[Corneal scars: confocal images as the basis of qualifying for PTK or PK]. / Blizny rogówki--obrazy konfokalne jako podstawa kwalifikacji do fotokeratektomii terapeutycznej (PTK) lub keratoplastyki drazacej (PK).

PURPOSE: The study aimed to evaluate corneal scars of various origin using confocal microscopy in order to qualify patients for phototherapeutic keratectomy or penetrating keratoplasty. MATERIAL AND METHODS: We studied 21 patients with scars of various origins in 28 corneas. The age of patients (9 women and 12 men) ranged from 27 to 47 years (mean 31.8). In 10 patients (17 corneas) scars were caused by superficial or profound inflammatory processes of viral, bacterial or fungal origin. In 7 patients (7 corneas) the causative factor was blunt or lacerating injury (linear and planar) and in 4 patients (4 corneas) scars developed after the removal of foreign bodies. All corneas were examined using a ConfoScan-P4 scanning slit confocal microscope (Tomey). RESULTS: Post-inflammation scars differed in microscopic appearance, depending on the etiology and clinical state, which affected the mode of treatment. Three scars caused by penetrating trauma were qualified for penetrating keratoplasty. Out of 4 scars caused by non-penetrating trauma, 2 were treated by PTK and 2 by penetrating keratoplasty. In patients with impaired vision after the removal of corneal foreign bodies, confocal microscopy revealed focal areas of increased illumination and intracorneal encrustations. CONCLUSIONS: Confocal microscopy enabled us to determine the structure of corneal scar and the depth at which each scar was located, which helped us to choose between PTK and penetrating keratoplasty. The presence or absence of needle-like structures allowed us to detect inflammatory processes within the scar and to evaluate the state of the remaining corneal tissue.

[The state of anterior eye segment after posterior chamber intraocular lens implantation with transscleral fixation]. / Stan przedniego odcinka galki ocznej z soczewka tylnokomorowa mocowana do twardówki.

PURPOSE: The aim of the study was to evaluate the state of anterior eye segment in postoperative period after PC-IOL transscleral fixation. MATERIAL AND METHODS: The material comprised 31 eyes in 31 patients, (11 women and 20 men), aged 20-80 years (average 61 years), who underwent the primary or secondary PC-IOL implantation with transscleral fixation. The examination was performed 10 to 14 months (average 12 months) after surgery. The clinical state of the corneas was evaluated using endothelial and confocal microscopy. The position of the IOL, its location and symmetry were evaluated with ultrasound biomicroscopy. RESULTS: The visual acuity ranged from 0.1 to 1.0. In 20 eyes (64%) the position of PC-IOL was correct. In the rest of cases the inappropriate position of implants was observed. The decrease of endothelial cells density was 13% in eyes with primary implantation and 7% in cases with secondary implantation of IOL. In the corneal endothelium, there were features of pleomorfism and polymegatism; in a few cases some deposits were observed. CONCLUSION: The implantation of posterior chamber intraocular lenses with transscleral fixation is recommended for some cases of primary or secondary problems with capsule support. The PC-IOL implantation with transscleral fixation can be the alternative method for the anterior IOL implantation.

[Iron deposits in cornea in confocal microscope]. / Zlogi zelaza w rogówce w mikroskopie konfokalnym.

PURPOSE: The study aimed to evaluate the iron deposits in corneas in confocal microscope. MATERIAL AND METHODS: The material comprised 16 eyes which underwent photorefractive keratectomy (PRK) procedure. The structure of corneas was evaluated between 3-10 years after PRK. The visual acuity after PRK was the same as the best corrected visual acuity before the procedure. The structure of corneas was evaluated in vivo using scanning slit confocal microscopy. The confocal images of corneas in patients after PRK were compared with confocal corneal images of patients with corneal scars (2 eyes), keratoconus (2 eyes), after radial keratotomy (RK) (2 eyes) and healthy patients. RESULTS: Within the central part of corneal epithelium and anterior part of stroma, the clusters of iron deposits were observed. They were round and produced different shapes. In the paracentral and peripheral part of corneas the subepithelial nerve plexus was detected. Beneath, the pattern of keratocytic nuclei, characteristic for state after PRK, was detected. In patients with corneal scars, keratoconus and after RK, the same clusters of deposits were detected. In cases of corneal scars, additionally high reflectivity of corneal structure was observed. CONCLUSIONS: The iron deposits in corneal structure arise in epithelium and anterior part of corneal stroma. The iron deposits which produce different shapes have no influence on visual acuity.

