EVALUATION OF THE CORNEAL STROMAL DEMARCATION LINE AFTER THE ACCELERATED CORNEAL CROSS-LINKING USING ANTERIOR SEGMENT OCT.

OBJECTIVES: Evaluation of the visibility and depth of the demarcation line in the corneal stroma in eyes with keratoconus 1 month and 3 months after epi-off accelerated corneal cross-linking (ACXL) using anterior segment optical coherence tomography (AS OCT). MATERIAL AND METHODS: This study analyses a group of 34 eyes with keratoconus 1 month and 3 months after ACXL (9 mW/cm2 for 10 min). The group was classified based on the ABCD clinical classification of keratoconus according to Belin and Duncan. AS OCT (ZeissCirrus 500, Anterior Segment Premier module) was used to assess the visibility and exact depth of the demarcation line in the corneal stroma. RESULTS: The demarcation line was visible 1 month after ACXL in 76.5% of eyes with a mean depth of 238.13 ±20.36 μm and 3 months after ACXL in 100% of eyes with a mean depth of 263.43 ±12.59 μm. Statistical analysis of the group did not show a significant relationship between the disease stage and the demarcation line visibility; however, there was a trend towards higher age (>30 years) in the group in those eyes where the demarcation line was visible vs. partially visible 3 months after ACXL. We found no difference in the mean and maximum line depth when comparing 1 month and 3 months after the procedure. There were no cases of disease progression 3 months after ACXL in the group. CONCLUSION: Our study suggests that the assessment of the demarcation line in the corneal stroma is more reliable 3 months compared to 1 month after ACXL. We also observed a trend towards higher patient age in eyes where the demarcation line was clearly visible 3 months after ACXL. We did not confirm a relationship between the stage of keratoconus and the depth of the line, nor a difference in its mean and maximum depth 1 month and 3 months after the procedure.

Visual Training in Virtual Reality in Adult Patients with Anisometric Amblyopia.

PURPOSE: Amblyopia is one of the most common childhood disease. The average prevalence of amblyopia in children is estimated at 2-5 %. It arises during the child development until the age of six, if not treated then, it persist throught adulthood. The aim of our work is to retrospectively analyze the results of treatment of anisometropic amblyopia using dichoptical training in virtual reality in adult amblyopic patients. MATERIALS AND METHODS: Our group consisted of 84 amblyopic patients with anisometropic amblyopia with an average age of 33.8 ± 9.4 years. Patients played a video game twice a week in the Oculus Rift 3D virtual reality. Together they completed 8 visual trainings, with one training lasting 60 minutes. Before and after the training we evaluated the best corrected visual acuity (BCVA). DISCUSSION: Throughout the group, we observed an improvement of 0.1 BCVA from 0.48 to 0.58 Sloan table (p.

Detection of Small Subsets of CD4+ Lymphocytes with SmartFlare Nanoprobes.

SmartFlare technology allows detection of mRNA in single living cells. We studied the possibility of using SmartFlare nanoprobes for detection of small subsets of CD4+ lymphocytes. It was found that SmartFlare allows detection of transcriptional master regulators of major CD4+T helper subsets in living human lymphocytes. Nanoprobes labeled with Cy5 fluorophore were better detected by flow cytometry than nanoprobes labeled with Cy3. Appropriate time of lymphocyte incubation with SmartFlare probes was 24 h.

Pupillary abnormalities in childhood - 2 case presentations.

Anisocoria is a condition characterized by an unequal size of the eyes' pupils. There is a broad spectrum of aetiological factors including benign and also life- threatening situations. The most important point is the ability to find the anatomical location of the pathology. Understanding to the anatomical, physiological and pharmacological influences helps us to solve the diagnostic challenge. In the article authors present the issue of the anisocoria in the childhood through two case presentations. Causes of an unequal size of the eyes' pupils are in this two cases different. In both of the cases the anisocoria is temporary with spontaneous resolution without any therapy. Diagnostic challenge is well- described with the analysis of important Pilocarpin pharmacological tests. Pharmacological diagnostic tests are a very effective method to differentiate between the pharmacological mydriasis and the mydriasis caused by another factor. Strictly taken patient´s history with targeted questions searching for recent contact with some drugs, plants or medications is crucial. Sometimes it is necessary to consider an unusual diagnosis - benign episodic unilateral mydriasis.

Effect of Botulinum toxin A application in neuro-ophtalmologic indications on Schirmers test and tears osmolarity.

