RHEOHEMAPHERESIS IN THE TREATMENT OF DRY FORM OF AMD. A CASE REPORT.

AIM: We present a case report of a patient with dry form of age-related macular degeneration (AMD) in whom we monitored the effect of rheohemapheresis (RhF) treatment over 6 years. METHODS: A 67-year-old man was examined in April 2014 at the Department of Ophthalmology at the University Hospital in Hradec Králové for metamorphopsia and decreased visual acuity of the left eye. The patient received general treatment for hypercholesterolemia with Lipfix 10 mg once a day (atorvastatin 10 mg). The cholesterol level in the blood was 3.41 mmol/l, the lipid profile was normal. The patient's previous ocular medical history was unremarkable. The patient reported ocular complaints over the course of the last year, the main symptom of which was image distortion on the Amsler grid on the left eye. Baseline best corrected visual acuity of the left eye was 6/10. Visual acuity in the right eye was 6/6. In both eyes, the findings on the anterior segment corresponded to the patient's age, with the exception of incipient cortical cataract. On the fundus of both eyes, the border of the optic nerve was demarcated, in the macula of the left eye there were a number of soft confluent drusen, in the central periphery there were no pathological changes. On the fundus of the right eye the finding was similar, but to a lesser degree. Optical coherence tomography on the macula of the left eye showed drusoid ablation of the retinal pigment epithelium (RPE), with accumulation of hyperreflectivities below the RPE. Pattern-reversal electroretinography (pERG): showed a slightly prolonged retention of the activity of the central region of the retina (p50 wave) and ganglion cells (N95 wave). Multifocal electroretinography (mfERG) in the central 30° of the retina was within normal limits. Electroretinography (ERG) demonstrated physiological photopic and scotopic rod activity. The patient was treated with 8 RhF procedures, two per week, with a 2-week interval, and the pulse was repeated 4 times. RESULTS: We noted a gradual resorption of soft drusen in the patient, with attachment to the RPE line according to OCT examination at the following sixmonthly check-ups over the next 6 years. Visual acuity of both eyes was maintained at the baseline values at the last check-up in April 2020, the area of soft drusen was significantly reduced. The function of the rod, cone system and the central region of the retina mfERG fluctuated only to an insignificant degree during the entire follow-up period, with a tendency towards a slight increase in activity after RhF treatment. CONCLUSION: We noted an improvement of the anatomical and functional findings in a patient with dry form of AMD during a 6-year follow-up period after RhF treatment. The visual acuity of the affected eye remained at the baseline values.

RHEOPHERESIS IN THE TREATMENT OF AGE-RELATED MACULAR DEGENERATION.

PURPOSE: Evaluation of the long-term effect of rheopheresis treatment of dry form of age-related macular degeneration (AMD). MATERIALS AND METHODS: The treatment group consisted of 65 patients and 55 patients in the control group, with a minimum follow-up period of 60 months. The basic treatment consisted of 8 rheopheresis procedures, and the additional treatment (booster therapy) of 2 rheopheresis procedures 1.5-2 years after the basic treatment. We evaluated changes in best corrected visual acuity, anatomical effect, electrical activity of the retina, haematological, biochemical and immunological parameters. RESULTS: Rheopheresis treatment contributed significantly: 1) to stabilisation of best corrected visual acuity of the treated patients, which initially showed an insignificant increased during the 2-years follow-up period, and then slightly decreased. By contrast, visual acuity decreased in the control group, to an insignificant degree up to 4 years, then statistically significantly. 2) to an improvement of the morphological findings in 62.4% of treated patients compared to 7.5% in the control group, while disease progression to stage 3 (neovascular form of the disease or geographic atrophy) with a significant decrease of visual acuity occurred in only 7.1% of treated patients, versus 37.0% in the control group. 3) to regression, even to the attachment of drusenoid pigment epithelial detachment (DPED). To a reduction of the area of DPED in 80.4% of treated patients, in contrast with an steaincrease in the area of DPED in 47.1% of patients in the control group, and the development of new DPED in only 2 eyes of treated patients compared with 16 eyes of patients in the control group. 4) to a preservation of the integrity of the ellipsoid layer in the fovea in 68.2% of the treated patients, while by contrast we found a damaged ellipsoid layer in the fovea in 66.6% of the control patients. 5) to a stabilisation of the activity of ganglion cells, the pineal system and the activity of the central area of the retina, with eccentricity between 1.8° and 30° in the treated patients, compared to alteration in the control group manifested mainly after 3.5 years of the follow-up period. 6) to a statistically significant improvement in rheological parameters, thereby increasing flow in microcirculation and positively influencing the metabolism in the retina. Also to a positive effect on the classical, alternative and lectin pathway of complement activation, a reduction in the level of proprotein convertase subtilisin kexin 9 (PCSK9), and thus also the level of LDLcholesterol, and 7) Additional treatment with 2 RHF procedures (so-called "booster therapy") seems to be a safe and suitable method of prolonging the stabilisation phase, or even improving visual acuity, anatomical and functional findings. CONCLUSION: We demonstrated positive changes in anatomical, functional and humoral parameters upon rheopheresis treatment of AMD. Their correlation provides a real possibility to identify patients at risk and to manage an individualised regime of rheopheresis therapy. This method of treatment is effective and safe, with a low percentage of non-serious adverse effects.

