A comparative clinical study of the visual results between three types of multifocal lenses.

PURPOSE: To compare the patients' visual results after bilateral implantation of the multifocal intraocular lenses (MIOLs): ReZoom (NXG1, Abbott Medical Optics, Abbott Park, IL, USA), Acrysof ReSTOR (SA60D3, Alcon Laboratories, Fort Worth, TX, USA) and Tecnis MF (ZM900, Abbott Medical Optics). MATERIALS AND METHODS: A prospective, nonrandomized, comparative trial of 30 patients (60 eyes) aged 46-71 (mean age 56.3 +/- 5.96) divided into three equal groups with implanted bilaterally multifocal lenses: ReZoom IOL, Acrysof ReSTOR IOL and Tecnis MF IOL. The patient selection criteria included no other eye disease besides cataract, and corneal astigmatism of 1.5 diopters or less. In each case, the patients were scheduled to have standard phacoemulsification surgery with IOL implantation into the bag. The postoperative target was emmetropia. The mean follow-up was 6 months in all eyes. The following parameters were assessed/carried out: slit-lamp examination, uncorrected and best spectacle-corrected far and near visual acuity, autorefractometry, intraocular pressure, contrast sensitivity and subjective satisfaction with vision using the VF-14 survey. RESULTS: After surgery, all eyes were within +/-2.0D of target refraction. The mean uncorrected distance visual acuity improved in all cases. The postoperative BCDVA was better than 20/30 at the sixth month in all eyes. Six months postoperatively, the mean uncorrected distance visual acuity (UCDVA) +/- standard error (SE) in the ReZoom, ReSTOR and Tecnis MF groups was 0.11 +/- 0.01, 0.17 +/- 0.02 and 0.14 +/- 0.02 (LogMAR) respectively. All results were significantly better compared to preoperative values (p < 0.001) but did not differ between the study groups (p > 0.05). At the final visit, 75% of eyes in the ReZoom group achieved J1 (Jaeger standard) in comparison to 85% in the ReSTOR and Tecnis MF groups. Eighty percent of patients with bilaterally implanted ReSTOR and Tecnis MF IOL were spectacle-independent, in comparison to 70% with implanted ReZoom IOL. Thirty percent of patients with implanted Rezoom and Acrysof Restor IOL and 20% with implanted Tecnis multifocal IOL reported little or moderate halo and glare. The patients' satisfaction after the procedure was excellent; the scoring on the VF-14 survey ranged from 70-100%, with an average of 93%. No patient was dissatisfied with the results of the surgery. CONCLUSIONS: The implantation of tested multifocal intraocular lenses provides good near and distance visual acuity. We did not observe any statistically significant differences between the tested multifocal intraocular lenses with regard to best-corrected distance visual acuity, presence of glare and halo, as well as satisfaction with vision.

[Effect of anti-inflammatory therapy on the treatment of dry eye syndrome]. / Wplyw leczenia przeciwzapalnego na powodzenie terapii zespolu suchego oka.

Dry eye syndrome is a common chronic disease; agents and strategies for its effective management are still lacking. The syndrome tends to be accompanied by ocular surface inflammation; therefore, the use of anti-inflammatory agents might prove beneficial. The authors present up-to-date guidelines, strategies, and efficacy of dry eye syndrome management, including anti-inflammatory treatment. As no diagnostic tests are now available to assess ocular surface inflammation severity, the right timing to launch an anti-inflammatory agent is difficult to determine. Patients with mild intermittent bouts of symptoms which can be alleviated with ophthalmic lubricants do not typically require anti-inflammatory therapy. The latter should be considered in those who do not respond to lubricating drops, obtain poor results on clinical tests, and show symptoms of ocular surface irritation (eg. conjunctivae redness). Anti-inflammatory treatment of dry eye syndrome may include short-term corticosteroids, cyclosporine A emulsion, oral tetracycline therapy, oral omega-3 fatty acid supplements, and autologous serum eye drops. Anti-inflammatory treatment should be safe and effective; potential benefits should be evaluated for each individual patient. The authors have reviewed the advantages of anti-inflammatory treatment in dry eye syndrome, presented in literature.

[Assessment of tears secretion after refractive surgery]. / Ocena wydzielania lez u pacjentów po chirurgii refrakcyjnej.

