Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding (the GRASS trial)-Multi-centre, assessor-blinded randomised clinical trial.

PURPOSE: Gastric residual measurement is routinely performed in premature infants prior to feeding despite a lack of evidence of benefit. We aimed to evaluate if the exclusion of routine gastric residual measurement and evaluation has an impact on the time taken to achieve full enteral feeding in preterm neonates. METHODS: International multi-centre randomised controlled trial. Clinically stable, appropriate for gestational age infants between 26+0 and 30+6 weeks of gestation and less than 1.5 kg birth weight were eligible. Infants were randomised to the intervention arm (no monitoring of gastric aspirates) or control arm (routine care). Primary outcome was the achievement of enteral feeds of 100 ml/kg/day by day 5 of life. RESULTS: Ninety-five infants were recruited with 88 included in an intention-to-treat analysis, 45 in the intervention arm and 43 in the control arm. There was no imbalance in baseline characteristics. Thirty-three (73.3%) infants in the intervention group and 32 infants (74.4%) in the control group reached full feeds by day 5 of life (p = 0.91) with no difference in median time to full feeds. There were no statistically significant differences in survival or the major morbidities of prematurity. CONCLUSION:  There was no difference in time to attainment of enteral feeds of 100 ml/kg/day in premature infants when gastric residuals were not monitored. In the absence of a clinical benefit to routine monitoring, it may be appropriate to discontinue this practice and only monitor residuals when clinical concern of feeding intolerance or gastrointestinal pathology arises in this group of patients. TRIAL REGISTRATION:  NCT03111329- https://clinicaltrials.gov/ . Registered 06/04/2017. WHAT IS KNOWN: • Previous randomized trials have shown little benefit to the performance of routine assessment of gastric residuals in preterm infants. Despite this, they continue to be performed due to concerns from observational data regarding development of NEC. Meta-analysis to date has failed to answer the question regarding NEC. WHAT IS NEW: • In very low birth weight infants who are fed using modern feeding practice of faster feed advancement, to minimize use of central access and parenteral nutrition, exclusion of routine checks of gastric residuals did not increase the proportion of infants reaching full enteral feeds by day 5. No harm was seen when residual checks were not performed. • In the absence of a clinical benefit to the routine performance of gastric residuals in very low birth weight infants, it may be appropriate to discontinue their use and instead check residuals when clinical concern of pathology arises.

Platelet Extracellular Vesicles in Cord Blood of Term and Preterm Newborns Assayed by Flow Cytometry: the Effect of Delay in Sample Preparation and of Sample Freezing.

Plasma levels of circulating platelet extracellular vesicles (PEVs) are an emerging marker of platelet activation, thrombosis, inflammation, and endothelial dysfunction. Analysis of PEVs in cord blood of preterm newborns may reflect the underlying pathology and possibly serve as a new diagnostic and prognostic tool. However, collection, preparation and analysis of cord blood samples in clinical settings is a logistically complex process. We have studied the effect of delay in sample preparation and sample freezing on the PEV analysis by flow cytometry. PEVs in the cord blood plasma were identified after double labelling with monoclonal antibodies CD36+CD41 or CD41+CD62. Both, the delay and the freezing significantly affected the count and often also fluorescence of the detected PEVs. Additionally, our pilot study utilizing fresh cord blood samples of term and preterm newborns demonstrated significantly decreased CD36 and CD62 PEV fluorescence in preterm newborns. Our data highlight the importance of pre-analytical steps in the analysis of cord blood PEVs and suggest that not only the count, but also the level of PEV fluorescence may have possible diagnostic potential.

[Retrospective analysis of monochorionic twin pregnancies born in the Institute for the Care of Mother and Child between 2012-2015]. / Analýza prípadu monochoriálních dvojcat porozených v Ústavu pro péci o matku a díte ve ctyrletém období (2012-2015).

