BILATERAL EYE INJURY WITH BILATERAL BLOWOUT FRACTURE CAUSED BY A HIGH-PRESSURE WATER JET IN 16-YEARS-OLD FIREMAN GIRL. CASE REPORT.

PURPOSE: The aim is to present a report of a case of bilateral eye injury with bilateral blowout fracture caused by a high-pressure water jet from a fire hose in a 16-year-old girl during a competition for young firefighters. METHODS: We present a case report of a 16-year-old female patient with bilateral extensive eyelid contusion, oedema and lacerations of upper eyelids, lacerations of bulbar conjunctiva, contusion of both eyes, left optic nerve and bilateral blowout fractures of orbits.  Results: The initial ocular examination revealed "hand motion" in the right eye and no light perception in the left eye. Intraocular pressure was low in both eyes. Motility of both eyes was reduced, especially in the left eye. Lacerations of the eyelids and conjunctiva required a surgical procedure. No repair of the upper canaliculus of the left eye was attempted. Paralytic mydriasis and loss of lens accommodation in both eyes did not change throughout the follow-up period. A surgical procedure was applied to resolve the left blowout fracture, ocular motility of the right eye improved spontaneously. Traumatic cataract developed in the left eye within 1 year after injury, requiring cataract surgery and posterior capsule lens implantation, the right lens remained clear. Massive scarring of the retina and choroid in the lower parts of the eyes and in the macula reduced best corrected visual acuity in the right eye to 0.15 and in the left eye to 0.08. Intraocular pressure is within normal limits without any glaucoma therapy. The follow up period is three years. CONCLUSION: This is the first reported case of child with an eye injury caused by a high-pressure water jet during a sports activity.

The Importance of Evaluating the Development of Oct Findings During Conservative Treatment of Vitreomacular Traction Complicated by Macular Hole Formation.

Macular hole (MH) was considered untreatable condition for a long time until Kelly and Wendel described the posibility of surgical treatment with pars plana vitrectomy (PPV) in the nineties of the twentieth century. Since then have both surgical instruments and operation techniques developed rapidly and PPV has become the mainstay of MH therapy. Only stage I according to Gass classification which equates vitreomacular traction (VMT) according to Vitreomacular Traction Study group classification is routinely treated conservatively with observation only. It is however necessary to assess each case individually as some small and favourable MHs may close spontaneously. Here we present a case report of 59 years old woman with mild myopia and best corrected visual acuity (BCVA) 6/6 bilaterally. She presented on July 2017 with blurry vision in her right eye and was diagnosed with bilateral VMT according to optical coherence tomography. BCVA was 6/9 in her right eye and 6/6 in her left eye. During five weeks a full thickness MH developed in left eye that was accompanied by a decrease in BCVA to 6/12p. Considering favourable size and configuration of MH and the fact that the patient preferred conservative approach, we postponed the surgery, observed the MH and recommended bed rest. The MH closed spontaneously during five weeks with resulting BCVA 6/6. In her right eye the VMT released during four months with resulting BCVA 6/6 as well. The authors of the study declare that the formation and theme of the professional report and its publication are not in conflict of interest or supported by any pharmaceutical company.

SIMULTANEOUS BILATERAL ACUTE ANGLE-CLOSURE GLAUCOMA IN MILLER FISHER SYNDROME.

PURPOSE: To report a case of patient with Miller Fisher syndrome, complicated by simultaneous bilateral acute angle-closure glaucoma in her slightly (+1.5) hyperopic eyes. METHODS: We present a case report of a 71-year-old female patient presenting with total ophthalmoplegia, areflexia, ataxia and bilateral acute angle-closure glaucoma. RESULTS: The initial ocular examination revealed hand motion in the both eyes and oedematic corneas. Initial intraocular pressure was immeasurable high (measurment by Tonopen Avia). Measurement was possible after intravenous Mannitol 20 % infusion on both eyes as 54 and 56 mm Hg, respectively. Local medical therapy of pilocarpine, timolol, dorsolamide and dexamethasone improve intraocular pressure into normal limits within several hours. Prophylactic peripheral Nd-YAG laser iridotomy was performed on a both eyes two days later. Systemic treatment involved plasma exchange and rehabilitation program. Subsequent cataract surgery on both eyes with posterior capsule lens implantation improve the best corrected visual acuity on right eye from 0.5 to 1.0 and the left eye from 0.5 to 0.8, respectively. Intraocular pressure is within normal limits without any glaucoma therapy. Follow up period is three years. CONCLUSIONS: This is the second reported case of patient with Miller Fisher syndrome and simultaneous bilateral acute angle-closure glaucoma and the fifth reported case of Miller Fisher syndrome and acute angle-closure glaucoma. Treatment for both conditions made a very good recovery.

