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According to the guidelines by the ETROP (Early Treatment for Retinopathy of Prematurity) study group, laser therapy is the gold standard in the treatment of retinopathy of prematurity. However, progression of the disease is seen in 12% of eyes despite the treatment. Since there is no causal treatment, new therapies of retinopathy of prematurity, are continually sought, such as anti-VEGF agents, beta-blockers, or insulin-like growth factor gene therapy. In cases with concomitant retinal detachment, surgery is performed. The standard therapy for retinopathy of prematurity stages 4-5 involves pars plicata vitrectomy and lensectomy (stage 5), ab externo surgery (scleral buckling) and lens-sparing vitrectomy (some cases of stage 4). Classic vitrectomy with lensectomy is reserved only for cases with advanced retinal tractions, retina-lens apposition or for cases of intraoperative lens damage during the lens-sparing vitrectomy. The ab externo surgery does not eliminate vitreous tractions, but it stabilises the neovascular membrane activity (transforming it into a scar). The indication for this type of operation is stage 4 retinopathy of prematurity with peripheral proliferations, except for the posterior--aggressive form of retinopathy of prematurity. Many papers have been published on combined therapy involving vitrectomy and conservative treatment. In conclusion, optimal timing of surgical intervention is difficult to determine in stages 4 and 5, because the anatomical and functional outcomes in stage 5 are unfavourable. Both, ab externo surgery and vitrectomy tend to produce poor macular vision in eyes with advanced retinopathy of prematurity, therefore surgical intervention at stage 4 just before the local macular retinal detachment provides better anatomical and functional outcomes.

(1) To compare the incidence of refractive errors and the orthoptic condition in ten-year-old children, born prematurely and treated with cryotherapy versus children, whom did not apply such a procedure. (2) To estimate condition of the extraocular muscles.A group of 60 prematurely born children was divided into 2 subgroups: I--30 children treated with cryotherapy, II--30 no treatment was applied. All the children had anterior segment, fundus and visual acuity examined. Refraction following cycloplegia was evaluated. Visual acuity and orthoptic status was assessed.In the group of prematurely born children who had retinopathy in the infantile age and were treated with cryotherapy, refractive errors were frequently observed. In over half of those children squint or impaired eye movement were found. In the group of children who required no cryotherapy the percentage of those with refractive errors was similar.In prematurely born children with retinopathy refractive errors and squint occur quite often. Prematurely born children should be subject to ophthalmologic follow-up throughout their childhood.

Comparison of the effectiveness and safety of cyclocryocoagulation and transscleral contact cyclophotocoagulation with diode laser (TSCPC) in children.Sixty nine eyes of 60 children at the age from 4 months to 16 years were examined. Majority of patients was aphakic after congenital, traumatic and complicated cataract extraction. Aniridia, Sturge-Weber disease and ROP complications were observed. In 40 eyes cyclocryotherapy (I group), in 29 eyes TSCPC (II group) were performed. Intraocular pressure (IOP) was assessed in the early and late postoperative period. The number of procedures per one eye, IOP, visual acuity, and complications after cyclodestructive procedures were estimated. Follow-up ranged from 3 months to 4 years, mean 23 months.Transscleral cyclocryocoagulations were performed once to 4 times in one eye with intervals from 1 month to 1 year, mean 1.3 procedures per eye. TSCPC was performed once in 29 eyes and twice in 4 cases, it was 1.14 procedures per eye. Before treatment IOP ranged from 21.3 to 50.6 mmHg, mean 29.18 mmHg in the I group and 24.4-54 mmHg mean 34.85 mmHg in the II group and in the early postoperative period were 10-25 mmHg, mean 17.7 and 2-26 mmHg, mean 14.65 mmHg relatively. Decreasing of IOP was observed in 39% of eyes after cryotherapy and 57.9% after TSCPC, p = 0.0003. In the long-term follow-up in IOP below 22 mmHg after cyclocryotherapy in 60% of eyes and after TSCPC in 79% was observed. Visual acuity ranged from no light perception to 0.5, mean 0.04. No changes of vision after cyclocryocoagulation were noted. After TSCPC transient visual function decreased from 0.2 to 0.04 in 1 eye but recovered after 2 weeks. After cyclocryotherapy only conjunctival oedema was observed in majority of cases. In the early postoperative period after TSCPC uveitis occured in 3 eyes (10.35%), transient hypotony in 2 eyes, hyphaema in one eye.Diode cyclophtocoagulation decreases IOP more effective than cyclocryocoagulation in children but complications after TSCPC are more severe than after cyclocryotherapy.

