TOPIRAMATE-INDUCED BILATERAL ANGLE-CLOSURE GLAUCOMA. A CASE REPORT.

INTRODUCTION: Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma. CASE REPORT: The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure. CONCLUSION: The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.

CONTEMPORARY PRACTICES IN CATARACT SURGERY - SUBJECTIVE PREFERENCES OF CZECH CATARACT SURGEONS.

AIMS: The aim of the work was to find out the current subjective preferences of Czech cataract surgeons in terms of individual procedures, techniques and materials used during cataract surgery. MATERIAL AND METHODS: This study was conducted in the form of a questionnaire (online, a total of 44 questions). The survey respondents were members of the Czech Society of Refractive and Cataract Surgery. Questions 1-10 concerned the characteristics of the respondent (age, number of operations performed, type of workplace, etc.). Questions 11-20 focused on the surgical procedure used by the specific surgeon (anaesthesia, viscomaterial, position of the main incision, use of antibiotics at the end of the operation, etc.). Questions 21-34 concerned the type of intraocular lens used. Lastly, in questions 35-44, respondents were asked about their individual preferences if cataract surgery were to be performed on them. RESULTS: The questionnaire was fully or partially completed by 72 surgeons (26% of the originally approached subjects). Most of the respondents were experienced surgeons, 74.5% of them have been performing surgeries for more than 10 years, out of which 55.5% perform more than 500 operations per year. The average age of the respondents was 50 years. 65.3% of surgeons use hydroxypropylmethylcellulose during surgery, 74% do not use a femtosecond laser for surgery, 50% never perform posterior circular capsulorhexia, and 98% apply antibiotics to the anterior chamber at the end of surgery. Surgeons predominantly use hydrophobic (80.8%), aspherical (72.3%), clear (54.3%), single-focal (97.9%) and non-preloaded (78.3%) lenses. However, if they were not limited or restricted in any way in their choice, they would prefer aspherical lenses (94.6%), multifocal or extended-focus lenses (78%) and preloaded lenses (96.8%). CONCLUSION: The subjective preferences of Czech cataract surgeons are relatively variable regarding the individual steps. Often the procedures used do not always correspond with the actual preferences of the surgeon. On the contrary, there is almost complete unity in the steps recommended by professional societies (intracameral antibiotics at the end of the operation).

RESULTS OF POSTERIOR LAMELLAR KERATOPLASTIES IN PHAKIC EYES.

PURPOSE: To evaluate the results of posterior lamellar keratoplasties (DMEK and PDEK) in phakic eyes. MATERIAL AND METHODS: Retrospective analysis of surgeries performed in our department between June 2016 and December 2019. The main focus was put on postoperative visual acuity, corneal endothelial cell density and possible peroperative and postoperative complications including cataract formation. RESULTS: We performed 12 surgeries on 11 eyes of 7 patients. The most prevalent primary diagnosis was Fuchs endothelial dystrophy (7 eyes), followed by bullous keratopathy after phakic anterior chamber IOL implantation (2 eyes) and ICE syndrome (2 eyes). The average length of follow-up was 12.5 months. Clinically significant complicated cataract had developed and was removed in 3 eyes, one eye required rebubbling due to graft detachment and one eye required rePDEK due to graft failure. At the end of follow-up, the average visual acuity was 0.87, while 82% of eyes achieved VA 0.8 or better, and the average endothelial cell density was 1589 cells/mm2. CONCLUSION: Posterior lamellar keratoplasties (DMEK and PDEK) can be performed on phakic eyes. When performed by an experienced surgeon, these are safe procedures with good postoperative results and significant advantage in preserving younger patients accommodation.

ARTIFICIAL COSMETIC IRIS - POTENTIAL RISK OF VISUAL IMPAIRMENT. A CASE REPORT.