[Treatment of corneal ulcerations with use of the amniotic membrane]. / Leczenie owrzodzen rogówki z zastosowaniem blony owodniowej.

UNLABELLED: Corneal ulcerations may cause complications such as, for example, the loss of transparency, descemetocele or perforation of the cornea. Widely used therapies do not always bring expected results. Recently the amniotic membrane has been applied for the treatment of corneal ulceration. PURPOSE: The purpose of the present study was to evaluate the efficacy of the amniotic membrane suturing over the locations of corneal ulcers. MATERIAL AND METHODS: The amniotic membrane was sutured over the locations of corneal ulcers in 9 eyes of 9 patients suffering from ulcers which did not regress with traditional therapeutic methods. After meticulous debridement of the ulcer floor and border area the amniotic membrane was sutured to the cornea with a single 10.0 Nylon suture (around the ulcer area), and additionally suture were fixed to the sclera. Following the procedure contact lenses were placed over the area for protection. The observation period was 6 months. Follow-up examinations were performed regularly during the first seven postoperative days, then after 2, 4 and 12 weeks; the final follow-up took place 6 months after the procedure. RESULTS: In all patients we observed healing of the corneal defect, improvement of visual acuity and regression of the active inflammatory process. After this procedure the subjective symptoms subsided. CONCLUSION: The amniotic membrane can be used for the treatment of corneal ulceration of various etiology.

[Structural changes in the cornea after LASIK-u during the early postoperative period]. / Zmiany struktury istoty wlasciwej rogówki po LASIK-u we wczesnym okresie pooperacyjnym.

PURPOSE: The study aimed to evaluate in vivo the corneal structure after refractive surgery and monitor morphologic and morphometric changes in the post-operative period. MATERIAL AND METHODS: The study included 35 eyes (25 patients) who underwent LASIK correction of myopia. The structure of the cornea was evaluated in vivo using a scanning slit confocal microscope. Each cornea was examined before, 2, 4 and 8 weeks after procedure. The keratocyte density was evaluated morphometrically in the anterior and posterior corneal stroma. RESULTS: Before surgery the keratocyte density in the anterior stroma ranged from 900 to 1200/mm2, while in the posterior stroma it ranged from 600 to 950/mm2. 8 weeks after LASIK the keratocyte density in anterior stroma ranged from 695 to 1048/mm2 and in posterior stroma from 565 to 935/mm2. CONCLUSIONS: After LASIK the keratocyte density decreases in anterior stroma while in posterior stoma it is constant.

[Changes in corneal structure observed with confocal microscopy during Fuchs endothelial dystrophy]. / Zmiany struktury rogówki obrazowane w mikroskopii konfokalnej w przebiegu dystrofii Fuchsa.

PURPOSE: The study aimed to in vivo evaluate corneal structure in Fuchs' dystrophy. MATERIAL AND METHODS: Forty-two eyes of 21 patients (11 women and 10 men) aged 34-80 (mean 60.8) were studied. Sixteen patients presented clinical symptoms. The cornea was examined using a Confoscan P4 scanning slit confocal microscope (Tomey). Before examination, the cornea was anesthetized with 0.5% propacaine (Alcaine, Alcon) in order to inhibit the corneopalpebral reflex. A 40x microscope objective was covered with a drop of polyarylic acid gel (Vidisic, Mann Pharma) and then it was moved horizontally close to the patient's cornea and the examination was carried out. RESULTS: In the early stage of Fuchs dystrophy, slit biomicroscopy revealed fine dark spots within the corneal endothelium, while in the advanced stage the cornea had the appearance of beaten metal. On confocal microscopy, there were diffused hyporeflective areas in the early-stage disease. The endothelial cells located beyond these areas were pleomorphic and polymegathic. In the late stage we observed diffused hyporeflective areas surrounded by hyperreflective endothelial cells, which could not be analyzed separately. Within the corneal stroma, the collagen fibers were blurred and the background illumination was increased. In the posterior part of the stroma, dark bands were seen. The epithelium contained cystic structures (blisters). The membranes of the basal cells were thickened and the background illumination was increased. CONCLUSIONS: Confocal microscopy allows to diagnose Fuchs dystrophy and visualize endothelial cells within the swollen cornea.

