CYCLOCRYOCOAGULATION IN SECONDARY NEOVASCULAR GLAUCOMA AND OUR RESULTS.

PURPOSE: To retrospectively evaluate the use of cyclocryocoagulation (CCK) in secondary neovascular glaucomas performed at the Department of Ophthalmology, Faculty of Medicine, Charles University and University Hospital Hradec Králové in the years 2016-2019. MATERIAL AND METHODS: In a retrospective study, 30 procedures of 26 eyes of 24 patients were evaluated. All patients underwent CCK surgery. The main entry criteria were the presence of secondary neovascular glaucoma in diabetes or on the basis of occlusion of the retinal artery or vein and subsequent dispensarization of the patient in the 1st and 6th month after the operation. The parameters evaluated were: the best-corrected visual acuity (BCVA), intraocular pressure value (IOP), data of pain and change in the number of active substances of antiglaucoma therapy. RESULTS: The mean age of patients at the time of the procedure was 62 years (range 22-85 years). The average number of procedures per eye was 1.15 out of a total of 30 procedures, 26 eyes were performed on 24 patients. The most common indication for CCK in secondary glaucoma-vascular complications in diabetes were in 21 procedures, vascular complications - after occlusion of the retinal vein or artery were in 9 cases. Two patients had both eyes operated on within one year. Three patients underwent two procedures on the same eye during the study period. One of them had two procedures on both eyes. The average value of the number of active substances of antiglaucoma drugs decreased from 3.10 to 2.87 after the 1st month (p = 0.318) and after 6 months it was 2.6 (p.

Evaluation of retinal light scattering, visual acuity, refraction and subjective satisfaction in patients after Acrysof IQ PanOptix intraocular lens implantation.

AIM: To evaluate the retinal light scattering, visual acuity, refraction and subjective satisfaction in patients after implantation of Acrysof IQ PanOptix intraocular lens. METHODS: Our group included 32 eyes of 21 patients who underwent cataract surgery or refractive lensectomy with Acrysof IQ PanOptix multifocal intraocular lens implantation at the Ophthalmology Clinic of Faculty Hospital Hradec Králové during the time from September 2015 to December 2017. The observed parameters were visual acuity, subjective refraction, retinal light scattering and patient subjective satisfaction. Preoperative refractive values and visual acuity values were compared with results obtained on day 1, 1 month and at an average of 27 months postoperatively. Subjective satisfaction and degree of light scattering on the retina were evaluated at the end of the follow-up period. RESULTS: Preoperative, uncorrected distant visual acuity improved from an average of 0,51 ± 0,29 (expressed in decimal values) to 0,94 ± 0,10 at the end of the follow-up period. Preoperative best-corrected distance visual acuity improved from an average of 0,95 ± 0,19 to 1,00 ± 0,09 at the end of the follow-up period. The mean value of preoperative uncorrected near visual acuity was 8,29 ± 4,93 of Jaeger charts, the mean value of uncorrected near visual acuity at the end of the follow-up period was 1,00 ± 0 of Jaeger charts. Subjective satisfaction was assessed using a standardized VF-14 questionnaire at least 1 year after surgery (mean follow-up of 27 months). Retinal light scattering was examined using an Oculus C-Quant instrument. The retinal light scattering value in our sample was 1,12 ± 0,19. In only 6 eyes of 4 patients, the resulting value was outside the physiological range used for eyes with lens crystallina Conclusion: The value of light scattering on the retina is a factor affecting the degree of sensitivity to glare after implantation of multifocal intraocular lenses. In our group, we observed a deviation from the physiological range of retinal light scattering in only 6 eyes of 4 patients, but this did not lead to a deterioration in subjective postoperative satisfaction.

Suprachoroideal haemorrhage in postoperative period of antiglaucoma surgery, case report.

