[Variability of the eyeballs axial length in children with pseudophakia]. / Zmiennosc dlugosci osiowej pseudofakijnych galek ocznych u dzieci.

PURPOSE: The aim of the study is to evaluate the dynamics of axial elongation of pseudophakic eyes and changes in refraction pseudophakic eyes in children after monocular or binocular cataract surgery. MATERIAL AND METHODS: the observations of 79 children (158 eyes) aged from 4 to 18 years (mean 9.7 +/- 0.55) after cataract surgery were conducted. The examined group consisted of 105 pseudophakic eyes, the comparative group consisted of 53 eyes without surgery in the same observed group of children. Moreover, the patients were evaluated in the following group: moncular - binocular cataract, primary or secondary IOL implantation, the age in groups were between 4-7 and between 8-18 years. Analysis statistically: STATGRAPHICS and SIMSTAT programs, p (alpha) = 0.05. RESULTS: In the examined group (105 eyes) the mean follow-up time was 4.2 years (+/- 0.3), the average age of patients was 9.7 years (+/- 0.7). Improvement of visual acuity was achieved mean 0.5 in 52.4% post operative eyes observed, myopic shift was -0.7D (+/- 0.52). The anatomic eyeball length increased up to 0.5mm (+/- 0.27). The average age of patients of the control group was 9.7 years (+/- 0.83), follow-up 4.3 years (+/- 0.44), visual acuity 0.8 (+/- 0.03). Mean elongation of the axial length was 0.56 mm(+/- 0.26), mean refraction of the eyeball was +0.38 D (+/- 0.54). The difference of the changes of refraction between examined and control group was statistically significant. The comparison of final refraction in optical pathway (p = 0.32) and the growth of anatomic eyeball length (p = 0.14), proved no significant differences in the group with monocular and binocular IOL. The comparative analysis of final refraction in optical pathway (p1 = 0.36), and the growth of anatomic eyeball length (p2 = 0.26) in the group with primary or secondary IOL and in the younger or older children (p1 = 0.52; p = 0.98) in the both groups, did not significantly differ. CONCLUSIONS: The dynamics of axial elongation of pseudophakic and phakic eyes in children is similar. The myopic shift of pseufophakic eyes is bigger than in phakic eyes. It should be undertaken in calculation of the refractive power of intraocular lenses.

[Gaucher's disease--ocular manifestation and treatment]. / Choroba Gauchera--objawy i leczenie.

Gaucher's disease is the most common lysosomal storage disorder due to a deficiency of glukocerebrosidase activity. It leads to an accumulation of glukosylceramide within the cells of the the reticuloendothelial system. Gaucher's disease is divided into three subtypes based on clinical symptoms. Type I--nonneuronopathic--chronically progressive in adulthood, type II--acute neuronopathic--infantile form lead up to the difficult damage nervous system, and type III--juvenile form--subacute neuronopathic. The aim of this paper is to present the typical ocular symptoms which occured in the disease. Gaucher's disease is the lysosomal storage disorder which is treated by enzyme replacement therapy.

[Gyrate atrophy of the choroid and retina in children]. / Zanik girlandowaty naczyniówki i siatkwki u dzieci.

THE AIM: the history and clinical findings of 3.5 and 5.5-years old siblings with gyrate atrophy (GA) of the choroid and retina are presented. PATIENTS AND METHOD: Siblings: a girl at the age 3.5 years and her brother 5.5 years were examined. Clinical and biochemical findings were performed. RESULTS: The best corrected visual acuity of both girl and boy was below normal values. Myopia of middle degree and myopic astigmatism was presented in both eyes of siblings. On fundus examination sharply defined bizarre shaped atrophic areas of peripheral choroid and retina were seen in both eyes of children. Fluorescein angiography of gyrate atrophy. The boy's plasma ornithine level was increased to 974.950 umol/L and the girl's to 1007.188 umol/L. The concentration of ornithine, lysine and arginine in the urea of these patients was high. CONCLUSION: Early clinical and biochemical diagnosis of gyrate atrophy of the choroid and retina in children is very important, because low protein diet with elimination of arginine can reduce the progression of this severe disease.