[The alterations in corneal structure at III/IV stage of keratoconus by means of confocal microscopy and ultrasound biomicroscopy before penetrating keratoplasty]. / Zmiany struktury rogówki w III/IV stopniu stozka rogówki obrazowane badaniami mikroskopii konfokalnej i biomikroskopii ultradzwiekowej przed przeszczepem drazacym.

PURPOSE: The aim of the study was in-real time observation and morphological evaluation of the human corneas at III/IV stage of keratoconus, using the scanning slit confocal microscope Confoscan P4 and ultrasound biomicroscopy--UBM. MATERIAL AND METHODS: The patients with keratoconus were examined according to the Amsler scale. The material consisted of 12 corneas of 11 patients (8 men, 3 women), where assessment of the corneal structure was performed with the confocal microscope ConfoScan P4 (Tomey) and ultrasound biomicroscopy--UBM Model 840 (Humphrey Instruments). The comparison of different corneal regions (central and peripheral) was evaluated. RESULTS: The confocal microscopy and UBM revealed thinning of the layers of the corneal structure and pathological changes in the central area, especially at IV stage of keratoconus. The desquamating superficial cells were elongated, arranged around the apex of the cornea. Below the Bowman's membrane a considerable disarrangement of collagen fibers reflected by bright background illumination was observed. In the posterior part of the stroma the folds were detected. The examination of the cornea showed thickening in the peripheral part, central detachment of the Descemet's membrane and the endothelium from the posterior surface of the cornea. The thickness of the cornea varied from 0.201 to 0.384 mm in the central part and 0.675 to 0.740 mm in the peripheral area. CONCLUSION: Confocal scanning microscopy combined with ultrasound biomicroscopy enables the cornea to be examined in vivo. It can be used to localize pathological changes in individual corneal layers and to assess their extent.

[The examination of healthy human corneas with confocal microscope]. / Obserwacje przyzyciowe prawidlowych ludzkich rogówek przy uzyciu mikroskopu konfokalnego.

PURPOSE: The aim of this study was to observe the normal human corneas in vivo, using the Scanning Slit Confocal Microscope "Confoscan P4" (Tomey). MATERIALS AND METHODS: 50 corneas of 25 patients, aged 18 to 45 (mean 26), 10 women and 15 men were examined by means of the Confocal Slit Scanning Microscope. Obtained results were analysed in relation to patients' age and sex. The comparison of right and left cornea in each patient was performed. The structure of the epithelium, stromal keratocytes in the anterior, middle and rear part of the stroma, the pattern of the nerve plexus, the appearance of Bowman's and Descement's membranes and the condition of the endothelium were observed. RESULTS: In the analyzed group of patients there were no differences in the findings between the right and left eye. No age and sex related changes were observed. CONCLUSION: Confocal Scanning Microscope allows for real-time, noninvasive observation of the human corneal cell structure in vivo and is capable of evaluation of corneal morphology and physiology.

[Hypoplasia of the optic disc in children]. / Niedorozwój tarczy nerwu wzrokowego u dzieci.

PURPOSE: Analysis of etiological factors and functional assessment of the eyes. MATERIAL AND METHODS: Optic disc hypoplasia was diagnosed in 43 children, aged 12 months--12 years, unilateral in 9 (20.9%). The follow-up ranged from 8 months to 9 years, the mean age of patients during the last examination was 10.4 years. RESULTS: The following presumed etiological factors were stated in anamnesis: abose of alcohol by the mothers during pregnancy, syphilis, influenza, herpes and severe anemia. Visual acuity ranged from light perception with false localization to 5/50; in 58% of cases it was not above 1/50 but in 1/5 of the eyes visual acuity for short distance was sufficient for school needs. Concentric contraction and nasal scotoma were revealed in visual field. Hypermetropia was found in 28 eyes. In 3 cases mental dificiency was observed, in 1 of them with atrophy of a temporal cerebral cortex and epilepsia occurred in 1 child.