Suprachoroidal haemorrhage (SCH) is a serious complication of intraocular procedures. Physiologically there is only a minimal amount of fluid in the suprachoroid space, pathologically the fluid volume increases, which causes ablation of the choroid. SCH could be divided into different cathegories, according to the character of the fluid into serous and haemorrhagic; by the time of occurrence in relation to the surgery into peroperative and postoperative. Diagnosis is based on biomicroscopic and ultrasound examinations. The ocular risk factors for SCH are glaucoma, myopia and aphakia; systemic risk factors include vascular fragility, arterial hypertension and blood coagulation disorders. In the pathogenesis hypotonia of the eye, that causes rupture of the ciliary vessels, plays a very important role. SCH can be treated both conservatively and surgically. As to pharmacotherapy we use gabapentin to suppress neuropathic pain and prednisone, topical mydriatics and anti-inflammatory agents. The type of surgical treatment differs according to time of occurrence, if SCH occurs during the operation, the intervention consists mainly in the wound closure and the repositioning of the weakening tissues; in postoperative forms, we choose drainage procedures, possibly vitreoretinal procedures. Our patient, an 80-year-old myop and chronic glaucomatic treated intensively both topically and systematically underwent trabeculectomy on his left eye due to unsatisfactory intraocular pressure (IOP) and significant glaucoma progression. The surgical intervention went without any complications. In the early post-operative period, there was persisting elevation of IOP, therefore sclera lap was discontinued and 5-fluorouracil was applied under the filter blister. Subsequent hypotonia caused a hemorrhagic SCH with intraocular hypertension, which was resolved by draining the blood with sclerotomias and thus releasing intraocular hypertension. The visual acuity of the left eye gradually improved to almost original values. Intraocular pressure, however, is not well compensated despite many following antiglaucoma surgeries. Therefore, even with the patients maximum therapy, glaucoma continues to progress. In our case, we confirm that it is possible to solve even the relatively most complicated cases of SCH. We stress the necessity to consider the presence of risk factors of the occurrence of SCH before indicating intraocular procedures and also recommend thinking carefully about other less invasive surgical techniques. In glaucoma, it is appropriate taking in account the prediction of life compared to the expected rate of progression of vision loss.

The use of micropulse laser in patients with diabetic macular edema at the Department of Ophthalmology, Faculty Hospital Hradec Králové.

INTRODUCTION: Diabetic macular edema (DME) is the most frequent cause of decreased vision in patiens with diabetes type 2. DME is caused by increased permeability of macular capillaries. The aim of our study was to retrospectively evaluate the results of micropulse laser treatment, 577 nm wavelength, in pacients with DME with follow-up three months and one year. METHODS: The retrospective trial with one year follow-up includes 63 eyes of 37 patients with diabetic macular edema treated from September 2015 to January 2017.  Most patients had diabetes type 2 (34 patients), 3 patients had diabetes type 1. Diffuse DME was diagnosed in 54 eyes, focal DME in 9 eyes. Most of the patients (42 eyes) suffered from non proliferative diabetic retinopathy, 21 eyes showed signs of proliferative retinopathy. DME lasted on average for 29 months before initiating with micropulse laser (median 21 months). On average 1,56 laser visits were needed for the treatment of 1 eye, usually in 3 months interval. Photocoagulation of macula was performed in all patients by micropulse laser, 577 nm wavelenght/IQ 577TM IRIDEX). We used 5 % duty cycle. The average glycated hemoglobin in the group was 66,8 mmol/mol, maximal 100 mmol/mol. Estimated data were statistically evaluated by Friedman and Dunn´s test. RESULTS: At the end of 1 year period we found out improvement in BCVA (increase of at least 5 letters of ETDRS charts) in 20 eyes, 25 eyes showed stabilisation of BCVA (alltogether 71 % of the group), in 18 eyes we found out decrease of BCVA of more than 5 letters of ETDRS charts. On average we estimated decrease of visual acuity from 62 to 61,1 letters (p > 0,05). After one year we estimated 63 µm CRT decrease on average, from 442 µm to 379 µm (p= 0,0124). CONCLUSION: In our group of DME patiens treated by micropulse laser we have estimated BCVA stabilisation and signifiant improvement of macular edema in ¾ eyes, confirmed by OCT. We have estimated clinically significant decrease of macular edema in the whole group with one-year follow-up.

