Contrast sensitivity assessment in primary open angle glaucoma and ocular hypertension.

INTRODUCTION: Contrast sensitivity assessment is an important additional examination, which enables the full insight into the patient's quality of vision, and early diagnosis of visual disturbances. MATERIAL AND METHODS: Forty six patients (92 eyes) with primary open angle glaucoma or ocular hypertension were enrolled in the study. The enrolment criteria were full or almost full visual acuity and the patients with visual field defects or any other ocular disease were excluded. Contrast sensitivity was assessed both under photopic and mesopic conditions (with and without glare) using the Functional Vision Analyzer separately for each eye. Furthermore, the retinal nerve fiber layer (RNFL) thickness was measured using scanning laser polarimetry (GDx). RESULTS: Contrast sensitivity was significantly reduced under both mesopic and photopic conditions in patients with primary open angle glaucoma or ocular hypertension. CONCLUSIONS: Evaluation of contrast sensitivity is a valuable diagnostic test, which enables the assessment of visual dysfunction in patients with primary open angle glaucoma or ocular hypertension persisting despite good visual acuity.

Choroidal thickness in clinically significant pseudophakic cystoid macular edema.

PURPOSE: To study the choroidal thickness with an enhanced depth imaging spectral domain optical coherence tomography in clinically significant pseudophakic cystoid macular edema (CME). METHODS: Twenty patients with CME after uneventful cataract surgery were included. Choroidal thickness was analyzed and measured at various points: subfoveal and 1.5 mm nasal, 1.5 mm temporal, 1.5 mm inferior, and 1.5 mm superior from the center of the fovea. We compare choroidal thickness between affected and fellow eyes. RESULTS: The mean subfoveal choroidal thickness measured in 28 eyes with CME was 229.14 ± 62.61 µm and 280.82 ± 79.09 µm in fellow eyes. At any point (subfoveal, 1,500 µm; nasal, 1,500 µm; temporal, 1,500 µm; inferior, 1,500 µm; 1,500 µm superior from the center of the fovea), the choroidal thickness of the affected eye was significantly (P < 0.01) thinner than that of the fellow eye. CONCLUSION: The thinner choroid in eyes with CME than in fellow eyes may suggest that the reduced choroidal blood flow in the choriocapillaris is also a possible factor of CME.

Macular hole formation and spontaneous closure after vitrectomy for vitreomacular traction documented in spectral-domain optical coherence tomography.

BACKGROUND: We present a case of a macular hole formation and its spontaneous closure after vitrectomy for vitreomacular traction. To our knowledge, it is the first description of spontaneous closure of the macular hole after vitrectomy for vitreomacular traction. CASE PRESENTATION: A 78-year-old woman presented decreased visual acuity and metamorphopsia in the right eye due to vitreomacular traction. A vitrectomy with internal limiting membrane peeling and an air tamponade was performed in the right eye. Spectral-domain optical coherence tomography was obtained during all visits.Seven days after the vitrectomy, the spectral-domain optical coherence tomography showed a resolved vitreomacular traction and a full-thickness macular hole. Examination after a further three weeks showed that the full-thickness macular hole had spontaneously closed. 5 months later spectral-domain optical coherence tomography showed a normal foveal contour without intraretinal microcystic spaces and a resolution of the photoreceptor and external limiting membrane elevation. CONCLUSIONS: While performing a vitrectomy for vitreomacular traction posterior hyaloid membrane creates anterior-posterior traction on the fovea, and, during detachment, retinal layer damage occurs in the macular area and a full-thickness macular hole may develop. Removal of the anterio-posterior vitreous traction may play the main role and may help the spontaneous closure of the macular hole after vitrectomy for vitreomacular traction.

[Ophthalmological assessment of driving ability of drivers at the age more than 60 years]. / Ocena okulistyczna zdolnosci do prowadzenia pojazdów samochodowych u kierowców po 60. roku zycia.

