Bcl-2 and Bax protein expression in human optic nerve axons in the eyeballs after severe trauma and in the eyes with absolute glaucoma.

The aim of our study was to evaluate the immunohistochemical expression of Bcl-2 and Bax protein in optic nerve axons after severe eyeball injury and in the eyes with absolute glaucoma. A series of 19 eyeballs, enucleated because of absolute glaucoma and 41 eyeballs, enucleated, following extensive injury, at the Department of Ophthalmology of the Medical University of Bialystok, were taken into our study. The immunohistochemical reaction was performed with Bcl-2 and Bax protein antibodies and by the LSAB technique. DAB was used in order to visualise the reaction. The optic nerve axons in glaucomatous eyeballs showed statistically significant higher Bax protein expressions than those of Bcl-2 proteins. In the optic nerve axons after severe eyeball injury, a non-significantly higher Bcl-2 protein expression was observed.

Expression of PCNA and Ki-67 in posterior uveal melanomas in adults.

The aim of the study was to evaluate the expression of cell proliferation markers (PCNA and Ki-67) in posterior uveal melanomas in adults. Thirty-six enucleated eyes (without prior treatment) were included in histopatological study. A series of 15 cases of spindle cell type melanomas, 12 epithelioid and 9 of a mixed type were assessed, using the immunohistochemical method with monoclonal PCNA and Ki-67 antibodies. PCNA expression was observed in 75% and Ki-67 in 13.8% of all the examined tumours. The mean score of PCNA and Ki-67 index were the highest in tumours, which contained epithelioid cells and in large, more advanced (pT3, pT4) uveal melanomas. The results showed that the evaluation of expression of PCNA and Ki-67 may provide an additional infonnation about the progression of tumor process.

[Late manifestations of the optic nerve damage after closed head trauma]. / Odlegle w czasie powiklania, dotyczace nerwu wzrokowego, po przebytych zamknietych urazach glowy.

PURPOSE: A follow-up assessment of the visual system in patients who had undergone close head injury and in whom simple atrophy of the optic nerve occurred several months after the trauma. PATIENTS: Among patients treated in Department of Ophthalmology in Bialystok in the years 1984-1995 there were 2 women and 3 men, aged 19-61 years, who suffered from advancing simple atrophy of the optic nerve and who had undergone severe closed head trauma 3-5 months earlier. In one case the time interval between trauma and the visual sequelae amounted to 11 years. METHODS: The patients underwent a follow-up examination at 3 to 11 years after their initial treatment in the Department of Ophthalmology. Besides a conventional ophthalmologic examination, a static perimetry was performed as well as ultrasonography in projection B and Colour-Coded Doppler sonography (TCCD) of the orbital vessels. RESULTS: When compared to the findings at discharge, in 2 patients visual acuity improved to 5/12, in the remaining 3 no improvement was noted. In all patients the optic discs were white, while other structures of the globe appeared within normal limits. Blood flow in the central retinal artery, ophthalmic artery and in the long posterior cilliary arteries remained undisturbed, as assessed with TCCD. CONCLUSIONS: 1. Lack of visual disturbances immediately after head injury does not preclude their development in the protracted period after the trauma. 2. The reason of the late development of visual sequelae after head trauma is not clear. Normal flow, found in the major vessels of the globe, might indirectly suggest disturbances of microcirculation within the optic nerve with a consequent optic atrophy.

[Evaluation of some clinical parameters in patients with retinitis pigmentosa in relationship to the type of inheritance]. / Ocena wybranych parametrów klinicznych u pacjentów z retinitis pigmentosa z uwzglednieniem sposobu dziedziczenia choroby.

PURPOSE: Analysis of selected clinical parameters in patients with various types of retinitis pigmentosa. PATIENTS AND METHODS: We examined 51 patients aged 8-67 suffering from different genetic forms of RP identified on the ground of pedigree analysis. We analyzed onset of nyctalopia, degree of retinal degeneration, degree of visual field loss, dark adapted electroretinographic testing flicker (ERG) and presence of posterior subcapsular cataract. CONCLUSIONS: XLRP is one of the most severe RP forms. In the groups with ADRP and sRP, the patients have varied expression of disease.

[Variations of Doppler blood flow parameters in central retinal artery in relation to position of sample volume]. / Zmiennosc parametrów dopplerowskich przeplywu krwi w srodkowej tetnicy siatkówki w zaleznosci od miejsca pomiaru.

