THE PREVALENCE OF MYOPIA IN SCHOOL-AGE CHILDREN IN SLOVAKIA AND THE COVID-19 PANDEMIC.

AIMS: The aim of the authors' study was to determine the prevalence of myopia and premyopia in children and adolescents attending primary school in a village in the north of Slovakia in the period before and after the peak of the Covid-19 pandemic. MATERIAL AND METHODS: Changes in the spherical equivalent and axial length of the eyes were measured in 2019 and 2022 in a group of 47 children and adolescents within the age range of 7-12 years at the time of first measurement. In all the individuals, refraction was measured using an automatic keratorefractometer without the use of cycloplegic eye drops, and axial length was measured with an optical biometer. Refraction was also measured using an automatic keratorefractometer after using cycloplegic eye drops. RESULTS: We recorded a significant change in the mean spherical equivalent (1.02 ±1.16 D vs. 0.72 ±1.29) and the axial length of the eyes (23.05 ±0.72mm vs. 23.30 ±0.74mm) when comparing the measurements from 2019 to 2022. The probands manifested a myopic refractive shift of -0.30 D throughout the entire cohort (-0.24 D in boys and -0.38 D in girls), and the mean axial length increased by 0.2 mm in the entire cohort (by 0.3 mm in boys and 0.2 mm in girls). The percentage of myopic and premyopic eyes increased (4.3% vs. 8.5% a 31.9% vs. 48.9%). CONCLUSION: We noted a decrease in the spherical equivalent and increase in the axial length of the eyes after the Covid-19 pandemic compared to the period before the pandemic in Slovak school-aged children. During this period, the prevalence of myopia and premyopia increased.

CHANGES IN THE VISION OF ADULT AMBLYOPIC PATIENTS FOLLOWING CLEAR LENS EXTRACTION.

AIMS: The aim of the study was to retrospectively evaluate changes in vision after the implantation of trifocal (tIOL) or rotationally asymmetric multifocal artificial intraocular lenses (mIOL) in patients undergoing clear lens extraction. The main goal was to determine whether changes to central visual acuity occur after the implantation of an IOL at a follow-up examination after one year. Other objectives were to determine the difference between the groups with implanted diffractive and rotationally asymmetric artificial intraocular lenses, as well as to evaluate the risk of accurate correction in patients who had lived most of their lives "undercorrected". MATERIAL AND METHODS: In our study, we present a retrospective longitudinal evaluation of results in patients after the implantation of an artificial intraocular lens. In the period from 2013 to 2020, we evaluated changes in the vision of 22 patients aged 39-59 years, of whom 18 were women and 5 were men. The average preoperative refraction of myopic eyes was +5.7 ±2.13 Dsf and +1.24 ±0.86 Dcyl. In amblyopic eyes, 7 diffractive lenses and 15 rotationally asymmetric lenses were used. RESULTS: Uncorrected distance visual acuity before surgery and one year (1Y) after was 0.13 ±0.09 vs. 0.57 ±0.28 (p < 0.001); the best corrected distance visual acuity before and 1Y after was 0.53 ±0.22 vs. 0.62 ±0.29 (p = 0.024); uncorrected near visual acuity before and 1Y after was 0.06 ±0.06 vs. 0.48 ±0.32 (p < 0.001); the best corrected near visual acuity before and afér the surgical procedure was 0.45 ±0.27vs. 0.55 ±0.35 (p = 0.014). CONCLUSION: Implantation of tIOL and mIOL lenses was effective in our group of patients with amblyopia, thus improving uncorrected distance and near visual acuity and without serious adverse effects. At the same time, we evaluate that the change in refraction and the removal of anisometropia lead to a significant change in the best corrected visual acuity for distance or near vision at the one-year follow-up examination.

USE OF A FEMTOSECOND LASER IN CATARACT SURGERY.