[Bilateral Congenital Multiple Pigmented Vitreous Cysts in a Three-year-old Girl: Ten Years Follow up]. / Bilaterální kongenitální mnohocetné pigmentované vitreální cysty u tríleté dívky - deset let sledování.

The authors present a case report of a three-year-old female patient with bilateral multiple anterior vitreous cysts. During examination for intermittent esotropia of the right eye was diagnosed not only hypermetropia, astigmatism and anisometropia, but also pigmented changes in peripheral retrolental space of both eyes. Clinical examination under general anaesthesia revealed bilateral multiple pigmented immobile vitreous cysts. There were five almost spherical, translucent, but slightly pigmented cysts on its cover on the right eye and four similar on the left, but visible only with dilated pupils. A dilating of pupils was slow and required more mydriatics than in similar aged children. Follow up period is ten years now. Occlusion therapy of amblyopia was performed to nine years of age. Treatment of refractive error and esotropia with correction for hypermetropia, astigmatism and anisometropia continues. Best corrected visual acuity in thirteen-year-old girl is 1,0 in both eyes without any visual disturbances described by patient. Corrected visual acuity in each eye is 1,0, right eye with +3,5 D sph., -3,5D cyl., axis 175°, left eye with +7,5 D sph., -3,0 D cyl., axis 35°. Patient is otherwise healthy and without any mental deficit. Position of all cysts remains unchanged and stabile during the follow up period (with recommendation to avoid hits to the head for all time, mainly in sports). Formation and slow progression of partial cortical cataract in the area of contact of the lens and one cyst in inferonasal quadrant of the lens on the right eye is monitored. A lamellar retinal extrafoveal defect of posterior pole of the right eye was found by OCT imaging.Key words: vitreous cyst, idiopathic, congenital, bilateral, multiple, pigmented, immobile, hypermetropia, astigmatism, anisometropia, esotropia, cortical cataract, retinal lamellar extrafoveal defect, OCT.

[Treatment of pediatric traumatic macular holes]. / Lécba traumatické makulární díry u detí.

PURPOSE: To report the results of treatment of the traumatic macular holes (TMH) in four children. METHODS: Retrospective study analyzed data of 4 children, males with a mean age of 12.3 years (range, 9-17 years), with diagnosis of TMH. All patients suffered a blunt trauma of the eye during the sport activities. The symptoms of three patients began after being hit to the face with a soccer balls, one boy was hit to his eye by a tennis rocket. Right eyes and left eyes were occurred identically. All patients were followed with ophthalmic examination, fundus photography and optical coherence tomography (OCT). One patient aged 10 years two weeks after blunt trauma with a soccer ball achieved spontaneous closure of TMH. Three patients aged nine to 17 years with TMH underwent surgical repair between September 2007 and May 2012 with three-port vitrectomy. After induction of posterior vitreous detachment vitrectomy with or without internal limiting membrane (ILM) peeling and gas or silicone oil injection were performed followed by prone positioning of head for ten days. Silicon oil was in an only patient removed within 3.5 month. RESULTS: All four macular holes were closed successfully. Follow-up period was from 10 to 31 month (ranged, 20 month). There were no reoperations. There were no surgical complications during follow-up period. Visual acuity (VA) improved in all eyes. In spontaneously closed TMH was VA improved from 0.5 to 1.0. In surgically treated group VA improved from initial 0.016 to 0.1 (ranged, 0.061) to final 0.25 to 0.5 (ranged, 0.36). CONCLUSION: Pars plana vitrectomy is a safe method for treatment TMH in children without tends to spontaneous closure of TMD in OCT imaging. Predisposition for TMH in population south-east Asia is suspected.Key words: traumatic macular hole, children, optical coherence tomography, vitrectomy, spontaneous closure.

Endothelial dysfunction expressed as endothelial microparticles in patients with end-stage heart failure.

