Purpose: To assess the changes in eye optics and visual functions depending on the level of blood sugar and glycated hemoglobin (HbA1c) in insulin-dependent type 2 diabetes mellitus (IPSD) patients with excessive body weight, who receive long-term insulin therapy.

Material and methods. 32 patients (64 eyes), of which 84.4 % were women and 15.6 % men, with insulin-dependent diabetes mellitus (IPSD) but without severe general diabetic complications or concomitant eye pathology were monitored ophthalmologically for 3 years. The average duration of insulin therapy was 6 years. The average age of the patients was 60.94 ± 1.04 years; average weight, 89.1 ± 14.8 kg; average height, 163.8 ± 7.3 cm; average body mass index, 31.3 ± 4.8 kg/m2. The level of blood glucose level was determined daily with individual Accu-Check and/or OneTouch select glucometers, supplemented by scheduled monthly examinations with an endocrinologist. The level of glycated hemoglobin (HbA1c) was determined once every 3–6 months. Vision was measured by international requirements for patients with diabetes using the ETDRS (Early Treatment Diabetic Retinopathy Study Research Group) system with an ESV-3000 device. To assess lens transparency, the international Lens Opacities Classification System III (LOCS III) was used. Glycaemia level was monitored by the patients themselves with the help of individual blood glucose meters and by endocrinologists in scheduled monthly checkups. HbA1c level was measured once every 3 to 6 months.

Results. Over the follow-up period, the subjective visual acuity slightly deteriorated. The anterior segment remained practically unchanged, the vitreous body showed a destruction increase, the state of the retina remained stable and conformed to that of nonproliferative diabetic retinopathy. The glucose level showed a significant drop, while the level of glycated hemoglobin HbA1c practically remained constant. The LOCS III criteria showed an increased clarity of the lens nucleus (NO), a worse transparency of cortical layers (C) deteriorated; the NC nucleus colour and P parameters of the posterior subcapsular layer practically remained the same. Conclusions. According to our data, during the development of diabetic cataracts in patients with type 2 IPSD, NO of the lens changes first followed by C changes (they become worse). With the normalization of glycemia level, diabetic retinopathy does not progress, the NO of the lens can improve, and the NC and P do not change. Normalization of glycemia is not a retarding factor for the already existing changes in C or the state of the vitreous. HbA1c is a marker and trigger for possible lens changes in patients with type 2 diabetes and prolonged insulin therapy. HbA1с is effective for tracking the dynamics of changes in the eye in these patients. The fact that the positive correlation of HbA1c and C at follow-up start changed to the negative correlation toward the end of the study indicates a disruption in lens state compensation and does not cancel the negative dynamics of state C even with a decrease in the level of HbA1c.

Purpose. A comparative analysis of the results of two-stage optico-functional rehabilitation of patients with a high risk of postoperative asthenopic syndrome (AS).

Materials and methods. 36 patients (72 eyes) who had no binocular vision at a distance of 5 m and had a symmetrical position of the eyes, or a position close to symmetry, were randomly divided into 2 equal groups of comparison. Patients in both groups underwent functional treatment followed by the correction of refractive errors with FemtoLASIK technology. To eliminate accommodation dysfunctions, a medical device OXYS was used. Diploptic treatment was carried out using a Speckle-M laser apparatus and Bagolini raster glasses. To expand fusional reserves, a prism compensator (OKP-20, Russia) and a Speckle-M laser apparatus were used. The patients of the first group underwent a fast course of medical and functional rehabilitation for 5 working days (2 times a day with a break of 2–3 hours). As an additional pharmacological support, daily instillations of phenylephrine hydrochloride 2.5 % without preservatives were prescribed. The other group received the same functional treatment for 10 working days.

Results. After the fast and the standard rehabilitation courses, the patients revealed an increase in absolute accommodation and a decrease in the coefficient of micro fluctuations, an expansion of fusional reserves, an increase in stereovision acuity, and an increased number of cases of binocular vision. No statistically significant difference of clinical and functional parameters obtained as a result of the fast and the standard rehabilitation courses was revealed.