[Central corneal thickness and intraocular pressure in the youth]. / Grubosc centralnej czesci rogówki a pomiary cisnienia wewnatrzgalkowego u mlodziezy.

PURPOSE: To estimate the central corneal thickness in young patients and to evaluate the relationship between the intraocular pressure (IOP) and pachometry. PATIENTS AND METHODS: Eighty eyes of 40 children at the age from 9-18 years, mean 13.75 were examined. The applanation tonometry, pachometry, refraction and examination of corneal diameter were done. To statistical purpose t-Student test was used alpha = 0.05. RESULTS: IOP ranged from 12 to 24 mmHg, in 32 eyes was above 17 mmHg, mean 20.2 +/- 1.46 mmHg (I group) and in 48 eyeballs ranged from 12 to 17 mmHg, mean 15.6 +/- 0.96 mmHg (II group), p = 0. In the I group pachometry was from 480 to 591 microm, mean 542 +/- 11.1 and in the II group from 451 to 570 microm mean 521.7 +/- 9.39 p = 0.006. Mean refractive error in the I group was -0.4 D (from -5.0 to +4.0 D) and in the II group mean -0.8 (from -6.25 to +4.75), p = 0.45. In the both groups corneal diameter was from 11.5 to 12.5 mm. Comparing eyeballs of patients at similar age, refraction and corneal diameter, it was shown that central corneal thickness in the group with higher IOP was statistically significantly bigger than in the group II. CONCLUSION: Measuring IOP in children we have to take into account the corneal thickness.

[Cyclodestructive procedures in secondary glaucoma in children]. / Zabiegi cyklodestrukcyjne w jaskrze wtórnej u dzieci.

PURPOSE: Comparison of the effectiveness and safety of cyclocryocoagulation and transscleral contact cyclophotocoagulation with diode laser (TSCPC) in children. PATIENTS AND METHOD: Sixty nine eyes of 60 children at the age from 4 months to 16 years were examined. Majority of patients was aphakic after congenital, traumatic and complicated cataract extraction. Aniridia, Sturge-Weber disease and ROP complications were observed. In 40 eyes cyclocryotherapy (I group), in 29 eyes TSCPC (II group) were performed. Intraocular pressure (IOP) was assessed in the early and late postoperative period. The number of procedures per one eye, IOP, visual acuity, and complications after cyclodestructive procedures were estimated. Follow-up ranged from 3 months to 4 years, mean 23 months. RESULTS: Transscleral cyclocryocoagulations were performed once to 4 times in one eye with intervals from 1 month to 1 year, mean 1.3 procedures per eye. TSCPC was performed once in 29 eyes and twice in 4 cases, it was 1.14 procedures per eye. Before treatment IOP ranged from 21.3 to 50.6 mmHg, mean 29.18 mmHg in the I group and 24.4-54 mmHg mean 34.85 mmHg in the II group and in the early postoperative period were 10-25 mmHg, mean 17.7 and 2-26 mmHg, mean 14.65 mmHg relatively. Decreasing of IOP was observed in 39% of eyes after cryotherapy and 57.9% after TSCPC, p = 0.0003. In the long-term follow-up in IOP below 22 mmHg after cyclocryotherapy in 60% of eyes and after TSCPC in 79% was observed. Visual acuity ranged from no light perception to 0.5, mean 0.04. No changes of vision after cyclocryocoagulation were noted. After TSCPC transient visual function decreased from 0.2 to 0.04 in 1 eye but recovered after 2 weeks. After cyclocryotherapy only conjunctival oedema was observed in majority of cases. In the early postoperative period after TSCPC uveitis occured in 3 eyes (10.35%), transient hypotony in 2 eyes, hyphaema in one eye. CONCLUSION: Diode cyclophtocoagulation decreases IOP more effective than cyclocryocoagulation in children but complications after TSCPC are more severe than after cyclocryotherapy.

Influence of beta-adrenergic antagonists on tear secretion in children.

