Ewa Mrukwa-Kominek

Publications of Ewa Mrukwa-Kominek

• Nonpenetrating very deep sclerectomy with hyaluronic acid implant vs trabeculectomy - a 2-year follow-up.

  Authors: Rafał Leszczyński, Maria Formińska-Kapuścik, Beata Bubała-Stachowicz, Ewa Mrukwa-Kominek, Erita Filipek, Krzysztof Pawlicki

  Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 05/2012;

  OBJECTIVE: To study and compare the efficacy and safety of nonpenetrating very deep sclerectomy (NPVDS) with the use of hyaluronic acid implant (SKGEL) to trabeculectomy (TB) in patients with withOBJECTIVE: To study and compare the efficacy and safety of nonpenetrating very deep sclerectomy (NPVDS) with the use of hyaluronic acid implant (SKGEL) to trabeculectomy (TB) in patients with with medically uncontrolled glaucoma. METHODS: Prospective, controlled study of patients with open-angle glaucoma was designed. Seventy-eight eyes of 68 patients with medically uncontrolled glaucoma were assigned either to the NPVDS or to the TB group of trial. Examinations were applied before and 7 days, 1, 3, 6, 12, 18, and 24 months after surgery. MAIN OUTCOME MEASURE: Best-corrected logMAR visual acuity, intraocular pressure, number of additional procedures, antiglaucoma medications, number of complications. RESULTS: At 24 months, success rate defined as IOP ≤ 21 mmHg with medication and additional procedures in NPVDS group was 92.31 %, and 94.88 % in control group (p = 0.64). There was no statistically significant difference between intraocular pressure in NPVDS (14.56 ± 4.07 mmHg ) and control (TB) (15.38 ± 3.38 mmHg) group (p = 0.34). Number of glaucoma mediations decreased from 2.18 ± 0.56 to 0.54 ± 0.56 in NPVDS and from 2.28 ± 1.41 to 0.61 ± 0.03 in TB group (p = 0.71). Early and late postoperative complications included two cases of hyphema, two of choroidal detachment, two of filtering bleb fibrosis, four of cataract progression in the NPVDS group; and five cases of hyphema, four of choroidal detachment, one of filtering bleb fibrosis, one of blebitis, and 12 of cataract progression in the control group. CONCLUSIONS: NPVDS is an effective surgical option for patients with medically uncontrolled glaucoma. NPVDS is associated with a lower risk of complications, and in particular cataract progression, compared to TB. APPLICATION TO CLINICAL PRACTICE: NPVDS is a modification of NPDS devised for patients with medically uncontrolled open-angle glaucoma.

• [Optical coherence tomography in the imaging of the iridocorneal angle].

  Authors: Łukasz Drzyzga, Ewa Mrukwa-Kominek, Ewa Mielniczuk, Wanda Romaniuk

  Klinika oczna. 01/2011; 113(1-3):71-4.

  Anterior segment optical coherence tomography (AS OCT), enables visualization and measurements of the anterior segment of the eye. In particular, it is a valuable tool in the imaging of theAnterior segment optical coherence tomography (AS OCT), enables visualization and measurements of the anterior segment of the eye. In particular, it is a valuable tool in the imaging of the iridocorneal angle. In this paper, we reviewed parameters used for analysis of the iridocorneal angle in AS OCT and compared changes of these parameters after cataract surgery, laser iridotomy and illumination. Special attention was paid to changes of such quantitative parameters as TISA (trabecular-iris space area), AOD (angle opening distance), and ARA (angle recess area).

• Etiopathogenesis and management of high myopia. Part II.

  Authors: Maria Zejmo, Maria Formińska-Kapuścik, Ewa Pieczara, Erita Filipek, Ewa Mrukwa-Kominek, Elzbieta Samochowiec-Donocik, Olga Domańska, Magdalena Smuzyńska

  Medical science monitor : international medical journal of experimental and clinical research. 11/2009; 15(11):RA252-5.

