The Role of Angiogenesis Factors in the Formation of Vascular Changes in Scleroderma by Assessment of the Concentrations of VEGF and sVEGFR2 in Blood Serum and Tear Fluid.

Systemic sclerosis (SSc) is a connective tissue disorder characterized by tissue hypoxia, excessive fibrosis of skin and internal organs, and angiogenesis imbalance. The aim of the study was to evaluate in SSc patients the association between the retinal microcirculation disturbances and the presence of peripheral trophic changes and to determine the role of angiogenesis factors in the formation of vascular changes in scleroderma. Twenty-five SSc patients and 25 age- and sex-matched healthy controls were included to the study. Assay of vascular endothelial growth factor (VEGF) and soluble VEGF receptor-2 (sVEGFR-2) in blood serum and tears was done for all patients and controls using enzyme-linked immunosorbent assay. Retinal blood circulation was investigated with fluorescein angiography (FA) in the SSc patients only. In our research, proportion of mainly hypertensive patients presenting with a large spectrum of retinal microvascular lesions was 72%, while proportion of patients with skin microvascular lesions within distal phalanxes of fingers and toes was 76%. We noticed that patients with pathological changes in the FA examination had finger ulcerations significantly more often than patients without changes in the eye fundus. There were no statistically significant differences in the serum concentration of VEGF and sVEGFR2 between subjects in both analyzed groups. Analysis of lower levels of VEGF (p = <0.001) and sVEGFR-2 (p = <0.001) in blood serum accompanied by simultaneous higher levels of VEGF/sVEGFR-2 ratio in tears of SSc patients, as compared with the control group, indicates the superiority of proangiogenic factors in patients' tears.

[Evaluation of color perception in individuals addicted to narcotic substances in the Farnsworth-Munsell 100-Hue test]. / Ocena testem Farnswortha-Munsella 100-Hue percepcji barw u osób uzaleznionych od narkotyków.

BACKGROUND: The aim of the study was to assess color perception in the Farnsworth-Munsell 100-Hue test in individuals addicted to narcotic substances, and to analyze the acquired color vision disorders, depending on the duration of addiction and abstinence. MATERIAL AND METHODS: Ninety-five persons were qualified for the study. All the subjects were divided into 3 groups. Group I (drug addicts) comprised 45 individuals addicted to narcotic substances and nicotine. Group II (smokers) consisted of 30 individuals addicted only to nicotine, and group III (abstinents) included 20 individuals free of addictions. In all the study groups anamnesis, survey, standard ophthalmological examination and the Farnsworth-Munsell 100-Hue test were performed. RESULTS: In the Farnsworth-Munsell 100-Hue test the mean values of total error score (TES) for the purposes of the analysis, expressed in the values of square root (√TES), proved to be significantly higher in group I than in the two other groups (p < 0.001). In group I, the √TES values exceeding critical values of age norms occurred significantly more frequently than in groups II (p < 0.01) and III (p < 0.05). A positive correlation between duration of addiction and the √TES values was indicated (ρ = 0.234, p < 0.05). The longer was the period of abstinence, the lower were the √TES values, indicating the improved ability to distinguish between colors. CONCLUSIONS: The Farnsworth-Munsell 100-Hue test proved useful in the detection and assessment of acquired dyschromatopsy induced by narcotic substances. The observed disorders appeared to be dependent on the duration of addiction and abstinence. Med Pr 2016;67(6):777-785.

Serum MicroRNAs as Potential Biomarkers of AMD.

