Long term effect on IOP of a stainless steel glaucoma drainage implant (Ex-PRESS) in combined surgery with phacoemulsification.

AIM: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS R50) for the surgical treatment of primary open angle glaucoma (POAG) and cataract when combined with phacoemulsification. METHODS: Clinical, prospective, multicentre, single treatment arm, non-randomised, non-masked study. The Ex-PRESS device was implanted at the limbus under a conjunctival flap. Phacoemulsification cataract extraction and in the bag IOL implantation were performed through clear cornea temporally. PRIMARY OUTCOME: IOP change; secondary outcomes: side effects and VA changes. RESULTS: 26 eyes of 25 patients were implanted with the device. The mean (SD) follow up was 23.9 (10.4) months and the mean age was 75.1 (7.1) years. 17/26 eyes have more than 3 years of follow up. One case was discontinued because of device removal, one because of death, and three were lost to follow up. EFFICACY: preoperative IOP was 21 (4) mm Hg; at 1, 2, and 3 years IOP was 15.3 (3.1) mm Hg (35% reduction), 16.6 (2.7) mm Hg (29% reduction), and 16 (2.6) mm Hg (22% reduction) respectively. Kaplan-Meyer determined overall success rate (IOP < or = 21 mm Hg at the last visit with or without medications) as 76.9%. The number of antiglaucoma medications was reduced by 95% at year 1. Only six patients (23%) were taking IOP lowering treatment at their last visit, five with one medication and one with two medications. Side effects: early postoperative complications were clinically mild and included six cases of hypotony (IOP <5 mm Hg), three cases of hyphaema (<2 mm) with no clinically significant further effects. Long term complications were two cases (7.7%) of device rotation (one treated by reposition) and three cases (11.5%) of conjunctival erosion at 2 and 3 years. CONCLUSIONS: The Ex-PRESS implant, combined with phacoemulsification cataract extraction, is clinically safe and effective, maintaining in the long term a large reduction in IOP and in the number of antiglaucoma medications.

Corneal stromal calcification after topical steroid-phosphate therapy.

Secondary corneal calcification involving the full thickness of the stroma is a rare potential complication of severe dry eye conditions, recurrent corneal ulcerations, chronic ocular inflammation, or multiple surgical procedures. We describe on a patient with unusual, hitherto unreported calcareous degeneration of the corneal stroma after topical steroid-phosphate therapy for chronic keratoconjunctivitis after Stevens-Johnson syndrome. The patient's serum levels of calcium and phosphorus were normal. Histopathologic and electron microscopic examination of the corneal button revealed mainly intracellularly located crystalline calcium deposits throughout all layers of the corneal stroma but sparing the Bowman layer. Energy-dispersive x-ray analysis confirmed the presence of calcium phosphate. The calcium deposits were closely associated with intracellular and pericellular accumulations of glycosaminoglycans. Our findings indicate that corneal stromal calcification may develop after topical steroid-phosphate medication, and suggest a possible role of alterations in the glycosaminoglycan metabolism of stromal keratocytes in the calcification process.

Presence of kynurenic acid and kynurenine aminotransferases in the inner retina.

Kynurenine aminotransferases (KATs I and II) are pivotal to the synthesis of kynurenic acid (KYNA), the only known endogenous glutamate receptor antagonist and neuroprotectant. This study is the first to identify KYNA in the rat retina and to examine immunohistochemically the distribution of KAT isoforms. As determined by HPLC, KYNA concentration in the retina was 99.9 +/- 24.6 pmol/g wet wt. Immunohisto- chemical experiments showed that both KATs were present in the retina. KAT I was preferentially localised on Müller cell endfeet while KAT II was expressed in cells within the ganglion cell layer. In conclusion, KYNA is present and synthesised in the inner retina. This may suggest a modulatory role in glutamate-mediated retinal neurotransmission.

Comparative ultrasonographic study of the effect of pilocarpine 2% and Ocusert P 20 on the eye components.

