[Bilateral exudative retinal detachment as the first sign of breast cancer--case report]. / Obustronne wysiekowe odwarstwienie siatkówki jako pierwszy objaw raka piersi--opis przypadku.

Metastatic choroidal tumours are the most common type of intraocular neoplasms in adults. Currently choroidal metastases are being diagnosed more frequently, generally due to the higher incidence of carcinomas, longer survival of cancer patients and better diagnostic possibilities. The most common primary cancers locations are breasts in women and lungs in men. These tumours are usually symptomatic and only in very rare cases metastases are the first symptom of carcinoma. We present such an atypical case of a 53-year-old female patient with bilateral exudative retinal detachment, which was the first symptom of a generalized malignancy originating in the mammary gland. Primary tumours and metastatic lesions both require a meticulous interdisciplinary examination, as well as the interdisciplinary treatment. Close liaison between oncologists and other specialists can result in faster diagnosis and improve treatment outcomes. Moreover, public health programs aimed at early detection of the most common tumours may help achieve better treatment results.

X-linked retinoschisis--clinical manifestation, genetic and electrophysiological analysis of three generations with p.Arg197Cys mutation of RS1 gene.

The aim of the study is to present an atypical case of late-onset X-linked retinoschisis. We present a case of a 37 year-old male patient with a few months' history of visual impairment. A clinical exam with optical coherence tomography and flash electroretinography (flash-ERG) was performed and the patient was diagnosed with X-linked retinoschisis. Genetic testing of the patient's family confirmed the disease and p.Arg197Cys mutation of RS1 gene was identified. In conclusion, optical coherence tomography and flash electroretinography enabled a proper diagnosis of X-linked retinoschisis in a patient with symptoms manifesting in the fourth decade of life. Genetic testing revealed male sufferers and female carriers among his family members.

[Scleral necrosis after scleral buckling surgery of the patient with pyoderma gangrenosum]. / Martwica twardówki po operacji wglabiajacej u chorej z pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a rare skin disease caused by immune dysfunction. The systemic diseases are often associated. The aim of the study was to report necrotic scleritis which developed after scleral buckling procedure in the case of the 64 years old patient suffered from primary retinal detachment and idiopathic PG. The retinal reattachment was achieved. The conjunctival wound dehiscence, necrotising scleritis and marginal keratitis as a manifestation of the patergic reaction were diagnosed. The treatment with corticosteroids locally (Dexamethason) and systematically (Prednison and Sulfasalazine), was administrated. The improvement and stabilisation of the local condition of ocular surface were observed. After reduction of systemic drugs, the exacerbation of local inflammation and vitritis was observed. The prolonged therapy was necessary. The risk of wound healing disturbances of an ocular surface with aggravated necrotic reaction must be expected after ocular surgery of the patient with PG. The adequate immunosupressive prolonged treatment with proper collaboration with the dermatologist is necessary.

[Is Helicohacter pylori infection associated with CRS occurrence?]. / Czy zakazenie Helicobacter pylon ma zwiazek z wystepowaniem idiopatycznej centralnej chorioretinopatii surowiczej?

Upper gastrointestinal tract endoscopy was performed in 14 patients with clinically determined central serous chorioretinopathy to detect eventual Helicobacter pylori infection. In 11 patients Helicobacter pylori infection was detected using urease test and histopathological examination. Obtained results confirm suggestions that Helicobacter pylori infection may be a factor associated with CRS etiopathogenesis. To understand those correlations large studies and large patients population are to be performed.

Confocal microscopy imaging of the cornea in patients with silicone oil in the anterior chamber after vitreoretinal surgery.

