[Results of combined chemotherapy and local ophtalmic therapy of children with intraocular retinoblastoma]. / Wynki chemioterapii skojarzonej z miejscowym leczeniem dzieci z siatkówczakiem wewnatrzgalkowym.

Until recently chemotherapy in retinoblastoma was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (weal extension, orbital extension, neoplastic infiltrates of the optic nerve at resection line, intracranial metastasis and generalized disease). Recent experience has proved that use of chemotherapy for intraocular retinoblastoma before local treatment (so called "chemoreduction") has allowed not only to decrease the number of enucleations and indications for external beam irradiation or limit the extension of local therapy; but also to increase the chances for vision preservation and to decrease the risk of severe complications. Twenty children aged 0,5-96 months (with lesions in 29 eyes) in whom intraocular retinoblastoma was diagnosed between January 1996 and June 2000, were the subject of this study. Among 29 children, in 15 (52%) stage V according to Reese-Ellsworth was established. Enucleation before chemotherapy was necessary in 9 cases, and in two more children the eye had to be removed after 1-2 courses of chemotherapy. In 11 remaining children (with 18 involved eyes) VEC chemotherapy combined with delayed local therapy (cryotherapy, photocoagulation, brachytherapy) was employed. Out of 18 treated cases enucleation could be avoided in 13 (72%), including 12 qualified as Reese-Ellsworth stage II or I. No eye with stage V could be saved. First-line chemotherapy combined with local treatment should be standard treatment for intraocular retinoblastoma groups I and II. More effective therapy is required for advanced cases particularly for Reese-Ellsworth eye group V.

[Analysis of 100 cases of retinal detachment treated with conventional surgery in the years 1997-1998]. / Analiza 100 przypadków odwarstwienia siatkówki leczonych konwencjonalnymi metodami w latach 1997-1998.

PURPOSE: The observed increasing number of severe cases of retinal detachment was the ground of the attempt to state the causes of this phenomenon. MATERIAL AND METHODS: Retrospective evaluation of 100 consecutive cases of retinal detachment operated on with conventional methods between September 1997 and October 1998 was performed. The following data were analysed: sex and age of patients, period between the first symptoms and time of diagnosis and surgery. The clinical characteristics of retinal surgery comprise: extent of detachment, macular involving, type and number of breaks, degenerations and PVR. RESULTS: In the majority of cases very severe retinal detachments were observed, including 3-4 quadrants, with large tears or multiple breaks, with PVR B or C. Duration of the detachment ranged from several days in very few cases to several months, on average lasting several weeks. Attachment of the retina was achieved in 80 cases, improvement of the visual acuity in 47. CONCLUSION: Our data indicate the necessity to improve the early diagnosis of retinal detachment and changes predisposing to its development.

[Strabismus and binocular vision disorders in premature infants with retinopathy treated with cryotherapy]. / Wystepowanie zeza i zaburzen obuocznego widzenia u wczesniaków z retinopatia leczona krioterapia.

PURPOSE: To assess frequency of refraction errors, abnormal eye position and binocular vision disorders in children with retinopathy treated with cryotherapy. MATERIAL AND METHODS: Subjects of the study were 67 children, aged 2-7, treated with cryotherapy for active phase retinopathy. RESULTS: The largest group consisted of children with good visual acuity (48%). Refraction error was found in 94% of the examined eyes. Hypermetropia was more common (54%) than myopia (40%). Majority of the examined children had squint, and esotropia was much more frequent (52%). The deviation in 37% of children was over 10 degrees. In the group with birth weight under 1000 grams as well as in those with birth weight 1000-1500 grams the squint occurred in 48%, and in children weighing over 1500 grams in 4.0%. Only 54% of the studied children had normal binocular vision. CONCLUSIONS: Retinopathy of prematurity is a risk factor for development of refraction errors, strabismus and amblyopia. In infants with retinopathy of prematurity treated with cryotherapy it is necessary to have vision check-ups during their early childhood years.

[Use of cryotherapy in retinopathy of prematurity]. / Zastosowanie krioterapii w retinopatii wczesniaków.

PURPOSE: To present our experiences in cryotherapy for ROP. MATERIAL AND METHODS: From October 1991 to August 1995, transscleral cryotherapy was applied in 128 eyes of 70 babies with ROP. There were 34 girls and 36 boys with birth weight between 650 g and 1990 g and gestational age from 24 to 36 weeks. In above 90% of cases, ROP reached zone II and stage 3 with "plus" disease. In 84% of the eyes the extent of ROP was greater than 5 clock hours. Prethreshold severity was diagnosed in 7 and threshold in 110 eyes. In 11 eyes these categories could not be seventy determined. The chronologic age of infants at cryotherapy ranged from 8 to 22 weeks, mean 12 weeks. In all cases, cryotherapy was carried out under general anesthesia using a technique described in CRYO-ROP study. No serious complications during or after cryotherapy were observed. RESULTS: Favorable structural outcome was found in 119 eyes of 70 treated infants. In 82 eyes of 46 infants, with at least 12-month follow-up examination, also functional outcome was evaluated, basing on the examination with the Teller Acuity Card Procedure; the results were favorable in 57% of the eyes. Structural and functional outcomes were in agreement in 47 of the 82 eyes and discordant in 33. CONCLUSIONS: Our experience confirms the benefit of cryotherapy in the treatment of active ROP. In most cases cryotherapy should be applied in threshold ROP but in some cases especially in those with very rapid progression it should be done earlier. Because of the unpredictability of the natural course of ROP it is essential to use the scheme of ophthalmological examinations proposed by CRYO-ROP Study.