Botulinum toxin type A (BT-A) is used in the treatment of neuro-ophthalmologic disorders such as essential blepharospasm and facial hemispasm for more than 20 years. Although the long-term effect of repeated application of the BT-A was confirmed, the BT-A effect on tears production and retention is not clear. In our work we investigated whether applied BT-A in patients with blepharospasm and hemifacial spasm affect tears production. Tears quality was measured with Schirmers and tear osmolarity test during neuro-ophthalmologic diseases treatment, which was evaluated before and 14 days after application of BT-A (Botox inj, Allergan, Irvine, USA) into the orbicularis oculi muscle. BT-A doses of 16-18 U with unilateral and 32 to 36 U bilateral applications were used. The mean tear production in Schirmers test before BT-A application was 8.38 ± 0.63 mm, and 2 weeks after BT-A application was 7.12 ± 0,6 mm (n = 50). Tear osmolarity was 305.4 ± 9.2 mOsm before BT-A application, and 2 weeks after BT-A application it was 305.2 ± 8,6 mOsm (n = 13). We found significant difference between two groups in tear quantity (p < 0.012), but not quality (p > 0.05). Application of the BT-A reduced the amount of tears measured by Schirmers test. These results confirm rational basis of the empirical clinical experience where an artificial tears substitution is recommended for patients with neuro-ophthalmologic disorders treated by BT-A.

Advances and Challenges of Nanoparticle-Based Macrophage Reprogramming for Cancer Immunotherapy.

Despite the progress of modern medicine, oncological diseases are still among the most common causes of death of adult populations in developed countries. The current therapeutic approaches are imperfect, and the high mortality of oncological patients under treatment, the lack of personalized strategies, and severe side effects arising as a result of treatment force seeking new approaches to therapy of malignant tumors. During the last decade, cancer immunotherapy, an approach that relies on activation of the host antitumor immune response, has been actively developing. Cancer immunotherapy is the most promising trend in contemporary fundamental and practical oncology, and restoration of the pathologically altered tumor microenvironment is one of its key tasks, in particular, the reprogramming of tumor macrophages from the immunosuppressive M2-phenotype into the proinflammatory M1-phenotype is pivotal for eliciting antitumor response. This review describes the current knowledge about macrophage classification, mechanisms of their polarization, their role in formation of the tumor microenvironment, and strategies for changing the functional activity of M2-macrophages, as well as problems of targeted delivery of immunostimulatory signals to tumor macrophages using nanoparticles.

Keratopigmentation (Corneal Tattoo) - Our First Experience.

INTRODUCTION: Keratopigmentation or corneal tattooing represents an unique cosmetic solution for corneal leucomas and also for other pathological changes affecting cornea or iris. Procedure is based on pigment insertion into the corneal stroma. Goal is to improve the appearance of the affected eye. These days are most frequently used tattoo kits with different sterilised inks made primary for skin tattooing. As a new possibility there are also available biocompatible micronized mineral pigments. METHODS: Authors will introduce four case reports of four patients with corneal leucomas, who wanted to undergo the corneal tattooing to improve the cosmetic appearance of their blind eyes. Authors decided for keratopigmentation with an use of inks intended primary for skin tattooing. RESULTS: In all four patients was the final appearance of tattooed cornea more than satisfying. Postoperative examination didn´t detect diffusion, fading, colour changes of the pigments. No complications such as toxic or immune reaction due to the pigment were recorded. All four patients were subjectively fully satisfied with the cosmetic result of the keratopigmentation. CONCLUSION: Based on the first experience authors consider keratopigmentation to be a safe and relatively uncomplicated surgical method. Corneal tattooing is also quite cheap, does not require patient´s hospitalization and postoperative reconvalescence in usually short term. Key words: keratopigmentation, corneal tattoo, corneal leucoma, blind eye.

Femtosecond Laser - assisted intrastromal corneal segment implantation - our experience.