PURPOSE: Evaluation of visual function of drivers at the age more than 60 years, and assessment of the degree in which they meet requirements for candidates for driving license. MATERIALS AND METHODS: Sixty three drivers at the age 60 and more have been examined. Corrected and uncorrected distance visual acuity, Ischihara test for color vision and confrontation visual field were done in all of them. Furthermore, patients have been inquired on everyday driving habits. RESULTS: 11% of patients did not meet ophthalmological requirements for drivers as defined by the law; 29% of patients had satisfying corrected visual acuity, but used to drive without correction. 60% of patients had satisfying corrected and uncorrected visual acuity and used correction during driving activity. The most common reason of impaired visual acuity was ametropia (83% of persons). The other reasons were: AMD (7%), cataract (6%) and glaucoma (4%). CONCLUSIONS: (1) Owners of the driving licenses with no time limit are often active drivers, who do not fulfill ophthalmological requirements. (2) Implementation of additional medical examination for drivers at the age 60 and more should be considered. (3) Currently used ophthalmological examinations for drivers, may be insufficient, because they do not include all disorders of vision influencing enlarged risk of road collision.

The use of dynamic magnetic resonance in the diagnosis of ocular motility disorders.

UNLABELLED: Dynamic Magnetic Resonance (dMRI) of the extraocular muscles is based on performing a number of short sequences, while the patient fixates consecutive points placed in different positions of gaze. PURPOSE: To check the relation between dMRI findings and the results of clinical examination in patients with various types of strabismus. MATERIALS AND METHODS: We have selected three patients with lateral rectus palsy, superior rectus palsy and inferior rectus restriction from the group, in which we have performed dMRI. We have taken measures of the affected muscles shape, sectional area and volume. The results were related with the clinical examination. RESULTS: The measurements obtained with use of dMRI reflect the actual state of the affected muscle as seen on the Hess screen. The limitation of the muscles action is represented by a lack of increase in the sectional area and volume in respective gaze intervals. The restriction of the muscle affects its shape by pulling it towards the place of entrapment. CONCLUSIONS: Data acquired by means of dMRI correspond to the clinical findings and allow a quantitative analysis of the degree of muscle weakness. Defining the extent of the morphological changes in extraocular muscles, related with long-lasting paralysis, let us make an informed decision regarding further treatment.

Factors affecting patient cooperation and level of pain perception during phacoemulsification in topical and intracameral anesthesia.

PURPOSE: To evaluate selected factors that may influence pain perception and patient cooperation with the surgeon during phacoemulsification performed under topical and intracameral anesthesia. METHODS: A total of 203 consecutive patients who had uncomplicated cataract phacoemulsification with foldable intraocular lens implantation through clear corneal 2.8 mm temporal incision under topical anesthesia were enrolled into the study. The factors assessed included gender, age, level of education, professional activity, place of residence, pain sensitivity declared preoperatively, patient mood before operation, preoperative visual acuity, and whether it was the patient's first or second cataract surgery. The correlation between postoperatively declared level of pain perception and cooperation with the surgeon was also evaluated. For statistical analysis, gamma correlation coefficient test was used. RESULTS: The strongest correlation was found between gender and cooperation and level of perceived pain. The weakest dependencies were noticed between the level of education and these parameters. Women, patients who were professionally active, and patients who were in a better mood before the operation were more cooperative. A strong correlation was found between patient pain perception and cooperation. CONCLUSIONS: Pain perception was positively influenced by female gender, rural place of residence, younger age of patient, and lower preoperative visual acuity. Cooperation with the surgeon was positively influenced by female gender, professional activity, patient good mood before operation, and no pain perception during surgery. There was no correlation between level of education, preoperatively declared pain sensitivity, sequence of operation, and estimated parameters.

[Comparison of efficacy and safety of cataract phacoemulsification in patients with different degree of nuclear sclerosis]. / Porównanie wyników fakoemulsyfikacji zacmy o róznym stopniu stwardnienia jadra soczewki i bezpieczenstwa jej wykonania.

PURPOSE: To compare the course of surgery and operative outcomes in patients with different stages of nuclear hardness. MATERIAL AND METHODS: The study comprises 36 patients with hard nucleus cataract (III and IV degree in LOCS scale)--group II and 45 patients with softer types of cataract (I and II degree in LOCS scale)--group I. All patients underwent clear corneal phacoemulsification and foldable intraocular lens implantation. In both groups intraoperative course was assessed and energy with effective phaco time were measured. Visual acuity, intraocular pressure, central corneal thickness and endothelial cell density were estimated preoperatively and one week postoperatively. RESULTS: Energy and effective phaco time were significantly higher in group II. Mean visual acuity in both groups was 0.8 +/- 0.2. Intraocular pressure, central corneal thickness and endothelium cell loss were not significantly different in both groups. Endothelium cell loss were not significantly correlated with increase of energy or duration of phacoemulsification in any of groups. CONCLUSIONS: Cataracts with higher stage of nuclear hardness required more energy and effective phaco time to be employed, but it did not influenced significantly postoperative visual acuity, intraocular pressure, central corneal thickness change and loss of endothelial cells.

