EFFECT OF RANIBIZUMAB AND AFLIBERCEPT ON RETINAL PIGMENT EPITHELIAL DETACHEMENT, SUBRETINAL AND INTRARETINAL FLUID IN AGE-RELATED MACULAR DEGENERATION.

PURPOSE: The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients. MATERIAL AND METHODS: The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test. RESULTS: Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 μm (median -37.5 μm), -84.3 μm (median -85 μm) and -109.3 μm (median -81 μm) in patients treated with ranibizumab, and -46.3 μm (median -30 μm, p = 0.389), -127.7 μm (median -104 μm, p = 0.096) and -204.4 μm (median -163 μm, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891). CONCLUSION: We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.

Implantation of posterior chamber phakic intraocular lens for myopia and hyperopia - long-term clinical outcomes.

PURPOSE: To evaluate long-term refractive outcomes of implantable collamer lens (ICL) implantation and late postoperative complications. METHODS: We assessed outcomes of patients who underwent ICL implantation (type ICM V4 for myopia, ICH V3 for hyperopia, TICM V4 for astigmatism) in our department between 1998 and 2013. It comprised 62 eyes (40 myopic and 22 hyperopic). The average follow-up period was 10.5 years. We evaluated: uncorrected and best-corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), ICL vault, endothelial cell density and late postoperative complications. RESULTS: In myopes, the average UCVA was 1.0±0.37 and BCVA 1.18±0.38, in hyperopes 0.78±0.19 and 1.14±0.18, respectively. The average SE in myopes, whose target refraction was emmetropia, was -0.6±0.83 Dsf, in hyperopes +0.73±0.93. Central ICL vault was 206.16µm±105.94, (range 10-427) in myopes, 195.5µm±109.09, (range 20-404) in hyperopes. The most common late postoperative complication was cataract formation. Three myopic eyes (7.5%) developed symptomatic anterior subcapsular opacities with loss of at least two lines of BCVA. Cataract significantly affecting visual acuity occurred in 5 myopic eyes (12.5%) and 2 hyperopic eyes (9.09%). In these eyes, ICL removal and cataract surgery was performed. CONCLUSIONS: In our experience, ICL implantation in moderate and high ametropia was effective and relatively safe. The most common late complication was cataract formation. This complication can be managed effectively surgically with good refractive outcomes without loss of BCVA.

Incidence of cataract following implantation of a posterior-chamber phakic lens ICL (Implantable Collamer Lens) - long-term results.

AIM: To evaluate late postoperative complications, especially cataract occurrence, its morphological type and factors affecting its development in patients implanted with ICL (Implantable Collamer Lens). METHODS: We analysed the results of ICL implantation in 34 patients (type ICM V4 for myopia, ICH V3 for hyperopia, TICM V4 for astigmatism) in our department between 1998 and 2013. The cohort comprised 62 eyes (40 myopic and 22 hyperopic). Seven eyes with a toric ICL implanted were included in these groups according to spherical equivalent (SE). The average follow-up period was 10.5 ± 3.5 years. We examined uncorrected and best-corrected visual acuity (UCVA and BCVA), SE, ICL vaulting (using anterior segment OCT) and occurrence of late postoperative complications, especially cataract formation in 2 groups of patients - myopes and hyperopes. RESULTS: Among the most common late postoperative complications were pigment dispersion syndrome in 27 eyes, 43.5% (12 myopic eyes and 15 hyperopic eyes) and cataract formation. Lens opacities, including opacities without loss of BCVA, were observed in 18 eyes (29%). Opacities affecting visual acuity were observed in 10 eyes (16.1%). Cataract significantly affecting visual acuity occurred in 7 eyes, i.e. 11.3% (5 myopic eyes and 2 hyperopic eyes). In these eyes, ICL removal and cataract surgery with implantation of posterior chamber intraocular lens (PC IOL) was performed. The most common morphological type of cataract were anterior subcapsular opacities (83.3%), the average time of onset was 3.4 ± 1.9 years after ICL implantation. We did not prove a statistically significant association either between cataract occurrence and age at the time of surgery, or between cataract occurrence and higher preoperative spherical equivalent. We did not prove a significant association between cataract occurrence and low vault, however in 7 eyes after cataract surgery and ICL removal we do not know the vault values. In one eye uveitis with cystoid macular oedema was observed, in two highly myopic eyes repeated ICL dislocation and cataract occurred. In both of these cases the ICL was removed. CONCLUSIONS: According to our experience, implantation of ICL in moderate and high ametropia was relatively safe upon assessing the long-term outcomes. Among the most common complications were pigment dispersion syndrome and anterior subcapsular cataract formation. Cataract can be managed effectively surgically with good refractive outcomes without loss of BCVA. However, loss of accommodation after cataract surgery and risk of vitreoretinal complications must be considered.Key words: ICL (Implantable Collamer Lens), posterior chamber phakic intraocular lens, refractive surgery, cataract occurrence.

