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The aim of the study was to report the effects of surgical treatment of three victims of a cluster munition in Ukraine. A 32-year-old woman and her sons-6-year-old male twins-presented in Poland after 18 days of delay in treatment. All ocular injuries were bilateral. One of the boys presented with total retinal detachment and a post-traumatic cataract as well as corneal sutures in one eye and a post-traumatic cataract in the other eye. The other boy had already developed atrophy in one eye and a vitreous hemorrhage in the other eye. The woman suffered from bilateral post-traumatic cataract with multiple glass intraocular foreign bodies (IOFBs). The surgical treatment included cataract surgery with intraocular lens implantation in three eyes, removal of IOFBs in one eye, and enucleation of the atrophic eye with implantation of an ocular prosthesis preventing constriction of face tissues. The eye with retinal detachment underwent pars plana vitrectomy, and the vitreous hemorrhage resolved itself. Postoperatively, visual acuity improved significantly in four of six eyes. Only in the eye with an open-globe injury and persistent retinal detachment, the final visual acuity was still poor. In conclusion, cluster munition may lead to bilateral ocular trauma with IOFBs, open-and close-globe injuries, and severe vision loss if left untreated. Modern ophthalmic surgery leads to vision with IOL improvement and solving the eyes after severe combat injury., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nowomiejska, Adamczyk, Haszcz, Preys and Rejdak.)

Purpose: To report the visual outcomes of different techniques for iris pupilloplasty in eyes after traumatic and iatrogenic damage., Methods: 70 consecutive eyes with posttraumatic (80%) and postoperative (20%) iris damage were included. According to the preoperative diagnosis, the eyes were divided into three groups: mydriasis (50%), partial iris defects (24%), and iridodialysis (26%). Multiple techniques were performed: the Siepser slip-knot technique, the "lasso" technique, and suturing to the sclera. These techniques were combined in some cases., Results: The best improvement of visual acuity was found for the Siepser slip-knot technique with a median of 0.7 (SD ± 0.83) before surgery and 0.52 logMAR (SD ± 0.65) after surgery with regard to the surgical technique, and for mydriasis with a median of 0.7 (SD ± 0.75) before surgery and 0.52 logMAR (SD ± 0.49) after surgery with regard to preoperative diagnosis. Pupilloplasty was combined with additional surgery (corneal suturing, secondary intraocular lens implantation, anterior or pars plana vitrectomy) in 80% of cases. Apart from corneal suturing, all additional procedures ensured improvement in visual acuity., Conclusions: The slip-knot technique was the only suturing technique that resulted in a significant improvement in visual acuity. Other surgical procedures are usually needed in the majority of cases that undergo pupilloplasty, and they also give visual gain.

To evaluate visual outcomes and safety of the double-needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double-needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow-up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow-up at three months. Further studies with longer follow-up evaluations are required to verify long-term complications.

Background: Several techniques for fixation of the posterior chamber intraocular lens (IOL) have been developed. We evaluate long-term functional outcomes and safety of posterior chamber IOL implantation using Hoffman scleral haptic fixation and sutureless Sharioth technique in patients with posttraumatic and postoperative aphakia., Methods: This retrospective case-series included 42 eyes operated by one surgeon. The data including demographic data, ocular history, preoperative, early postoperative and final best corrected visual acuity (BCVA), rate of complications as well as postoperative IOL position were collected. The mean follow-up was 14.5 months. Hoffman haptic scleral fixation was performed in 31 eyes, Sharioth technique-in 11 eyes. Aphakia was due to eye trauma (19) or complicated cataract surgery (23)., Results: Overall, the final BCVA improved in 26 eyes, did not change in 5 eyes, and worsened in 11 eyes. No significant differences in BCVA were found between groups operated with Hoffman scleral fixation and Sharioth technique. Postoperatively, we noticed two dislocations of IOL fixated using Sharioth technique and none after Hoffman technique. No severe complications were observed., Conclusion: Both transscleral fixation techniques are feasible methods of secondary IOL implantation in posttraumatic and postoperative aphakia. with low incidence of complications, however visual outcomes are diverse.

Purpose. To evaluate longitudinal functional and anatomical results after combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP) using a wide-field Landers intraoperative temporary keratoprosthesis (TKP) in patients with vitreoretinal pathology and corneal opacity due to severe ocular trauma. Material and Methods. Medical records of 12 patients who had undergone PPV/PKP/KP due to severe eye trauma were analyzed. Functional (best-corrected visual acuity) and anatomic outcomes (clarity of the corneal graft, retinal attachment, and intraocular pressure) were assessed during the follow-up (mean 16 months). Results. Final visual acuities varied from NLP to CF to 2 m. Visual acuity improved in 7 cases, was unchanged in 4 eyes, and worsened in 1 eye. The corneal graft was transparent during the follow-up in 3 cases and graft failure was observed in 9 eyes. Silicone oil was used as a tamponade in all cases and retina was reattached in 92% of cases. Conclusions. Combined PPV and PKP with the use of wide-field Landers TKP allowed for surgical intervention in patients with vitreoretinal pathology coexisting with corneal wound. Although retina was attached in most of the cases, corneal graft survived only in one-fourth of patients and final visual acuities were poor.

