[Contrast sensitivity and fluorescein angiography in evaluating the ocular changes in the relation to the diabetes mellitus type I compensation in young adult patients]. / Citlivost na kontrast a fluorescencní angiografie pri hodnocení ocních zmen v rámci posouzení kompenzace diabetes mellitus 1. typu u mladých dospelých pacientu.

UNLABELLED: The authors performed simultaneous contrast sensitivity examination (CS) and fluorescein angiography (FAG) in 42 patients older than 18 years of age; in 65% of them the duration of the diabetes mellitus type I (T1DM) was longer than 10 years. In these 27 patients, the diagnosis of non-prolipherative diabetic retinopathy (NPDR) was established by means of FAG in 44%, in contrast to only 19% by means of the direct ophthalmoscopy solely. The other findings (56%) were corresponding with diabetic preretinopathy (DpR) due to rare micro-aneurysms (establishes by means of FAG), and changes of the macular structure and pronounced dilation and tortuosity of the capillaries (by means of direct ophthalmoscopy). Out of the other 15 patients with T1DM duration of less than 10 years, the NPDR was established in 3 patients, and DpR confirmed in other 7 patients from the group. The authors compared the decrease in every single space frequency marked on the CS curvature for 31 eyes with NPDR and 39 eyes with DpR with the normal findings in patients without T1DM established in previous studies. Comparing NPDR with the norm, the authors found important and fundamental pathological defect of the CS (p = 0.0058). DpR comparing with the norm showed significant defect of the CS (p = 0.0197). Comparing NPDR and DpR, the difference was found in more noticeable pathological defect of the CS (p = 0.0228). The compensation of the metabolic state was evaluated from average year long values of the glycolated hemoglobin (Hb1Ac) in the last 10 years of the T1DM duration by means of DCCT method. The group of followed-up patients consisted of pairs of matched patients with NPDR and DpR of the same gender, time of beginning and duration of the metabolic disease. In the NPDR patients, the compensation was not good in 72% of this period, whereas in DpR patients the satisfactory compensation lasted for 53% of this period. During the follow up period, in NPDR the average Hb1Ac level was 8.49 +/- 0.88%, and in DpR this Hb1Ac value was 7.61 +/- 0.28%, with statistically significant difference (p = 0.0033). During the period, in DpR patients no serious complication was marked, in the NPDR group, the incipient diabetic nephropathy twice and slight diabetic neuropathy were noticed. The occasional pathological values of the microalbuminuria were not possible to correlate with beginning of the NPDR. CONCLUSION: The contrast sensitivity (CS) represents in the differential diagnosis of the NPDR and DpR a screening examination method. To specify the NPDR, the FAG is suitable and for both clinical entities specifies the extent of foveolar and perifoveolar involvement. Only the many years lasting follow up of Hb1Ac values documents the importance of long-term T1DM compensation in the prevention of pathological ocular changes development.

[Macular area in glaucoma patients]. / Makulární oblast u pacientu s glaukomem.

PURPOSE: To evaluate the possible use of HRT II and OCT 3 for detection and monitoring of glaucoma changes in the macular area. METHODS: In the retrospective study 65 eyes (13 healthy and 52 with primary open angle glaucoma) of 36 patients have been monitored. All patients underwent complete ophthalmologic examination including visual acuity testing, biomicroscopy of fundus, computer perimetry, HRT II and eleven patients were examined using OCT 3. The visual field has been tested on HFA (Humphrey Field Analyzer) using the full threshold test 30-2. Foveolar sensitivity and foveolar sensitivity compared to the age have been evaluated. The optic nerve head has been examined and subsequently evaluated using HRT II. The retinal nerve fiber layer (t-RNFL) and Cup Shape Measurement (t-CSM) in the temporal area have been monitored. The macula has been examined on OCT 3. Foveolar thickness, inner and outer macular thickness, average macular thickness and aggregate macular volume have been monitored. RESULTS: Decrease of the visual acuity and foveolar sensitivity have been registered with the deterioration of the visual field. Further general decrease of the value of t-RNFL and increase of the t-CSM index have been registered from the results of the HRT II examinations. This corresponds to decrease of the nerve fibers and excavation deepening in the temporal area. Average macular thickness and total macular volume examined on OCT 3 demonstrate aggregate decrease of values with the progressive changes in the visual field. CONCLUSION: With the progressive visual field changes with the open angle glaucoma patients occurs also deterioration of finding in the macular area. Changes discovered using the subjective examination and expressed as a slight decrease of the visual acuity as well as decrease of the foveolar sensitivity on HFA can be objectively proved using HRT II and OCT 3.