[Estimation of Doppler qualitative blood flow parameters in the eyeball arteries in early pregnancy]. / Ocena dopplerowskich parametrów jakosciowych przeplywu krwi w tetnicach galki ocznej we wczesnej ciazy.

PURPOSE: The study was aimed to evaluate changes in Doppler blood flow indices in the eyeball arteries in women in the early stage of pregnancy compared with non pregnant woman. MATERIAL AND METHODS: Color Doppler imaging (CDI) of ophthalmic artery, central retinal artery and posterior ciliary arteries was performed in 15 health pregnant women between 6 and 9 weeks of gestation and in 13 non pregnant women. RESULTS: S/D values were statistically significantly higher in women in early pregnancy, compared with non pregnant woman. In the eyeball arteries, of both pregnant and non pregnant woman, blood flow indices were the highest in the ophthalmic artery, and decline subsequently in the central retinal artery and ciliary posterior arteries. CONCLUSIONS: Women in early pregnancy had higher values of all blood flow parameters but only values of systolic-diastolic index was statistically significant.

Choroidal Thickness in Women with Uncomplicated Pregnancy: Literature Review.

Pregnancy is a time when many changes occur in a woman's body. The goal of these changes is the provision of optimum conditions for the development of the foetus. Pregnancy also affects eye physiology. Well recognized physiological changes include a reduced corneal sensitivity, an increase in its central thickness and curvature, and a decrease in intraocular pressure. The association between choroidal thickness and pregnancy is not clear. Haemodynamic and hormonal changes taking place during pregnancy and the question of whether these changes are reflected by choroidal thickness are especially important. It is assumed that the choroid, which is one of the most highly vascularized tissues characterized by the highest blood flow to tissue volume ratio in the whole body, should respond by an increase in its thickness to an increase in blood flow and drop in the value of peripheral resistance. Measurement of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) in women with uncomplicated pregnancy provides important information concerning the effects of physiological changes in the eye.

[Proliferative vitreoretinopathy--selected issues concerning morphology and pathophysiology]. / Witreoretinopatia proliferacyjna--wybrane zagadnienia morfologii i patofizjologii.

Based on the literature review the article presents state of the art knowledge on creation, structure and pathophysiology of membranes occurring in PVR. Additionally selected clinical risk factors are discussed.

[Pathomorphology of membranes appearing in proliferative vitreoretinopathies]. / Patomorfologia blon powstajqcych w przebiegu witreoretinopatii proliferacyjnych.

Immunohistochemical techniques were used to investigate the cell content of epiretinal membranes occuring in proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR). Ten epiretinal membranes were obtained during surgery from eyes with PVR and five from eyes with PDR. This material was studied histopathologically and immunohistochemically. Retinal pigment epithelial cells, glial cells, macrophages, T lymphocytes and type IV collagen were identified in these membranes. The findings indicate that the cells mentioned possess a potential role in creating vitreoretinal membranes in PVR and PDR.

[Botulinum toxin injection to the lateral rectus for the treatment of intractable diplopia]. / Zastosowanie iniekcji toksyny botulinowej do miesnia prostego bocznego w celu zniesienia uciazliwego dwojenia.

The aim of the study is to evaluate the use of botuline A (BTXA) as a form of treatment for squinting patients with onerous diplopia. Two patients with exotropia and one patient with esotropia had injections of BTX A to the lateral rectus muscles of the affected side. The number of injections ranged from 1 to 2. Two patients went on to have surgery. All patients in our study found that BTX A improved their symptoms of diplopia. We conclude that BTX A has an important role in the treatment of squinting patients with burdensome diplopia.

[The influence of viscoelastic's maintenance in the anterior chamber on early results and complications after trabeculectomy]. / Wplyw pozostawienia srodka wiskoelastycznego w komorze przedniej oka na wczesne wyniki i powiklania po trabekulektomii.

