The influence of corneal tunnel length on surgically induced astigmatism after various types of microincision phacoemulsification.

PURPOSE: To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques. METHODS: Patients who underwent a planned phacoemulsification surgery with an implantation of a foldable, acrylic IOL were selected for the study. All surgeries were performed under topical anaesthesia, with the same phaco machine. Group I consisted of 30 eyes of 30 patients after bimanual 1.4 mm microincision cataract surgery (B-MICS). Group II consisted of 30 eyes of 30 patients after coaxial 1.8 mm microincision cataract surgery (C-MICS). Group III consisted of 30 eyes of 30 patients after coaxial 2.4 mm small incision cataract surgery (C-SICS).Best corrected visual acuity, autorefractometry, tonometry, a slit lamp examination and anterior segment OCT were performed preoperatively and 1, 7, 30 and 90 days postoperatively. The temporal peripheral corneal thickness and the chord length of the main incision were measured. Vector method was used to calculate SIA. RESULTS: Mean preoperative BCVA was 0.52 ± 0.19 and it improved to 0.98 ± 0.05 (p < 0.05). Mean corneal tunnel chord length was 1.30 ± 0.16 mm 90 days postoperatively in group I, 1.30 ± 0.19 mm in group II and 1.48 ± 0.22 mm in group III. SIA was 0.54 ± 0.48 mm in group I, 0.45 ± 0.21 mm in group II and 0.62 ± 0.30 mm in group III. There were no correlations between the chord length of the corneal tunnel and SIA calculated with using vector analysis method. CONCLUSIONS: Unlike the incision width, the length of the clear corneal tunnel in small incisions and microinicions, has no significant influence on SIA.

Pupil diameter during cataract surgery after intracameral injection of the first ready-to-use combination of mydriatics and anaesthetic at the beginning of surgery in patients with a preoperative pupil diameter <6 mm.

PURPOSE: We evaluated, in a real-life setting, the effect of Mydrane® (ready-to-use combination of tropicamide, phenylephrine hydrochloride and lidocaine, injected into the anterior chamber at the beginning of cataract surgery to induce mydriasis and intraocular anaesthesia) on the pupil diameter during cataract surgery in patients with a preoperative pupil diameter <6 mm after the use of topical mydriatics. METHODS: We collected and analysed the data of 59 consecutive patients whose pupils dilated to a diameter <6 mm after the administration of mydriatic eye drops during the preoperative visit and who received Mydrane® during cataract surgery. RESULTS: In the group of 59 patients with a preoperative pupil diameter <6 mm after topical mydriatics, cataract surgery was performed in 36 patients (61.0%) using only Mydrane® to obtain mydriasis, with no additional drug or medical device. The mean pupil diameters in this group (36 of 59) during the preoperative assessment after topical mydriatics and just before capsulorhexis when Mydrane® was injected during surgery were 5.1 ± 0.74 and 6.15 ± 1.14 mm. Additional drugs were used in 23 patients (39%). In this group, the mean pupil diameters after topical mydriatics and just before capsulorhexis using Mydrane® were 4.58 ± 1.06 and 5.6 ± 1.26 mm, respectively. CONCLUSION: In a real-life setting, the mean pupil diameter achieved during cataract surgery after the intracameral injection of Mydrane® in patients with a preoperative pupil diameter <6 mm was over 1 mm larger than the mean pupil diameter after topical mydriatics, despite the trauma caused by the operation.

Dry eye in Sjögren's syndrome - characteristics and therapy.