[Treatment of Keratoconus with Corneal Cross-linking--Results and Complications in 2 Years Follow-up]. / Corneal cross-linking v liecbe keratokónusu--výsledky a komplikácie v dvojrocnom sledovaní.

OBJECTIVE: The objective of the study was to assessment of changes of monitored parameters after CXL. Incidence of complications were assessed in the whole group and in groups of patients divided according to the selected criteria. Evaluated parameters were also relations between them and in time. METHODS: The 86 eyes of patients with progressive keratoconus who underwent CXL according to the Dresden protocol in the years 2007-2009 at the Ophthalmic clinic FN Brno Bohunice were included in this study. RESULTS: There was observed significant increase of BCVA (letters--before CXL 42,30±10,35, 1st year after CXL (1Y) 44,68±10,04, p<0,01, 2nd year after CXL (2Y) 44,44±10,57, p<0,01) and SE (-5,95±3,98D, -5,27±3,84D, p<0,01, -4,94±3,68D, p<0,01), and decrease of maximum curvature of the cornea (MAX--before CXL 50,39±4,17D, 1Y 49,46±4,13D, p<0,01, 2Y 49,42±4,14D, p<0,01). Change of ultrasound CCT, polymegatisms, pleomorfisms and corneal endothelial cell density was not significant. The value of MAX is the most important parameter in estimating the effect of CXL. The highest incidence of corneal opacity after CXL was observed in the eyes of patients with III. stage of keratoconus over 40 years old, carrying hard contact lenses and with biomikroskopic symptom of keratoconus on the cornea. We found that corneal thickness measurement with Orbscan II and the mesurement of IOP with noncontact method is incorrect by patients after CXL. CONCLUSION: Corneal cross-linking of the cornea is safe and effective procedure of stopping the progression of keratoconus in 97% of eyes in the period up to 2 years after CXL.

[Supracor, Laser Correction of Presbyopia: One-year Follow-up Outcomes]. / Supracor, laserová metoda korekce presbyopie: výsledky rocního sledování

PURPOSE: Evaluation of one-year postoperative results after Supracor laser procedure. METHODS: The study group consisted of 8 hyperopic patients (16 eyes) seeking alternatives to wearing glasses for both distance and near vision. These patients underwent Supracor refractive surgery in the Department of Ophthalmology of The University Hospital Brno in the time period from July 2012 to February 2013. The patient mean age at operation was 57,2 years (±4,6), mean binocular uncorrected near visual acuity was Jaeger No. 13, distance visual acuity 0,5 (±0,19). Average follow-up period was 15,5 months (±2,4). We evaluated binocular uncorrected and best corrected distance visual acuity (UDVA, BCDVA), near visual acuity (UNVA, BCNVA), and intermediate visual acuity (UIVA, BCIVA) 12 months after surgery, further the stability of visual acuity, objective refraction, mesopic contrast sensitivity, occurrence of complications, and patient satisfaction. RESULTS: In all 8 patients, binocular UDVA of at least 1,0 was achieved. The mean spherical equivalent was +0,25 D (±0,64). UNVA was Jaeger No. 3 or better in 7 patients (68,7 %), 5 of them could read Jaeger No. 1. UIVA Jaeger No. 1 was achieved in 5 patients (62,5 %), Jaeger No. 2 in 2 patients (25 %), and Jaeger No. 4 in 1 patient (12,5 %). In all eyes, preoperative mesopic contrast sensitivity was within the normal range for the given age. Postoperatively it remained within the normal range in 11 eyes (68,7 %). In 5 eyes (31,3 %) we found adecrease below the lower limit in higher spatial frequencies (12 and 18 cycles/degree) during the entire follow-up period. According to the patient questionnaire, 7 patients (87,5 %) were fully satisfied with the outcome of the surgery and they felt independent of wearing glasses, 1 patient was dissatisfied. 7 patients (87,5 %) did not report the presence of photic phenomena (halo, glare), 1 patient suffered from these problems. We did not encounter any intraoperative or postoperative complications.Conlusion: According to our first experience, good distance, near, and intermediate visual acuity and arather high patient satisfaction can be achieved with the use of the Supracor procedure. Supracor seems to be asuitable method of presbyopia correction in motivated, adaptable patients who meet strict indication criteria. With regard to the small number of patients in our study group, agreater number of patient evaluations will be required in the future, and long-term results will be of interest as well.Key words: Supracor, presbyopia, LASIK, refractive surgery.

