Nanolaser in cataract surgery and its impact on corneal endotelium.

PURPOSE: To compare safety and efficacy of new nanolaser photofragmentation technique with standard ultrasound phacoemulsification cataract surgery technique. Metods: A group of 20 patients - 40 eyes who underwent bilateral cataract surgery, one eye with ultrasound phacoemulsification (group I), n = 20 fellow eye with nanosecond laser framentation (group II ). Lens Opacities Classification System III was used to classify cataract stage. All 40 eyes had stage III cataract, Nucleus Opalescence was NO2 - NO3. Uncorrected visual acuity (UCVA), endothelial cells density (DEC), hexagonal cells rate, index of endothelial cells pleomorfism, and corneal thickness were evaluated prior to surgery and at day 7 follow up. RESULTS: All 40 eyes had uneventful surgery,without complications. Preoperative UCVA in group I was 0,70±0,07 and 0,68 ± 0,10 in group II. At follow up check 7 days after surgery UCVA was 0,98 ± 0,05 in group 1 and 0,98 ± 0,04 in group II (p-NS). The mean DEC (cells/mm2) before surgery was 2508 ± 205,54 in group 1 and 2472 ± 287,85 in group II. After surgery density decreased to 2024,92±271,50 in group 1 and 2138,5 ± 390,85 in group II. Difference in endothelial cells decrease between groups showed no statistical significance. There was no statistical significance in differences of hexagonal cells rate and corneal thickness between both groups pre and postoperatively. CONCLUSION: Nanolaser lens photofragmentation and ultrasound phacoemulsification can be considered equal regarding impact on endothelial cells.

[Epi-Lasek--our experience]. / Epi-Lasek--nase skúsenosti.

UNLABELLED: The aim of this study is to find advantages of alcohol assisted epithelial flap creation before surface excimer--laser refractive ablation. METHODS: One hundred eyes undergoing Epi-Lasek with 20% alcohol in the beginning of procedure. Mean preoperative spherical equivalent was - 3.44 D +/- 1.8 and/from -1.0 to - 8.0 D/spectacle--corrected visual acuity was from 1.0 to 0.8 in 100% eyes. All epithelial separations were performed with the Lasitome Gebauer. In the beginning of operation was used 20% alcohol for 15 second. RESULTS: The mean uncorrected visual acuity at 1 month after operation was from 1.0 to 0.8 in 92% eyes. After 12 months, the mean spherical equivalent was -0.262 +/- 0.15D (from +0.50 to -0.75D). At 12 months no haze was observed. CONCLUSION: Our clinical results confirmed, that using 20 % alcohol or Epi-Lasek is contribution to refractive excimer surgery. Epi-Lasek enhances creation and separation of epithelial flap, leaves epithelial basal membrane attached to Bowmans layer and though creates optimal conditions for excimer laser surface ablation.

[EPI-LASIK--2 years' clinical results]. / EPI-LASIK--2-rocné klinické skúsenosti.

PURPOSE: To evaluate the clinical results of Epi-LASIK, a new surface ablation surgical technique for the treatment of low and middle myopia. METHODS: Twenty eyes of 10 patients had Epi-LASIK for the correction of low and middle myopia. Mean preoperative spherical equivalent of the refractive error was 3.64 diopters (D) +/- 1.9 D, and the best spectacle-corrected visual acuity was from 1.0 to 0.8 in 100 % of eyes. All epithelial separations were performed with the Krumiech-Barraquer microkeratome (Lasitome Gebauer). In the postoperative period the patients filled out a questionnaire grading pain score of the treated eyes. RESULTS: The mean uncorrected visual acuity at 1 month after the operation was from 1.0 to 0.8 in 90 % of eyes. After 12 months, the mean spherical equivalent of the refractive error of the treated eyes was -0.262 +/- 0.15 D (from -0.25 to +0.25 D). One hundred percent of eyes had clear corneas at 6 months after the treatment. After 24 months, the mean spherical equivalent of the refractive error was -0.258 I 0.14 D, no "haze" was observed. CONCLUSIONS: The first clinical results suggest that Epi-LASIK is a safe, less painful and efficient method for the correction of low and middle myopia. We suppose, further studies will establish this method as a very good alternative surface ablation procedure.