In this paper, the authors present a case report of a 46-year-old patient with decompensated pigmentary glaucoma and anterior uveitis after unilateral implantation of a BrightOcular artificial cosmetic iris (Stellar Devices, New York, USA). Postoperatively, there was a decrease of endothelial cells (ECD) down to 1216 cells/mm2, a uveal reaction in the anterior chamber and a significant decompensation of intraocular pressure (IOP). During the first examination at our clinic, the explantation of the artificial cosmetic iris was indicated. However, despite all warnings, the patient repeatedly refused this procedure. The patient later decided to undergo the artificial cosmetic iris explantation due to persistent elevation of IOP with intense eye pain. The cosmetic iris implant was removed almost five months after its implantation. Postoperatively, the anterior uveitis resolved, but there was a further decrease in ECD of 130 cells/mm2 and also an increase in IOP, despite maximal antiglaucoma therapy. Nearly one month after removal of the artificial cosmetic iris, the patient underwent implantation of the Express P50 drainage shunt (Alcon Inc, Fort Worth, TX, USA). After the drainage procedure, IOP was normalized and remained within physiological limits during the first year after surgery. Thereafter, there was a recurrence of elevated IOP, which subsided to normal, after initiation of a combination of two antiglaucoma therapies. Four years after surgery the eye was quiescent, ECD stationary, the optic nerve head was stable, and the visual field remained within the physiological norm. This case report highlights a potentially harmful procedure that is presented as a relatively safe alternative for an iris colour change, representing a deceptive marketing strategy for companies trading in these implants.

INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY -AVAILABLE TECHNOLOGIES AND POSSIBILITIES OF USE. A REVIEW.

Optical coherence tomography (OCT) is a non-contact and non-invasive imaging and diagnostic method, that allows the imaging of ocular tissues on transverse sections in extremely high quality of micrometer resolution. The physical principle of OCT is analogous to ultrasound, but it uses infrared radiation instead of acoustic waves. By using a low coherent radiation source, it is possible to achieve a higher resolution. Based on the obtained data, the computer can reconstruct two or three-dimensional images of the examined tissue. In recent years, we have seen a rapid development in ophthalmic surgery, especially in surgical instruments and imaging methods. However, the technology of surgical microscopes does not change significantly and thus becomes a limiting factor in the development of ophthalmic microsurgery. The integration of the OCT into surgical microscopes, so the introduction of the Intraoperative Optical Coherence Tomography (iOCT), opens up further possibilities for displaying/looking at the operating field and adapting surgical techniques to the current situation during the surgery. On the contrary, the disadvantage is the prolongation of the surgery time and thus the theoretical increase in possible complications related to the surgery. iOCT can be used for operations on the anterior and posterior segment of the eye. In anterior segment surgery, it is used mostly in penetrating and lamellar keratoplasty, glaucoma surgery and cataract surgery. In posterior segment surgery, it is used during pars plana vitrectomy. The aim of the article is to provide a comprehensive overview of the current possibilities of using iOCT in eye surgery.

UVEAL EFFUSION SYNDROME. CASE REPORT.

PURPOSE: Purpose of this article is to present a case report of a patient with uveal effusion syndrome who underwent deep posterior sclerotomy. CASE REPORT: A 73-year-old patient with unilateral decrease in the best corrected visual acuity, ablation of choroid and secondary retinal detachment in the right eye was admitted to our clinic for examination in November 2017. At the first examination, the best corrected visual acuity in the right eye was 0.3, in the left eye 1.0. Intraocular pressure was 16 mmHg in the right eye and 21 mmHg in the left eye. After performing ultrasound biomicroscopy of the anterior segment (Accutome, Keeler, USA), ultrasound sonography of the affected eye (Accutome, Keeler, USA), magnetic resonance imaging, computed tomography, abdominal ultrasound and blood tests, we concluded the finding as uveal effusion syndrome. We initiated a conservative treatment consisting of oral administration of carbonic anhydrase inhibitor in combination with topical use of prostaglandin analogue. Despite conservative treatment the best corrected visual acuity of the affected eye decreased to 0.05 so we proceeded to a surgical procedure - deep posterior sclerotomy with perioperative scleral sampling for histological examination (detection of glycosaminoglycans in the sclera wall by Alcian blue staining), which was negative. This histological result ranks the patient as the third type of uveal effusion syndrome (ie, non-nanophthalmic with a normal sclera). After the operation both the ablation of choroid and retinal detachment reattached and the best corrected visual acuity in the right eye improved to 0.3. After the subsequent cataract surgery, the ablation of choroid and retinal detachment occurred again, this time with spontaneous recovery. Postoperatively, the best corrected visual acuity in the right eye was 0.5 and at the last check-up at our clinic 0.6. CONCLUSION: Deep posterior sclerotomy is a method of choice of surgical treatment for uveal effusion syndrome that does not respond to conservative therapy.

