Severe acute bilateral alcohol-induced toxic optic neuropathy--case report.

Toxic optic neuropathies are not frequently encountered in routine practice, however, they present a challenge both in terms of diagnosis and treatment. The aim of this paper is to present an unusual case of ethyl alcohol poisoning causing bilateral toxic optic neuropathy with loss of vision.

[Surgically induced astigmatism after bimanual phacoemulsification through microincision and after standard phacoemulsification]. / Niezbornosc indukowana chirurgicznie po bimanualnej fakoemulsyfikacji przez mikrociecie oraz po standardowej fakoemulsyfikacji zacmy.

PURPOSE: The purpose was to compare surgically induced after bimanual phacoemulsification performed through a 1.7 mm superotemporal clear corneal microincision (B-MICS), and after coaxial phacoemulsification performed through a 3.2 mm superotemporal clear corneal incision, calculated with various mathematical methods. MATERIAL AND METHODS: Group 1 consisted of 29 eyes after bimanual phacoemulsification performed through a 1.7 mm superotemporal clear corneal microincision. Group 2 consisted of 31 eyes after coaxial phacoemulsification performed through a 3.2 mm superotemporal clear corneal incision. Ophthalmic examination was performed preoperatively, 1 day, 7 days, 1, 3 and 6 months postoperatively. We performed auto-refractometry, keratometry, tonometry and visual acuity testing (UCVA and BCVA). SIA was calculated using: vector method, vector decomposition, Cravy's and Naeser's method. RESULTS: There was no difference in mean UCVA and BCVA between the groups in the whole observation period. In vector method SIA did not differ significantly between the groups during the whole follow-up. In vector decomposition (C90 component), SIA was higher in group 2 than in group 1, one day and 1 month postoperatively. Cravy's and Naeser's method showed that SIA in group 2 was significantly higher as long as the 1-st month postoperatively. In the final examination, there was no significant difference in SIA values between the groups for all methods of calculations. CONCLUSIONS: Technique B-MICS through a 1.7 mm incision offers equally good functional results, as standard phacoemulsification through 3.2 mm superotemporal clear corneal incision. The SIA axis was more stable in microincision group in the whole follow-up period.

[Methods of calculating surgically induced astigmatism]. / Metody obliczania niezbornosci indukowanej chirurgicznie.

Evaluation of surgically induced astigmatism is important, as it allows to thoroughly assess the influence of surgical incision on corneal refraction. This influence can be established by calculating surgically induced astigmatism according to an appropriate mathematical method. The purpose of the study was to describe various mathematical methods used in the current literature to calculate surgically induced astigmatism. When comparing results of calculation of surgically induced astigmatism among different studies, it is necessary to take into account values obtained with the use of the same method of calculation, as various methods evaluate astigmatism differently.

Incidence and functional outcome of phacoemulsification complicated by posterior capsular rupture.

PURPOSE: To evaluate retrospectively anatomic and functional results of phacoemulsification with posterior chamber intraocular lens implantation, complicated by intraoperative posterior capsular rupture (PCR). MATERIAL AND METHODS: Data were gathered from medical records of 930 patients (one thousand eyes), who underwent phacoemulsification. The examined group consisted of 52 eyes of 52 patients, 27 women (52%), and 25 men (48%), 50 to 84 years old (mean age 73.52 +/- 7.8), who underwent phacoemulsification complicated by intraoperative posterior capsular rupture. The control group consisted of 427 patients, including 263 women (61.59%) and 164 men (38.41%), at the age 44 to 93 (mean age 70.3 +/- 10.2), who underwent uncomplicated cataract phacoemulsification. All patients had ophthalmic examination preoperatively, one day postoperatively and 10 to 14 days postoperatively. The evaluated data included: patients' age and gender, pre- and postoperative best corrected visual acuity, intraocular pressure, state of the anterior and posterior segment, early postoperative complications, type of implanted intraocular lens and whether anterior vitrectomy was performed. Nonparametric tests were used for statistical analysis (Wilcoxon signed-ranks test and Mann-Whitney U test). RESULTS: A statistically significant difference in postoperative BCVA between both groups was found. Mean postoperative BCVA in the PCR group was 0.63 +/- 0.27, whereas mean postoperative BCVA in the reference group was 0.78 +/- 0.18 (p < 0.001). Ten patients in the PCR group (19%), required anterior vitrectomy. In-the-bag implantation was performed in all eyes from the reference group, but it constituted only 31% (16 eyes), of the PCR group. We found that eyes with PCR are 2.6 times more likely to develop other intraoperative complications and early postoperative complications in comparison with controls. In our study eyes with PCR were about 5 times more likely to have a final BCVA worse than 0.5 than eyes from uncomplicated surgery group. CONCLUSIONS: Eyes with intraoperative PCR during phacoemulsification have a higher risk of reduced BCVA, however, it is possible to achieve good final BCVA in the majority of eyes. Appropriate intraoperative and postoperative management will usually allow to perform a successful procedure with safe placement of an intraocular lens, thus ensuring a relatively favourable outcome.