  High myopia (HM) is defined as refractive error above -6.0 D (-8.0 diopters) with axial eyeball length above 26 mm, and is connected with the process of excessive myopisation. HM is not a homogenousHigh myopia (HM) is defined as refractive error above -6.0 D (-8.0 diopters) with axial eyeball length above 26 mm, and is connected with the process of excessive myopisation. HM is not a homogenous disease. HM is considered to be inherited in 3 different patterns: dominant, autosomal recessive, and X-linked. Many genetic mutations linked to the development of HM have been described, including high grade myopia, and MYP1-16; different patterns of inheritance may reflect different types of HM. Over 150 genetic syndromes are associated with HM. The clinical state of the HM eyeball may also depend on environmental risk factors influencing the progression of refractive error. The complexity of etiopathogenesis makes it difficult to distinguish to what extent the development of HM is related to genetics versus exposure to environmental factors. HM remains a leading cause of visual loss. HM and its complications are considered to be one of the most significant causes of blindness and visual impairment in young, professionally active people, becoming an important social problem. Contemporary data concerning genetic factors, family aggregation, and epidemiological data of visual impairment connected with HM are presented in this paper. Therapeutic options for this refractive error are presented as well.

• Etiopathogenesis and management of high-degree myopia. Part I.

  Authors: Maria Zejmo, Maria Formińska-Kapuścik, Ewa Pieczara, Erita Filipek, Ewa Mrukwa-Kominek, Elzbieta Samochowiec-Donocik, Rafał Leszczyński, Magdalena Smuzyńska

  Medical science monitor : international medical journal of experimental and clinical research. 09/2009; 15(9):RA199-202.

  High-degree myopia (HM) is defined as a refractive error above -6 D (-8 diopters). An axial eyeball length above 26 mm and is also connected with excessive myopisation. Mechanical stretching andHigh-degree myopia (HM) is defined as a refractive error above -6 D (-8 diopters). An axial eyeball length above 26 mm and is also connected with excessive myopisation. Mechanical stretching and thinning of the choroids may lead to the development of irreversible degenerative changes in the eyeball and visual impairment. HM prevalence varies significantly by geographical area, ranging from 1.7-3.3%, while in highly urban regions of South-East Asia it affects up to 24% of university students. HM is not a homogenous disease. It is considered to be inherited in different patterns: dominant, autosomal recessive, and X-linked. Many genetic mutations linked to HM development have been described and the different patterns of inheritance may reflect different types of HM. Moreover, the clinical state of the HM eyeball may result from both genetic and environmental risk factors influencing the progression of the refractive error. The development and progression of HM is connected with sustained prolonged near work involving accommodation-convergence imbalance leading to retinal blur, the years spent at school, the amount of near work, especially writing and reading, which is related to slight chronic under-accommodation, and improper light stimuli in early childhood. Contemporary definitions of HM, views on etiopathogenesis, excessive axial elongation, and pathological changes within the eyeball in the course of HM leading to visual impairment are presented here. Genetic and environmental risk factors influencing the progression of HM, its significantly different prevalence in various geographical areas, and therapeutic options for the refractive error are also presented.

• A comparative clinical study of the visual results between three types of multifocal lenses.

  Authors: Stanislawa Gierek-Ciaciura, Lukasz Cwalina, Lukasz Bednarski, Ewa Mrukwa-Kominek

  Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 09/2009;