[The effectiveness of corneal cross-linking in stopping the progression of keratoconus]. / Efektivita corneal cross-linkingu v zastavení progresie keratokónusu.

OBJECTIVE: Objective of the study was to prove the efficiency of corneal cross-linking (CXL) in stopping the progression of keratoconus. METHODS: In this study were included 58 eyes of patients with progressive keratoconus who underwent CXL according to the Dresden protocol in the years 2007-2009 at the Ophthalmic clinic FN Brno Bohunice. The eyes of patients were divided into four groups according to the change of maximum curvature of the cornea two years after CXL. RESULTS: Stabilization of maximum curvature of the cornea have been reported in 40 % of eyes, regression in 57 % of eyes by an average of 1,92D and disease progression in 3 % of eyes 2 years after CXL. The eyes with regression over 2D had significantly higher best-corrected visual acuity before and after the procedure compared to the group with stabilization. Spherical equivalent increased significantly in all groups, on average, in the group with stabilization of 0,54D, in the group with mild regression of 0,71D and in the group with a large regression of 2,09D. In the group with a large regression 100 % of eyes had stabilization or increase in SE. Our observations showed that, when a decrease in the patient keratometric values of cornea is present after CXL, it is comprehensive and applies to all parameters. CONCLUSION: We have confirmed that corneal cross-linking stops the progression of the disease in 97 % of eyes two years after the procedure.

[Diagnostic pitfalls of pseudo-foster kennedy syndrome - a case report]. / ÚSKALIA DIAGNOSTIKY PSEUDO-SYNDRÓMU FOSTERA KENNEDYHO.

To the outpatient facility of the Department of Ophthalmology, Faculty Hospital Brno, Czech Republic, E.U., was in June 2013 referred a 24 years old man with the suspicion of Foster Kennedy syndrome. On the fundus examinations, the findings were in correlation with the symptoms of this syndrome: slightly pale optic disc of the right eye and edema with the anterior extension of the optic nerve head of the left eye. The perimetric examination revealed bilateral visual fields defects, mainly in the nasal parts of the visual fields which is not typical for this syndrome. The native magnetic resonance imaging (MRI) examination was negative. Due to the suspicion of pathologic finding in the visual pathway area, the blood levels of pituitary gland hormones were examined and revealed elevated prolactin levels. In the indicated MRI examination with contrast, in the revised reading, a suspicious microadenoma of the pituitary gland was detected. Due to the atypical changes in the perimetric examinations, other possible causes of visual fields defects as coincidence of multiple, each other independent pathologies (neuritis or neuropathy of the optic nerve, neuromyelitis optica (Devic disease), Lebers hereditary optic neuritis (LHON) etc.) to exclude or to confirm the Pseudo-Foster Kennedy syndrome were taken into account. The patient is regularly followed up at our outpatient facility as well as at the outpatient facility of the Department of Neurosurgery, where, until now, the follow up only was recommended. The diagnosis of this case was, until now, set as Pseudo- Foster Kennedy syndrome, with unclarified cause of the clinical findings.