BACKGROUND: Sjögren's syndrome is an autoimmune disease, and its important feature is the lymphocyte infiltration of exocrine glands, including lacrimal glands. It contributes to defects of their activity and causes that one of the main manifestation of Sjögren's syndrome is dry eye. Unfortunately, the discrimination between dry eye related and non-related to Sjögren's syndrome is difficult at the initial stages of diseases. In addition, the available agents for the treatment of Sjögren's syndrome-related dry eye have limited efficacy. AIM: The purpose of this study was to describe and emphasize differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye together with the determination of novel therapeutic options for Sjögren's Syndrome-related dry eye. METHOD: A review of the relevant papers describing characteristics of Sjögren's Syndrome-related dry eye and its therapy was conducted. This article is based on both pre-clinical and clinical evidences. RESULTS: On the basis of our analysis, we indicated differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye. Moreover, there are some novel markers that could be used in the diagnosis of Sjögren's Syndrome-related dry eye. In addition, expect artificial tear, other agents e.g. hydroxychloroquine can be effective in therapy of disease. CONCLUSIONS: Sjögren's Syndrome-related dry eye is a disorder, whose diagnosis may be difficult and mistaken for non-Sjögren's Syndrome-related dry eye. However, Sjögren's Syndrome-related dry eye has some specific features. In addition, the development of newer and safer therapeutic agents for Sjögren's syndrome-related dry eye is needed, and therefore further clinical, randomized studies are necessary.

Optical Coherence Tomography in the Differential Diagnosis of Patients with Multiple Sclerosis and Patients with MRI Nonspecific White Matter Lesions.

In the differential diagnosis of nonspecific white matter lesions (NSWMLs) detected on magnetic resonance imaging (MRI), multiple sclerosis (MS) should be taken into consideration. Optical coherence tomography (OCT) is a promising tool applied in the differential diagnostic process of MS. We tested whether OCT may be useful in distinguishing between MS and NSWMLs patients. In patients with MS (n = 41) and NSWMLs (n = 19), the following OCT parameters were measured: thickness of the peripapillary Retinal Nerve Fibre Layer (pRNFL) in superior, inferior, nasal, and temporal segments; thickness of the ganglion cell-inner plexiform layer (GCIPL); thickness of macular RNFL (mRNFL); and macular volume (MV). In MS patients, GCIPL was significantly lower than in NSWMLs patients (p = 0.024). Additionally, in MS patients, mRNFL was significantly lower than in NSWMLs patients (p = 0.030). The average segmental pRNFL and MV did not differ between MS and NSWMLs patients (p > 0.05). GCIPL and macular RNFL thinning significantly influenced the risk of MS (18.6% [95% CI 2.7%, 25.3%]; 27.4% [95% CI 4.5%, 62.3%]), and reduced GCIPL thickness appeared to be the best predictor of MS. We conclude that OCT may be helpful in the differential diagnosis of MS and NSWMLs patients in real-world settings.

Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study.

Purpose: To evaluate the effect of Mydrane (contains tropicamide, phenylephrine hydrochloride, and lidocaine hydrochloride) on time needed to induce mydriasis and mydriasis stability during cataract surgery. Methods: This was an observational, non-interventional, multicenter study of patients undergoing cataract surgery who received Mydrane for mydriasis and intraocular anesthesia. The study was conducted at seven ophthalmology departments at university hospitals in Poland. Patients admitted for cataract surgery within a 2-week period were asked to participate in the study. Patients whose pupils dilated to a diameter ≥6 mm after topical mydriatic administration during preoperative examinations were scheduled to receive Mydrane and included in the registry. No additional inclusion criteria were used. Patients' medical histories, examination results, and operative details were recorded. Pupil diameter was measured during surgery. Surgeons were asked to complete a Likert-based survey in parallel. Results: A total of 307 patients were enrolled. The mean pupil diameter was 7.0 ± 1.0 mm before capsulorhexis and 6.9 ± 1.2 mm before lens implementation. A pupil diameter ≥6 mm was achieved in 91.9% and 87.6% of patients before capsulorhexis and lens implantation, respectively. We asked 58 surgeons whether they agreed with the statement "Mydriasis was obtained in a short time after the administration of Mydrane"; the surgeons agreed with this statement after 92.2% (283/307) of surgeries. In addition, after 88.2% of surgeries, the surgeons agreed with the statement "Mydriasis was stable after the administration of Mydrane." Conclusions: Mydriasis was rapidly and stably obtained after Mydrane injection, as demonstrated by pupil diameter measurements during surgery and surgeons' feedback.

Intraoperative floppy iris syndrome ­ epidemiology and clinical assessment.