OBJECTIVE: The purpose of this study was to describe monochorionic twin pregnancies and their complications, born between 24th and 37th week of gestation in the Institute for the Care of Mother and Child in years 2012-2015. DESIGN: Retrospective cohort. SETTING: The Institute for the Care of Mother and Child, Praha. METHODS: From 2012 to 2015 we observed 177 monochorionic twin pregnancies from which two or one viable fetuses were born, or both fetuses died in utero. RESULTS: From a total of 177 women, 12 (6.8%) gave birth before 26th week of gestation, between 26+0 - 27+6 four women (2.3%) gave birth, 37 women (20.9%) between 28+0 - 31+6, 84 women (47.8%) between 32+0 - 35+6 and after 36th week of gestation 40 women (22.6%) gave birth. Mean week of delivery was 33.8. Indications for termination of pregnancies were premature rupture of membranes (PPROM) in 11.9%, onset of spontaneus uterine contractions in 12.4% and in 53.3% other iatrogenic indication. 23.3% of pregnancies in our cohort were uncomplicated and terminated after 36th week of gestation. We performed caesarean section in 94.3%, in 5.7% patients gave birth vaginally. In vitro fertilization had 19.9% women, 80.1% conceived spontaneously. The age range of pregnant women in our cohort was 20-43, with median 32.3. Mean weight of bigger fetus was 2047.6 g (min. 520 g, max. 3530 g), mean weight of smaller fetus was 1799.5 g (min. 350 g, max. 2790 g). In 30 cases (16. 9%) we performed intrauterine intervetion. In 21/30 cases (11.9%) for TTTS diagnose, in 5/30 cases (2.8%) for congenital abnormalities or TRAP sequence and in 4/30 cases (2.2%) for sIUGR type III. The most frequent complication in our cohort was sIUGR (36 patients - 20.3%), TTTS (21 patients - 11.9%) and on the third place congenital abnormality or TRAP sequence (five patients - 2.8%) Nineteen patients gave birth to one viable fetus, in two cases both fetuses died in utero. In one case, in twin pair, one new-born died shortly after the birth - it had several congenital abnormalities and due to anhydramnion it was impossible to perform amnioinfusion and umbilical cord occlusion. After the birth it was given palliative care. CONCLUSION: The study brought data about specific risks in monochorionic twin pregnancies and suggests careful observation of women in fixed intervals and necessity of immediate referral to perinatal centre in case of any suspicious or pathological finding.

[Herbal therapy during pregnancy - myths and facts]. / Herbal terapie v prubehu tehotenství - mýty a fakta.

UNLABELLED: Herbal therapy during pregnancy is a very popular method of alternative medicine. Frequency of the herbal therapy in the Czech Republic is not known, but international epidemiologic studies estimate that herbal therapy is used by high proportion of pregnant women (on average 28.9% of pregnant women in Europe, with the lowest frequency in Scandinavian countries (10%) and the highest in Eastern Europe (52%)). The positive effect of herbal therapy on pregnancy and childbirth is very popular and often discussed topic on the pregnancy websites. Optimistic reports, which are based on methodologically controversial studies or which are only empirically documented, promote the positive effect of herbal therapy on pregnancy, fetus development and childbirth. Aim of this article is to show potential harm of herbal therapy and describe proven adverse effects of some of the most common herbal products. KEYWORDS: herbal therapy, gravidity, childbirth, neonatal mortality, neonatal morbidity.

The Current State of Artificial Intelligence in Neuro-Ophthalmology. A Review

This article presents a summary of recent advances in the development and use of complex systems using artificial intelligence (AI) in neuro-ophthalmology. The aim of the following article is to present the principles of AI and algorithms that are currently being used or are still in the stage of evaluation or validation within the neuro-ophthalmology environment. For the purpose of this text, a literature search was conducted using specific keywords in available scientific databases, cumulatively up to April 2023. The AI systems developed across neuro-ophthalmology mostly achieve high sensitivity, specificity and accuracy. Individual AI systems and algorithms are subsequently selected, simply described and compared in the article. The results of the individual studies differ significantly, depending on the chosen methodology, the set goals, the size of the test, evaluated set, and the evaluated parameters. It has been demonstrated that the evaluation of various diseases will be greatly speeded up with the help of AI and make the diagnosis more efficient in the future, thus showing a high potential to be a useful tool in clinical practice even with a significant increase in the number of patients.

The Current State of Artificial Intelligence in Neuro-Ophthalmology. A Review.

