Corneal endothelial status in different grades of late spontaneous in-the-bag IOL dislocation.

PURPOSE:  To evaluate corneal endothelial cell density (ECD) in the eyes with different grades of late spontaneous in-the-bag intraocular lens (IOL) dislocation. METHODS:  A prospective study included seventy-eight patients who applied for IOL dislocation. Overall 80 eyes were divided into four grades based on the in-the-bag IOL dislocation classification. All eyes underwent a complete ophthalmological examination. ECD was evaluated using in vivo corneal confocal microscopy. RESULTS:  Median corneal ECD was 1929 (1022-2958) cells/mm2 of all the patients. The lowest number of ECD was in grade 2 (grade 1 median ECD 1990.33 (1182-2425.33) cells/mm2, grade 2-1577.0 (1022-2958) cells/mm2, grade 3-2205.84 (1259-2807.67) cells/mm2 and grade 4-2072.17 (1045-2581.0) cells/mm2). A statistically significant difference was observed between the median of ECD of grade 2nd and 3rd (p = 0.023). By grouping cases into those with and without glaucoma, we found that corneal ECD was significantly lower in eyes with glaucoma compared with eyes without glaucoma in grades 3 and 4 (p < 0.05), while in other grades, the difference did not reach the significance level. We divided the corneal ECD of all eyes into two categories ≤ 1500 cells/mm2 and > 1500 cells/mm2. Logistic regression demonstrated that the odds of having corneal ECD less than 1500 cells/mm2 increased by 3.5-fold if patients with IOL dislocation had been diagnosed with glaucoma previously. CONCLUSION:  Late spontaneous in-the-bag IOL dislocation reduced corneal ECD. Previously diagnosed glaucoma was the most common comorbidity. This condition has a significant impact on corneal ECD for patients with IOL dislocation.

Novel microsurgical management of uveitis-glaucoma-hyphema syndrome.

PURPOSE: To report a series of cases and microsurgical management of rarely occurring uveitis-glaucoma-hyphema (UGH) syndrome in patients with single-piece acrylic intraocular lens (IOL) placed in the capsular bag. METHODS: It was a series of patients with UGH syndrome induced by posterior chamber IOL/capsular bag complex instability (pseudophakodonesis), who underwent IOL fixation to the iris. Visual acuity, intraocular pressure, number of glaucoma medications and IOL status (position) were recorded by the same protocol before and 6 months after the surgical treatment. RESULTS: The case series presents three patients with UGH syndrome caused by single-piece acrylic IOL placed in-the-bag. Each patient had uneventful phacoemulsification with posterior chamber IOL implantation few years ago and pseudophakodonesis caused by weakened zonules from pseudoexfoliation with subsequent development of UGH syndrome. IOL fixation to the iris with satisfactory postoperative results was performed due to the development of UGH. Signs of syndrome did not recur 6 months after the operation. CONCLUSION: UGH syndrome can be induced by unstable in-the-bag IOL due to zonular laxity. Depending on the severity of the syndrome, this condition can be fought by applying a minimally invasive approach-IOL suturing to the iris with direct observation under the surgical microscope precisely in the anticipated location with no or minimal pupil deformation. Symptoms of UGH did not recur due to increased stability of the IOL and, as a result of this, declined irritation of the uveal tissue.

Clinical evaluation of aqueous outflow system in vivo and correlation with intraocular pressure before and after non-penetrating glaucoma surgery.