PURPOSE: One of the complications of the corneal refractive surgery is a transient disturbance in tears secretion, which can lead to the dry eye syndrome. The aim of the study was to evaluate the tears secretion in patients after PRK, LASEK and LASIK surgery for myopia. MATERIAL AND METHODS: We examined 115 eyes of 69 patients (46 woman and 23 men), mean age 30.82, with myopia and myopic astigmatism, treated with three different refractive procedures. The patients included in this study were divided into three groups: Group I: 35 eyes of 22 patients (15 woman and 7 men) treated with PRK. The mean spherical equivalent of the refractive error was -4.18 dioptres (from -8.75 to -2.0). Group II: 41 eyes of 23 patients (13 woman and 10 men) treated with LASEK. The mean spherical equivalent of the refractive error was -5.73 dioptres (from -12.0 to -2.75). Group III: 39 eyes of 24 patients (18 woman and 6 men) treated with LASIK. The mean spherical equivalent of the refractive error was -7.49 dioptres (from -10.75 to -3.75). In this study the amount of tears secreted was analyzed on the base of Schirmer I test, performed before and after surgery. Test was always performed in the same room, in the morning hours (before noon), with constant temperature and air humidity values. RESULTS: In the PRK group the mean value of Schirmer I test was 20.91 mm before surgery. 14 days after surgery the mean value decreased to 14.09 mm, 1 month after surgery to 11.66 mm. Then increase in tears secretion was observed: 2 months after surgery the mean value of Schirmer I test was 13.94 mm, 3 months after surgery 15.23 mm, and 6 months after surgery 17.4 mm. In the LASEK group the mean value of Schirmer I test was 20.39 mm before surgery. 14 days after surgery the mean value decreased to 15.78 mm, 1 month after surgery to 13.05 mm. Two months after surgery the mean value of Schirmer I test was 15.24 mm, 3 months after surgery 16.17 mm, and 6 months after surgery 18.15 mm. In the LASIK group the mean value of Schirmer I test was 20.72 mm before surgery. 14 days after surgery the mean value decreased to 12.97 mm, 1 month after surgery to 5 mm. 2 months after surgery mean value of Schirmer I test was 12.79 mm, 3 months after surgery 15.05 mm, and 6 months after surgery 17.82 mm. CONCLUSIONS: Corneal refractive surgery causes transient reduction of tears secretion, especially during the first three postoperative months. The tears secretion was reduced most significantly in the LASIK group. In patients treated with PRK and LASEK tears secretion during the postoperative period was comparable with slightly better secretion in the LASEK patients.

[The application of the confocal microscopy for the diagnosis of corneal inflammation]. / Zastosowanie mikroskopii konfokalnej do diagnostyki rozinicowej zapalen rogówki.

In the course of keratitis, the early diagnosis is very important to start with the effective treatment. Clinical state and slit lamp biomicroscopic examination not always allows to establish etiologic factor. In this paper, usefulness of the confocal microscopy in vivo examination to diagnose cases of not clear etiology in corneal inflammation, was presented. Authors presented the correlation between the clinical signs and the confocal images basis in five examined patients.

[Pterygium: allergic etiology?]. / Skrzydlik--etiologia alergiczna?

Pterygium is a wedge-shaped fibrovascular growth of conjunctiva that extends onto the cornea. The etiopathogenesis of pterygium is still not fully elucidated. Exposure to ultraviolet light is suggested as one of the most important factors contributing to pterygium development. However, other factors including allergens, harmful chemical substances, wind, dust and pollens also may contribute to its development. The aim of the study was to evaluate the influence of immune reactions on the pathogenesis of pterygium.

[Assessment of MemoryLens in own materials]. / Ocena soczewek MemoryLens w materiale wlasnym.

PURPOSE: The aim of this study is the assessment of results of cataract phacoemulsification with the implantation of MemoryLens. Phacoemulsification is the most often used method of cataract extraction nowadays. This method led to shorter incision and reduction of postoperative astigmatism. Using phacoemulsification method the foldable intraocular lenses are applied. MATERIAL AND METHODS: The cataract phacoemulsification with implantation of the only one prefolded intraocular lens were done in 25 eyes. RESULTS: Fast visual acuity recovery and no postoperative complications were observed. CONCLUSION: MemoryLens are easy to insert, and the effectiveness of this method is similar to implantation of other intraocular foldable lenses.

[Complications after LASIK surgery]. / Powiklania zabiegów LASIK.

LASIK is now very often used refractive surgery procedure. It is very effective, but there are some intraoperative and postoperative complications possible. In this paper I would like to describe almost all possible LASIK complications.

[History of excimer laser refractive surgery in Poland]. / Historia laserowej chirurgii refrakcyjnej laserem excimerowym w Polsce.

First publication about excimer laser in 1983 became the beginning of laser refractive surgery. At the beginning excimer laser was used for PRK procedure for correction of myopia. Laser refractive surgery developed rapidly in 90-ties when LASIK and LASEK procedures started to be used for any kind of refractive errors. In Poland laser refractive surgery begun to be used in 1990.