Conclusions. Functional and medicament treatment of patients with refractive disorders and the absence of binocular vision prior to FemtoLASIK is shown to be effective. This treatment reduces the risk of postoperative AS and increases the patient’s satisfaction with the results of the surgery. 

Purpose. A combined comparative study of the impact of antiglaucomatous surgeries on the anatomical and optical parameters of the cornea.

Materials and methods. The study involved 38 patients (38 eyes) aged 43 to 75 with primary open-angle glaucoma (POAG), which were divided into 2 groups. Patients of group I (15 eyes) underwent classical deep sclerectomy (DSE), while those of group II (23 eyes), had non-penetrating deep sclerectomy (NDSE). All patients underwent a comprehensive examination before and after surgery, including precision visometry, corneal topography, OCT pachymetry.
Results. Group I revealed a significant change in the parameters on the 3rd day after the surgery; in particular, the average value of corneal astigmatism increased from -0.93 D to -3.62 D, the curvature radius of the cornea in the vertical meridian increased from 7.56 ± 0.07 mm to 8.34 ± 0.04 mm, the thickness of the central cornea changed from 514.5 ± 0.04 μm to 520.6 ± 0.06 μm. In group II, the corneal astigmatism increased from -0.86 D to -2.75 D, and the curvature radius of the cornea in the vertical meridian changed from 7.72 ± 0.05 mm to 8.12 ± 0.03 mm, the central thickness of the cornea increased from 515.4 ± 0.04 to 516.8 ± 0.12 μm.

Conclusion. The degree of surgically induced changes of anatomic and optical parameters of the cornea in POAG patients depended on the amount of intervention: NDSE has a lesser effect on these parameters than classical DSE.

Purpose. To increase the efficiency of surgical treatment and develop an algorithm for managing patients with the consequences of acute retinal necrosis (ARN).

Material and methods. The study included 35 patients (42 eyes) aged 18 to 74 with acute retinal necrosis. All patients underwent a microinvasive (23 Ga) vitrectomy with membrane peel, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. The operated eyes were divided into 2 groups. The main group consisted of 17 eyes with a clinical picture of fibrosis of the vitreous without retinal detachment (10 eyes) and retinal detachment without pronounced fibrosis of the vitreous (7 eyes). The comparison group included 25 eyes which had retinal detachment and fibrosis of the vitreous at the time of surgery. The visual acuity varied between incorrect light projection and 0.15 with correction.

Results. A stable anatomical and optical result was achieved in all cases. Complete adhesion of the detached retina was achieved in 94.1 %, which is explained by the fact that surgical treatment was in most cases performed in the absence of pronounced stages of proliferative vitreoretinopaty. In all cases of the main group, an increase in visual acuity was noted. In 53 % of cases, visual acuity achieved 0.1 to 0.3 and in the remaining 47 % it was 0.3 % or above. This can be accounted for by the prevalence of peripheral necrotic lesions, as well as a lower incidence of macular edema and optic neuropathy. However, in the comparison group, an increase in visual acuity was only observed in 56 % cases, with visual acuity reaching 0.1 or higher only in 24 % of the eyes. A high frequency (72 %) of necrosis expansion to the posterior eye pole with an irreversible damage to the optic nerve and the macular region was revealed.

Conclusion. Active dynamic observation of patients with ARN helps detect changes requiring surgical treatment, which leads to higher functional and anatomical outcomes, as well helps avoid the disability of the patients. Surgical treatment prior to the formation of retinal detachment in severe traction syndrome with or without retinal tears is advisable. An algorithm was proposed for managing surgical patients, depending on the clinical manifestations of ARN effects.

The purpose of the work was to study peripheral refraction in myopic patients without correction, in soft contact lenses (SCL), in monofocal glasses, and in Perifocal-M glasses.

