[Trabeculectomy as the initial procedure in primary congenital glaucoma]. / Trabekulektomia jako pierwszy zabieg w pierwotnej jaskrze wrodzonej.

PURPOSE: To estimate the effectiveness of trabeculectomy performed in buphthalmic eyes. MATERIAL AND METHODS: 42 eyes of 24 children, 14 boys and 10 girls. There were 18 children (32 eyes) operated on at the age from 7 days to 12 months (group I) and 6 patients (10 eyes) at the age from 3 to 7 years (group II) with primary congenital glaucoma. Corneal diameter ranged from 11.5 to 15 mm in infants, in 10 eyes of 6 children elder than 2 years it was from 13 to 15 mm. The axial length of eyeballs was from 19 to 23.5 mm. Forty five trabeculectomies were performed, in 3 cases they were repeated two and six years after the first procedure. Follow up was from 1 year to 22 years, mean 82 months, 7 years of group I, 6 years of group II. RESULTS: 29 of 42 eyes (64.2%) with intraocular pressure varied between 8 and 21 mm Hg, other eyes required additional local antiglaucoma treatment. Normal IOP was obtained in 95.2% of eyes. Trabeculectomy normalized IOP in 68.9% eyes of infants (group I), whereas in elder children the percentage came up to 50 (group II). In other eyes pharmacological agents decreased IOL to values below 21 mm Hg, in the group I in 97% of eyes and in the group II in 90% of cases. CONCLUSION: Trabeculectomy performed as a first procedure in primary congenital glaucoma is effective in infants and older children with buphthalmos in long-term follow-up. The necessity to perform this operation in very small children and even neonates does not always mean poor prognosis, and intraocular pressure can be stabilized at safe level for many years.

[Intraocular correction of aphakia after cataract extraction for uveitis in adolescents]. / Korekcja wewnatrzgalkowa afakii po usunieciu zacmy wiklajacej zapalenie blony naczyniowej u mlodziezy.

PURPOSE: To demonstrate 3 cases with pediatric pseudophakia after cataract extraction as a complication of unilateral uveitis. MATERIAL AND METHODS: The boys were at the age of 8, 11 and 15 years at the moment of surgery. Uveitis was monocular, the etiology unknown and clinically significant cataract was diagnosed after several months from the beginning of inflammation. The last recurrence of uveitis was observed 1 to 6 months before operation. There were intermediate uveitis (2 cases) and anterior uveitis (1 cases). In 2 eyes PMMA implant was placed in-the-bag and in one eye in the ciliary sulcus. During surgery we did not observe any complications except greater tendency to bleeding. Follow-up after operation ranged from 1.5 to 2.5 years. RESULTS: Visual acuity before cataract extraction was 0.01; 0.04 and 0.02 and during last visit after surgery it was 0.9, 0.6 and 0.4 respectively. Postoperative near distance visual acuity was 0.5, 0.75 and 1.25. We observed cystoid macular oedema in the latter case. Two months after PC-IOL implantation the symptoms of mild inflammation in the eye of 15-year-old boy with anterior uveitis occurred. Intraocular pressure before and after operation ranged from 12 to 17 mm Hg. Corneal central endothelial cell density was from 2850/mm2 to 3100/mm2 before and from 2469/mm2 to 2979/mm2 during last visit. CONCLUSION: Cases of posterior pseudophakia during uveitis in children showing good functional and anatomical state of eyes in the long term observation after IOL implantation recommend the intraocular correction in carefully selected uveitic pediatric patients.

[Scanning laser tomography in the diagnosis of juvenile glaucoma]. / Skaningowa tomografia laserowa w diagnostyce jaskry mlodzienczej.

