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This retrospective study aimed to assess the effectiveness of using MicroPulse transscleral cyclophotocoagulation (µP-TSCPC) in patients who had previously undergone pars plana vitrectomy (PPV), depending on the endotamponade used.For the study, a total of 60 patients were enrolled who underwent PPV followed by tμP-TSCPC as a result of an increase in intraocular pressure (IOP) over the norm of 21 mmHg. In this group of patients, 20 received silicone oil endotamponade during PPV, 20 received sulfur hexafluoride gas SF6, and in another 20 a differentiated balanced salt solution (BSS) was used.The main indications for conducting PPV were (1) retinal detachment (silicone oil endotamponade was used; n = 12); (2) dislocation/subluxation of the patient's own or artificial intraocular lens (balanced salt solution (BSS) endotamponade was used; n = 11); (3) the presence of an epiretinal membrane and/or a macular hole (BSS endotamponade was used; n = 9, or SF6; n = 20); and (4) hemorrhage into the vitreous chamber (silicone oil endotamponade was used; n = 8).The choice of endotamponade used during PPV was not found to determine the effectiveness of µP-TSCPC treatment. The effectiveness of µP-TSCPC in patients after PPV depended, above all, on the etiology of the disease, for which PPV was previously performed. The lowest effectiveness of µP-TSCPC was noted in cases where the reason for conducting PPV was hemorrhage into the vitreous chamber and silicone oil endotamponade was used, while the highest effectiveness was noted in cases where PPV was conducted owing to the presence of an epiretinal membrane and/or a macular hole and SF6 endotamponade was used.

Purpose. To present applications of anterior segment optical coherent tomography (AS OCT) for anomalies of the eye in a Polish paediatric cohort. Materials and Methods. Seventy-four eyes of infants and older children were examined. The majority of them underwent general anaesthesia to allow OCT to be performed in the operating room, but a few were examined in a routine way. We focused on corneal, anterior chamber, iris, and lens disorders. Measurements included corneal morphology, anatomy of the anterior chamber, and general involvement of surrounding tissues in pathologic lesions. Results. We divided the paediatric patients into several groups by considering the type of disease and involvement of particular tissues. The groups were selected based on OCT usefulness in describing their ocular disorders. Conclusion. The collected anterior segment disorders showed huge usefulness for paediatric diagnosis and treatment planning.

Age-related macular degeneration (AMD) is a progressive, chronic disease of the central area of the retina, which, if untreated, leads to blindness. This study aimed to compare the effectiveness of therapy using anti-VEGF drugs, namely brolucizumab and aflibercept, in patients with neovascular AMD (nAMD) during a monitoring period lasting around 20 weeks. The analysis consisted of 40 patients diagnosed with neovascular age-related macular degeneration, with 20 patients receiving aflibercept (Eylea, Bayer) at a dose of 2 mg/50 µL into the vitreous chamber at the following intervals—3 doses, 4 weeks apart, followed by a fourth dose after 8 weeks. The remaining 20 patients received brolucizumab (Beovu, Novartis) at a dose of 6 mg/50 µL, administered in the following schedule—3 initial doses, 4 weeks apart, with the administration of a fourth dose decided for each patient individually by the doctor, depending on disease activity, assessed through imaging tests. To evaluate treatment effectiveness, the following measurements were used: ‘read distance and near visual acuity’ for each eye separately using the Snellen chart; and non-invasive retinal imaging techniques—optical coherence tomography (OCT) and OCT angiography (OCTA). In patients treated using brolucizumab, during the observation period, statistically significant differences were found in the following parameters: flow area (p = 0.0277); select area (p = 0.0277); FOVEA (p = 0.0073); visus (p = 0.0064). In brolucizumab-treated patients, changes in OCT and OCTA, indicating an improvement, were already visible after the first injection of the drug, whereas in the aflibercept-treated group, changes were only visible after the fourth injection. We found a higher effectiveness of brolucizumab therapy compared to aflibercept in patients with nAMD during an observations period lasting 20 weeks. Our observations are significant, although they require further research.