[Immunofluorescent analysis of anterior lens capsule allotransplantation for chronic corneal ulcers]. / Imunofluorescencná analýza allotransplantátov prednej sosovkovej kapsuly u chronických vredov rohovky.

This study uses immunofluorescent analysis to find out in histologic corneal sections a possible rejection reaction in anterior lens capsule allotransplantation for chronic corneal ulcers. The experiment included control group of rabbit corneas with repeat injury to epithelium and anterior stroma as well as surgically treated group. Fluorescein-conjugated human antibodies to IgA, IgM, IgG, complement and fibrinogen were used in the study. For detection we used method of direct immunofluorescence. Positive was only examination on fibrinogen in sections of treated group eyes 2 days after surgery. Last examination after 3 months failed to detect positivity in any of the tested markers. We preliminarily conclude that anterior lens capsule allotransplantation for chronic corneal ulcers does not result in rejection reaction and that components of humoral immunity do not participate in immune reaction.

[Surgical correction of lagophthalmos by implantation of a gold weight]. / Chirurgická úprava lagoftalmu implantáciou zlatého závazia.

This study concerns the problematics of upper branch of n. VII rehabilitation. Surgical technique is presented which involves implantation of gold weight into the upper eyelid which was used in 17 patients. The study emphasizes importance of oculoplastic surgery which should become an integral part of management of facial nerve paresis.

[Immunofluorescence identification of limbal stem cells in a culture of donor corneas]. / Imunofluorescencná identifikácia limbálnych kmenových buniek v kultúre donorskej rohovky.

The purpose of this study was to identify limbal stem cells in the culture of human donor cornea. After standard cultivation procedure we used monoclonal antibody against alpha-enolase for identification of stem cells. This antibody serves as a probe for the identification of biochemical marker of stem cells. Using immunofluorescent microscopy we identified in specimens alpha-enolase positive cells which in vitro but not in situ showed also some morphologic differences from other cellular elements of the culture.

[Corneal topography and LASIK]. / Rohovková topografia a LASIK.

PURPOSE: The purpose of this study is to outline the importance of corneal topography after LASIK surgery and to show the association between topographic findings and postoperative results. PATIENTS: One hundred and fourteen eyes, 70 patients with myopia (from -6.00 to -14.00 Dsph) who underwent surgery by LASIK. METHODS: We identified 5 types of topographic patterns which were classified to symmetric and asymmetric groups. We evaluated the association between the type of topography pattern and the following parameters: age, sex, astigmatism, pre-operative refraction, post-operative uncorrected and best corrected visual acuity. RESULTS: Fifty eight eye filled the criteria of the first group (uniform pattern), 30 eyes of the second group (bowtie), 4 eyes of the third group (penninsula), 3 eyes of the fourth group (semicircular) and 3 eyes of the fifth group (irregular pattern). Significant association between topographic corneal patterns and observed parameters has been confirmed in post-operative uncorrected visual acuity, post-operative refraction and astigmatism (p < 0.05). Age and sex were not significant parameters for the outcome of surgery. CONCLUSION: Majority of eyes (89%) had symmetric corneal topography pattern which highly surpassed our expectations. Comparison of topography patterns with observed parameters proves that the shape of ablation zone influences post-operative quality of vision.

UV-B induced production of MMP-2 and MMP-9 in human corneal cells.

The purpose of this study was to determine the production of metalloproteinases (MMP) 2 and 9 following UV-B irradiation in human corneal epithelial cells and fibroblasts. Epithelial cells and fibroblasts were separated from human donor corneas and exposed to UV-B lamp irradiation for 20, 40, 80 and 120 s. Media samples were collected at 8, 24, 48 and 72 h and gelatinase A and B production was assayed by the ELISA test. Statistical significance of production was assessed by the paired t-test. Increased production of MMP-2 was found in human corneal fibroblasts in response to UV-B irradiation. A statistically significant production of MMP-2 was not observed in human corneal epithelial cells following UV-B exposure. We did not detect any increase in MMP-9 after irradiation in either epithelial cells or fibroblasts. MMP-2 is produced by the corneal fibroblasts in the acute phase after UV-B irradiation. MMP-9 is not released in vitro following UV-B irradiation damage and therefore does not directly participate in the pathophysiology of acute photokeratitis.