The aim of our research was to evaluate the optic nerve head parameters of children with juvenile glaucoma with the scanning laser ophthalmoscope from Laser Diagnostic Technologies Inc. The material consisted of 46 eyes of 25 children aged from 7 to 18 years. There were 18 glaucomatous eyes (I group) and 28 eyes without glaucoma (II group) as a control group. The three examinations were repeated every three months. Mean values of Vol. B in the glaucomatous group were -0.327 +/- 0.098, first visit; -0.390 +/- 0.130, second visit; 0.344 +/- 0.096 mm3, third visit. These values in the control group were--0.234 +/- 0.73; -0.224 +/- 0.071; -0.252 +/- 0.069 mm3. The difference was statistically significant. Mean values of Volume A were significantly lower in the I group: 0.216 +/- 0.034, 0.207 +/- 0.033, 0.203 +/- 0.030 mm3 than in the II group: 0.269 +/- 0.039, 0.283 +/- 0.032, 0.271 +/- 0.042 mm3. CD ratio was higher in the glaucomatous eyes: 0.447 +/- 0.080; 0.491 +/- 0.069; 0.484 +/- 0.074 in comparison with the control group: 0.376 +/- 0.060; 0.368 +/- 0.067; 0.399 +/- 0.056. It was significant difference. More changes of biomorphometric parameters of the optic nerve head were observed in the glaucomatous group during follow-up period. The role of laser scanning ophthalmoscopic tomography is very important in the diagnosis of early forms of juvenile glaucoma in the youth.

[Therapeutic contact lenses in infant corneal ulcerations]. / Zastosowanie soczewek kontaktowych w leczeniu ubytków rogówki u niemowlat.

PURPOSE: We present our own results of treatment in corneal ulcerations with therapeutic contact lenses in 4 infants aged between 3 days to 5 weeks. MATERIAL AND METHODS: Four patients (5 eyes) with deep corneal ulcerations of various origin were treated with soft contact lenses at the Clinic of Pediatric Ophthalmology in Katowice. All eyes received one type of the therapeutic lens. Contact lenses were worn between 8 and 21 days. After application of contact lenses pharmacological therapy was used individually for each patient, according to the result of microbiological tests. RESULTS: All patients were successfully cured. A scar of cornea was observed only in one infant because the contact lens had been used too late. Four infants had no corneal haze after the treatment. CONCLUSION: The best results were obtained using the contact lenses early, during the first days of treatment. Contact lenses caused decreasing of pain and reduced application of medicines. They were a good protection for injured cornea.

[Cataract in uveitis in children]. / Zacma w zapaleniu blony naczyniowej oka u dzieci.

PURPOSE: To evaluate the anatomical and functional state of eyeballs after cataract extraction in uveitis in children and to analyze the factors affecting visual outcome. MATERIAL AND METHODS: Among 182 examined eyes with uveitis we have observed cataract in 22 eyeballs of 17 children (12%). Before operation in 72.7% cases visual acuity was less or equal 0.02, in the others it was not more than 0.2. The age of patients ranged between 2 and 18 years, the mean age 8 years. The cause of uveitis was: chronic tonsillitis or sinusitis in 6 patients, juvenile rheumatoid arthritis in 2 patients, heterochromic Fuchs iridocyclitis in 2 children, in the others the cause was unknown. In 4 eyeballs (18%) we have observed increased intraocular pressure before operation. Follow-up ranged from 6 months to 15 years, the mean was 5 years. RESULTS: We have obtained normal visual acuity in 31.8% cases and better than 0.1 in 68.2% od eyes. In children with juvenile rheumatoid arthritis, 2 eyeballs lost light perception as a result of corpus vitreous fibrosis and in one case we have observed only light perception. Optic nerve glaucomatous neuropathy was the cause of poor functional result in 2 eyes (0.02 and 0.04). Another causes of not satisfactory visual acuity were: corneal dystrophy (2 eyes), cystoid macular oedema (2 eyes) and amblyopia ex anopsia (2 eyes). CONCLUSIONS: We have obtained normal or good visual acuity in majority of the operated eyes. The causes of poor vision were the anatomical changes after uveitis before the cataract extraction.

[Laser scanning laser ophthalmoscopy in diagnosis of juvenile glaucoma cases with myopia]. / Laserowa tomografia skaningowa glowy nerwu wzrokowego w diagnostyce jaskry mlodzienczej w oczach krótkowzroczynch.

