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.

EFFECT OF PHARMACOLOGICAL PUPIL DILATION ON INTRAOCULAR LENS POWER CALCULATION IN PATIENTS INDICATED FOR CATARACT SURGERY.

PURPOSE: To evaluate the influence of pupil dilation on ocular parameters measured by optical biometry and the influence of pupil dilation on intraocular lens (PC IOL) power calculation by using the third-generation (SRK/T) and the fourth-generation (Haigis) formula. METHODS: 40 eyes of patients indicated for cataract surgery were included in this study. Each patient was examined by optical biometer firstly without artificial mydriasis (AM) and then after AM, which was achieved using local application of short-term acting mydriatics. Biometric data were measured by Lenstar LS 900 optical biometer, we recorded axial length of the eye (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and corneal astigmatism and optical power of cornea. These data we measured were used for calculation of the PC IOL optical power using both the SRK/T and the Haigis formula. The target postoperative refraction was set to emmetropia. Statistical analysis was performed for evaluation of influence of AM on each ocular parameter and influence of AM on the recommended PC IOL power calculated by the SRK/T and the Haigis formula. RESULTS: No statistically significant effect of AM on AL, LT and keratometry was demonstrated. On the contrary we demonstrated significant effect on CCT and ACD. No effect of AM on the PC IOL power calculation using the SRK/T formula was proved - the PC IOL optical power before AM and after AM did not differ in any case. When using the Haigis formula for the PC IOL power calculation, the recommended optical power of the PC IOL changed by +0.5 Dpt in 9 eyes, i.e., 22.5 % of the whole group, but statistical analysis did not show this change as statistically significant. CONCLUSION: Pharmacological dilation of the pupil significantly affects some intraocular parameters measured by optical biometer and in the case of using the Haigis formula it can influence recommended power of the PC IOL. Conversely, when using the SRK/T formula, pharmacological dilation of pupil does not affect the recommended PC IOL power.

OCULAR COMPLICATIONS OF DIABETES MELLITUS IN PREGNANCY - CASE REPORT.

Pregnancy is associated with increased risk of progression of diabetic retinopathy (DR), the greatest risk of worsening occurs during the second trimester of pregnancy and persists as long as one year after the childbirth. The risk factors include duration of the diabetes, insufficient metabolic control, severity of DR at the time of conception and presence of coexisting vascular disease, such as arterial hypertension, and pregnancy itself. The recommendations for retinopathy screening in pregnancy vary significantly. A dilated fundus exam should be done in the beginning of pregnancy, the next follow-up throughout pregnancy depends on the severity of ocular findings. The cooperation of multi-disciplinary team consisting of ophthalmologist, obstetrition and endocrinologist is essential to provide the best health care. The authors present a case report of a pregnant woman with type 1 diabetes mellitus (DM), who had a progression of DR and diabetic macular edema (DME) in both eyes during pregnancy. She has had DM for 24 years and has been treated with insulin. The patient was examined at the 23rd week of the second pregnancy (first pregnancy was terminated because of missed miscarriage). The diagnosis of advanced proliferative DR and advanced DME in both eyes was made so we performed panretinal laser photocoagulation of the retina of both eyes. Despite that the ocular findings got worse and we found vitreous haemorrhage in the left eye. We performed pars plana vitrectomy (PPV) of the left eye at the 28th week of pregnancy, nevertheless the DME got worse in both eyes, so we recommended to terminate the pregnancy at the 31st week because of the risk of loss of vision. The visual acuity of the left eye improved, but suddenly there was vitreous haemorrhage in the right eye after the delivery. We indicated PPV of the right eye, the outcome of the surgery was satisfying. We still take care about this patient.

Treatment of idiopathic choroidal neovascular membrane with ranibizumab - our experience.