[Clinical Results of the Implantation of Two Types of Multifocal Rotational Asymmetric Intraocular Lenses]. / KLINICKÉ VÝSLEDKY IMPLANTACE DVOU TYPU MULTIFOKÁLNÍ ROTACNE ASYMETRICKÉ NITROOCNÍ COCKY.

PURPOSE: The aim of the study was evaluation and comparison of clinical results of two types of rotationally asymmetric multifocal intraocular lens (LENTIS Mplus and LENTIS MplusX). MATERIAL AND METHODS: The study included 247 eyes of 124 patients aged 25 - 76 years (mean, 58 years). After phacoemulsification multifocal intraocular lens LENTIS Mplus (group A, n = 141) or LENTIS MplusX (group B, n = 106) was implanted. Patients were divided into two groups according to the type of intraocular lens. Patients were evaluated at 1 month, 3 months and 6 months after surgery. We assessed the uncorrected visual acuity, best corrected visual acuity, subjective refraction, contrast sensitivity and subjective satisfaction. RESULTS: Mean preoperative monocular uncorrected distance visual acuity (UCDVA) in the group A was 0,40 ± 0,27; in the group B 0,34 ± 0,25. Postoperatively UCDVA was statistically significant improved in both groups (group A: 1,01 ± 0,20; group B: 0,90 ± 0,15). Mean preoperative monocular uncorrected near visual acuity (UCNVA) was Jaeger (J) 12,82 ± 4,16 (group A), resp. J 12,73 ± 3,99 (group B). Postoperatively UCNVA was statistically significant improved in both groups (group A: J 1,81 ± 1,42; group B: J 1,54 ± 1,72). There was not found statistically significant difference between both groups in these parameters. Contrast sensitivity was evaluated in patients who have undergone clear lens extraction in both eyes. There was not found the statistically significant reduction of contrast sensitivity in both groups. Subjective satisfaction was assessed in the range of marks 1-5. The average mark of the subjective satisfaction ratings in the group A was 1,37; in the group B 1,25. CONCLUSION: Our study found the multifocal intraocular lens LENTIS Mplus and LENTIS MplusX give high-quality distance and near vision and provide high degree of spectacle independence. There was not found statistically significant difference in all parameters between the Group A (implantation Mplus LENTIS) and the Group B (implantation LENTIS MplusX) in our study. However, in our study we have observed higher subjective satisfaction and lower incidence of optical phenomena in the Group of patients with the implantation of intraocular lens LENTIS MplusX.Key words: LENTIS Mplus, LENTIS MplusX, visual acuity, contrast sensitivity, optical phenomen.

[Pars Plicata Vitrectomy in Premature Newborns for Retinal Detachment as a Result of Retinopathy of Prematurity, our Results]. / Pars plicata vitrektomie u nedonosených novorozencu pro odchlípení sítnice v dusledku retinopatie nedonosených, nase výsledky.

INTRODUCTION: The aim of this work is to evaluate our own results of surgical treatment of retinal detachment in immature newborns. Retinopathy of prematurity (ROP) is one of the most complicated ocular disorders, both in terms of diagnosis and therapy. It is a potentially blinding illness that arises from the incomplete development of the bloodstream of the neuroretina of preterm infants. Currently, the most effective therapy is ablation of the avascular retina by laser photocoagulation or cryocoagulation. Despite this treatment, the immature retina may develop it´s detachment. METHODOLOGY: We report 2 case-reports, retrospective results of 4-eyes in 2 patients with severe ocular and overall complications of prematurity. The ocular background of preterm babies was investigated in arteficial mydriasis by an indirect ophthalmoscope, and later with the RetCam photographic device. The ROP stages were evaluated according to the ICROP classification. All eyes were treated with cryo-retinopexy at the threshold stage of ROP, followed by intraocular surgery for progression of traction retinal detachment. The surgical technique was a 3-port 25-G PPV (pars-plicata vitrectomy) with insertion of ports 1.5 mm from limbus. The PPV was performed using the Constellation (ALCON) operating unit, controlling the intraocular pressure for 15 torr. The assessment of visual acuity was performed according to the scale: no light perception (no response of the child to light), light sensitivity (positive or negative reaction to illumination), fixation of light. RESULTS: The retina stayed attached in all operated eyes, more in each case-report. CONCLUSION: Contemporary vitreoretinal surgery allows for the anatomical success of traction retinal detachment surgery during ROP already in neonatal age.Key words: retinal detachment, retinopathy of prematurity, PPV, surgery.

