[Results of tectonic epikeratoplasty in the management of corneal perforations]. / Wyniki epikeratoplastyki tektonicznej w leczeniu perforacji rogówki.

PURPOSE: To present therapeutic application of tectonic epikeratoplasty as logical patch in severe ocular surface disorders. MATERIAL AND METHODS: Full thickness corneo-scleral transplants, 14 mm in diameter were used in 67 operations of 41 patients with corneal perforation or descemetocele. (14 women and 27 men), in the period 1998-2008. The mean age of patients was 55.2 +/- 17.7 years (range 15-82). The transplants were sutured over the limbus or the scleral rim and was implanted under the conjunctiva after 360 degrees peritomy. Donor tissue unsuitable for penetrating keratoplasty because of poor endothelium or corneal scarring, was obtained from Lublin Eye Bank. RESULTS: We observed closing of the perforation in all cases. Healing of the ulceration with scar formation and new vessels ingrowth was noted. In some eyes repeated epikeratoplasties were performed. CONCLUSIONS: Tectonic epikeratoplasty is a safe and simple method of treatment of corneal perforations. It provides a biological patch stimulating the healing of corneal defects. It gives time for systemic treatment before further ocular surface reconstructive procedures can be performed.

[Novelty of vital dyes in ophthalmic surgery]. / Zastosowanie nowych barwników w chirurgii okulistycznej.

The aim of this paper is to present recent developments in the area of novelty of vital dyes in intraocular surgery. The authors present the advantages and disadvantages of several vital dyes currently used in ophthalmic surgery. Vital dyes are used to allow better intraoperative visualization of both the anterior and posterior segments. Indocyanine green and trypan blue are the most frequently used and the most efficacious dyes for staining the important anatomic areas but often are associated with significant side effects. These dyes are used in cataract and vitreo-retinal surgery. Other dyes including rhodamine 6G, E68, bromophenol blue, light green and Chicago blue are still under preclinical assessment.

Eyelid Disorders in Ophthalmology Practice: Results from a Large International Epidemiological Study in Eleven Countries.

PURPOSE: Anecdotal evidence suggests that eyelid disorders are common, although estimates of prevalence vary. The current study determines the prevalence of eyelid disorders, meibomian gland dysfunction (MGD) and related diseases (specifically ocular surface disease) in a population of patients presenting for routine ophthalmologic consultations. METHODS: This cross-sectional epidemiologic survey evaluated patients presenting for routine ophthalmic visits. During the consultation an ophthalmologist completed a questionnaire, and each patient underwent an ophthalmic examination and completed a quality of life questionnaire. RESULTS: Three hundred forty-nine ophthalmologists, recruited from 11 countries, provided data on 6525 patients. Patients were predominantly females (61.6%). The mean age of the study population was 57.0 ± 17.6 years. Eyelid disorders were diagnosed in 5109 (78.3%) patients and were statistically associated with: atopic dermatitis, seborrheic dermatitis, dry eye, age-related macular degeneration, diabetes, cataract, allergy and MGD (P < 0.05, all associations). Eyelid abnormalities were identified in 59.6% of patients; conjunctival or corneal abnormalities were observed in 64.9% and 28.1% of patients, respectively. MGD was diagnosed in 54.3% patients and was statistically significantly associated with the presence of eyelid disorders and eyelid margin abnormalities (P < 0.001, both comparisons). Dry eye was diagnosed in 61.8% of patients. Concurrent dry eye and MGD were present in 67.6% of patients. Most patients reported some degree of impaired vision and daily/work activities related to dry eye. Impact on contact lens usage, emotions and quality of sleep was also reported. The effects on daily life were associated with the presence of MGD. CONCLUSION: In conclusion, eyelid disorders were highly prevalent in this 'real-world' population of patients from ophthalmology clinics. Routine ophthalmologic consultations provide an opportunity to improve patient quality of life and to modify topical therapy in patients who may be predisposed to eyelid disorders.

TFOS European Ambassador meeting: Unmet needs and future scientific and clinical solutions for ocular surface diseases.