[Long term results of phakic 6 refractive implantation for myopia correction]. / Dlouhodobé výsledky implantace Phakic 6 Refractive pri korekci krátkozrakosti.

OBJECTIVE: To evaluate the safety and the long term results of anterior chamber phakic lens, Phakic 6 Refractive, for myopia correction. METHODS: In this retrospective study we reviewed the charts of 35 myopic patients (62 eyes) who had implantation of anterior chamber phakic lenses (Phakic 6 Refractive, Ophthalmic Innovations International, California, USA) for correction of myopia. The mean age of patients was 26 years (18 to 45 years). The mean spherical refraction was -9.9 (-4 to -18 D). The best corrected distant visual acuity (BCDVA) was 0.92 (1.2 to 0.3) before surgery. The mean follow-up was 8 years (4 to 10). The mean endothelial cell count was 2481 cells/mm2 and the mean pachymetry was 540 µm before surgery. In those patients who needed a second surgical intervention (explantation or lens reposition) the last follow-up visit is the visit before the lens explantation or reposition. The same surgeon (P. R.) performed all surgeries and used the same technique in each surgery. RESULTS: On the final follow up visit the BCDVA was in the mean 1.02 (1.5 to 0.5). The spherical refraction was in the mean - 0.53 D (-3.0 to +1.0). We noticed a 16% decrease in the mean number of corneal endothelial cells, and no change in the pachymetry values. We had to explant the lenses in 7 eyes (12 %) because of the decreased endothelial cells count. 2 eyes (3.0 %, 1 patient) had to receive treatment for glaucoma, 4 eyes (6.5 %) had to have the artificial lens repositioned, 1 patient had to have photocoagulation therapy for a retinal tear. 93 % of the study eyes had stable refraction during the study period. There was a 10 % increase in the average BCDVA, and there was a 95 % improvement of the original refractive error. CONCLUSIONS: In selected cases, the implantation of Phakic 6 Refractive anterior chamber lens is a viable option despite it is currently largely abandoned. Key words: Phakic 6 Refractive implantation, myopia correction.

[Acute posterior multifocal placoid pigment epitheliopathy - case report]. / Akutní zadní multifokální plakoidní pigmentová epiteliopatie.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) affects individuals between 20 to 30 years of age and ocular manifestations are often preceded by flu-like illness. Symptoms of the disease include acute vision decrease associated with central and paracentral scotoma. Impairment of vision is usually bilateral, but may be asymmetric. We report the case of a man at the age of twenty-one, who was treated for APMPPE. Due to the involvement of the macula, low visual acuity and related immunogenetic predisposition (HLA-B27 positivity) was recommended corticosteroid therapy with a good therapeutic effect. Key words: acute posterior multifocal placoid pigment epitheliopathy (APMPPE), white dot syndromes, macular edema.

[Wet form age-related macular degeneration two years treatment results using anti VEGF drugs]. / Dvouleté výsledky lécby vlhké formy vekem podmínené makulární degenerace s pouzitím léku proti vaskulárnímu endotelovému rustovému faktoru.