AIMS: Cataracts continue to be the leading cause of blindness worldwide. Phacoemulsification is the gold standard in the treatment of cataracts. The aim of the study was to compare the postoperative results of the phacoemulsification technique in comparison with femtosecond laser-assisted cataract surgery (FLACS). MATERIAL AND METHODS: Our work retrospectively evaluates the results of patients after implantation of an artificial intraocular lens for cataract from May 2017 to March 2019. The study evaluated a total of 80 implanted lenses in 47 patients operated on by two surgeons. Of the 47 patients, 28 were women. The mean age in the group at the time of surgery was 63.7 years, ranging from 34-79 years. Patients could choose FLACS (n = 45) surgery or standard phacoemulsification procedure (n = 35). RESULTS: Upon a comparison of the group regarding uncorrected distal visual acuity (UCDVA) up to 12 months after surgery, the group FAKO CATARACTS recorded 0.85 ±0.18 vs. 0.93 ±0.12 in the FEMTO CATARACTS group (p = 0.021), comparably uncorrected near visual acuity (UCNVA) was 0.77 ±0.18 vs. 0.84 ±0.17 (p = 0.034) respectively. A difference in the use of phacoemulsification energy (OZIL) was measured in patients with phacoemulsification 3.5 ±3.1 and in the use of femtosecond laser 2.2 ±3.1, (p = 0.005). In all cases, an AT LISA 839 trifocal lens (Carl Zeiss Meditec, Germany) was implanted. CONCLUSION: The femtosecond platform assists the surgeon in cataract surgery with capsulorhexis and pre-fragmentation of the lens nucleus, which can be advantageous especially for complicated cataracts. We recorded significantly higher uncorrected distance and near visual acuity in the FLACS group, and also a significantly lower value of the phacoemulsification energy used.

ENDOTHELIAL CELL LOSS AFTER PARS PLANA VITRECTOMY.

AIMS: To analyse the changes in endothelial cell density (ECD) after pars plana vitrectomy (PPV) and to identify the factors implicated. PATIENTS AND METHODS: This was a prospective, consecutive, and non-randomised, case-control study. All 23-gauge vitrectomies were performed by a single surgeon at a tertiary centre. ECD was measured at baseline before surgery and on postoperative Days 30, 90, and 180. The fellow eye was used as the control eye. The primary outcome was a change in ECD after PPV. RESULTS: Seventeen patients were included in this study. The mean age of the patients was 65 years. The mean ECD count at baseline was 2340 cells/mm2. The median ECD loss in the vitrectomised eye was 3.6 %, 4.0 %, and 4.7 % at Days 30, 90, and 180, respectively, compared to +1.94 %, +0.75 %, +1.01 %, respectively, in the control eye. The relative risk of ECD loss after PPV was 2.48 (C.I. 1.05-5.85, p = 0.0247). The pseudophakic eyes lost more ECD than the phakic eyes, but this was not statistically significant. There were no significant differences in diagnosis, age, surgical time, or tamponade used after surgery. CONCLUSIONS: Routine pars plana vitrectomy had an impact on the corneal endothelial cells until Day 180 post-op. The phakic status was slightly protective against ECD loss after PPV, although it was not statistically significant. The pathophysiology of corneal cell damage after routine PPV remains unclear. Further studies are required to confirm these findings.

Eyelid edema as a first sign of lymphoma.

Chronic eyelid edema may be a symptom of different disease. The most common are autoimmune diseases such as orbital pseudotumor, vasculitis, sarcoidosis, or impaired vascular or lymphatic drainage. Rarely has it been reported as the sole manifestation of the lymphoma. Eyelid lymphoma is a special clinical entity in the spectrum of hematological malignancies. Here we present our clinical experience with eyelids lymphomas. First case is a 76-year-old female patient with bilateral edema of upper eyelid non-responding to anti-inflammatory therapy. Histological examination diagnosed mantle cells lymphoma. In the second case, 58-year-old patient was diagnosed with solitary unilateral tumor of the lower eyelid, where primary biopsy was ordered and diagnosis of MALT lymphoma was established after histological examination. In both cases, it was not solitary eyelid tumor, but systemic disease with multiple lymphadenopathy and bone marrow infiltration were found in follow-up examinations. Subsequently, patients care was given to the hemato-oncologist.

Visual Training in Virtual Reality in Adult Patients with Anisometric Amblyopia.

PURPOSE: Amblyopia is one of the most common childhood disease. The average prevalence of amblyopia in children is estimated at 2-5 %. It arises during the child development until the age of six, if not treated then, it persist throught adulthood. The aim of our work is to retrospectively analyze the results of treatment of anisometropic amblyopia using dichoptical training in virtual reality in adult amblyopic patients. MATERIALS AND METHODS: Our group consisted of 84 amblyopic patients with anisometropic amblyopia with an average age of 33.8 ± 9.4 years. Patients played a video game twice a week in the Oculus Rift 3D virtual reality. Together they completed 8 visual trainings, with one training lasting 60 minutes. Before and after the training we evaluated the best corrected visual acuity (BCVA). DISCUSSION: Throughout the group, we observed an improvement of 0.1 BCVA from 0.48 to 0.58 Sloan table (p.

Iris and ciliary body cysts and phakic intraocular lenses.

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.

Pupillary abnormalities in childhood - 2 case presentations.