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure.

INTRODUCTION: Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. PURPOSE: To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). METHODS: During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0-10), pressure, and glare (on the scale 0-5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. RESULTS: In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. CONCLUSION: SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery.

Surgical Treatment of Idiopathic Macular Hole Using Different Types of Tamponades and Different Postoperative Positioning Regimens.

PURPOSE: To compare the effect of different types of intraocular tamponade and different types of postoperative positioning on the closure of idiopathic macular hole (IMH). METHODS: Prospective randomized clinical trial enrolling 104 eyes of 100 patients (age, 57-87 years) undergoing MH surgery. All patients were operated on by an experienced surgeon using 25-gauge pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Patients were randomized according to the type of intraocular tamponade and postoperative positioning into the following four groups: SF6 + nonsupine reading position (n = 26) (group 1), air + nonsupine reading position (n = 25) (group 2), air + prone position (n = 26) (group 3), or SF6 + prone position (n = 27) (group 4). The follow-up period was 6 months. RESULTS: MH closure was achieved in 87 eyes (83.7 %) in the overall sample after the first surgery, with closure rates of 100%, 56%, 84.6%, and 92.6% in groups 1, 2, 3, and 4, respectively. The group 2 was significantly less successful compared to the other three groups (p < 0.05). MH of sizes ≤400 µm was closed in 97.2% of cases after the first surgery, with no significant differences between groups (p = 0.219). MH with sizes over 400 µm was closed in 70.9% of cases after the first surgery, with both groups with air tamponade being significantly less successful than group 1. The nonsupine reading position was subjected to a better subjective evaluation in terms of postoperative comfort and quality of sleep, with no differences between air and SF6 tamponade tolerance. CONCLUSION: PPV with ILM peeling, intraocular tamponade, and positioning remains the basic surgical approach in the treatment of IMH. For MH ≤ 400 µm, a high closure rate can be achieved by combining air tamponade and nonsupine reading position. For macular holes >400 µm, the greatest anatomical success can be achieved by using the SF6 tamponade in combination with the nonsupine reading position.

Virtiol - Simulation of Quality of Vision with Multifocal and Edof Intraocular Lenses.

Pupose: To experimentally compare the visual acuity and the subjective perception of different types of multifocal intraocular lenses (IOL) using a VirtIOL device/simulator in a group of volunteers with artephakia. MATERIAL AND METHODS: This was an experimental study involving a total of 20 volunteers with artephakia (35 eyes). Each volunteer rated 5 types of IOLs, 4 presbyopia-correcting IOLs - WIOL-CF, Tecnis Symphony ZXR00, Acrysof IQ PanOptix TFNT00, M-flex 630 F, and as a reference lens, we used the monofocal IOL Acrysof SA60AT. The corrected distance visual acuity (CDVA), distance corrected intermediated visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were measured. Additionally, volunteers evaluated the quality of vision under normal or changed lighting conditions, and ranked IOL on scale from 1 to 5. RESULTS: The CDVA evaluated using the VirtIOL device was very good for all tested IOLs (0.04-0.09 log MAR) with minimum differences. However, CDVA without simulator (-0.01 logMAR) was statistically significantly better in all cases. DCIVA was also very similar in each of the investigated IOLs, surprisingly even with monofocal IOL (0.21-0.23 logMAR), without using simulator the DCIVA was statistically significantly worse (0.36 logMAR). The DCNVA was the best for PanOptix intraocular lens (0.22 logMAR); M-flex, Symphony and WIOL-CF lenses had comparable results (0.31-0.34 logMAR). Again, surprisingly similar results were obtained with the use of monofocal IOL (0.36 ± 0.14). Subjective perception of vision through the IOLs was best rated for the monofocal control IOL, whereas Symphony, WIOL-CF and M-flex did not show any statistically significant difference either with or without glare. All tested IOLs were statistically significantly better if compared to PanOptix with or without glare. CONCLUSION: Simulation of vision through IOLs using VirtIOL simulator allows to compare different models of multifocal IOLs from the viewpoint of visual acuity and subjective perception. However, some caution should be exercised when evaluating the results, given that in our experiments, the monofocal IOL achieved relatively good results at near distance, which does not correspond to clinical experience. On the contrary, from the comparison of the results of CDVA without and with VirtIOL, it is obvious that visual acuity is slightly adversely affected by added optics.