  PURPOSE: To compare the patients' visual results after bilateral implantation of the multifocal intraocular lenses (MIOLs): ReZoom (NXG1, Abbott Medical Optics, Abbott Park, IL, USA), Acrysof ReSTORPURPOSE: To compare the patients' visual results after bilateral implantation of the multifocal intraocular lenses (MIOLs): ReZoom (NXG1, Abbott Medical Optics, Abbott Park, IL, USA), Acrysof ReSTOR (SA60D3, Alcon Laboratories, Fort Worth, TX, USA) and Tecnis MF (ZM900, Abbott Medical Optics). MATERIALS AND METHODS: A prospective, nonrandomized, comparative trial of 30 patients (60 eyes) aged 46-71 (mean age 56.3 +/- 5.96) divided into three equal groups with implanted bilaterally multifocal lenses: ReZoom IOL, Acrysof ReSTOR IOL and Tecnis MF IOL. The patient selection criteria included no other eye disease besides cataract, and corneal astigmatism of 1.5 diopters or less. In each case, the patients were scheduled to have standard phacoemulsification surgery with IOL implantation into the bag. The postoperative target was emmetropia. The mean follow-up was 6 months in all eyes. The following parameters were assessed/carried out: slit-lamp examination, uncorrected and best spectacle-corrected far and near visual acuity, autorefractometry, intraocular pressure, contrast sensitivity and subjective satisfaction with vision using the VF-14 survey. RESULTS: After surgery, all eyes were within +/-2.0D of target refraction. The mean uncorrected distance visual acuity improved in all cases. The postoperative BCDVA was better than 20/30 at the sixth month in all eyes. Six months postoperatively, the mean uncorrected distance visual acuity (UCDVA) +/- standard error (SE) in the ReZoom, ReSTOR and Tecnis MF groups was 0.11 +/- 0.01, 0.17 +/- 0.02 and 0.14 +/- 0.02 (LogMAR) respectively. All results were significantly better compared to preoperative values (p < 0.001) but did not differ between the study groups (p > 0.05). At the final visit, 75% of eyes in the ReZoom group achieved J1 (Jaeger standard) in comparison to 85% in the ReSTOR and Tecnis MF groups. Eighty percent of patients with bilaterally implanted ReSTOR and Tecnis MF IOL were spectacle-independent, in comparison to 70% with implanted ReZoom IOL. Thirty percent of patients with implanted Rezoom and Acrysof Restor IOL and 20% with implanted Tecnis multifocal IOL reported little or moderate halo and glare. The patients' satisfaction after the procedure was excellent; the scoring on the VF-14 survey ranged from 70-100%, with an average of 93%. No patient was dissatisfied with the results of the surgery. CONCLUSIONS: The implantation of tested multifocal intraocular lenses provides good near and distance visual acuity. We did not observe any statistically significant differences between the tested multifocal intraocular lenses with regard to best-corrected distance visual acuity, presence of glare and halo, as well as satisfaction with vision.

• Contact transscleral cyclophotocoagulation in the treatment of neovascular glaucoma: A five-year follow-up.

  Authors: Rafal Leszczynski, Robert Domanski, Maria Forminska-Kapuscik, Ewa Mrukwa-Kominek, Iwona Rokita-Wala

  Medical science monitor : international medical journal of experimental and clinical research. 03/2009; 15(3):BR84-87.

  Background: The purpose of the study was to evaluate the long-term efficacy of contact transscleral cyclophotocoagulation (TSCPC) performed after panretinal photocoagulation and cryoapplication inBackground: The purpose of the study was to evaluate the long-term efficacy of contact transscleral cyclophotocoagulation (TSCPC) performed after panretinal photocoagulation and cryoapplication in patients with angle closure neovascular glaucoma. Material/Methods: Thirty eyes of 30 patients with angle closure neovascular glaucoma were enrolled (15 women and 15 men, mean age: 55+/-21years). Diode TSCPC was performed in all patients after panretinal photocoagulation and cryotherapy. Follow-up was 60 months. Results: The mean pretreatment and postoperative intraocular pressures (IOPs) were 39.8+/-12 and 20.6+/-3.6 mmHg, respectively (p<0.00001). The mean number of treatment sessions was 2.4+/-1.5 (range: 1+/-7), with 18 eyes receiving only one treatment. There was a decrease in visual acuity in 3, hyphema in 4, uveitis in 2, cataract in 3, and phthisis in 1 eye. Conclusions: 1. TSCPC provides long-term control of IOP in patients with angle closure neovascular glaucoma. 2. Laser panretinal photocoagulation and cryoapplication should be considered before TSCPC. 3. TSCPC is associated with numerous complications, hyphema being the most frequent.

• Nonpenetrating very deep sclerectomy with reticulated hyaluronic acid implant in glaucoma treatment.