PURPOSE: The evaluation of intraocular pressure and number of complications in the early postoperative period in patients after trabeculectomy with viscoelastic agent used to recreate the anterior chamber at the end of procedure. MATERIAL AND METHODS: Between November 2001 and February 2002, in 56 patients (58 eyes) with primary open-angle glaucoma trabeculectomy was performed. Patients were divided into two groups. Trabeculectomy was performed with leaving the viscoelastic agent (Provisc) in the anterior chamber at the end of surgery in 29 eyes of 28 patients (Group A), while in 28 patients (29 eyes) the anterior chamber was filled with Ringer solution (Group B). Preoperative IOP in group A ranged from 19 to 48 mmHg, mean--28.41 mmHg. In group B it ranged between 19 and 41 mmHg, mean--25.07 mmHg. The follow-up time was 1 month in every case. RESULTS: The mean IOP on the first, fifth, 14th and 30th day after surgery was 14.0 mmHg, 13.2 mmHg, 12.03 mmHg and 11.76 mmHg respectively in group A, while in group B corresponding values were: 9.0 mmHg, 8.97 mmHg, 8.83 mmHg and 8.9 mmHg. The shallowing of anterior chamber and choroidal detachment were observed in 4 eyes (13.8%) in group A and in 8 eyes (27.6%) in group B postoperatively. The increased IOP during first days after surgery was observed in 3 cases (10.3%) in group A. CONCLUSIONS: The viscoelastic agent left in the anterior chamber at the end of trabeculectomy significantly decreases the frequency of anterior chamber shallowing and choroidal detachment and reduces number of cases with hypotony.

[Advancements in diagnosis and surgical treatment of strabismus in adolescent and adults]. / Postepy w diagnostyce i leczeniu operacyjnym zeza u mlodziezy i doroslych.

PURPOSE: To present complete process of pre-operative strabismus diagnosis, which can be used for prediction of post-operative diplopia in adolescents and adults. MATERIAL AND METHODS: The study involved three patients, who were qualified for the surgical treatment of strabismus. Complete pre-operative diagnosis predicting potential post-operative diplopia was performed in all patients. The prismatic test for diplopia, hyperfunctional muscle botuline toxin injection, and prism correction were performed RESULTS: Regarding the results of tests, two patients were qualified for surgical treatment. None of them suffered from diplopia after this treatment. The third patient in pre-operative tests showed unacceptably high risk of intolerable diplopia. CONCLUSIONS: Post-operative diplopia in adolescents and adults represents a serious problem, especially in susceptible patients. Accurate and complete pre-operative diagnosis allows for risk reduction in post-operative diplopia. The predictive test for post-operative diplopia, botuline toxin injection and prism correction in isolation are not always able, to give a reliable indication, as to the sensory status following strabismus surgery. A combination of the three above mentioned techniques give more reliable diagnosis. For patients, who can possibly suffer from post-operative diplopia, the adjustable suture technique should be applied.

[Evaluation of blood-flow parameters in extraocular arteries in patients with primary open-angle glaucoma before and after surgical treatment]. / Ocena parametrów przeplywu krwi w tetnicach zewnetrznych oka u chorych z jaskra pierwotna otwartego kata przed i po leczeniu operacyjnym.

PURPOSE: To determine blood-flow parameters in extraocular vessels in patients with primary open-angle glaucoma before and after trabeculectomy. MATERIAL AND METHODS: Between November and December 2002 in 18 patients (12 women and 6 men) with primary open-angle glaucoma trabeculectomy was performed. In preoperative period, 10 days after and between third and sixth month after trabeculectomy, patients were subjected to complete ocular examination and evaluation of blood flow velocity (mean, systolic, diastolic) and pulsation indexes in posterior ciliary arteries with Doppler focused pulsating ultrasonography. Based on the results of the last examination patients were divided in two groups before the treatment. Group A included 9 patients (4 men and 5 women), age ranged from 46 to 77 (mean 63.67). Preoperative IOP in this group ranged from 14.6 mmHg to 34.5 mmHg (mean 25.6 mmHg). Blood-flow velocities were lowered in 9 patients for 20% below the norm. Pulsation indexes ranged from 1.0 to 1.3 in 7 patients and from 1.3 to 1.5 in 2 patients. Group B included 9 patients (6 women and 3 men) age ranged from 58 to 88 (mean 73.5). Preoperative IOP in this group ranged from 14 to 44 mmHg (mean 27.24 mmHg). Blood-flow velocities were lowered in 9 patients for 30-50% below the norm and pulsation indexes were higher then 1.2. Three of the 9 described patients had no velocities in diastolic phase and pulsation indexes were higher than 2.0. RESULTS: Postoperative IOP in group A ranged from 7.1 to 17.3 mmHg (mean 11.0 mmHg). Four of the 7 described patients had velocities higher for 20-30% than preoperatively and were normal. Pulsation indexes lowered to 1.0-1.2. In 3 patients velocity increase was observed later (after 6 months). In group B postoperative IOP ranged from 4.9 to 14.6 mmHg (mean 8.6 mmHg). Velocity increase was observed and it reached the lower limit of the norm or were higher. Pulsation indexes lowered to 1.0-1.2. CONCLUSION: The parameters of blood-flow in posterior ciliary arteries improved in all cases after trabeculectomy.