Change of tear osmolarity after refractive surgery.

  Purpose: To compare the influence of the LASIK and ReLEx SMILE refractive method on tear osmolarity Methods: Prospective non-randomized comparative study. We evaluated the results in two groups of patients who underwent binocular refractive surgery to remove myopia and possibly astigmatism in the eye clinic of Horní Pocernice. In each group were 15 patients (30 eyes), patients of one group undergoing FS-LASIK refractive surgery, in the second group a ReLEx SMILE procedure. Bilateral measurement of the tear film osmolarity using the TearLab instrument on the day of surgery, the first day after surgery, one month and 3 months after surgery was performed on each patient. Results: The mean preoperative value of the osmolarity of the tear film was practically the same in both groups, in the ReLEx SMILE group 294.9 ± 13.4 mOsm/l and in the FS-LASIK group 296.4 ± 13.1. One and three months after the surgery in the ReLEx SMILE group, these values increased to 301.4 and 296.4 ± 13.3 mOsm/l respectively, the elevation of values one month after surgery was statistically significant. In the FS-LASIK group, one month after surgery, the osmolarity was 320.1 ± 14.7, three months postoperatively 306.5 ± 13.1 mOsm / l. Both of these values compared to the preoperative value were statistically significantly higher. The increase of the mean osmolarity was statistically significantly higher in the FS-LASIK group compared to the ReLEx SMILE. Three months after surgery, the difference between groups was not statistically significant. Conclusion: In our group of patients, after the FS-LASIK refraction procedure, we noted a higher mean osmolarity of tear film in comparison with patients after the ReLEx SMILE in all evaluated timepoints (1 day, 1 month and 3 months after surgery). We consider ReLEx SMILE as a method with less impact on the quality of tear film, with a faster return to original osmolarity and potentially higher patient comfort. Key words: Tear osmolarity, Relex SMILE, FS-LASIK.

Results of the first 12 months treatment of macular edema complicating BRVO in patients treated with ranibizumab.

THE AIM OF THE STUDY: Retrospective evaluation of the first 12 months treatment of macular edema in BRVO with ranibizumab based on anatomical and functional parameters. METHODS: 54 eyes with macular edema complicating BRVO were included in the study, with an average initial best corrected visual acuity 4/16 ETDRS charts, an average central retinal thickness 512.3 µm, and in average 4 months till the beginning of treatment with ranibizumab. After 3 initial injections of 0.5 mg ranibizumab treatment was performed in pro re nata regimen, with adjuvant laser (grid laser photocoagulation) as an additional treatment option.  The number of injections administered, the number of eyes where grid laser photocoagulation was provided, functional parameters as a letter gain and BCVA (eyes with final BCVA ≥ 4/8 ETDRS, final BCVA in according to initial BCVA) and anatomical parameters as a mean CRT and  CRT ≤ 250 µm, respectively ≤ 300 µm were evaluated. RESULTS: In the whole group, an average of 4.8 injections of ranibizumab were administered in the first 12 months. Grid laser photocoagulation was performed in 42 eyes: in 8 eyes prior to the beginning of treatment with ranibizumab, 7 eyes before and during the treatment, 29 eyes only during the treatment. The main gain of letters after 12 months of treatment was +16.5 letters, with 63¨% (n = 34) eyes earning ≥ 15 letters. In the whole group 72 % (n = 39) eyes achieved the resulting BCVA ≥ 4/8 ETDRS after 12 months of treatment. The eyes with initial BCVA ≥ 4/10 ETDRS resulted in BCVA ≥ 4/8 ETDRS in 96 % (n = 23 eyes) and 11 eyes even  achieved BCVA ≥ 4/4. The mean CRT after 12 months of treatment was 290.3 µm, 33.3 %  of eyes had final CRT ≤ 250 µm, and 64.8 % had final CRT ≤ 300 µm. CONCLUSION: When applying a relatively low number of injections in the first year of treatment with ranibizumab, the final best corrected visual acuity was very good at the end of the observation period, and its dependence on the initial best corrected visual acuity was confirmed. Satisfactory results of central retinal thickness were found as well. Key words: branch retinal vein occlusion, macular edema, ranibizuma.

