Pars plana vitrectomy with transscleral fixation of posterior chamber lens in the treatment of post-traumatic lens dislocation.

PURPOSE: To present our experience with post-traumatic lens dislocation management by vitrectomy followed with sutureless artificial lens fixation. METHODS: The retrospective study involved 15 patients (12 men and 3 women) aged from 36 to 78 (on average, 63 years old), from the Vitreoretinal Surgery Teaching Hospital, operated in the years 2013-2015. All cases concerned ocular traumas with dislocation of the natural or artificial lens to the anterior chamber, vitreous body chamber, or post-traumatic aphakia. After vitrectomy, patients had the implant fixated with a technique devised by Scharioth-sutureless fixation of posterior chamber implants in the groove area, with haptics placed in scleral tunnels parallel to the corneal limbus. Preoperative and postoperative condition of the eye was assessed. RESULTS: The average period of observation was 29 weeks. Average pre-surgery refraction was + 10.75, while post-surgery + 1.25. Average best-corrected visual acuity in Snellen charts before surgery was 0.3 and at the end of the observation period 0.5. The improvement in visual acuity after surgery in relation to visual acuity before surgery was statistically significant (P = 0.005). In the first 2 weeks after surgery, minor hypotonia was observed in three of the patients, while in two-moderate bleeding to the vitreous body and the anterior chamber, which subsided without surgical intervention. A slight decentration of the implant observed in two cases did not affect later refraction or BCVA. CONCLUSION: Basing on the abovementioned facts, we believe that this surgical approach facilitates the fixation of the dislocated lens and allows a successful treatment of secondary implantation or repositioning of a dislocated intraocular lens.

[Obstacles to medication compliance for patients with glaucoma]. / Przyczyny pomijania zalecanych dawek leków przez pacjentów z jaskra.

PURPOSE: Aim of the study was to identify obstacles to medication adherence (compliance) for patients with glaucoma. MATERIAL AND METHODS: A prospective case series of structured interviews were conducted in 150 patients with glaucoma. (75 patients treated in the glaucoma out-patient clinic of the Department of Ophthalmology, Medical University, Lublin, Poland and 75 patients treated in regional out-patient clinics). Questionnaire of an anonymous survey, formulated on the basis of the publication: Tsai J.C. et al. "Compliance barriers in glaucoma: a systematic classification", J. Glaucoma. 2003, 12, 393-398. RESULTS: The results of the survey showed omissions of particular doses of medications in 62.7% of patients from regional outpatient clinics and in 35.3% of patients treated at the Department of Ophthalmology. It was shown that 32.7% of respondents from regional outpatient clinics and 8.7% from the Department of Ophthalmology Glaucoma Clinic declared remaining without antiglaucoma drops for more than one day. As reasons for omissions of single doses of the medications: forgetfulness (54.7%), too many doses of medications (10%) and little knowledge about the disease (10%) were usually pointed. According to the respondents: little knowledge (32%) and financial factors (22%) are the main causes of medications withdrawal for longer time. CONCLUSIONS: The most common obstacles to medication compliance for patients with glaucoma include: forgetfulness, low level of knowledge about the disease, financial factors and too many doses of the medications. Fewer doses and the presence of a supporting person have a positive influence on compliance.