLUSIONS: The length of the interoperative period influences the status of binocular vision in patients after bilateral cataract extraction. It is also connected with an increased number of patients with asthenopic symptoms and exophoria.

Evaluation of white-to-white distance and anterior chamber depth measurements using the IOL Master, slit-lamp adapted optical coherence tomography and digital photographs in phakic eyes.

INTRODUCTION: The accurate measurement of the anterior chamber internal diameter and depth is important in ophthalmic diagnosis and before some eye surgery procedures. The purpose of the study was to compare the white-to-white distance measurements performed using the IOL-Master and photography with internal anterior chamber diameter determined using slit lamp adapted optical coherence tomography in healthy eyes, and to compare anterior chamber depth measurements by IOL-Master and slit lamp adapted optical coherence tomography. MATERIAL AND METHODS: The data were gathered prospectively from a non-randomized consecutive series of patients. The examined group consisted of 46 eyes of 39 patients. White-to-white was measured using IOL-Master and photographs of the eye were taken with a digital camera. Internal anterior chamber diameter was measured with slit-lamp adapted optical coherence tomography. Anterior chamber depth was measured using the IOL Master and slit-lamp adapted optical coherence tomography. Statistical analysis was performed using parametric tests. A Bland-Altman plot was drawn. RESULTS: White-to-white distance by the IOL Master was 11.8 +/- 0.40 mm, on photographs it was 11.29 +/- 0.58 mm and internal anterior chamber diameter by slit-lamp adapted optical coherence tomography was 11.34?0.54 mm. A significant difference was found between IOL-Master and slit-lamp adapted optical coherence tomography (p<0.01), as well as between IOL Master and digital photographs (p<0.01). There was no difference between SL-OCT and digital photographs (p>0.05). All measurements were correlated (Spearman p<0.001). Mean anterior chamber depth determined using the IOL-Master was 2.99 +/- 0.50 mm and by slit-lamp adapted optical coherence tomography was 2.56 +/- 0.46 mm. The difference was statistically significant (p<0.001). The correlation between the values was also statistically significant (Spearman, p<0.001). CONCLUSIONS: Automated measurements using IOL-Master yield constantly higher values than measurements based on direct eye visualization slit-lamp adapted optical coherence tomography and digital photographs. In order to obtain accurate measurements of the internal anterior chamber diameter and anterior chamber depth, a method involving direct visualization of intraocular structures should be used.

The effect of the selected factors on corneal endothelial cell loss following phacoemulsification.

INTRODUCTION: Corneal endothelium is a single layer of cells, which do not regenerate. Damage to the endothelium can take place in the course of certain diseases and after intraocular operations. When the number of endothelial cells decreases, corneal decompensation can occur. Pre- and postoperative measurement of the number of the corneal endothelial cells can help assess the degree of corneal damage during the surgery. PURPOSE: To compare the effect of various factors, such as: sex, age, corneal incision, intraocular pressure, cataract density, visual acuity and surgeon's experience on corneal endothelial cell loss following uneventful phacoemulsification. MATERIAL AND METHODS: 365 patients (114 men and 251 women aged 19 to 91 years) undergoing phacoemulsification were examined preoperatively and postoperatively at 4 weeks. 68 eyes underwent phacoemulsification through a 1.8 mm microincision and 297 eyes through a standard 2.75 mm incision. Patients were operated on by four surgeons. RESULTS: There was a significant difference in the postoperative endothelial cell loss relative to the degree of cataract hardness (p < 0.001). Endothelial cell loss was significantly higher in patients aged 71 and above than in the remaining age groups. Significant differences in the postoperative endothelial cell loss were observed in relation to the clear corneal incision size (p < 0.01). Preoperative best corrected visual acuity influenced the postoperative endothelial cell loss in a statistically significant way (p < 0.05). Endothelial cell loss was strongly influenced by the surgeon's experience. CONCLUSIONS: Surgeon's experience, hardness of cataract, type of corneal incision, age and preoperative visual acuity influenced endothelial cell loss at 4 weeks following uneventful phacoemulsification, however such factors as sex and intraocular pressure showed no statistically significant influence on corneal endothelial cell loss.

Phacoemulsification with Malyugin ring in an eye with persistent pupillary membrane--case report.

During fetal development the lens receives nourishment through a vascular net called "tunica vasculosa lentis" which forms the pupillary membrane on its anterior surface and may cause iris deformation. Nowadays, even more attention is paid to the safety of surgical procedures. Phacoemulsification in eyes with a narrow pupil, which doesn't respond to standard mydriatic agents applied preoperatively, is a challenge for any ophthalmic surgeon. Recently, a new device for intraoperative pupillary stretching has been described--the Malyugin ring. We describe a patient with persistent pupillary membrane succesfully operated for hard cataract using standard phacoemulsification with Malyugin ring. The purpose of using Malyugin ring in this case was to avoid intraoperative bleeding caused by cutting blood vessels that might have been present within the pupillary membrane, to secure a wide and stable pupil, to avoid accidental aspiration of the membrane, to postpone the moment of cutting the membrane until the end of the procedure and in this way to increase overall safety of the procedure. The case indicates that Malyugin ring is a good tool which used intraoperatively may assist the surgeon in cataract extraction in eyes with persistent pupillary membrane of unknown blood vessel content.

Comparative analysis of early distance visual acuity in patients after coaxial phacoemulsification through the micro-incision (1.8 mm) and after standard phacoemulsification through the small incision (2.75 mm).