This article presents a  summary of recent advances in the development and use of complex systems using artificial intelligence (AI) in neuroophthalmology. The aim of the following article is to present the principles of AI and algorithms that are currently being used or are still in the stage of evaluation or validation within the neuro-ophthalmology environment. For the purpose of this text, a literature search was conducted using specific keywords in available scientific databases, cumulatively up to April 2023. The AI systems developed across neuro-ophthalmology mostly achieve high sensitivity, specificity and accuracy. Individual AI systems and algorithms are subsequently selected, simply described and compared in the article. The results of the individual studies differ significantly, depending on the chosen methodology, the set goals, the size of the test, evaluated set, and the evaluated parameters. It has been demonstrated that the evaluation of various diseases will be greatly speeded up with the help of AI and make the diagnosis more efficient in the future, thus showing a high potential to be a useful tool in clinical practice even with a significant increase in the number of patients.

Defect-diaphragmatic ratio: a new parameter for assessment of defect size in neonates with congenital diaphragmatic hernia.

AIM: The aim of our study is to introduce a new objective method of perioperative evaluation of the size of diaphragmatic defect to enable comparison of results among various centres and methods used for diaphragmatic reconstruction. MATERIALS AND METHODS: Prospective observational study of neonates with congenital diaphragmatic hernia (CDH) and respiratory distress within 24 h of birth operated on from January 2009 to December 2011. Weight, length, thoracic shape and the diameters of diaphragmatic defect were measured. To determine the relative size of the defect, a defect-diaphragmatic ratio (DDR = defect area:diaphragm area × 100) was calculated. The measured and calculated data were subsequently compared between Gore-Tex patch group (GT) and primary repair group (PR). Mann-Whitney U test was used for statistical analysis. RESULTS: Forty-seven patients with CDH were admitted during study period. The overall survival rate was 79 % (37/47). Preoperative stabilization was achieved in 85 % (40/47). Survival of operated neonates was 93 % (37/40). Diaphragmatic reconstruction with Gore-Tex patch was used in 7 neonates (17 %), and primary repair in 33 (83 %). Mortality in Gore-Tex group was 29 %; mortality in primary repair group was 3 %. Data of anthropometric measurement were complete in 34 children (5 GT and 29 PR). Significant differences were found between GT group and PR group in the size of diaphragmatic defect with the transverse and sagittal diameters of defect (48.0 ± 5.7 vs. 30.1 ± 5.9, P < 0.00061; 34.0 ± 12.5 vs. 16.0 ± 7.3, P < 0.0022) and DDR (18.29 ± 4.60 vs. 5.77 ± 3.28, P < 0.0005), respectively. CONCLUSION: The value of DDR as an objective criterion of the extent of diaphragmatic defect was confirmed by the close correlation between DDR and feasibility of primary repair in the study group. This objective assessment of defect size may improve comparing various surgical techniques and results of different centres, and thus facilitates sharing experience with management of neonates with CDH.

Large diaphragmatic defect: are skeletal deformities preventable?

PURPOSE: The aim of study was to compare growth, nutritional status and incidence of chest wall deformities and scoliosis in survivors of large congenital diaphragmatic hernia (CDH) defect (Gore-Tex patch reconstruction) with survivors with smaller defects and primary reconstruction. MATERIALS AND METHODS: An anthropometric study of 53 children who underwent CDH repair in neonatal period was carried out. Weight, height, and skin-fold thickness were measured, scoliosis and chest wall deformity were evaluated. Body mass index (BMI) and thoracic index (TI) were calculated using standard rules. The measured data were compared with national population standard with the use of standard deviation score (SDS). According to the type of diaphragmatic reconstruction, the patients were divided into two groups [Gore-Tex patch (10) versus primary repair (43)]. Student t test and Fisher exact tests were used for statistical analysis. RESULTS: Pectus excavatum was found in 25 (47%) patients, poor posture in 33% and significant scoliosis in 5%. Compared with the population norm, CDH children had a significantly lower body height SDS (mean -0.39, p < 0.05), weight SDS (mean -0.75, p < 0.001), BMI (mean SDS -0.68, p < 0.001) and lower TI (mean SDS -0.62, p < 0.01). Gore-Tex versus primary repair group significantly differed in incidence of pectus excavatum and BMI (PE: p = 0.027, BMI SDS: p = 0.016). A majority of anthropometric parameters (weight, height, thoracic index, and thorax circumference) and incidence of scoliosis and poor posture in children after Gore-Tex patch reconstruction did not significantly differ from children after primary repair. CONCLUSION: The differences in some anthropometric parameters (weight, BMI, and TI) and in the skeletal deformity suggest that the CDH not only disturbs normal lung growth, but also seems to have implications on some other aspects of somatic development. Whether these changes could be related to the type of diaphragmatic reconstruction or rather to the size of the defect remains uncertain.