This paper documents a rare nonprogressive developmental disorder-bilateral circumscribed posterior keratoconus-in a 60-year-old man referred for a cataract surgery. For the first time ultrasound biomicroscopy was used to visualise the local anterior bulging of the posterior corneal surface with concomitant thinning of the stroma. The amount of localized posterior depression, corneal thickness and the refractive power of both the posterior and anterior corneal curvature were measured using slit-scanning topography analysis (Orbscan).

Fungal keratitis, an important cause of corneal infectious disease, is one of the most challenging types of microbial keratitis to diagnose, isolate the etiologic fungal organism and treat successfully. Aspergillus spp. are most commonly responsible for fungal keratitis worldwide. Most cases occur in hot, humid climates. Fungi invade the ocular surface only when it is compromised and gain access into the corneal stroma through a defect in the epithelial barrier. Pathogens multiply then, and cause inflammatory reaction together with tissue necrosis. Symptoms of fungal keratitis typically are not as acute as those of other forms of microbial keratitis. On examination, both signs seen in other forms of microbial keratitis and specific features of fungal keratitis are observed. In all cases with suspected fungal keratitis, corneal smears and cultures should be performed as soon as possible. Antifungal therapy should be restricted to those cases with fungus-positive laboratory results. The use of topical corticosteroids in the treatment of fungal keratitis is contraindicated. In about one-third of patients pharmacological therapy is not successful. In those cases, surgical intervention is essential. The main goal of surgical intervention is to control infection and maintain the integrity of the globe. The most commonly performed surgery in fungal keratitis is therapeutic penetrating keratoplasty. The use of topical corticosteroids is contraindicated in early postoperative period.

We reviewed ophthalmic manifestations in Lyme borreliosis, concentrating on clinical and laboratory diagnosis, differential diagnosis and treatment options. Ocular involvement may occur in every stage of the disease. Conjunctivitis and episcleritis are the most frequent manifestations of the early stage. Neuro-ophthalmic disorders and uveitis occur in the second stage whereas keratitis, chronic intraocular inflammation and orbital myositis have been reported in the third stage of borreliosis.

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.

Purpose: To present the evaluation of computed tomography (CT) application for detecting the intraocular foreign bodies., Material and Methods: Sixteen computed tomographies of orbit to localise a foreign body were performed in the 2nd Radiology Department at Lublin University School of Medicine from May 1995 to October 1998. During examination 2 mm computed tomography cuts were taken. In almost all cases fundus examination was not possible because of hazy media (cataract, vitreous haemorrhage, endophthalmitis). Pars plana vitrectomy was applied to remove foreign body in all cases., Results: In 14 cases a foreign body was localised inside the eye (3 of them were embedded in the wall of the eye) and in 2 cases a double perforation was noticed. With pars plana vitrectomy 12 of 14 intraocular foreign bodies were removed. Two foreign bodies deeply embedded in the wall of the eye were left. One of the two foreign bodies after double perforation was removed from the orbit and the second, which was localized deeply in the orbit, was left., Conclusion: The localisation of the foreign bodies using the computed tomography is a very accurate and sensitive method, facilitating further surgery.

A case is reported of exogenous Candida endophthalmitis after ocular injury with a metal wire used for hop growing. A detailed description of treatment with vitrectomy and intravitreal amphotericin B injection is presented. On the basis of our experience, in such cases it is advisable to perform vitrectomy with amphotericin B intravitreal injection and silicone oil tamponade to prevent retinal detachment.

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 present study was designed to evaluate the topography of a series of keratoconus patients., Subjects and Methods: Using a computer-assisted videokeratography (Eye Sys) we determined the topographic findings of 85 eyes of 46 consecutive patients with keratoconus. We analysed some quantitative topographic parameters like: power at the apex, central corneal power, the amount of irregular astigmatism, distance between the apex and the visual axis, difference in central corneal power between the two eyes of the same individual and steepening of the inferior cornea compared with the superior cornea., Results: Keratoconic topographic alterations were classified into two groups. Fifty seven of the cones (71%) could be described as peripheral with steepening of the cornea extending to the limbus. The remaining twenty three eyes (29%) had steepening confined to the central cornea. In many instances corneal topography was characterized by a high degree of nonsuperimposable mirror image symmetry (enantiomorphism) in the location of the topographic alterations between the two eyes of an individual patient. In all patients, irrespective of the topographic pattern, the inferior midperipheral cornea was steeper than superior cornea as quantified by an l-S value., Conclusion: Study of the topography in keratoconus using this technique may prove useful for documenting the pattern of involvement of the anterior corneal surface and providing insight into the pathogenesis of this condition.