OBJECTIVE: To evaluate the anatomical and functional outcome of ranibizumab therapy in patients with idiopathic choroidal neovascularization (CNV). File and Methodology: The group consists of 6 patients. Patients were older 18 years but they were under 50 years of age. The monitoring period lasted 12 months. We confirmed active idiopathic CNV in subfoveal position with fluorescein angiography (FAg) and optical coherence tomography (OCT). The activity of idiopathic CNV we demonstrated with leakage of dye by FAg examination. The presence of serous retinal pigment epithelium detachment and / or subretinal fluid and / or intraretinal edema in the form of intraretinal cysts demonstrated activity of CNV on OCT scans. A decrease of the visual acuity under 85 letters was observed at the ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart. After the initial administration of ranibizumab a pro re nata regimen was used. We indicated repeated injection of ranibizumab in patients with signs of activity of idiopathic CNV on OCT scans or by FAg. Also we indicated repeated injection of ranibizumab in patients with new loss of visual acuity on the ETDRS visual acuity chart connected with signs of activity of CNV on OCT scans or by FAg. RESULTS: On average, we observed the gain of +11 letters on the ETDRS visual acuity chart after 12 months of the follow-up period. On average we observed reduction of central macular thickness -233μm. At the 12th month of follow-up we observed in all patients of our group only inactive scar without exudation. No serous retinal pigment eithelium detachment, subretinal fluid or intraretinal cysts were observed. Only 3 injections of ranibizumab were administered on average to each patient during the 12 months of the follow-up period. CONCLUSION: In our study, we observed the positive effect of ranibizumab on the course of idiopathic CNV. With ranibizumab treatment we achieved regression of CNV with resorption of macular edema in all patients of our group. With the disappearance of the activity of idiopathic CNV ranibizumab gives real hope to improve visual acuity.

[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.

[The benefit of pars plana vitrectomy for the resolution of complications of proliferative diabetic retinopathy]. / Prínos pars plana vitrektomie pro resení komplikací proliferativní diabetické retinopatie.

Between 1997 and 2007, we have conducted eye surgery on 72 patients (i.e. 72 eyes) as a consequence of proliferative diabetic retinopathy complications. The patients' average age was 61; the follow-up observations were carried out over a period of one year after the surgery. When we compare the initial vision with the visual acuity measured during the last follow-up examination in the late post-operative period, i.e. one year after the surgery, we can conclude that the vision of46 eyes (63%) had improved, 17 eyes (24%) did not show any change in vision, and the vision of nine eyes (13%) had deteriorated. Visual acuity of 1/60 (metric system) or better was found in 55 eyes (76%) during the late post-operative period; 6/60 vision or better was found in 29 eyes (40%), and four eyes (6%) showed 6/12 vision or better. If we compare the vision in the early post-operative period with the visual acuity during the last follow-up examination in the late post-operative period, we can conclude that in most cases, i.e. in 45 eyes (62.5%), the vision did not change any further during the months after the surgery, and one eye (1.5%) even showed improvement in visual acuity. It was confirmed that a positive result of pars plana vitrectomy observed in the early post-operative period may indeed persist even during the following months and years of the patient's life.

[Anatomical results of cryosurgical procedures in rhegmatogenous retinal detachment - our experience]. / Anatomické výsledky kryochirurgických operací pri rhegmatogenním odchlípení sítnice - nase zkusenosti.

AIM: To evaluate retrospectively anatomical results of cryosurgical treatment of non-complicated idiopathic rhegmatogenous retinal detachment. To assess the successfulness of primary cryosurgical surgeries, permanent retinal re-attachment; to review the efficacy of cryosurgical procedures according to chosen surgical technique and patients age as well. MATERIAL AND METHODS: In the evaluated group were included 120 eyes of 120 patients operated on in the years 2003- 2012 at the Department of Ophthalmology, Faculty Hospital and School of Medicine, Palacký University, Olomouc, Czech Republic, E.U. All of the patients were phakic. The patients were evaluated at one and three months after the surgery. The posterior pole examinations were done by means of biomicroscopic examination and indirect ophthalmoscopy. The retina was evaluated as attached in whole extent in case of re-established contact between the neurosensory retina and the retinal pigment epithelium in the whole periphery. RESULTS: In 106 (88 %) patients, the re-attachment of the retina was achieved by solely cryosurgical procedure; in 117 (97.5 %) patients, the definite re-attachment of the retina was achieved. In three patients (2.5 %), the retina remained detached. Statistically better results were obtained in patients with peroperative exodrainage of the subretinal fluid and in patients younger than 50 years of age. CONCLUSION: We established the usefulness of cryosurgical operative procedure in treatment of uncomplicated idiopathic rhegmatogenous retinal detachment in phakic patients. Especially in young phakic patients, the cryosurgical procedure may be protective to preserve the clear lens and eye accommodation.