[The histopathologic picture after chemical eye injury and the role of limbal stem cells]. / Histopatologický obraz po chemickom poranení oka, úloha limbálnych kmenových buniek.

The aim of this experimental study was to evaluate the role of limbal stem cells on corneal wound healing. The experimental objects were New Zealand white rabbits. Damage to the cornea was caused by 2.5 N NaOH solution for 50 sec. and was subsequently washed out by saline solution. The rabbits were euthanased 24 hours after alkaly burn and the tissue was fixated in 10% formalin. The samples were embedded in paraffin and stained with haematoxilin and eosin. The specimen showed focal inflammatory reaction with the presence of macrophages an round--nucleated cells in the limbal area.

[The excimer laser and severe myopia--comparison of LASIK and PRK]. / Excimerový laser a t'azká myopia--porovnanie metódy LASIK a PRK.

The aim of this study is to compare the results of photorefractive keratectomy (PRK) with method of laser-assisted keratomileusis (LASIK) in the treatment of high myopia by excimer laser. The study compares 100 eyes after PRK operated on by technique of multizonal ablation divided into group of moderately high myopia (-6.0 ... -9.0 Dsph/85 eyes) and severely high myopia (over -9.25 Dsph/15 eyes) with a group o 100 eyes operated on by LASIK similarly classified (moderately high myopia/67 eyes and severely high myopia/33 eyes). The eyes were treated by excimer laser Keracor 117 manufactured by Technolas company. Statistic analysis used one-way analysis of variance. One year after operation emmetropia within +/- 1.0 Dsph was 52% in the first and 47% in the second group after PRK. After LASIK it was 71% and 54% respectively. No statistically significant differences have been found between the groups. In spite of this, analysis of postoperative complications, line loss of the preoperative best spectacle corrected acuity and patients satistaction shows that LASIK is a better method in correction of high myopia by excimer laser.

Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term followup.

OBJECTIVE: This study aimed at revisiting vernal keratoconjunctivitis (VKC) on the basis of anamnestic, clinical, immunologic, histopathologic, and followup data of 195 patients. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: One hundred and ninety-five patients with VKC. METHODS: Clinical evaluation and outcome in 151 of 195 patients with a median followup of 47 months. Evaluation was by telephone survey in 69 patients. MAIN OUTCOME MEASURES: (1) Demographic, clinical, and immunologic features of VKC and their influence on the course of the disease; (2) conjunctival and corneal complications and efficacy of treatment observed during the followup period. RESULTS: VKC is a chronic disease. More than 60% of patients had repeated recurrences all year round. Males had an earlier presentation of symptoms than females and the male/female ratio decreased with age. Major (greater than 80%) and minor (up to 80%) diagnostic criteria were defined for clinical signs and symptoms of the disease. Negative skin test or radioallergosorbent test was present in approximately 50% of patients, whereas eosinophil infiltration was a constant histopathologic finding. A marked conjunctival sensitivity to nonspecific stimuli was noted in more than one third of patients. In 6% of cases, a reduction of visual acuity resulted from corneal scarring, and in 2% of patients, steroid-induced glaucoma was observed. The large size of giant papillae indicates poor prognosis for the persistence of the disease and its evolution into a chronic, perennial condition. CONCLUSIONS: VKC is a chronic eosinophilic disease of the ocular surface involving IgE, non IgE-mediated mechanisms, and age-sex-related influences. Although the disease has a good prognosis, severe visual impairments may result from long-standing inflammation.

[Comparison of hyperopic photorefractive keratectomy and LASIK in correction of hypermetropia with excimer laser]. / Porovnanie metódy hyperopickej fotorefraktívnej keratektómie a LASIK v korekcii hypermetropie excimerovým laserom.