Cryo- and laser therapy of stage 3 have reduced, but not eliminated the occurrence of retinal detachment in stages 4a, 4b and 5 of ROP. In this disease the treatment of these stages is still the greatest challenge to the ophthalmologist. Therefore, the aim of this paper is to present our up-to-date possibilities of treatment of different kinds of retinal detachments in ROP, including segmental scleral buckling, encircling scleral buckling, scleral resection, vitrectomy and its modifications in ROP. Guidelines of surgery of retinal detachment in active stage 4 and 5 of retinopathy of prematurity have been described.

The purpose of the study was to assess the outcomes of the diode laser in the treatment of retinopathy of prematurity and to discuss the up-to-date possibilities of treating of active phase of this disease.96 children (185 eyes) treated with diode laser retinal photocoagulation for active stage 3 of ROP in our department in years 1996-2000.Favorable structural outcome was observed in 83.8% of treated eyes. In the remaining eyes the disease progressed despite of the treatment and falciform retinal fold (5.4%), partial retinal detachment (6.5%) and total retinal detachment (4.3%) developed. No serious complications were observed after the treatment.Diode laser retinal photocoagulation is a safe and effective procedure for treating active stage 3 of retinopathy of prematurity. It has been especially useful for treatment of changes in zone 1 and 2 of the disease. Diode laser photocoagulation is now the preferred method of treating active stage 3 of ROP in our department.

To evaluate the usefulness of conventional methods in retinal detachment (RD) surgery basing on the relationship between factors characterizing clinical picture of the RD, the type and course of surgical procedures and the retinal reattachment.252 patients (252 eyes), operated on in the last 5 years in our clinic were enrolled in the studies. There were 120 men and 132 women, aged 9 to 83, mean 53. In all cases scleral buckling procedures with silicone band or sponge and cryocoagulation of the breaks were used. The relationship between retinal reattachment and the following parameters were examined: visual acuity, retinal degenerations, myopia, extent of the detachment, number and kinds of breaks, macular involvement, state of vitreous, PVR, intraocular pressure, extent of scleral buckling, subretinal fluid drainage and intra- or post-operative complications.Retinal reattachment was achieved in 82% of the eyes with one operation and additionally in 7% after reoperation. The significant relationship was found between: visual acuity, intraocular pressure, extent of the detachment, number of breaks, PVR, extent of scleral buckling and retinal reattachment.PVR is a significant cause of failure in RD surgery with conventional methods and PVR grade C is the threshold beyond which the percentage of reattachments decreases to about 50%. Value of other risk factors, determining severity of RD is not certain for prognosis. Cerclage with silicone band is a method of choice in the majority of RD with PVR grade B and C. Our observations do not confirm the reports of severe complications caused by cerclage, which might be connected with excessive tightening of the band.

The aim of this work is to present our own experience in the treatment of retinoblastoma with cryopexy.24 children were observed, among whom 23 had bilateral and 1 unilateral retinoblastoma. We applied transconjunctival cryopexy to small neoplasmatic foci in retina located anterior to the equator. In 21 eyes this treatment was supplementary to brachytherapy and photocoagulation. We used probes of temperature -65C. Each freezing lasted about 20 seconds. The treatment was repeated every 6-8 weeks. In some cases different degree of post-surgical hemorrhages occurred.In 1/4 of cases already after a single freezing the tumour was destroyed and cicatrized. Only in 2 out of 24 treated eyes the desired effect was not reached.Cryopexy is an effective method of treatment of small foci of retinoblastoma located in the periphery of the eye fundus. This method is usually supplementary to brachytherapy.

It is 30 years since Krwawicz presented a new method of cataract surgery at low temperature. This operation was not only widely accepted, but also showed the possibilities of the use of low temperature in medicine. It soon became apparent that such methods might be helpful in treating a number of eye diseases. This was beginning of a new branch of ophthalmology, cryoophthalmology. The paper presents its development, its position in ophthalmology and the latest achievements. After the 30 years, cryoophthalmology has preserved its importance and its constant evolution; it remains the subject of investigations of many research centres.