Left ventricular assist devices (LVAD), currently used in treatment of terminal heart failure, are working on principle of rotary pump, which generates continuous blood flow. Non-pulsatile flow is supposed to expose endothelial cells to high stress and potential damage. Therefore, we investigated longitudinal changes in concentration of circulating endothelial microparticles (EMP) as a possible marker of endothelial damage before and after implantation of LVAD. Study population comprised 30 patients with end-stage heart failure indicated for implantation of the Heart Mate II LVAD. Concentrations of microparticles were measured as nanomoles per liter relative to phosphatidylserine before and 3 months after implantation. At 3 months after implantation we observed significant decrease in concentration of EMP [5.89 (95 % CI 4.31-8.03) vs. 3.69 (95 % CI 2.70-5.03), p=0.03] in the whole group; there was no difference observed between patients with ischemic etiology of heart failure (n=18) and with heart failure of non-ischemic etiology (n=12). In addition, heart failure etiology had no effect on the rate of EMP concentration decrease with time. These results indicate possibility that LVAD do not cause vascular damage 3 months after implantation. Whether these results suggest improvement of vascular wall function and of endothelium is to be proved in long-term studies.

Lichen secondary metabolites as DNA-interacting agents.

A series of lichen secondary metabolites (parietin, atranorin, usnic and gyrophoric acid) and their interactions with calf thymus DNA were investigated using molecular biophysics and biochemical methods. The binding constants K were estimated to range from 4.3×10(5) to 2.4×10(7)M(-1) and the percentage of hypochromism was found to be 16-34% (from spectral titration). The results of spectral measurement indicate that the compounds act as effective DNA-interacting agents. Electrophoretic separation studies prove that from all the metabolites tested in this study, only gyrophoric acid exhibited an inhibitory effect on Topo I (25µM).

[Pars plana vitrectomy due to the intravitreal hemorrhage caused by persistent hyaloid artery in three children]. / Pars plana vitrektomie pro hemoftalmus na podklade arteria hyaloidea persistens u trí detí

PURPOSE: To report pars plana vitrectomy (PPV) of a vitreous hemorrhage (VH) as a complication of a persistent hyaloid artery (PHA) in three children. A persistent hyaloid artery is result of incomplete regression of embryonic hyaloid vascular system, and is mostly seen as the fibrotic remnants of the artery at the disc. Severity of a pathology varying from an asymptomatic course during a life to complications as an ambylopia, strabismus, cataract, nystagmus or intraocular bleeding, usually a vitreous hemorrhage. Changed vitreopapillary interface can troubled posterior vitreous detachment. METHODS: Three case reports analyzed data of three children, 6-years-old and 10-years-old boys and 6-years-old girl, with VH and PHA treated by PPV with diathermy of partially regressed PHA in period from 2006 to 2011. There was unilateral, right side pathology in all children, all left eyes were normal. A traumatic origin, a blunt trauma and a bike accident respectively, was found in both boys. In a girl, she was the only patient, who was treated before VH for amblyopia, was no history of trauma. RESULTS: Preoperative best corrected visual acuity (BCVA) varied between light perception to 6/9 and improved postoperatively to 6/9 - 6/6. We waited for spontaneous resolving of VH for four month in older boy, but it was complicated by other trauma (falling down at home) and recurrent bleeding. Progression of traumatic cataract in older boy 22 month postoperatively worsened BCVA to 6/60. Cataract surgery with implantation of an artificial posterior chamber lens and Nd: YAG laser capsulotomy improved BCVA to 6/6. An occlusion therapy was used in both 6-years-old children postoperatively. Postoperative average follow-up period is 54 month. There were no recurrent intraocular bleeding postoperatively. CONCLUSION: Pars plana vitrectomy removed VH not only as an optical barrier, but eliminated the vitreopapillary traction too. Timing of early vitrectomy eliminated risk of recurrent VH and the other complications.