AIM: The aim of the study was to establish the efficacy of anti VEGF (Vascular Endothelial Growing Factor) drugs in the treatment of wet form ARMD (Age-Related Macular Degeneration) in everyday clinical practice in the Department of Ophthalmology, Faculty Hospital, Hradec Králové, Czech Republic, E.U., in patients registered in the Czech national registry AMADEUS. MATERIAL AND METHODS: Retrospective study with 24 months follow-up period. In the group were evaluated 143 eyes of 140 patients, out of them were 77 women (65.8 %), of average age 73.09 (71.69 - 74.48) years, and 40 men (34.2 %) of average age 74 (58 - 85) years. All of the patients were completely examined before the beginning of the treatment; during the treatment were, except the standardized eye examination, in patients treated with ranibizumab the color fundus photography and Optical Coherence Tomography (OCT) with measuring of the central retinal thickness performed every three months at least. The patients treated by pegaptanib were examined every six weeks before the drug application. The fluorescence angiography (FA) was performed at the beginning of the treatment to establish the type and extension of the choroidal neovascularization and during the treatment in case of necessity to establish the activity of the choroidal neovascular membrane (CNV). The treatment by ranibizumab was in the regimen PRN (pro re nata), and pegaptanib was applied every six months during the first year with the follow-up evaluation of the findings. The treatment evaluations were performed at 12 and 24 months. RESULTS: During the two years follow - up period, the authors noticed in patients treated with ranibizumab loss of 5.12 letters of ETDRS optotypes in case of mostly classical CNV, in occult CNV loss of 5.45 letters, and in minimally classical CNV loss of 2.83 letters. In three evaluated eyes with classical CNV in patients treated with pegaptanib we noticed after 2 years loss of 6.67 letters, in eleven eyes with occult CNV we established loss of 9.91 letters, and in two eyes with minimally classical CNV the average best-corrected visual acuity (BCVA) remained unchanged. The pegaptanib treatment results may be influenced by small number of evaluated patients. The visual acuity changes during the two years treatment were not statistically significant. We noticed the decrease of average CRT (central retinal thickness) in all types of CNV treated both with ranibizumab and pegaptanib after the two years follow up. To reach these results, an average of 5.51 applications of ranibizumab and 9 applications of pegaptanib during the two years were used. CONCLUSION: In the followed-up group we found, comparing to the natural course of neovascular form of ARMD, retarding of the BCVA decrease during the two years treatment with VEGF inhibitors in everyday clinical practice. Better results were achieved with ranibizumab treatment, however the differences were not statistically significant. Key words: age related macular degeneration, AMADEUS Czech national registry, ranibizumab, pegaptanib.

AlphaCor artificial cornea: clinical outcome.

PURPOSE: The purpose of this study was to describe the long-term results of AlphaCor implantations, and to evaluate the main complications and risk factors. METHODS: Retrospective analysis of preoperative and follow-up data from 15 AlphaCor implantations. Analysis of outcomes, trends, and associations was performed and compared with data from published clinical trials and a literature review. RESULTS: The survival rate of the device at 1, 2, and 3 years was 87%, 58%, and 42%, respectively. Postoperative visual acuity ranged from hand movement to 0.8. The most significant complications were stromal melt (nine cases), optic deposition (three eyes), and retroprosthetic membrane formation (three eyes). The most common device-unrelated complication was trauma (three patients). All complications were managed without loss of the eye. CONCLUSION: AlphaCor provides a treatment option for patients with corneal blindness in which a donor tissue graft would not succeed.

[Suprachoroid hemorrhage without the connection to the surgical procedure]. / Suprachoroidální hemoragie bez souvislosti s operacním výkonem.

The aim of our report is to present 2 cases of patients with suprachoroidal hemorrhage (SH). Suprachoroidal hemorrhage occur relatively infrequently and in our cases are not associated with the surgery or postoperative period. The first case was a patient with suprachoroidal hemorrhage following spontaneous corneal penetration after corneal ulcer. The second case was a patient with a suprachoroidal hemorrhage after severe contusion of the eye globe. The most important is rapid diagnosis of disease, differentiation from other eye diseases and initiation of therapy. We discuss clinical symptomatology, diagnostic and treatment of suprachoroidal hemorrhage.

[AquaLase method--influence to the secondary cataract appearance and its safety]. / Metoda AquaLase--vliv na vznik sekundární katarakty a její bezpecnost.