BACKGROUND: Age-related macular degeneration (AMD) is a major cause of blindness worldwide. Circulating microRNAs (miRNAs) in serum have emerged as novel candidate biomarkers for many diseases. The aim of the present study was to identify a serum microRNA (miRNA) expression profile specific for dry and wet forms of AMD. MATERIAL AND METHODS: Serum miRNA expression was first screened using TaqMan® Human MicroRNA Array A (Applied Biosystems). An extensive, self-validated, individual, quantitative RT-PCR (qRT-PCR) study was then performed on a cohort of 300 AMD patients (150 wet form and 150 dry form) and 200 controls. The Mann-Whitney U test and nonparametric Spearman's rank correlation coefficient were used for statistical analysis. RESULTS: miRNA expression analysis revealed increased expression of miR661 and miR3121 in serum of patients with dry AMD and miR4258, miR889, and Let7 in patients with wet form. Expression of analyzed miRNA was not observed or remained at low level in controls. CONCLUSIONS: Differences in miRNA serum profile exist between patients with wet and dry form of AMD, which indicates miRNAs as potential biomarkers of AMD. Further studies should be performed to confirm its significance in clinical practice.

Assessment of skin microcirculation by laser Doppler flowmetry in systemic sclerosis patients.

INTRODUCTION: First lesions to occur in the course of systemic sclerosis (SSc) involve microcirculation. AIM: The study involved assessment of the suitability of laser Doppler flowmetry (LDF) in examination of the performance of skin microcirculation in the distal portion of the upper extremity in SSc patients. MATERIAL AND METHODS: Overall the study involved 27 patients with systemic sclerosis. The control group comprised age - and gender-matched 27 healthy individuals. All the study subjects underwent microcirculation perfusion measurement at rest (rest flow - RF) as well as microcirculatory flow challenge tests - reactive hyperaemia test (RHT) and thermal stimulation test (TST). RESULTS: The study did not show any differences in the skin microcirculation perfusion at rest between the test group and the control, while reactive hyperaemia test results revealed significantly lower skin microcirculation perfusion values during the cuff inflation in SSc patients, as compared to the controls. In the test group, a lower perfusion value was observed during secondary hyperaemia following cuff release. Comparative analysis of skin microcirculation perfusion changes during the thermal stimulation test revealed a significantly lower change of the perfusion value and longer time of return to the baseline in the test group as compared to the control group. CONCLUSIONS: The study performed has shown the suitability of LDF in the assessment of the microangiopathy degree in systemic sclerosis patients. The skin perfusion value in SSc patients should be assessed on the basis of parameters obtained in microcirculation challenge tests.

[Ocular findings in Polish Armed Forces in Iraq and Afghanistan, a review of medical examinations by The Military Medical Commission in Lodz]. / Analiza okulistyczna stanu zdrowia zolnierzy powracajqcych z misji w iraku i w Afganistanie na podstawie badan Terenowej Wojskowej Komisji Lekarskiej (TWKL) w Lodzi.

PURPOSE: To determine the prevalence of ocular disorders among Polish soldiers returning from Iraq and Afghanistan military campaigns. MATERIAL AND METHODS: A retrospective review of medical records of the Military Medical Commission of Lodz, Poland was performed. Records of 296 randomly selected soldiers, including 98 who returned from Iraq in 2004 and in 198 who returned from Afghanistan in 2012, were assessed. All subjects underwent comprehensive ocular examinations according to the military regulations. We used statistical analysis to review the results. RESULTS: The incidence of ocular disorders in Iraq and Afghanistan groups was 17.3% and 15.1%, respectively. The study revealed that the most common disorders among soldiers were refractive errors affecting 6.8% subjects, followed by defective color vision (4.7%) and solar retinopathy (3.0%). Combat injuries were diagnosed in 3 subjects, including 2 cases of corneal injury and 1 case of retinal detachment due to blast exposure. CONCLUSIONS: Combat injuries occurred in 1% of soldiers returning from Iraq and Afghanistan military campaigns. There were no statistically significant differences between Iraq and Afghanistan groups in the incidence of ocular disorders. Solar retinopathy was the most common problem related to the long-term exposure to rough climate conditions in both groups. ocular findings, Iraq, Afghanistan.