[Prenatal diagnosis and management of fetuses with congenital diaphragmatic hernia]. / Diagnostika a management prenatální péce o plod s vrozenou bránicní kýlou.

OBJECTIVE: The aim of this article is to review current options of prenatal diagnosis and management of fetuses with congenital diaphragmatic hernia at the Institute for the Care of Mother and Child. SETTING: Institute for the Care of Mother and Child, 3. LF UK, Prague. METHODS: Review of the literature. RESULTS: Prenatal diagnosis of congenital diaphragmatic hernia based on 2D ultrasound. Measurement of the lung-to-head ratio (LHR), observed to expected lung to head ratio (O/E LHR), side of the diaphragmatic defect, assessment of the liver position and presence of associated anomalies (negative prognostic factors) are used for prediction of outcome. Prenatal diagnosis can be suplemented by 3D ultrasonography and magnetic resonace imaging. An important part of succesful management of CDH is the referal of cases to a specialised center.

ARTEFICIAL INTELLIGENCE IN DIABETIC RETINOPATHY SCREENING. A REVIEW.

OBJECTIVE: The aim of this comprehensive paper is to acquaint the readers with evaluation of the retinal images using the arteficial intelligence (AI). Main focus of the paper is diabetic retinophaty (DR) screening. The basic principles of the artificial intelligence and algorithms that are already used in clinical practice or are shortly before approval will be described. METHODOLOGY: Describing the basic characteristics and mechanisms of different approaches to the use of AI and subsequently literary minireview clarifying the current state of knowledge in the area. RESULTS: Modern systems for screening diabetic retinopathy using deep neural networks achieve a sensitivity and specificity of over 80 % in most published studies. The results of specific studies vary depending on the definition of the gold standard, number of images tested and on the evaluated parameters. CONCLUSION: Evaluation of images using AI will speed up and streamline the diagnosis of DR. The use of AI will allow to keep the quality of the eye care at least on the same level despite the raising number of the patients with diabetes.

Innovative strategies for treating retinal diseases.

OBJECTIVE: The aim of this comprehensive paper is to acquaint the readers with innovative approaches in the treatment of retinal diseases, which could in the coming years to get into clinical practice. Retinal prostheses, retinal pigment epithelial (RPE) transplantation, gene therapy and optogenetics will be described in this paper. METHODOLOGY: Describing the basic characteristics and mechanisms of different types of therapy and subsequently literary minireview clarifying the current state of knowledge in the area. RESULTS: Retinal prostheses, RPE transplantation, gene therapy and optogenetics offer yet unexplored possibilities and are considered as the future of treatment of retinal diseases where classical pharmacotherapy or surgical treatment are no longer sufficient. However, all these methods challenge not only in the innovative technical implementation itself, but also for the ethical, administrative and economic demands. CONCLUSION: There will be certainly interesting development in the treatment of retinal diseases, but it is not possible to fully estimate which modality of treatment will be dominant in the future.

Surgical Treatment of Idiopathic Macular Hole Using Different Types of Tamponades and Different Postoperative Positioning Regimens.

PURPOSE: To compare the effect of different types of intraocular tamponade and different types of postoperative positioning on the closure of idiopathic macular hole (IMH). METHODS: Prospective randomized clinical trial enrolling 104 eyes of 100 patients (age, 57-87 years) undergoing MH surgery. All patients were operated on by an experienced surgeon using 25-gauge pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Patients were randomized according to the type of intraocular tamponade and postoperative positioning into the following four groups: SF6 + nonsupine reading position (n = 26) (group 1), air + nonsupine reading position (n = 25) (group 2), air + prone position (n = 26) (group 3), or SF6 + prone position (n = 27) (group 4). The follow-up period was 6 months. RESULTS: MH closure was achieved in 87 eyes (83.7 %) in the overall sample after the first surgery, with closure rates of 100%, 56%, 84.6%, and 92.6% in groups 1, 2, 3, and 4, respectively. The group 2 was significantly less successful compared to the other three groups (p < 0.05). MH of sizes ≤400 µm was closed in 97.2% of cases after the first surgery, with no significant differences between groups (p = 0.219). MH with sizes over 400 µm was closed in 70.9% of cases after the first surgery, with both groups with air tamponade being significantly less successful than group 1. The nonsupine reading position was subjected to a better subjective evaluation in terms of postoperative comfort and quality of sleep, with no differences between air and SF6 tamponade tolerance. CONCLUSION: PPV with ILM peeling, intraocular tamponade, and positioning remains the basic surgical approach in the treatment of IMH. For MH ≤ 400 µm, a high closure rate can be achieved by combining air tamponade and nonsupine reading position. For macular holes >400 µm, the greatest anatomical success can be achieved by using the SF6 tamponade in combination with the nonsupine reading position.

