Refractive Errors Among Members of the Armed Forces of the Czech Republic.

Objective: To evaluate the prevalence of refractive errors among members of the Armed Forces of the Czech Republic, to recommend a safe way of correcting refractive errors with regard to the specific needs of military personnel (especially members of combat units and flying personnel), and to propose a system for solving these errors in order to increase combat effectivity. Methodology: Questionnaire to determine previous refractive surgery and spectacle correction wear. Measurement of refraction with a hand-held autorefractometer and evaluation of current visual acuity on ETDRS optotypes (Landolt rings). Results: 259 servicemen (518 eyes) were investigated. The return rate of the questionnaires was 100%. The incidence of myopia greater than -0.75D was 22% (113 eyes), myopia greater than -0.5D 32% (166 eyes). The mean value of myopia was -0.78 D (SD ±0.6). Hypermetropia values ranged from +0.25 to +5.0 D. The mean value of hypermetropia was 0.63 D (SD ±0.7). Astigmatism values ranged from -0.25 to -3.75. The mean value of astigmatism was -0.55 Dcyl (SD ±0.49). The average visual acuity was 84.1 letters ETDRS SD (±6.1), visual acuity worse than 80 letters was manifested by 23% of the members of the monitored group. 25 people (10%) had undergone laser refractive surgery. Visual acuity after laser refractive surgery was measured in 19 people (38 eyes). Mean uncorrected post-laser visual acuity was 83.87 (SD ±6.1) ETDRS letters. The mean follow-up period after laser refractive surgery was 6.78 (SD ±4.8) years. Conclusion: Despite the initial selection of military personnel and entry limitations, the prevalence of refractive errors is comparable to the general population. However, in contrast with the general population, refractive errors larger than -3.0 D were not represented in the group. Due to the finding of insufficient correction of refractive errors, increased emphasis should be placed on identifying and regularly observing military personnel with refractive errors

Myopic Correction with Iris-Fixated Phakic Intraocular Lenses: Twelve-Year Results.

PURPOSE: To evaluate a 12-year follow-up of myopic patients after iris-fixated phakic intraocular lenses (IF pIOLs) implantation. Setting. Ophthalmology Department, Military University Hospital in Prague (Czech Republic). DESIGN: Single-center retrospective cohort study. METHODS: We describe the results of a cohort study that included 85 eyes of 46 myopic patients who underwent implantation of Verisyse myopia, Veriflex, and Verisyse myopia toric (all Abbott Medical Optics, Inc.) intraocular lenses. Refractive functions and adverse events were assessed preoperatively, at 6 months, and 1, 2, 5, and 12 years after IF pIOL implantation. RESULTS: Mean spherical equivalent was measured as -9.37 ± 2.87 D, 0.14 ± 0.61 D, and -0.42 ± 1.08 D, preoperatively, at 6 months and 12 years postoperatively, respectively. There was a significant reduction in the cylinder after surgery. At 12 years postoperatively, 90% of eyes had uncorrected distance visual acuity (UDVA) of 20/40 and 64% of 20/20. The safety index was 1.10 for the whole postoperative follow-up period. We found cataract formation in 3 eyes (3.5%). The endothelial cells loss (EC loss) directly caused by IF pIOL implantation was 6.0%, 8.10%, 12.8%, and 11.9%, at 1, 2, 5, and 12 years, respectively. In our cohort, 95% of eyes lost a higher percentage of EC than would be expected from a physiological loss at 12 years postoperatively. We found a significant negative interaction between preoperative pachymetry and EC loss, indicating that the lower pachymetry leads to a faster decline in endothelial cells density (ECD). IF pIOL re-enclavation was found in 28% of eyes. 7% of subluxations were caused by trauma. The mean time of nontraumatic re-enclavation was 6 years postoperatively. CONCLUSIONS: The study confirmed the advantages of IF pIOL implantation due to rapid visual recovery and stable visual function over the 12-year follow-up and also showed the influence of lower corneal pachymetry regarding EC loss.

Psychogenic non-epileptic seizures: our video-EEG experience.

OBJECTIVE: The aim of our study was to assess the number of psychogenic non-epileptic seizures (PNES) in our patients with a refractory seizure disorder, to determine the 'typical' PNES semiology using video-EEG monitoring and describe other PNES parameters. METHODS: We evaluated prospectively 596 patients with pharmacoresistant seizures. All these patients underwent continuous video-EEG monitoring. In consenting patients, we used suggestive seizure provocation. We assessed seizure semiology, interictal EEG, brain MRI, psychiatric co-morbidities, personality profiles, and seizure outcome. RESULTS: In the sample of 596 monitored patients, we detected 111 (19.3%) patients with PNES. Of the 111 patients with PNES, 86.5% had spontaneous and 76.5% had provoked seizures. The five most typical symptoms were: initially closed eyelids (67.6%), rapid tremor (47.7%), asynchronous limb movement (37.8%), preictal pseudosleep (33.3%), and side-to-side head movement (32.4%). Interictal EEG was rated as abnormal in 46.2% and with epileptiform abnormality in 9%. Brain MRI was abnormal in 32 (28.8%) patients. Personality disorders (46.8%), anxiety (39.6%), and depression (12.6%) were the most frequent additional psychiatric co-morbidities. PNES outcome after at least 2 years is reported; 22.5% patients was seizure-free; one-third had markedly reduced seizure frequency. We have not seen any negative impact of the provocative testing on the seizure outcome. DISCUSSION: Video-EEG monitoring with suggestive seizure provocation supported by clinical psychiatric and psychological evaluation significantly contributes to the correct PNES diagnosis, while interictal EEG and brain MRI are frequently abnormal. Symptoms typical for PNES, as opposed to epileptic seizures, could be distinguished.