The aim of the study was to compare the results of tear film volume, conjunctival and corneal state of children eyes both treated with beta-blocker and healthy ones. We have examined 40 eyes of 20 children at the age from 7 to 17 years. Group I - 20 glaucomatous eyes treated with 0.5% timolol twice daily during at least 12 months. Group II - 20 eyes of control age-matched group. Schirmer I test without anesthesia and lissamine green staining was performed to evaluate conjunctival and corneal surface. The values of Schirmer I test were: group I from 12 to 24 mm, the mean 17.06 +/- 1.78 mm and group II from 16 to 35 mm, the mean 29.3 +/- 2.67, p = 0.000004. Keratoepitheliopathy was observed in 4 eyes (20%) of group I and was rated as 3rd and 6th degree of Franck classification. In the group II, there were only single staining points classified as 1st degree noticed in 2 eyes (10%), p = 0.37. The long-term treatment with timolol causes a decrease in tear secretion in children, which can further generate keratoepiteliopathy. Therefore, we suggest application of the artificial tears in these patients.

[Coding sequence analysis of CYP1B1 exon III in the Polish population of patients with primary congenital and juvenile glaucoma]. / Analiza sekwencji kodujacej eksonu III genu CYP1B1 w polskiej populacji pacjentów chorych na jaskre wrodzona i mlodziencza.

Several mutations of CYP1B1 gene, a member of cytochrome P450 gene family, have been associated with occurrence of primary congenital glaucoma. The aim of presented work was to investigate CYP1B1 gene exon III mutations in 72 unrelated Polish patients with primary congenital glaucoma (C), juvenile glaucoma (J) and juvenile glaucoma suspects (P). In one patient we have detected homozygous duplication of 10bp at nucleotide 8046 resulting in synthesis of truncated protein, first found among the polish population. Furthermore, sequence analysis revealed three distinct single nucleotide polymorphisms at nucleotides 8131 (C-->G), 8184 (C-->T) and 8195 (A-->G,) in examined populations. The haplotypes in homozygous state (C/C/A, C/C/G, and G/T/A) were present in 52.6% cases. Since it is suggested that the presence of these haplotypes may be linked to mutations in exon II of the CYP1B1 gene, we plan to analyze that exon in the future.

[Evaluation of retinal nerve fiber layer thickness in eyes with juvenile glaucoma after trabeculectomy]. / Ocena grubosci warstwy wlókien nerwowych siatkówki w oczach z pierwotna jaskra mlodziencza po trabekulektomii.

PURPOSE: To examine the influence of intraocular pressure (IOP) decreasing after trabeculectomy on the retinal nerve fiber layer thickness (RNFL) in glaucoma in the youth. MATERIAL AND METHODS: Nineteen eyes of 12 patients at the age from 10 to 18, mean 13.6 years, treated for juvenile glaucoma were examined. All of them were operated on performing trabeculectomy. Before trabeculectomy and mean 14.9 months after operation IOP was measured and the RNFL thickness with laser scanning polarimeter GDx was estimated. RESULTS: Values of IOP before surgery ranged from 23 to 28, mean 25.3 mmHg and after surgery ranged from 12 to 24, mean 14.3 mmHg. Symmetry and superior integral did not change, p = 0.96 after surgery. Average thickness of RNFL before operation was 60.61 microm and after surgery 63.09 microm, p = 0.06, superior average 74.14 microm and 78.33 microm, p = 0.06, inferior average 70.54 microm and 72.42 microm relatively p = 0.14. CONCLUSIONS: Decreasing IOP after trabeculectomy allows to maintain preoperative values of retinal nerve fiber layer thickness in eyes with juvenile glaucoma.

[Heparin-surface-modified PMMA intraocular lenses in children in early and late follow-up]. / Wszczepy soczewek heparynizowanych u dzieci we wczesnym i póznym okresie obserwacji.

