Long-term results after primary intraocular lens implantation in children with juvenile idiopathic arthritis-associated uveitis.

PURPOSE: To evaluate the long-term outcome after cataract surgery with primary intraocular lens implantation in children with juvenile idiopathic arthritis-associated uveitis. METHODS: The medical records of all 24 children (34 eyes) with chronic juvenile idiopathic arthritis-associated uveitis who underwent cataract surgery between 1990 and 2013 were reviewed retrospectively. Primary intraocular lens implantation was performed in all patients. RESULTS: Median age at diagnosis of uveitis in the first eye was 5.3 years (range: 2.7-9.4 years) and median age at the time of cataract surgery in the first eye was 9.7 years (range: 4.1-16.9 years). Postoperative follow-up time ranged from 1 to 23.1 years, with a median of 10.9 years. Best corrected visual acuity at the last follow-up was good (⩾20/40) in 65% of the eyes. Postoperatively, glaucoma developed in 8 eyes (24%), posterior capsular opacification and secondary membrane formation requiring surgery in 15 eyes (44%), macular oedema in 5 eyes (15%) and phthisis in 2 eyes (6%). CONCLUSION: This study shows a favourable visual outcome in most of the cases. Primary intraocular lens implantation may be considered in juvenile idiopathic arthritis-associated uveitis complicated by cataract in patients with well-controlled inflammation.

Ocular manifestation of congenital toxoplasmosis, clinical implication - case report.

The aim of this case report was to present extremely severe, ophthalmic complications in form of rare, congenital toxoplasmatic bilateral defect of eye-balls concomitant with advanced uveitis, microphthalmia and eye-multistructural developmental abnormalities leading to irreversible visual disability. The ocular diagnosis was confirmed in Ret-Cam II and ultrasonography and it was accompanied with congenital multiorgan lesions including hepato-splenomegaly, thrombocytopenia, leukomalacia, hydrocephalus and ventriculomegaly with neurological symptoms. Serology, PCR of cerebro-spinal fluid and cord blood confirmed the presence of congenital Toxoplasma gondii infection in the infant. The authors took the effort of insightful analysis for the causes of applied treatment failure in mother during pregnancy, analyzing the inefficacy of Spiromycin therapy in pregnant woman and evaluating false-negative result of amniocentesis for Toxoplasma gondii presence. Among many issues concerning anti-toxoplasmatic treatment in mother and infant presented in this article, the need for multiple repetition of toxoplasmatic tests should be underlined including amniotic fluid PCR and ultrasonography which can add much important data for correct diagnosis. The authors indicate that the lack of benefits from conservative therapy in case of suspected Toxopalsma gondii suggestion lead to dramatic multiorgan complications, especially ophthalmo-neurologic, leading to irreversible visual disability.

[The ophthalmologic signs in cerebellum tumor. Preliminary report].

Introduction: The aim of the study was an analysis of ophthalmic symptoms coexisting with the tumour of the cerebellum. Material and methods: The study included 14 patients in the age between 21­55 years old with the tumor of cerebellum, who were operated in the Neurosurgery Clinic of the Pomeranian Medical University in Szczecin. The comprehensive ophthalmic examination were performed before and after 5 days from surgery. The examinations included evaluation of: pupillary reactions, visual acuity, fundus ophthalmoscopy, intraocular pressures, eye motility, visual field, optometrical tests and visual manual localization test. Results: The symptoms found before surgery of cerebellum tumors: diplopia (3 persons), early papilloedema (4 persons), nystagmus (2 persons), lack (5 persons) and weakened of convergence reô€lex (3 persons), latent strabismus (5 persons), manifest strabismus (3 persons). On the 5th day after the surgery were found: nystagmus (1 person), lack (5 persons) and weakened of the convergence reô€lex (3 persons). Visual manual localization was disparate depending on location of the tumor in the cerebellum; prevailed crossed and uncrossed localizations. Conclusions: 1. The natural dynamic of the tumor and surgical damage to the posterior cranial cavity structures can be monitored by assessment of the condition of the organ sight. 2. It is recommended to make the visual manual localization tests such as exponent disorders of senso-motorical deviations, which may occur in the patients with the cerebellum tumor.

The ophthalmologic signs in case of C1 neurinoma without hydrocephalus - case report.

INTRODUCTION: We present a case of the patient suffering from the tumor of cranio-spinal junction in whom a wide spectrum of ophthalmic and neuroophtalmic signs was noted. METHODS: The comprehensive neuro-ophthalmic examination were performed (pupillary reactions, visual activity, fundus ophthalmoloscopy, intraocular pressures, eye movements, visual field, MRI, MR angiography). Additionally immunohistochemistry and laboratory tests were made. RESULTS: The case of 24 years male with peripapillary subretinal hemorrhage, that occurred after a surgical excision of a tumor at cranio-cervical junction. The mechanism of the dynamics of the expanding intracranial space occupying processes is also discussed. CONCLUSIONS: Space occupying lesion of the level of cranio-spinal junction causes vascular changes in the fundus of the eye of the high dynamic and diversity. Surgical decompression in such cases is a maneuver of choice to maintain the reversibility of changes if proceeded in early stage.