INTRODUCTION: The purpose of the study was to evaluate early postoperative visual acuity outcomes of coaxial phacoemulsification with a foldable intraocular lens implantation, performed through a 1.8 mm wide clear corneal microincision (C-MICS) and to compare it with standard phacoemulsification through a 2.75 mm incision. MATERIAL AND METHODS: The examined group consisted of a non-randomised, prospective series of 130 eyes of 130 patients who underwent coaxial 1.8 mm microincision cataract surgery with foldable intraocular lens implantation (MI60, Bausch & Lomb). The reference group comprised 123 eyes of 123 patients who underwent standard phacoemulsification through the 2.75 mm incision with foldable intraocular lens implantation (Akreos Adapt AO, Bausch & Lomb). The following parameters were evaluated preoperatively and one day after the surgery: distance uncorrected visual acuity, distance best corrected visual acuity, intraocular pressure, anterior and posterior segment of the eye. All patients were divided into groups according to the LOCS III scale. RESULTS: The improvement of distance uncorrected visual acuity and distance best corrected visual acuity was observed postoperatively in both groups. The mean uncorrected visual acuity in the examined group was significantly better than in the reference group on the first postoperative day (0.88 +/- 0.18 vs 0.79 +/- 0.26). CONCLUSIONS: The early postoperative visual acuity results of C-MICS were better than the results of standard small incision phacoemulsification. As far as fast visual rehabilitation after MICS is concerned, the early uncorrected visual acuity should be considered as an important yardstick in measuring success in cataract surgery. These results are due to the MICS technique, which seems to be the minimally invasive surgery, and should be regarded nowadays as a procedure of choice.

Evaluation of contrast sensitivity measurements after retrobulbar optic neuritis in Multiple Sclerosis.

BACKGROUND: The evaluation of contrast sensitivity is an important additional examination that allows the physician to achieve the full picture of a patient's quality of vision. In low-contrast conditions, more discrete visual dysfunctions may be revealed, which could be overlooked in high-contrast tests. METHODS: The examined group consisted of 33 eyes of 27 patients with multiple sclerosis. The study included patients with full or almost full visual acuity, without visual field defects or any other ophthalmic condition, and who had never undergone any ocular surgery or trauma. The reference group consisted of 49 eyes of 37 patients. This group included healthy subjects with full visual acuity. Contrast sensitivity was examined with a Functional Vision Analyzer™ device in photopic conditions (with and without glare) and in mesopic conditions (with and without glare). RESULTS: In patients with multiple sclerosis who had experienced optic neuritis, contrast sensitivity was found to be significantly reduced in all spatial frequencies in both mesopic and photopic conditions (with and without glare). CONCLUSIONS: Contrast sensitivity in patients with multiple sclerosis who have also had optic neuritis is significantly reduced. This may explain patients' complaints regarding their quality of vision, despite good visual acuity. Contrastometry is a useful basis for further examination, providing additional information regarding a patient's quality of vision.

High-altitude retinopathy--case report.

High-altitude retinopathy is one of altitude-related illnesses. Its signs include high-altitude retinal hemorrhages, dilated vessels and peripapillary hyperemia. Increased intracranial pressure seems to be the main cause of all high-altitude diseases including high-altitude retinopathy, cerebral oedema and high-altitude pulmonary oedema. We present the case of high-altitude retinopathy in a 35-year-old woman who reported decreased vision in her right eye, scotomas and high-altitude retinopathy after ascending to more than 7000 meters above sea level. The associated optical coherence tomography findings, fundus photography and literature review are presented. High-altitude retinopathy is an important multifactorial condition of unknown mechanism and etiology, which significantly impacts human vision. Climbing high mountains can cause retinopathy in otherwise healthy people and may lead to permanent sequelae such as retinal nerve fiber layer and optic nerve defects. These symptoms, however, may resolve without causing any permanent damage to the retina. Conservative treatment may help to relieve them. With increasing popularity of mountaineering, ophthalmologists should be prepared to diagnose and treat high-altitude retinopathy.

[Evaluation of quality of life of patients after phacoemulsification with accommodating lens implantation]. / Ocena jakosci zycia pacjentów po fakoemulsyfikacji z wszczepieniem akomodacyjnej soczewki wewnatrzgalkowej.

INTRODUCTION: Intraocular lens implantation is an important part of cataract surgery, as it has a significant influence on the final result. Accommodative intraocular lenses (IOLs) are the latest solution for the lack of accommodation in pseudophakic eyes. PURPOSE: To evaluate the quality of life of patients who underwent cataract surgery with accommodating IOL implantation and to compare the data with results of patients after standard monofocal IOL implantation. MATERIAL AND METHODS: The study group consisted of 20 patients (40 eyes), aged from 48 to 73 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of an accommodating IOL Crystalens HD (Bausch & Lomb, USA). The control group consisted of 20 patients (40 eyes), aged from 63 to 83 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of a standard monofocal single-piece acrylic intraocular lens AcrySof (Alcon, USA). All enrolled patients had no coexisting ocular diseases which could influence the final visual acuity. All surgeries were uneventful. At one month postoperatively, the patients were requested to answer 36 questions included in the questionnaire in order to evaluate the quality of visual function. RESULTS: There was a significant improvement in the quality of life in both groups after cataract surgery. The study group tended to assess their own eyesight higher than the control group. Patients from the study group use spectacle correction for a lower number of activities, they find it easier to use fine motor skills when performing activities without spectacle correction in comparison with patients from the control group. Patients from the study group use spectacle correction for reading significantly less frequently, they also find it easier to read the normal size and small print without spectacle correction, in comparison with patients from the control group. CONCLUSIONS: Patients with accommodating IOLs self-evaluate their own eyesight highly, use spectacle correction for a lower number of activities and find it significantly easier to perform precise activities without spectacle correction, in comparison with patients after the standard monofocal intraocular lens implantation.