Corneal Cross-Linking for Pediatric Keratoconus.

AIM: The aim of this study was to evaluate corneal cross-linking (CXL) for keratoconus in pediatric patients. MATERIALS AND METHODS: After keratometric qualification according to the Amsler-Krumeich system, corneal collagen cross-linking was performed using ultraviolet light and photosensitizing riboflavin drops in 111 eyes of 74 children with a mean age of 15 ± 1.67 years. None of the children studied wore contact lenses before the procedure. Visual acuity, intraocular pressure, keratometry, and pachymetry parameters were analyzed before and after corneal cross-linking. RESULTS: Visual acuity was 0.64 ± 0.31 and 0.66 ± 0.29 before CXL and at the end of the follow-up, respectively; the difference was not statistically significant. The mean intraocular pressure before CXL was 14.48 ± 3.13 mmHg, while the mean value at the end of the follow-up was 14.23 ± 3.03 mmHg; no statistically significant difference was found. Pre- and post-CXL astigmatism was 3.98 ± 2.34 Dcyl and 3.63 ± 1.86 Dcyl, respectively; the difference was not statistically significant. The mean keratometry before CXL was 47.99 ± 3.96 D; the mean post-follow-up value was 47.74 ± 3.63 D. The mean corneal thickness (pachymetry) at the apex of the keratoconus-the thinnest zone of the cornea-before CXL was 492.16 ± 38.75 µm, while the mean value at the end of the follow-up was 479.99 ± 39.71 µm; the difference was statistically significant. CONCLUSIONS: Corneal cross-linking is an effective method for preventing keratoconus progression in children. However, further and detailed ophthalmic follow-up of patients who underwent CXL before the age of 18 is highly advisable.

Mowat-Wilson syndrome: Case report.

BACKGROUND: Mowat-Wilson syndrome (MWS) is a rare genetic condition resulting in multiple congenital anomalies, including facial dysmorphism, structural anomalies of the internal organs, functional disorders, and, although less commonly, ocular abnormalities. To present a child with MWS and eye abnormalities. METHODS: A 3-year-old boy was born at 37 weeks of pregnancy with dysmorphic features, neurodevelopmental disorders, genetically confirmed MWS, nystagmus, strabismus, and suspicion of congenital glaucoma. Ophthalmic examination was carried out under general anesthesia; eyeball ultrasound and electrophysiological examination (flash visual evoked potentials) were also performed. RESULTS: The examinations revealed nystagmus, a normal response of pupils to light in both eyes, and normal intraocular pressure, that is, 17 and 18 mm Hg in the right and left eye, respectively. Corneal thickness was 606 µm in the right eye and 588 µm in the left eye. Gonioscopy revealed displacement of Schwalbe line anterior to the limbus of the cornea (posterior embryotoxon). Fundus examination revealed a pink optic disk with a cup-to-disc ratio of 0.5, macular pigment regrouping, and normal blood vessels. Flash visual evoked potentials: P2 latency was normal. P2 amplitude from the left hemisphere was reduced to 50%, and P2 amplitude over the right hemisphere was normal. CONCLUSION: Children with genetically determined congenital anomalies need regular ophthalmic checkups to accurately assess the eye and determine the prospects of vision function development.

Isolated retinal astrocytic hamartoma with 7-year follow-up: A case report.

RATIONALE: Retinal astrocytic hamartoma (RAH) is a rare benign tumor originating from astrocytic cells located in the neural cell layer of the retina. It is commonly seen in patients with phakomatoses such as tuberous sclerosis complex or neurofibromatosis, rarely as an isolated retinal mass. This lesion is usually asymptomatic; however, these located in the area of the optic nerve, macula, or exhibiting the features of exudation, neovascularization may present visual disturbances and decreased visual acuity. PATIENT CONCERNS: We present a rare case of a 15-year-old boy, with no significant past medical history, whose cause of visual disturbances turned out to be isolated RAH. DIAGNOSES: Based on the results of color images of the fundus, fluorescein angiography as well as the analysis of magnetic resonance imaging, the patient was diagnosed with RAH. INTERVENTIONS: Additionally an B-scan ultrasonography, static and kinetic perimetry were performed. OUTCOMES: Fundoscopic examination showed a unilateral yellowish, well-circumscribed, mulberry-like lesion with a wide base, located in inferosnasal quadrant, in the vinicity of the optic nerve. The patient underwent neurological, pediatric, and genetic evaluations that excluded other pathological findings or underlying systemic disease. LESSONS: The prognosis for RAH is generally good, however, the lesion requires regular ophthalmologic follow-up to rule out the progression of the tumor mass. The patient 7-year follow-up history is without evidence of tumor growth, local or general deterioration of the condition.

Ocular features in Aicardi syndrome: A case report.