A new case of ALG8 deficiency (CDG Ih).

UNLABELLED: Congenital disorders of glycosylation (CDG) represent an expanding group of inherited diseases. One of them, ALG8 deficiency (CDG Ih), leads to protein N-glycosylation defects caused by malfunction of glucosyltransferase 2 (Dol-P-Glc:Glc1-Man(9)-GlcNAc(2)-P-P-Dol glucosyltransferase) resulting in inefficient addition of the second glucose residue onto lipid-linked oligosaccharides. So far, only five patients have been described with ALG8 deficiency. We present a new patient with neonatal onset. The girl was born at the 29th week of gestation complicated by oligohydramnios. Although the early postnatal adaptation was uneventful (Apgar score 8 and 9 at 5 and 10 min), generalized oedema, multifocal myoclonic seizures, and bleeding due to combined coagulopathy were present from the first day. Diarrhoea progressing to protein-losing enteropathy with ascites and pericardial effusion developed in the third week of life. Pharmacoresistant seizures and cortical, cerebellar and optic nerve atrophy indicated neurological involvement. No symptoms of liver disease except coagulopathy were observed; however, steatofibrosis with cholestasis was found at autopsy. The girl died at the age of 2 months owing to the progressive general oedema, bleeding and cardio-respiratory insufficiency. Molecular analysis revealed two heterozygous mutations in the ALG8 gene: c.139A>C (p.T47P) and the novel mutation c.1090C>T (p.R364X). CONCLUSION: The prognosis of patients with ALG8 deficiency is unfavourable. The majority of affected children have early onset of the disease with heterogeneous symptoms including multiple organ dysfunction, coagulopathy and protein-losing enteropathy. Neurological impairment is not a general clinical symptom, but it has to be taken into consideration when thinking about ALG8 deficiency.

[Current options of prenatal diagnosis in congential diaphragmatic hernia]. / Soucasné moznosti prenatální diagnostiky kongenitálni diafragmatické hernie.

OBJECTIVE: The aim of this article is to review the current options of prenatal diagnosis in congential diaphragmatic hernia (CDH). SUBJECT: Systematic review. SETTING: Institute for the Care of Mother and Child, 3rd Medical Faculty, Prague. SUBJECT AND METHOD: Review of recent published data. CONCLUSION: The basic method for prenatal diagnosis of congenital diaphragmatic hernia is 2D ultrasonography: measurement of lung-to-head ratio (LHR), observed to expected lung to head ratio (observed to expected LHR - O/E LHR), localization of diaphragmatic defect, assessment of liver position and presence of associated anomalies (negative prognostic factors). Prenatal diagnosis can be supplied with 3D ultrasonography and magnetic resonace (imaging methods for valid measurement of fetal lung volume and/or presence of associated congenital defects confirmation). The reactivity of intrapulmonary arteries are evaluated by hyperoxygenation test and measurement of arterial Doppler parameters. Isolated diaphragmatic hernia is not an indication for invasive prenatal diagnostic methods. Important part of succesful prenatal diagnosis and therapy of CDH is concentration of cases in specialized centre.

Treatment of Vitreomacular Traction with Intravitreal Injection of Perfluoropropane.

PURPOSE: To evaluate the effect of one intravitreal injection of expansile gas in the treatment of vitreomacular traction (VMT). METHODS: A retrospective review of eyes with VMT treated with singl injection of 0,3 ml of 100% C3F8 gas was performed. The procedure was performed on an outpatient basis under topical anesthesia. RESULTS: Twelve consecutive patient (14 eyes) with symptomatic VMT underwent pneumatic vitreolysis. Mean extend of vitreomacular adhesion was 490,5 µm (408-751). A posterior vitreous detachment developed in 13 eyes (92,9 %) after a single gas injection, in 11 eyes (84,6 %) during the first month of follow-up, in 2 eyes within two month of injection. Mean baseline and last BCVA were 0,5 (0,16-0,18) and 0,67 (0,2-1,0) respectively (p.

