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Purpose: The purpose was to compare surgically induced after bimanual phacoemulsification performed through a 1.7 mm superotemporal clear corneal microincision (B-MICS), and after coaxial phacoemulsification performed through a 3.2 mm superotemporal clear corneal incision, calculated with various mathematical methods., Material and Methods: Group 1 consisted of 29 eyes after bimanual phacoemulsification performed through a 1.7 mm superotemporal clear corneal microincision. Group 2 consisted of 31 eyes after coaxial phacoemulsification performed through a 3.2 mm superotemporal clear corneal incision. Ophthalmic examination was performed preoperatively, 1 day, 7 days, 1, 3 and 6 months postoperatively. We performed auto-refractometry, keratometry, tonometry and visual acuity testing (UCVA and BCVA). SIA was calculated using: vector method, vector decomposition, Cravy's and Naeser's method., Results: There was no difference in mean UCVA and BCVA between the groups in the whole observation period. In vector method SIA did not differ significantly between the groups during the whole follow-up. In vector decomposition (C90 component), SIA was higher in group 2 than in group 1, one day and 1 month postoperatively. Cravy's and Naeser's method showed that SIA in group 2 was significantly higher as long as the 1-st month postoperatively. In the final examination, there was no significant difference in SIA values between the groups for all methods of calculations., Conclusions: Technique B-MICS through a 1.7 mm incision offers equally good functional results, as standard phacoemulsification through 3.2 mm superotemporal clear corneal incision. The SIA axis was more stable in microincision group in the whole follow-up period.

Evaluation of surgically induced astigmatism is important, as it allows to thoroughly assess the influence of surgical incision on corneal refraction. This influence can be established by calculating surgically induced astigmatism according to an appropriate mathematical method. The purpose of the study was to describe various mathematical methods used in the current literature to calculate surgically induced astigmatism. When comparing results of calculation of surgically induced astigmatism among different studies, it is necessary to take into account values obtained with the use of the same method of calculation, as various methods evaluate astigmatism differently.

Background: To evaluate the changes in corneal shape after phacoemulsification, PC IOL implantation and pars plana vitrectomy., Material and Methods: This study comprised 25 eyes of 25 patients who received phacoemulsification, 5.5 mm PMMA IOL implantation through 6 mm clear cornea incision with one single suture, and pars plana vitrectomy in one step - group A. To unique and compare the differences in surgical induced astigmatism (SIA) between combined procedures and two steps procedures, 2 control groups in one step surgery (only phacoemulsification with PCIOL--group B or only pars plana vitrectomy--group C) with the same shape and location of incision in cataract surgery and sclerotomy sites were analyzed., Results: The highest value of SIA was in group A which was not statistic significant different than group B (p = 0.97). In-group C, SIA was the lowest, and there was also not significant difference between groups A (p = 0.063). The differences in SIA between group B and C were statistic irrelevant too. (P = 0.09) Shifts in axis to with the rule component were noted in 43.9 % of cases in-group A, 40.79% in-group B, and 58.96% in-group C. The highest shift in axis to against the rule meridian was observed in-group B (tab. 2) and in direction with the rule in-group C., Conclusions: No statistical significance was observed in the amounts of the induced astigmatism and refractive cylinder among the group of combined phacoemulsification, IOL implantation and pars plana vitrectomy. However, optical rehabilitation can be delayed by a postoperative astigmatism.

The Aim: the history and clinical findings of 3.5 and 5.5-years old siblings with gyrate atrophy (GA) of the choroid and retina are presented., Patients and Method: Siblings: a girl at the age 3.5 years and her brother 5.5 years were examined. Clinical and biochemical findings were performed., Results: The best corrected visual acuity of both girl and boy was below normal values. Myopia of middle degree and myopic astigmatism was presented in both eyes of siblings. On fundus examination sharply defined bizarre shaped atrophic areas of peripheral choroid and retina were seen in both eyes of children. Fluorescein angiography of gyrate atrophy. The boy's plasma ornithine level was increased to 974.950 umol/L and the girl's to 1007.188 umol/L. The concentration of ornithine, lysine and arginine in the urea of these patients was high., Conclusion: Early clinical and biochemical diagnosis of gyrate atrophy of the choroid and retina in children is very important, because low protein diet with elimination of arginine can reduce the progression of this severe disease.