Material and methods. A total of 97 patients (184 eyes) aged 9–18 years with various degrees of myopia were examined. The peripheral refraction was measured using a Grand Seiko WR-5100K binocular open-field autorefractometer without correction, in glasses, and in the SCL. For the eviation of gaze, a nozzle was designed, which was attached to the device stand at a distance of 50 cm from the patient's eyes. On the nozzle, there were 4 marks for fixing the gaze in the position of 15° and 30° to the nose (N) and to the temple (T) from the central position.

Results. In patients with myopia of various degrees without correction and with correction by monofocal glasses, hyperopic defocus formed in all zones on average. In eyes that were corrected with SCL and were mildly myopic in all zones, hyperopic defocus was detected. In moderate myopia, myopic defocus was detected in the zones T30° and N30°. With a high degree of myopia, myopic defocus was detected on the periphery in all zones except T15°, reaching -2.23 ± 1.35 D in the T30° zone and -1.56 ± 0.82 D in the N30° zone. In Perifocal-M glasses, myopic defocus formed in mildly myopic eyes: in the T15° zone its value was -0.95 ± 0.12 D, -0.24 ± 0.05 D in the N15° zone, and -1.14 ± 0.13 D in the T30° zone. Hyperopic defocus was observed only in the zone at N30°, and its value was minimal compared to other types of correction which was 0.13 ± 0.05 D. In moderate myopia, myopic defocus was observed only in the zone N15° at -0.28 ± 0.04 D. In all other zones, hyperopic defocus remained, but its magnitude was minimal compared to monofocal glasses: 0.6 ± 0.1 D at T30°, 0.05 ± 0.04 D at T15°, and 0.74 ± 0.11 D at N30°. 

Conclusion. In relation to peripheral defocus, perifocal glasses have an advantage in correcting myopia of a low and, in part, moderate degree.

Purpose: to evaluate the results of symmetric binocular hypocorrection of myopia with FemtoLasik surgery in patients with presbyopia of various age groups.

Material and methods. 33 patients (66 eyes) with myopic refraction, aged 36 to 50, were operated by FemtoLasik. The intended Femto Flap thickness was 100 μm. The patients were divided into three groups depending on age; group 1 included 16 patients (32 eyes) aged 39–44, group 2 had 12 patients (24 eyes) aged 45–50, and group 3 (controls) was composed of 5 patients (10 eyes) of pre-presbyopic age (36–38 years).

Results. The symmetric binocular hypocorrection proved efficient in 35 % of cases in the group 1 and 50 % of cases in group 2. In the control group the intended and obtained values coincided in all 100 % of cases.

Conclusion. A possible cause of the discrepancy between the intended and the obtained hypocorrection effect may be a reduced corneal hydration of patients older than 39 years.

Purpose: to assess the level of catecholamines norepinephrine and dopamine in rat retina with experimental retinopathy of prematurity (EROP) at a time corresponding to the peak of neovascularization.

Material and methods. The study was performed on 41 infant Wistar rats (82 eyes). The rats were divided into 2 groups: the experimental group (with EROP, n = 21) and the control group (n = 20). In order to reproduce the EROP, the newborn rats were placed for 14 days in the incubator together with their mother. Every 12 hours, the oxygen concentration in the incubator ranged from 60 to 15 %. The control group consisted of pups who were held in conditions with a normal oxygen content (21 %) from the moment of birth. The pups were withdrawn from the experiment on the 10th, 14th, 23rd and 28th day, whereupon they were subjected to binocular enucleation followed by histological examination, in addition, the content of noradrenaline and one of the metabolites of dopamine (L-DOPA) was determined in retinal samples of the eyeballs obtained on the 23rd day by highly effective liquid chromatography technique with electrochemical detection.