ONE-YEAR FOLLOW-UP OUTCOMES OF TREATMENT OF WET AGE-RELATED MACULAR DEGENERATION WITH AFLIBERCEPT.

PURPOSE: To evaluate one-year follow-up outcomes of treatment with aflibercept in patients with newly diagnosed wet age-related macular degeneration (ARMD). METHOD: Retrospective evaluation of treatment of 28 eyes of 28 patients with an average age of 74.2 years who were treated with aflibercept at the Department of Ophthalmology at Královské Vinohrady University Hospital. All patients were treated according to the summary of product characteristics (SPC), i.e. with an initial 3 injections at monthly intervals, followed by 4 injections every 2 months. We evaluated the change in best corrected visual acuity (BCVA) on Early Treatment of Diabetic Retinopathy Study (ETDRS) optotypes, and the change of central retinal thickness (CRT) with the aid of optical coherence tomography (OCT). RESULTS: The average initial BCVA value was 61.5 letters of ETDRS optotype. After the initial 3 injections, BCVA improved to 70.5 letters, after one year of treatment there was a slight decrease to 68.1 letters. Better or same visual acuity was recorded in 25 eyes (89.3%), a deterioration occurred in 3 eyes (10.7%). CRT was reduced from an initial average value of 360.9 µm to 253.3 µm after the initial phase and to 233.8 µm after one year of treatment. At the end of the observation period, 25 eyes (89.3%) were without signs of activity of the pathology. No complications of treatment were recorded. CONCLUSION: In our cohort we confirm the efficacy and safety of the aflibercept preparation in patients with newly diagnosed wet form ARMD. By adhering to a fixed therapeutic regime it is possible to obtain similarly excellent results of treatment in real clinical practice as in clinical trials. Key words: aflibercept, anti-VEGF therapy, optical coherence tomography, wet form ARMD The authors of the study declare that no conflict of interest exists in the compilation, theme and subsequent publication of this professional communication, and that it is not supported by any pharmaceuticals company.

[Approximative intestinal anastomosis in newborns with multifocal necrotizing enterocolitis]. / Aproximacní strevní anastomóza pri multifokální nekrotizující enterokolitide u novorozence.

Multifocal necrotizing enterocolitis (NEC) may result in extensive bowel necrosis and short bowel syndrome. Authors present case report of premature newborn (BW 1700 g, gestational age 30 w.) where an extensive multisegmental NEC of small and large intestine was found during first explorative laparotomy. Proximal jejunostomy 28 cm beyond ligament of Treitz was performed and the rest of involved intestine was left in situ. After 48 hours multiple small bowel resections were performed leaving 12 cm of small intestine (5 short segments) distal to the jejunostomy. Five approximative anastomoses were performed to restore continuity among these segments and ileocaecal valve. Each of approximative anastomosis was constructed with limited number of 4-6 interrupted stitches and all anastomoses healed without complication. Intestinal continuity between proximal jejunostomy and the reconstructed segment of ileum was reestablished nine weeks later. Total length of small bowel was 50 cm. The patient was discharged at the age of 5 months weighing 4145 g with supplemental pareneteral nutrition. The technique of rapid approximative anastomosis may contribute to save maximal intestinal length in cases with the risk of short bowel syndrome.

The role of near-infrared spectroscopy monitoring in preterm infants.

Neurological morbidities such as peri/intraventricular hemorrhage and periventricular leukomalacia largely determine the neurodevelopmental outcome of vulnerable preterm infants and our aim should be to minimize their occurrence or severity. Bed-side neuromonitoring could provide valuable pieces of information about possible hemodynamic disturbances that are significantly associated with neurological morbidities and increased mortality. Near-infrared spectroscopy offers evaluation of regional cerebral oxygenation, which in conjunction with other non-invasive methods may give us a more complete picture about end-organ perfusion. This monitoring tool could help us fully understand the pathophysiology of severe neurological morbidities and guide our management in order to reduce their incidence.