[Corneal foreign bodies in children]. / Rohovková cizí telíska u detí

UNLABELLED: The purpose of the study was to answered three questions. Which part of all patients with diagnosis of corneal foreign body (CFB) diagnosed in period from 2006 to 2010 were children? Is there any dependence on sex like in adults? Is there any typical mechanism of injury in children? METHODS: Retrospective study analyzed data of 2381 patients with diagnosis of CFB, 2225 men and 156 women. There were in the group 0-17 years 154 patients, 82 boys and 72 girls, in group 18-64 years 2103 men and 80 women and in group patients older than the age of 65 years 40 men and 4 women. Mechanism of injury was analyzed in the group of children. RESULTS: CFB is a common condition in working-age adult men due to occupational exposure, eg grinding, drilling or cutting. CFB is very rare in adult women. Similar dominance of men was in the group of patients older then the age of 65 years. The results demonstrate, that both sex in group of children occurred equally. The majority of the mechanism of injury in children wasnt recognized (115 children). The biggest recognised group was use of swing in case-history of 17 children with corneal metallic foreign body, 15 of them were children younger than the age of 7 years. Seven children suffered injury by part of plants such as thorns or bark from branch of tree. Three boys had in case-history common mechanism of grinding. Remaining mechanisms of injury were less frequent. CONCLUSION: From 2006 to 2010, 154 (6.5 %) pediatric eye injuries of CFB were treated in Department of Ophthalmology for Children and Adults. Both sex in group of children occurred equally. Although majority of mechanism of injury remained unrecognised, use of swing is among children younger then the age of 7 years important unknown mechanism of injury. Is possible to prevent it, eg rust prevention of metallic suspensions of swing, protective eyeweare, cap.

Preeclampsia, dilated cardiomyopathy and renal failure as the first manifestation of systemic lupus erythematosus: a case report.

We report the case of a 26-year-old woman with severe renal and congestive heart failure as a primary manifestation of systemic lupus erythematosus after her premature terminated pregnancy for the symptoms of preeclampsia with HELLP syndrome. Preeclampsia, due to the similarity with SLE in many signs and symptoms, delayed the diagnosis. The importance of the renal biopsy that helped us to make a differential diagnosis in a patient with an unclear proteinuria persisting postpartum is obvious. We suggest that a diagnostic algorithm of patients suffering from preeclampsia should exclude SLE since only an early and adequate treatment can prevent irreversible organ impairment.

[Terson's syndrome, pars plana vitrectomy and anatomical and functional outcome]. / Tersonuv syndrom, anatomické a funkcní výsledky pars plana vitrektomie.

The retrospective case review was aimed to demonstrate anatomical and functional results of pars plana vitrectomy (PPV) in patients with Terson's syndrome (TS). The most common cause of TS was an acute subarachnoid hemorrhage of ruptured intracranial aneurysm (6 eyes). One patient suffered traumatic subdural and subarachnoid hemorrhage. PPV was performed in 7 eyes of 6 patients (2 women and 4 men). The patients ranged in age from 18 to 53 years (average 37.5 year), the mean age was 37.5 years. The interval between intracranial hemorrhage and PPV varied from 2 to 12 month (average 7.5 months). The visual acuity postoperatively improved in all 7 eyes. The mean period of observation was 12.5 month. Intraoperative complications included retinal break (1) only. Late complications included epiretinal membrane (2), glaucoma (1), cataract (2) and conjunctival cyst (1). Pars plana vitrectomy is highly effective and relatively safe method in hastening visual rehabilitation of adults with Terson's syndrome.

[Surgical treatment of late tractional retinal detachment appearing on the basis of retinopathy of prematurity]. / Chirurgická lécba pozdního trakcního odchlípení sítnice vzniklého na podklade retinopatie nedonosených.

Retinopathy of prematurity (ROP) is a proliferative retinopathy affecting predominantly immature children and children with low birth weight under 2500 g in 5-6%. During 11 years we operated on 15 eyes of 15 patients aged 5-31 years, because of late tractional retinal detachment (TRD) appearing on the basis of ROP. The average follow-up period was 37.2 months; the minimal follow-up period was 1 year. In all patients, the personal medical history revealed the pre-term birth at the gestation age of 28-34 weeks. The birth weight was in the range 850-1600 grams. According to the extend of vitreoretinal traction and type of retinal defect we indicated: a) primary cryosurgical procedure (CP) with episcleral silicone implants. The operation was indicated in 6 eyes: cerclage, segmental perilimbal plombage in the temporal half and puncture of the subretinal fluid; b) pars plana vitrectomy (PPV). In total in 9 eyes the PPV was indicated, in 5 eyes it was supplemented with relaxing retinotomy, and in 7 eyes with silicone oil (SO) implantation. Three eyes were re-operated by means of PPV with SO implantation. The final anatomical success of the surgical treatment of the prognostic unfavorable TRD, including re-operations was achieved in 12 eyes (80%), which we consider as a good one. The visual acuity improved or remained the same also in 12 eyes (80%) and visual acuity 6/60 and better (20/200 or 0.1) in 8 out of 15 eyes (53%).