PURPOSE: To compare anatomical and functional state of eyeballs after congenital cataract extraction and heparin-surface-modified PMMA (HSM-PMMA) or PMMA implanted lenses and to conclude, which type of implants is more advantageous in young patients. MATERIALS AND METHODS: 42 eyes of 30 children at the age of 3-16 years with congenital or developmental cataract after extraction and IOL implantation: I group--HSM-PMMA lenses in 24 eyes, and PMMA lenses in 18 eyes--II group. Mean age in the I group was 6 years and in the II group 8 years, p = 0.07. The presence of cellular and pigment deposits on the IOL surface as a sign of postoperative inflammation was examined by slit-lamp within 1 month after surgery. We have compared the results of visual acuity (V/A), corneal endothelium cell density and posterior capsule state. The examination were done in the short-term follow-up mean 14.1 months (4-24 months) in the I group and mean 32.1 months (16-48 months) in the II group. In the long-term follow-up mean 38 months (30-44 months) in the I group, and mean 56.1 months (40-72 months) in the II group. RESULTS: Within first month after operation cellular and pigment deposits on the IOL surface were seen more often in the II group, p = 0.03. Best corrected V/A was comparable in both groups in the short-term and the long-term follow-up. At last visit, mean value of V/A was 0.54 (I group) and 0.42 (II group), p = 0.37. There was no significant difference between central corneal endothelial cell density in both groups: before (2893 +/- 261/mm2 and 2821 +/- 217/mm2, p = 0.143) and after operation (2371 +/- 202/mm2 and 2361 +/- 299/mm2, p = 0.428). In the short-term follow-up, but not longer than within first 12 months after surgery the frequency of clinically significant posterior capsule opacification (PCO) was less in the HSM-PMMA group (8%), than in the PMMA group (33%), p = 0.006. In the long-term follow-up there was no statistically significant difference in PCO appearance between these groups (44% and 50%, p = 0.27). CONCLUSIONS: Heparin-surface-modified intraocular lenses reduced postoperative inflammation and delayed the incidence of PCO in children. Heparin-surface-modified intraocular lenses are more advantageous, than PMMA lenses in young patients.

[Prognosis in juvenile glaucoma after trabeculectomy]. / Rokowanie w jaskrze mlodzienczej po trabekulektomii.

PURPOSE: To evaluate the efficacy of trabeculectomy in the patients with juvenile glaucoma in the long-term follow-up. MATERIAL AND METHODS: In 22 of 37 patients--41 trabeculectomies with basal iridectomy were performed. The age of children ranged from 6 to 18 years, mean 12.4 years. In one eye of 15-year-old boy we used Mitomycin C during reoperation. The follow-up period ranged from 2 to 14 years, mean 8 years. Patients were divided into 2 groups depending on the follow-up: I group (19 eyes) was observed 2-6 years, mean 5.1 years, II group (18 eyes) 7-14 years, mean 11.1 years. In the I group 57.9% and in the II group 61% of children were myopic. RESULTS: Intraocular pressure lower or equal to 21 mmHg with no glaucoma medication was obtained in 79% of eyes in the I group and 66.7% of eyes in the II group. The difference was not statistically significant. In other eye local application of B-blockers and dorzolamid decreased intraocular pressure to values safe for the optic nerve, what was monitored by visual acuity and laser scanning tomography. CONCLUSION: Prognosis of juvenile glaucoma patients treated with trabeculectomy is satisfactory but the effectiveness of this procedure decreases together with the elongation of the follow-up period.

[Optic nerve disc in unilateral myopia in children]. / Obraz tarczy nerwu wzrokowego w krótkowzrocznosci jednostronnej u dzieci.