The mission of the Tear Film & Ocular Surface Society (TFOS) is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface. Fundamental to fulfilling this mission is the TFOS Global Ambassador program. TFOS Ambassadors are dynamic and proactive experts, who help promote TFOS initiatives, such as presenting the conclusions and recommendations of the recent TFOS DEWS II™, throughout the world. They also identify unmet needs, and propose future clinical and scientific solutions, for management of ocular surface diseases in their countries. This meeting report addresses such needs and solutions for 25 European countries, as detailed in the TFOS European Ambassador meeting in Rome, Italy, in September 2019.

[Lyell'a syndrome--two case presentations]. / Zespól Lyell'a--opis dwóch przypadków.

Clinical symptoms of toxic epidermal necrosis (TEN) include massive epidermolysis within skin and mucous membranes. Similar to extensive stage II burns, this may be a life-threatening condition. Patients with TEN are usually treated in specialized burn centers andlor surgery departments. Here we present and discuss 2 case reports of patients with ocular complications of TEN. The aim of this study is to emphasize the necessity of ophthalmic control and treatment during the early and late phase of TEN.

[Decrease of the postoperative inflammatory reaction during pars plana vitrectomy (PPV) after administration of triamcinolone acetonide]. / Zmniejszenie pooperacyjnego odczynu zapalnego wskutek zastosowania octanu triamcynolonu podczas witrektomii pars plana.

PURPOSE: To prospectively evaluate the effect on postoperative inflammatory reaction and recovery after application of triamcinolone acetonide (TA) during pars plana vitrectomy (PPV), to visualize the vitreous. MATERIAL AND METHODS: Pars plana vitrectomy (PPV) was performed in 45 patients (21 males, 24 females) (29 with retinal detachment, 6 with macular hole, 1 with cystoid macular edema, 3 with diabetic retinopathy, 3 with vitreous haemorrhage, 1 with preretinal membrane, 1 with PVR and 1 with lens luxation). After surgical separation of the posterior vitreous and removal of any visible epiretinal membrane, TA was injected over the posterior pole. For the control group we used 15 patients (10 with retinal detachment, 2 with macular hole, 1 with preretinal membrane, 1 with lens luxation and 1 with vitreous haemorrhage) (10 males, 5 females) treated with PPV but without TA administration. To evaluate the degree of postoperative inflammation and to monitor the dynamics of the blood-aqueous barrier disruption, the laser flare cell meter (Kowa FM-500) was used. RESULTS: Tyndalometric mean values in the control group of eyes recorded 1 day after PPV were 32.41 +/- 6.1 ph/ msec while values in TA-treated group were significantly lower (20.26 +/- 2.4, p < 0.02). 10 days after surgery in TA group results were still significantly lower as compared to the control group (16.4 +/- 2.6 vs 32.5 +/- 9.6, p < 0.005). As observed 6 weeks after PPV, tyndalometric recordings in TA-treated group remained lower as those observed in the control group (16.1 +/- 3.1 vs 32.0 +/- 8.1, p < 0.01). CONCLUSIONS: The eyes which received TA-assisted PPV showed significantly less breakdown of the blood-ocular barrier than those with routine PPV. Intraoperative administration TA facilitates postoperative recovery after surgery lowering the inflammatory reaction.

In vivo retinal tolerance of various heavy silicone oils.

PURPOSE: Heavy silicone oils are currently under investigation as a permanent tamponade in eyes with inferior PVR. This study was an investigation of Densiron 68 (Fluoron GmbH, Neu-Ulm, Germany) and several new heavy silicone oil admixtures on the basis of the perfluoroalkanes F4H5 (perfluorobutylpentane), F4H6 (perfluorobutylhexane), and F4H8 (perfluorobutyloctane) with respect to their long-term tolerance in a rabbit model. METHODS: Because of the better solubility of the F4Hn-species (n = 5-8) in comparison to F6H8, we used F4H5, F4H6, and F4H8 to generate highly viscous, heavy silicone oils (HSO). After vitrectomy and fluid-air exchange, the left eye of each of five rabbits per group was filled with HSO 68-1500 (Densiron 68), HSO 45-5000, HSO 45-3000, HSO 46-5000, HSO 46-3000, HSO 48-5000, or HSO 48-3000, or pure F4H5, F4H6, or F4H8. Detailed clinical investigation, ERG testing, and histologic evaluation were performed throughout a 3-month follow-up. RESULTS: Densiron 68 and HSOs based on F4H5, as well as the three control oils (silicone oil of 1000, 3000, and 5000 mPa . s) were well tolerated over 3 months. Histologically, the retina was unaffected. In contrast, intraocular inflammation, cataract formation, and retinal detachment and degeneration were noticed in all groups with HSOs based on F4H6 or F4H8. CONCLUSIONS: Biocompatibility of the new HSOs is dependent on the lipophilic behavior (R(F)/R(H) ratio) and furthermore on the molecular dimension of the used semifluorinated alkanes (SFAs). HSOs on the basis of F4H5 may have advantages over silicone oils, on the basis of F6H8, for use as a tamponade agent for the inferior retina in difficult retinal situations.