The aim of this study was to investigate the changes in the retinal capillary plexuses in patients after pars plana vitrectomy (PPV), which is used for the treatment of rhegmatogenous retinal detachment (RRD). In this study, we included the results of 114 patients who underwent PPV after total retinal detachment (RRD, retinal detachment group). It should be kept in mind that to qualify for the study group, there was a condition that retinal detachment be only present in one eye, allowing the fellow healthy eye to be used for the control group, and the study, therefore, did not include cases where retinal detachment occurred binocularly. Optical coherence tomography (OCT) and OCT-A images were taken at 9 ± 2 months (median 10 months) after the surgery, with the study conducted in the years 2017–2019. OCT was used to examine the external limiting membrane (ELM), central macular thickness (CMT) and retinal nerve fiber layer (RNFL), while OCT-angiography (OCT-A) was used to examine the extent of the foveal avascular zone (FAZ) in the deep and superficial capillary plexuses. Changes in the FAZ area of the superficial plexus (SCP) between the study and control groups were analyzed over 346 ± 50 days. In our study, we observed changes in the FAZ area between the RRD and control groups in the SCP (203.65 ± 31.69 μm2 vs. 215.30 ± 35.82 μm2, p = 0.28733) and DCP (284.79 ± 35.82 µm2 vs. 336.84 ± 32.23 µm2, p = 0.00924). Changes in the RNFL thickness between the study and control groups over 346 ± 50 days were as follows: 90.15 μm vs. 82.44 μm, p = 0.19773. Disruption of the external limiting membrane was observed in 78.95% (90 eyes) of the study group. In the control group, it was undamaged, and no integrity disorder was observed. In the RRD, changes occurred in the FAZ of both the SCP and the DCP, which reduced the extent of this zone, an effect that was more pronounced in DCPs. A better understanding of the anatomical and hemodynamic changes taking place in the retina after macula-off RRD might be helpful in answering the question as to why BCVA in these cases is “only” or “as much as” from 0.4 to 0.1, namely, that it might be related to changes in the neurosensory retina after macular peeling.

BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye. Complications following PPV include raised intraocular pressure (IOP). This retrospective study aimed to compare methods of endotamponade used during 23-gauge PPV and the risk of raised IOP during 24-month follow-up at a single center. MATERIAL AND METHODS The study included 196 patients (age, 15-86 years; mean, 63.5 years) (196 eyeballs). There were 93 patients (47.45%) with a preoperative history of type 2 diabetes mellitus and 14 patients (7.14%) with a history of myopia. IOP was measured with Goldmann applanation tonometry at one-, three-, six-, 12-, and 24-month follow-up. The outcome was compared following endotamponade with silicone oil, sulfur hexafluoride (SF6), and balanced salt solution (BSS). RESULTS Mean IOP at one-month follow-up was 17.2 mmHg (±3.61 mmHg; range, 9-45 mmHg), and at 24-month follow-up was 17.3 mmHg (±3.23 mmHg; range, 7-30 mmHg). IOP following PPV was significantly associated with the indication for PPV (P=0.023), and the type of endotamponade used (P=0.049). In patients with silicone oil endotamponade, the risk of IOP at 24 months was increased by 2.3 times compared with SF6 or BSS endotamponade. Patients with SF6 endotamponade had a risk of IOP that was 3.3 times lower than for silicone oil tamponade or BSS tamponade. CONCLUSIONS Silicone oil endotamponade in PPV was associated with an increased risk of IOP at 24-month follow-up.

Background & Objective:Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland.Methods:In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of pResults:The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05).Conclusion:Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.

Aims: To evaluate the ocular and systemic factors involved in cataract surgery complications in a teaching hospital using artificial intelligence.Methods: One eye of 1,229 patients with a mean age of 70.2 ± 10.3 years old that underwent cataract surgery was selected for this study. Ocular and systemic details of the patients were recorded and then analyzed by means of artificial intelligence. A total of 1.25 billion simulations of artificial intelligence learning and testing were conducted on several variables and a customized model of analysis was developed.Results: A total of 73 complications were recorded in this study. According to the analysis performed, the main factors involved in cataract surgery complications were: a surgeon in training, axial length and intraocular lens power. The model predicted how long surgery would last with an error of Conclusions: According to the data here obtained, artificial intelligence could be an interesting option to build customized models able to prevent complications and to predict actual surgery time. The customized algorithm option allows the development of better models adaptable to different units as well as the possibility to be calibrated for the same unit along time.