UNLABELLED: The diagnosis of the open angle glaucoma in myopic eyes remains one of the major problems, as the changes of the optic head in myopia may be similar to glaucomatous changes. The aim of the study was to analyse biomorphometric parameters of the optic nerve head in myopic eyes with glaucoma with scanning laser ophthalmoscope from Laser Diagnostic Technologies Inc. There was 29 children examined and among them 12 children with glaucoma and myopia as a study group (I) and 17 children with myopia as a control group (II). RESULTS: TCA means values; group I: 1.994 +/- 0.158, group II:2.028 +/- 0.200 CD means values; group I; 0.315 +/- 0.072, group II: 0.247 +/- 0.057 Rim means values; group I: 1.366 +/- 0.164, group II: 1.511 +/- 0.136 Vol. A mean values; group I: +0.205 +/- 0.03, group II: +0.83 +/- 0.03 Vol. B mean values; group I: -0.159 +/- 1.608, group II: -0.117 +/- 0.08. Average values of the biomorphometric parameters of the optic nerve head were worse in group I than in group II, but there was not statistical significance between the differences. Scanning laser ophthalmoscopy may be used as very important additional examination in juvenile glaucoma cases with myopia.

[The significance of myopia and birth weight in prematurity]. / Wartosc krótkowzrocznosci a urodzeniowa masa ciala u wczesniaków.

AIM: The relation between myopia and birth weight of premature newborns was assessed in this study. MATERIAL AND METHODS: There were 90 children (180 eyes) involved in the study, their birth weight ranged between 580 and 2450 g (mean 1698), and myopia ranged from -1.5 to -22.5 D (mean -9.8 D). Children were divided into two groups: group I: 38 children (76 eyes) with birth weight from 580 to 1500 g (mean 1158 g), group II: 52 children (104 eyes) with birth weight from 1501 to 2450 g (mean 2093 g). Mean value of myopia in group I was -10.4 D and -9.4 D in group II. RESULTS: The results were assessed with Statgraphics software. The analysis of mean values regression showed no relation between myopia and birth weight in group I (regression coefficient b = 0.003, p = 0.24) and no relation in group II (regression coefficient b = 0.008, p = 0.016) at significance level alpha = 0.01.

[The computer as an assistant to the physician]. / Komputer pomocnikiem lekarza.

BACKGROUND: The possibilities of using computer in physician's research work are presented as an example of statistical analysis of axial eyeball length in relation to the age in myopic children with low birthweight. MATERIAL AND METHODS: The study group consisted of 100 children aged from 3 to 15 years, with birthweight from 580 to 2450 g, where in 180 eyes myopia ranging from -1.5 to -22.0 Dsph and axial length of the eye from 20.0 to 30.9 mm were present. The dynamics of eyeball's axial length increase was compared between two groups: one-in which no symptoms of retinopathy of prematurity were present (no-RROP), and the second--in which signs of regressed retinopathy of prematurity were observed (RROP). RESULTS: The results of the analysis are shown in analytical and graphical modes. Statistically significant differences were shown between axial lengths of eyeball's in the analysed groups of mean 9-year-old premature children (no-RROP: 25.19 mm and RROP: 24.33 mm). It was shown that the use of a computer reduces the time of performing statistical analysis of large amount of data.

[Hypoplasia of the optic disc in children]. / Niedorozwój tarczy nerwu wzrokowego u dzieci.

PURPOSE: Analysis of etiological factors and functional assessment of the eyes. MATERIAL AND METHODS: Optic disc hypoplasia was diagnosed in 43 children, aged 12 months--12 years, unilateral in 9 (20.9%). The follow-up ranged from 8 months to 9 years, the mean age of patients during the last examination was 10.4 years. RESULTS: The following presumed etiological factors were stated in anamnesis: abose of alcohol by the mothers during pregnancy, syphilis, influenza, herpes and severe anemia. Visual acuity ranged from light perception with false localization to 5/50; in 58% of cases it was not above 1/50 but in 1/5 of the eyes visual acuity for short distance was sufficient for school needs. Concentric contraction and nasal scotoma were revealed in visual field. Hypermetropia was found in 28 eyes. In 3 cases mental dificiency was observed, in 1 of them with atrophy of a temporal cerebral cortex and epilepsia occurred in 1 child.

[Condition of the posterior capsule in pseudophakia in children]. / Stan tylnej torebki soczewki w pseudofakii u dzieci.