Analysis of causes of intraocular lens explantations in the material of Department of Ophthalmology, Medical University of Lodz.

PURPOSE: Implantation of intraocular lenses (IOLS) has become a standard practice in cataract surgery, however, similar to any other type of surgery, using IOLs is not complication-free and sometimes explantation of intraocular lenses may be necessary. This study was to gather data and analyze causes of intraocular lens explantations, performed in the Department of Ophthalmology, Medical University of Lódz. MATERIALS AND METHODS: The data were gathered from medical documentation of all patients who underwent intraocular lens removal from January 2003 to July 2006. The examined group consisted of 16 patients (16 eyes): 9 women (fraction 0.56), and 7 men (fraction 0.44), at the age from 21 to 82 years (mean age 62.4 years, SD +/- 15.5). In all patients IOL explantation was performed under local, peribulbar anaesthesia. RESULTS: Two groups of patients were distinguished: patients who had an anterior chamber lens explanted (3 patients, fraction 0.19) and patients who underwent posterior chamber lens explantation (13 patients, fraction 0.81). Causes of AC IOL explantations were: vaulting of the IOL (1 eye, fraction 0.06), luxation of the IOL to the vitreous cavity (1 eye, fraction 0.06), and painful eyeball after anterior chamber lens implantation (1 eye, fraction 0.06). Causes of PC IOL explantations were: subluxation of the IOL (6 eyes, fraction 0.38), luxation of the lens to the vitreous cavity (3 eyes, fraction 0.19), luxation of the lens to the anterior chamber (1 eye, fraction 0.06), endophthalmitis (2 eyes, fraction 0.13) and incorrect lens power (1 eye, fraction 0.06). CONCLUSIONS: In the majority of eyes (n = 13, fraction 0.81) the removed implant was replaced by another intraocular lens, but 3 eyes (fraction 0.19) were left aphakic. We did not observe serious intra- or early postoperative complications which might influence the final result of the operation.

[Results of bimanual phacoemulsification with intraocular lens implantation through the micro incision]. / Wyniki operacji zacmy metoda bimanualnej fakoemulsyfikacji z wszczepieniem soczewki--wewnqtrzgalkowej przez mikrociecie.

PURPOSE: To evaluate the postoperative results of bimanual, cold phacoemulsification with foldable lens implantation through 1.7 mm incision. MATERIAL AND METHODS: Thirty four bimanual cold phacoemulsifications with Acri. Smart (AcriTec) IOL implantation through 1.7 mm incision were performed in the Department of Ophthalmology, Medical University of Lódz, between March and May 2004. In the group of 34 patients, 24 were women and 10 were men. The mean age of patients was 67 years (range between 42 and 77). Preoperative visual acuity ranged from 0.5/50 to 5/10. Mean visual acuity was 0.3. Preoperative astigmatism ranged from 0.15 to 2.3 diopters (mean 0.7). Preoperatively, nuclear density was estimated according to LOCS III classification. Twenty patients (59%) had 1 to 3 nuclear density, and 14 (41%) had 4 to 6 nuclear density. All surgeries were performed with Oertli machine using the burst mode with a sleeveless phaco tip. Postoperative examinations were conducted on the 1st and the 7th day, and I month after the surgery. Visual acuity, astigmatism, status of the cornea and IOL centration were evaluated. RESULTS: No intraoperative complications were observed. All 34 patients maintained corneal transparency with no signs of thermal damage around the wound. Visual acuity improved in all cases. Mean visual acuity in 33 patients who had no coexisting ocular diseases I month after surgery was 0.98 and the mean induced astigmatism was 0.2 diopters. In all cases IOLs were very well centred. CONCLUSIONS: Bimanual phacoemulsification is a very safe method allowing to minimise corneal incision. Using Acri. Smart IOLs, the induced astigmatism is very small, almost imperceptible to patients.