Basing on the clinical material of the years 1984-1991 the authors have compared the results of retinal detachment surgery in two groups of patients, depending on the method of adhesion. Diathermy was used in 182 eyes (group I) and cryosurgery in 274 (group II). Retinal attachment was achieved in 69% of the eyes in group I and in 74% in group II. Inadequate closing of the breaks was the cause of failure in 22.8% of the cases in group I and in 30.6% in group II. Various changes of the macula were observed in 31% of the eyes in group I and in 24.5% in group II. Statistically significant relationships were found between method of adhesion and: development of PVR (p0.05), appearance of pigmentary changes in the eye ground (p0.01) and cicatrization of the breaks (p0.01). Stronger cicatrization was observed after cryosurgery as well as the pigmentary changes in the fundus which have not influenced the results. The studies revealed that no significant differences depending on the method of adhesion were found in results of retinal detachment surgery.

After the discussion of the advantages of the low temperature application in viral ulcerations of cornea, the results of the cryotherapy in 1200 patients are presented. The average period of treatment of the viral ulcerations, with no involvement of corneal stroma, was 2.9 days, whereas with the involvement 9.2 days. The recurrent viral ulceration was observed in 6.2% of the patients but the re-application of the cryotherapy always resulted in recovery.

Basing on 11 cases of angiomatosis retinae, diagnosed and treated in the last 30 years in the Ophthalmological Clinic in Halle, the authors discussed the problems concerning this rare disease. Their observations confirmed the opinion that photocoagulation is the method of choice in the treatment of angiomatosis retinae and that it is successful in small, less than 2 disc diameter angiomas. The further possible therapeutical methods are cryocoagulation, radioactive-isotopes and vitrectomy. As the treatment should be repeated and the long-lasting follow-up is necessary, the efficient cooperation with the patients is very important.

The transconjunctival cryoapplication was performed in 8 patients (13 eyes) with the recurrent pars planitis and the simultaneous involvement of peripheral retina and choroid. Before the surgery, the peripheral fundus of the eye was examined with the Goldmann three-mirror lens and afterwards, the cryoapplication of lesions was performed. The topical treatment, dexamethasone and indomethacin drops, followed the surgery only. In all cases the inflammation disappeared but the macular edema and vitreal exudation regressed slowly. The considerable improvement of visual acuity was achieved in 8 eyes (61%). So far, the results of the observations are satisfactory and they entitle the authors to carry on the application of the treatment mentioned above.

The goal of the study was the evaluation of the influence of the nowadays most frequently used surgical methods in cases of retinal detachment on the macula not involved in the detachment. The study takes into account surgical interventions which have the same indications and principles of action. They are based on an extra-scleral indentation--temporary or permanent one--by means of a Lincoff-Kreissig balloon and a meridional silicone sponge implant. The examinations comprised 54 patients. They were divided into 2 groups: 1st group (24 patients) was treated by cryopexy and a Lincoff-Kreissig balloon, the 2nd group (30 patients) by cryopexy and a meridional silicone sponge implant. In all the patients of both groups the retina reattached. During the 5-years observation of patients of the 1st group no macular changes were detected; one did not observe metamorphopsia or disturbances of the color vision. In the 2nd group instead 17 patients claimed metamorphopsia, 20 patients showed disturbances of the color vision and angiography changes involving the macular region (13 patients).

Presented are the results of treatment of 59 patients with severe chemical and thermal burns of the cornea who--besides being subjected to a traditional procedure--were also treated by cryotherapy. In the majority of cases low temperature considerably hastened the process of the regeneration of corneal epithelium and the clearing up of its opacification. It considerably influenced the shortening of the treatment period and the improvement of the visual acuity.

An analysis of patients treated in the Ophthalmic Department in Bydgoszcz for eye burns in the 10 years period from 1980 till 1990. Taken into account were the causes of burns, the treatment installed in the early period and in cases of late complications. All the patients were asked to call in for a control examination in order to compare the condition of the eyes at the date of discharge and in the long-lasting time. Among 118 eyes in 91 the visual acuity amounted 0.5-1.0, in the remaining 25 it was only hand movements--0.4. The main causes of low visual acuity were: corneal leucoma, secondary glaucoma, complicated cataract. The eye was enucleated in 2 patients because a painful ocular atrophy developed in the course of the pathological process. These were the cases of thermal burns combined with a mechanical injury. The obtained results were evaluated as sufficiently favourable and comparable to the data of other authors.