[Internal limiting membrane peeling as prophylaxis of epimacular membrane formation in eyes undergoing vitrectomy for rhegmatogenous retinal detachement]. / Peeling vnitrní limitující membrány na odchlípené makule jako prevence rozvoje epimakulární membrány po pars plana vitrektomii pro rhegmatogenní amoci sítnice.

PURPOSE: Rhegmatogenous retinal detachment is a serious condition that can significantly impair visual function, even after a successful surgery. One of the complications that can significantly impair visual acuity in the postoperative period is a development of the epimacular membrane (ERM). The aim of this work is to monitor the effect of peeling of the internal limiting membrane (ILM) in the macula at the anatomical and functional results in the postoperative period, especially with regard to the development of ERM. METHODS: Prospective study of 21 eyes, which underwent peeling of ILM during pars plana vitrectomy for rhegmatogenous retinal detachment (on detached macula). The ILM peeling was done without using decalin during this procedure. We tested best corrected visual acuity (BCVA) and followed fundus biomicroscopic findings. Proliferative vitreoretinopathy (PVR) was evaluated according to the recommendations of the Retina Society Terminology Committee. To exclude the development of ERM in the macula optical coherence tomography (OCT) was performed at the end of the 18-month follow-up period. RESULTS: In total, the results of 21 eyes of 21 patients who underwent PPV for rhegmatogenous retinal detachment were evaluated. In all of them was during PPV performed ILM peeling on detached macula, these are followed prospectively. ILM peeling without using decalin was sufficient in all eyes. All eyes with ILM peeling did not develop ERM at the end of the follow-up period. CONCLUSIONS: ILM peeling during PPV for rhegmatogenous retinal detachment reduces the risk of developing secondary ERM.

[Scleral buckling for Rhegmatogenous retinal detachment]. / Operace rhegmatogenního odchlípení sítnice zevním postupem.

Rhegmatogenous retinal detachment (RRD) is the separation of the sensory retina from the pigment epithelium (RPE). RRD is caused by a retinal tear in the periphery and the vitreoretinal (VR) traction, which allows access of the vitreous fluid to the subretinal space. Treatment of symptomatic retinal detachment is currently surgical only. Surgical options are intraocular and extraocular. This is the retrospective evaluation of the group of 17 eyes of 17 patients with RRD, which were operated by scleral buckling. Patients were 9 men and 8 women, age range 19-61 (median 46) years. The observation period is 1-13 months (median 7). The possible types of external interventions procedure were used only two: the radial plombage (in one case double) and cerclage. 15 patients (88 %) were phakic, and 2 were pseudophakic. In 12 eyes (71 %) were the quadrant RRDs, 2 eyes had dialysis in periphery of the retina, 1x it was the top half and 1x bottom half, and 1 patient had a subtotal RRD. In 9 (53 %) cases were used type of operation cryocoagulation with radial buckle and in 8 cases cryocoagulation with the cerclage. In four cases, was injected the gas tamponade into the vitreous at the end of the surgery. Primary attaching the retina occurred in 16 cases (94 %) and the retina remained flat in 14 eyes (82.4% ), in 2 cases occurred re-detachment (11.7 %). Preoperative best corrected visual acuity (BCVA) ranged from hand movement to 20/20 (average Snellen equivalent 20/63) and postoperative BCVA was 1/50 - 20/20 (average 20/50). Improving BCVA was statistically significant (Wilcoxon p=0.01). We consider the cryosurgical procedure for phakic eyes as the gold standard of the surgical treatment of uncomplicated rhegmatogenous retinal detachment. The main reason for the eventual failure of this technique is persistent vitreous traction and proliferative vitreoretinopathy (PVR).