The ultrasonographic examination of pilocarpine 2%- and Ocusert P 20-treated eyes clearly demonstrated that the side effects, such as accommodative myopia and changes of the anterior chamber depth and of the lens thickness, were less pronounced in the Ocusert-treated group.

Histoenzymologic study of hyalocytes in tissue culture.

The mitochondrias of the hyalocytes contain lactic dehydrogenase but no glucose-6-phosphate dehydrogenase, so that only aerobic respiration is possible. Among the lysosomal enzymes, acid phosphatases and beta-glucuronidase are found, the latter facilitating the turnover of the hyaluronic acid. There is no galactosidase, as the hyaluronic acid of the vitreous does not contain galactose.

The sense of self-concept change in patients after radial keratotomy.

PURPOSE: The study focuses on the problem of self-concept change in patients after radial keratotomy. METHODS: Twenty-five patients (17 female, 8 male) were studied from 6 to 18 months after radial keratotomy using the Adjective Check List by Gough and Heilbrun with the application of double instruction. It concerned self-concept change over a period of observation after surgery, as compared to retrospective (preoperative) self-concept. RESULTS: For current self-concept, patients obtained significantly higher results in the following measures: the number of positive words used for self-description (P < .05); need scales, like affiliation (P < .005), heterosexuality (P < .01), and intraception or insight (P < .05); self-confidence (P < .01); military leadership (P < .05), logical decision making (P < .05); two measures concerning logical-analytical thinking (P < .05). CONCLUSIONS: The results indicate that after radial keratotomy, patients perceived themselves in a more positive way than before surgery, especially as more self-confident in interpersonal functioning.

Oxygen delivery to the anterior chamber of the eye--a novel function of the anterior iris surface.

By means of pO2-needle electrodes the oxygen tension in the anterior chamber of rabbit and cynomolgus monkey eyes was measured and correlated with the topography. It can be clearly shown that the pO2 in front of the pupil is substantially lower than in front of the anterior iris surface. It is evident that the O2-supply of the anterior chamber is provided by the iris vasculature. This result was confirmed by measurements after partial or total iridectomy. A brief recapitulation of the morphology of the iris showed that the abundance of iris vasculature is well understandable in view of these pO2 measurements.

A simplified technique for non-penetrating deep sclerectomy.

PURPOSE: To present a modified technique for non-penetrating deep sclerotomy (NPDS) with limited use of sharp instruments. MATERIALS AND METHODS: A special fine spatula is used to separate the Descemet membrane from stromal tissue afterpreparing superficial and deep scleral flaps and opening the Schlemm's canal. Another specially designed spatula is used to protect the membrane when excising the overlying trabecular and stromal tissue. The other steps of the surgery are identical with the original Kozlov method. The modified surgery was performed by one surgeon experienced in NPDS, and three others starting their transition to this technique under the guidance of the first. Sixty-six patients (66 eyes) with primary open-angle glaucoma (51) or pseudo-exfoliature glaucoma (15) were treated with NPDS. RESULTS: Two microperforations (3%) of the Descemet membrane were the only intraoperative complications. They did not require iridotomy or any special treatment. In the early postoperative period one 2-mm hyphema was observed, and in five cases there was transient hypotony. In one other case there was a choroidal detachment, which resolved spontaneously in less than two weeks. IOP the day after surgery ranged from 5 to 13 mmHg (mean 9.6) and after one year from 10 to 22 mmHg (mean 14.6). Late complications and IOP control were similar to conventional NPDS. CONCLUSIONS: These procedures performed by one experienced and three inexperienced surgeons gave satisfactory results and the modified method can be recommended for surgeons beginning nonpenetrating glaucoma surgery, and should shorten their learning curve.

Etiology of uveitis in rural and urban areas of mid-eastern Poland.