An international strategic plan to preserve and restore vision: four curricula of ophthalmic education.

PURPOSE: To highlight the four International Curricula of Ophthalmic Education developed by the Task Forces of the International Council of Ophthalmology, published in Klinische Monatsblätter für Augenheilkunde in November 2006. DESIGN: A global perspective of developing educational curricula as tools to improve eye care. METHODS: Review of the experience and conclusions of the four international panels. RESULTS: The Task Force on Resident and Specialist Education developed a curriculum consisting of 15 topics in basic, standard, and advanced levels to provide flexibility of educational programs of the ophthalmic specialist in different locations across the world. The curricula were designed to be an educational tool to stimulate multiple levels of training of the ophthalmic specialist. The Task Force on Ophthalmic Education of Medical Students designed a curriculum covering 11 topics and provides illustrative materials for teachers and students. The Task Force strongly advocates the ophthalmology curriculum to be part of the core program of general medical schools education. The Task Force on Para-ophthalmic Vision Specialist Education developed a curriculum to highlight the importance of a team approach to eye care, consisting of ophthalmic specialists and paraophthalmic personnel to produce maximum efficiency. The Task Force on Continuing Medical Education (CME) designed a curriculum exploring the principles, elements, categories, and administration of CME activities in a variety of topics. CONCLUSIONS: These curricula shifted the traditional apprentice system of education to a curriculum-based training program in which goals, expectations, competencies, and technical training are defined to improve eye care worldwide.

Elevated concentrations of kynurenic acid, a tryptophan derivative, in dense nuclear cataracts.

PURPOSE: Kynurenines and their glycoside derivatives in the ocular lens absorb ultraviolet radiation and thus possibly help protect the retina from ultraviolet light. The current study analysed kynurenine aminotransferase I (KAT I) activity and kynurenic acid (KYNA) concentrations in human senile cataractous lenses and in experimentally induced cataracts in diabetic rats treated with streptozotocin (STZ). METHODS: KYNA levels and KAT I activity were investigated with HPLC and detected fluorimetrically in the nuclei of 91 human cataractous lenses collected during planned extracapsular extraction. The lenses were classified on the Lens Opacity Classification System III scale and compared with clear lenses regarding KYNA concentrations. Cataractous lenses from STZ-treated rats were compared with control lenses. RESULTS: KYNA concentration was 0.95 +/- 0.22 in human NC0 (nuclear color) control lenses, 0.8 +/- 0.72 in NC1, 1.18 +/- 0.88 in NC2, 1.31 +/- 0.70 in NC3, 1.78 +/- 0.92 in NC4, 8.80 +/- 8.28 (p < 0.05 vs. NC0) in NC5, and 14.0 +/- 11.1 (p < 0.05 vs. NC0) in NC6. A correlation was found between KYNA concentrations and the grade of cataract (r = 0.047, p < 0.001). KAT I activity in human cataracts was 0.44 +/- 0.16 pmol/mg protein- 1 hr- 1. Elevated KYNA concentrations in rat cataractous lenses were also observed (p < 0.05). CONCLUSIONS: KYNA levels are elevated in senile nuclear human cataracts and in cataractous lenses of rats with experimentally induced diabetes.

Early electroretinographic features of streptozotocin-induced diabetic retinopathy.

