Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.

Late in-the-bag intraocular lens dislocation: incidence, prevention, and management.

Phacoemulsification and modern cataract surgery.

Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients.

Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery.

Late in-the-bag spontaneous intraocular lens dislocation: evaluation of 86 consecutive cases.

Aim To analyse the occurrence of the anterior capsule contraction following cataract surgery. Capsule contraction syndrome (CCS) is defined as an extreme reduction in diameter of anterior capsulectomy, capsular bag diameter and, occasionally, displacement of the IOL after extracapsular cataract extraction. It is relatively frequent in pseudoexfoliation, advanced age, in association with uveitis, pars planitis and myotonic muscular dystrophy. Materials and methods 5965 eyes of patients were operated on cataract between 1.01.1994 and 31.12.1997 in Tadeusz Krwawicz Chair of Ophthalmology and 1st Eye Hospital, Medical School in Lublin. Two types of surgical procedures were performed: "divide and conquer" phacoemulsification with 4.5-8 mm continuous curvilinear capsulorhexis (3385 eyes) and extracapsular cataract extraction with "can opener" capsulotomy (2580 eyes). Results 20 cases of clinically apparent CCS were referred to the Department: in the course of intensive postoperative inflammation--5, in patients over 80--4, in pseudoexfoliation syndrome--2, myotonic dystrophy--1, ectopia lentis--2, other causes--6. In order to improve visual acuity in 4 cases surgical removal of the distorted and opaque anterior capsule was performed, in 3 cases relaxing radial tears were done, in 3 cases secondary anterior capsulotomy was performed using Q-switched Nd:YAG laser. Conclusions In cases where the occurrence of CCS is especially high large diameter capsulorhexis should be performed and IOL designed to provide maximal peripheral capsular bag expansion should be implanted.

Capsule contraction syndrome

Background: Zinsser-Engman-Cole syndrome (Z.E.C.) is a very rare type of ectodermal dysplasia, inherited in X-linked recessive manner and characterised by poikiloderma, nail dystrophy, lingual leucoplakia, bone marrow hypoplasia, hyperkeratosis and hyperhidrosis of planta and palms, dental anomalies and caries, premature grey hair. Patient and Methods: We report on a 46-year-old man who presented with occlusion of lacrimal puncta, trichiasis, severe dry eye, recurrent corneal ulceration and perforation, uveitis. HLA typing, flow cytometry of peripheral lymphocytes, bone marrow biopsy, conjunctival biopsy and extensive laboratory evaluation towards autoimmune and infectious diseases were performed. Results: CD4+ T cells fraction was decreased, CD8+ and CD3+ HLA DR+ elevated. The patient was HLA-B27 positive. Laboratory studies revealed increased erythrocyte sedimentation rate and C-reactive protein level, hypochromic and hypoplastic anaemia, negative serum titers of antibodies to Epstein-Barr virus, HIV, HTLV-I, toxoplasma gondii and treponema pallidum, repeated titers to cytomegalovirus, herpes simplex and herpes zoster viruses - IgM negative, IgG positive. Corneal perforation was treated with amniotic membrane transplantation and corneal transplantation. Conclusion: The defect in cell-mediated immune mechanisms in Z.E.C. syndrome explains the corneal perforation, sicca syndrome and uveitis, first reported in this syndrome.

[Zinsser-Engman-Cole syndrome (dyskeratosis congenita) with severe sicca syndrome, panuveitis and corneal perforation--a case report].

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.

Corneal astigmatism after trabeculectomy

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.

[Fungal infections of the cornea--diagnostics and management].

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.

[Use of the laser-flare meter for early diagnosis of corneal graft rejection and for monitoring therapy].

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