Results. Histological examination showed that in our EROP model the neovascularization peak occurs on the 23rd day of the experiment. At this time rat pups with EROP showed a significantly lower retinal L-DOPA level as compared to the control values (13.99 ng/g and 30.5 ng/g, respectively), and the norepinephrine level significantly exceeded such values (63.7 ng/g and 7.69 ng/g, respectively).

Conclusion. A relative deficiency of dopamine and a relative excess of norepinephrine of the rat pups with EROP is noted at the time of the highest vascular activity of the retina. The obtained data confirm anti-angiogenic properties of dopamine and pro-angiogenic properties of noradrenaline in the second phase of EROP development.

Purpose: to study the drainage properties of fibrillar-structured materials under conditions of hydrodynamics which are maximally close to physiological conditions, using the results of a bench experiment.

Material and methods. Drainage properties of fibrillary-structured materials have been studied in several bench experiments using an original device that creates conditions of eye hydrodynamics maximally close to physiological conditions. The studied materials were produced by the method of electrospinning, vacuumized and sterilized. The effect of drainage structure density and drainage type (polylactide, copolymer of polylactide and caprolactone, polycaprolactone) on the drainage capacity were evaluated, as well as the stability of their drainage properties.

Results. The research revealed considerable drainage properties of all investigated objects. The study of various drainages showed a statistically significant effect of the density of the internal structure and type on the drainage capacity. Also, a nonlinear increase in the filtering capacity with a regular increase in perfusion pressure was revealed. This phenomenon, regarded as adaptive hydrodynamic properties, in addition to reducing the level of the intraocular pressure (IOP), can contribute to smoothing of diurnal fluctuations, thereby enabling the stabilization of visual functions. In the experiment, the optimal structure was determined, which corresponds to the conditions of physiological hydrodynamics of the eye and ensuring the maintenance of intraocular pressure in the low-norm region. Fibrillar structured drains made of polylactide and its copolymer with polycaprolactone with a porosity of 78–84 %, an average fiber diameter of 5–5.7 μm and a pore size of 25.8–29 μm optimally correspond to hydrodynamic conditions maximally close to physiological conditions.

Conclusion. Fibrillar-structured materials have significant drainage properties depending on the density of the internal structure and the type of drainage due to threshold activation of additional pores create the conditions, close to the physiological ones, for the regulation of the IOP, and ensure the persistence of visual functions after operations. 

Purpose: to reveal the changes of the morphological structure of cadaveric human sclera after Nd: YAG laser irradiation.

Material and methods. Laser pulses (Nd: YAG) (Lumenis) (power 7.0–7.4 mW, pulse duration 4 ns, wavelength 1064 nm) were applied to the sclera of an isolated eyeball at a distance of 4 to 8 mm from the limbus. Three irradiation types were used: one series of single pulses, a series of triple pulses, and a series of six pulses.

Results. Incisions created with single pulses showed insignificant surface defects of the sclera. In triple pulses, the defect of the anterior layers of the sclera capture affected 15 % of the scleral thickness, and in six pulses the defect reached 30 % of the scleral thickness.

Conclusions. To achieve a punctate hole in the sclera, a single Nd: YAG pulse is insufficient. To obtain a significant depth of scleral incision at least a triple pulse is needed, which must be taken into account in clinical practice as well as in assessing the results of Nd: YAG laser impact on the rigidity of the sclera.

Scleral lenses improve visual acuity in patients with irregular corneal astigmatism, which is especially important when other methods of correction are ineffective.

Purpose: to assess the efficiency of Zenlens scleral lenses in patients with irregular cornea.

Material and methods. A total of 120 patients (164 eyes) were examined, including 86 males and 34 females, aged from 13 to 63 years (mean age 35 ± 12 years). The patients were divided into 4 groups. Group 1 consisted of patients with keratoconus, group 2 — postpenetrating keratoplasty, group 3 — keratoconus after cross-linking and/or corneal ring segment implantation, while group 4 consisted of patients with other diseases. The efficiency criteria included visual acuity before and after scleral lens fitting and wearing time (hours per day). To determine social significance of scleral lens wearing, we selected 30 patients (46 eyes) with average best-corrected visual acuity (BCVA) before fitting 0.21 ± 0.08 (0.1–0.3).

