Measurement of corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer as potential new non-invasive methods in assessing a risk of cerebral edema in type 1 diabetes in children.

AIMS: Some patients with diabetic ketoacidosis develop cerebral edema (CE) in the course of type 1 diabetes mellitus (T1D), which may result in central nervous system disorders and high mortality. The imperfection of existing neuroimaging techniques for early recognition of CE forces us to search for the new and non-invasive methods. The aim of the study was to assess the usefulness of new methods (pachymetry, transorbital ultrasonography-USG, optical coherence tomography-OCT study) in the assessment of the risk of CE occurrence in children with newly diagnosed T1D. METHODS: The study group included 50 children with newly diagnosed T1D, 54 patients with long-term T1D as a reference group and 40 children without glucose tolerance disorders as controls. In all subjects, a corneal thickness (CCT) index with pachymeter, optic nerve sheath diameter (ONSD) using transorbital USG and retinal nerve fiber layer (RNFL) during OCT study were measured and compared with selected clinical parameters of T1D. RESULTS: In patients from a study group at onset of T1D, the higher CCT (p < 0.001) and ONSD (p < 0.001) values were observed as compared to the results obtained after 48 h of metabolic compensation. The ONSD correlated negatively with pH value (r = - 0.64; p < 0.001), BE (r = - 0.54, p < 0.001) and HCO3- (r = - 0.50; p < 0.001). A positive correlation between RNFL and Na+ levels (r = 0.47; p < 0.005) was also observed. CONCLUSIONS: Transorbital USG and pachymetry may serve as the potential promising methods for the non-invasive assessment of the increased risk of development of CE in patients with T1D.

[Level of selected antibacterial tear proteins in children with diabetes type 1]. / Poziom wybranych bialek antybakteryjnych we lzach u dzieci z cukrzyca typu 1.

PURPOSE: Antibacterial immunity in diabetes is impaired, which increases the risk of general and local infections. The aim of the study was to evaluate non-specific local antibacterial immunity based on lactoferrin and lysozyme concentration in tears in children with diabetes type 1. MATERIAL AND METHODS: Children at the age of 10-18 years old were studied. Group 1. consisted of children without diabetes, group 2. included patients with new onset of diabetes and group 3. consisted of children with decade-long diabetes. Among all patients tears were collected from inferior coniunctival fornix with hematocrit glass capillaries in purpose to measure lactoferrin and lysozyme concentration. ELISA method was used in laboratory testing. RESULTS: Level of lactoferrin did not differ significantly among all groups. Concentration of lysozyme was statistically lower in group with decade-long diabetes (group 3.) compared to patients without diabetes. Mild correlation between lactoferrin and lysozyme levels was seen in individual patients in whole group of probands together. CONCLUSIONS: Diabetes type 1 in children is associated with significant changes in concentration of tear proteins, which contribute to antibacterial immunity.

Causes of visual disability in children and young adults.

PURPOSE: Blindness and visual disability is a great problem all over the world. Loss of visual acuity in children requires special attention. The aim of the study was to determine the causes of uni- and bilateral low vision in children and young adults. Patients were from our clinic and from the School for the Blind and Visually Impaired in Lodz. MATERIAL AND METHODS: The study group included 271 patients aged from 3 months to 21 years, visually disabled and with uniocular reduction of visual acuity to 25% or less. RESULTS: The commonest cause of low visual acuity in the group was optic nerve atrophy (22%) due to perinatal hypoxia. Other important causes were retinopathy of prematurity (17%) and congenital abnormalities of the eye globe (11%). The main causes of uniocular low vision were anisometropia and strabismus. CONCLUSIONS: The main cause of visual impairment and disability in the study group from our region was optic nerve atrophy. Retinopathy of prematurity was also frequently seen in the handicapped children and was responsible for severe visual loss. Anisometropia and strabismus were predominant causes of uniocular visual deterioration, but not of visual disability.

[Chosen etiopathogenetic factors in formation and development of retinopathy of prematurity (ROP)]. / Wybrane czynniki etiopatogenetyczne w powstaniu i rozwoju retinopatii wczesniaków.

Retinopathy of prematurity remains a serious problem in newborns. Sometimes despite of better ophthalmologic control and knowledge of pathomechanism of ROP, there is no possibility to avoid blindness. Today attention is concentrated on searching in pathophysiology, immunology and other branches of medical sciences to explain the nature of disease. The aim of this article is to analyze some factors which play an important role in development of ROP.

[Ocular complications in leukemias and malignant lymphomas in children]. / Powiklania okulistyczne w bialaczkach i chloniakach zlosliwych u dzieci.

PURPOSE: The aim of the study was to determine the prevalence and types of ocular abnormalities in children with leukemias or lymphomas. MATERIAL AND METHODS: We have studied 39 children (age 0.5-17 years) with leukemia or lymphoma. Ocular manifestations were present in 54% of study group (21 children). The most frequent ocular findings were seen in conjunctiva (33.4%). 15.4% patients presented with posterior segment findings, without loss of ocular acuity. Other symptoms were dry eye syndrome and proptosis. CONCLUSIONS: Children treated for leukemia or lymphoma should be systematically examined by ophthalmologist. Ophthalmic complications can be results of basic disease, treatment or manifestations of relapse.

[Changes in organ of vision in proliferative diseases of hematopoietic system in children]. / Zmiany w narzadzie wzroku w chorobach rozrostowych ukladu krwiotwórczego wieku dzieciecego.

Leukemias and lymphomas are the most common neoplasms of hematopoietic system in children. The aim of the study was to determine ophthalmological signs in these disaeses referring to available literature.

[Epidemiology of cataract in clinical material of Department of Ophthalmology, Medical University of Lódz]. / Epidemiologia zacmy w materiale Kliniki Chorób Oczu Uniwersytetu Medycznego w Lodzi.

PURPOSE: Analysis of some epidemiological features of patients operated for senile and presenile cataract at our department in years: 1992, 1994, 1997, 2000 and 2002. MATERIAL AND METHODS: In the analyzed years 4385 patients (1594 males and 2791 females) aged from 36 to 97 years were operated. The age of patients, sex, duration of cataract symptoms before surgery, preoperative visual acuity, type of cataract, place of living and coexistence of diabetes or high myopia, were taken into consideration. RESULTS: The mean age of patients was 70.4. A statistically significant difference between mean age in 1997 (69.7), and 2000 (71.6) and 2002 (71.4) was found. Women tended to be operated on 2 years later than men (mean age for women--71.1, mean age for men--69.1). 16% of patients suffered from diabetes, and 6.7% had high myopia. Senile cataract affected people with high myopia at earlier age (mean--67.3 years). 67.5% of patients were of big town origin, 13% came from small towns and 19% were from the country. Patients from big towns were operated in higher age (mean--72.4 years) than patients from small cities (mean--69.9 years), and from country (mean--70.2 years) and had better visual acuity (mean--0.20) than patients from small towns (mean--0.16) and from country (mean--0.13). Preoperative visual acuity in the range 0.4-1.0 was found in 0.4% of patients in 1992, and in 28% in 2002. The visual acuity <0.1 was found in 77.5% of patients in 1992 and in 45% of patients in 2002. CONCLUSIONS: Mean age of patients operated for cataract is increasing and there is a tendency of performing operations in cases with better visual acuity. Women suffer from cataract later than men. People of country origin were operated at earlier age with worse visual acuity comparing to patients coming from towns. Senile cataract affects people with high myopia at earlier age.