[Functional results of cryosurgical procedures in rhegmatogenous retinal detachment including macula region - our experience]. / Funkcní výsledky kryochirurgických operací pri rhegmatogenním odchlípení sítnice vcetne makuly nase zkusenosti.

AIM: Aim of this study is to evaluate retrospectively functional results of cryosurgical treatment of uncomplicated, idiopathic rhegmatogenous retinal detachment including macula region in phakic patients operated on at the Department of Ophthalmology, Faculty Hospital, Palacký University, Olomouc, Czech Republic, E.U., during the period 2002 -2013, and to evaluate the significance of the macula detachment duration for the final visual acuity. METHODS: In the study group were included 56 eyes of 56 patients operated in the years 2003 - 2012 at the Department of Ophthalmology, Faculty Hospital, Palacký University, Olomouc. All patients were phakic and in all of them, the retinal detachment including the macula region was diagnosed. The mean follow-up period of the patients was 8,75 months. The initial and final visual acuity testing were performed. Comparing the initial and final visual acuity we rated the level of the visual acuity change. The result was stated as improved, if the visual acuity improved by 1 or more lines on the ETDRS chart. The result was rated as stabilized, if the visual acuity remained the same or it changed by 1 line of the ETDRS chart only. The result was evaluated as worsened, if the visual acuity decreased by 1 or more lines of the ETDRS chart. In the followed-up group, the authors compared visual acuity levels in patients with the macula detachment duration 10 days and 11 days. For the statistical evaluation of achieved results, the Mann - Whitney U test was used. RESULTS: The visual acuity improved in 49 (87 %), did not changed in 5 (9 %) and worsened in 2 (4 %) patients. The patients with macula detachment duration 10 days achieved statistically significant better visual acuity than patients with macula detachment duration 11 days. CONCLUSION: Patients with macula detachment duration 10 days have better prognosis for functional result than patients with macula detachment duration 11 days.

[The effect comparison of ranibizumab and sodium pegaptanib on the retinal pigment epithelium ablation size in the treatment of age-related macular degeneration]. / Porovnání úcinku ranibizumabu a pegaptanibu sodného na velikost ablace RPE pri lécbe vlhké formy vekem podmínené makulární degenerace.

AIM: To evaluate the effect difference of ranibizumab and sodium pegaptanib in the ablation treatment of the retinal pigment epithelium (RPE) in age-related macular degeneration MATERIAL AND METHODS: Retrospective analysis of data of patients with age-related macular degeneration treated by means of anti-VEGF therapy at the Department of Ophthalmology, School of Medicine, Palacky University, Olomouc, Czech Republic, E.U. during the period May 2009 - October 2010. For the analysis were used data from patients with follow-up period longer than 6 months and present serous RPE ablation caused by occult choroidal neovascularization (CNV), verified by optic coherence tomography (OCT) and fluoresceine angiography (FAG). STUDY GROUP: Ranibizumab was used as treatment during the period in 37 eyes of 37 patients (average age 73.2 years; right eye (RE) in 20 cases, left eye (LE) in 17 cases. Sodium pegaptanib was applied in 17 eyes of 17 patients (average age 72.4 years; RE in 10 cases and LE in 7 cases), The follow-up period in the ranibizumab group was 8.51 (SD 3.32) months, and in the pegaptanib group 9.94 (SD 5.50) months. RESULTS: In the ranibizumab group decreased the average RPE ablation base from 2865 microm (SD 810 microm) to 2270 microm (SD 1265 microm) and the prominence of the ablation from 334 microm (SD 160) to 238 microm (SD 178 microm). In patients treated by pegaptanib, decreased the average basis from 3245 microm (SD 930 microm) to 2159 microm (SD 1185 microm), and the prominence of the ablation from 354 microm (SD 173 microm) to 208 microm (SD 107 microm). The statistical significance test did not prove significant differences (level of significance p = 0.05) in the change either of the base or the prominence of the RPE ablation in any group of patients (prominence p = 0.09, base p = 0.21; Mann-Whitney test). In three patients (8.1%) treated by ranibizumab, the RPE rupture occurred. No RPE rupture was recorded in patients treated by sodium pegaptanib. CONCLUSION: Although no statistically significant difference in the efficacy of both drugs in the treatment of the RPE ablation was found, in patients treated by sodium pegaptanib, there is evident tendency of higher efficacy in decrease of the RPE ablation prominence, and lower incidence of RPE rupture. The study is limited by small number of patients and short follow-up period.