Purpose: To assess the incidence, and to identify medications and clinical features associated with intraoperative floppy iris syndrome in patients undergoing cataract surgery. Material and methods: The non-randomized, observational, prospective study was performed in 616 eyes (610 patients) after cataract surgery to determine the incidence of intraoperative floppy iris syndrome and the medications associated with its higher prevalence. We used a slit lamp adapted optical coherence tomography to evaluate anterior segment of 155 eyes (154 patients), measuring pupil diameter before and after the use of mydriatics and assessing the pre-dilated iris thickness at the dilator and sphincter muscle region. Results: The overall incidence of intraoperative floppy iris syndrome was 4% (25/616 eyes). The highest prevalence of intraoperative floppy iris syndrome was shown in patients exposed to tamsulosin (39%). Pupil diameter in mm before and after mydriasis was significantly smaller in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (pre-dilated ­ 1.85 ± 0.43 vs. 2.16 ± 0.37; p < 0.01; dilated ­ 5.04 ± 1.01 vs. 5.70 ± 0.87; p < 0.01). The thickness of the iris in sphincter muscle region in µm was similar in patients with and without intraoperative floppy iris syndrome (520.3 ± 76.1 vs. 520.6 ± 72.4; p > 0.05). Significantly thinner iris in dilator muscle region was found in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (409.9 ± 55.7 vs. 448.6 ± 55.8; p < 0.05). The presence of intraoperative floppy iris syndrome was correlated with a higher risk of intraoperative complications. Conclusions: Patients with intraoperative floppy iris syndrome have decreased pupil diameter and a thinner iris in dilator muscle region. Slit lamp optical coherence tomography is a useful device to preoperatively detect clinical features associated with intraoperative floppy iris syndrome. These findings may warn the surgeon of potential intra-operative difficulties. Slowa kluczowe: zespól sródoperacyjnie wiotkiej teczówki (IFIS), epidemiologia, operacja zacmy, optyczna koherentna tomografia skojarzona z lampa szczelinowa (sl-OCT).

Prospective analysis of outcomes of cataract phacoemulsification with the implantation of the Crystalens accommodative intraocular lens. / Prospektywna ocena wyników fakoemulsyfikacji zacmy z wszczepieniem wewnatrzgalkowej soczewki akomodacyjnej Crystalens.

Objectives: To evaluate visual outcomes after bilateral implantation of Crystalens accommodative intraocular lenses. Material and methods: The study group consisted of 20 patients (40 eyes) who underwent uneventful phacoemulsification through a 2.8 mm wide clear corneal incision followed by the implantation of an accommodative intraocular lens Crystalens HD or Crystalens AO. Uncorrected visual acuity, best corrected visual acuity, distance corrected intermediate visual acuity, distance corrected near visual acuity, best near visual acuity 1, 3, 6, 12 months postoperatively were evaluated. Distance visual acuity was measured with Snellen test. Near (40 cm) and intermediate (80 cm) visual acuity were measured with Jeager test. Results: The mean uncorrected distance visual acuity was 0.94 and 0.89 at month 1. and 12., respectively. The distance corrected intermediate visual acuity was 0.9 and 0.86 at month 1. and 12., respectively. The distance corrected near visual acuity was J1 in 10% and J3 in 50% of patients at month 1. It was J1 in 10% and J3 in 55% of patients at month 12. Conclusions: Crystalens intraocular lens implantation in our patients enabled them to achieve good distance, near and intermediate visual acuity. The majority of patients did not require spectacle correction for distance and near (87.5% and 65%, respectively). The achieved results did not differ significantly at months 1., 6., and 12. postoperatively.

The effect of corneal tunnel length in patients after standard phacoemulsification through a 2.75 mm incision on surgically induced astigmatism, corneal thickness and endothelial cell density.