PURPOSE: To determine variability in measurements of Doppler blood flow parameters in central retinal artery in relation to sample volume location from the optic disc. MATERIAL AND METHOD: Eighty central retinal arteries were examined using color Doppler ultrasonography in 40 healthy volunteers (22 female, 18 male), aged 45 +/- 9 with 7.5 MHz linear-array probe. The measurements of blood velocities and resistance indices in the arteries were obtained at points where distance from optic disc surface ranged from 1.5 mm to 6 mm. RESULTS: Blood velocities increased significantly when sampled closer to the globe (r = -0.61, and r = -0.32 for peak-systolic and end-diastolic velocities, respectively). Mean peak-systolic velocities were 13.0 +/- 2.7 cm/s when distance 2.1 +/- 0.46 mm from optic disc, and 9.3 +/- 2.5 cm/s when distance 4.27 +/- 0.9 mm. Mean end-diastolic velocities were 4.3 +/- 1.2 cm/s and 3.6 +/- 1.1 cm/s, respectively. Resistance indices inclined to increase when the distance between the measurement site and the globe shortened. Resistance indices were 0.67 +/- 0.06 when measured closer to the globe and 0.60 +/- 0.06 when measured farther from it. CONCLUSION: Position of sample volume in relation to optic disc has to be taken into account and defined if measurements of blood flow Doppler parameters of the central retinal artery are to be reproducible.

[Blood flow parameters in ocular vessels of patients with glaucoma]. / Parametry dopplerowskie przeplywu krwi w naczyniach krwionosnych oka u chorych na jaskre.

PURPOSE: To determine Doppler flow parameters in ocular vessels of glaucomatous patients. MATERIAL AND METHODS: 38 glaucomatous patients, aged 64 +/- 16, and 57 healthy volunteers were examined with 7.5 MHz linear-array probe. Consistently identified arterial structures included ophthalmic artery, central retinal artery and short posterior ciliary arteries. The peak systolic, end-diastolic and mean velocities were measured from Doppler spectra. Resistance and pulsatility indices were also determined. RESULTS: End-diastolic and mean velocities in central retinal artery of glaucomatous eyes were: 1.5 +/- 1.9 cm/s, 4.0 +/- 2.0 cm/s, whereas in healthy eyes they were significantly higher: 3.5 +/- 1.0 cm/s, 5.4 +/- 1.5 cm/s, respectively. These velocities in short posterior ciliary arteries in glaucomatous patients were significantly lower: 2.4 +/- 2.3 cm/s, 5.6 +/- 2.2 cm/s, comparing to healthy subjects: 4.8 +/- 1.7 cm/s, 7.3 +/- 2.2 cm/s. Resistance and pulsatility indices in central retinal artery and short posterior ciliary arteries were significantly higher in the group of patients: RI = 0.85 +/- 0.18, PI = 2.11 +/- 0.92--in central retinal artery and RI = 0.81 +/- 0.18, PI = 1.96 +/- 0.91--in short posterior ciliary arteries, comparing to healthy subjects: RI = 0.61 +/- 0.08, PI = 1.20 +/- 0.17--in central retinal artery, RI = 0.61 +/- 0.09, PI = 1.13 +/- 0.18--in short posterior ciliary arteries. Impedance indices were increasing progressively with intraocular pressure elevation. There were no significant differences of Doppler blood flow parameters in ophthalmic artery between patients and control group. CONCLUSIONS: Blood flow velocities in central retinal and short posterior ciliary arteries are lower, and resistance and pulsatility indices are higher in glaucomatous eyes in comparison to healthy subjects, whereas in ophthalmic artery doppler parameters are similar in both groups.

[Remote results of conservative treatment of traumatic optic neuropathy]. / Odlegle wyniki leczenia zachowawczego pourazowych obrazen nerwu wzrokowego.

The problem of pathogenesis and effective treatment of traumatic optic neuropathy (TON) is still an open question. According to current opinions the immediate results of conservative treatment with megadose corticosteroids are similar to those obtained with surgical decompression. No data on late results of both modes of treatment are at present available. This study was undertaken to assess the late results of conservative treatment of traumatic optic neuropathy. The clinical material comprised 15 patients (3 women and 12 men, age 14-64 years), who developed clinical symptoms of TON as a consequence of closed head trauma. All were treated conservatively with megadose steroid therapy. 10 patients presented to follow-up examination performed 3-11 years after the injury. A full ophthalmologic survey and colour-coded Doppler (CCD) examination of the orbital vessels were performed in all subjects. In 6 patients there was full blindness of the affected eye since the injury. Their visual acuity did not improve despite vigorous treatment and their eyes were still blind at the late follow-up examination. No flow found with CCD in their central retinal arteries at follow-up might suggest structural disruption of the nerve. In 5 of these patients ocular atrophy evolved between the injury and follow-up examination. 4 patients, who on admission displayed merely light sensation, responded to 2-3 weeks of steroid therapy with improvement of visual acuity to 3/50, 5/50, 5/10, 5/7. After 4-6 years however, visual acuity of all these patients deteriorated again to mere light perception in three and 1/50 in another one. Optic atrophy was diagnosed in all the affected eyes. Our results indicate that conservative treatment of TON, even if giving satisfactory relief of the symptoms, may not be reliable in permanent restrainment of the sequela of traumatic optic neuropathy.

[Activity of cathepsin a in subretinal fluid in primary retinal detachment]. / Aktywnosc katepsyny A w plynie podsiatkówkowym w pierwotnym odwarstwieniu siatkówki.