Objective: The pattern of urinary excretion of total sulphated glycosaminoglycans (GAGs) and their particular types: chondroitin sulphate/dermatan sulphate (CS/DS) and heparan sulphate (HS) was analysed in obese patients with type 2 diabetes mellitus (T2DM) treated with metformin in monotherapy for the period of six months.Methods: The urinary sulphated glycosaminoglycans were quantitated using standardised dye (1.9-dimethylmethylene blue)-binding method and normalised to creatinine level.Results: Urinary total GAGs, CS/DS and HS levels were significantly higher in untreated diabetic patients in comparison to healthy subjects. Moreover, it was observed that urinary total GAGs, CS/DS and HS levels in diabetic patients after six-month metformin therapy were significantly decreased versus pre-treatment situation.Conclusions: The obtained results suggest that the six-month treatment with metformin in obese patients with T2DM has a regulating influence on the systemic changes in proteoglycans/glycosaminoglycans, resulting in a decrease in the urinary excretion of total GAGs, CS/DS and HS.

Background The Corvis® ST tonometer is an innovative device which, by combining a classic non-contact tonometer with an ultra-fast Scheimpflug camera, provides a number of parameters allowing for the assessment of corneal biomechanics. The acquired biomechanical parameters improve medical diagnosis of selected eye diseases. One of the key elements in biomechanical measurements is the correct corneal contour detection, which is the basis for further calculations. The presented study deals with the problem of outer corneal edge detection based on a series of images from the afore-mentioned device. Corneal contour detection is the first and extremely important stage in the acquisition and analysis of corneal dynamic parameters. Result A total of 15,400 images from the Corvis® ST tonometer acquired from 110 patients undergoing routine ophthalmologic examinations were analysed. A method of outer corneal edge detection on the basis of a series of images from the Corvis® ST was proposed. The method was compared with known and commonly used edge detectors: Sobel, Roberts, and Canny operators, as well as others, known from the literature. The analysis was carried out in MATLAB® version 9.0.0.341360 (R2016a) with the Image Processing Toolbox (version 9.4) and the Neural Network Toolbox (version 9.0). The method presented in this paper provided the smallest values of the mean error (0.16%), stability (standard deviation 0.19%) and resistance to noise, characteristic for Corvis® ST tonometry tests, compared to the methods known from the literature. The errors were 5.78 ± 9.19%, 3.43 ± 6.21%, and 1.26 ± 3.11% for the Roberts, Sobel, and Canny methods, respectively. Conclusions The proposed new method for detecting the outer corneal contour increases the accuracy of intraocular pressure measurements. It can be used to analyse dynamic parameters of the cornea.

We compared the visual and refractive outcomes, intraocular pressure (IOP), endothelial cell loss (ECL), and adverse events in keratoconus patients after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) with the best corrected visual acuity (BCVA) below 0.3 (logMAR 0.52). This is a prospective, comparative cohort study of 90 eyes (90 patients) with a clinical diagnosis of keratoconus. Patients underwent a complete eye examination before the surgical approach, 6 and 12 months postoperatively that consisted of BCVA, refractive astigmatism (AS), central corneal thickness (CCT), IOP, and ECL. Secondary outcomes were adverse events related to the surgical procedure. With lower ECL and less adverse events, DALK was revealed to be beneficial over PK with similar visual outcomes. Results: There was no significant difference between the BCVA in the DALK and PK groups (at 6 months: 0.49 ± 0.17 vs. 0.48 ± 0.17, p = 0.48, at 12 months: 0.54 ± 0.17 vs. 0.52 ± 0.14, p = 0.41). The mean value of AS was significantly lower after the PK procedure when compared to DALK, after both 6 and 12 months of follow up (p &lt, 0.001). The CCT in the DALK group was significantly lower when compared to the PK group (at 6 months: 452.1 ± 89.1 µm vs. 528.9 ± 69.9 µm, p &lt, 0.0001, at 12 months: 451.6 ± 83.5 µm vs. 525.5 ± 37.1 µm). The endothelial cell loss at 12 months after surgery was significantly lower after DALK when compared to PK (p &lt, 0.0001). DALK transplantation should be considered as an alternative procedure in the surgical treatment of keratoconus.