PURPOSE: The purpose was to determine the effect of the corneal tunnel length in the 2.75 mm wide clear corneal incision, created during phacoemulsification on surgically induced astigmatism, central corneal thickness and corneal endothelial cell loss. MATERIAL AND METHODS: The study comprised 27 eyes (27 patients) who underwent phacoemulsification through 2.75 mm temporal clear corneal incision. Patients were examined preoperatively, 1 day, 7 days and 1 month postoperatively. Exclusion criteria were: previous intraocular surgery, corneal disorders and previous ocular trauma. Best corrected distance visual acuity, keratometry, slit-lamp examination, anterior segment optical coherence tomography and corneal endothelial cell density measurement were performed. Surgically induced astigmatism was calculated with vector method. Statistical analysis was done using non-parametric tests: Wilcoxon test, Mann-Whitney U test and Spearmann correlation coefficient. RESULTS: Mean best-corrected distance visual acuity was 0.30±0.24 preoperatively and 0.94 ± 0.18 postoperatively (p<0.05). Mean corneal incision length 1 day postoperatively was 1.84±0.36 mm. Surgically induced astigmatism was 0.51 ± 0.41 D one month postoperatively. Clear corneal incision length and surgically induced astigmatism were positively correlated (p<0.05). Mean central corneal thickness was 0.51 ± 0.05mm preoperatively, 0.56± 0.09 mm one day and 0.51 ±0.05 mm one month postoperatively (p <0.05). Clear corneal incision length and central corneal thickness 30 days postoperatively were not corrdlated (p=0.27). Mean corneal endothelial cell density was 2483?417 cells/mm² preoperatively and 2325 ± 410 cells/mm² postoperatively. The difference was significant (p<0.05). Clear corneal incision length and corneal endothelial cell loss were not correlated (p>0.05). CONCLUSIONS: The results suggest that the length of the 2.75 mm clear corneal incision influences the surgically induced astigmatism, but it doesn't influence the central corneal thickness and corneal endothelial cell loss. Shorter clear corneal incisions induce smaller surgically induced astigmatism in comparison with longer incisions of the same width and localization. Unequivocal confirmation.of the influence of clear corneal incision length on surgically induced astigmatism requires further investigation on a larger group of patients. Using laser techniques could help, as it would enable to examine patients in groups with different predefined clear corneal incision lengths.

Contrast sensitivity assessment in primary open angle glaucoma and ocular hypertension.

INTRODUCTION: Contrast sensitivity assessment is an important additional examination, which enables the full insight into the patient's quality of vision, and early diagnosis of visual disturbances. MATERIAL AND METHODS: Forty six patients (92 eyes) with primary open angle glaucoma or ocular hypertension were enrolled in the study. The enrolment criteria were full or almost full visual acuity and the patients with visual field defects or any other ocular disease were excluded. Contrast sensitivity was assessed both under photopic and mesopic conditions (with and without glare) using the Functional Vision Analyzer separately for each eye. Furthermore, the retinal nerve fiber layer (RNFL) thickness was measured using scanning laser polarimetry (GDx). RESULTS: Contrast sensitivity was significantly reduced under both mesopic and photopic conditions in patients with primary open angle glaucoma or ocular hypertension. CONCLUSIONS: Evaluation of contrast sensitivity is a valuable diagnostic test, which enables the assessment of visual dysfunction in patients with primary open angle glaucoma or ocular hypertension persisting despite good visual acuity.

Treatment outcomes of pars plana vitrectomy in patients with Benson's disease.

Introduction: In Benson's disease (scintillatio albescens or asteroid hyalosis) slight, white condensations of phospholipids are seen in the vitreous. In advanced stages, the decrease of visual acuity or subjective discomfort of vision may follow due to floaters. The pars plana vitrectomy is the treatment of choice in these patients. Purpose: To evaluate surgical treatment outcomes in Bensons' disease. Material and methods: The research was carried out in a group of patients with Benson's disease, who had undergone 23G or 25G pars plana vitrectomy in 2012­2014. The evaluated data included: diagnosis, the pre- and postoperative best corrected visual acuity as well as the pre- and postoperative ocular ultrasound (B scans). The study group consisted of 7 patients (8 eyes), including 5 men and 2 women, at the age of 66 to 82 years (mean age of 74 years). Results: In 5 patients with concomitant cataract, combined procedures of phacoemulsification and pars plana vitrectomy were performed. In one patient, pars plana vitrectomy was done first followed by phacoemulsification with intraocular lens implantation at a later date. In two cases, only pars plana vitrectomy was performed. All patients were examined 7 days postoperatively and the follow up period ranged from 1 month to 1 year (mean follow up duration of 8 months). Visual acuity and subjective comfort of vision improved in all cases. Conclusions: Pars plana vitrectomy enables improvement of visual acuity and subjective comfort of vision in patients with Benson's disease. It was confirmed in both subgroups, i.e. in patients who underwent both pars plana vitrectomy and phacoemulsification with intraocular lens implantation, and those in whom only vitrectomy was performed