  Authors: Rafał Leszczyński, Stanislawa Gierek-Ciaciura, Maria Forminśka-Kapuścik, Ewa Mrukwa-Kominek, Iwona Rokita-Wala

  Medical science monitor : international medical journal of experimental and clinical research. 03/2008; 14(2):CR86-89.

  BACKGROUND: The purpose of our study was to assess intraocular pressure control (IOP) and postoperative complications in nonpenetrating very deep sclerectomy (NPVDS) with reticulated hyaluronic acidBACKGROUND: The purpose of our study was to assess intraocular pressure control (IOP) and postoperative complications in nonpenetrating very deep sclerectomy (NPVDS) with reticulated hyaluronic acid implant (SKGEL) and Mitomycin C (MMC). MATERIAL/METHODS: Fifty eyes from fifty patients with medically uncontrolled glaucoma were randomized to either the NPVDS or NPDS group. The NPVDS procedure was similar to traditional NPDS (control group); however, excision of sclera and exposure of ciliary body were also performed, and only a narrow scleral flap was retained at a distance of 0.5 mm from Schlemm's canal. Mitomycin-C 0.2 mg/ml was applied on and under the superficial flap of the sclera during both NPVDS and NPDS. Follow-up examinations were carried out at 1 week, and then at 1, 3, 6, and 12 months after surgery. Success was defined as IOP <22 mmHg with or without glaucoma medication and laser procedures. RESULTS: The 12-month success rate in the NPVDS group was 96%, not significantly higher than in the control group (88%, p=0.88). There was no statistically significant difference in IOP between the NPVDS (15.9+/-2.5 mmHg) and NPDS (16.3+/-3.6 mmHg) groups (p=0.57). Complications included four cases of hyphema, three of choroidal detachment (myopic eyes), and one of filtering bleb fibrosis in the NPVDS group, and three cases of hyphema, two of choroidal detachment (myopic eyes), and three of filtering bleb fibrosis in the NPDS group. CONCLUSIONS: NPVDS is an effective surgical modality for patients with glaucoma. The safety of NPVDS is comparable to that of NPDS.

• Correction of high myopia with different phakic anterior chamber intraocular lenses: ICARE angle-supported lens and Verisyse iris-claw lens.

  Authors: Stanislawa Gierek-Ciaciura, Ariadna Gierek-Lapinska, Krzysztof Ochalik, Ewa Mrukwa-Kominek

  Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie. 02/2007; 245(1):1-7.

  PURPOSE: To evaluate the efficacy, predictability and safety of implanting two models of anterior chamber IOLs for high myopia. Comparison of the refractive results between two groups of patientsPURPOSE: To evaluate the efficacy, predictability and safety of implanting two models of anterior chamber IOLs for high myopia. Comparison of the refractive results between two groups of patients implanted with different IOLs. MATERIALS AND METHODS: Forty eyes were implanted with phakic IOLs. The ICARE myopia lens was implanted in 20 eyes of 12 patients with preoperative myopia that ranged from -21.875 to -10.0. The mean patients' age was 30 years. The Verisyse IOL was implanted in 20 eyes of 12 patients with spherical equivalent of the refractive error from -21.625 to -10.375D, and the mean patients' age was 32.25 years. The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up period was 12 months. RESULTS: Twelve months after surgery, the mean refractive error (SE) was -0.19D (100% of eyes were within +/-1.0D of the target refraction) in the ICARE group, and -0.86D (95% of eyes were within +/-1.0D of the target refraction) in the Verisyse group. The postoperative refraction remained stable during the entire follow-up period. The mean uncorrected visual acuity was 0.7 in the ICARE group, and 0.69 in the Verisyse group 1 year postoperatively. There was no loss in visual acuity 1 year after surgery in the ICARE implanted eyes, one patient in the Verisyse group lost 1 line of BCVA as compared to the preoperative state. Mean endothelial cell density loss was 6.12% and 6.79% in the ICARE and Verisyse groups, respectively. There were no statistically significant differences regarding the analyzed outcome parameters between the two study groups. CONCLUSION: The implantation of both anterior chamber phakic intraocular lenses to correct high myopia resulted in a stable and predictable refractive outcome. Efficacy and safety of surgery for both implanted lens models are very high.