BACKGROUND: This study set out to document the early electrophysiological and immunohistochemical changes that occur in the retina of experimentally induced diabetic rats. METHODS: Diabetes was induced in rats by intraperitoneal injection of 60 mg/kg of streptozotocin (STZ). Electroretinogram readings were taken monthly under either short-duration or long-duration stimuli for up to 3 months after STZ. Oscillatory potentials (OP) and the amplitudes and implicit times of a- and b-waves were analysed, and b-wave amplitudes were analysed using a Naka-Rushton fit. Scotopic a-waves were analysed with photoreceptor models, and Rmp3 (the maximum a-wave amplitude) and S (sensitivity) were calculated. Three months after STZ injection, immunohistochemistry for glial fibrillary acidic protein was performed on the retinas of the STZ-treated rats and age-matched controls. RESULTS: The implicit OP times were significantly longer in the diabetic rats as compared with the controls, and this difference was noted as early as 1 month following STZ treatment. Other electrophysiological parameters, such as OP amplitudes, a- and b-wave amplitude as well as the implicit times, did not differ from controls at this stage. The sacrificed STZ-treated rats also demonstrated marked enhancement of glial fibrillary acidic protein immunoreactivity, suggesting that at least in experimentally induced diabetic retinopathy there is increased Müller cell reactivity. CONCLUSION: The results of this study indicated that functional alterations in the retina develop rapidly after the onset of diabetes. Analysis of each electroretinogram component may be useful in further investigating the development mechanisms of diabetic retinopathy.

[Effect of mydriasis and accommodation on intraocular pressure and pigment release in patients with the pigment dispersion syndrome]. / Wplyw akomodacji i mydriazy na cisnienie wewnatrzgalkowe i uwalnianie barwnika u chorych z zespolem rozproszonego barwnika.

PURPOSE: To determine if mydriasis and accommodation affect intraocular pressure (IOP) and pigment release in patients with the pigment dispersion syndrome (PDS). MATERIAL AND METHODS: Seventeen patients (34 eyes) diagnosed with PDS were included in the study (10 men and 7 women). Tonometry was performed on all patients before, and at 1 and 2 hours after mydriasis and before, and at 1 and 2 hours after sustained reading. The statistical analysis was performed using the paired T-test. RESULTS: In both tests the differences in intraocular pressure values were not statistically significant. Pigment liberation occurred in 11.8% of patients after mydriasis but was not associated with an increase in IOP. CONCLUSION: Accommodation during sustained reading did not cause significant pigment release or an IOP rise.

[Fundus autofluorescence imaging in patients with Stargardt dystrophy and fundus flavimaculatus]. / Obrazowanie autofluorescencji dna oka u chorych z choroba Stargardta i fundus flavimaculatus.

PURPOSE: To identify patterns of fundus autofluorescence (AF) in patients with Stargardt dystrophy and fundus flavimaculatus. MATERIAL AND METHODS: 20 patients in age 7 to 47 years with Stargardt dystrophy and fundus flavimaculatus, were examined. Ophthalmic evaluation included nonstandarized Snellen visual acuity, complete ophthalmic examination, fluorescein angiography and color fundus photographs. The autofluorescence images were obtained using a confocal scanning laser ophthalmoscope HRA2. RESULTS: In 15 patients lack or decreased AF signal in a foveal region with punctate diffuse spots with increased and decreased AF signal extending far from the macular region were observed. In 4 patients apart from lack of the AF signal in the central area punctate spots were restricted to the macular region. In 1 patient AF image was copletely normal. CONCLUSIONS: Autofluorescence imaging allows for evaluation of the area with changes on the RPE level typical for this disease and is helpful, noninvasive examination for diagnostic process in such patients. A wide variation in clinical phenotype can occur in patients with Stargardt disease and fundus flavimaculatus. Obtained different phenotypes in autofluorescence imaging may correlate with different clinical types of this disease, described in the literature.

[Posterior staphyloma in the normal lenght eyeball--a case report]. / Garbiak tylny w galce ocznej o prawidlowej dlugosci--opis przypadku.