A prospective study on different methods for the treatment of choroidal neovascularization. The efficacy of verteporfin photodynamic therapy, intravitreal bevacizumab and transpupillary thermotherapy in patients with neovascular age-related macular degeneration.

BACKGROUND: The aim of this study was to compare the efficacy of verteporfin photodynamic therapy (PDT), intravitreal injections of bevacizumab (IVB) and transpupillary thermotherapy (TTT) in patients with neovascular age-related macular degeneration (AMD). MATERIAL/METHODS: The study design was a prospective, interventional, comparative case series. Between December 2006 and March 2009, 426 eyes of 426 consecutive patients presenting with neovascular AMD were included into the study. Patients presented with subfoveal CNV predominantly classic, minimally classic, and occult with no classic component; lesion size less than 5000 µm in the greatest linear dimension, and the area of hemorrhages ≤1/3 were randomized to receive either PDT (group I) or IVB (group II) in a 1:1 ratio. Other patients with CNV were included into the group III and received TTT. RESULTS: One hundred eyes were treated with PDT. Mean baseline logMAR BCVA was 0.62 and final visual acuity decreased to 0.74 (p<0.05, Wilcoxon test); 104 eyes were treated with IVB. Mean baseline BCVA was 0.82 and final visual acuity increased to 0.79 (p>0.05, Wilcoxon test); 222 patients were treated with TTT. Mean baseline BCVA was 1.10 and final visual acuity decreased to 1.15 (p>0.05, Wilcoxon test). Among all eyes the average number of treatment sessions was 2.34 (SD 1.17). CONCLUSIONS: Our study shows that IVB injections had the best efficacy in the improvement of final BCVA. However, both IVB and TTT demonstrated good stabilization of vision. Although after PDT final BCVA was significantly worse from baseline, it may also be beneficial for some patients with neovascular age-related macular degeneration.

Assessment of blood flow in posterior ciliary arteries and its correlation with intraocular and arterial blood pressures in patients with open angle glaucoma.

BACKGROUND: At present, the vascular theory of glaucomatous neuropathy is still the subject of intensive scientific studies aiming at settling the relationship between the development of glaucomatous neuropathy and vascular factors. Therefore the purpose of this study was to assess the blood flow parameters in the posterior ciliary artery and middle cerebral artery in patients with glaucoma and the correlation of glaucomatous changes with flow in vessels supplying the retina, choroid and anterior segment of the optic nerve in patients with glaucoma with and without coexisting arterial hypertension. MATERIAL/METHODS: The study comprised 50 patients who were divided into two groups: group I - 25 patients (50 eyes) with primary open angle glaucoma (POAG) without coexisting arterial hypertension; and group II - 25 patients (50 eyes) with POAG with diagnosed and treated arterial hypertension. RESULTS: The median of the mean maximal velocity in posterior ciliary arteries was 10.4 cm/s in patients from group I. In patients with POAG and arterial hypertension the median of the mean maximal velocity in posterior ciliary arteries was 8.95 cm/s (p<0.002). In group I the median of the Gosling pulsatility index (PI) in posterior ciliary arteries was 1.0, whereas in group II the median was 1.16 (p<0.002). The median of the pulsatility transmission index (PTI) for cerebral and ocular vessels was 1.3 in group I, whereas in group II the median was 1.38 (p<0.02). CONCLUSIONS: The coexistence of arterial hypertension in glaucoma patients significantly worsens microcirculation in the area of posterior ciliary arteries and may be the cause of accelerated progression of glaucomatous neuropathy.

Topical Treatment of Elevated Intraocular Pressure in Patients with Graves' Orbitopathy.