PURPOSE: The aim of this study was to evaluate the aqueous outflow system through channelography with fluorescein during non-penetrating glaucoma surgery (canaloplasty or phacocanaloplasty) and find correlations with preoperative and postoperative intraocular pressure (IOP). METHODS: Thirty-six patients (40 eyes) who had channelography while undergoing non-penetrating glaucoma surgery were included in this prospective study. Several parameters assessed during the channelography included: diffuse and superficial scleral staining, the number of visible superficial connections to collectors, trabecular permeability and number of micro-ruptures of the trabecular meshwork. IOP, the best-corrected visual acuity, the number of glaucoma medications was recorded at 1 day, 7 days, 3 months and 6 months after the operation. RESULTS: The change in IOP at 6 months from baseline significantly correlated with the number of visible superficial connections to collectors (r = 0.4, p = 0.021). Eyes with canaloplasty showed a mean baseline IOP of 19.4 (4.9) mmHg and mean glaucoma medication usage of 2.9 (1.0), which decreased to 13.2 (3.1) mmHg with 0.3 (0.8) medications, respectively, at 6 months postoperatively (p < 0.001). Eyes with phacocanaloplasty surgery showed a mean baseline IOP of 28.2 (9.6) mmHg with 2.6 (0.9) mean drugs, which decreased to IOP of 12.8 (3.4) mmHg with 0.5 (0.8) medications at 6 months (p < 0.001). CONCLUSION: A larger number of defined visible superficial connections to collectors after injection of fluorescein into SC is related to a more pronounced IOP decrease after non-penetrating glaucoma surgery.

A new maximum color contrast sensitivity test for detecting early changes of visual function in age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To determine the association between age-related macular degeneration (AMD) and color perception established by the Farnsworth-Munsell 100 hue (F-M 100) and maximum color contrast sensitivity (MCCS) tests. MATERIALS AND METHODS: We performed a case-control study, which comprised of 100 patients with AMD and 100 healthy controls. To test visual acuity (VA), a typical Snellen chart was used. The computerized F-M 100 and MCCS programs were used for color discrimination. RESULTS: The results of VA, and the F-M 100 and MCCS tests in the healthy controls were statistically significantly better than in the patients with AMD (1.0 vs. 0.82±0.16, P=0.005; 87.39±24.11 vs. 185.39±74.43, P=0.005; 1.33±1.17 vs. 1.96±0.46, P=0.005, respectively). When VA was 1.0 in patients with AMD, the total error scores of the F-M 100 test and MCCS test compared with healthy persons were even worse (166.09±66.57 vs. 87.39±24.11, P=0.002; 1.67±0.92 vs. 1.33±1.17, P=0.001, respectively). Analysis of the results of patients with AMD compared to healthy controls showed the highest error score in the blue color range. CONCLUSIONS: The results of the color contrast sensitivity test decreased by half in patients with AMD compared with ophthalmologically healthy patients when they performed the F-M 100 test and by one and half when they performed a MCCS test in the blue color range.

Associations between contrast sensitivity and aging.

OBJECTIVE: The aim of this study was to assess age-related visual functions (visual acuity and contrast sensitivity) and compare the results by different age groups. MATERIAL AND METHODS: A total of 231 patients were examined. The patients were divided into 5 age groups: 10 patients in group 1, 30-39 years; 40 patients in the group 2, 40-49 years; 77 patients in the group 3, 50-59 years; 71 patients in the group 4, 60-70 years; and 33 patients in the group 5, 71-85 years. A typical Snellen's chart (the direction of the gap in Landolt C) was used for noncorrected and best-corrected visual acuity testing. Contrast sensitivity was evaluated by employing a Ginsburg Box, VSCR-CST-6500. RESULTS: Noncorrected visual acuity was significantly better in the group 2 than the group 3 (0.86 [0.28] vs. 0.69 [0.33], P=0.018). Moreover, noncorrected and best-corrected visual acuity was significantly better in the group 4 than the group 5 (0.52 [0.35] vs. 0.35 [0.28], P<0.001; and 0.9 [0.21] vs. 0.69 [0.27], P<0.005, respectively). Contrast sensitivity at the nighttime without glare was significantly worse in the group 2 than the group 1 at the spatial frequencies of 3, 12, and 18 cycles per degree (P=0.001, P=0.05, and P=0.01, respectively). The patients in the group 2 had significantly worse contrast sensitivity at the nighttime and daytime with glare at the spatial frequencies of 1.5, 12, and 18 cycles per degree (P=0.054, P=0.04, and P=0.01 and P=0.011, P=0.031, and P=0.011, respectively). The greatest differences in contrast sensitivity were observed between the groups 4 and 5, and it was 2 to 4 times better in the group 4. Comparing these groups, all the differences at the nighttime and daytime with and without glare were significant. CONCLUSIONS: Contrast sensitivity was worst among the oldest persons (71-85 years), and it began to worsen already in the persons aged 40-49 years. Contrast sensitivity was very similar in the age groups of 40-49 and 50-59 years.