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: To present severe involvements of Borrelia burgdorferi in the etiology of uveitis, optic neuritis and other ocular inflammatory conditions., Methods: IgM and IgG antibodies for Borrelia burgdorferi were detected by ELISA. Since May 1995 we have examined 78 patients for borreliosis., Results: Borreliosis was diagnosed in 11 patients (4 males, 7 females; aged 7 to 48). 7 persons remembered being bitten by a tick, 3 months to 3 years before the onset of ocular symptoms. All patients had systemic symptoms and signs. Ocular manifestations were as follows: nonspecific chronic conjunctivitis in 4 patients, keratitis in 2, diminished corneal sensation in 1, iritis in 1, intermediate uveitis and perivasculitis in 1, posterior uveitis in 3, retinal haemorrhage in 1, optic neuritis in 1, optic disc oedema in 2, sixth nerve paresis in 1 patient., Conclusions: We emphasize the importance of performing serological tests for borreliosis in patients with uveitis, inflammatory diseases of unknown etiology, optic neuritis and other neuro-ophthalmic conditions.

The purpose of our study was to compare the incidence of intrabulbar infections following cataract extraction and its correlation with the results of preoperative bacterial cultures. We examined 2344 patients who were operated on from 1st January 1993 to 31st December 1994 in our hospital. Patients were divided into 3 groups. In the first group surgery, was performed only in cases where preoperative cultures were negative, in the second group conjunctival cultures were prepared just before surgery. In the third group no preoperative cultures were prepared. Additionally in the second and the third group one drop of 5% Betadine solution was administered to the conjunctival sack just before surgery. We conclude that negative preoperative conjunctival cultures did not prevent from postoperative infections of the eye. After resigning of preoperative bacterial cultures the incidence of intrabulbar infections following cataract surgery did not increase in our study.

Purpose: To evaluate the usefulness of some parameters of the aqueous humor: pH, pO2 (oxygen pressure), pCO2 (carbon dioxide pressure) and HCO3- concentration in the diagnosis of uveitis. Changes of these parameters following conventional treatment and cryotherapy have also been investigated., Material and Method: We used 40 grey rabbits (weighing 2.5-3.0 kg). Uveitis was evoked by intravitreal injection of 5 mg of animal albumin. Cryotherapy was performed by transconjunctival, quintuple cryoapplication (30 s) over ciliary body. Samples of aqueous humor were collected 6, 12, 24 and 48 hours after albumin injection. pH, pO2, pCO2 values and HCO3- concentration were determined using Astrup microanalyser., Results: Parameters of aqueous humor, especially pH, pCO2 and HCO3- turned out to be fairly sensitive indicators reflecting the natural history of experimental uveitis. Cryotherapy characteristically modulates the pH, pCO2 and HCO3- values in the anterior chamber., Conclusions: We came to the conclusion that monitoring of these parameters may give some important information about the intensity of the course of uveitis and the influence of the treatment. Normalisation of the values usually parallels clinical improvement.

Aim: The purpose of this study was to noninvasively quantify, with the use of a laser-flare meter, the alterations of the blood-aqueous barrier following penetrating keratoplasty. This could objectively indicate the disruption of this barrier in eyes with early allograft rejection, possibly even before the manifestation of the clinical signs, and would help to monitor the efficacy of the treatment., Material and Methods: We used the laser flare-meter (Kowa FM-500) to investigate alterations of the blood-aqueous barrier following uncomplicated penetrating keratoplasty (PK) and in corneal allograft rejection. Examination was performed in 53 eyes of 50 patients after uncomplicated PK (7 days to 12 months after PK), in 20 normal control eyes and in 8 patients with acute allograft rejection before and during the treatment. The treatment consisted of systemic and topical administration of steroids and in some cases additionally topical immunosuppressants., Results: Mean flare values in the control eyes were 3.9 +/- 1.0 photon counts/ms. During the first two weeks after uncomplicated keratoplasty they were significantly increased (18.2 +/- 5.8) but were postoperatively slowly decreasing in time, nearly reaching the control values within 6-12 months. They were considerably higher in eyes with acute allograft rejection (34.0 +/- 13.1), but gradually diminished to 8.1 +/- 1.2 after successful treatment., Conclusions: The application of laser flaremetry is useful in the follow-up of patients after perforating keratoplasty, especially after high risk grafts. The method helps to detect quantitatively early allograft rejection and is beneficial in monitoring the effectiveness of the treatment.