Comparison of Three Methods of Tonometry in Patients with Inactive Thyroid-Associated Orbitopathy.

INTRODUCTION: Intraocular pressure (IOP) measurement in patients with thyroid-associated orbitopathy (TAO) can be difficult and misleading, particularly in patients with diplopia and eye deviation (esotropia or hypotropia). However, when measuring IOP, it is also necessary to pay sufficient attention to TAO patients without diplopia in primary gaze direction and without motility disorder that might not be readily apparent. PURPOSE: The aim of this study was to evaluate the accuracy of measurement of intraocular pressure (IOP) using three different types of tonometers: the rebound tonometer (iCARE), the Goldmann applanation tonometer (GAT) and the non-contact airpuff tonometer (NCT) in patients with inactive TAO.  Materials and Methods: A total of 98 eyes of 49 adult patients with TAO were examined. The study group included 36 females and 13 males, with an age range of 19-70 years and a median age of 55.0. All the patients had evidence of thyroid disease,  a history of mild to moderate TAO, no clinical signs or symptoms of active disease, and no diplopia in direct gaze direction. In addition to a comprehensive eye examination, all the patients underwent measurement of intraocular pressure with three tonometers: NCT, iCARE, and GAT. The measurements with these three devices were compared. RESULTS: The mean IOP was 18.1 ± 2.4 mmHg (range 13-25 mmHg) with GAT, 22.3 ±5.0 mmHg (range 13-35 mmHg) with NCT, and 18.0 ±2.4 mmHg (range 13.3-26 mmHg) with iCARE. The mean difference between the GAT and iCARE measurements (using the Bland-Altman analysis) was -0.1 ±1.16 mmHg (limits of agreement -2.4 to 2.1). The mean difference between the GAT and NCT measurements was 4.2 ±3.6 mmHg (limits of agreement -2.8 to 11.2). The mean difference between the iCARE and NCT measurements was -4.3 ±3.7 mmHg (limits of agreement -11.6 to 2.9). No significant difference was found between GAT and iCARE (p = 1.000). However, there was a significant difference between GAT and NCT (p < 0.0001), as well as between iCARE and NCT (p < 0.0001).  Conclusions: In patients with TAO, NCT significantly overestimates IOP values compared to the GAT and ICare. By contrast, the iCARE rebound tonometer provides IOP measurements comparable to the gold standard GAT in these patients.

Current use of the automatic retinal oximetry. Review.

PURPOSE: To inform about possible use of the automatic retinal oximetry for the retinal oxygen saturation measurement in the eye and systemic diseases. METHODS: We performed a literature review dealing with issues of retinal oxygen saturation monitoring by dual non-invasive retinal oximetry Oxymap T1 (Oxymap ehf. Reykjavík, Iceland). RESULTS: We have found two main strains writing our paper on retinal oxygen saturation eye diseases. The first section concerns diseases created by having hypoxia as its main pathological factor  - for example diabetes mellitus and retinal vein occlusion. The second group deals with atrophy as the main pathological mechanism which is typical for decreasing retinal oxygen consumption - for example glaucoma or retinitis pigmentosa (the second one named is not included in our work). Oximetry in systemic diseases creates a relatively new chapter of this branch with a very big potential of interdisciplinary cooperation for the future. It is possible the cooperation will not only include diabetologists but also neurologists (for example, in diseases like sclerosis multiplex or Devics, Alzheimers and Parkinsons disease) and haematologists (retinal oxygen saturation changes in patients with different rheological attributes of blood). CONCLUSION: Retinal oxygen saturation measuring by automatic retinal oximetry is a relatively new method with scientifically confirmed high reproducibility of results. Currently it is the only experimental method with vast potentials not only in the realm of the possibility of observing eye diseases (diabetic retinopathy, retinal vein occlusion or glaucoma) but also in developing interdisciplinary cooperation with diabetologists, neurologists and haematologists.