Results. Average uncorrected visual acuity before fitting did not exceed 0.2 and average visual acuity after fitting was 0.8 ± 0.15. Average improvement in visual acuity after fitting compared to uncorrected visual acuity was at least six lines in all groups and average improvement of visual acuity was approximately three lines compared to BCVA before fitting. 74.4 % and 19.5 % of patients demonstrated long-term (> 10 hours per day) and partial (8–10 hours per day) wear, respectively. Short-term wear (< 8 hours per day) was noted in 6.1 % of patients. Visual acuity of  patients with low BCVA (mean 0.21 ± 0.08) increased by 0.57 (271.4 %).

Conclusion. Scleral lenses can be successfully used for visual acuity improvement and social rehabilitation of patients with irregular cornea when other methods of correction are ineffective. 

Purpose: to evaluate the hypotensive effect and adverse reactions occurrence in patients with primary open angle glaucoma (POAG) who received Bimatoprost (Bimoptic Rompharm) monotherapy.

Materials and methods. 46 patients (75 eyes) with stage I–III POAG were prescribed bimatoprost therapy. Of these, 16 patients (20 eyes) had newly diagnosed glaucoma, 15 patients (27 eyes) previously received treatment with prostaglandin analogs (APG — Latanoprost), and 15 patients (28 eyes) previously received treatment with a fixed combination (FC) composed of timolol B-blocker and brinzolamide carbonic anhydrase inhibitor. The reason for transferring the patient from therapy with APG and FC to monotherapy with Bimatoprost was insufficient hypotensive effect of APG/FC therapy, and the presence of dry eye syndrome of varying severity in most patients. The results were evaluated after 1, 4 and 12 weeks of Bimatoprost therapy.

Results. A hypotensive effect of monotherapy with Bimatoprost was confirmed in patients with newly diagnosed POAG. An additional hypotensive effect was revealed when patients with POAG were transferred from APG and FC therapy to monotherapy with Bimatoprost. Adverse reactions: mild and moderate hyperaemia, periorbital manifestations such as skin pigmentation, deepening of upper eyelid folds, narrowing of the palpebral fissure (ptosis) were noted, respectively, in 8, 6.7, 1.3, 2.7, 2.7 % of cases respectively, but did not require a discontinuation of the therapy in any patient. Eyelash growth was noted by 3 patients (4 %). This effect was not considered to be a side effect, since none of the patients bothered. In 47 % of patients who had previously received APG and FC therapy and had dry eye syndrome of varying severity, objective and subjective positive changes relating to dry eye syndrome was noted. A positive dynamic of morphometric parameters of the optic nerve and cells of the retinal ganglion complex was revealed in patients of all groups of study.

Conclusion. Monotherapy with Bimatoprost can be recommended as therapy of choice for patients with newly diagnosed glaucoma, and those previously receiving antihypertensive therapy with PGAs or fixed combinations (-blocker + carbonic anhydrase inhibitor) including those having dry eye  syndrome of varying severity.

Purpose. To assess the effectiveness and safety of intravitreal aflibercept injections in clinically significant diabetic macular edema (DME) in a routine clinical practice.

Material and methods. This was a prospective, observational, single-center study. During the study, anti-VEGF treatment naïve patients with clinically significant DME received five monthly intravitreal injections of aflibercept 2 mg followed by bimonthly injections. The observation period was 1 year.

Results. The study included 11 eyes of 10 patients with clinically significant DME. Use of 8 intravitreal aflibercept injections resulted in central retinal thickness (CRT) reduction by 50 % from the baseline within 1 year of therapy. CRT decreased on average from 446.18 ± 106.88 μm to 226.27 ± 44.56 μm by the end of observational period. In addition, an increase in visual acuity was observed from an average from 0.33 ± 0.22 at the start of therapy to 0.62 ± 0.33 at the end of the observation. Serious adverse events over the entire period of treatment were not observed.