The aim of this study was to assess and compare the frequencies of uveitis etiology in inhabitants of rural and urban areas of mid-eastern Poland. We reviewed the cases of 563 patients (263 males, 300 females; aged 2-87) with uveitis, treated at the 1st Department of Ophthalmology at the Medical Academy in Lublin and at the District Ophthalmic Hospital in Kielce, Poland, from January 1996-December 2000. Anatomical classification of uveitis was used according to the International Uveitis Study Group and etiological classification including uveitis associated with trauma, infection, systemic disease, non-associated with a systemic disease and masquerade syndromes. Data regarding age, gender, place of residence, anatomical location and etiology of uveitis were obtained. Statistical analyses were performed using Pearson's chi-square test, Spearman's rank correlation test and logistic regression. Etiology of uveitis was established in 70.0% of cases. The most common cause of uveitis was infection. Patients from rural areas were significantly more likely to have uveitis of infectious origin whereas patients from urban areas significantly more likely to have uveitis associated with a systemic disease. In conclusion, the pattern of uveitis in mid-eastern Poland confirms the influence of environmental factors on the etiology of this heterogenous disease.

[Radiation sterilization of disposable medical equipment]. / Sterylizacja radiacyjna sprzetu medycznego jednorazowego uzytku

In the Institute of Nuclear Research in Warsaw, the double-function linear electron accelerator LAE 13/9 has been operating since 1972, currently yielding radiation in the amount equivalent to 1 millon Ci of cobalt 60, thus providing unique research possibilities. The author has discussed the technical base in Poland and Comecon Member Countries, and planning and prognostic in this respect in other countries, as well.

[Histopathological studies of eyes removed after surgical treatment of retinal detachment]. / Badania histopatologiczne galek ocznych usunietych po operacjach odwarstwienia siatkówki.

Among the examined eyes a cerclage was done in 13, in 5 an additional invagination, in 4 a posterior vitrectomy (2 eyes with membrane excision, 1 with injection of the SF6 gas and 1 with an injection of silicone). In 7 eyes the enucleation was caused by the atrophy of the eye ball, in 5 by absolute glaucoma and in 1 by suspected sympathetic ophthalmia. The most characteristic pathological changes were: inflammatory granuloma as a reaction for silicone band (4 eyes), scleral atrophy in the area of invagination (10 eyes), choroidal atrophy (12 eyes), proliferation of the pigment epithelium (10 eyes) and atrophy, fibrosis and proliferation of the glia in the retina.

[Acanthamoeba keratitis]. / Zapalenie rogówki wywolane przez Acanthamoeba.

Acanthamoeba keratitis has become a clinical problem together with the widespread use of soft and rigid contact lenses. The number of cases with this kind of infection is growing, but many of cases are diagnosed too late or misdiagnosed. The authors presented, for the first time in Polish literature, a case of acanthamoeba keratitis concerning a 62 aged man. The disease was diagnosed in the right aphakic eye after a 5-year use of soft contact lens, just after cataract operation performed in the clinic in the left eye.

[The role of Chlamydia trachomatis in the etiology of conjunctivitis]. / Znaczenie Chlamydia trachomatis w etiologii zapalenia spojówek.

PURPOSE: To turn attention to the etiological importance of chlamydia in chronic conjunctivitis. METHODS: From December 1993 to November 1994 the authors examined 95 patients with chronic conjunctivitis for the presence of Chlamydia trachomatis antigens in conjunctival epithelial cells using direct immunofluorescent antibody tests. RESULTS: The test was positive in 23 patients and most of them responded positively to general tetracycline treatment combined with locally used Sulfacetamide or Floxal. CONCLUSION: Chlamydia trachomatis are common causes of conjunctivitis in adults.

[Vitrectomy in the treatment of endophthalmitis]. / Witrektomia w leczeniu zapalen wnetrza galki ocznej.