[Contemporary possibilities of artificial vision in blind patients using artificial neuro-prosthesis--review]. / Soucasné moznosti náhrady vid6ení nevidomých pacientü pomocí arteficiálních neuroprotéz.

The authors present the knowledge summarization of vision substitute using artificial retinal neuroprostheses. The overview was compiled from available literature found in the Medline and Embase databases. The text focuses on global summarizing of the whole issue since the beginning of the development to the state up to date. In individual types of neuroprostheses, the advantages, disadvantages, and possible obstacles to their use in clinical practice are discussed. Furthermore, the brain plasticity and functional changes of the brain in blinds are considered. The aim of the review is not to present all information in detail, but complex overview with relevant literature sources.

[Czech Ophthalmologic Society's data collecting system for the monitoring and evaluating of the exsudative age-related macular degeneration treatment--the nation-wide project "AMADEUS"]. / Informacní zázemí Ceské oftalmologické spolecnosti CLS JEP pro monitoring a hodnocení lécby vlhké formy vekem podmínené makulárni degenerace-národní projekt AMADEUS.

The Czech Ophthalmologic Society (member of the Czech Medical Society of Jan Evangelista Purkyne) in collaboration with the Institute of Biostatistics and Analysis of the Masaryk University in Brno established a nation-wide information system for the follow-up of the epidemiology and treatment of the exsudative age-related macular degeneration (ARMD). The project named AMADEUS is a multi-centric, non-invasive, observation prospective study with the aim to improve the patients' treatment and to unify the criteria for the follow-up of the ARMD in the real clinical practice in the Czech Republic. The basic instrument of the whole project is a clinical register collecting parametric data from 9 specialized centers. Especially the project monitors the photodynamic therapy with Verteporfyrine (Visudyne) and treatment by anti-VEGF agents, or Pegaptanib (Macugen) and Ranibizumab (Lucentis). The project's protocol is trying to collect representative data about ARMD diagnosis and treatment; during regularly controls, the efficacy and safety of the treatment are followed-up.The data collecting does not influence the treatment strategy or the availability of chosen treatment for the patient. Since October 2008 until the end of the year 2009, the registry collected complex information about more than 1402 newly treated ARMD patients; out of them, in 582 cases the one-year follow-up period was regularly terminated. The available data shows well-considered indication of drugs indications by the doctors; the treated patients fulfill the indications criteria set by the scientific society. According to the data from the registry, in some treating centers the application schedule is not followed-up in some drugs (especially Pegaptanib); there is the possibility to improve the treatment. All the clinical centers participating in the AMADEUS registry will continue in the data collecting, which after a longer period of time will facilitate further treatment optimization and eliminating of the established imperfections. Further information about the project may be found at the web site: www.amadeus.registry.cz.

[Exsudative age-related macular degeneration treatment results in patients registered in the nation-wide AMADEUS register]. / Výsledky lécby vlhké formy vekem podmínené makulární degenerace u pacientu evidovaných v celonárodním registru AMADEUS.

The nation-wide register of patients with the exsudative age-related macular degeneration surveys the appearance and the success rate of the treatment of this disease in the Czech Republic. During the 12 months follow-up period of 38 patients treated with Macugen in monotherapy, receiving at least 7 injections of Macugen during one year period, we found the loss of less than 15 letters of the ETDRS chart in 62.2 % of treated eyes. During the 12 months follow-up period of 205 patients treated with Lucentis in monotherapy, receiving at least 3 injections of Lucentis, we found the loss of less than 15 letters of the EDTRS chart in 82.0 % of treated eyes. During the 12 months follow-up period of patients treated with Visudyne in monotherapy we found the loss of 15 letters of the EDRTS chart in 77.1% of treated eyes.

[The intravitreal application of the tissue plasminogen activator in the treatment of submacular hemorrhage--a case report]. / Intravitreální aplikace tkánového aktivátoru plazminogenu v lécbe submakulární hemoragie--kazuistika.