[Surgical correction of presbyopia]. / Chirurgiczna korekcja presbyopii.

There are a lot of surgical procedures to correct refractive errors, but the surgical correction of presbyopia is still a problem. In this paper the authors present surgical procedures, which can be used to correct presbyopia. There are three groups of surgery: the corneal, scleral and intrabulbar procedures.

[Phakic IOL]. / Soczewki fakijne.

Refractive errors can be corrected by three different means, as follows: optical devices, corneal refractive surgery and intraocular procedures. Each intraocular procedure has its advantages and disadvantages. In this paper the authors present the nowdays state of refractive phakic IOL's.

[Complications of laser in situ keratomileusis--corneal flap striae and fold--own material]. / Powiklania po zabiegu LASIK--zmarszczki i faldy platka rogówki--material wlasny.

PURPOSE: The purpose of this study was, to classify striae and folds seen after LASIK as an early and late complications. MATERIAL AND METHODS: At the First Department and Clinique of Ophthalmology Silesian Medical School in Katowice LASIK procedure was performed since 1997. The material consisted of 155 eyes of 120 patients. There was a 24-month observation period after the procedure. The corneal cap techniques were used with Chiron-Adatomed Automated Corneal Shaper (mikrokeratom). The stromal bed was fotoablated with the Aesculap-Meditec MEL 60 excimer laser and Asclepion-Meditec MEL 70 G-Scan excimer laser. RESULTS: Four types of folds and striae were described: pseudostriae, vertical or oblique folds at the hinge of the flap, small faint in stroma and deep, irregular striae or folds in stroma. CONCLUSIONS: Corneal flap striae and folds, which we can see as a Laser in situ Keratomileusis complications have a variety of appearances and different postoperative courses, that require accurate diagnosis and management.

[Laser correction of myopia and myopic astigmatism in children--literature review]. / Laserowa korekcja krótkowzrocznosci i astygmatyzmu krótkowzrocznego u dzieci.

Anisometropic myopia and myopic astigmatism are very often refractive error in children. Suitable correction of different vision defects in children might prevent the consequences of amblyopia and lack of development of binocular vision. This article presents the effectiveness of correction in myopia and myopic anisometropia using laser method such as PRK, LASEK and LASIK. It is the literature review.

[Is every iris pigment lesion a melanoma? Case report]. / Czy kazda zmiana barwnikowa teczówki jest czerniakiem? Opis przypadku.

In this paper authors present a history and clinical findings of 78 years old man with suspicion of iris melanoma. Malignant melanoma accounts for 70% of cell malignant tumors of the eye. The paper also contains short review of the most important clinical characteristic, diagnostic and treatment of iris melanoma.

[Application of duo-systems (piggy back) in correction of keratoconus]. / Zastosowanie duosystemów (piggy back) w korekcji stozka rogówki.

The purpose of the paper was to determine possibilities and effectiveness of application of piggy back system in keratoconus and choosing the best soft contact lens to meet the demands of the system. 335 patients were examined (511 eyes), including 131 women (163 eyes) and 204 men (348 eyes). Retrospective method involved patients with chronic corneal erosion and symptoms of intolerance of hard contact lenses. It was found out that application of piggy back system is the best therapeutic method in cases of chronic corneal erosion and it improves comfort of wearing lenses. Sof Lens 66 proved to fulfill the assumed criteria best. Application of piggy back reduces opacity within keratoconus top and it prevents or delays necessity of penetrating keratoplasty.

[New possibilities of individual fitting of hard contact lenses with use of computer programs and videokeratography (CVK)]. / Nowe mozliwosci indywidualnego dopasowania soczewek kontaktowych twardych z uzyciem programów komputerowych oraz wideokeratografii (CVK).

The aim of the following paper is to evaluate possibilities of modern computer technologies and CVK in fitting of hard contact lenses in difficult cases of keratoconus or in order to improve their tolerance. 425 patients were examined (761 eyes) 289 men and 135 women, age - between 11 and 56 years of life, giving the average of 26 years. Evaluation was carried out by means of retrospective method, analyzing the effect of fitting in the 2nd and 3rd stage of keratoconus, advancement in the Amsler and Muckenchirn's scale. The procedure involved the technique of parallel application to the cornea. Computer technique enabled fast and precise fitting of lenses in difficult cases.

[Evaluation of eye total aberration in patients after PRK and LASIK procedures]. / Zmiany aberracji ukladu optycznego oka po zabiegach PRK i LASIK.