PURPOSE: To study effect of AquaLase method used for final management of posterior capsule during cataract surgery on the posterior capsule opacification (PCO) and to verify safety of this method for the eye tissue. METHODS: The prospective clinical study involving 50 patients (100 eyes) with bilateral cataract having lens removal at the Department of Ophthalmology, University Hospital Hradec Králové in the period from September 2007 to March 2009. During the surgery was lens removed using torsional phacoemulsification and bimanual irrigation/aspiration. Cleaning of the posterior capsule of the right eye was performed using AquaLase method. All patients were examined pre-operatively and 3, 6 and 12 months after surgery. Each examination covered best corrected visual acuity (BCVA), endothelial cell count (ECC), corneal pachymetry and digital retroillumination photographs of the anterior segment focused on the posterior capsule were obtained. The Evaluation of Posterior Capsule Opacification (EPCO 2000) software and the Open-Access Systematic Capsule Assessment (OSCA) system were used for PCO evaluation. RESULTS: BCVA was 0.8 in all patients. Average value for PCO index was in 3, 6 and 12 months postoperatively for right eye 0.260 +/- 0.198; 0.259 +/- 0.173; 0.308 +/- 0.191; for left eye 0.279 +/- 0.170; 0.280 +/- 0.153; 0.333 +/- 0.197. Average value for OSCA score was for right eye 0.599 +/- 0.240; 0.605 +/- 0.333; 0.598 +/- 0.256; for left eye 0.627 +/- 0.403; 0.635 +/- 0.357; 0.541 +/- 0.328. Nd-YAG capsulotomy was performed in one right eye one year after surgery. Pachymetry and ECC results show that the method AquaLase is safe for corneal endothelium. CONCLUSION: One year after surgery, most cases of PCO were graded as minimal by both software's of analysis. The results were not statistically significant. Pachymetry and ECC results show that the AquaLase method is safe for corneal endothelium.

[Influence AquaLase at corneal endothelial cells]. / Vliv AquaLase na rohovkové endoteliální bunky.

PURPOSE: To assess the effect of the cleaning of the posterior capsule using pulses of balanced salt solution (BSS) on the corneal endothelial cells. METHODS: This pilot study involves 43 patients with bilateral cataracts having lens removal using torsional phacoemulsification (Ozil, Infiniti, Alcon) and bimanul irrigation/aspiration (I/A). Posterior capsule of the right eye of each patient was cleaned using pulses of BSS (AquaLase, Infiniti, Alcon). Surgery was performed by one of 2 surgeons (NJ, PR), both eyes of each patient was operated on by the same surgeon. Best corrected visual acuity (BCVA), endotelial cell count and pachymetry were evaluated pre- and postoperatively as well as occurence af peri- and postoperative complications. RESULTS: Preoperative mean pachymetry (P) was 566 +/- 45 microm in the right eye (RE) and 562 +/- 42 microm in the left eye (LE), mean endotelial cell count (ECC) 2541 +/- 317 cells/mm2 (RE) and 2567 +/- 311 cells/mm2 (LE). Three months after surgery P was 557 +/- 43 microm (RE) and 558 +/- 45 microm (LE) and ECC 2368 +/- 416 cells/mm2 (RE) and 2396 +/- 417 cells/mm2 (LE). There was no statistical difference in postoperative changes of both corneal parameters between right and left eyes. Best corrected visual acuity improved in all eyes and no peri-or postoperative complications occured. CONCLUSIONS: Cleaning of the posterior capsule using AquaLase is safe for corneal endothelial cells.

Ultrasonic imaging of an object at the presence of Fourier and non-Fourier transformation in the transmitted through the object acoustic field.

A metal object is computer visualized by registration of the amplitudes of the transmitted through the object short acoustic pulses. The pulses are separated by time, because of the presence of holes and internal compact components in the longitudinal section (structure along the propagation direction of acoustic wave). The acoustic field transmitted through the object is composited from a field presenting Fourier transformation of the hole shape and field, transmitted through the metal components in the longitudinal section of the object. A computer Fourier transformation of the digital data of the amplitude fields transmitted through the object components is performed instead of converging lens. The Fourier series of the object obtained as digital data after the transformation is multiplied with a term, describing the angle distribution of the field on spatial frequencies. The reconstruction of the image of the metal components is performed by reverse transformation, i.e. summing up in all spatial frequencies. 3D visualization of the transmitted through the hole acoustic field determines the hole geometry (circular, square, rectangular). It is shown that at the transmission of a short acoustic pulse through the components with different thicknesses and holes, presenting Fourier and non-Fourier transformation can be registered separately in contrast to the optics.

[Effect of oxytocin on fibrinolysis and the status of the kallikrein-kinin system]. / Vliianie oksitotsina na fibrinoliz i sostoinie kallikrein-kininovoi sistemy.

The effect of the neuropeptide oxytocin, administered i. m., on the state of fibrinolysis and the kallikrein-kinin system was studied throughout an experiment on 88 Wistar albino nonpregnant female rats. Oxytocin was shown to cause fibrinolytic activation as a result of the elevated activity of the plasmin enzyme, plasminogen activators and the suppressed activity of antiplasmins. At the same time oxytocin stimulated the activity of the kallikrein-kinin system as was seen from the reduced level of serum kallikreinogen and the increased level of kallikrein.