Keratoprosthesis surgery as an alternative to keratoplasty.

Corneal transplant surgery after chemical or thermal burns has a very low success rate. Vision in these patients can be restored by using an artificial cornea (keratoprosthesis). In this report, we present 5 clinical cases of implanting a fresh corneal graft with Boston type 1 keratoprosthesis in patients with corneas inappropriate for standard corneal transplantation. The mean follow-up was 26.4 months (range, 12 to 36 months; SD, 13.1). The main measures of outcomes were visual acuity and keratoprosthesis stability. At least 1 year after the operation (5 eyes), vision acuity was >0.1 in 100% of the eyes and >0.4 in 50% of the eyes. Retention of the initial keratoprosthesis was 100%. The results of this study seem to be similar to those reported internationally. The anatomical and visual functions of the eyes were stable after keratoprosthesis implantation, though for a longer follow-up period, additional surgical procedures may be required.

Inherited macular dystrophies and differential diagnostics.

The inherited macular dystrophies are characterized by different grade central visual loss and different character macula atrophy, because of retinal pigment epithelium lesion. The cause of photoreceptors degeneration is still not known. In this article, we review subjective and objective ophthalmological examines essential to diagnosis and differential diagnosis of inherited autosomal dominant and autosomal recessive macular dystrophies. It is known seven gene mutations (ABCA4, ELOVL4, PROML1, VMD2, Peripherin/RDS, TIMP3, XLRS), which may cause inherited macular dystrophies development. Inheritance type of inherited macular dystrophies, prevalence, beginning of disease, spread of the disease between female and male, clinic, electroretinography, electrooculography, differential diagnosis, genetic research and prognosis are also reviewed.

Does matrix metalloproteinase-3 polymorphism play a role in age-related macular degeneration in patients with myocardial infarction?

OBJECTIVE: The aim of our study was to determine if the genotype of the matrix metalloproteinase-3 (MMP-3) gene might carry the risk of age-related macular degeneration (ARMD) in patients with myocardial infarction. MATERIAL AND METHODS: A total of 499 patients with an acute myocardial infarction or with a history of myocardial infarction were enrolled into the study. They were subdivided into 2 groups: 273 patients with ARMD and 226 patients without ARMD. The control group comprised 560 persons from a random sample of the Lithuanian population. DNA was analyzed using real-time polymerase chain reaction to genotype polymorphism 5A/6A at a position -1171 of the MMP-3 gene promoter. RESULTS: Of the 499 patients with myocardial infarction, 47% had early-stage ARMD. The patients with ARMD were older than the patients in the group without ARMD (62.1±10.8 vs. 59.6±11.1, P<0.01). The analysis of MMP-3 gene polymorphism did not reveal any differences in the distribution of 5A/5A, 5A/6A, and 6A/6A genotypes between the ARMD group, non-ARMD group, and the control group (24.2%, 52.5%, and 23.3% in the ARMD group; 28.7%, 51.9%, and 19.4% in non-ARMD group; and 25.7%, 49.3% and 25.0%, in the control group, respectively). CONCLUSIONS: MMP-3 gene polymorphism had no predominant effect on the development of ARMD in patients with myocardial infarction.

Risk factors for fluctuations in corneal endothelial cell density (Review).