  Introduction: The intrastromal corneal ring segments implantation is widely used as an effective method for keratoconus correction. Femtosecond laser technology represents very precise and modern approach in corneal tunnel creation. Nevertheless complication like an extrusion of the implanted ring segment rarely appears. There are few different types of intrastromal corneal segments available. Keraring (Mediphacos Ltd.) is primary designed for keratoconus treatment. MATERIALS AND METHODS: We evaluated results of the Keraring implantations in 32 patients (48 eyes) with keratoconus or with marginal pellucid degeneration. We implanted 78 segments totally in the period from January 2015 to February 2017, with the assistance of femtosecond laser. We present our data collected after the 6 months follow up. Uncorrected visual acuity - UCVA and best corrected visual acuity - BCVA were evaluated. We scored the changes in the subjective and objective refraction. The complications were observed. RESULTS: Preoperative UCVA was in 44 (91,60%) eyes under or equal 0,3. Postoperative UCVA after 6 months was in 29 (60,41%) eyes over or equal 0,3. Visual acuity improved in 38 (79,16%) eyes totally with the gain of 1 to 9 lines, BCVA improved in 27 (56,25%) eyes and in 15 (31,25%) eyes stayed postoperatively unchanged. There was reduction of the spherical equivalent (SE), in the subjective and objective refraction. In our group there we detected 9 (18,75%) extrusions of the implanted ring segment, which occurred on average 7,3 months (range 2/ 16 months) after the surgery. CONCLUSION: Intrastromal corneal ring segments implantation with the femtosecond laser assistance is an effective approach in the keratoconus treatment. Complications are not often observed. With careful selection of the suitable patient it is possible to avoid them. Key words: keratoconus, intrastromal corneal ring segments, femtosecond laser.

The treatment results in patients with lmphoma disease in the orbit.

INTRODUCTION: Lymphoma is a malignant disease that can affect several structures of the orbit and eye adnexa. In the area of orbit the non-Hodgkins lymphoma (NHL) is typical, which may be indolent or aggressive. Indolent subtypes include MALT (mucosa-associated lymphoid tissue), follicular lymphoma (FL), lymphoplasmocytic lymphoma (LPL). Conversely, subtypes such as diffuse large cell lymphoma (DLBCL), mantle cell lymphoma (MCL) and Burkitt lymphoma (BL) are aggressive. The disease can be presented as primary or secondary malignancy of the orbit. MATERIAL AND METHODS: A group of 35 patients from the Department of Ophthalmology, Faculty of Medicine, Comenius University in Bratislava in the period from January 1 2009 to December 31 2016 with diagnosed non-Hodgkins lymphoma located in the area of the orbit. For all patients, the generally valid diagnostic criteria for the NHL in the eye area were met. We processed the first signs of disease, the proportion of women and men with NHL, the percentage of NHL types in the orbit area. Statistically, we evaluated the age at which NHL occurred in patients and evaluated the incidence of the disease over the reference period. We have statistically processed the forms of the applied therapy, their adverse effects, the recurrence of the disease, the presence of other malignancies in the lymphoma patient. RESULTS: Of the total number of NHL patients in orbit region 13 (37%) were male and 22 (63%) female. The overall mean age at which lymphoma was diagnosed was 60 years. Median for the total age of patients was 61. In women, a slightly higher average age and median was found. On the other hand, lower values of both parameters were present in men. The modus of both sexes was the same, 70 years. We have seen various first symptoms in our group. We found that the most common symptom is red eye, and the rarest is the deterioration of the central visual acuity. The longest lasting symptom was swelling of eyelids (on average, up to 10 years) and the shortest described eye itching. Overall, the average duration of symptoms was 28 months, with a median of 13 months. In our group of patients were 3 % of LPL, 6 % of Burkitts lymphoma, 6 % of FL, 8 % of MCL, 17 % of DLBCL, and 60 % of malignant lymphoma. MALT lymphoma occurred in 62 % in orbital and 38 % in conjunctival localization. In 2 patients with MALT lymphoma of the conjunctiva to start with systemic therapy wasn't neccessary. In 21 patients with MALT lymphoma excisional biopsy or orbitotomy was the first step to diagnose lymphoma disease in 3 cases; in 18 patients the infiltration of the orbit or conjunctiva occured 1 to 3 years after primary diagnose of systemic lymphoma disease. In general, NHL localization was 29 % in conjunctiva and 71 % in the orbital area. In 9 % of the orbital lymphoma, we observed lymphoma ingrowth to the conjunctiva. Systemic therapy was initiated in patients in II. stage and higher stage of the disease according to the Ann Arbor system. Totally 63 % of the group were treated by systemic therapy. Recurrence occurred in 5 patients, representing 14 % of the observed, but only in one patient with MALT lymphoma. Preoperative and postoperative (excisional biopsy, orbitotomy) central visual acuity (CVA) stayed unchanged, postoperative swelling did not affect CVA, and CVA didn't change even during long-term follow-up. CONCLUSION: Careful differential diagnosis determines the therapy of the disease, since the primary symptoms are usually nonspecific for ocular lymphoma. Significant factors for therapy include tumor grading and clinical staging by AJCC 2009 (American Joint Committee on Cancer, Chicago, Illinois). Correct evaluation of the symptoms is an important step to indicate excisional biopsy or orbitotomy: After histopathological results we can start adequate therapy in the cooperation with oncohematologist. Key words: conjunctival tumors, orbit, lymfoma, orbitotomy.