PURPOSE: Evaluation of the posterior capsule transparency in children after congenital cataract surgery with posterior intraocular lens implantation. MATERIAL AND METHODS: Examination comprised 41 eyes of 29 patients with posterior IOLS, aged 5-17 years (mean 10.3). In all cases, posterior capsule was unimpaired during surgery. RESULTS: During follow-up, (mean 27 months), 36.6% the eyes showed posterior capsule opacity of various degree. Neodymium YAG laser capsulotomy was performed in 13 cases and instrumental capsulotomy in 2. Opacity of the posterior capsule caused a decrease of visual acuity below 0.4. It improved after capsulotomy in all cases. No serious complications were observed.

[Eyeball axis changes in children's myopia]. / Zmiennosc osi galki ocznej w krótkowzrocznosci u dzieci.

The aim of study was to assess changes in eyeball axial length in myopic children depending on age in comparison with hyperopic and emmetropic groups. The study group consisted of 200 children (100 girls and 100 boys), from 3 to 17 years old (mean 9.8). Myopia was diagnosed in 376 eyes (-4.0 D to -24.0 D, mean -9.64 D) with axial length from 21.0 to 30.95 mm (mean 26.05 mm). Control group consisted of 334 eyes (167 children) with mean refraction +0.53 D and axial length from 20.0 to 23.9 mm (mean 22.36 mm). We have used the Statgraphics program for statistical analysis. A statistically significant difference was found between mean eyeball axial length within myopic group of girls (mean 25.77 mm) and boys (mean 26.31 mm) with p = 0.321 and significance level alpha = 0.05. The axial length increases irregularly over time. The axis of the eyeball in myopic children aged between 3 and 17 increases more than in emmetropic and hyperopic (up to 1.0 D) children.

[Optic neuritis in children and adolescents]. / Zapalenia nerwu wzrokowego u dzieci i mlodziezy.

The aim of the study was to analyse the cause, course and results of treatment in cases of optic nerve inflammation, including frequency of recurrencies. One hundred and ten children aged 2-18 years treated in our clinic from 1989 to 1994 were examined. Mean age was 13 years. Bilateral inflammation was found in 60% of cases, 176 eyes were assessed. The disease was more frequent in autumn, winter. In children below 14 (62%) inflammation concerned the intraocular part of the nerve while in older children it was mainly retrobulbar. Recurrence of the disease was observed in 1/3 of cases. In younger patients, the cause of the inflammation was usually viral infectious disease or chronic focal infection. In older children, the main causes were trauma or underlying neurological diseases. The treatment administered resulted in a normalisation of the visual field in more than half of the cases and visual acuity improvement in 73.5% of cases after retrobulbar inflammation, and in 75% of cases after intra-bulbar inflammation. During an average follow-up of 3 years, full visual acuity was achieved in 56% of eyes after retrobulbar inflammation and 46% of eyes after intra-bulbar inflammation. Signs of post-inflammatory neuropathy were present in 46% of eyes. Full recovery of visual function was achieved especially in those cases where it was not deeply decreased during the disease.

[Primary intraocular implants in congenital cataract]. / Pierwotne wszczepy w zacmie wrodzonej.

Analysis of 47 eyes in 31 patients, aged 5-17 years with posterior or anterior IOL's implantation performed during cataract surgery was done. Visual acuity examined 7 days after surgery was 0.02-0.4 in the cases with cataract in one eye and 0.2-1.0 in those with cataract in both eyes. After the mean period of 2.5 years, visual acuity of at least 0.5 was achieved in all cases with binocular pseudophakia and in 20% of those with one pseudophakic eye. Uveitis was the most frequent complication in early postoperative period (25.5% of eyes) and posterior capsule opacities were observed later (31.9% of eyes).

[Binocular single vision in children with pseudophakia]. / Pojedyncze widzenie obuoczne u dzieci z pseudofakia.

The studies comprised 45 patients, aged 5-17 years with IOL implantations performed during primary cataract surgery or secondarily some time after traumatic or congenital cataract and dislocated lens extraction. Simultaneous perception was achieved in 58% cases after primary and in 44.4% after secondary IOL implantations. Fusion was found only in primary IOL implantations in 38.4% of patients. The results of binocular single vision are better after primary as compared to secondary IOL implantations in children after traumatic cataract.