[Surgical treatment of retinal detachment with bilateral idiopathic retinal dialysis]. / Chirurgická lécba odchlípení sítnice s bilaterální idiopatickou retinální dialýzou.

The retrospective study was aimed at demonstrating anatomical and functional results of surgical treatment in patients with bilateral idiopathic retinal dialysis (BIRD). In the period of 1985-2001 the authors operated on BIRD in 10 eyes of five patients (three men and two women). No eye injury or inflammation was present in the case history of the patients. The age of the patients was between 11 and 30 years, the mean age was 19.2 years. The symptoms typical for retinal detachment were present in four eyes only and absent in the other six eyes. Hyperopia of both eyes in analogy with myopia of both eyes was observed in two patients, respectively, whereas emmetropia was present in one patient. The retinal dialysis (RD) occurred in lower temporal quadrant in all eyes (100%), in one eye (10%) it also occurred together with an discontinuous RD in upper temporal quadrant and in another eye it was extended into lower nasal quadrant. Demarcation lines were present in 5 eyes (50%), subretinal solid strands in 1 eye (10%). Scleral buckling procedures were performed as the primary surgical procedure in all 10 eyes of 5 patients. Eight eyes was operated on with the use of segmental circumferential sponge buckles of silicone and two eyes with the use of encircling elements of solid silicone. Retina was successfully reattached postoperatively in 9 eyes (90%) and remained detached in one eye (10%). The visual acuity preoperatively 6/12 or better remained unchanged postoperatively in 8 eyes (80%). The visual acuity postoperatively improved in 1 eye (10%) and in 1 eye (10%) visual acuity was decreased. The mean period of observation of the patients was 86 months. The necessity of a routine examination of the extreme retinal periphery of the fellow asymptomatic eye of the young adult with no history of trauma and with the retinal detachment associated with retinal dialysis in one eye is also discussed.

[Primary pars plana vitrectomy in the treatment of penetrating eye injuries involving intraocular foreign bodies in the vitreous body ]. / Primární pars plana vitrektomie v lécbe penetrujícího poranení oka zasahujícího do sklivce s nitroocním cizím telískem.

The method of choice in the treatment of penetrating eye injuries affecting the vitreous body with an intraocular foreign body is in the majority of patients primary pars plana vitrectomy with transvitreal extraction of the foreign body (FB). During the period from April 1999 till September 2000 the authors treated thus at the Ophthalmological Clinic of the General Faculty Hospital and 1st Medical Faculty Charles University Prague 26 eyes of 26 young men with an average age of 34 years. The mean interval between the injury and primary PPV was 8.5 days. The patients were followed up on average for 23.5 months. The entrance of the penetrating injury was in 17 eyes in the cornea or limbus, in 9 eyes in the sclera. In two eyes posttraumatic endophthalmitis developed. The intraocular FB was 6 mm2 in size in 16 eyes and 6-20 mm2 in 10 eyes. In primary PPV we indicated in 14 eyes internal tamponade with gas or silicone oil. On account of late retinal complications which developed as a result of proliferative vitreoretinopathy we indicated in eight eyes PPV reoperation. At the end of the investigation period in 3 eyes inoperable detachment of the retina developed. As the main negative prognostic factor for final visual acuity the authors evaluated a size of the FB greater than 6 mm2, other negative prognostic factors are the scleral entrance injury, complications of the entrance injury (prolapse of the iris, vitreous body, haemophthalmus) and the development of posttraumatic exogenous endophthalmitis.

[Pars plana vitrectomy and primary implantation of silicone oil in the treatment of acute exogenous endophthalmitis in eyes without retinal detachment]. / Pars plana vitrektomie s primární implantací silikonového oleje v lécbe akutní exogenní endoftalmitidy na ocích bez odchlípení sítnice.