Is pseudo-intractability in population of patients with epilepsy still alive in the 21st century? Audit of 100 seizure-free patients, referred with the diagnosis of pharmacoresistant epilepsy.

OBJECTIVE: There is no universally accepted definition of pseudo-intractable epilepsy. Pseudo-intractability means that the resistance to treatment is, in fact, caused by clinical errors. The purpose of our study was to identify the reasons for intractability and subsequent effective therapeutic management approaches in a group of patients with established pseudo-intractable epilepsy. METHODS: The study was designed as a retrospective audit of 100 adult patients who, in their past medical history, were diagnosed as having intractable epilepsy but, following adjustments to their medical management, were seizure free for at least 2 years. Patients underwent standard clinical evaluation, including EEG and/or video-EEG monitoring. We re-evaluated past medical, family, seizure and pharmacological history and morphological findings. Epilepsy was re-classified according to the ILAE classification. RESULTS: We identified possible errors including incorrect diagnosis and/or inappropriate previous epilepsy management in all 100 patients. Incorrect diagnosis (seizure type and/or syndrome) was observed in 47 patients (47%). Thirty two patients (32%) with idiopathic generalized epilepsy were treated for complex focal seizures with inappropriate choice of medication. Therapeutic errors were identified in 48 patients (48%). Issues with medication compliance were found in 20 patients (20%). Potential seizure precipitating factors were detected in 23 patients (23%). CONCLUSIONS: Our study of 100 patients confirmed that the problem of pseudo-intractability still exists. Every case of pharmacoresistance in epilepsy could potentially be caused by one or more clinical errors.

Psychogenic non-epileptic seizures, prospective clinical experience: diagnosis, clinical features, risk factors, psychiatric comorbidity, treatment outcome.

In our study, we evaluated 249 patients with refractory seizures using video-EEG monitoring. In this sample, we identified 56 (22.5%) patients with psychogenic non-epileptic seizures - PNES only. Spontaneous seizures were recorded in 49 (87%) patients with PNES. Suggestive seizure induction using intravenous saline placebo was successful in 77.1% of induced PNES cases. Disease duration prior to PNES diagnosis was quite long. Prolonged past and current intake of high number of different antiepileptic drugs was also typical for these patients. We evaluated ictal PNES semiology. Whereas ictal EEG was normal in all PNES patients, interictal EEG was abnormal in 46.4%. Brain MRI was abnormal in 30.4%. Personality disorders were the most frequent psychiatric co-morbidity (in 44.6% of PNES patients), emotionally unstable (borderline) personality disorder was predominant (in 32.1% of PNES patients). Risk factors for epilepsy misdiagnosis and PNES manifestation are discussed. Therapeutic outcome after two years of combined treatment (psychopharmacotherapy and/or psychotherapy) is presented; approximately one third of patients were seizure-free following two years of treatment, one third of patients were responders (>or= 50% reduction in seizure frequency) and one third did not respond to treatment.

Treatment of Interictal Depression with Citalopram in Patients with Epilepsy.

The purpose of this study is to assess the efficacy and safety of the selective serotonin-reuptake inhibitor (SSRI) citalopram in depressed epileptic patients. We evaluated 43 epileptic patients who suffered from depression and whose total score on the 21 items of the Hamilton Scale for Depression (HAMD 21) exceeded 15 points. These patients were examined by the psychiatrist and scaled before treatment and after 4 and 8 weeks of treatment with citalopram. The dose of citalopram was flexible, related to the actual condition of the patient. In each patient and in the whole group of patients we compared the monthly seizure frequency (total, partial seizures, generalized tonic-clonic seizures) recorded during treatment with citalopram with that recorded during the 2 months preceding the start of citalopram. During treatment we observed a decrease in the total score on the HAMD 21 from a mean initial value of 21.5 +/- 2.9 (range, 17-26) prior to therapy 14.5 +/- 2.9 (range, 10-19) (P < 0.001) after 4 weeks of treatment and to 9.9 +/- 3.1 (range, 4-19) (P < 0.001) after 8 weeks of treatment. There were 9 (20.9%) responders after 4 weeks of treatment and 28 responders (65.1%) after 8 weeks, all of them with decrease on the HAMD 21 greater than 50%. Nausea was the most common adverse event in 7 patients (16.3%) during the first month of treatment and in 3 patients (6.9%) during the second month of treatment. Sexual dysfunction (decrease of libido) was reported in 2 (4.7%) male patients during the entire course of treatment. No seizure worsening was observed in our patients. Monthly seizure frequency did not change significantly: 2.24 (+/-0.76) seizures before treatment with citalopram, 2.29 (+/-0.81) seizures in the first month of treatment, 2.21 (+/-1.00) seizures in the second month of treatment. No occurrence of de novo generalized tonic-clonic seizures was recorded in individual patients. Citalopram is a safe and effective antidepressant in the treatment of depressed epileptic patients.