RATIONALE: Aicardi syndrome is a genetic malformation syndrome with a triad of dysgenesis or agenesis of the corpus callosum, distinctive chorioretinal lacunae and infantile spasms. It is a rare developmental disorder first described in 1965. The disease affects 1 in 100,000 live births. PATIENT CONCERNS: We describe a 34-month-old girl diagnosed with Aicardi Syndrome. DIAGNOSIS: Based on the results of color images of the fundus, medical history as well as the analysis of karyotype and DNA microarrays, the patient was diagnosed with Aicardi's syndrome. INTERVENTIONS: Additionally an B-scan ultrasonography and an electrophysiological test was performed. OUTCOME: Fundoscopic examination revealed optic disc colobomas in both eyes, extensive chorioretinal lacunae at the posterior pole with retinal pigment epithelium regrouping and atrophy. Flash visual evoked potentials (FVEP) P2 amplitude was lower than normal range. B-scan ultrasonography revealed an optic disc lesion consistent with optic disk coloboma. LESSONS: Children with congenital central nervous system malformations should undergo regular ophthalmic checkups to facilitate diagnosis and determine prognosis of visual function development.

Anterior ischemic optic neuropathy after conventional coronary artery bypass graft surgery.

BACKGROUND: Perioperative optic neuropathy is a disease which can lead to serious, irreversible damage of vision. This complication could be the result of non-ocular surgery, for example, cardiac or spinal procedures. We present a case of anterior ischemic neuropathy (AION) which occurred following a conventional coronary artery bypass graft procedure. CASE REPORT: A 57-year-old man, 4 days after Conventional Coronary Artery Bypass Graft surgery as result of multi-vessel stabile coronary artery disease and history of anterolateral wall myocardial infarction, was admitted to the Eye Clinic due to significant loss of vision in his right eye. The patient had hypertension and was a heavy smoker. On admission, the slit lamp examination revealed a relative afferent pupillary defect in the right eye. The fundus examination showed optic disc edema with the presence of flame hemorrhages. Best corrected visual acuity (BCVA) was 0.02. The results of eye examination and fluorescein angiography confirmed the diagnosis of AION. Anti-aggregation and antithrombotic treatment was continued with steroids and vasodilators. After 7 days of this treatment we noticed the improvement of BCVA to 0.2. At 6-month follow-up, the vision was stable, and fundus examination revealed optic disc atrophy. CONCLUSIONS: After cardiac surgical operations, such as coronary artery bypass graft procedures, anterior ischemic optic neuropathy may occur. In those cases, close cooperation between the various specialists is necessary.

[Phacoemulsification of subluxated opacified lens in pseudoexfoliation glaucoma patients, performed with the use of a capsular tension ring and iris retractors]. / Fakoemulsyfikacja podwichnietych zmetnialych soczewek u chorych z jaskra pseudoeksfoliacyjna z zastosowaniem pierscienia dotorebkowego i retraktorów teczówkowych.

PURPOSE: To evaluate results of phacoemulsification of subluxated lens in patients suffering from pseudoexfoliation-related cataract and glaucoma, performed with the use of a capsular tension ring (CTR) and iris retractors and implantation of artificial intracapsular lens. PATIENTS AND METHODS: The retrospective covered 15 patients (15 eyes) at the average age of 75 years, with a subluxated, cloudy lens and pseudoexfoliation glaucoma with IV PEX. Due to poor mydriasis resulting from the course of the pseudoexfoliation syndrome, it was necessary with all the patients to apply iris retractors in order to enlarge the pupil. The opacified lens were removed by means of phacoemulsification. In order to provide additional peripheral support and to maintain the artificial lens in the central position after the surgery, a tension ring was implanted into the lenticular capsule. A foldable intraocular lens was implanted inside the capsule. RESULTS: The observation period was 12 months. The average visual acuity prior the surgery was 0.18+/-0.2, while after a year after the surgery it was 0.56+/-0.32 (p<0.001). Besides, the intraocular pressure was observed to decrease from 18.2+/-5.02 mm Hg before the surgery to 15.8+/-0.84 mmHg (p<0.001) after the surgery. The anti-glaucoma medication ratio was also reduced from 2.1 to 1.3 in the post-surgery period. Inflammatory reaction of the anterior chamber was observed in 7 eyes. CONCLUSIONS: Application of a CTR and iris retractors during a surgery of cataract in patients with subluxated opacified lens considerably facilitates the implantation procedure of an artificial lens into the capsule, and it allows to improve the visual acuity and stabilize the intraocular pressure while reducing the quantity of the applied anti-glaucoma drugs.

[Phacotrabeculectomy in patients with cataract and chronic open angle glaucoma, and patients with cataract and pseudoexfoliation glaucoma]. / Fakotrabekulektomia w leczeniu zacmy z jaskra pierwotna otwartego kata oraz zacmy z jaskra pseudoeksfoliacyjna.