Ophthalmic treatment and vision care of a patient with rare ring chromosome 15: a case report.

The Aim. Ring chromosome 15 is a very rare genetic abnormality with a wide spectrum of clinical findings. Up to date, about 50 cases have been documented, whereas no reports on ophthalmological treatment of such patients have been published. The aim of this study is not only to describe a new patient, but also, for the first time, to present the results of nonoperative management of divergent strabismus. Material and Methods. We present an amblyopic patient with 46,XX, r(15) karyotype: treated conservatively for exotropia of 60 prism diopters. The management consisted of refractive and prismatic correction, eye occlusion, and orthoptic exercises between the age of 15 months and 8 years. Results. The deviation angle of exotropia was decreased to 10 prism diopters, the visual acuity improved to 1.0 in both eyes (Snellen chart) and the fixation pattern was normal. The prisms enabled permanent symmetrical stimulation of the retina, which lead to a development of normal single binocular vision (Maddox test, filter test, and synoptophore tests). Conclusions. Parental karyotype was normal; the analysis of a three-generation pedigree has shown no genetic abnormalities or pregnancy losses so the child's karyotype anomaly was classified as de novo that is a single occurrence of this type of chromosomal disorder in this family. Strabismus in ring chromosome 15 patients is a difficult condition to manage, although success may be achieved.

Iris rubeosis, severe respiratory failure and retinopathy of prematurity--case report.

THE AIM: Case study reports for the first time about development of massive iris neovascular complication in course of retinopathy of prematurity related to systemic and ocular ischemic syndrome due to tracheostomy-requiring extremely severe premature respiratory failure. MATERIAL AND METHOD: Premature female, 950 grams birth weight, born from 17-year-old gravida 1, at 28 weeks' gestation by cesarean section due to premature placental abruption with threatening hemorrhages, with 1 to 5 Apgar score. The baby developed severe respiratory failure which required tracheostomy advanced bronchopulmonary dysplasia treated with steroids (BPD) and respiratory distress syndrome (RDS) with failure to extubate together with secondary ocular ischemia. All the mentioned with multifactorial organs complications (NEC, leucopenia, anemia, pneumonia, periventricular leucomalacia, electrolyte abnormalities and metabolic acidosis) resulted in massive peripupillary iris neovascularization (NVI) in both eyes coexisting with retinopathy of prematurity (ROP) in 38 weeks' PMA infant. Ultrasonography-B, slit-lamp and indirect fundus examinations with photography were used to document focusing ocular diagnosis. The previous retinopathy of prematurity screening examinations performed at standard intervals of time starting from four weeks of life, that is 32 weeks' PMA continuing every two weeks did not present typical lesions seen in retinopathy however in the second zone of retina slightly marked "plus sign" was visible. Ophthalmological examination at 38 weeks' PMA disclosed massive, round capillary dilatation of the minor arterial circle, spreading to the iris periphery form pupillary margin, and narrow pupils which did not fully react to mydriasis. The intraocular pressure was normal. Ultrasound examination revealed major thickening and echo increase of peripheral retina with its partial detachment. RESULT: Diode-laser pan-retinal photocoagulation and cryoapplication was performed leading to successful regression of neovascular anterior segment (rubeosis was no longer visible by slit-lamp examination) as well as inhibition of retinopathy of prematurity progression. CONCLUSION: In described preterm infant, vasoactive molecules released by the ischemic retina may have induced vasodilation of iridal vessels, therefore increasing the perfusion of segments of the minor arterial circle, rendering them clinically visible by examination. It has been observed that hypoxia besides other inflammatory risk factors may have significant influence not only on the development of severe anterior-neovascular complications but also on rapid progression of advanced ROP stages with omission of typical clinical stages of ROP. Simultaneously retinal laser-panphotocoagulation with cryotheraphy seems to be the beneficial method for treatment of these complications. The therapy is effective and destroys the cells that produce Vascular Endothelial Growth Factor (VEGF) which is known to be the most important key factor in the progression of ROP.

Rapid onset anterior segment complication following diode laser photocoagulation for retinopathy of prematurity: a case report.

Laser treatment for retinopathy of prematurity (ROP) has been proven to be beneficial. We present a case of uncommon, progressive anterior eye segment complication treated with diode laser photocoagulation for ROP which subsequently required surgical management. A 1210 g premature infant, born at 28 weeks of gestation, had bilateral stage 3 threshold ROP on his first screening, at 5 weeks of age. Confluent, laser ablation of avascular retina (Iris Medical, OcuLight S) in order to prevent the progression of ROP was applied. On the next ophthalmological examination, only in the right eye, an uncommon complication, not responding to conservative treatment, was noted. It was described as excessive conjunctiva hypertrophy, misdirected toward the center of the cornea. Indispensable surgical excision of hypertrophied conjunctiva was required, yielding a beneficial outcome. Histology revealed the presence of fibrous tissue. Hypertrophy of conjunctiva after diode laser photocoagulation requires surgical removal in order to prevent vision impairment.