Conclusion. Aflibercept showed high efficacy and safety in the treatment of clinically significant DME in routine clinical practice. To obtain optimal functional and morphological results in the treatment of patients with DME, it is necessary to start therapy with 5 loading intravitreal aflibercept injections.

Purpose. To evaluate the effectiveness of dry eye syndrome (DES) treatment in patients with meibomian gland dysfunction (MGD) before refractive surgery.

Materials and methods. We examined 48 women (aged 29.6 ± 3.9 years) with myopia, DES, and MGD of noninfectious etiology before performing LASIK. Group 1 of these patients received presurgical correction of DES for 2 months, including instillation of 3 % trehalose as a bioprotector (Thealoz®; 3–4 times a day); application of 5 % dexpanthenol in the conjunctival cavity (before going to bed); eyelid hygiene (2 times per day), which included cleaning (Theagel®), warm compresses on eyelid area, massage of eyelid margin (Blephaclean wipes). Group 2 only received bioprotective and reparative therapy for 2 months. Testing included a standard ophthalmological examination; assessment of DES symptoms (OSDI scale, points); BUT test (sec) and Schirmer-1 test (Sh-1, mm); measuring the height of the lower tear meniscus (optical coherence tomography, μm); lissamine green staining with calculation of xerosis index by Bijsterveld (points); assessment of MGD severity (points). Processing of the results included calculation of M ± s; Wilcoxon t-test, Mann Whitney U-test.

Results. A positive change of OSDI (decrease from 31.9 ± 2.9 to 8.71 ± 1.1 points), xerosis index (decrease from 4.71 ± 0.5 to 2.1 ± 0.3 points) and BUT test (increase from 4.14 ± 0.53 to 8.66 ± 0.93 sec) was significantly stronger in patients of group 1 (p < 0.05) in comparison with patients of group 2 (decrease in OSDI from 33.2 ± 3.1 to 15.6 ± 2.4 points; decrease of xerosis index from 4.75 ± 0.50 to 3.7 ± 0.5 points; BUT increase from 4.21 ± 0.47 to 6.05 ± 0.73 sec). Apparently, this was caused by a significant decrease in the severity of MGD (from 2.1 ± 0.3 to 0.9 ± 0.2 points) and a decrease in the severity of lipid deficiency due to eyelid hygiene in patients of group 1. In group 2, MGD severity change proved unreliable. Change of Sh-1 and the height of the lower tear meniscus was unreliable in all cases. 

Conclusion. The inclusion of eyelid hygiene (Theagel and Blephaclean) in the pre-surgery preparation of patients with DES and MGD leads to a more significant correction of eye surface condition compared to isolated bioprotective and reparative therapy, thus providing an opportunity of more favorable conditions for carrying out surgical correction of ametropia. 

The literary review is focused on reactive hypertension after eye surgeries. Possible causes of increased intraocular pressure are described. Methods of therapy and prevention of reactive hypertension after cataract phacoemulsification and intravitreal injections are analyzed. Literary data show an emphasis on the efficacy and safety of applying a fixed combination of brimonidine and timolol.

The paper reports on promising methods of drug delivery in glaucoma treatment: contact lenses, punctum plugs, intraocular implants, subconjunctival and supraciliary injections, ocular rings, hydrogels, nanocarriers.

So far, no article concerning the history of epidemiological studies on myopia in Poland after World War II has been published. Therefore, the aim of the work is to present the history of epidemiological studies on myopia in Poland after World War II. In order to obtain answers to the research questions, studies of source and archival materials were conducted. It turned out that the leading centers in Poland conducting research on myopia were the Pomeranian Medical University in Szczecin and the Medical University of Silesia in Katowice.