Background The purpose of this work was to study the evolving trends in techniques and indications for corneal transplantation in Poland. Methods This retrospective, descriptive analysis of corneal transplantations was performed at the Ophthalmology Department of Saint Barbara Hospital, Trauma Center, Sosnowiec, Poland, between 1988 and 2014. Structure of indications and surgery type rates over 26 years were tabulated by means of 5-year intervals. Results Between 1989 and 2014, 1762 corneal transplantations were performed, including 1375 (78%) cases of penetrating keratoplasty, 137 (8%) lamellar keratoplasty, 112 (6%) patch grafts, and 138 (8%) keratolimbal allografts. The major indications and their respective overall percentage were corneal leucoma (24%), pseudophakic/aphakic bullous keratopathy (22%), Fuchs dystrophy (13%), keratoconus (13%), re-graft (11%), keratitis (9%), and limbal stem cell deficiency (8%), with changes in relative frequency of the leading indications over the following time intervals. The number of corneal transplantations gradually increased during the years reviewed. The rates of lamellar, keratolimbal, and patch grafts have grown dynamically since 2010, reaching 20%, 17%, and 12%, respectively, of procedures performed during 2010 to 2014. Conclusions Over the past quarter of a century, there has been evolution in corneal transplantation service, from the first penetrating keratoplasty to the wide spectrum of procedures, including femtosecond laser–assisted keratoplasty. Although, since 2010, the rates of lamellar and keratolimbal allografts have grown rapidly, penetrating keratoplasty has remained the leading technique.

Aim. The comparative analysis of the central and peripheral corneal thicknesses using two different imaging systems: Scheimpflug camera and swept-source OCT was performed to investigate the differences in corneal thickness analysis in diabetic patients. Materials and Methods. The study group consisted of the 147 eyes of 107 diabetic patients who were examined and compared with 138 eyes of 89 nondiabetic cataract patients. The inclusion criteria for the study group was diabetes mellitus type II identified no less than 10 years ago, with NPDR not requiring prior laser treatment. The control group was recruited from nondiabetic patients. Measurements were obtained on the Pentacam Scheimpflug imaging system and Casia swept-source OCT. All study parameters from anterior chamber images were processed for five different zones, the central zone and four peripherals—superior, inferior, nasal, and temporal. A fit zone diameter of 4 mm was applied for both instruments. Results. The Pentacam system overestimated corneal measurements in the DM group when compared with the Casia OCT in superior corneal zone (p=0.04), inferior corneal zone (p=0.02), nasal corneal zone (p<0.001), and temporal corneal zone (p=0.01). In the control group, there were also statistically significant differences between the Pentacam and Casia OCT measured values in inferior corneal zone (p=0.001), nasal corneal zone (p=0.04), and temporal corneal zone (p<0.001). Conclusion. Scheimpflug camera pachymetry measurements showed statistically higher CCT values when compared with swept-source OCT measurements.

Purpose. Comparative analysis of central and peripheral corneal thickness in PEX patients using three different imaging systems: Pentacam-Scheimpflug device, time-domain optical coherence tomography (OCT) Visante, and swept-source OCT Casia. Materials and Methods. 128 eyes of 80 patients with diagnosed PEX were examined and compared with 112 normal, non-PEX eyes of 72 cataract patients. The study parameters included 5 measured zones: central and 4 peripheral (superior, inferior, nasal, and temporal). Results. The mean CCT in eyes with PEX syndrome measured with all three instruments was thicker than that in normal eyes. Corneal thickness measurements in the PEX group were statistically significantly different between Pentacam and OCT Casia: central corneal thickness (p=0.04), inferior corneal zone (p=0.01), and nasal and temporal corneal zones (p<0.01). Between Pentacam and OCT Visante inferior, nasal and temporal corneal zones were statistically significantly different (p<0.01). Between OCT Casia and OCT Visante, there were no statistically significant differences in measured parameters values. Conclusion. The central corneal thickness in eyes with PEX syndrome measured with three different independent methods is higher than that in the non-PEX group, and despite variable peripheral corneal thickness, this one parameter is still crucial in intraocular pressure measurements.