[Ocular Surface Evaluation in Patients Treated with Prostaglandin Analogues Considering Preservative Agent]. / Hodnocení ocního povrchu u pacientu lécených analogy prostaglandinu s ohledem na obsazenou konzervacní látku.

PURPOSE: The aim of this study was to evaluate the ocular surface in patients treated with prostaglandin analogues considering contained preservative agent. METHODS: 60 patients with glaucoma or ocular hypertension treated with prostaglandin analogue monotherapy were enrolled in this observational study. 20 patients with glaucoma suspect or ocular hypertension without local or systemic glaucoma medication formed the control group. Demographic data and medical history were recorded for each participant. Patients filled in the Ocular surface disease index© (OSDI) questionnaire and underwent an ophthalmological examination including assessment of conjunctival hyperaemia according to Efron, tear film break up time (BUT) and fluorescein staining according to the Oxford grading scheme. Treated participants were divided into 3 groups according to the preservative contained in the currently used prostaglandin analogue: the preservative-free group (18 patients), the polyquaternium group (17 patients) and the benzalkonium chloride (BAK) group (25 patients). RESULTS: The control group had significantly lower fluorescein staining than the preservative-free group (p=0.001), the polyquaternium group (p=0.007) and the BAK group (p=0.002). The conjunctival hyperaemia was significantly lower in the preservative-free group compared to the polyquaternium group (p=0.011). There was no significant difference among the other groups. The difference neither in the OSDI score nor in the BUT was statistically important. CONCLUSION: This study confirmed that the ocular surface is worse in patients treated with prostaglandin analogue monotherapy than in people without glaucoma medication. A significant difference among treated patients depending on a preservative agent was not proved.Key words: benzalkonium chloride, glaucoma, ocular surface disease, preservatives, prostaglandin analogues.

[Automatic Retinal Oxymetry in Patients with Diabetic Retinopathy]. / Automatická retinální oxymetrie u pacientu s diabetickou retinopatií.

AIM: To determine if oxygen saturation in retinal vessels depends on the degree of diabetic retinopathy. MATERIAL AND METHODS: A prospective study comparing values of oxygen saturation in retinal arteries, veins, and arterio - venous (A-V) difference in healthy persons and in patients with diagnosed diabetes. The study included 114 eyes of 76 patients with diagnosed diabetes, and 57 eyes of 57 patients without diabetes as a control group. RESULTS: The average retinal arterial saturation in patients without diabetes was 96.5 ± 2.6 %, and increased in patients with severe non-proliferative or proliferative diabetic retinopathy to 100.5 ± 5.6 %. The average venous saturation in patients without diabetes was 62.3 ± 7.4 % and increased to 74,0 ± 7.2 % in patients with severe non-proliferative diabetic retinopathy. CONCLUSION: In patients with diabetic retinopathy, we confirmed the increase of hemoglobin oxygen saturation as in the arterial as in the venous blood in retinal vessels; and significant decrease of arterio-venous difference according to the severity of diabetic involvement was confirmed as well.Key words: automatic retinal oxymetry, diabetic retinopathy, oxygen saturation, Oxymap.

[Iris melanoma in a child]. / Melanom duhovky u detského pacienta.

Iris melanomas are very rare in children. The paper presents the case of a 12-year-old boy with iris melanoma of spindle-cell type A and pre-operatively associated with uncontrolled secondary glaucoma. Tumour resection was complicated by lens extraction and consecutive PC IOL implantation. Antiglaucomatous surgery was performed due to the persistently elevated intraocular pressure. Currently, the intraocular pressure is within the normal range and the patient has no signs of the presence of tumour cells or metastases.Key words: iris melanoma, spindle-cell type, secondary glaucoma.

[ProVens® in the Therapy of Glaucoma and Ocular Hypertension]. / ProVens® v lécbe glaukomu a ocní hypertenze.