The authors observed 27 patients (39 eyes) with glaucoma in the course of the pseudoexfoliation of the lens capsule syndrome treated in the period of 1979-1989. In all the patients the corneo-scleral angle was open with a considerable amount of pigment; 30 eyes exhibited opacification of the lens. The conservative anti-glaucomatous treatment was successful in only 2 patients. Control of the IOP was attained in 5 eyes after a laser trabeculoplasty and in 23 eyes after the Elliot-Fronimopoulos goniotrepanation. Discussed was the lesion of the visual function occurring in the presented syndrome.

The authors present the results of analysis of the treatment of 184 patients (360 eyes) with diabetic retinopathy; it comprises as well the out-patients as the in-patients divided into 4 groups in dependence on the changes and the treatment applied (laser focused photocoagulation, panretinal photocoagulation, cryopexy) the majority of patients reported to the hospital with an advanced proliferative diabetic retinopathy and this allowed only the performance of a panretinal photocoagulation and in a part of cases only cryopexy. The attention is called to the necessity of an early detection of pathological changes and of an early treatment.

Seven children with an atypical parasitic uveitis were treated in the Department of Ophthalmology in Bialystok in the period 1985-1989. Parasitic background had been discovered in all the children: toxocara in 3, lambliasis in 2 and nematodiasis also in 2. Specific treatment achieved an improvement of the visual acuity and the inflammatory process abated.

The purpose of the paper was to study whether the use of cryotherapy can cause decrease of angiogenic activity of the primary avascular retina in kittens with oxygen induced retinopathy. The studies showed that after cryotherapy comes to a considerable decrease of angiogenic activity of this part of the retina. It indicates that cryotherapy should arrest the development of more advanced stages of retinopathy of prematurity.

The material consists of 142 eyes in 138 children aged 2-17 years who sustained contusions and perforating injuries. Pathological changes of the vitreous have been observed in 75 p.c. of cases: haemorrhages, opacities, destructive and fibrous changes and even a total fibrosis of the vitreous with shortening of the anatomical axis of the eye. Vitrectomy was performed in 23 cases with extraction of the foreign body in 11. In eyes with a destruction of the vitreous and with vitreoretinal proliferation a laser photocoagulation of the retina or transscleral cryopexy was performed. It is considered that the prophylactical treatment is indicated in all eyes exhibiting structural changes in the vitreous.

Low temperatures applied to a healthy cornea provokes in its stroma the formation of a limited area deprived of cells. Excited histiocytic cells which obtained the capacity of movement penetrate soon to this area from the surroundings. They demonstrate also ultra-phagocytic capabilities storing silver. This evidences the setting in motion of cells of the reticulo-endothelial system of the healthy cornea caused by the low temperature; these cells replace the cells of the stroma damaged by the cold. The cornea however does not loose its transparency. Recognition of the action of low temperature by creating a cell-free area and by stimulation of the cells of the RE system in a healthy cornea has a significance for a better knowledge and understanding of the mechanism of the influence of low temperature on the cornea.

Photocoagulation and cryopexy were applied in 5 patients with retinoschisis; in 3 they were connected with a temporary invagination of the sclera by means of a Lincoff-Kreissig balloon. After the photocoagulation the authors attained the control of the increase of schisis in 3 patients; in 1 woman-patient a progress of pathological changes was seen. Cryopexy connected with a temporary invagination lead to a good result in a case not formerly treated. The same method in patients treated before by the photocoagulation of the detachment area was definitely less effective. It was suggested that the use of invagination and pressure upon the eye after the break of the choroi-retinal barrier may speed-up the absorption of the fluid from schisis cavity.

The authors discuss the results of cryopexy applied prophylactically in 32 eyes. The freezing was executed at least 6 weeks before the cataract extraction in eyes endangered by retinal detachment. This were the high myopia eyes, so called fellow eyes and eyes in persons aged between 30 and 40 years. Retinal detachment did not occur in either of the observed eyes in the period of 1-5 years.

Cyclocryoapplication in glaucomatous patients is performed since 1983 by the method settled on the basis of results of experimental investigations. Observations concern 174 persons with various forms of glaucoma. Best results were obtained in patients with glaucoma in the course of uveitis, with secondary glaucoma after perforating injuries and after intracapsular cataract extraction. Fewest favourable results were observed in patients with closed angle glaucoma.