Purpose: In this study, we evaluated the efficacy of topical hypotensive treatment and/or systemic corticosteroids therapy in patients with elevated intraocular pressure and Graves' orbitopathy (GO). Methods: We included 172 eyes in 86 individuals with duration of GO ≥ 3 months, intraocular pressure in either eye ≥ 25.0 mmHg, and GO ranked ≥ 3 at least in one eye in modified CAS form. The study subjects were divided into three treatment subgroups: subgroup I was administered latanoprost once a day; subgroup II was administered a combined preparation of brimonidine and timolol BID; subgroup III was the control group, not receiving any topical hypotensive treatment. All the study participants received systemic treatment, intravenous corticosteroid therapy at the same dose, according to the European Group of Graves' Orbitopathy (EUGOGO) guideline. Results: On the final visit, the mean IOP value was significantly lower in all treatment subgroups compared to the initial values. In both subgroups receiving topical treatment, the IOP reduction was higher than in the control group receiving systemic corticosteroids only. However, the latanoprost eye drops decreased intraocular pressure more effectively than drops containing brimonidine and timolol. Conclusion: Topical ocular hypotensive treatment is effective in reducing intraocular pressure in GO and decreases intraocular pressure more effectively than systemic corticosteroid therapy alone.

Correctable and non-correctable visual impairment among young males: a 12-year prevalence study of the Military Service in Poland.

PURPOSE: To evaluate the prevalence of correctable and non-correctable visual impairment in a representative sample of young males commissioned for Military Service in Poland. MATERIAL AND METHODS: Data concerning vision status was retrospectively reviewed in 969 subjects of European Caucasian origin, most of whom live and have lived in Poland. They were selected from the original database comprising 105017 subjects examined in the period 1993-2004. Based on the age of subjects they were divided into two groups; group I aged 18-24 and group II aged 25-34 years. Visual impairment was defined as distance visual acuity of <20/40 in one or both eyes. Non-correctable impairment was defined as that which was not eliminated by refractive correction. RESULTS: A total of 1938 eyes of 969 white males were examined. There was statistically significant association between rates of visual impairment and increasing age (p < 0.001). Visual impairment was found in 128 (13.2%) subjects in at least one eye. Non-correctable visual impairment was found in 12 (1.2%) subjects. Amblyopia was the main cause, accounting for eight cases (66.67%). Correctable visual impairment was found in the remaining 116 (12.0%) patients. Among them myopia was the most common refractive error and accounted for 75.8%. Differences between age-specific rates of refractive errors were statistically significant (p = 0.003). CONCLUSIONS: Appropriate refractive correction improves visual acuity in most subjects presenting with visual impairment. There was a relatively low prevalence of non-correctable visual impairment in a population of young adults in Poland, and this was mainly due to amblyopia.

[Epidemiology of ocular diseases--a review of medical examinations from The Area of Military Medical Commission in Lodz]. / Epidemiologia wybranych chorób narzadu wzroku u badanych przez Terenowa Wojskowa Komisje Lekarska w Lodzi.

PURPOSE: To determine the prevalence of ocular diseases among candidates and members of Military Service. MATERIAL AND METHODS: A retrospective review of medical examinations for entry to the military service from The Area of Military Medical Ophthalmic Commission in Lodz. We used statistic analysis to review the results. RESULTS: Statistic analysis revealed that the commonest ocular diseases are in order: refractive errors, color vision disturbances and strabismus. CONCLUSIONS: 1. The prevalence of ocular diseases among candidates and members of Polish Military Service is the same as discovered in other ophthalmologic researches. 2. Commonest ocular diseases were refractive errors (21.63% in total).

[The role of endocannabinoid system in physiological and pathological processes in the eye]. / Rola ukladu endokannabinoidowego w fizjologicznych i patologicznych procesach w galce ocznej.