PURPOSE: To evaluate cathepsin A activity in the subretinal fluid in the primary retinal detachment. MATERIALS AND METHODS: The studies were performed on subretinal fluids taken from 38 patients operated for the primary retinal detachment. Duration of the detachment was contained between 1 week and 6 months. Cathepsin A activity was determined by the ninhydrin method with synthetic substrate (N-Cbz-Phe-Ala) at its optimum pH 5.0. RESULTS: Cathepsin A activity was demonstrated in all investigated fluids. The highest activity was found at about the 4th week of the detachment and then it decreased. No differences of enzyme activity according to sex and refraction error were found. CONCLUSION: The increasing proteolytic activity in the subretinal fluid could be an important factor in gradual degrading of the structure and function of the detached retina, because cathepsins are involved in digestion of outer segment proteins of rods and cones and degradation of mucopolysaccharide interphotoreceptor matrix. Retinal degradation during detachment is probably induced by both insufficient nutrition and the effect of increasing lysosomal enzymes.

[Use of color Doppler ultrasonography for evaluation of blood flow in orbital vessels]. / Zastosowanie kolorowej ultrasonografii dopplerowskiej do oceny przeplywów w naczyniach oczodolu.

PURPOSE: The aim of this study was to establish the normal values of blood flow velocities in ophthalmic and central retinal vessels. PATIENTS AND METHODS: 29 healthy subjects: 18 men and 11 women, mean age 55 +/- 20 years, were examined in Color Doppler technique with spectral analysis with the 7.5 MHz linear transducer. The peak systolic, end diastolic and mean flow velocities were measured. The resistance index (RI) and pulsatility index (PI) were also estimated. RESULTS: The values of velocities are comparable with results of other authors, especially when the similar frequency of the transducers was used. No significant differences of flow parameters were found between genders and right and left eyes when comparing the means. Ophthalmic artery velocities significantly declined as a function of age, but the RI and PI indices were similar. There were age-related differences between flow parameters in central retinal vessels. CONCLUSIONS: Ultrasound system characteristics, methodology of the examination and age factor should be considered in clinical evaluation of orbital vessels with color Doppler imaging.

[Combined operations of cataract and glaucoma]. / Jednoczesne operacje zacmy i jaskry.

PURPOSE: To discuss results and possible complications of combined, simultaneous operations of cataract and glaucoma. MATERIAL: 21 patients suffering from cataract and glaucoma; 16 women, aged from 59 to 88 years, and 5 men from 66 to 84 years. The patients were treated in the Department of Ophthalmology, Medical Academy in Bialystok in the years 1991 to 1996. METHODS: Intracapsular extraction of cataract with lens implantation to the anterior chamber and trabeculectomy was performed in 3 patients with simple glaucoma and hypermatured or brown cataract. In 7 patients only extracapsular cataract extraction was carried out along with trabeculectomy, whereas in 11 remaining ones--trabeculectomy with extracapsular removal of cataract followed by implantation of lens to the posterior chamber (10 subjects) or anterior chamber (1 subject). RESULTS: Postoperative visual acuity was 5/50-5/16 in 28% of patients. In the remaining 72% it amounted to 5/12 or more. Intraoperative and early postoperative complications occurred in 15 patients (71%), but they were only transitory. Delayed follow-up demonstrated that visual acquity had not worsened as compared to the preoperative status, though visual field deteriorated in 3 cases. Intraocular pressure was within normal limits in all patients. CONCLUSIONS: Combined, simultaneous operation of glaucoma and cataract does not seem to give rise to more complications than both procedures performed separately.

[Injuries of cranial nerves II-VII in 350 patients hospitalized due to closed head trauma]. / Uszkodzenia nerwów czaszkowych II-VII u 350 chorych hospitalizowanych z powodu zamknietych urazów glowy.

Ophthalmological examination was performed in 350 consecutive inpatients with closed head injury, treated in the Neurosurgical Department, Bialystok over a period of two years. The group comprised 266 men and 84 women, aged between 16 and 90 years. The purpose of the study was to screen for the symptoms of damage to cranial nerves II-VII. In 12% of cases internal, external or total III nerve palsy was identified. In 2% of cases there were symptoms of damage to the VII nerve, in 1.4% of damage to the V nerve and in 1.1% to the II nerve. In 0.6% of cases damage was observed to the VI nerve. There were no cases of damage to the IV nerve. Thus the III nerve was found to be the most susceptible to damage in head-injured patients.

[Familial occurrence of congenital aniridia]. / Rodzinne wystepowanie wrodzonego braku teczówki.

Aniridia and coloboma iridis are congenital defects which are inherited in common as an autosomal dominant trait. The study presents an analysis of 15 pedigrees of 15 patients from 3 families; it confirms the hereditary character of aniridia and iris coloboma and indicates the variability of the genetic expression.

[Parasitic uveitis in children]. / Pasozytnicze zapalenia blony naczyniowej u dzieci.

Seven children with an atypical parasitic uveitis were treated in the Department of Ophthalmology in Bialystok in the period 1985-1989. Parasitic background had been discovered in all the children: toxocara in 3, lambliasis in 2 and nematodiasis also in 2. Specific treatment achieved an improvement of the visual acuity and the inflammatory process abated.