PURPOSE: To present our experience with the surgical management of endophthalmitis. MATERIAL AND METHODS: The results of 27 pars plana vitrectomies in 19 patients with clinical evidence of endophthalmitis were analysed. The endophthalmitis was considered as endogenous in 4 cases and exogenous in 15 cases. RESULTS: With the use of vitrectomy good anatomical and functional results were obtained. Pre-operative visual acuity was worse than 1/50 in 16 patients and ranged from 1/50 to 4/50 in 3 patients. Postoperative visual acuity was worse than 1/50 in 7 patients, ranged from 1/50 to 4/50 in 3 patients and was better than 5/50 in 9 patients. CONCLUSIONS: Pars plana vitrectomy in the management of endophthalmitis makes it possible to collect material for culture, removal of viable organisms and inflammatory products. In cases of posttraumatic endophthalmitis vitrectomy allows to prevent future complications.

[Anterior vitrectomy in the treatment of Hruby-Irvine-Gass syndrome]. / Zastosowanie witrektomii przedniej w leczeniu zespolu Hruby'ego-Irvine'a-Gassa.

From 1980-1986 46 unselected aphakic patients suffering from persisting cystoid macular edema and vitreous incarceration to the surgical wound were treated by closed vitrectomy and removal of displaced vitreous through a limbal incision. In 30 eyes visual acuity improved averaging 0.35 if the revision was done within one year. In 12 eyes, treated usually after intervals of more than 1 year, vision remained unchanged and in 4 eyes visual acuity decreased, in two of them due to retinal detachment and in other two because of advance macular changes. When medical therapy fails the decision to undertake surgical revision should not be delayed. This releases also the coexisting traction to the retinal periphery.

[Acute bilateral ischemia of the optic nerve in gastrointestinal hemorrhage]. / Ostre obustronne niedokrwienie nerwów wzrokowych w przebiegu krwawienia z przewodu pokarmowego.

Presented is a case of a permanent, total, bilateral loss of vision occurring in the course of treatment by blood transfusions of a severe anaemia caused by a duodenal ulcer haemorrhage. The mechanism of ischaemia of the optic nerve in similar cases and possibilities of its treatment are discussed.

[Recession of the inferior rectus muscle in superficial anesthesia in the treatment of thyroid orbitopathy]. / Recesja miesnia prostego dolnego w znieczuleniu powierzchownym w leczeniu hipotropii w przebiegu orbitopatii tarczycowej.

Recession of the inferior rectus in surface anaesthesia by 5% cocaine drops was performed in 8 patients with signs of hypotropia in the course of thyroid orbitopathia and with diplopia persisting after conservatory treatment and not corrected by prisms. This method enables us an accurate intraoperative settlement of the distance of recession and it may be recommended in cases metabolically normalized, with not too much advanced exophthalmos, with a stability of the motor disturbances for at least 6 months and without any signs of inflammation.

[Pathogenesis of secondary glaucoma in epithelial invasion]. / Patogeneza jaskry wtórnej w inwazji nablonka.

Apart from meticulous wound closure certain amount of fibrin and fibroblastic activity are necessary to prevent epithelial ingrowth. Prostaglandin inhibitors and steroid may enhance such danger. The most frequent reason for glaucoma were peripheral anterior synechiae. Open angle glaucoma with stratified epithelium lining the trabeculum was less frequent. Glaucoma can be caused by goblet cells produced mucus blocking the trabeculum. Desquamated epithelial cells, pupillary block caused by epithelial invasion of anterior hyaloid and intense inflammatory reaction can also exceptionally induce secondary glaucoma.

[Eye tumors in children. Histopathological aspects of differential diagnosis]. / Guzy ukladu wzrokowego u dzieci. Histopathologiczne aspekty diagnostyki róznicowej.

Ocular tumors in children, due to their biological characteristics, possess a special position in ophthalmology. Most of these tumors are today curable with early diagnosis and correct treatment. Therefore their differential diagnosis should be familiar to all pediatricians and ophthalmologists. Tumors were divided into three groups, concerning their localization (lid and orbit, epibulbar, intraocular). In each group histopathologic and clinical pictures of most important benign (hamartomas, choristomas and pseudotumors) and malignant (primary and metastatic) tumors were separately described and correlated, with special attention paid to differential diagnosis.