PURPOSE: The aim of the study is to present a case of posterior staphyloma in the eyeball of the normal length. METHODS AND RESULTS: A 17-year-old boy underwent full ophthalmologic examination due to impaired vision in the right eye (R.E.) lasting for one month. The visual acuity of R.E. and L.E. was found to be 0.8 and 1.0, respectively; near visual acuity for both eyes--0.5, intraocular pressure in both eyes--16 mmHg. The anterior part of both eyes was normal. The R.E. ophthalmoscopy revealed the presence of posterior staphyloma near the temporal-upper optic disc margin accompanied by serous retinal detachment above the macula. The L.E. ophthalmoscopy--normal. The eyeball length 23 mm and posterior staphyloma depth 2.4 mm. Refraction test--normal without any vision defect. Additionally fluorescein angiography, US B and OCT confirmed the presence of posterior staphyloma of the right eye. During the 3-month follow up the retinal detachment markedly decreased. CONCLUSIONS: The case report shown that posterior staphyloma may develop in the eyeball of normal length although its incidence is rare. New diagnostic methods, especially OCT, are very helpful in the clinical picture evaluation.

Relation between grade of diabetic retinopathy and perilimbal capillary density: digital fluorescein angiographic study.

PURPOSE: To evaluate the relation between the capillary drop out in perilimbal area and the stage of diabetic retinopathy using the new approach of digital fluorescein angiography and digital image analysis technology. MATERIAL AND METHODS: Anterior and posterior segment fluorescein angiography were performed in 100 diabetic participants (43 males and 57 females, mean age +/- SD was 60 +/- 10.9 years) and 81 healthy persons as control group (41 males and 40 females, mean age +/- SD was 60.8 +/- 16.7 years). The loss in perilimbal capillary was estimated objectively by measuring the perilimbal intercapillary area (PIA). RESULTS: A significant loss in the perilimbal capillary density was observed in all stages of diabetic retinopathy (P < 0.05). 31.7 +/- 18% increase in perilimbal intercapillary area in average due to diabetes comparing to the control group, was observed. CONCLUSIONS: The perilimbal capillary area drops and ischemic changes associated with diabetic retinopathies showed strong correspondence.

[Assessment of the macula function by static perimetry, microperimetry and rarebit perimetry in patients suffering from dry age related macular degeneration]. / Ocena funkcji plamki za pomoca perymetrii statycznej, mikroperymetrii oraz perymetrii "rarebit" u chorych z postacia sucha AMD.

PURPOSE: To compare the visual field results obtained by static perimetry, microperimetry and rabbit perimetry in patients suffering from dry age related macular degeneration (AMD). MATERIAL AND METHODS: Fifteen eyes with dry AMD (hard or soft macula drusen and RPE disorders) were enrolled into the study. Static perimetry was performed using M2 macula program included in Octopus 101 instrument. Microperimetry was performed using macula program (14-2 threshold, 10dB) within 10 degrees of the central visual field. The fovea program within 4 degrees was used while performing rarebit perimetry. RESULTS: The mean sensitivity was significantly lower (p<0.001) during microperimetry (13.5 dB) comparing to static perimetry (26.7 dB). The mean deviation was significantly higher (p<0.001) during microperimetry (-6.32 dB) comparing to static perimetry (-3.11 dB). The fixation was unstable in 47% and eccentric in 40% while performing microperimetry. The median of the "mean hit rate" in rarebit perimetry was 90% (range 40-100%). The mean examination duration was 6.5 min. in static perimetry, 10.6 min. in microperimetry and 5,5 min. in rarebit perimetry (p<0.001). Sensitivity was 30%, 53% and 93% respectively. CONCLUSIONS: The visual field defects obtained by microperimetry were more pronounced than those obtained by static perimetry. Microperimetry was the most sensitive procedure although the most time-consuming. Microperimetry enables the control of the fixation position and stability, that is not possible using the remaining methods. Rarebit perimetry revealed slight reduction of the integrity of neural architecture of the retina. Microperimetry and rarebit perimetry provide more information in regard to the visual function than static perimetry, thus are the valuable method in the diagnosis of dry AMD.

[Intravitreal bevacizumab (Avastin) iniections for neovascular age-related macular degeneration (AMD)--preliminary results]. / Doszklistkowe iniekcje bevacizumabu (Avastin) w leczeniu wysiekowej formy zwyrodnienia plamki zwiazanego z wiekiem (AMD)--doniesienie wstepne.