Objective: Assessment of post operation astigmatism and dynamics of its reduction within three month after the procedure., Material and Methodology: The research included cataract removal in 140 eyes by means of phacoemulsification (100) and extracapsular (40) methods. Central keratotomy and refraction measurements were conducted with a refractor on 2nd, 7th, 30th and 90th day after the procedure., Results: Average value of postoperative astigmatism after an extracapsular cataract removal was 4.69 D on the second day. After a phacoemulsification without a suture the value was 1.36 D, with a single loop suture -1.98 D, with a single criss-cross suture it was 2.89 D. Two alternative parameters of astigmatism reduction were suggested: a half-value period and a rate of reduction., Conclusions: Average early postoperative astigmatism values after an extracapsular cataract removal are at least twice as high as in the case of a phacoemulsification cataract removal. A suture applied after a phacoemulsification results in an increase in early postoperative astigmatism. Astigmatism half-value period and rate of reduction provide a good description of the dynamics of postoperative astigmatism reduction.

Purpose: To evaluate the astigmatic effect after phacoemulsification depending on size and location of incision., Material and Methods: Three groups of 30 patients each: In 1st group with scleral tunnel incision enlarged to 6 mm with continuous cross-like suture at 12 o'clock; In 2nd group with 3.2 mm scleral incision without suture at 12 o'clock; In 3rd group with 3.2 mm superotemporal incision in clear cornea, no suture. Postoperative astigmatism was examined by keratometry after 1 day, 1 week and 1 and 3 months post surgery. Surgically induced astigmatism was calculated by polar values method., Results: After 3 months observation the lowest mean postoperative corneal astigmatism was achieved in group III. The SIA was 0.71 in group III, 1.08 in group I and 0.95 in group II. The differences between group III and groups I, II were statistically significant., Conclusions: Surgically induced astigmatism can be minimized with incision in clear cornea and no suture.

Unlabelled: The study evaluates amount and direction of postoperative astigmatism after usually performed techniques of cataract surgery., Material and Methods: 90 consecutive patients (120 eyes) mean aged 74.5 years, who underwent cataract surgery with clear corneal superior (Group 1) or temporal incision (Group 2), sclero-corneal tunnel sutureless incision (Group 3) or limbal ECCE incision with x sutures (Group 4), were examined with respect to postoperative astigmatism. Anterior chamber opening was determined by primary astigmatism and nucleus hardness. All measurements were performed based on keratometry., Results: The highest mean value of with the rule astigmatism was assessed in Group 4. From the other hand, the least value were determined in group 2--95% with the rule and 5% oblique and in group 1--40% with the rule, 40% against the rule 20% oblique. In group 3, the value of postoperative astigmatism was higher, as compared with Group 1 and 2. It was assessed with similar proportion as in Group 1., Conclusions: At present cataract surgery techniques are not free of induced astigmatism. Study demonstrates significance of preoperative primary astigmatism assessment, with respect to surgery technique, to avoid postoperative astigmatism.

At present, cataract extraction offers great improvement for uncorrected and best corrected visual acuity and rapid postoperative rehabilitation. Cataract surgery is now treated as refractive surgery. Postoperative astigmatism has remained the only obstacle to the achievement of good, uncorrected visual acuity after cataract surgery. Postoperative astigmatism is a very complex clinical problem. The main influence on its appearance has preoperative astigmatism as well as shape and length of anterior chamber opening, suturing technique and wound healing.

Purpose: To evaluate postoperative astigmatism after cataract surgery., Material and Methods: The studied group consist of 135 patients subjected to cataract surgery; 75 patients (75 eyes) had extracapsular cataract extraction with 12 mm corneoscleral incision (group I); 30 patients (30 eyes) had phacoemulsification with 3.5 mm corneal incision (group II); 30 patients (30 eyes) had phacoemulsification with 3.5 mm tunnel incision (group III). Astigmatism was measured on the 6th day and 2 years after surgery., Results: Mean astigmatism on the 6th postoperative day was 4, 19 D (SD = 1.20) for group I, 2.50 D (SD = 0.47) for group II and 1.79 D (SD = 0.61) for group III. The differences between all the groups were statistically significant. The astigmatism assessed 2 years after surgery returned to preoperative values and there was statistic difference only between group I and III., Conclusion: Two years after cataract surgery astigmatism is comparable with the preoperative values irrespective of the operation technique.