[HYBRID MONOVISION]. / HYBRIDNÍ MONOVISION.

AIM: To evaluate our own results of the use of hybrid monovision technique, in patients after bilateral cataract surgery, where in the dominant eye the monofocal intraocular lens is implanted and in the non-dominant eye the multifocal intraocular lens (IOL) is implanted. MATERIAL AND METHODS: Prospective follow-up of group of 33 patients with bilateral cataract surgery and induced hybrid monovision. In the dominant eye, the hydrophilic monofocal aspheric intraocular lens Auroflex (Aurolab) was implanted, and in the non-dominant eye the hydrophilic multifocal aspheric intraocular lens Seelens (Hanita) was implanted. During the post-operative period, the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), best-corrected near visual acuity (CNVA), and distance-corrected near visual acuity (DCNVA) were established. Further, the monocular contrast sensitivity, subjective satisfaction, and dysfotopsias appearance were examined. The examinations were held 3 and 6 months after the surgery. RESULTS: In dominant eyes with implanted monofocal lens, UDVA improved from 0.61 ± 0.39 logMAR preoperatively to 0.03 ± 0.14 logMAR at 6 months after the surgery. In non-dominant eyes, with implanted multifocal intraocular lens, UDVA improved from 0.30 ± 0.23 logMAR preoperatively to -0.04 ± 0.06 logMAR. The average binocular UDVA (bUDVA) was -0.07 ± 0.08 logMAR and binocular CDVA (bCDVA) -0.12 ± 0.06. The average UNVA in dominant eyes 6 months after the surgery was 0.62 ± 0.18 logMAR, in non-dominant eyes 0.18 ± 0,15 logMAR, binocularly 0.15 ± 0.11 logMAR. The contrast sensitivity was in the eyes with implanted multifocal IOL slightly worse comparing to the eyes with implanted monofocal lens, albeit only in the space frequency of 6 cycles per degree (CPD) this difference was statistically significant. Subjectively, the presence of dysfotopsia and other problems were very low, the average values of single answers were from 1.3 to 2.1 (on the scale 1 - 5, 1 - no problems and 5 - severe problems). Also, we noticed high percentage of subjective satisfaction with the surgery results (94 %). Six percent of patients wear glasses for near distance as a standard, 42 % of patients wear them occasionally, and 45 % of patients dont use glasses for near distance at all. CONCLUSION: The technique of hybrid monovision is effective, safe, and relatively cheap method solving the loss of accommodation in patients after the cataract surgery. This method extends the spectrum of our possibilities how to solve the loss of accommodation in these patients.Key words: hybrid monovision, multifocal intraocular lens, contrast sensitivity.

[Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade]. / Chirurgické resení idiopatické makulární díry 25-gauge pars plana vitrektomií s peelingem vnitrní limitující membrány asistované briliantovou modrí a plynovou tamponádou.

UNLABELLED: 25-gauge pars plana vitrectomy with briliant blue assisted internal limiting membrane peeling and gas tamponade for idiopatic macular hole. PURPOSE: The evaluation of anatomic and visual outcomes in idiopatic macular holes treated with 25-gauge pars plana vitrectomy, briliant blue (BB) assisted internal limiting membrane (ILM) peeling and gas tamponade. MATERIALS AND METHODS: Retrospective analysis. 53 eyes of 52 patients (39 women, 13 men) of mean age 68,8 years (58-83) with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification from 6/2012 to 7/2014 were included. All patient undergone 25-gauge pars plana vitrectomy with brillinat blue assisted ILM peeling, gas tamponade (35 cases 15 % C3F8, 18 cases 20% SF6). 50 cases (94,3%) were performed in retrobulbar anesthesia, 3 cases in general anesthesia. Face-down positioning should have beeen maintained for three days. Best corrected visual acuity (BCVA), optical coherence tomography findings and complications were evaluated. RESULTS: The mean follow-up time was 6 months (1-22). Macular hole closure was achieved in 49 eyes (92,5%). The mean BCVA improved from 0,16 (0,5-0,05) to 0,5 (1,0-0,1). BCVA was improved by 3 and more ETDRS lines in 42 eyes (79,2%). CONCLUSION: 25-gauge pars plana vitrectomy with briliant blue assisted internal limiting membrane peeling and gas tamponade is safe and effective method of macular hole therapy with high anatomic and functional effect.