The opinion of the Expert Group of the Polish Society of Ophthalmology on using nepafenac in the prevention of postoperative macular edema after cataract surgery in diabetic patients.

Nepafenac is an innovative non-steroidal anti-inflammatory drug used in ophthalmology for the prevention of macular edema after cataract surgery. Along with its anti-inflammatory effect, nepafenac has some unique properties which distinguish it from other non-steroidal anti-inflammatory drugs. It is a prodrug activated to amfenac after it penetrates through the corneal layers to the aqueous humour and the ciliary body. Having electrically neutral molecules of lipophilic properties, nepafenac does not accumulate in the cornea and does not cause its degeneration. Additionally, it quickly achieves higher concentrations in the aqueous humour as compared to other non-steroidal anti-inflammatory drugs. Nepafenac shows high selectivity and activity against COX-2 isoform, the key enzyme implicated in inducing inflammation, which is the main cause of macular edema. Furthermore, nepafenac has the unique scleral and suprachoroidal distribution pathways. Finally, its effect on the intraocular pressure is none to negligible. Nepafenac treatment should be initiated prior to cataract surgery and continued long enough to reduce the risk of late-onset macular edema. The Expert Group of the Polish Society of Ophthalmology consider using nepafenac in the prevention of post­operative macular edema in diabetic patients undergoing cataract surgery as expedient and reasonable. The proposed optimum pre- and postoperative treatment regimen can be modified for individualised therapy.

The influence of a prolonged interoperative period on binocular vision after bilateral cataract extractions.

PURPOSE: To evaluate the influence of the extent of the interoperative period on binocular vision function in patients after consecutive bilateral cataract extractions and intraocular lens implantation. METHODS: The study included patients operated due to bilateral cataract. Presence of asthenopic symptoms, distance and near squint angle, fusional amplitudes, stereopsis, and convergence were evaluated. Preoperative, interoperative, and postoperative differences in best-corrected visual acuity between eyes were also noted. Multivariate analysis was conducted in order to establish the relation between the interoperative period and binocular status. RESULTS: The study included 104 patients (74 female, 30 male, mean age 69.9 years, range 32-88). Mean interoperative period was 20.3 ± 12.9 months, range 1.5-47.7. Prolongation of the interoperative interval had a significant negative impact on stereopsis measured by TNO (R2 = 0.215, p = 0.001) and Randot (R2 = 0.179, p = 0.001) stereotests, as well as for near point of convergence (R2 = 0.09, p = 0.002). It was also related, but not independently, to reduction in fusional amplitudes, mainly for distance (R2 = 0.18, p = 0.001 for divergence and R2 = 0.12, p = 0.001 for convergence). Asthenopic symptoms were reported by 17 (16.3%) patients. The incidence of exophoria was significantly (p = 0.002) higher in patients with an interoperative interval longer than 24 months. CONCLUSIONS: The length of the interoperative period influences the status of binocular vision in patients after bilateral cataract extraction. It is also connected with an increased number of patients with asthenopic symptoms and exophoria.

The effect of the selected factors on corneal endothelial cell loss following phacoemulsification.