Objectives. The aim of this study is to evaluate longitudinal RNFL thickness changes in patients with open-angle glaucoma (OAG) who underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and ILM removal using OCT RTVue XR 100 Avanti. Methods. Retrospective analysis of OCT scans of 40 patients who underwent PPV or combined phacovitrectomy with ILM peeling for the idiopathic ERM has been carried out. The patients were divided into two groups for the study: patients with the ERM and OAG and those with ERM without glaucoma. A trend analysis of the RNFL thickness changes in 1 month and 3, 6, and 12 months was created. Results. At 1 month after surgery, the RNFL thickness increased significantly in the temporalis quadrant from 89.9 μm to 105.7 μm in patients with OAG. Comparison between group with OAG and group without glaucoma showed that the RNFLT in the temporalis quadrant decreased significantly 6 months after the surgery. Conclusion. Postoperative changes in RNFL thickness appeared to be transient, and there was temporal retardation of the retinal nerve fibers without affecting visual acuity in both groups.

Purpose. To report the surgical approach, anatomical and functional results, and complications in the group of patients with corneal perforation. Materials and Methods. 247 eyes with corneal perforation were operated on between January 2010 and July 2016. The three surgical procedures, dependent on size and location of perforation, were performed: full-sized penetrating keratoplasty, corneoscleral patch graft, and anterior lamellar keratoplasty. The eyes underwent the minimum 6-month follow-up visit. Results. Between January 2010 and July 2016, 247 surgeries were performed: 116 penetrating keratoplasties, 117 corneoscleral patch grafts, and 14 anterior lamellar keratoplasties. More than one procedure was necessary in 32 eyes. Final improvement of the visual acuity, within a gain of 2 or more lines with the Snellen test, was achieved in 56 operated eyes. To achieve better final visual acuity, 75 eyes required successive surgical treatment. Complications of the surgery comprised persistent epithelial defect, glaucoma or ocular hypertension, corneal oedema, graft melting, loose corneal sutures, reinfection, anterior synechiae and fibrinoid membranes, and endophthalmitis. In 26 eyes, the treatment failure was reported. Conclusions. There is no one general-purpose surgical technique to treat corneal perforations. The complex nature of this pathology remains the individual, careful but also very distinct and multifactorial approach.

To evaluate long term results of phacoemulsification with PC IOL and capsular tension ring (CTR) implantation in lens subluxation.The study comprised of 134 patients--146 eyes with subluxated lens. In all cases phacoemulsification with PC IOL and CTR implantation was performed.No intaroperative complications has occured. Postoperative complications included: inflammation in the anterior chamber in 3 eyes (2.1%), retinal detachment in 2 eyes (1.4%). In all cases there was no PC IOL decentration.(1) CTR facilitates phacoemulsification with PC IOL implantation in lens subluxation. (2) Phacoemulsification of subluxated lens with PC IOL and CTR implantation seems to be safe and effective procedure.

Pseudoexfoliation syndrome (PEX) often coexists with glaucomatous optic nerve head damage. Confocal scanning laser tomography Heidelberg Retina Tomograph (HRT) is the most competent and accurate technique of monitoring of glaucomatous optic nerve head damage. Our aim was to determine correlation between stage of PEX and glaucomatous optic nerve head damage, by using HRT system.Two groups of patients underwent examination. The examined PEX-group with 35 eyes with III stage and 35 eyes with IV stage of PEX. The control group (POAG patients) of 44 eyes. Stereometric parameters Disc Area, Cup Area, Cup/Disc Area Ratio, Rim Area, Height Variation Contour, Cup Volume, Rim Volume, Mean Cup Depth, Max Cup Depth, Cup Shape Measure, Mean RNFL Thickness, RNFL Cross Section Area were obtained by HRT.No statistical differences were noted between III and IV stage of PEX for DA, HVC, RV, Mean RNFL Thickness and RNFL Cross Section Area parameters. Between III stage of PEX and control group no statistical differences were confirmed for HVC. Between IV stage of PEX and control group no statistical differences have respect to: CSM, Mean RNFL Thickness and RNFL Cross Section Area stereometric parameters.IV stage of PEX syndrome is the serious risk for glaucomatous neuropathy and requires precise monitoring.