The cornea is a transparent, avascular and abundantly innervated tissue through which light rays are transmitted to the retina. The innermost layer of the cornea, also known as the endothelium, consists of a single layer of polygonal endothelial cells that serve an important role in preserving corneal transparency and hydration. The average corneal endothelial cell density (ECD) is the highest at birth (~3,000 cells/mm2), which then decrease to ~2,500 cells/mm2 at adulthood. These endothelial cells have limited regenerative potential and the minimum (critical) ECD required to maintain the pumping function of the endothelium is 400-500 cells/mm2. ECD < the critical value can result in decreased corneal transparency, development of corneal edema and reduced visual acuity. The condition of the corneal endothelium can be influenced by a number of factors, including systemic diseases, such as diabetes or atherosclerosis, eye diseases, such as uveitis or dry eye disease (DED) and therapeutic ophthalmological interventions. The aim of the present article is to review the impact of the most common systemic disorders (pseudoexfoliation syndrome, diabetes mellitus, cardiovascular disease), eye diseases (DED, uveitis, glaucoma, intraocular lens dislocation) and widely performed ophthalmic interventions (cataract surgery, intraocular pressure-lowering surgeries) on corneal ECD.

Prevention of posterior capsule opacification with 3 intraocular lens models: a prospective, randomized, long-term clinical trial.

UNLABELLED: The aim of this prospective randomized study was to evaluate the impact of different sharp-edged intraocular lenses (IOLs) (hydrophobic acrylic or silicone) on posterior and anterior lens capsule opacification (PCO and ACO) at 3-year postoperative follow-up. MATERIAL AND METHODS: A total of 96 eyes (89 patients) having a standard uncomplicated phacoemulsification procedure for age-related cataract were included in a prospective clinical study: 34 eyes with a 3-piece acrylic hydrophobic (AcrySof, MA3OBA), 32 eyes with a 1-piece acrylic hydrophobic (AcrySof, SA3OAL), and 30 eyes with a 3-piece silicone (CeeOn 911A) IOL. Visual acuity, capsulorrhexis/optic overlapping, ACO and PCO (using EPCO2000 system) were evaluated at 3-year follow-up. Capsulotomies performed by means of neodymium-yttrium-aluminum-garnet (Nd:YAG) laser were recorded. RESULTS: Three years after surgery, the grade of ACO of the capsulorrhexis rim area and the capsule/optic area was significantly greater in the silicone IOL group than in the acrylic IOL groups (P<0.05). During 3 postoperative years, there were no significant differences in the PCO values either in the entire IOL optic area or in the central 3-mm optic zone comparing the groups. Three years after surgery, 9% of eyes with a 3-piece acrylic IOL, 3.1% of eyes with a 1-piece acrylic IOL, and no case in the silicone IOL group had Nd:YAG capsulotomy (P>0.05). CONCLUSION: The 3-year follow-up after cataract surgery showed no difference in PCO development (EPCO2000) between acrylic hydrophobic and silicone sharp-edged IOLs. However, the need for Nd:YAG laser capsulotomy was higher in the acrylic IOL groups than the silicone IOL group, though the difference was not significant. ACO was greatest in the eyes with 3-piece silicone IOLs.

[Associations between color perception and optic nerve disk drusen]. / Regos nervo disko druzu sasajos su spalvu jusle.

UNLABELLED: The aim of this study was to determine the association between color perception determined by maximum color contrast sensitivity and Farnsworth-Munsell 100-hue tests and visual acuity in the presence of optic nerve disk drusen. MATERIAL AND METHODS: A case-control study, including 137 persons, was performed. Thirty-seven patients (67 eyes) with optic nerve disk drusen and 100 healthy controls (200 eyes) were examined. For visual acuity testing, a typical Snellen chart (the direction of the gap in Landolt C) was used. A computerized Farnsworth-Munsell 100-hue test and maximum color contrast sensitivity programs were used for color discrimination. RESULTS: The results of maximum color contrast sensitivity test, and the Farnsworth-Munsell 100-hue test were better in healthy controls than patients (1.94 ± 0.66 vs. 2.2 ± 0.85, P=0.02; 94.1 ± 53.9 vs. 120.6 ± 61, P=0.003, respectively). CONCLUSION: The study revealed that the presence of optic nerve disk drusen was associated with decreased perception of colors.