OBJECTIVE: Evaluation of corneal morphology by confocal microscopy after vitreoretinal surgery complicated by passage of silicone oil into the anterior chamber. Design Case series (case control study). METHODS: Eight patients (eight eyes) who had undergone vitreoretinal surgery and had silicone oil in the anterior chamber but no clinically evident corneal abnormalities made up the patient group. The control group consisted of eight patients (eight eyes) who had undergone vitreoretinal surgery with application of silicone oil tamponade but who had no silicone oil clinically observable in the anterior chamber. In vivo examination of the cornea using a ConfoScan 3 (Nidek Technologies) confocal microscope equipped with the standard 40x immersion lens was performed. Central, upper, and lower parts of the cornea were assessed separately. High-magnification evaluation of the status of corneal layers and endothelial cell density in upper parts of the cornea directly in contact with silicone oil in the anterior chamber and in parts of the cornea not in direct contact with silicone oil was carried out. RESULTS: Alterations in corneal morphology, especially in endothelium and posterior and medium stroma, were observed. In all cases, changes were more advanced in the upper part of the cornea. Endothelial cell density was significantly decreased in upper parts of the cornea. CONCLUSIONS: In patients with silicone oil in the anterior chamber, confocal microscopy imaging reveals early morphological alterations of the cornea before their clinical manifestation.

[Spontaneous RPE tear in high myopia]. / Samoistne przedarcie warstwy barwnikowej siatkówki (RPE) w przebiegu wysokiej krótkowzrocznosci.

PURPOSE: The aim of this study is to present the case of a spontaneous retinal pigment epithelial tear in high myopia. MATERIAL AND METHODS: A 56 years old woman with high myopia (refractive error -10.0D) in both eyes and amblyopia in right eye since childhood, complained of a decrease in left eye vision for one and a half month. Full ophthalmic examination, fundus photography, ultrasound examination and indocyanine green angiography were performed. RESULTS: At first visit BCVA was 5/25 in her left eye. A subretinal hemorrhage accompanied by retinal pigment epithelial tear inferotemporal to the fovea was found in ocular examination. B-scan ultrasound did not revealed any traction at the fovea. 3 months later BCVA was 5/16 OS. The area of the atrophy of RPE--Bruch's membrane--choriocapillaris complex expanded and hyperpigmentation occured above the RPE tear. 3 months later BCVA was 2/50 OS, we observed a dark brown pigment spot surrounded with a subretinal hemorrhage somewhat above the RPE tear. Indocyanine green angiography demonstrated an initial choroidal neovascularization at superotemporal edge of hypertrophic pigment epithelium (Fuch's spot). CONCLUSIONS: A spontaneous RPE tear might be the beginning of Fuchs' spot. A mechanical stress associated with eye movement is transmitted through the thin sclera and Bruch's membrane onto RPE and may cause a tear in its most vulnerable place i.e. at the margin of posterior staphyloma.

[Simultaneous phacoemulsification, posterior chamber lens implantation and pars plana vitrectomy--clinical observation]. / Jednoczasowa fakoemulsyfikacja z implantacja sztucznej soczewki tylnokomorowej i witrektomia przez pars plana--obserwacje kliniczne.

PURPOSE: The aim of the study was to present our experience and observations with phacovitrectomy and IOL implantation. MATERIAL AND METHODS: 60 patients, aged 26-74 years (mean 52 years), 36 women, 24 men: 5 (8.3%) with idiopathic macular hole /I group/, 5 (8.3%) macular pucker /II group/, 39 (65%) with rhematogenous retinal detachment /III group/, 7 (11.7%) with proliferative diabetic retinopathy /IV group/, and 4 (6.6%) with vitreous hemorrhage /V group/. RESULTS: Visual acuity improved in 44 (73.3%) patients, remained unchanged in 7 (11.6%) and was worse in 9 (15%) cases. The most common intraoperative complication was oedema of the corneal epithelium in 13 (21.7%) cases and postoperational raise of the intraocular pressure in 13 (21.6%) cases. CONCLUSIONS: Phacovitrectomy does not significantly raise up the number of complications, it is safe and beneficial for both, the patient and the surgeon. It must be born in mind that post operational fibrin formation after phacovitrectomy is bigger.

[Simultaneous phacoemulsification, posterior chamber lens implantation and pars plana vitrectomy]. / Jednoczasowa fakoemulsyfikacja z implantacja sztucznej soczewki tylnokomorowej i witrektomia przez pars plana.

The aim of the study was to present current knowledge in the field of combined surgery: phacoemulsification with intraocular lens implantation and pars plana vitrectomy.