Anisocoria is a condition characterized by an unequal size of the eyes' pupils. There is a broad spectrum of aetiological factors including benign and also life- threatening situations. The most important point is the ability to find the anatomical location of the pathology. Understanding to the anatomical, physiological and pharmacological influences helps us to solve the diagnostic challenge. In the article authors present the issue of the anisocoria in the childhood through two case presentations. Causes of an unequal size of the eyes' pupils are in this two cases different. In both of the cases the anisocoria is temporary with spontaneous resolution without any therapy. Diagnostic challenge is well- described with the analysis of important Pilocarpin pharmacological tests. Pharmacological diagnostic tests are a very effective method to differentiate between the pharmacological mydriasis and the mydriasis caused by another factor. Strictly taken patient´s history with targeted questions searching for recent contact with some drugs, plants or medications is crucial. Sometimes it is necessary to consider an unusual diagnosis - benign episodic unilateral mydriasis.

Effect of Botulinum toxin A application in neuro-ophtalmologic indications on Schirmers test and tears osmolarity.

Botulinum toxin type A (BT-A) is used in the treatment of neuro-ophthalmologic disorders such as essential blepharospasm and facial hemispasm for more than 20 years. Although the long-term effect of repeated application of the BT-A was confirmed, the BT-A effect on tears production and retention is not clear. In our work we investigated whether applied BT-A in patients with blepharospasm and hemifacial spasm affect tears production. Tears quality was measured with Schirmers and tear osmolarity test during neuro-ophthalmologic diseases treatment, which was evaluated before and 14 days after application of BT-A (Botox inj, Allergan, Irvine, USA) into the orbicularis oculi muscle. BT-A doses of 16-18 U with unilateral and 32 to 36 U bilateral applications were used. The mean tear production in Schirmers test before BT-A application was 8.38 ± 0.63 mm, and 2 weeks after BT-A application was 7.12 ± 0,6 mm (n = 50). Tear osmolarity was 305.4 ± 9.2 mOsm before BT-A application, and 2 weeks after BT-A application it was 305.2 ± 8,6 mOsm (n = 13). We found significant difference between two groups in tear quantity (p < 0.012), but not quality (p > 0.05). Application of the BT-A reduced the amount of tears measured by Schirmers test. These results confirm rational basis of the empirical clinical experience where an artificial tears substitution is recommended for patients with neuro-ophthalmologic disorders treated by BT-A.

Keratopigmentation (Corneal Tattoo) - Our First Experience.

INTRODUCTION: Keratopigmentation or corneal tattooing represents an unique cosmetic solution for corneal leucomas and also for other pathological changes affecting cornea or iris. Procedure is based on pigment insertion into the corneal stroma. Goal is to improve the appearance of the affected eye. These days are most frequently used tattoo kits with different sterilised inks made primary for skin tattooing. As a new possibility there are also available biocompatible micronized mineral pigments. METHODS: Authors will introduce four case reports of four patients with corneal leucomas, who wanted to undergo the corneal tattooing to improve the cosmetic appearance of their blind eyes. Authors decided for keratopigmentation with an use of inks intended primary for skin tattooing. RESULTS: In all four patients was the final appearance of tattooed cornea more than satisfying. Postoperative examination didn´t detect diffusion, fading, colour changes of the pigments. No complications such as toxic or immune reaction due to the pigment were recorded. All four patients were subjectively fully satisfied with the cosmetic result of the keratopigmentation. CONCLUSION: Based on the first experience authors consider keratopigmentation to be a safe and relatively uncomplicated surgical method. Corneal tattooing is also quite cheap, does not require patient´s hospitalization and postoperative reconvalescence in usually short term. Key words: keratopigmentation, corneal tattoo, corneal leucoma, blind eye.

ACUTE MYOPIA WITH ELEVATION OF INTRAOCULAR TENSION AS AN ADVERSE SIDE EFFECT OF ANTIDEPRESSANT MEDICATION.

CASE-REPORT: The author presents case report of acute induced myopia with mild intraocular pressure elevation by young patient using trazodone. The presentation is completed with the documentation of anterior chamber depth and angle changes by using and after discontinuation of trazodone. CONCLUSION: Acute transient myopia may be rare side effect of systemic used drugs in predisposed patients. Early and correct diagnosis is very important, because induced myopia may be accompanied by acute angle-closure glaucoma or supraciliary choroidal effusion. The only correct treatment in this case is discontinuation of the drug. Key words: acute angle-closure glaucoma, acute myopia, antidepressants, side effects, trazodone.

CHANGE OF CENTRAL AND PERIPHERAL VISION IN PATIENT WITH SYMPTOMATIC CYST OF RATHKE'S CLEFT FOLLOWING TRANSSPHENOIDAL RESECTION.