Plant of Cannabis sativa/ marihuana except for its psychotropic effects possesses a range of pharmacological properties, that has been utilized for medical purposes over a period of millenia. Investigations concerning biochemical mechanism of action of the main and most active pharmacological compound of Cannabis sativa, cannabinoid 9-THC, contributed to the discovery of cannabinoid receptors both in the central nervous system (CNS) and peripheral tissues, that mediated actions of this substance. The discovery made possible identification of a new, endogenous signaling system reffered to as the endocannabinoid system. Besides cannabinoid receptors CB1 and CB2, the system includes it's endogenic ligands (endocannabinoids) and compounds that participate in their biosynthesis and inactivation. Structure and functioning of the endocannabinoid system is conservative in all vertebrates. It's activation with plant, synthetic and endogenous cannabinoids has an influence on multiple physiological and pathological processes within the eye.

[Possibilities of applying cannabinoids' in the treatment of glaucoma]. / Mozliwosci zastosowania kannabinoidów w leczeniu jaskry.

Over a period of several decades numerous scientific research has proven that, regardless of the route of administration, cannabinoids are able to decrease intraocular pressure. What is more, these compounds are characterized by neuroprotection and vasodilatation properties, that additionally substantiate it's therapeutic utility in conservative treatment of glaucoma. So far, it has not been described in details what mechanism is used to lower the intraocular pressure by cannabinoids. Nevertheless, the presence of endocannabinoid receptors in structures of the eye responsible for formation and outflow of aqueous humor is an explanation for effectiveness of these compounds, when administered in topical form. These days, with the aid of modern pharmacological technology are available significantly bigger possibilities of improving bioavailability of cannabinoids administered to the eye than in the past, as well as limitation of it's undesired side effects.

[Character of refractive errors in population study performed by the Area Military Medical Commission in Lodz]. / Charakterystyka wad refrakcji u osób badanych przez Terenowa Wojskowa Komisje Lekarska w Lodzi.

PURPOSE: To determine the prevalence of refractive errors in population. MATERIAL AND METHODS: A retrospective review of medical examinations for entry to the military service from The Area Military Medical Commission in Lodz. Ophthalmic examinations were performed. We used statistic analysis to review the results. RESULTS: Statistic analysis revealed that refractive errors occurred in 21.68% of the population. The most commen refractive error was myopia. CONCLUSIONS: 1) The most commen ocular diseases are refractive errors, especially myopia (21.68% in total). 2) Refractive surgery and contact lenses should be allowed as the possible correction of refractive errors for military service.

[Ophthalmic reasons in unfitness for military service in medical evidence of the Area Military Medical Commission in Lodz]. / Okulistyczne przyczyny niezdolnosci do sluzby wojskowej stwierdzone na podstawie orzeczen Terenowej Wojskowej Komisji Lekarskiej w Lodzi.

PURPOSE: To assess ocular causes for rejection from the military service. MATERIAL AND METHODS: A retrospective review of medical examinations for entry to the military service from The Area Military Medical Commission in Lodz. Ophthalmic examinations were performed according to meet eligibility criteria. We used statistic analysis to review the results. RESULTS: Statistic analysis revealed that during period 1993-2004 ocular diseases were causes of 4.68% rejections from the army. The major ocular causes were high refractive errors. CONCLUSIONS: 1. Ocular diseases are important causes for rejection from the army (4.68% in total). 2. Major ocular causes for rejection are: high refractive errors, glaucoma and chronic diseases of the choroid, retina and optic nerve.

[The assessment of bacterial flora and antibiotic-sensitivity of bacteria isolated from conjunctival sac, skin of the eyelids and inflammatory lesions in patients with acne vulgaris and rosacea]. / Ocena skladu jakosciowego i lekowrazliwosci flory bakteryjnej izolowanej z worka spojówkowego, skóry powiek i ze zmian chorobowych skóry twarzy w przebiegu tradziku pospolitego i tradziku rózowatego.