[Optical coherence tomography in pars plana vitrectomy for idiopathic macular hole]. / Optická koherentní tomografie u pars plana vitrektomie pro idiopatickou makulární díru.

26 eyes of 25 patients after macular hole surgery were followed-up for 6 months in average (range of 2-25 months). The overall anatomic success rate was 77 %. The internal limiting membrane was peeled after its staining with trypan blue in all closed macular holes. The macular hole surgery resulted in anatomic success of stage Ib or II in 11 (100 %) eyes, of stage III in 7 (64 %) eyes and in stage IV in 2 (50 %) eyes. There was an improvement or a stabilisation of the best corrected visual acuity (BCVA) in 85 %. BCVA improved from 4/20 to 4/12 in average. 45 % of patients with closed macular hole attained BCVA 4/10 or better, 5 (25 %) of them with the best visual acuity at presentation improved to 4/8 in average. In 23 % cases of clinically normal fellow eyes, optical coherence tomography (OCT) detected an abnormality of the vitreoretinal surface. OCT is essential for evaluation of anatomical success after macular hole surgery. It is necessary to perform it also in a fellow eye to exclude clinically silent abnormality of the vitreoretinal surface.

[ Findings on optical coherence tomography in patients with macular degeneration treated with photodynamic therapy using Visudyne]. / Nálezy na optické koherentní tomografii u pacientu s makulární degenerací lécených pomocí fotodynamické terapie s preparátem Visudyne.

Findings on Optical Coherence Tomography in Macular Degeneration with Predominantly Classic Subfoveal Choroidal Neovascularization Treated by Photodynamic Therapy with Visudyne. We determined findings on optical coherence tomography (OCT) in macular degeneration with predominantly classic subfoveal choroidal neovascularization treated by photodynamic therapy (PDT) with Visudyne. We performed 21 correlations of central retinal thickness (CRT) on OCT2 with findings on fluorescein angiography (FA) in our study. We quantified CRT on OCT2 in 14 cases before, during and after the end of the treatment. The control group was composed from patients, who were not able to undergo the treatment and therefore it was postponed. CRT on OCT correlated with FA in 95% of cases in our study. Maximal decreasee of CRT is demonstrated during the first three months of treatment. Values of CRT on OCT are in patients after repeated sessions of PDT lower than before the first session. These values can grow up a little for some time due to increase of amount of intraretinal fluid during the first week after the session of PDT. During next follow-up there are no big differences between values of CRT. In the control group CRT on OCT increases progressively during the follow-up.

[Implantation of the AcrySof MA30BA lens using the Monarch system]. / Implantace cocky AcrySof MA30BA systémem Monarch.

The authors describe experiences with implantation of the intraocular lens AcrySof MA30BA by the Monarch IOL delivery system. They consider the facility of Monarch's system completion, the location of the lens in the cartridge and its folding, lens passage through the cartridge and its expansion intraocculary. The authors evaluate the width of incision necessary for the conduction of injector, preoperative and postoperative course, final visual acuity and inducted astigmatism. The results of the work show that implantation of the lens AcrySof MA30BA by the IOL Monarch delivery system is easy and safe. The width of incision after implantation performs criterion of the no stitch technique and corresponds contemporary requirements of the modern cataract surgery of small incision.

[Photodynamic therapy with Visudyne in macular degeneration associated with subfoveal classical choroidal neovascularization]. / Fotodynamická terapie s preparátem visudyne u makulární degenerace se subfoveolárne ulozenou prevázne klasickou choroidální neovaskularizací.

Photodynamic therapy with the preparation Visudyne (PDT) is the only treatment which retards statistically significantly the decline of vision in patients with age related and myopic macular degeneration with a subfoveal, predominantly classic choroidal neovascularization. The authors present their own experience with the treatment of the first 12 patients. During 6-month treatment a loss of more than 3 lines of ETDRS optotypes was recorded in two patients (17%). The presented results of FTV are consistent with data published abroad. As the one-year therapeutic results in two patients are encouraging, it will be necessary in future to prolong the follow up time and increase the number of patients.