CHANGE OF CENTRAL AND PERIPHERAL VISION IN PATIENT WITH SYMPTOMATIC CYST OF RATHKE'S CLEFT FOLLOWING TRANSSPHENOIDAL RESECTION.

A seventysix-year-old female was acutely admitted to the Eye Clinic of the University Hospital in Martin with a 1 month history of impaired central and peripheral vision on the right eye. At the admission patient`s right eye VA was fingers at 20 cm, the left eye had a central vision preserved. Magnetic resonance of the brain and orbits demonstrated cystic tumor expansion in the sellar region with compression of optic chiasm and optic nerves (more on the right side), in diff. dg. as cystic macroadenoma of the pituitary gland. Endocrinological examination found secondary hyperprolactinaemia from pituitary oppression, other hormonal parameters were without deviation. Consequently, the ENT examination recommended endoscopic resection via the transsphenoid approach. After resection of the lesion and histological examination of the sample, the finding was evaluated as a Rathke's cleft cyst. Symptomatic Rathke's cleft cysts of pituitary gland are rare, but the visual symptoms are typical findings due to chiasm proximity. On ophthalmological examination 3 weeks after surgery has central vision increased significantly (VOD 6/9) on the right eye and peripheral vision has partially adjusted on both eyes. Key words: Rathke's cleft cyst, perimeter, central visual acuity, transsphenoidal endoscopic resection.

Uveal melanoma survival rates after single dose stereotactic radiosurgery.

This paper presents the long-term results of single dose stereotactic radiosurgery for intraocular uveal malignant melanoma, and summarizes the results of the retrospective study in 170 Slovak patients. A group of uveal melanoma patients (149 choroidal melanoma, 21 ciliary body melanoma) from 20 to 92 years of age with 59 year median were treated in 2001-2016. There were 81males (47.7%) and 89 females 89 (52.3%). The median overall follow-up time was three years. The median tumor volume at baseline was 0.5 cm³ (ranging from 0.2 to 1.6 cm³). The therapeutic dose was 35.0 Gy by 99% of dose volume histogram. The survival after single dose stereotactic radiosurgery was 96% in one year, 93% in two years, 84% in five years, 80% in seven years and 52% in eleven years. Secondary enucleation was necessary for 22 patients because of secondary glaucoma complication. The enucleation free interval ranged from one to six years. The survival rates in five year intervals and necessity of secondary enucleation due to complications after single dose stereotactic radiosurgery is comparable to other techniques.

Conjuctival lesions - the relationship of papillomas and squamous cell carcinoma to HPV infection.

The etiology of papilloma formation is multifactorial. There is a strong association between human papillomavirus (HPV) and the development of these conjunctival lesions. HPV is tumorigenic and commonly produces benign tumors with low malignant potential. Papillomas rarely go through malignant transformation. MATERIAL AND METHODS: Retrospective study of patients with a diagnosis of conjunctival papilloma or squamous cell carcinoma. RESULTS: From a collection of 125 patients with conjunctival non-pigmented tumours in the period from 2007 to 2017, in 119 (95.2%) patients histological examination confirmed papilloma and in 6 (4.8%) patients it confirmed carcinoma. Of the total number of patients, 39 were women (31.2%) and 86 men (68.8%). The mean age of patients was 68.4 years (range 20-94 years). Localization of lesions: bulbar conjunctiva - 65 (52.0%), upper eyelid tarsal conjunctiva + fornix - 6 (4.8%), lower eyelid + fornix - 27 (21.6%), caruncle - 20 (16.0%) and plica semilunaris - 7 (5.6%) patients. In the patient cohort we recorded 2 papillomas that were transformed into squamous cell carcinoma. HPV16 was positive in these patients, the carcinomas were from the area of the bulbar conjunctiva, and the surgical solution was associated with the perioperative administration of Mitomycin C. In one case, the inverted papilloma developed into orbital carcinoma within 2 years of primary excision, and the patient underwent radical surgical procedure (partial exenteration of the orbit) followed by radiotherapy. CONCLUSION: Transformation of the papilloma into the carcinoma is rare, but it must always be taken into consideration in case of a recurrence of the disease. HPV can infect the conjunctiva. The ophthalmologist, in collaboration with a pathologist, may recommend appropriate laboratory tests to confirm the diagnosis. Long-term outpatient follow-up of patients after excision of the conjunctival papilloma is also necessary. Key words: epibulbar tumors, conjunctival tumors, papilloma, carcinoma.