Factors determining age-related macular degeneration: a current view.

Age-related macular degeneration affects the macula and is the leading cause of significant and irreversible central visual loss. It is the most common cause of visual loss in people older than 60 years. The pathogenesis of age-related macular degeneration is complex and not completely understood. It is thought that age-related macular degeneration has a multifactorial etiology, the development of which may be caused by interrelation of environmental and genetic factors and body characteristics. In this article, risk factors such as age, gender, cigarette smoking, color of the iris, nutrition, body mass index, oxidative stress, and genetic factors (complement factor H gene, Apo E gene, and others) are reviewed. Here, choroidal neovascularization process, in which hypoxia, inflammatory process, and proteolytic enzymes play a determinant role, is discussed. Considerable attention is paid to genetic polymorphism of matrix metalloproteinases, especially to matrix metalloproteinases 2 and 9, respectively gelatinases A and B, also to matrix metalloproteinase 9.

Relations between patient personality and patients' dissatisfaction after multifocal intraocular lens implantation: clinical study based on the five factor inventory personality evaluation.

To assess the level of visual function and the influence of personality traits on patients' (pts) satisfaction with the visual function following the four different MIOL implantation. METHODS: We evaluated the visual outcomes over a 6 months follow-up period after cataract surgery with bilateral implantation of four different multifocal IOLs. The spectacle independence, photic phenomena, the influence of personality traits on patients' satisfaction with the visual function were assessed. RESULTS: A total of 170 eyes of 85 pts were included. There was no statistically significant difference in UDVA (F = 1.6 p = 0.177) and CNVA (F = 1.2 p = 0.30) between the groups 6 months after the surgery. The ReSTOR group had a worse CDVA than the M-flex (p = 0.019) and TECNIS (p = 0.005) groups. The ReSTOR and AT.LISAtri groups had a statistically significantly better UNVA than the M-flex (p = 0.020 and p = 0.013) and TECNIS groups (p = 0.001 both). The independence on spectacles for near distance was from 71.8% (in M-flex group) to 100% (in ReSTOR). The answers of the pts with the prevailing neurotic personality type contradicted the answers given by the pts with other prevailing personality types (p < 0.01). CONCLUSIONS: MIOL implantation helped ensure better postoperative visual acuity, but some pts were unhappy with the postoperative outcomes. It was established that the subjective satisfaction or dissatisfaction of patients after MIOL implantation is related to certain personality traits: pts with neuroticism as the dominant personality trait were least happy with the postoperative outcomes; pts with conscientiousness and agreeableness as dominant personality traits demonstrated the highest satisfaction with the postoperative outcomes.

[Association of metabolic syndrome with abnormalities of bulbar conjunctival vessels]. / Metabolinio sindromo ir jo komponentu sasajos su akies obuolio jungines kraujagysliu pokyciais.

