Background and methodsBased on the available literature, it is suggested, in the clinical evaluation of the chiasmal tumors, that the following electrophysiological tests: visual evoked potentials to pattern-reversal stimulation, multifocal visual evoked potentials (mfVEPs), and pattern electroretinogram (PERG) play an important role in the diagnosis of the optic nerve and retinal dysfunction in the course of pituitary tumors.ResultsMacroadenomas and also microadenomas may cause dysfunction of retinal ganglion cells (RGCs) and their axons, even in the absence of changes in the routine ophthalmological examination, retinal sensitivity in standard automated perimetry, and retinal nerve fiber layer thickness in optical coherent tomography. The most frequently observed changes in electrophysiological tests were as follows: in PVEPs—the crossed/uncrossed asymmetry distribution, altered waveform, increase in P100-wave peak time, and/or reduction in amplitude; in mfVEPs—the peak time prolongation and/or amplitude reduction in C1-wave; in PERG—the reduction in N95-wave amplitude and decreased N95:P50 amplitude ratio. Hemifield PVEPs were more often abnormal than full-field PVEPs. Multi-channel recording is recommended for the assessment of the anterior visual pathway. The use of mfVEP offers the possibility to register localized disturbances of the optic nerve and ganglion cells. Additionally, an amplitude of N95-wave reduction in PERG correlated with a lack of postoperative visual acuity recovery. The postoperative improvement in the visual field was found to be associated with a normal N95:P50 amplitude ratio. The RGCs dysfunction manifested by decrease in PhNR/b-wave amplitude ratio was associated with the worse visual fields outcome. A review of the literature summarizing the electrophysiological testing in the pituitary adenoma is discussed.ConclusionIn patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.

SummaryBackground:The aim of this paper was to analyze the causes of orbital cellulitis in connection with covert dental changes as well as to establish the role of radiological procedures in the final diagnosis and further treatment of such cases.Material/Methods:Thirty-two patients, aged 25–56, 22 women and 10 men were diagnosed and treated between January 2007 and April 2011 at the Pomeranian Medical University in Szczecin. The patients were examined in the infirmary of the ophthalmological department due to unilateral blepharo-oedema, abrupt pain and vision disturbances; in 5 cases, body temperature increased up to 37.8°C was observed. Next, the patients underwent conventional X-ray examinations of the orbit to exclude any foreign bodies in the eyeball, as well as pantomographies to evaluate the dental status. Visible periapical or periodontal changes in dentition were analyzed with intraoral X-rays with the use of DIGORA System 2.1. Changes found in 3 patients on pantomograms and connected with iatrogenic procedures were further evaluated with CT (64 lines and 128 layers) in frontal, sagittal and axial projections. Orbital disorders were also diagnosed by an ophthalmologist and radiologist with Doppler ultrasound (US) examinations. A linear transducer of 7.5–10 MHz to observe the morphology and vascularity of the eyeball was applied.Results:Iatrogenic treatment was the cause of sinusitis and cellulitis in three cases: incorrectly implanted dental implant in one case, root of the 3rd molar pushed into the sinus in the second case, and communication between the maxillary alveolar process and the sinus after extraction in case of the third patient. Asymptomatic periapical osteolysis, periodontal disease or dead teeth were found in all cases. Diagnosis of orbital cellulitis of dental origin was determined on the basis of clinical, radiographic and ultrasound findings. Ophthalmologic and dental treatment was applied simultaneously.Conclusions:Co-operation between ophthalmologists, radiologists and dentists is necessary during the treatment of such orbital diseases.

PurposeTo present a patient with a diagnosis of pituitary adenoma and progressive visual pathway dysfunction detected in the electrophysiological tests in one-year follow-up. Patient is a 59-year-old male with a non-secreting pituitary macroadenoma.MethodsRoutine ophthalmological evaluation, standard automatic perimetry (SAP), retinal nerve fibers layer and the ganglion cell complex thickness in optical coherent tomography (OCT), as well as electrophysiological examinations (pattern electroretinogram—PERG, multi-channel pattern visual evoked potentials—multi-channel PVEPs record according to ISCEV standards) were performed. The examination and additional tests were conducted 3 times (in 0, 6 and 12 months) and 6 months after neurosurgery.ResultsVisual acuity, funduscopic examinations, SAP, OCT and electrophysiological test results at the first visit were all normal. In both eyes, the abnormalities were observed only in the multi-channel PVEP and PERG despite the absence of the changes in the routine ophthalmological examination and additional tests after 6- and 12-month follow-up. The tumor growth but without chiasmal compression was confirmed by magnetic resonance imaging. The progression of the optic pathway dysfunction in the electrophysiological tests was a cause of surgical removal of the pituitary tumor.ConclusionThis case highlights novel observations that in patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.

Wstęp: Obserwacje kliniczne wskazują, że u pacjentów z cukrzycą stwierdza się częstsze występowanie zmętnienia torebki soczewki po operacji fakoemulsyfikacji zaćmy z wszczepieniem soczewki. Nowe metody operacyjne i modyfikacje sztucznych soczewek wewnątrzgałkowych zmniejszają częstość występowania zmętnienia torebki tylnej soczewki (PCO) i wykonywania YAG – kapsulotomii z powodu zaćmy wtórnej. Wyniki przeprowadzonych dotychczas badań sugerują, że operacja usunięcia zaćmy z wszczepieniem soczewek pokrytych heparyną zmniejsza ryzyko PCO u pacjentów z cukrzycą typu 2.Celem pracy była ocena wpływu soczewki akrylowej hydrofobowej heparynizowanej na częstość występowania I stopnia zaawansowania zmętnienia przedniej (ACO) i tylnej torebki soczewki oraz ostrości wzroku u pacjentów z cukrzycą typu 2 po niepowikłanej operacji zaćmy.Materiały i metody: Do prospektywnego badania zakwalifikowano 18 pacjentów (36 oczu) z cukrzycą typu 2, bez cech retinopatii. Przeprowadzono standardową operację usunięcia zaćmy z wszczepieniem soczewki akrylowej hydrofobowej heparynizowanej (Polylens Y10AS) do jednego oka (grupa badana) i nieheparynizowanej (Alcon SA60AT) do drugiego oka (grupa kontrolna). Oceniano najlepiej skorygowaną ostrość wzroku do dali (DBCVA) oraz występowanie ACO i PCO w badaniu retroiluminacji. Otrzymane wyniki badań poddano analizie statystycznej.Wyniki: W okresie rocznej obserwacji nie stwierdzono różnic istotnych statystycznie w występowaniu ACO i PCO w oczach pacjentów z cukrzycą z wszczepionymi soczewkami heparynizowanymi w porównaniu z oczami tych samych pacjentów z implantami nieheparynizowanymi. Nie wykazano także znaczących różnic w DBCVA między omawianymi grupami w ciągu 12 miesięcy obserwacji.Wnioski: Wyniki przedstawionych badań sugerują, że soczewki akrylowe hydrofobowe heparynizowane i nieheparynizowane wykazują podobną biokompatybilność u pacjentów z cukrzycą typu 2.