• [Effect of anti-inflammatory therapy on the treatment of dry eye syndrome]

  Authors: Ewa Mrukwa-Kominek, Anna Rogowska-Godela, Stanisława Gierek-Ciaciura

  Klinika oczna. 02/2007; 109(1-3):79-84.

  Dry eye syndrome is a common chronic disease; agents and strategies for its effective management are still lacking. The syndrome tends to be accompanied by ocular surface inflammation; therefore, theDry eye syndrome is a common chronic disease; agents and strategies for its effective management are still lacking. The syndrome tends to be accompanied by ocular surface inflammation; therefore, the use of anti-inflammatory agents might prove beneficial. The authors present up-to-date guidelines, strategies, and efficacy of dry eye syndrome management, including anti-inflammatory treatment. As no diagnostic tests are now available to assess ocular surface inflammation severity, the right timing to launch an anti-inflammatory agent is difficult to determine. Patients with mild intermittent bouts of symptoms which can be alleviated with ophthalmic lubricants do not typically require anti-inflammatory therapy. The latter should be considered in those who do not respond to lubricating drops, obtain poor results on clinical tests, and show symptoms of ocular surface irritation (eg. conjunctivae redness). Anti-inflammatory treatment of dry eye syndrome may include short-term corticosteroids, cyclosporine A emulsion, oral tetracycline therapy, oral omega-3 fatty acid supplements, and autologous serum eye drops. Anti-inflammatory treatment should be safe and effective; potential benefits should be evaluated for each individual patient. The authors have reviewed the advantages of anti-inflammatory treatment in dry eye syndrome, presented in literature.

• [The application of the confocal microscopy for the diagnosis of corneal inflammation]

  Authors: Ewa Mrukwa-Kominek, Stanisława Gierek-Ciaciura, Iwona Rokita-Wala, Aleksandra Pierzchała

  Klinika oczna. 02/2006; 108(1-3):119-23.

  In the course of keratitis, the early diagnosis is very important to start with the effective treatment. Clinical state and slit lamp biomicroscopic examination not always allows to establishIn the course of keratitis, the early diagnosis is very important to start with the effective treatment. Clinical state and slit lamp biomicroscopic examination not always allows to establish etiologic factor. In this paper, usefulness of the confocal microscopy in vivo examination to diagnose cases of not clear etiology in corneal inflammation, was presented. Authors presented the correlation between the clinical signs and the confocal images basis in five examined patients.

• [Assessment of tears secretion after refractive surgery]

  Authors: Ewa Mrukwa-Kominek, Paweł Stala, Stanisława Gierek-Ciaciura, Ewa Lange

  Klinika oczna. 02/2006; 108(1-3):73-7.