OBJECTIVE: To assess the effect of the ProVens® dietary supplement administration on intraocular pressure in patients with glaucoma and ocular hypertension. MATERIAL AND METHODS: The patients included in the trial were given the ProVens® dietary supplement once daily. One ProVens® tablet contains: 50 mg of maritime pine bark extract, 100 mg of green tea extract, and 3 mg of blueberry extract. The main ProVens® components are proanthocyanins from the bark of the maritime pine tree Pinus pinaster, polyphenols from green tea, and anthocyanins from blueberries. The total number of patients included in the trial was 46. Out of these, 35 patients were monitored for asymptomatic ocular hypertension and 11 patients for open-angle glaucoma treated with prostaglandin analogs. Intraocular pressure was measured by applanation tonometry in the beginning of the trial, after one month, and after three months of their inclusion in the trial, always at the same time of the day. RESULTS: In the group of patients with ocular hypertension, there was a statistically significant reduction in the intraocular pressure from the baseline values of 24.2 ± 2.1 mm Hg to 20.9 ± 2.5 mm Hg within the period of three months (p < 0.0001). In the group of patients with open-angle glaucoma, there was a statistically significant reduction of the intraocular pressure from the baseline values of 18.4 ± 3.2 mm Hg to 17.0 ± 3.1 mm Hg within the period of three months since the beginning of administration of the product (p = 0.022). When comparing both groups, we observed a significantly higher reduction in intraocular pressure (p = 0.0001) in the group of patients with ocular hypertension. In the whole group, no adverse effects were reported during the intake of this dietary supplement. CONCLUSION: Intake of the ProVens® dietary supplement containing proanthocyanins from the bark of the maritime pine tree Pinus pinaster together with a mixture of herbal antioxidants appears to be one of the methods of how to improve the control of intraocular pressure, particularly in patients with ocular hypertension. KEY WORDS: glaucoma, ocular hypertension, ProVens®, proanthocyanins, antioxidants, maritime pine bark extract.

[The importance of angle kappa for centration of multifocal intraocular lenses]. / Význam úhlu kappa pro centraci multifokálních nitroocních cocek.

PURPOSE: To evaluate patient satisfaction with multifocal intraocular lens (MIOL) implants (AcrySof Restor) in relation to the size of angle kappa and precise centration of the MIOL. METHODS: Fifty-two eyes of 26 patients were included in this study. All patients underwent bilateral phacoemulsification and multifocal intraocular lens implantation (AcrySof Restor) from January 2008 to April 2010. Preoperative and postoperative examinations included slit lamp biomicroscopy, near and distance uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity and measurement of angle kappa. Precise centration of the IOL with respect to the centre of the pupil was evaluated postoperatively. Subjective photic phenomena were evaluated separately for each eye and the patients were asked to compare the perception between the right and left eye. RESULTS: Angle kappa was positive in all cases, ranging from +1° to +7°. The mean angle kappa was 2.78° and 2.10° in the right and left eye, respectively. The IOL was centred exactly to the centre of the pupil in 40 eyes. In twelve eyes there was a slight decentration of the IOL (3 nasal, 4 temporal, 2 superotemporal, 2 superior, 1 inferior). Different subjective perception of photic phenomena between the two eyes was recorded only in five patients. All these patients were among those with a decentred IOL. Temporal and superotemporal decentration of the IOL caused pronounced photic phenomena in five cases - in four cases there was a greater angle kappa of +3° to +4°. In one case of temporal decentration and a small angle kappa (+1°), the patient failed to observe a difference between both eyes. In the cases of inferior, superior and nasal decentration of the IOL, no difference between both eyes was seen. CONCLUSION: According to our results, temporal decentration of the IOL is associated with the greatest risk in multifocal IOL implantation, particularly in cases with a higher angle kappa. An evaluation of angle kappa should be a part of preoperative examination before MIOL implantation. Patients with a high angle kappa should be excluded because of a higher risk of postoperative photic phenomena. Key words: angle kappa, multifocal intraocular lens, photic phenomena.

[Efficacy and tolerability of preservative-free tafluprost 0.0015 % in the treatment of glaucoma and ocular hypertension]. / Úcinnost a snásenlivost tafluprostu 0,0015% bez konzervacních látek v lécbe glaukomu a ocní hypertenze.