[HYBRID MONOVISION]. / HYBRIDNÍ MONOVISION.

AIM: To evaluate our own results of the use of hybrid monovision technique, in patients after bilateral cataract surgery, where in the dominant eye the monofocal intraocular lens is implanted and in the non-dominant eye the multifocal intraocular lens (IOL) is implanted. MATERIAL AND METHODS: Prospective follow-up of group of 33 patients with bilateral cataract surgery and induced hybrid monovision. In the dominant eye, the hydrophilic monofocal aspheric intraocular lens Auroflex (Aurolab) was implanted, and in the non-dominant eye the hydrophilic multifocal aspheric intraocular lens Seelens (Hanita) was implanted. During the post-operative period, the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), best-corrected near visual acuity (CNVA), and distance-corrected near visual acuity (DCNVA) were established. Further, the monocular contrast sensitivity, subjective satisfaction, and dysfotopsias appearance were examined. The examinations were held 3 and 6 months after the surgery. RESULTS: In dominant eyes with implanted monofocal lens, UDVA improved from 0.61 ± 0.39 logMAR preoperatively to 0.03 ± 0.14 logMAR at 6 months after the surgery. In non-dominant eyes, with implanted multifocal intraocular lens, UDVA improved from 0.30 ± 0.23 logMAR preoperatively to -0.04 ± 0.06 logMAR. The average binocular UDVA (bUDVA) was -0.07 ± 0.08 logMAR and binocular CDVA (bCDVA) -0.12 ± 0.06. The average UNVA in dominant eyes 6 months after the surgery was 0.62 ± 0.18 logMAR, in non-dominant eyes 0.18 ± 0,15 logMAR, binocularly 0.15 ± 0.11 logMAR. The contrast sensitivity was in the eyes with implanted multifocal IOL slightly worse comparing to the eyes with implanted monofocal lens, albeit only in the space frequency of 6 cycles per degree (CPD) this difference was statistically significant. Subjectively, the presence of dysfotopsia and other problems were very low, the average values of single answers were from 1.3 to 2.1 (on the scale 1 - 5, 1 - no problems and 5 - severe problems). Also, we noticed high percentage of subjective satisfaction with the surgery results (94 %). Six percent of patients wear glasses for near distance as a standard, 42 % of patients wear them occasionally, and 45 % of patients dont use glasses for near distance at all. CONCLUSION: The technique of hybrid monovision is effective, safe, and relatively cheap method solving the loss of accommodation in patients after the cataract surgery. This method extends the spectrum of our possibilities how to solve the loss of accommodation in these patients.Key words: hybrid monovision, multifocal intraocular lens, contrast sensitivity.

[Historic Survey of Posterior Lamellar Keratoplasty Techniques - an Overview]. / Historický prehled technik zadní lamelární keratoplastiky.

Some of the modifications of posterior lamellar keratoplasty is at the present considered by most of the corneal surgeons as method of choice in case of patients corneal endothelium damage. However, this surgical technique undergoes in the last 20 years relatively rapid development. Even in the current time, there exist side by side and are used different types and modifications of this sort of transplantation. Because of this reason, differences among individual methods are sometimes not accurately understood and the terminology may be used not exactly as well. The authors specify all until now described surgical methods, describe differences among single surgical procedures, and point out their advantages and disadvantages. The methods are described in the same order as they were historically introduced into the literature.Key words: posterior lamellar keratoplasty, surgical methods.

[Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade]. / Chirurgické resení idiopatické makulární díry 25-gauge pars plana vitrektomií s peelingem vnitrní limitující membrány asistované briliantovou modrí a plynovou tamponádou.

UNLABELLED: 25-gauge pars plana vitrectomy with briliant blue assisted internal limiting membrane peeling and gas tamponade for idiopatic macular hole. PURPOSE: The evaluation of anatomic and visual outcomes in idiopatic macular holes treated with 25-gauge pars plana vitrectomy, briliant blue (BB) assisted internal limiting membrane (ILM) peeling and gas tamponade. MATERIALS AND METHODS: Retrospective analysis. 53 eyes of 52 patients (39 women, 13 men) of mean age 68,8 years (58-83) with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification from 6/2012 to 7/2014 were included. All patient undergone 25-gauge pars plana vitrectomy with brillinat blue assisted ILM peeling, gas tamponade (35 cases 15 % C3F8, 18 cases 20% SF6). 50 cases (94,3%) were performed in retrobulbar anesthesia, 3 cases in general anesthesia. Face-down positioning should have beeen maintained for three days. Best corrected visual acuity (BCVA), optical coherence tomography findings and complications were evaluated. RESULTS: The mean follow-up time was 6 months (1-22). Macular hole closure was achieved in 49 eyes (92,5%). The mean BCVA improved from 0,16 (0,5-0,05) to 0,5 (1,0-0,1). BCVA was improved by 3 and more ETDRS lines in 42 eyes (79,2%). CONCLUSION: 25-gauge pars plana vitrectomy with briliant blue assisted internal limiting membrane peeling and gas tamponade is safe and effective method of macular hole therapy with high anatomic and functional effect.

[Clinical Results after Continuous Corneal ring (MyoRing) Implantation in Keratoconus Patients]. / Výsledky implantace plného rohovkového krouzku (MyoRing) v lécbe keratokonu.

PURPOSE: to present one and two years clinical results after intrastromal continuous corneal ring implantation in keratoconus patients. METHODS: Retrospective evaluation of the results of patients with keratoconus, after MyoRing implantation for improving of visual functions. The uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), the residual subjective refractive error, pachymetry, keratometry and the size of corneal astigmatismus were evaluated. Peroperative and postoperative complications were investigated. The minimal follow-up time was 12 months. RESULTS: The study included 32 eyes of 30 patients with mean age of 30.08 (± 11.56) years. UDVA improved from 1.03 (± 0.41) logMAR to 0.36 (± 0.25) logMAR 12 months and 0.31 (± 0.27) logMAR 24 months after surgery. These changes were stastistically significant. The maxima value of corneal curvature (Kmax) was preoperatively 52.48 (± 6.35) D, 46.08 (± 4.44) D 12 months and 45.53 (± 5.52) D 24 months after surgery. Both changes were statistically significant (P ˂ 0,00000). The mean value of corneal curvature (K mean) was preoperatively 50.10 (± 4.96) D, 44.25 (± 4.40) D 12 months and 44.11 (± 5.38) D 24 months after surgery. Both changes were statistically significant. In any of the patients we did not register any severe peroperative or postoperative complication. CONCLUSION: The MyoRing implantation is an effective and safe method in improvement of visual functions in keratoconus patients. Clinical results are stable in one and two years follow-up time.

[The incidence of endophtalmitis after the application of intravitreal injections in FNKV with regard to various prophylactic antibiotic regimens]. / Výskyt endoftalmitidy po aplikaci intravitreálních preparátu na Oftalmologické klinice FNKV s ohledem na ruzné profylaktické ANTIBIOTICKÉ rezimy.