AIM: To evaluate bacterial flora of conjunctival sac, the skin of the eyelids and inflammatory lesions in patients with acne vulgaris, rosacea and of healthy people. Bacterial colonization of conjunctival sac, the skin of the eyelids and skin lesions is more frequent in patients with acne vulgaris and rosacea. Because antibiotic resistant strains of bacteria are quite often met, it seems important to determine antibiotic-sensitivity of isolated bacteria. MATERIAL AND METHODS: 178 people underwent bacteriological examination of conjunctival sac, skin of the eyelids and skin lesions: 64 patients with acne vulgaris, 59 patients with rosacea and 55 healthy persons. Microorganisms were identified with laboratory techniques with the use of bio-Merieux kits and determination of drug-sensitivity was performed with recognized laboratory techniques. RESULTS: Positive cultures and general frequencies of the isolations were found to be higher in both groups in comparison with the reference group (the group of clinically healthy people). In healthy persons practically the only saprophytic bacteria--the most often S. epidermidis and S. viridans--were isolated. Whereas in patients suffering from acne vulgaris and rosacea the pathogenic bacteria--S. aureus, P. fluorescens, P. acnes, P. aeruginosa--were additionally isolated. Different spectrum of sensitivity to antibiotics of bacteria isolated from conjunctival sac, the skin of the eyelids and skin lesions in the cases of acne vulgaris and rosacea was proved. CONCLUSIONS: 1. In the cases of acne vulgaris the majority of isolated bacteria from conjunctival sac included Streptococcus spp., Staphylococcus spp. and Enterobacteriaceae. 2. In the severe cases of rosacea the main bacteria found in conjunctival sac were S. aureus, S.pyogenes, P.aeruginosa, E. faecalis, A. baumanii, P. fluorescens. 3. Because of changeable drug-sensitivity of bacterial strains, it seems to be necessary to perform individual culture and antibiogram in every patient with inflammatory lesions, in particular in clinically severe and resistant to therapy cases of acne vulgaris and rosacea. 4. The higher frequency of the bacterial colonisations in the conjunctival sac in patients with acne vulgaris and rosacea can be a potential source of ocular infections in the cases of local and systemic disorders of protective mechanisms. 5. Estimation of bacterial flora and antibiotic sensitivity of bacteria isolated from conjunctival sac, the skin of the eyelids and skin lesions should be perform, especially when patients are prepared for eye surgery.

[Phacosclerothalamotomy--new surgical procedure in the treatment of coexisted cataract with glaucoma. Essence of technique surgery]. / Fakosklerotalamotomia--nowa metoda chirurgicznego leczenia wspólistniejacej zacmy i jaskry. Istota techniki operacyjnej.

PURPOSE: To present some relevant stages of phacosclerothalamotomy procedure. MATERIAL AND METHODS: Surgery comprised: superior clear corneal phacoemulsification with in the bag IOL implantation combined with 4 ab interno sclerostomy with high frequency diathermic probe. The position of the probe was checked under gonioscopic view and microscopic or endoillumination light. Six patients (6 eyes) were enrolled. In 5 patients there was POAG and POCG in 1. RESULTS: Phacoemulsification were performed uneventfully. During sclerothalamotomy bleeding within trabecular meshwork and shallowing of anterior chamber were observed. The value of IOP was lower in each case postoperatively. Antiglaucoma medications ratio was decreased. CONCLUSIONS: Phacosclerothalamotomy links up some advantages of small incision cataract surgery with surgical bypass between anterior chamber and Schlemm's canal as well as deep sclerostomy (thalamotomy) performed ab interno with diathermic probe. This technique allows to avoid some complications of filtration surgery.

Monoclonal anti-TNFalpha antibody (infliximab) in the treatment of patient with thyroid associated ophthalmopathy.

TNFalpha (tumor necrosis factor alpha) plays a central role in the development of thyroid associated ophthalmopathy (TAO). We describe and document by ophthalmic (CAS and NO SPECS scales) and radiological (MRI) evaluation a positive effect of anti-TNFalpha antibody (infliximab) administration on active TAO in a 58 years old woman with Graves' disease. The single dose of infliximab administration resulted in a dramatic reduction of inflammation studies and improvement of visual function as measured by MRI and CAS and NO SPECS scales, without noticeable short-term side effects. A randomized prospective study is needed to determine whether infliximab proves to be sufficiently effective in reducing the inflammatory symptoms of TAO, and whether it can be administered safely for a prolonged period without side effects.