Purpose: To present current state of knowledge on the subject of astigmatism etiopathogenesis., Material and Methods: A review of contemporary literature concerning pathomechanism of astigmatism., Results: The optical, morphological and functional changes taking place in the visual pathway during the astigmatism are described. Special attention was focused on the functional modifications in the neuronal system of Brodmann's 17th area. The frequency of occurrence as well as the forms of astigmatism among children and adults are characterized. The results of papers indicating environmental and genetic reasons of astigmatism as well as the possible pathomechanism of astigmatism creation are presented. The necessity of astigmatism treatment before the end of visual cortex plasticity has been pointed out. The attitude towards some surgical methods of astigmatism treatment is expressed.

Purpose: The purpose of this study was to evaluate changes of the corneal curvature as a result of excimer laser ablation using the TOSCA and TSA system., Material and Methods: At the First Department and Clinic of Ophthalmology, Silesian Medical School in Katowice, 8 patients (8 eyes) with the II and III degree of keratoconus according to the Amsler scale, including 4 women (4 eyes) and 4 men (4 eyes), were classified for the excimer laser surgery with the method of PRK with TOSCA program and TSA system with MEL 70 G-Scan (Asclepion-Meditec). The eyes did not tolerate contact lenses at all or because of peripheral location of the keratoconus. The patients were from 18 to 42 years of age (the mean age was 25.8 years). The observation period was 4 weeks., Results: According to the statistical results lack of correlation between the height of the absolute corneal curvature at the keratoconus and the achieved change after the surgery was reported. The improvement of patients absolute visual acuity was improving and reached 0.2 of the unit., Conclusion: To sum up, we can say that the favourable effect of decreasing the irregular corneal astigmatism with the method of laser fotoablations with topography-controlled system was maintained throughout the whole observation period, which probably allowed to shift in time planned corneal transplantation.

Purpose: The purpose of this study was to evaluate changes of the corneal curvature as a result of linear incisions with excimer laser and also to evaluate durability of the achieved effect, including the changes in visual acuity, topographic maps of the corneal curvature and keratometric changes at the location of keratoconus 2, 4, 8, 16, 24 weeks postoperatively., Material and Methods: At the First Department and Clinic of Ophthalmology, Silesian Medical School in Katowice, 294 patients went through ophthalmological examinations. 164 patients (187 eyes) with the III degree of keratoconus according to the Amsler scale, including 69 women (77 eyes) and 95 men (110 eyes), were classified for the excimer laser surgery with the method of linear, corneal incisions with MEL-60 (Aesculap-Meditec). The eyes did not tolerate contact lenses at all or because of peripheral location of the keratoconus. The patients were from 16 to 60 years of age (the mean age was 27.9 years)., Results: According to the statistical results, there were no difference between the effects of treatment between men and women. Correlation between the results of the surgery and the patients age showed that the latter did not have any effect on the final result. Lack of correlation between the height of the absolute corneal curvature at the keratoconus and the achieved change after the surgery was reported, thus changes of the corneal curvature parameters do not depend on its parameters before the surgical procedure. Absolute visual acuity of patients was improving and reached maximally 0.252 of the unit. As a result of the single surgery, the maximum change of keratometric values was 4.949 D, and the minimum was 3.611 D. In the case of the secondary surgery, the maximum keratometric value at the axis of the incision was 8.55 D and the minimum one was 7.101 D., Conclusion: To sum up, we can say that the favourable effect of decreasing the irregular corneal astigmatism with the method of linear laser fotoablations was maintained throughout the whole observation period, which allowed to shift in time planned corneal transplantation.