INTRODUCTION: Corneal endothelium is a single layer of cells, which do not regenerate. Damage to the endothelium can take place in the course of certain diseases and after intraocular operations. When the number of endothelial cells decreases, corneal decompensation can occur. Pre- and postoperative measurement of the number of the corneal endothelial cells can help assess the degree of corneal damage during the surgery. PURPOSE: To compare the effect of various factors, such as: sex, age, corneal incision, intraocular pressure, cataract density, visual acuity and surgeon's experience on corneal endothelial cell loss following uneventful phacoemulsification. MATERIAL AND METHODS: 365 patients (114 men and 251 women aged 19 to 91 years) undergoing phacoemulsification were examined preoperatively and postoperatively at 4 weeks. 68 eyes underwent phacoemulsification through a 1.8 mm microincision and 297 eyes through a standard 2.75 mm incision. Patients were operated on by four surgeons. RESULTS: There was a significant difference in the postoperative endothelial cell loss relative to the degree of cataract hardness (p < 0.001). Endothelial cell loss was significantly higher in patients aged 71 and above than in the remaining age groups. Significant differences in the postoperative endothelial cell loss were observed in relation to the clear corneal incision size (p < 0.01). Preoperative best corrected visual acuity influenced the postoperative endothelial cell loss in a statistically significant way (p < 0.05). Endothelial cell loss was strongly influenced by the surgeon's experience. CONCLUSIONS: Surgeon's experience, hardness of cataract, type of corneal incision, age and preoperative visual acuity influenced endothelial cell loss at 4 weeks following uneventful phacoemulsification, however such factors as sex and intraocular pressure showed no statistically significant influence on corneal endothelial cell loss.

Comparative analysis of early distance visual acuity in patients after coaxial phacoemulsification through the micro-incision (1.8 mm) and after standard phacoemulsification through the small incision (2.75 mm).

INTRODUCTION: The purpose of the study was to evaluate early postoperative visual acuity outcomes of coaxial phacoemulsification with a foldable intraocular lens implantation, performed through a 1.8 mm wide clear corneal microincision (C-MICS) and to compare it with standard phacoemulsification through a 2.75 mm incision. MATERIAL AND METHODS: The examined group consisted of a non-randomised, prospective series of 130 eyes of 130 patients who underwent coaxial 1.8 mm microincision cataract surgery with foldable intraocular lens implantation (MI60, Bausch & Lomb). The reference group comprised 123 eyes of 123 patients who underwent standard phacoemulsification through the 2.75 mm incision with foldable intraocular lens implantation (Akreos Adapt AO, Bausch & Lomb). The following parameters were evaluated preoperatively and one day after the surgery: distance uncorrected visual acuity, distance best corrected visual acuity, intraocular pressure, anterior and posterior segment of the eye. All patients were divided into groups according to the LOCS III scale. RESULTS: The improvement of distance uncorrected visual acuity and distance best corrected visual acuity was observed postoperatively in both groups. The mean uncorrected visual acuity in the examined group was significantly better than in the reference group on the first postoperative day (0.88 +/- 0.18 vs 0.79 +/- 0.26). CONCLUSIONS: The early postoperative visual acuity results of C-MICS were better than the results of standard small incision phacoemulsification. As far as fast visual rehabilitation after MICS is concerned, the early uncorrected visual acuity should be considered as an important yardstick in measuring success in cataract surgery. These results are due to the MICS technique, which seems to be the minimally invasive surgery, and should be regarded nowadays as a procedure of choice.

Evaluation of contrast sensitivity measurements after retrobulbar optic neuritis in Multiple Sclerosis.

BACKGROUND: The evaluation of contrast sensitivity is an important additional examination that allows the physician to achieve the full picture of a patient's quality of vision. In low-contrast conditions, more discrete visual dysfunctions may be revealed, which could be overlooked in high-contrast tests. METHODS: The examined group consisted of 33 eyes of 27 patients with multiple sclerosis. The study included patients with full or almost full visual acuity, without visual field defects or any other ophthalmic condition, and who had never undergone any ocular surgery or trauma. The reference group consisted of 49 eyes of 37 patients. This group included healthy subjects with full visual acuity. Contrast sensitivity was examined with a Functional Vision Analyzer™ device in photopic conditions (with and without glare) and in mesopic conditions (with and without glare). RESULTS: In patients with multiple sclerosis who had experienced optic neuritis, contrast sensitivity was found to be significantly reduced in all spatial frequencies in both mesopic and photopic conditions (with and without glare). CONCLUSIONS: Contrast sensitivity in patients with multiple sclerosis who have also had optic neuritis is significantly reduced. This may explain patients' complaints regarding their quality of vision, despite good visual acuity. Contrastometry is a useful basis for further examination, providing additional information regarding a patient's quality of vision.