AIM: To examine and evaluate the relationships of the metabolic syndrome and abnormalities of bulbar conjunctival vessels among middle-aged Kaunas population. MATERIAL AND METHODS: Analysis was performed on 383 asymptomatic persons aged 38-39 years (170 men and 212 women). Metabolic syndrome was defined using criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). For determination of abnormalities in bulbar conjunctiva vessels and microcirculation, each participant underwent noncontact slit lamp examination. The changes of vessel walls and bloodstream, extravasal alterations were evaluated, and conjunctival index was calculated. RESULTS: Metabolic syndrome was present in 10.7% of individuals. Persons with metabolic syndrome had a 2.35-point higher conjunctival index compared to the controls (P=0.003). After evaluation of various components of metabolic syndrome to conjunctival index, it was determined that the greatest change in the means of conjunctival index was due to hyperglycemia (P=0.02) and central obesity (P=0.05). Metabolic syndrome was related to venular dilatation (OR=3.78; 95% CI, 1.86-7.72), arteriolar narrowing (OR=1.98; 95% CI, 0.97-4.09), decreased arteriolar-venular ratio (OR=2.35; 95% CI, 1.13-4.98), and increased venular tortuosity (OR=2.24; 95% CI, 1.06-4.82). Multiple logistic analysis revealed that venular dilatation (OR=3.38; 95% CI, 1.43-7.99) and arteriolar narrowing (OR=2.22; 95% CI, 0.98-5.01) were significant factors in the prognosis of metabolic syndrome. CONCLUSIONS: Metabolic syndrome was significantly related to abnormalities of bulbar conjunctival vessels such as venular dilatation, arteriolar narrowing, decreased arteriolar-venular ratio, and increased venular tortuosity. Both conjunctival index and individual conjunctival microvascular changes may be prognostic factors for metabolic syndrome, but long-term studies on associations between metabolic syndrome and changes of bulbar conjunctival vessels are needed.

[Comparison of postoperative results after implantation of hydrophilic acrylic or hydrophobic acrylic intraocular lens: data of one-year prospective clinical study]. / Akriliniu hidrofiliniu ir akriliniu hidrofobiniu intraokuliniu lesiu pooperaciniu rezultatu palyginimas (prospektyviojo klinikinio tyrimo vieneriu metu duomenys).

OBJECTIVE: To evaluate and compare the impact of two sharp-edge optic foldable intraocular lenses (IOLs) of similar design made from different material (hydrophilic acrylic or hydrophobic acrylic) on visual function, anterior and posterior capsule opacification at one-year follow-up after cataract phacoemulsification. MATERIAL AND METHODS: Seventy-two eyes of 72 patients scheduled for cataract surgery were included in a prospective clinical study. Two foldable sharp-edge optic posterior chamber acrylic IOLs of similar design were used. Thirty-nine eyes of 39 patients received a single-piece hydrophilic acrylic (PC 511, Ophtec) IOL and 33 eyes of 33 patients - single-piece hydrophobic acrylic (AcrySof, SA60AT, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsulorrhexis/optic overlapping, and posterior capsule opacification (PCO) were evaluated. The intensity of ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3-mm optic zone were assessed using a photographic image analysis system (EPCO 2000). The patients were examined at one year postoperatively. RESULTS: There were no significant differences in best-corrected visual acuity and capsulorrhexis/optic overlapping between IOL types at 1-year follow-up after surgery. In the single-piece hydrophilic acrylic IOL group, the grade of ACO density was significantly higher in capsulorrhexis rim area (1.56+/-0.71 and 1.00+/-0.75) and in the capsule/optic area (1.62+/-0.67 and 1.00+/-0.75) (P<0.05). PCO values of the entire IOL optic area (0.12+/-0.13 and 0.024+/-0.02) as well as in the central 3-mm optic zone (0.06+/-0.11 and 0.001+/-0.003) was significantly higher in the single-piece hydrophilic acrylic IOL group one year postoperatively (P<0.05). In 33.3% of cases of the single-piece hydrophilic acrylic IOL group, contraction of haptics to IOL optics was present one year postoperatively, which was not present in any case of the single-piece hydrophobic acrylic IOL group. CONCLUSIONS: One-year follow-up after cataract surgery has shown a significant difference in ACO and PCO development comparing single-piece hydrophilic acrylic and single-piece hydrophobic acrylic intraocular lenses. The effect of hydrophobic acrylic foldable lenses on preventing anterior and posterior capsule opacification is mainly a result of the acrylic hydrophobic biomaterial.

Influence of three-piece and single-piece designs of two sharp-edge optic hydrophobic acrylic intraocular lenses on the prevention of posterior capsule opacification: a prospective, randomised, long-term clinical trial.