[Scleral buckling for rhegmatogenous retinal detachment]. / Operace rhegmatogenního odchlípení sítnice zevním postupem.

Rhegmatogenous retinal detachment (RRD) is the separation of the sensory retina from the pigment epithelium (RPE). RRD is caused by a retinal tear in the periphery and the vitreoretinal (VR) traction, which allows access of the vitreous fluid to the subretinal space. Treatment of symptomatic retinal detachment is currently surgical only. Surgical options are intraocular and extraocular. This is the retrospective evaluation of the group of 17 eyes of 17 patients with RRD, which were operated by scleral buckling. Patients were 9 men and 8 women, age range 19-61 (median 46) years. The observation period is 1-13 months (median 7). The possible types of external interventions procedure were used only two: the radial plombage (in one case double) and cerclage. 15 patients (88 %) were phakic, and 2 were pseudophakic. In 12 eyes (71 %) were the quadrant RRDs, 2 eyes had dialysis in periphery of the retina, 1x it was the top half and 1x bottom half, and 1 patient had a subtotal RRD. In 9 (53 %) cases were used type of operation cryocoagulation with radial buckle and in 8 cases cryocoagulation with the cerclage. In four cases, was injected the gas tamponade into the vitreous at the end of the surgery. Primary attaching the retina occurred in 16 cases (94 %) and the retina remained flat in 14 eyes (82.4% ), in 2 cases occurred re-detachment (11.7 %). Preoperative best corrected visual acuity (BCVA) ranged from hand movement to 20/20 (average Snellen equivalent 20/63) and postoperative BCVA was 1/50 - 20/20 (average 20/50). Improving BCVA was statistically significant (Wilcoxon p=0.01). We consider the cryosurgical procedure for phakic eyes as the gold standard of the surgical treatment of uncomplicated rhegmatogenous retinal detachment. The main reason for the eventual failure of this technique is persistent vitreous traction and proliferative vitreoretinopathy (PVR).

[Surgical treatment of very advanced rhegmatogenous retinal detachment]. / Operacní resení u velmi pokrocilých rhegmatogenních amocí

Rhegmatogenous retinal detachment is a serious ocular pathology. Therapeutic options are surgical only. Surgery is in advanced stages technically and financially demanding. In this paper, we consider the results operated detachments, which were for their advancement, with respect to the technical possibilities of the present intraocular surgery, on the border of the surgical possibilities. The group consisted of 37 eyes of 37 patients who were followed prospectively and had in the affected eye very advanced (old) rhegmatogenous retinal detachment. As a method to confirtm any visual functions were used visual evoked potentials in flash monocular stimulation (F-VEP). All patients had a cerclage performed 12 mm from the limbus, 20G pars plana vitrectomy (PPV), in 2 was also performed cataract surgery (phacoemulsification with implantation of an artificial intraocular lens to the bag). Surgery was done in 23 of 37 patients (62 % of the whole group), with the remaining 14 eyes was not due to the severity of finding highly advanced retinal detachment. Attached retina at the end of the observation period had 14 eyes (61% of the patients, 38% of the whole group). In 5 eyes was due to local re-detachment in the periphery only stabilized finding (22% of operated eyes, 14% of all). The values ​​of visual acuity in the subgroup of operated eyes were statistically significantly increased after surgery (Wilcoxon p = 0.036). The values ​​of F-VEP were not statistically significantly different between operated and non-operated patients and was not found any statistically significant correlation between the vision (and even after surgery) and F-VEP in operated eyes. Anatomical success of surgical treatment of advanced retinal detachment is possible. But the correlation was not found in visual acuity and F-VEP or the severity of preoperative disturbed visual function, even in the improvement in the postoperative period. F-VEP is not a suitable marker for determining the indication for the procedure, or to the prognostics and therefore we can not use this technique to distinguish between operable and inoperable findings. Based on our clinical experience, we recommend carefully consider the suitability of surgical treatment of rhegmatogenous retinal detachment with low vision than the hand movement with the correct projection of light, when the duration is longer than three months and the anatomic findings is contractile anterior proliferative vitreoretinopathy.