[Evaluation of quality of life of patients after phacoemulsification with accommodating lens implantation]. / Ocena jakosci zycia pacjentów po fakoemulsyfikacji z wszczepieniem akomodacyjnej soczewki wewnatrzgalkowej.

INTRODUCTION: Intraocular lens implantation is an important part of cataract surgery, as it has a significant influence on the final result. Accommodative intraocular lenses (IOLs) are the latest solution for the lack of accommodation in pseudophakic eyes. PURPOSE: To evaluate the quality of life of patients who underwent cataract surgery with accommodating IOL implantation and to compare the data with results of patients after standard monofocal IOL implantation. MATERIAL AND METHODS: The study group consisted of 20 patients (40 eyes), aged from 48 to 73 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of an accommodating IOL Crystalens HD (Bausch & Lomb, USA). The control group consisted of 20 patients (40 eyes), aged from 63 to 83 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of a standard monofocal single-piece acrylic intraocular lens AcrySof (Alcon, USA). All enrolled patients had no coexisting ocular diseases which could influence the final visual acuity. All surgeries were uneventful. At one month postoperatively, the patients were requested to answer 36 questions included in the questionnaire in order to evaluate the quality of visual function. RESULTS: There was a significant improvement in the quality of life in both groups after cataract surgery. The study group tended to assess their own eyesight higher than the control group. Patients from the study group use spectacle correction for a lower number of activities, they find it easier to use fine motor skills when performing activities without spectacle correction in comparison with patients from the control group. Patients from the study group use spectacle correction for reading significantly less frequently, they also find it easier to read the normal size and small print without spectacle correction, in comparison with patients from the control group. CONCLUSIONS: Patients with accommodating IOLs self-evaluate their own eyesight highly, use spectacle correction for a lower number of activities and find it significantly easier to perform precise activities without spectacle correction, in comparison with patients after the standard monofocal intraocular lens implantation.

[Contemporary views on perioperative prophylaxis of postoperative endophthalmitis]. / Wspólczesne poglady na profilaktyke okolooperacyjna pooperacyjnego zapalenia wnetrza galki ocznej.

INTRODUCTION: Post-operative endophthalmitis, although infrequent, leads to severe, often irreversible consequences. For many years in the medical literature there have been reports on the effectiveness of various forms of prevention including antibiotics used. AIM: The aim of this study was to systematize the principles of prevention on the basis of the literature. MATERIAL: Medical reports published in recent years were compared to the conclusions of the European Society of Cataract and Refractive Surgeons (ESCRS) conducted in 16 European countries between 2003 and 2005. RESULTS: The results indicate the lack of a uniform pattern of conduct not only in a global context, but even within European countries. Povidone iodine remains the basis of prophylaxis used before surgery to decontaminate the skin of eyelids and conjunctival sac. Topical antibiotics, mainly the new generation fluoroquinolones, are also commonly used perioperatively. Intracameral injections of cefuroxime at the end of surgery are increasingly used in endophthalmitis prophylaxis. Although their high efficacy and safety have been confirmed a few years ago, the drug formulation intended and registered for use in ophthalmology has been available in most countries since 2013. CONCLUSIONS: Contemporary post-operative endophthalmitis prophylaxis, although varied in different countries, allowed for a significant reduction in the incidence of this complication in recent years. Most ophthalmologists in European countries declare to follow the ESCRS recommendations.

[Cataract surgery in a patient with megalocornea - a case report]. / Operacja zacmy u pacjenta z rogówka olbrzymia - opis przypadku.