Quantitative thermographic analysis of viscoelastic substances in an experimental study in rabbits.

PURPOSE: To measure the temperature parameters on the corneal surface during the delivery of standardized ultrasound energy assisted with ophthalmic viscosurgical devices (OVDs) or different temperatures of irrigating solutions in an experimental animal model. SETTING: Department of Ophthalmology and Visual Rehabilitation, Medical University of Lodz, and Central Institute for Labor Protection, National Research Institute, Warsaw, Poland. METHODS: Thirty rabbits (60 eyes) were randomly divided into 6 groups in which different OVD or balanced salt solutions (BSS) were used: group 1: Viscoat (sodium hyaluronate 3%-chondroitin sulfate); group 2: Provisc (sodium hyaluronate 1%); group 3: soft-shell technique; group 4: Celoftal (hydroxypropyl methylcellulose 2%); group 5: BSS 22 degrees C; and group 6: BSS 4 degrees C. After the nucleus and lens cortex were removed, the anterior chamber was filled with OVD or BSS and a phaco tip was introduced into the pupillary plane and switched on. The same phaco tip parameters were used in all groups. For thermographic measurements (ie, maximal temperature [MT], dynamic rise in temperature [DRT], and time when the maximal level of temperature [TMLT] was achieved), a thermocamera was used. RESULTS: Mean preoperative temperature on the rabbit corneal surface was 22.76 degrees C +/- 1.48 degrees C (SD). Working with a phaco tip increased the temperature in each group. A significantly higher MT was observed in group 5 (27.85 degrees C +/- 0.52 degrees C), followed by group 2 (27.75 degrees C +/- 0.54 degrees C), group 3 (27.74 degrees C +/- 0.46 degrees C), and group 4 (27.25 degrees C +/- 0.60 degrees C), than in group 6 (26.81 degrees C +/- 0.34 degrees C) and group 1 (26.52 degrees C +/- 0.48 degrees C) (P<.05). Significantly higher values of DRT and shorter TMLT values were observed in group 5 (1.16 degrees C/s +/- 0.42 degrees C/s, 4 seconds) and group 6 (0.91 degrees C/s +/- 0.13 degrees C/s, 5 seconds) than in groups 2, 3, 1, and 4 (0.09 degrees C/s +/- 0.07 degrees C/s, 30 seconds; 0.08 degrees C/s +/- 0.04 degrees C/s, 40 seconds; 0.07 degrees C/s +/- 0.03 degrees C/s, 45 seconds; 0.06 degrees C/s +/- 0.02 degrees C/s, 50 seconds, respectively) (P<.0001). CONCLUSIONS: Currently used OVDs potentially offer different levels of protection against the increase in temperature that occurs during phacoemulsification. Therefore, the surgeon should consider this aspect when choosing an OVD, particularly in difficult cases (ie, hard nucleus, shallow anterior chamber, endothelial abnormalities).

Corneal biomechanical changes and intraocular pressure in patients with thyroid orbitopathy.