PURPOSE: To evaluate effects of intravitreal bevacizumab on visual acuity and angiographic lesions characteristics in patients with neovascular AMD and to report safety of such treatement. MATERIAL AND METHODS: 32 patients with confirmed choroidal neovascularisation (CNV) and AMD were treated. Patients received 2 intravitreal bevacizumabu (1.25 mg) iniections on 1-3 months basis. Control ophthalmic evaluations included visual acuity measurements with EDTRS charts, intraocular pressure measurements, complete ophthalmic examination in slit lamp, fluorescein angiography and blond pressure measurements. RESULTS: In 18 patients (56%) visual acuity improvement at a mean 3 lines on EDTRS charts was observed, in 9 patients (28%) visual acuity did not change and in 5 (16%) cases decreased visual acuity (about 1,5 lines in EDTRS charts) was noted. Mean follow-up period was 3 months after second injection. In most study eyes fluorescein angiography revealed a marked reduction in leakage from CNV. Apart from one case with endophthalmitis symptoms after second bevacizumab injection, we did not observed systemic or ocular adverse effects of the applied treatment. CONCLUSIONS: Short-term results suggest that intravitreal bevacizumab is relatively safe form of AMD treatement and is associated with improvement in visual acuity and reduction in angiographic leakage in most patients with neovascular AMD. Further evaluation of the long-term effectiveness of this treatment is warranted.

[Fungal infections of the cornea--diagnostics and management]. / Diagnostyka i postepowanie w grzybiczych zakazeniach rogówki.

Fungal keratitis, an important cause of corneal infectious disease, is one of the most challenging types of microbial keratitis to diagnose, isolate the etiologic fungal organism and treat successfully. Aspergillus spp. are most commonly responsible for fungal keratitis worldwide. Most cases occur in hot, humid climates. Fungi invade the ocular surface only when it is compromised and gain access into the corneal stroma through a defect in the epithelial barrier. Pathogens multiply then, and cause inflammatory reaction together with tissue necrosis. Symptoms of fungal keratitis typically are not as acute as those of other forms of microbial keratitis. On examination, both signs seen in other forms of microbial keratitis and specific features of fungal keratitis are observed. In all cases with suspected fungal keratitis, corneal smears and cultures should be performed as soon as possible. Antifungal therapy should be restricted to those cases with fungus-positive laboratory results. The use of topical corticosteroids in the treatment of fungal keratitis is contraindicated. In about one-third of patients pharmacological therapy is not successful. In those cases, surgical intervention is essential. The main goal of surgical intervention is to control infection and maintain the integrity of the globe. The most commonly performed surgery in fungal keratitis is therapeutic penetrating keratoplasty. The use of topical corticosteroids is contraindicated in early postoperative period.

Severe eye injury in an 11-year-old child during threshing--A case report.

A case is reported of severe eye injury in an 11-year-old boy which occurred during threshing in the parents' farmyard. A detailed description of surgical treatment, complications and 7-year follow-up is presented. Despite long lasting treatment and new surgical methods used, the eye became blind. On the basis of our experience we can conclude that adequate adult supervision of children is mandatory during work in farmyards, and this is probably the only way to avoid at least a part of severe injuries which cause great social and economic losses.

Retinopathy of prematurity: A refresher for obstetricians.

Advances in neonatal care improved the survival of many preterm infants, but also increased the incidence of retinopathy of prematurity (ROP). Numerous risk factors have been associated with the development of ROP, the most important of which are: low birth weight, early gestational age at delivery, and duration of oxygen therapy. Screening premature infants is a critical factor for any prevention and treatment protocol. The Retinopathy of Prematurity Subcommittee of the American Academy of Ophthalmology (AAO) and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) have developed guidelines that assist practicing physicians in managing children with ROP. A portion of these guidelines is particularly applicable to practicing obstetricians who, along with the pediatricians, are often the primary physicians for the affected families. The aim of this paper is to present a comprehensive overview of the epidemiology, etiology, manifestations, prevention, and management of ROP. In the last section, the authors present guidelines for practicing obstetricians that incorporate the most recent recommendations of ophthalmic and pediatric thought leaders.