The authors present the possibility to influence therapeutically the submacular hemorrhage caused by age-related macular degeneration in the presence of choroidal neovascular membrane by means of recombinant plasminogen tissue activator (rt-PA) and expansive gas intravitreal injection followed by pneumatic relocation of the hemorrhage out of the foveolar region. The therapy is presented in a case report. The submacular hemorrhage without treatment causes serious decrease of visual functions. The human recombinant plasminogen tissue activator that is a glycoprotein, activating the transformation of plasminogen directly to plasmin has a trombolytic effect. Rt-PA is activated by binding to fibrin with high affinity. This minimally invasive procedure gives the possibility to treat this prognostic unfavorable finding, so after the lysis and pneumorelocation of the hemorrhage from the macular region we can treat the choroidal neovascular membrane.

[Orbital apex syndrome of the aspergillus etiology--a case report]. / Syndrom orbitálního hrotu aspergilové etiologie--kazuistika.

The authors present a case report of a patient, in whom after a head injury the monolateral blindness occurred. Because of autoimmune thrombocytopeny the patient was treated with long-term corticosteroids. The clinical findings corresponded with the orbital apex syndrome. According to the results of the CT and MRI examinations, the sphenoidotomy was indicated, and the histological findings verified fragments of paranasal sinuses' aspergiloma. During the next course of the disease, despite antimycotic therapy, the progression of the aspergiloma in to the anterior cranial fossa occurred. Invasive sino-orbital aspergilosis, after the penetration of the infectious agent across the wall of the sinus, may cause the orbital apex syndrome with paralysis of all three cranial nerves innervating the extraocular muscles, sensoric defect in the area of the ophthalmic nerve and the involvement of the optic nerve.

[Ocular sparganosis in the Czech Republic--a case report]. / Ocní sparganóza v Ceské republice: Kazuistika.

The authors report a case of 14-year-old boy presented to the Ophthalmologic Department of University Hospital in Olomouc with the diagnosis af acute anterior uveitis. A living parasite has been detected in the anterior chamber in a slit lamp examination. The vitreous and retina remained uninvolved. The acute iridocyclitis associated with parasitic infection is a very rare cause of anterior uveitis in Central Europe. The patient underwent surgical removal of the parasite via paracentesis. The inflammation resolved under the treatment with atropine and dexamethasone drops within a few days. Histopathological examination revealed the parasite as a young larval stage of tapeworm from family Pseudophyllidea (sparganum). Based on the analysis of development cycles of different types of tapeworms and according the literature data on tapeworms found in the Czech Republic genus Spirometra seemed to be the most plausible cause of the patient's disease. As the most probable source of viable parasites authors suspect swallowed water containing tiny infected crustaceans in the dam near the town Olomouc in Moravia.

[Long-term functional effect of pars plana vitrectomy in complications of proliferative diabetic retinopathy]. / Dlouhodobý funkcní efekt pars plana vitrektomie u komplikací proliferativní diabetické retinopatie.

In the years 1997-2004, we operated on and at least one year followed-up due to complication of prolipherative diabetic retinopathy 47 eyes (40 patients), of the mean age 61 years. If we compare the initial visual acuity (VA) to the vision at the last examination in the late postoperative period, or at least one year after the surgery, we may state, that in 28 eyes (60%) the vision improved, in 11 eyes (23%) VA remained stable and in 8 eyes (17%) the vision decreased. In the late postoperative period, the visual acuity 1/60 (3/200 or 0.17) and better had 33 eyes (70%), VA 6/60 (20/200 or 0.1) and better 17 eyes (36%) and VA 6/12 (20/40 or 0.5) and better 2 eyes (4%). Comparing the VA at the time of the early postoperative period and the VA at the last examination in the late postoperative period, we observed, that mostly, in 34 eyes (72%) the VA did not changed during the months after the surgery, and, in one eye (2%), the VA even improved. It was confirmed to be realistic the favorite result of pars plana vitrectomy found in the early postoperative period may be preserved for the next month and years of patient's life.

[Early functional effect of the pars plana vitrectomy in complications of the proliferative diabetic retinopathy]. / Casný funkení efekt pars plana vitrektomie u komplikací proliferativní diabetické retinopatie.