AIM: To determine the relevance of the objective parameters addressing the altered biomechanical properties of cornea for glaucoma monitoring in patients with mild or moderate thyroid associated orbitopathy (TAO), and in healthy individuals. METHODS: Twenty-five patients with TAO (group 1) and 25 healthy adults (group 2) were included to the study. Both groups were of a similar age and the ratio women:man. For each patient, the following parameters of both eyes were measured with ocular response analyzer (ORA): corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc). In both groups participating in our study, all measurements were performed within minutes to reduce the diurnal effects. RESULTS: The mean age in group 1 was 56±11y and 76% were women, 24% were men. The mean age in group 2 was 64±11y and 68% were women, 32% were men. CH correlated negatively with IOPg in group 1 (r (2)=0.10, P<0.05). IOPg strongly correlated with IOPcc in both groups (group 1: r (2)=0.79, P<0.0001; group 2: r (2)=0.85, P<0.0001). There was positive correlation between CRF and IOPg in group 1 (r (2)=0.12, P<0.05) and in group 2 (r (2)=0.31, P<0.0001). Statistical analysis revealed no significant correlation between CRF and IOPcc in group 1 (r (2)=0.009, P>0.05) and also no significant correlation in group 2 (r (2)=0.04, P>0.05). CRF mean value in group 2 (11.51±1.72 mm Hg) was higher than in group 1 (10.85±1.45 mm Hg) (P<0.05). IOPg strongly correlated with IOPcc in both groups (group 1: r (2)=0.79, P<0.0001; group 2: r (2)=0.85, P<0.0001). There was also strong correlation between CRF and CH in both populations: group 1: (r (2)=0.58, P<0.0001), group 2: (r (2)=0.41, P<0.0001). CONCLUSION: Biomechanical parameters of cornea, as quantified by CH and CRF, and measured together with IOPcc, precisely reveal glaucoma staging in TAO and thus are reliable for diagnosing and follow-up in clinical practice.

[Effectiveness of the combined surgical treatment for glaucoma and cataract]. / Ocena skutecznosci operacji wieloproceduralnych w leczeniu wspólistniejacych zacmy i jaskry.

PURPOSE: There are currently some techniques of combined cataract and glaucoma treatment. They have been under debate for many years. We present efficacy of different techniques of combined cataract and glaucoma surgery MATERIAL AND METHODS: 50 patients (60 eyes, 21 male and 29 female), mean age 64.9+/-5.6 years enrolled in the study were divided into 3 groups in which the combined surgery were performed. Group 1: phacotrabeculectomy (20 patients, 27 eyes) (FT), group 2: phacoemulsification combined with deep nonperforative sclerectomy (20 patients, 23 eyes) (FS) and group 3: phacoemulsification combined with iridocleisis (10 patients, 10 eyes) (FW). Measure outcomes during 6 months of follow up were: value of postoperative intraocular pressure, visual acuity, pre and postoperative antiglaucoma medications ratio, intra and postoperative complications. RESULTS: There were not differences in preoperative intraocular pressure (IOP) among group 1 and 2 Significantly higher IOP was assessed in group 3. Preoperative antiglaucoma medications ratio was the highest in group 3 (3.5 +/- 1.5) as compared with group 1 and 2, (2.0 +/- 1.5). Postoperatively mean value of IOP was significantly lower as compared with the value in preoperative period in each group. After 3 months of follow up the IOP lower than 20 mmHg was achieved in 81.5% eyes in group 1, 73.9% eyes in group 2 and in 40 % of eyes in group 3. Six months postoperatively the target IOP was decreased to 62.9% in group 1 and 65.2% in group 2 and slightly increased to 50% in group 3. Postoperative antiglaucoma medications ratio was higher in group 3 (2.0 +/- 1.0), as compared with group 1 and 2, (1.5 +/- 1.0). The best visual acuity after 6 month of follow up was achieved in group 2, (0.8 +/- 0.2). More severe intraoperative complications such as: anterior chamber bleeding as well as postoperative complications eg.: hypotension, inflammation were noticed particularly in group 1 and 3 and choroidal effusion only in group 1. CONCLUSIONS: Efficacy in lowering of IOP after FT and FS is the highest within first 3 months postoperatively. In the late postoperative period the efficacy of these methods is significantly decreasing and additional conservative treatment has to be introduced. Interestingly, the efficacy of IOP normalization after FW in the late postoperative period increases. Most of intra and postoperative complications are link up on FT and FW techniques. Our results suggest that further investigations and preparing more adequate indications for surgical strategy among patients with combined cataract and glaucoma are needed.