  PURPOSE: One of the complications of the corneal refractive surgery is a transient disturbance in tears secretion, which can lead to the dry eye syndrome. The aim of the study was to evaluate thePURPOSE: One of the complications of the corneal refractive surgery is a transient disturbance in tears secretion, which can lead to the dry eye syndrome. The aim of the study was to evaluate the tears secretion in patients after PRK, LASEK and LASIK surgery for myopia. MATERIAL AND METHODS: We examined 115 eyes of 69 patients (46 woman and 23 men), mean age 30.82, with myopia and myopic astigmatism, treated with three different refractive procedures. The patients included in this study were divided into three groups: Group I: 35 eyes of 22 patients (15 woman and 7 men) treated with PRK. The mean spherical equivalent of the refractive error was -4.18 dioptres (from -8.75 to -2.0). Group II: 41 eyes of 23 patients (13 woman and 10 men) treated with LASEK. The mean spherical equivalent of the refractive error was -5.73 dioptres (from -12.0 to -2.75). Group III: 39 eyes of 24 patients (18 woman and 6 men) treated with LASIK. The mean spherical equivalent of the refractive error was -7.49 dioptres (from -10.75 to -3.75). In this study the amount of tears secreted was analyzed on the base of Schirmer I test, performed before and after surgery. Test was always performed in the same room, in the morning hours (before noon), with constant temperature and air humidity values. RESULTS: In the PRK group the mean value of Schirmer I test was 20.91 mm before surgery. 14 days after surgery the mean value decreased to 14.09 mm, 1 month after surgery to 11.66 mm. Then increase in tears secretion was observed: 2 months after surgery the mean value of Schirmer I test was 13.94 mm, 3 months after surgery 15.23 mm, and 6 months after surgery 17.4 mm. In the LASEK group the mean value of Schirmer I test was 20.39 mm before surgery. 14 days after surgery the mean value decreased to 15.78 mm, 1 month after surgery to 13.05 mm. Two months after surgery the mean value of Schirmer I test was 15.24 mm, 3 months after surgery 16.17 mm, and 6 months after surgery 18.15 mm. In the LASIK group the mean value of Schirmer I test was 20.72 mm before surgery. 14 days after surgery the mean value decreased to 12.97 mm, 1 month after surgery to 5 mm. 2 months after surgery mean value of Schirmer I test was 12.79 mm, 3 months after surgery 15.05 mm, and 6 months after surgery 17.82 mm. CONCLUSIONS: Corneal refractive surgery causes transient reduction of tears secretion, especially during the first three postoperative months. The tears secretion was reduced most significantly in the LASIK group. In patients treated with PRK and LASEK tears secretion during the postoperative period was comparable with slightly better secretion in the LASEK patients.

• [Corneal transplantation--immunological mechanisms of rejection episode]

  Authors: Lukasz Cwalina, Ewa Mrukwa-Kominek

  Klinika oczna. 02/2004; 106(4-5):686-90.

  Organ transplantation including cornea is often only the one method of treatment in case of their irreversible destruction. The genetic difference between donor and graft recipient makes theOrgan transplantation including cornea is often only the one method of treatment in case of their irreversible destruction. The genetic difference between donor and graft recipient makes the immunological system recognizes foreign antigens and triggers off a rejection episode. This article reviews corneal graft rejection immunology and indicates possible future options for the clinical evaluation of more specific therapeutic agents that modulate the immunological mechanisms of allograft rejection. It discusses also the role of HLA matching in the survival of corneal grafts especially in "high risk" eyes.

• [Correction of myopia by PRK method with the use of MEL 80 excimer laser--initial report]

  Authors: Dorota Wygledowska-Promieńska, Stanisława Gierek-Ciaciura, Ewa Mrukwa-Kominek, Izabela Zawojska, Iwona Rokita-Wala

  Klinika oczna. 02/2004; 106(1-2):50-3.

  PURPOSE: The aim of this study was to evaluate the effectiveness of PRK procedure by estimation: changes of visual acuity, refractive errors, IOP, pachymetry, high order aberrations before and afterPURPOSE: The aim of this study was to evaluate the effectiveness of PRK procedure by estimation: changes of visual acuity, refractive errors, IOP, pachymetry, high order aberrations before and after surgery. MATERIAL AND METHODS: In the First Department and Clinic of Ophthalmology Medical School 22 patients went through ophthalmological examination for PRK procedure. In this study we used MEL 80 excimer laser. There were 13 women (15 eyes) and 5 men (7 eyes). The myopia was corrected from -1.75D till -6.5D. The patients were from 22 to 41 years of age. RESULTS: The correction for myopia by PRK method with MEL 80 excimer laser is effective and safe laser procedure. Stabilization of the refraction post photorefractive keratectomy was after 2 months and there was no increase of intraocular pressure in all cases. The procedure increased the high order aberrations.

• [Macular corneal dystrophy--clinical state, histopathologic, immunohistochemical examinations and genetical dependence]

  Authors: Ewa Mrukwa-Kominek, Iwona Rokita-Wala, Stanisława Gierek-Ciaciura

  Klinika oczna. 02/2004; 106(6):802-5.