AIM: Comparing the incidence of endophtalmitis at the Ophthalmologic clinic of FNKV after the application of intravitreal injections with regard to various prophylactic antibiotic regimens.Methodics: Comparing the number of endophtalmitis cases during the period of 2005-2011, when the intravitreal applications were secured by full antibiotic prophylaxis (Floxal)/Oftaquix gtt. 5xd 3 days before the application and 3 days after the application with the years of 2012-2013, when Vigamox gtt. was used during the preparation of the eye before surgery to prevent inflammatory changes. RESULTS: In the years of 2005-2013, 5005 injections were applied. In total we recorded three cases of endophthalmitis. In all cases, a pars plana vitrectomy with sample collection for culture and microbiological analysis was performed. During the years of 2005-2011, 2 651 injections were applied with two cases of endophtalmitis (0,075%, 1:1 325, both cases culture-negative). During the years of 2012-2013, 2 355 injections were applied with one case of endophtalmitis (0,042 %, 1:2 355, culture-positive). CONCLUSION: According to our experience, limited prophylactic antibiotic regimen does not increase the incidence of endophtalmitis in comparison with full prophylactic antibiotic regimen.

[Corneal transplantations in the Czech Republic in 2012]. / Transplantace rohovek v Ceské republice v roce 2012.

OBJECTIVE: To determine the frequency of corneal transplantations in the Czech Republic in 2012, the percentage representations of the different types of surgeries and main indications for corneal transplantation. METHODOLOGY: All clinics performing the corneal transplantations were asked to complete a questionnaire about the number of corneal transplants, types of surgeries and indications for such procedures. The obtained data were compared with the annual report of corneal banks for the year 2012. RESULTS: Data for 465 transplantations were analyzed, it represents 92, 8 % of all corneas issued by the corneal tissue banks. The most common indication for corneal transplantation (regardless of type) was bullous keratopathy (40 % of cases), then keratoconus and other ectatic diseases (19,1 %) and endothelial dystrophy (16,1 %). The most common type of translation was penetrating keratoplasty (50,75 %), then posterior lamellar keratoplasty (44, 95 %) and anterior lamellar keratoplasty (4,3 %). CONCLUSION: Acquired data confirm increasing proportion of lamellar transplantations among all corneal keratoplasties, especially posterior lamellar keratoplasty. This approach probably affects indications, for which keratoplasties are made. Keratoplasties are indicated significantly due to endothelial corneal dystrophies such as bullous keratopathy and other endothelial dystrophies. Keratoconus represents approximately 20 % of indications to corneal transplantation.

[Long term efficiency of a deep sclerectomy with T-flux implant]. / Efektivita hluboké sklerektomie s implantaci T-Fluxu--dlouhodobé výsledky.

PURPOSE: To evaluate a long term efficiency of a deep sclerectomy with T-Flux implant on intraocular pressure METHODS: Retrospective noncomparative analysis of glaucomatic patients from our ambulance who underwent deep sclerectomy combined with T-flux implantation. The main postoperative outcome measures were intraocular pressure (IOP), number of treatments and Nd:YAG goniopunctures. RESULTS: Mean preoperative IOP was 26.7 (+/- 0.8) mmHg, mean postoperative IOP was 17.4 (+/- 0.8) at month 6, 16.5 (+/- 0.7) at month 12, 16.9 (+/- 0.9) at month 24, 17.2 (+/- 1.0) at month 36, 18.6 (+/- 1,1) at month 48, 17.6 (+/- 1.1) at month 60 and 18.3 (+/- 1.8) at month 72. Mean preoperative number of medications per patient was reduced from 2.5 (+/- 0.13) to 0.73 (+/- 0.13) at month 6, 1.02 (+/- 0,13) at month 12, 1.1 (+/- 0.15) at month 24, 1.0 (+/- 0.18) at month 36, 1.22 (+/- 0.18) at month 48, 1.68 (+/- 0,2) at month 60, 1.8 (+/- 0.3) at month 72. Four patients (10%) underwent early goniopuncture and six patients (15%) late goniopuncture. CONCLUSION: Deep sclerectomy combined with T-Flux implant appears to be a relatively safe antiglaucomatic surgery with a minimum number of complications, high predictability of the result and a very good long term effectivity.