BACKGROUND: Posterior capsule opacification (PCO) is still a major long-term complication of modern cataract surgery. We evaluated the impact of sharp-edged intraocular lenses (IOLs) with different haptic designs made from the same hydrophobic acrylic material on posterior and anterior lens capsule opacification. SETTING: Eye clinic of Kaunas University of Medicine, Lithuania. Prospective randomised clinical study. METHODS: Seventy-four eyes of 74 patients scheduled for cataract surgery were included in a prospective randomised clinical study. Thirty-seven eyes of 37 patients received a three-piece acrylic hydrophobic (AcrySof, MA3OBA, Alcon) IOL; and thirty-seven eyes of 37 patients received a one-piece acrylic hydrophobic (AcrySof, SA3OAL, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsular folds, capsulorrhexis/optic overlapping and posterior capsule opacification (PCO) were evaluated. ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3 mm optic zone were assessed using a photographic image-analysis system (EPCO2000). Follow-ups were performed postoperatively at 1 day, 6 months, 1 year and 2 years. RESULTS: There were no significant differences in best corrected visual acuity, grade of ACO and capsulorrhexis/optic overlapping between IOL types during the follow-up period. Patients in the one-piece acrylic hydrophobic IOL group more frequently presented with capsular folds behind the IOL optic area than those in the three-piece IOL group. In the three-piece acrylic hydrophobic IOL group, PCO values (mean (SD)) of the entire IOL optic area were significantly lower six months postoperative (three-piece: 0.002 (0.009); one-piece: 0.007 (0.017); p=0.04), one year postoperative (three-piece: 0.004 (0.016); one-piece: 0.026 (0.041); p=0.001) as well as one year postoperative in the central 3 mm optic zone (three-piece: 0.000 (0.0002); one-piece: 0.019 (0.049); p=0.001). However, two years postoperative, the PCO values of the groups did not show significant differences (entire IOL optic area: three-piece, 0.136 (0.223); one-piece, 0.154 (0.190); p=0.18; central zone: three-piece, 0.023 (0.065); one-piece: 0.020 (0.039); p=0.44). CONCLUSION: The 2 year follow-up after cataract surgery showed no significant difference in ACO and PCO development between three-piece and one-piece acrylic hydrophobic intraocular lenses.

[Tendencies of cataract surgery in Lithuania]. / Kataraktos chirurgijos tendencijos Lietuvoje.

OBJECTIVE: To review the tendencies of cataract surgery in Lithuania. MATERIALS AND METHODS: More than ten years the data are collected from all medical institutions in Lithuania, where cataract surgery is performed. Each year from 1994 standardized questionnaires are sent to all centers of the cataract surgery and afterwards collected in the database. The questionnaires contain questions regarding the incidence of cataract surgery, operation methods, the rate of applied intraocular lenses, their models, etc. RESULTS: A total of 74,954 cataract operations were performed in Lithuania from 1994 till 2004. Phacoemulsification for the first was used in Lithuania in 1996. Since that time, 18,393 phacoemulsification operations have been performed. The first foldable intraocular lens was implanted in Lithuania in 1998. A total of 5,140 foldable intraocular lenses were implanted till 2005. It makes up 7.36% from total number of implanted intraocular lenses during the period under review. CONCLUSIONS: We have been observing a great quantitative and qualitative increase in the amount of cataract surgeries for last ten years. This is due to the newest cataract surgery methods (manual small incision cataract surgery, phacoemulsification), introduction of viscoelastic agents, new generation lenses (foldable: acrylic, silicone), and modern phacoemulsificators to clinical practice.

Predictive Factors of Development of Graves' Ophthalmopathy for Patients with Juvenile Graves' Disease.