Analysis of the time and location of the silicone oil emulsification by spectral-domain optical coherence tomography after silicone oil tamponade.

PURPOSE: To estimate localization and the period up to the appearance of small hyperreflective round-shaped droplets using spectral-domain optical coherence tomography (SD-OCT) after pars plana vitrectomy with silicone oil tamponade. METHODS: A retrospective observational study included 24 patients who had undergone pars plana vitrectomy with silicone oil tamponade for proliferative vitreoretinopathy (PVR) retinal detachment. SD-OCT analysis was performed 1, 3, and 6 months after surgery. We characterized the emulsified silicone oil in the SD-OCT as the small hyperreflective round-shaped droplets. RESULTS: In SD-OCT examination, none of the patients had hyperreflective round-shaped droplets visible one month after vitrectomy with silicone oil tamponade. The hyperreflective droplets were found three months after surgery-in one patient above the optic nerve and in five patients intraretinally (in the cystoid spaces). Six months after vitrectomy, the hyperreflective round-shaped droplets were still present in the aforementioned patients' eyes and additionally in 3 eyes above the optic disc. CONCLUSIONS: Hyperreflective round-shaped droplets were found in a SD-OCT examination 3 months after silicone oil tamponade. The authors suggest that they are most likely the emulsified silicone oil droplets. The authors hypothesize that emulsification and migration of silicone oil begin within 3 months after surgery.

Influence of scleral buckling surgery with encircling band on subfoveal choroidal thickness in long-term observations.

PURPOSE: The aim of this study is the presentation of subfoveal choroidal thickness with enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) several months after scleral buckling with encircling band surgery. METHODS: 48 patients who underwent scleral buckling with encircling band surgery for unilateral rhegmatogenous retinal detachment were included in the retrospective observational study. The mean time from scleral buckling surgery to the final EDI-OCT examination was 22±6.7 months. We compare choroidal thickness between operated and fellow eyes. RESULTS: In all patients, the macula was detached before the surgery. The subfoveal choroidal thickness in 48 treated eyes was 260.9±45.8 µ m (range 155-383 µ m) and in the fellow eyes was 217.5±36.7 µ m (range 98-326 µ m). The subfoveal choroidal thickness of eyes after scleral buckling surgery in long-term EDI-OCT examination was significantly thicker (P<0.001) than in fellow eyes. CONCLUSIONS: The subfoveal choroid in eyes undergoing encircling band surgery was significantly thicker than in fellow eyes. We suspect that this may be the result of reduced choroidal blood flow. It also seems that the width and size of the material used in scleral buckling surgery may affect a change in the choroid circulation and increase subfoveal choroidal thickness.

Morphologic Changes in the Foveal Photoreceptor Layer before and after Laser Treatment in Acute and Chronic Central Serous Chorioretinopathy Documented in Spectral-Domain Optical Coherence Tomography.

Purpose. To analyze microstructural changes in the external limiting membrane (ELM) and photoreceptor layer before and after early and late conventional laser treatment in central serous chorioretinopathy (CSC) in 12 months follow-up study. Methods. A retrospective observational study included Group A: 19 patients (19 eyes) with symptomatic acute CSC and Group B: 16 patients (16 eyes) with symptomatic chronic CSC. Retinal microstructural changes were analyzed with SD-OCT paying a particular role in examining the photoreceptor layer and ELM. Results. The length of the photoreceptors, prior to treatment, was approximately 84 µ m in Group A and 82,5 µ m in Group B. Twelve months after laser treatment, photoreceptor length was approximately 49 µ m in Group A and 43 µ m (range 20-55 µ m) in Group B. No patients in Group A had noticeable photoreceptor defects nor ELM defects, but in 15 eyes in Group B photoreceptor and ELM defects were detected (P < 0.0001). Conclusions. When analyzing the photoreceptor layer and ELM during active CSC, it is not possible to evaluate any irreversible changes which have already occurred in this layer. Damage to the photoreceptor layer and ELM in patients with chronic CSC was only found after laser treatment and the absorption of subretinal fluid.