The aim of this work is to compare results of the correction of hyperopia by method of hyperopic photorefractive keratectomy (HPRK) with method of laser assisted keratomileusis known as LASIK. We evaluate group of 129 eyes operated by excimer laser Keracor 117 manufactured by Technolas company. 77 eyes underwent HPRK and 52 eyes hyperopic LASIK (HLASIK). The patients were divided to two groups, the first of which comprised 47 eyes with low hyperopia to +3.5 Dsph and the second 82 eyes with high hyperopia. Follow-up period was 12 months results were statistically evaluated by Student t-test. One year after treatment, in the first group was 62% eyes with hyperopia to +1.0 Dsph after HPRK and 70% after HLASIK. In the second group it was 32% and 44%, respectively. No statistically significant differences have been found between the two groups. In spite of that, we consider HLASIK method better than HPRK from the point of view of stability of results, occurrence of complications and estimated resulting refraction, especially in the eyes with low hyperopia.

[Implantation of silicone intraocular lenses--long-term results]. / Implantácia silikonových vnútroocných sosoviek--dlhodobé výsledky.

The author reports long time experience with implantation of silicone intraocular lenses. Briefly is described surgical technique, mainly the most common methods of folding of silicone intraocular lenses. Discussion concerns peroperative and postoperative complications and evaluation of the results after 3 years follow up.

[Endonasal endoscopic dacryocystorhinostomy]. / Endonazálna endoskopická dakryocystorinostómia.

Contemporary advances in endoscopic surgery of the paranasal sinuses make it possible to identify and open the lacrimal system via the nasal sinus. The authors describe four cases of chronic dacryocystitis with obstruction of the nasolacrimal duct in three women and one man aged 22 to 56 years. In all four patients the lacrimal sac was opened endoscopically by the endonasal route and safeguarded by drainage. In the discussion the authors deal with contemporary views on this problem.

[Argon laser trabeculoplasty--long-term results]. / Argón laser trabekuloplastika--dlhodobé výsledky.

A group of 302 eyes in 175 patients with primary open-glaucoma (POAG) were analyzed after argon laser trabeculoplasty (ALT) with postoperative follow-up of 2 up to 10 years. ALT was considered to be successful when IOP remained under 21 mmHg with no further damage of the optic disc or visual fields. The success rate was in 81.8% eyes after two years, 64.4% after five years, 27.8% after 8 years of the follow-up, and only 15.6% eyes were still controlled after 10 years. Our results confirmed, that ALT was effective in the eyes with POAG, yet there was a substantial diminishing effect as time progressed.

[Neodymium:YAG trabeculotomy]. / Neodymium:YAG trabekulotómia.

The author presents the results of ND: YAG trabeculotomy on 10 eyes with open-angle glaucoma. The surgery has been carried out as last treatment before trabeculectomy. The mean intraocular pressure (IOP) before laser surgery was 35 +/- 5.2 mm Hg. The IOP decrease below 22.0 mm Hg has been achieved in 50% of eyes. The mean follow-up of the patients was 1 year. Complications included transient postoperative IOP elevation (six eyes) and angle bleeding (three eyes).

[Diode laser trabeculoplasty in the treatment of primary open-angle glaucoma]. / Diódová laser trabekuloplastika v liecbe primárneho glaukómu s otvoreným uhlom.

The results of diode laser trabeculoplasty carried out on 14 eyes of primary open-angle glaucoma are demonstrated. Powers of 0.8-1.0 W were used, with spot 75 um and a pulse of 0.1 second and a mean ocular hypotensive effect of 6.82 +/- 2.94 mmHg (27.9%) was observed at 6 months after treatment. The 78.6% compensation was achieved. The results confirm that diode laser trabeculoplasty is an effective mode of treatment for eyes with primary open-angle glaucoma.

[Nd:YAG laser trabeculoplasty]. / Nd:YAG laser trabekuloplastika.

The results of ALT and Nd: YAG LTP are presented and compared in group 19 patients. The average IOP reduction and increase of outflow facilities were significant in both methods. Any difference of results between comparing methods were not statistically significant.