[Pars plana vitrectomy with corneal transplantation -- combined procedure]. / Jednoczasowy przeszczep drazacy rogówki z witrektomia przez pars plana.

The aim of our study is to present own observations with Eckardt temporary keratoprosthesis, during combined pars plana vitrectomy and corneal transplantation. We operated on two aphakic patients with unclear corneas and retinal detachment--I case, phthisis bulbi after recurrent uveitis--II case. Eckardt temporary keratoprosthesis was sutured to the corneal bed with 4 or 6 Ethilon 10.0 bites, pars plana vitrectomy was performed followed by corneal transplantation and silicone oil tamponade. We obtained good transplant clarity only in the I case, in the II case because of hipotony and persistent contract of silicone oil with cornea, transplant was cloudy and collapsed with small exception in the central area. After 3-rd month we noticed local retinal detachment in the periphery, which was suppressed with laser photocoagulations. We think, that Eckardt temporary keratoprosthesis gives possibility to do vitrectomy in patients with undear cornea, which was in the past impossible. However, combined procedure requires surgical skills in both: anterior and posterior segments of the eye.

[Acute posterior multifocal epitheliopathy: case report]. / Ostra wieloogniskowa tylna epiteliopatia--opis przypadku.

PURPOSE: To present an atypical course of acute posterior multifocal placoid epitheliopathy. MATERIALS AND METHODS: 59 years-old diabetic man was seen at emergency because of a few days history of blurred vision in his right eye. Ophthalmologic examination revealed patches of blurred margine, multiple, yellowish lesions 1-2 dd in the fundus in both eyes. There were also lesions typical for non proliferative diabetic retinopathy like microaneurysms, dot and blot intraretinal hemorrhages and hard exudates. Optic discs and blood vessels were normal. We found peripheral drusen extending from the equator to the ora serata in both eyes. During 8 months of observation, we performed three times ophthalmologic examination, fluorescein and indocyanine green angiographies, USG A and B. No treatment was given. CONCLUSIONS: There is disagreement about the site of origin of placoid lesions, etiology and pathogenesis in acute posterior multifocal placoid epitheliopathy. In our report we agree with thesis, that the choriocapillaris are the primary site of the break. We propose, that different duration of the APMPPE and recurrences are directly proportional to the state and quality of the blood vessels. The possible explanation for longstanding lesions in our patient is diabetic damage of the capillaries in the retina and choroid.

[Evaluation vitreous body in idiopathic macular holes--biomicroscropic and ultrasonographic picture]. / Stan ciala szklistego w idiopatycznych otworach plamki--ocena biomikroskopowa i ultrasonograficzna.

AIM OF THE STUDY: The aim of our study was to estimate the state of the vitreous body and the vitreoretinal interface in patients with idiopathic macular holes. MATERIAL AND METHODS: We examined 36 patients (41 eyes), 34 women and 2 men aged 65-72 with idiopathic macular holes. State of the hole (classified by Gass) was established on the biomicroscopical examination using Goldmann lens and double aspheric Volk lenses (+60.0, +90.0 D), ultrasonography Compuscan UAB 1000 Storz and fluorescein angiography. RESULTS: We classified stage 2 macular hole in 7 eyes (17%), stage 3 in 28 eyes (68%) and stage 4 in 6 eyes (15%). In the slit lamp examination we revealed partial posterior hyaloid detachment with posterior hyaloid membrane still attached at optic nerve head in 5 eyes, vitreomacular separation in 3 eyes, and vitreofoveal separation of posterior hyaloid membrane with the presence of focal condensation of the posterior hyaloid membrane in front of the fovea--operculum in 11 eyes, in stage 3 macular hole. In 8 eyes we observed lacunaes, and vitreoretinal tractions in 6. Ultrasonography was slightly more effective in revealing vitreomacular and partial PVD separation than biomicroscopical examination. In the case of vtireoretinal tractions or lacunaes, ultrasonography was worse than slit lamp examination. CONCLUSIONS: The exact evaluation of condition of the vitreous body and vitreo-retinal relationships are crucial for a further surgical treatment.