UNLABELLED: Construction of aberrometer unit gives us a possibility to clinically measure the optical defects of the eye beyond sphere and cylinder, quickly and efficiently. This technology of measurement quantify ocular aberrations, to design ideal refractive corrections. PURPOSE: The aim of this study was to evaluate ocular aberrations after PRK and LASIK procedures. MATERIAL AND METHODS: We measured the high order aberrations in 114 treated eyes by WASCA System. RESULTS: We noticed that all excimer procedures increased ocular aberrations. The higher aberrations appears after LASIK. The main assignment of excimer laser surgery is planning this type of ablation profile which does not increase aberrations.

[The evaluation of accommodation range in patients of various age groups by WASCA wavefront aberrometer]. / Ocena zdolnosci akomodacyjnych ukladu wzrokowego w zaleznosci od wieku z zastosowaniem systemu WASCA.

PURPOSE: The aim of this study was, to analyse the results of accommodation range measurement obtained in groups of patients of different age. Wavefront aberrometer was used for evaluation of accommodation range of the patients eyes. MATERIAL AND METHODS: The accommodation range was analysed in 200 eyes in 100 patients. The examined group of patients was divided into 4 groups, depending on the patients age. GROUP I--AGE: 20-30 years old; group II--age: 31-40 years old; group III--age: 41-50 years old; group IV--age: 51-60 years old. The measurements were analysed using WASCA System depend on: refractive error, sex and difference of pupil diameter for far and near vision. RESULTS: Different ranges of accommodation were obtained. We did not observe any correlation between the accommodation range and the sex and refractive error. We noticed statistically significant differences between the accommodation range and pupil diameter, as well as the patients' age. CONCLUSIONS: The WASCA System is a device, which can be used for analysis of accommodation range. This system gives us the possibility, to trace changes of eye accommodation range in the long period of time.

[In vivo evaluation of corneal structure changes after refractive procedures]. / Przyzyciowe zmiany struktury rogówki po zabiegach chirurgii refrakcyjnej.

PURPOSE: The aim of the study was to evaluate and compare in vivo the corneal structure changes after refractive procedures (PRK, LASIK, LASEK). MATERIAL AND METHOD: The analysed group of patients consisted of 226 corneas in 126 patients, who underwent correction of myopia and myopic astigmatism, using the procedures: PRK (120 eyes), LASIK (56 eyes) and LASEK (50 eyes). The photoablation of the corneas was performed with the Excimer Laser MEL 60 and MEL 70 G-Scan Aesculap Meditec. Postoperative observations were made using a confocal microscopes Confoscan P4 (Tomey) and ConoScan 2 (Fortune Technologies). The evaluations were performed in the early (up to 3 months) and late postoperative period (after PRK and LASIK-up to 2 years; after LASEK-up to 6 months). RESULTS: The confocal microscopy revealed some changes within the corneal epithelium and anterior part of stroma after PRK, LASIK and LASEK. After PRK, there was increased desquamation of superficial epithelial cells in early postoperative period. These cells were elongated after LASIK and LASEK procedures. After PRK and LASEK, the Bowman's membrane was absent in the central part of the cornea, during the whole observation period. After all these procedures, the anterior part of the corneal stroma in the ablation zone, showed increased background illumination of collagen fibres and an irregular pattern of elongated keratocytic nuclei, in the early postoperative period. No scar tissue--"haze" was found in cases after LASEK, what may occur after PRK procedure. The findings kept changing in the course of the follow up time. CONCLUSIONS: Confocal microscopy enables in vivo monitoring of changes, which occur in the corneal structure after refractive procedures; this facilitates the evaluation of corneal healing. LASEK is the least invasive refractive procedure, which allows prompt stabilization of the corneal structure.

[Use of intra-stromal corneal ring segments (INTACS) in refractive surgery]. / Zastosowanie segmentów sródrogówkowych (INTACS) w chirurgii refrakcyjnej.

Implantation of intrastromal corneal rings segments is a new refractive procedure. INTACS consists of 2 separate segments placed in the midperipheral cornea, in specially preparing lamellar channels. Polymethylo methacrylate rings, which flatter the anterior curvature of the cornea. The peripheral localization of these rings leaves the central cornea untouched. The 2 main advantages of the INTACS are, that it preserves the corneal center and is removable. Segments serve for the reduction of myopia from -1.00 D to -5.00 D. The refractive correction is modulated by INTACS thickness, which ranged from 0.25 to 0.45 mm.

[Complications after laser refractive surgery]. / Powiklania po zabiegach laserowej chirurgii refrakcyjnej.

The laser refractive surgery is very effective method of refractive errors correction. The method is very popular, but serious complications may occur and the visual acuity may decrease. In this article authors show the possible complications after the laser refractive procedures.