  Macular corneal dystrophy is a rare corneal disease, with autosomal recessive inheritance, in which characteristic diffuse corneal clouding and reduction of corneal thickness are present. Authors inMacular corneal dystrophy is a rare corneal disease, with autosomal recessive inheritance, in which characteristic diffuse corneal clouding and reduction of corneal thickness are present. Authors in this article presented the clinical state and molecular pathology underlying it's importance in diagnosis of the macular corneal dystrophy. As in other inherited diseases, the latest achievement of molecular biology, concerning the new mutation of the CHST6 gene, changed the classification of the macular corneal dystrophy, and can have the significant influence on genetic therapy of this disease.

• [Pterygium: allergic etiology?]

  Authors: Ariadna Gierek-Łapińska, Ewa Lange, Ewa Mrukwa-Kominek, Stanisława Gierek-Ciaciura

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 07/2003; 14(84):718.

  Pterygium is a wedge-shaped fibrovascular growth of conjunctiva that extends onto the cornea. The etiopathogenesis of pterygium is still not fully elucidated. Exposure to ultraviolet light isPterygium is a wedge-shaped fibrovascular growth of conjunctiva that extends onto the cornea. The etiopathogenesis of pterygium is still not fully elucidated. Exposure to ultraviolet light is suggested as one of the most important factors contributing to pterygium development. However, other factors including allergens, harmful chemical substances, wind, dust and pollens also may contribute to its development. The aim of the study was to evaluate the influence of immune reactions on the pathogenesis of pterygium.

• [Laser correction of myopia and myopic astigmatism in children--literature review]

  Authors: Ewa Mrukwa-Kominek, Stanisława Gierek-Ciaciura

  Klinika oczna. 02/2003; 105(6):425-7.

  Anisometropic myopia and myopic astigmatism are very often refractive error in children. Suitable correction of different vision defects in children might prevent the consequences of amblyopia andAnisometropic myopia and myopic astigmatism are very often refractive error in children. Suitable correction of different vision defects in children might prevent the consequences of amblyopia and lack of development of binocular vision. This article presents the effectiveness of correction in myopia and myopic anisometropia using laser method such as PRK, LASEK and LASIK. It is the literature review.

• [Complications after laser refractive surgery]

  Authors: Stanisława Gierek-Ciaciura, Ewa Mrukwa-Kominek, Dorota Wygledowska-Promieńska

  Klinika oczna. 02/2003; 105(3-4):233-6.

  The laser refractive surgery is very effective method of refractive errors correction. The method is very popular, but serious complications may occur and the visual acuity may decrease. In thisThe laser refractive surgery is very effective method of refractive errors correction. The method is very popular, but serious complications may occur and the visual acuity may decrease. In this article authors show the possible complications after the laser refractive procedures.

• [Use of intra-stromal corneal ring segments (INTACS) in refractive surgery]

  Authors: Dorota Wygledowska-Promieńska, Stanisława Gierek-Ciaciura, Ewa Mrukwa-Kominek

  Klinika oczna. 02/2003; 105(3-4):200-2.

  Implantation of intrastromal corneal rings segments is a new refractive procedure. INTACS consists of 2 separate segments placed in the midperipheral cornea, in specially preparing lamellar channels.Implantation of intrastromal corneal rings segments is a new refractive procedure. INTACS consists of 2 separate segments placed in the midperipheral cornea, in specially preparing lamellar channels. Polymethylo methacrylate rings, which flatter the anterior curvature of the cornea. The peripheral localization of these rings leaves the central cornea untouched. The 2 main advantages of the INTACS are, that it preserves the corneal center and is removable. Segments serve for the reduction of myopia from -1.00 D to -5.00 D. The refractive correction is modulated by INTACS thickness, which ranged from 0.25 to 0.45 mm.

• [In vivo evaluation of corneal structure changes after refractive procedures]

  Authors: Iwona Rokita-Wala, Stanisława Gierek-Ciaciura, Ewa Mrukwa-Kominek

  Klinika oczna. 02/2002; 104(5-6):332-40.