AIM: The aim of the study was to evaluate the efficacy, safety and local tolerability of preservative-free tafluprost 0.0015% (Taflotan®) in patients with glaucoma and ocular hypertension. MATERIALS AND METHODS: Multicentric, prospective observation study was performed in the Czech Republic from October 2010 to April 2011. A total of 78 centers participated and 754 patients were included. After the doctors decision to start the treatment with Taflotan®, the patients demographic data, previous treatment, intraocular pressure and the reason for switching the medication were recorded. At the follow-up visit after 6-12 weeks, the intraocular pressure, local tolerability (a 5-level scale), the patients and doctors satisfaction (a 4-level scale), and the patients preference were recorded. RESULTS: Altogether, data of 496 patients were evaluated. The majority of them were women (64.9 %). The patients mean age was 58.5 years. The most common diagnosis was primary open angle glaucoma (79.2 %), followed by ocular hypertension (7.3 %), normal tension glaucoma (4.2 %), and pseudoexfoliation glaucoma (3.6 %). In 140 patients, tafluprost 0.0015% was the first antiglaucomatous medication started, 261 patients switched from another monotherapy, and 95 patients were treated with fixed- or nonfixed combinations before starting tafluprost 0.0015%. The most common reason for switching to Taflotan® was local intolerability to the current antiglaucomatous therapy (most often irritation of the eye and hyperemia). The intraocular pressure decreased significantly from 19.9 ± 4.5 mm Hg to 16.3 ± 3.0 mm Hg (p < 0.001). The subjective tolerability of the antiglaucomatous therapy improved rapidly, with 57.4 % of patients rating the tolerability of Taflotan® as "very good" and 34.5 % as "good". In addition, 94.4 % of patients and 96.0 % of ophthalmologists were "very satisfied" or "satisfied" with the treatment. At the final visit, 79.8 % of patients preferred Taflotan® to the previous treatment. CONCLUSION: Taflotan® significantly decreased the intraocular pressure. It was well tolerated even in patients with previous intolerability to another antiglaucomatous therapy, including prostaglandins. The patients and ophthalmologists satisfaction with Taflotan® was high.

[Results of the cataract with the Acrysoft ReSTOR SN6AD3 intraocular lens implantation]. / Výsledky operaci katarakty s implantaci Acrysof ReSTOR SN6AD3.

PURPOSE: this study aims to evaluate the postoperative results of uncorrected visual acutity (UCVA) near and distance and contrast sensitivity after cataract surgery with Acrysof ReSTOR SN6AD3 implantation and to evaluate the personal questionnaire. METHODS: this prospective study included 40 eyes of 21 patients with cataract. Each patient had small incision cataract surgery with Acrysof ReSTOR SN6AD3 implantation. Corrected and uncorrected distance visual acuity, corrected and uncorrected close visual acuity and corrected scotopic contrast sensitivity were measured before and after surgery. The subjective impressions of patients were evaluated by a personal questionnaire. RESULTS: mean distance UCVA before surgery was 0.3 +/- 0.19, mean distance UCVA after surgery was 0.9 +/- 0.3. Mean near UCVA before surgery was 11.9 +/- 2.2, mean near UCVA after surgery was 1.8 +/- 1.1. Contrast sensitivity before surgery was 25.6 +/- 10.3 and after surgery was 33.3 +/- 1.8. The evaluation of the questionnaire revealed that 19 patients (95%) never wear glasses, 17 patients (80%) are fully satisfied with reading very small text and 17 patients (80%) are fully satisfied with far vision. Hallos around spot lights recorded 12 patients (60%). Problems with contrast noticed 3 patients (15%). All of the patients would prefer the implantation of the same intraocular lens and recommend it to friend. CONCLUSION: The results shows that uncorrected both distance and near visual acuity were better after surgery (p < 0.0001). Contrast sensitivity also improved after surgery (p = 0.0001). Personal questionnaire revealed high satisfaction after surgery.