PURPOSE: 10 describe a rare case ot a patient wiTh megalocorneas wno underwent cataract surgery. MATERIAL AND METHODS: A 52 years old patient with extremely wide corneas 16 mm in diameter in both eyes, was admitted to our department with cataract diagnosis. Four other male members of his family are known to have megalocorneas. This suggests X-linked recessive inheritance. The visual acuities were; 0.9 with correction -3.00 Dsph in the right eye and 0.6 with correction -5.50 Dsph in the left eye. Mosaic corneal dystrophy and slight iridodonesis was found in both eyes. Posterior subcapsular cataracts were seen in both eyes with predominance in the left eye. Moreover, flat peripheral retinal detachment in the lower part of the eye fundus was found, which was presumably long-lasting. Phacoemulsification through the clear corneal temporal micro-incision of 1.8 mm and the foldable intraocular lens IOL) implantation in the left eye were performed. The IOL refractive power was calculated with 101 Master and with standard contact ultrasound biometry. Preventive laser photocoagulation of the retina was performed in the right eye. RESULTS: No intraoperative and postoperative complications were observed. Two weeks after cataract surgery corrected visual acuity in the left eye was ii] with correction + 1.00 Dsph. The patient was very satisfied with the surgery result. CONCLUSIONS: Phacoemulsification with an implantation of foldable 101 in patients with megalocornea may be a safe procedure with very good functional results. Precise IOL power calculation may be difficult to achieve.

Results of phacoemulsification with Malyugin Ring in comparison with manual iris stretching with hooks in eyes with narrow pupil.

PURPOSE: To evaluate the results of phacoemulsification in eyes with a narrow pupil dilated with Malyugin Ring, in comparison with manual pupillary stretching with hooks. SETTING: Department of Ophthalmology, Medical University of Lodz, Poland. MATERIALS AND METHODS: The examined group (group 1) consisted of 23 eyes of 23 patients whose pupil was dilated using Malyugin Ring. The reference group (group 2) consisted of 17 eyes of 17 patients whose pupil was dilated manually by stretching with hooks. All patients underwent uneventful standard phacoemulsification. Patients were examined preoperatively, 1 day, and 1 month after the surgery. Best-corrected visual acuity (BCVA), intraocular pressure, anterior and posterior segment of the eye, and corneal endothelial cell density were evaluated. Statistical analysis was done using nonparametric tests. RESULTS: Mean preoperative BCVA in group 1 was 0.31±0.27 and in group 2 it was 0.26±0.26 (p>0.05). In both groups there was a significant improvement in BCVA after the surgery (p<0.05). Mean postoperative BCVA in group 1 was 0.75±0.30 and in group 2 it was 0.56±0.56 (p<0.05). Mean corneal endothelial cell loss measured 30 days postoperatively amounted to 9.35±11% in group 1 and 13.77±8.0% in group 2 (p<0.05). No serious complications were found. CONCLUSIONS: In eyes with narrow pupil, the use of Malyugin Ring makes the surgery easier and allows for better functional results and smaller corneal endothelial cell loss in comparison with manual pupillary stretching with 2 hooks.

Management of persistent diplopia after surgical repair of orbital fractures.

PURPOSE: To present the results of management of patients with persistent diplopia after orbital reconstructive surgery with respect to the type of ocular motility impairment pattern. METHODS: All patients referred during a 2-year period because of persistent diplopia after surgical repair of orbital fracture were categorized according to the degree and pattern of ocular motility impairment on the basis of orthoptic examination 3-4 weeks postoperatively. Patients were followed for a mean period of 10.5 months (range, 6-12 months), during which adequate treatment was implemented. RESULTS: A total of 52 patients were included in the study (45 males; mean age, 41.8 ± 16.6 years). Most could be divided into 1 of 4 groups according to the type of ocular motility impairment. The follow-up orthoptic examination revealed resolution of diplopia in 9 patients (15%) and persistent but unbothersome diplopia in 26 (43.4%). Significant diplopia was treated conservatively in 3 patients (5%) and with strabismus surgery in 14 (23.3%) cases. CONCLUSIONS: The results of this study indicate that in most cases of persistent diplopia after reconstructive surgery for orbital fractures, symptoms resolve over time without treatment; nevertheless, strabismus surgery is unavoidable in some cases.