Purpose: To evaluate early and late astigmatism appearing after extracapsular cataract extraction with PC IOL implantation., Material and Methods: Astigmatism was examined in one hundred consecutive patients before operation and one week, 6 months and 12 months postoperatively., Results: During the first week after surgery most patients (82%) had with the rule astigmatism, which decreased gradually from 3.95 D cyl (mean value) to 0.08 D cyl after a year. Against the rule astigmatism was present in 14% of cases and increased from 2.40 D cyl (mean value) to 3.07 D cyl in the same period of time. On the last examination 35% of patients didn't use any astigmatic correction., Conclusions: Traditional ECCE with PC IOLs causes postoperative astigmatism in most patients. Majority of them has with the rule astigmatism, which decreases gradually during the first postoperative year and may change into against the rule astigmatism.

Purpose: To assess the effect of the type of corneal incision and its closure on astigmatism after cataract extraction., Material and Methods: Induced astigmatism was evaluated in 94 eyes after cataract extraction with IOL implantation 7 days, 1 month, 3 months, 6 months and 12 months after operation. 3 groups: were compared I--after extracapsular extraction with corneo-scleral incision (10 h-2 h) and continuous cross-like suture, II--after phacoemulsifications with scleral tunnel incision (3.3 mm) without suture., Results: The highest induced astigmatism was observed 7 days after surgery in patients with the longest corneo-scleral incision with suture (group I). Induced astigmatism gradually decreased in time. In group after phacoemulsification especially with no suture low astigmatism with prompt stabilization was observed., Conclusions: The length and type of closure of the incision have an essential effect on induced astigmatism. Small incision, especially without suture induces minimal early postoperative astigmatism which remains stabile.

Purpose: The aim of this study was to evaluate the disruption of the blood-aqueous barrier (BAB) and the induced astigmatism following phacoemulsification, trabeculectomy and phacotrabeculectomy., Material and Methods: 141 eyes of patients who underwent different surgical procedures of the anterior segment were examined with the use of computer-assisted videokeratography. All maps were recorded preoperatively, and one and five days after surgery. We also applied a laser flare-meter in 41 eyes in order to quantify aqueous flare following these procedures., Results: The mean surgically-induced astigmatism following conventional trabeculectomy was 2.1 D and 1.4 D one and five days postoperatively, phacoemulsification with sutures 2.7 D and 1.9 D and phacotrabeculectomy 3.0 D and 2.4 D, respectively. Lower values of astigmatism obtained after sutureless phacoemulsification were 0.6 D and 0.3 D one and five days postoperatively, respectively (p < 0.05 vs Phaco+IOL+Trab. group, p < 0.01 vs other groups). It was found that aqueous flare values following phacotrabeculectomy were 58.0 photon counts/milisec.--one day, 39.3--3 days, 24.4--7 days, 20.4--10 days postoperatively. Significantly reduced values were observed after phacoemulsification--27.6 one day after surgery and 17.6--3 days later (p < 0.01 vs Phaco+IOL+Trab.group)., Conclusions: It could be concluded that induced astigmatism and the amount of inflammation were the highest after triple procedure and the lowest after phacoemulsification.

Purpose: The aim of the present study was to investigate the effect of conventional and mitomycin trabeculectomy on the corneal astigmatism., Subject and Methods: Measurements with the use of computer-assisted videokeratography (Eye-Sys) were performed in 34 glaucoma patients who underwent trabeculectomy. Color-coded topography maps were analyzed to obtain astigmatic data., Results: The mean surgically-induced astigmatism in conventional trabeculectomy group was 2.2 D and in the mitomycin group 4.0 D, 1 day post-op, 1.3 D and 3.0 D after 10 days and 0.4 D and 1.1 D after 3 months, respectively., Conclusion: There was an apparent correlation between the amount of induced astigmatism and the use of mitomycin. This may be related to the impaired healing process of trabeculectomy wound and lower intraocular pressure in the mitomycin group.

Purpose: This study was designed to show the corneal topography changes induced by contact lens use., Material and Method: The corneal topography has been examined in 19 contact lens users (37 eyes)., Results: The mayor changes in topography have been found between 6th and 18th week after stopping the contact lens wearing.