PURPOSE: To compare the results obtained after phacotrabeculectomy followed by implantation of an intracapsular lens in patients with cataract and chronic open angle glaucoma, and patients with cataract and pseudoexfoliation open angle glaucoma. MATERIAL AND METHODS: The retrospective study covered 55 eyes with cataract and glaucoma. In 28 eyes, chronic open angle glaucoma was diagnosed, and in 27--pseudoexfoliation glaucoma. In all cases, phacoemulsification of the opacified lens was carried out, a foldable intraocular lens was implanted in the capsule, and the trabeculum was removed by means of a punch. Visual acuity, intraocular pressure and the ratio of applied anti-glaucoma drugs were subject to the assessment. RESULTS: The observation period was 12 months. Within the COAG patient group, the average visual acuity prior to the surgery was 0.2+/-0.24, and after one year from the surgery it increased to 0.82+/-0.22. For PEX glaucoma patients, the values were respectively 0.3+/-0.25 before the surgery and 0.75+/-0.29 a year after it. Considerable reduction of the intraocular pressure was also achieved: in the COAG patients--from 19.51+/-3.8 mm Hg to 16.6+/-1.6 mm Hg, and in PEX glaucoma patients--from 22.28+/-5.18 mm Hg to 17.6+/-2.33 mm Hg one year after the surgery. Also, the quantity of anti-glaucoma drugs applied in the study groups was significantly reduced. The anti-glaucoma drug ratio in the COAG patients dropped from 1.8 to 0 after the surgery, and in the PEX glaucoma patients--from 2.3 to 0.3. CONCLUSIONS: Phacotrabeculectomy is an efficient and safe surgical method, to be recommended for patients both with primary open angle glaucoma and with pseudoexfoliation glaucoma.

[Frequency doubling perimetry in diagnosis of early glaucomatous optic nerve fiber damage]. / Perymetria zdwojonej czestotliwosci w diagnostyce wczesnej neuropatii jaskrowej.

PURPOSE: The comparative evaluation results of frequency doubling technology (FDT) in healthy subjects, in patients with glaucoma suspected and glaucoma, as well as analysis influences of selected risk factors onset, and progression of glaucoma (age, gender, intraocular pressure, refractive errors, circulation system disease, diabetes mellitus, vasospastic vascular disease) on FDT-parameters. MATERIAL AND METHODS: Sixty four patients (128 eyes), in age between 13-80, with refraction error from -14.5 to +6.5 D sph and average intraocular pressure 19.8 +/- SEM were included in this study. All patients were previously diagnosed towards glaucoma. The visual field testing with help of FDT Visual Field Instrument were made at least triple at all patients, with capitalize on the THR N-30 threshold program. Global indices: mean deviation (MD) and pattern standard deviation (PSD) and numerical value of mean retinal sensitivity for central visual field 5 degree sector (mean sensitivity to central 5 degrees--MS 5 degrees) come in comparative analysis. All data were analyzed by chi2 and Kruskal-Wallis tests. RESULTS: Comparative analysis examined groups of healthy persons, patients with glaucoma suspect and glaucoma, it proves statistically significant difference between MD, PSD and MS 5 degrees. Statistically no significant difference between PSD and MS 5 degrees at groups of healthy and glaucoma suspect patients was detected. In glaucoma group there did not reveal an influence on selected risk factors on FDT parameters. However, in glaucoma suspect group revealed an influence on most risk factors on perimetry parameters. CONCLUSIONS: FDT is useful for detection of glaucomatous nerve fiber damage. There should be taken precautions of interpretation FDT results at glaucoma suspect patients.

[The estimation of efficacy of the phacotrabeculectomy procedure in patient with cataract and pseudoexfoliation glaucoma]. / Ocena skutecznosci fakotrabekulektomii u pacjentów z zacma i jaskra w przebiegu zespolu pseudoeksfoliacji.

PURPOSE: The aim of the study was the estimation of phacotrabeculectomy effectiveness in patient with pseudoexfoliation syndrome. MATERIAL AND METHODS: The analyzed group consisted of 72 eyes of 65 patients in the range of 61-92 years old. 32 patients have phacoemulsification procedure (gr. I) and 40 patients have performed the procedure of the phacotrabeculectomy (gr. II). RESULTS: In 60% of the eyes marked postoperative improvement of visual acuity to more than 0.6 was observed. We noticed significant decrease of mean intraocular pressure (from 22.45 mmHg-17.88 mmHg), only in group II. CONCLUSIONS: We have concluded that the polyprocedular operation of phacotrabeculectomy in cataract with pseudoexfolation syndrome is an efficient procedure lowering mean intraocular pressure and improving visual acuity.

[Phacoemulsification in patients with cataract and pseudoexfoliation syndrome--own experience]. / Wyniki fakoemulsyfikacji w leczeniu zacmy u pacjentów z zespolem pseudoeksfoliacji w materiale wlasnym.

The aim of the study was the assesment of effectivness of phacoemulsification procedure in patients with cataract and pseudoexfoliation syndrome. Analysed group consisted of 72 eyes (8 patients), age 53 - 93 years with PEX and 50 eyes (50 patients), age 49-82 without PEX. All cases have performed the phacoemulsification with implantation of artificial posterior chamber lens using small incision procedure. In more than 50% of patients marked postoperative improvement of visual acuity up to 0,6. Year after operation significant decrease of intrabulbar pressure was observed. We conclude that phacoemulsification in cataract treatment is an efficient and save procedure with improvement of patient's visual acuity and with low number of postoperative complications.