UNLABELLED: Acute exogenous endophthalmitis (AEE) is the most serious post-traumatic or postoperative complication which without immediate treatment leads to amaurosis or anatomical loss of the eye. If comprehensive antibiotic treatment fails immediate pars plana vitrectomy (PPV) is indicated. Empirically and later also by laboratory methods the antiinflammatory effect of silicone oil (SO) was revealed. The objective of the present retrospective study is to demonstrate anatomical and functional results of PPV with implantation of SO for AEE on eyes without detachment of the retina. In 1990-2000 the authors operated a total of 22 eyes of 22 patients with AEE. The mean age of the patients was 59.6 years, the mean observation period 35.5 months. In 17 eyes postoperative and in 5 eyes post-traumatic AEE was involved. The mean interval between the original operation and PPV was 20.8 days and between the injury and PPV 5.4 days. In all patients we took at the beginning of PPV specimens of the vitreous body for cultivatin which gave in 63.6% a positive result. The intraocular lens was explanted in 81.8% eyes. After subtotal resection of the vitreous body we implanted SO and in all aphakic eyes we performed iridectomy in no. 6. PPV was completed by administration of vancomycin and ceftazidime into the vitreous space. In 95.4% of the eyes we preserved anatomically the bulbus, in one instance we eviscerated the bulbus three days after failure of PPV (4.6%). In 86.4% the retina remained anatomically attached and in the remaining 9% eyes beneath the SO traction detachment of the retina developed. Visual acuity improved in 72.7% eyes, it remained unchanged in 9.1% eyes and deteriorated in 18.2% eyes. Silicone oil was explanted in 40.9% eyes after a mean interval of 4.6 months following PPV. In the remaining patients we did not indicate explantation of SO, in particular because of the patients' advanced age, CONCLUSION: We recommend PPV and implantation of SO in AEE on eyes without detachment of the retina as the method of choice.

[Cataract surgery in eyes treated with vitrectomy for idiopathic macular holes]. / Operace katarakty u vitrektomovaných ocí pro idiopatickou makulární díru.

The authors evaluated the final functional results in 30 eyes where on account of nuclear and cortical cataract an intraocular lens was implanted. The operation was preceded by pars plana vitrectomy (PPV) with internal gas tamponade on account of an idiopathic macular hole (IMD). The cataract the development of which was recorded in 57 eyes was the manifestation of a late postoperative complication from a total number of 84 phakic eyes (67.9%) which were operated on account of IMD between April 1996 and June 1999. After cataract surgery the corrected visual acuity improved in 23.3% eyes. The investigation confirmed improvement and stabilization of the final corrected visual acuity in 24 eyes (80%) and confirmed the importance of these surgical procedures.

[Initial experience with surgical decompression of the vein in branch retinal vein occlusion]. / První zkusenosti s chirurgickou dekompresí zíly u vetvové retinální okluze.

Due to the development of the armamentarium and surgical techniques, the indications of pars plana vitrectomy (PPV) are expanding. It concerns also a relatively new indication, as is the branch retinal vein occlusion (BRVO) of the temporal part of the posterior pole of the retina with the secondary involvement of the macular region. The purpose of this prospective study is to demonstrate anatomical and functional results after the surgical decompression of the occlusion of the branch retinal vein draining the macular region. Since November 1999, 3 patients, one woman and 2 men (age 70, 47 and 76 years) with the quadrant BRVO of the temporal part of the retina involving the macular region were followed. The visual acuity before the surgery in all 3 patients was 6/36 (20/120 or 0.16) and the BRVO lasted for 3-5 months. The patients were examined by slitlamp biomicroscopy, and the course of the disease was documented by means of red-free fundus photographs as well as fluorescein angiograms. In all three patients, PPV and the adventitial sheathotomy of the arteriovenous crossing (AVC) were performed. Surgical decompression of BRVO and reperfusion of the ischemic part of the retina was achieved by separating the overlying arteriole from the venule at AVC. Neither per- nor postoperative complications were noted. In two patients, the visual acuity improved to 6/12 (20/40 or 0.5), and in the last one stabilized at 1/9 (20/180 or 0.11). The minimal follow-up period was 12 months. In conclusion, we recommend to performing this new type of delicate surgery procedure in individual cases on the basis of detailed biomicroscopial examination and fluorecein angiograms by an experienced vitreoretinal surgeon.