Purpose: To analyse results of cataract surgery with intraocular lens implantation in eyes with previous glaucoma surgery., Material and Methods: In the years 1994-1996 in 44 eyes of 39 patients (13 males and 26 females) cataract surgery was performed. The follow-up ranged from 3 to 12 months (mean 8.5 months). The time interval between glaucoma surgery and cataract surgery ranged from 1 month to 40 years. The most frequent kind of glaucoma surgery was trabeculectomy (77.3%). An inverse corneal incision and envelope capsulotomy was performed in every eye, thirty eight percent required synechiolysis and twenty percent iridoplastic surgery., Results: Intraoperatively there were 2 cases of posterior capsule tears with vitreous loss and 4 mild hemorrhages into anterior chamber. The most common postoperative complications were Descemet's membrane folds (36.4%), fibrinous exudate in anterior chamber (27.3%) and transient corneal oedema (9.2%). Fifty percent of eyes achieved the best corrected visual acuity-5/8 and better. Postoperative astigmatism mostly with the rule was observed in 86.4% eyes. Postoperative intraocular pressure was unchanged in 81.8% eyes, and in 13.8 percent of eyes preoperative glaucoma medication was no longer required., Conclusions: The technique of extracapsular cataract extraction with intraocular lens implantation is a safe procedure giving good visual rehabilitation and having no influence on glaucoma control in patients who had previous glaucoma surgery.

Purpose: To evaluate the development of astigmatism after cataract extraction depending on the kind of incision, Material and Methods: Astigmatism was examined in 107 eyes of 92 patients, who underwent cataract extraction, mostly with IOL's implantation. In 52 eyes phacoemulsification with tunnel incision, measuring 5 mm in 27 and 8 mm in 25, was performed. In the control group of 55 eyes incision with scleral flap measured 2/5 of the corneal circumference. In cases with 5 mm incisions no sutures were used, in 8 mm incisions wounds were closed with single sutures and in control group the double continuous sutures were applied. Astigmatism was measured in two days, one week, four weeks and 3 months after surgery., Results: Post-operative astigmatism decreased gradually and after 3 months was average 0.14 D in the eyes without sutures, 0.68 D in those with single ones and 1.78 D in the control group.

The authors presented results of 346 cataract extraction with IOL implantation--in 184 eyes anterior and in 162 posterior chamber. The follow-up ranged from 3 months to 6 years (mean 1.6 year). In 80.6% of cases, visual acuity after surgery was 0.6-1.0. Corneal astigmatismus 2.5-5.0 D was found in 31.2% of the eyes. The authors analysed early and late complications, taking into account the differences between anterior and posterior chamber IOLs implantation.

The author examined the postoperative astigmatism in 70 eyes of patients subjected to an extracapsular extraction with implantation of a posterior chamber lens in postoperative periods of 14 days, 3, 6 and 12 months. Compared were 2 groups of eyes with different methods of wound closure: by single knot stitches and by a continuous x-shaped suture. The degree of astigmatism showed to be higher in the 6 first postoperative months in the group of single knot stitches but after 6 months it became levelled with the degree of astigmatism detected in the group of continuous x-shaped suture.

One of the main problems of corneal transplantation is the postoperative astigmatism. In the last period the intraoperative application of the kerato-scope, new type of needles and threads in stitching the corneal patch created a chance for solving this problem. The authors present the methods used for stitching of the corneal patch, their advantages and the defects with consideration of differences resulting from the thickness and kind of the thread, from the length and form of the needle. Basing on personal experience and data from the literature they propose the technique of the suture which they are using.

Operations for the reduction of astigmatism in cases of keratoconus were performed on 10 eyes in 8 patients. Disruption of the continuity of the posterior limitans lamina of the cornea was not observed in either case. In 4 cases the intervention had to be repeated. The period of observation amounts presently 1-3 months.

Visual acuity with correction was checked in 86 persons with anterior and posterior chamber lenses in various postoperative periods. In the majority of examines of both groups in the late postoperative period the visual acuity was correct. The results obtained in both groups of patients were compared. The causes of astigmatism detected in some cases were considered.