[Results of one-year observation of the visual system of premature infants]. / Wyniki rocznej obserwacji narzadu wzroku dzieci przedwczesnie urodzonych.

65 infants with gestational age 25-36 weeks and birth weight 800-2650 g were observed. Retinopathy of prematurity was found in 27 infants; in 9 eyes of 7 infants cryotherapy was applied. Examination at the age of 12 months evaluated: position and movements of the eye, refraction, visual acuity with preferential looking method, as well as anterior segment and fundus of the eye. Disturbances in eye position and movements were observed in 26 infants. Emmetropia was found in 16 eyes, 77 were hypermetropic and 27 myopic. The length of the eyeballs ranged from 14.6 to 22.5 mm. Visual acuity was determined in 39 infants, in 9 of them only binocular. It was 0.2 (normal) in 22 eyes, > in 2 and < in 36 eyes.

[Value of silicone sponge in retinal detachment surgery]. / Wartosc gabki sylikonowej w operacjach odwarstwienia siatkówki.

Lincoff's development of silicone sponge and substitution cryosurgery for diathermy in the mid-1960s, was the beginning of the minimized surgery for retinal detachment, limited to the surgery of the breaks. The aim of this paper is to present our experiences with these kinds of operations, with special attention to the complications causing the necessity of removing the sponge. Our studies concerned the patients who underwent retinal detachment surgery, in the Ophthalmological Clinic in Cracow in the years 1983-1992, using scleral buckling procedures with silicone sponge. In 152 cases circumferential and in 36 radial local scleral buckling procedures were performed; in 30 cases local buckling was added to encirclement with silicone band. The complications, attributed to the sponge, were observed in 9.7% of cases. Anterior segment inflammatory reactions, often sterile were found in 15 eyes, in 7 of them it was necessary to remove the sponge. In 13 eyes the sponge was removed on account of its extrusion. In none of the cases removal of the sponge influenced the retinal attachment. Our studies confirmed, that silicone sponge is a very good material for scleral buckling procedures.

[Drainage of subretinal fluid in our clinical studies]. / Drenaz plynu podsiatkówkowego w swietle wlasnych badan.

The studies comprised 531 patients (544 eyes) who underwent retinal detachment surgery in the Ophthalmological Clinic in Cracow, in the years 1983-1992. Drainage of subretinal fluid was performed in 54.6% of the eyes and in this group attachment of the retina was achieved in 72.4% of cases; in the group of patients with nondrainage operations it was 74.5%. Intraocular haemorrhages, the only complications, which may be attributed to the drainage of subretinal fluid were found in 18.9% of eyes with drainage and in 8.1% without; this difference was statistically significant (p < 0.01). Statistically significant relationship (p < 0.01) was also found between subretinal fluid drainage and severity of the retinal detachment. The results showed that there were no significant relationships between drainage of subretinal fluid and the results of surgery and that it is indicated first of all in severe cases of retinal detachment in which method of choice is an encirclement procedure.

[Relationship between results of retinal detachment surgery and method of attachment]. / Zaleznosc miedzy wynikami leczenia operacyjnego odwarstwienia siatkówki a rodzajem blokady otworów.

Basing on the clinical material of the years 1984-1991 the authors have compared the results of retinal detachment surgery in two groups of patients, depending on the method of adhesion. Diathermy was used in 182 eyes (group I) and cryosurgery in 274 (group II). Retinal attachment was achieved in 69% of the eyes in group I and in 74% in group II. Inadequate closing of the breaks was the cause of failure in 22.8% of the cases in group I and in 30.6% in group II. Various changes of the macula were observed in 31% of the eyes in group I and in 24.5% in group II. Statistically significant relationships were found between method of adhesion and: development of PVR (p < 0.05), appearance of pigmentary changes in the eye ground (p < 0.01) and cicatrization of the breaks (p < 0.01). Stronger cicatrization was observed after cryosurgery as well as the pigmentary changes in the fundus which have not influenced the results. The studies revealed that no significant differences depending on the method of adhesion were found in results of retinal detachment surgery.

[Late results of surgical treatment of retinal detachment by the cerclage method using a silicone band]. / Odlegle wyniki leczenia operacyjnego odwarstwienia siatkówki metoda opierscienienia tasma sylikonowa.

Presented are the results of control examination performed in 121 patients in the period of 3 to 8 years after retinal detachment operation by the silicone band encircling method. Evaluated were: the anatomical reattachment, function of the eye and the cosmetic effect. The retina reattached in 63.2 p.c. of eyes. The visual acuity for far was at least 0.1 in over one half (55 p.c.) of eyes and for near 2.0 or more in 78.5 p.c. Among the persons examined by means of Amsler's test and Panel D-15 test a correct response was attained by -- respectively -- 44.7 p.c. and 76.1 p.c. of the examinees. A very good cosmetic effect was achieved in 44.9 p.c. and a good one in 47.2 p.c. of eyes.