  PURPOSE: The aim of the study was to evaluate and compare in vivo the corneal structure changes after refractive procedures (PRK, LASIK, LASEK). MATERIAL AND METHOD: The analysed group of patientsPURPOSE: The aim of the study was to evaluate and compare in vivo the corneal structure changes after refractive procedures (PRK, LASIK, LASEK). MATERIAL AND METHOD: The analysed group of patients consisted of 226 corneas in 126 patients, who underwent correction of myopia and myopic astigmatism, using the procedures: PRK (120 eyes), LASIK (56 eyes) and LASEK (50 eyes). The photoablation of the corneas was performed with the Excimer Laser MEL 60 and MEL 70 G-Scan Aesculap Meditec. Postoperative observations were made using a confocal microscopes Confoscan P4 (Tomey) and ConoScan 2 (Fortune Technologies). The evaluations were performed in the early (up to 3 months) and late postoperative period (after PRK and LASIK-up to 2 years; after LASEK-up to 6 months). RESULTS: The confocal microscopy revealed some changes within the corneal epithelium and anterior part of stroma after PRK, LASIK and LASEK. After PRK, there was increased desquamation of superficial epithelial cells in early postoperative period. These cells were elongated after LASIK and LASEK procedures. After PRK and LASEK, the Bowman's membrane was absent in the central part of the cornea, during the whole observation period. After all these procedures, the anterior part of the corneal stroma in the ablation zone, showed increased background illumination of collagen fibres and an irregular pattern of elongated keratocytic nuclei, in the early postoperative period. No scar tissue--"haze" was found in cases after LASEK, what may occur after PRK procedure. The findings kept changing in the course of the follow up time. CONCLUSIONS: Confocal microscopy enables in vivo monitoring of changes, which occur in the corneal structure after refractive procedures; this facilitates the evaluation of corneal healing. LASEK is the least invasive refractive procedure, which allows prompt stabilization of the corneal structure.

• [Vital changes in corneal structure after LASEK during the early postoperative period]

  Authors: Iwona Rokita-Wala, Stanisława Gierek-Ciaciura, Ewa Mrukwa-Kominek, Marek Obidziński

  Klinika oczna. 02/2002; 104(1):13-8.

  LASEK (Laser Epithelial Keratomileusis) is a new refractive surgery technique, with corneal epithelial flap formation, Excimer Laser photoablation, and subsequent flap reposition. Confocal microscopyLASEK (Laser Epithelial Keratomileusis) is a new refractive surgery technique, with corneal epithelial flap formation, Excimer Laser photoablation, and subsequent flap reposition. Confocal microscopy facilitates in vivo evaluation of the corneal structure, i.e., a morphological analysis of its layers, and the monitoring of postoperative alterations. PURPOSE: The purpose of the present study is to assess the corneal structure in vivo morphological after LASEK procedure with the use of confocal microscopy in the early postoperative period. MATERIAL AND METHOD: The analyzed group of patients consisted of 50 eyes in 30 patients who underwent correction of myopia and myopic astigmatism using the LASEK procedure. The epithelial flap formation was carried out with the use of a 20% alcohol solution. The photoablation was performed with the Excimer Laser MEL 70 G-Scan Aesculap Meditec. Postoperative observations were made using a Confoscan 2 (Fortune Technologies). The evaluations were performed on the first postoperative day, and then at 1, 2, 4 and 12 weeks following surgery. RESULTS: Confocal microscopy revealed some changes in the epithelium and corneal stroma. At the site of the photoablation the structure of collagen fibers was blurred, with increased reflectivity. No scar tissue was found. The pattern of keratoctic nuclei in the anterior corneal stroma was typical for the postphotoablation state during the whole observation period. Bowman's membrane and the subepithelial nerve plexus were absent in the central part of the cornea. The findings kept changing in the course of the follow up time. CONCLUSIONS: Confocal microscopy enables the monitoring of changes, which occur in the corneal structure after LASEK refractive procedures; this facilitates the evaluation of corneal healing. LASEK allows for prompt stabilization of the epithelial structure and the anterior corneal stroma. No overproduction of collagen fibers was observed at the photoablation area during the healing process.