Background. Due to low incidence of Graves' ophthalmopathy (GO) among children, the manifestation is poorly analyzed, posing a risk to late identification of insidious disease. Purposes. To identify predictive factors that may influence the development of GO in pediatric and young patients with Graves' disease (GD). Methods. A cross-sectional study of patients newly diagnosed with pediatric or juvenile GD during 2002-2012 was conducted at the Hospital of Lithuanian University of Health Sciences. Ocular evaluation was based on European Group on Graves' Orbitopathy survey. The ocular manifestations were analyzed in relation to demographic, environmental, and clinical factors. Results. In total, 130 patients with juvenile GD were included; 29.2% had GO. Median age at GD onset was 17 yrs (IQR 4-29). Main symptoms of GO were eyelids retraction (73.7%), proptosis (65.8%), injection of conjunctiva (42.1%), and eyeball motility disturbance (21.1%). Major significant and independent risk factors for GO development were high initial concentration of FT4 (OR = 5.963), TTHAb (OR = 6.358), stress (OR = 6.030), and smoking (OR = 7.098). Conclusion. The major factors that could influence GO development were smoking, stress, and increased levels of initial TRAb, FT4. Slight proptosis, retraction of eyelids, and conjunctive injection were found as predominant ophthalmological symptoms in juvenile GO.

Evaluation of Outflow Structures In Vivo after the Phacocanaloplasty.

Purpose. To evaluate the in vivo changes in Schlemm's canal (SC) and the trabecular meshwork (TM) in patients with primary open-angle glaucoma (POAG) after phacocanaloplasty using anterior segment optical coherence tomography (AS-OCT). Methods. Ten eyes of nine patients with POAG (6 men and 3 women) who underwent phacocanaloplasty. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), and use of glaucoma medications were evaluated. The main outcome measures were the area of SC and TM thickness assessed using AS-OCT before and 12 months after surgery. Results. We found statistically significant reduction in IOP (from 26.4 (8.6) mmHg to 12.9 (2.5) (p < 0.05) mmHg), increase in VA from 0.7 (0.4) to 0.9 (0.2), and decrease in glaucoma medication from 2.6 (1.2) to 1.1 (1.3) at 12 months postoperatively. There was a significant increase in the SC area (3081.7 (842.8) µm(2) versus 5098.8 (1190.5) µm(2), p < 0.001) and a decrease in mean TM thickness (91.2 (18.6) µm versus 81.3 (15.1) µm, p = 0.001) after surgery. We found negative correlations between SC area and IOP before surgery (r = -0.67, p = 0.03) and also between SC area before and IOP reduction 12 months after the phacocanaloplasty (r = -0.80, p = 0.005). Conclusions. Our results showed statistically significant dilation of SC area and reduction of TM thickness after phacocanaloplasty in POAG patients. The degree of SC expansion was related to the IOP decrease.

Role of MMP-2 (-1306 C/T) Polymorphism in Age-Related Macular Degeneration.

PURPOSE: To determine if the frequency of the MMP-2 (-1306 C/T) genotype has an influence on the development of early age-related macular degeneration (AMD). METHODOLOGY: The study enrolled 387 patients with early AMD and a random sample of 682 healthy persons (control group). The genotyping of MMP-2 (-1306 C/T) was carried out using the real-time polymerase chain reaction method. RESULTS: The analysis of the MMP-2 (-1306 C/T) gene polymorphism did not reveal any differences in the genotype distribution between the patients with AMD and the control subjects. When the study population was divided into age groups, the C/C genotype was more prevalent in the AMD patients aged <65 years than those aged ≥65 years (65.19% versus 53.88%, p = 0.0294), and the C/T genotype was more frequent in the AMD patients aged ≥65 years when compared with the AMD patients aged <65 years (40.78% versus 26.52%, p = 0.0037). Moreover, in the female group younger than 65 years, the frequency of the C/C genotype was greater in the AMD group than the control group (75% versus 58.91%, p = 0.0232). CONCLUSIONS: This study showed a significantly greater prevalence of the C/C and C/T genotypes in the patients with AMD younger than 65 years and those aged ≥65 years, respectively. Moreover, the AMD women aged <65 years were the carriers of the C/C genotype significantly more frequently than their control counterparts.