[Incidence of ocular congenital anomalies in clinical material]. / Czestoss wystepowania wad wrodzonych narzadu wzroku w materiale klinicznym.

The aim of the study was to analyse, basing on the clinical material of the years 1987-1992, the congenital ocular anomalies and to compare the results with the observations made 20 years ago. Among the total clinical material of 7333 examined patients in the age from 3 days to 18 years congenital anomalies, including high myopia, were found in 3882 cases (group A). There were 2201 boys and 1681 girls. Group B, without high myopia, comprised 2639 cases of congenital anomalies, 1539 boys and 1100 girls. It was established that the incidences of congenital retinal degenerations and optic nerve atrophy were now higher than in the 1970-s years. About 1/3 of cases with congenital anomalies were those with high myopia.

[Surgical results using the Friedenwald-Guyton method for congenital ptosis in children]. / Wyniki operacji sposobem Friedenwalda-Guytona wrodzonego opadniecia powieki górnej u dzieci.

The studies comprised 96 children with congenital ptosis, aged 10 months to 12 years, operated on in the years 1987-1992. Cosmetic and functional results, as well as the complications of the surgery were evaluated. A stable widening of a interpalpebral fissure with uncovering of the pupil was achieved in 96.6% of cases. The author concluded that the Friedenwald-Guyton's method is especially recommended in children with levator muscle dysfunction. The method is highly efficient, technically easy, causes little surgical trauma and rare complications.

[Ocular changes in Down's syndrome]. / Objawy oczne w zespole Downa.

The authors analyzed the kind of ocular changes and methods of therapy in 34 children, aged 5 months to 14 years, treated in the clinic in the years 1982-1992. The most frequent change was congenital cataract. The other signs observed were: Brushfield's spots, alternate esotropia, nystagmus, partial optic atrophy, retinal detachment, congenital glaucoma, ectropion and keratoconus. Occurrence of several anomalies were frequent. The adequate surgical treatment was applied depending on the kind of changes. Cataract extraction was made by aspiration method. Visual acuity improved in 58.8% of eyes.

[Occurrence of glaucoma in phakomatosis]. / Wystepowanie jaskry w fakomatozach.

Our clinical material of the last 10 years comprised 8 cases of phakomatosis with glaucoma: 6 children with Sturge-Weber-Krabbe's syndrome and 2 with Recklinghausen's disease. The age of the children was 15 months to 16 years. In 5 children with Sturge-Weber-Krabbe's syndrome glaucoma was found in one eye, in all cases with Recklinghausen disease it was bilateral. The following surgical methods of treatment were applied: trabeculectomy, trabeculectomy with cataract aspiration, cyclo-cryo-application and perforative cyclo-diathermy. The normalisation of the intraocular pressure was achieved in 88.9% of cases.

[Myopia as a complication of retinopathy of prematurity]. / Krótkowzrocznosc jako powiklanie retinopatii wczesniaków.

Studies were carried out on a total of 103 children, aged 3-15 years, with birth weight 580-2450 g (mean 1710 g), with myopia of various degree. Relationships between axial length of the eye, birth weight, gestational age, duration of oxygen exposure and the degree of myopia were evaluated. Analyses of vascular and retinal changes in the fundus of the eye typical of regressed retinopathy of prematurity were performed. The values of myopia ranged from 1.5 D to 22.0 D (mean (9.78 D) and axial length from 20.36 to 30.9 mm (mean 25.08). The studies revealed that myopia in retinopathy of prematurity is not associated with the axial elongation of the eyeball. No relationship between the degree of myopia and other examined parameters was found.

[Ultrasonographic imaging of retinal detachment in retinopathy of prematurity]. / Obrazowanie ultrasonograficzne odwarstwien siatkówki w retinopatii wczesniaków.

The authors presented results of ultrasonographic examinations of 89 eyes of newborns, aged 2-12 months, in the stadium V of ROP. Analysis of the configuration of detached retina in A and B scan was done. In 48.3% of cases the funnel was narrow both anterior and posterior and only in 7.8% it was open in both parts. In vitreous fibrous proliferations and dense opacities were observed. In the majority of cases ultrasonography revealed subretinal densities and proliferations, and in 17% of the eyes calcifications.