[Vision loss after uncomplicated pars plana vitrectomy]. / Ztráta zraku po nekomplikované pars plana vitrektomii.

Every eye surgery has its pitfalls and possible complications. Even after properly and noncomplicated orbital or intraocular surgery there can develop a loss of visual acuity or visual field. In the perioperative period was on the operated eye for epimacular membrane (23G pars plana vitrectomy) retinal arterial occlusion with fatal consequences for visual function. Entrance visual acuity decreased from 20/63 to counting fingers. Risk factors for age-related and underlying diseases were accompanied by systemic hypotension and mild anemia. Commonly available topical and general therapy did not lead to any significant improvement.

[Contribution to the investigation macular function for the surgical treatment of idiopathic macular holes]. / Príspevek k vysetrování funkce makulární krajiny pri chirurgické lécbe idiopatické makulární díry.

We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for idiopathic macular hole, with peeling MLI (membrana limitans interna) and instillation of gas tamponade (20% SF6 - sulfur hexafluoride). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). There was no other ocular pathology besides idiopathic macular holes (IMD). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT, Carl Zeiss). For examination of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, BCVA in the near (Jaeger charts), multifocal electroretinography (MfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. ANATOMICAL RESULTS: The primary closure of the IMD occurred in 29 (90%), the IMD was not closed, but it's edges were flattened in 2 eyes (6%), and once time the edges of the IMD were not flattened (3%). FUNCTIONAL RESULTS: The initial BCVA ranged from 0.1 to 0.5 (1.0 to 0.3 LogMAR). After one year of operations the visual acuity improved by 2 or more lines in 27 eyes (84%), of 3 or more lines in 18 eyes (56%), and 4 or more lines in 5 eyes (16%). PERG amplitudes (N95) in all eyes were between 4 to 9 microV (within the normal range of the laboratory), and was not found statistically significant difference between the values before surgery and 12 months after. Statistically significant difference (improvement) was found in the first and the second central ring of the MfERG. Improvement involved the values of P1 wave amplitude before surgery and 12 months after (Wilcoxon p < 0.01). The difference between the values of N1 and P1 latencies before surgery and month 12 was not statistically significant, as well as changes between the values of the amplitudes of waves N1 preoperatively and 12 months later. Due to the favorable anatomical and functional results we consider surgical treatment of macular holes through PPV with peeling MLI as a safe technique. When the indication to perform peeling is considered, there is a need to think about other factors, especially duration IMD, disease stage, type of intraocular tamponade and the patient's cooperation.

[Treatment of the choroidal neovascular membrane by ranibizumab (Lucentis): a case report]. / Lécba choroidální neovaskulární membrány preparátem ranibizumab (Lucentis): kazuistika.

A 73-year-old woman presented with a best-corrected visual acuity of 6/9 in her right eye and 6/36 in her left eye. Fundus examination revealed signs of age related macular degeneration in both eyes. In her right eye it was just dry form of the disease, in left one an elevated lesion associated with retinal cystoid edema was detected. Ocular coherence tomography and fluorescein angiogram confirmed a subfoveal occult choroidal neovascular membrane. We decided for intravitreal ranibizumab (Lucentis, 0.5 mg) treatment. One month after first injection, best-corrected visual acuity improved to 6/15 in her left eye. After six months, best-corrected visual acuity further improved to 6/12, with complete resolution subretinal fluid on ocular coherence tomography.

[Ultrasound biomicroscopy of the eye before and after the cataract surgery]. / Ultrazvuková biomikroskopie oka pred a po operaci katarakty.

Authors monitored changes of anatomical relationships of the anterior segment of the eye, following after the cataract surgery (standard phacoemulsification with implantation of the posterior chamber intraocular lens). They monitored especially the depth of the anterior chamber and angle width, and further anatomical relationships and configurations of anterior chamber structures. The results show, the cataract surgery may significantly change anatomical relationships and that these changes are advantageous (the anterior chamber goes deeper and the angle more width).