PURPOSE: The evaluation of biomorphometric parameters of optic nerve head of the eyes in myopic anisometropia, to state if glaucoma similar changes described in adults were present. MATERIAL AND METHODS: 17 children, 14 girls and 3 boys at the age from 7-18 years, mean 12.6 years with unilateral myopia of mean value 8.6 D. The parameters of optic nerve disc: total contour area (TCA), cup/disc ratio (C/D), neuroretinal rim area (Rim), volume of neuroretinal rim (Vol. A), cup volume (Vol. B), maximum slope (MSL) and average slope angle (ASL) were examined using laser scanning ophthalmoscope in the TopSS system of Laser Diagnostic Technologies Inc. The I group consists of myopic eyes, in the II group there were emmetropic eyes of the same children. RESULTS: Refraction in the I group ranged from -4.5 to -12 D, mean -8.6 D, in the II group from 0 to + 1.0 D, mean 0.07 D. The mean axial length of eyeballs was 25.57 SD 1.9 mm in the I and 22.47 SD 1.09 mm in II group--the difference was significant. There was not statistically significant difference between TCA in the I (mean 1.19 SD 0.75 mm2) and II group (mean 2.13 SD 0.49 mm2). Mean C/D ratio and cup volume were significantly smaller in myopic (C/D 0.23 SD 0.16 Vol. B -0.06 SD 0.05) than in emmetropic eyes (C/D 0.33 SD 0.11 mm3, Vol. B -0.18 SD 0.14 mm3). CONCLUSIONS: Optic nerve disc images in myopic and glaucomatous eyes in children are different. Smaller optic disc cup in myopic than in emmetropic eyes can show, that children myopic eyeballs enlarged without nerve fibers atrophy.

[Image of optic nerve disc with laser scanning tomography and results of static perimetry in children with juvenile glaucoma]. / Obraz tarczy nerwu wzrokowego w skaningowej tomografii laserowej a wyniki perymetrii statycznej u dzieci z jaskra mlodziencza.

UNLABELLED: The aim of our research was to estimate the correlation between optic nerve head parameters examined with laser scanning ophthalmoscope and results of central, visual field (MD and PSD) in the youth and the evaluation the role of this correlation in juvenile glaucoma early diagnosis. MATERIAL: Three groups of patients. Group I consisted of 32 eyes (16 children) with juvenile glaucoma in which trabeculectomy was performed. There were 72 eyes of 32 children with glaucoma juvenile suspect in the group II. Control group (III) contained 20 eyes of 10 children without glaucoma. The age of patients ranged from 9 to 18 years. The mean intraocular pressure was 16 mmHg in the I group, 18 mmHg in the II group and 15.6 mmHg in the III group. Simple Regression Analysis of mean values of biomorphometric parameters of optic nerve head for Mean Defect of central visual field was used in all three groups. RESULTS: The statistically significant correlation between Vol. B and MD was observed in the I group. There was no such correlation in the II group, but correlation between Av. Sl. and MD was presented. In the III group mean value of MD was the smallest one and correlated with Vol. B. Statistically significant correlation between mean values of PSD and Vol. B was observed in the I and II group, between PSD and Vol. A in group III. CONCLUSION: There was the correlation between optic nerve head parameters and mean deviation of retinal sensitivity of central visual field in the youth. This examination can be helpful in early diagnosis of primary juvenile glaucoma.

[Eye growth in children with primary congenital glaucoma after trabeculectomy]. / Rozwój galki ocznej u dzieci z pierwotna jaskra wrodzona po trabekulektomii.

PURPOSE: Evaluation of the influence of intraocular pressure (IOP) after trabeculectomy on the axial length and refraction of eyeballs in children with primary congenital glaucoma. MATERIAL AND METHODS: Thirty six eyes of 23 children at the age from 7 days to 6.5 years (mean 17.1 months), were examined. Measurements of corneal diameter, axial length, IOP and refraction were done before trabeculectomy and in the long-term follow-up (mean 7.9 years) after surgery. RESULTS: Horizontal corneal diameter didn't change and ranged from 10 to 15 mm, mean 13.22 mm. Mean value of axial length before trabeculectomy was 22.45 mm and 23.27 mm at last visit. The difference was statistically significant. The axis decreased in 3 eyes, was the same in 3 eyes. In the others the eye growth changed proportionally to the age of child. IOP values were statistically lower after surgery (mean 16 mmHg) than before treatment (mean 35.51 mmHg). There was no correlation between IOP and axial length of eyeballs (p = 0.69) and between IOP and refraction changes (p = 0.42) in the long-term follow-up. CONCLUSIONS: There is small influence of normalised IOP after trabeculectomy on size of eyeballs and refraction in children with primary congenital glaucoma. The development of eyeballs even buphthalmic is proportionally to the age.