During the 1997-2002 period, 48 eyes of 41 patients of the mean age 58 years were operated on because of complications of proliferative diabetic retinopathy. In the cohort of operated patients, the type I diabetes mellitus was determined in 10 (21%) cases, the type II diabetes mellitus in 36 (75%) cases, and in two cases (4%), another type of diabetes was detected. One patient of those two had LADA type diabetes and the second one had secondary diabetes due to chronic pancreatitis. In the early postoperative period, or during first three months postoperatively, after the pars plana vitrectomy, the visual acuity (VA) in 28 (59%) eyes improved, in 16 (33%) eyes remained the same, and in 4 eyes (8%) worsened. VA 1/60 (0.017 or 3/200) and better had 37 (77%) eyes, VA 6/60 (0.1 or 20/200) and better had 17 (37%) eyes, and VA 6/12 and better (0.5 or 20/40) had 3 (6%) eyes only. VA worse than 1/60 (0.017 or 3/200) had 11 (23%) eyes. Authors emphasize the importance of regular and detailed ophthalmologic examinations with early diagnosis of pathological changes and early start of adequate treatment.

[Personal experience in treatment of diabetic maculopathy]. / Nase zkusenosti v lécbe diabetické makulopatie.

The authors evaluate group of 111 eyes with diabetic macular edema treated by laser photocoagulation. The criterion to start laser therapy was biomicroscopically evident clinical significant macular edema. The visual acuity (VA) is evaluated during 1-5 years after the photocoagulation was started. The group with stabilized VA includes eyes with change of VA up to one line of Snellen optotypes. The groups with improved or worsened VA include eyes with change of 2 or more lines of Snellen optotypes. In the first year after the beginning of photocoagulation, VA in 87 eyes (78%) was stabilized, in 20 eyes (18%) improved, and in 4 eyes (4%) worsened. In the second year after the beginning of photocoagulation, VA in 85 eyes (77%) was stabilized, in 19 eyes (17%) improved, and in 7 eyes (6%) worsened. In the fifth year, VA in 82 eyes (74%) was stabilized, in 12 eyes (11%) improved, and in 17 eyes (15%) worsened comparing to the findings of first examination. It is evident from the study, the group with stable VA during the 5 years period changes a little bit, in the group with improved VA it is a perceptible decline from 18% to 11%. The most evident change is seen in the group with worsened VA--here we can notice an interesting conspicuous tendency of doubling the number of worsened eyes during each two years. Whereas 1 year after the beginning of the photocoagulation it consists of 4 eyes (4%) only, two years later, this is in the third year, it is 9 eyes (8%), and another two years later, thus 5 years after the beginning of photocoagulation it is already 17 eyes (15%). Very important finding is the low number of eyes in the group with worsened VA--together 7 (6%) at the examination performed 2 years after of the photocoagulation has been started because it is confirmed that in groups without treatment the number of eyes with worsened VA exceeds 50%. The photocoagulation near the center of the macula has to be performed with considerable caution--the authors have the experience that during several years after the photocoagulation the atrophic lesion enlarges up to twice its size to the original one, especially in older patients.

[Argon laser photocoagulation in the therapy of the wet form of age-related macular degeneration]. / Argon laserová fotokoagulace v terapii vlhké formy vekem podmínené makulární degenerace.

The authors evaluate the results of argon laser therapy of extrafoveal and juxtafoveal subretinal neovascular membranes in the wet form of age-related macular degeneration. Their experience is evaluated in the group of 24 eyes of 23 patients during the period of observation lasting from 6 to 42 months. It became obvious that in the group of 24 eyes with extrafoveal and juxtafoveal subretinal neovascular membrane the laser photocoagulation cured up the condition in 17 eyes (71%), whereas the therapy failed in 7 eyes (29%). Vision improved in 7 eyes (29%), retained stabilized in 10 eyes (42%), but deteriorated in 7 eyes (29%). Among 11 eyes with extrafoveal subretinal neovascular membrane the authors reached improvement in 10 eyes (90.9%), the therapy failed with one eye (9.1%), the vision improved in 6 eyes (55%), remained stabilized in 4 eyes (36%), but deteriorated in one eye (9%). In 13 eyes with juxtafoveal subretinal neovascular membrane 7 eyes were cured up (54%), the therapy failed in 6 eyes (46%), vision improved in one eye (8%), remained stabilized in 6 eyes (46%), but deteriorated in 6 eyes (46%). Based on the results obtained it has become obvious that laser photocoagulation is a useful method for the therapy of extrafoveal and juxtafoveal subretinal nasovascular membranes in te age-related macular degeneration. Better prognosis has been shown in the extrafoveal subretinal neovascular membrane.