A seventysix-year-old female was acutely admitted to the Eye Clinic of the University Hospital in Martin with a 1 month history of impaired central and peripheral vision on the right eye. At the admission patient`s right eye VA was fingers at 20 cm, the left eye had a central vision preserved. Magnetic resonance of the brain and orbits demonstrated cystic tumor expansion in the sellar region with compression of optic chiasm and optic nerves (more on the right side), in diff. dg. as cystic macroadenoma of the pituitary gland. Endocrinological examination found secondary hyperprolactinaemia from pituitary oppression, other hormonal parameters were without deviation. Consequently, the ENT examination recommended endoscopic resection via the transsphenoid approach. After resection of the lesion and histological examination of the sample, the finding was evaluated as a Rathke's cleft cyst. Symptomatic Rathke's cleft cysts of pituitary gland are rare, but the visual symptoms are typical findings due to chiasm proximity. On ophthalmological examination 3 weeks after surgery has central vision increased significantly (VOD 6/9) on the right eye and peripheral vision has partially adjusted on both eyes. Key words: Rathke's cleft cyst, perimeter, central visual acuity, transsphenoidal endoscopic resection.

[First Experience with Femtosecond Laser Presbyopia Correction Method INTRACOR]. / Prvé skúsenosti s korekciou presbyopie femtosekundovým laserom metódou INTRACOR.

We report the first experience with presbyopia correcting femtosecond laser surgical procedure INTRACOR. This procedure is so far the only one that is made purely intrastromally without generating a wound connected to corneal surface or anterior chamber.Presbyopia - caused by physiological aging and decreasing elasticity of the lens, impairs patients accommodative ability. In the case of the method INTRACOR, presbyopia is corrected by steepening of corneal curvature in the central optical zone. Procedure is usually performed only in the non-dominant eye. METHODS: Intracor procedure was performed in 10 eyes of 10 patients (3 women and 7 men, aged 47-58 years). All procedures were performed with the femtosecond laser VICTUS (Bausch - Lomb, USA) in the non-dominant eye by an experienced surgeon. RESULTS: One-year follow-up. Mean monocular uncorrected near visual acuity (UNVA) improved from 0.2 ± 0.1 before surgery to 0.7 ± 0.3 after treatment (mean improvement of four lines). Mean near uncorrected binocular visual acuity (UNBVA) improved from a mean preoperative value of 0.23 ± 0.08 to a mean postoperative value of 0.8 ± 0.22 (mean improvement of about 5 lines). The mean monocular uncorrected distance visual acuity (UDVA) was 0.9 ± 0.1 before surgery and 0.8 ± 0.3 after treatment (average loss of 1 line). The mean binocular uncorrected distance visual acuity improved from 1.0 ± 0,1 to 1,3 ± 0.3 after surgery. All patients had improvements in near vision. In 3 patient, monocular distance vision improved, in 6 patient improved binocular distance vision. We observed statistically significant decrease (mean loss of 1 line) of monocular best corrected distance visual acuity (BCDVA). Patients subjectively reported satisfaction with the quality of vision achieved for near and distance and high levels of spectacle independence under good lighting conditions.The results shows that INTRACOR method is well suitable for low hyperopic patients, who because of good distance visual acuity are not good candidates for refractive lens exchange with multifocal intraocular lens implantation. KEY WORDS: presbyopia, Intracor, intrastromal, femtosecond laser.

[Optic disc drusen - current diagnostic possibilities]. / Drúzová papila - súcasné diagnostické moznosti.

Authors present the findings of two patients with optic nerve drusen, and an overview of current examination techniques in the diagnostics of optic nerve drusen including ultrasound examination, fundus photography, florescein angiography, computerized perimetry, auto-florescence fundus examination, examination of the nerve fibre layer using optical coherence tomography (OCT) or nerve fibres layer analyzer (GDx). In the first case, the patient was recommended to be supervised without any therapy. The second patient with regard to perimeter finding, loss of nerve fibre layer and increase of the intraocular pressure was prescribed local anti-glaucoma therapy.

[Frosted branch angiitis syndrome]. / Syndróm omrznutých vetiev retinálnych ciev.

The authors present a case report of a 20-year-old patient with an atypical clinical picture of bilateral vasculitis associated with bilateral macular oedema and decrease in visual acuity. On basis of the clinical picture, frosted branch angiitis was diagnosed. The patient was instructed to continue the broad-spectrum antibiotic therapy prescribed by an ophthalmic practitioner of the appropriate catchment area. The visual acuity progressively improved and after application of systemic corticosteroid therapy the patients health state improved completely. According to the authors knowledge, this is the first diagnosed case of frosted branch angiitis in the Slovak Republic.

Changes in metabolic syndrome parameters after liposuction.

Liposuction - one of the most frequent procedures in cosmetic surgery - is the surgical aspiration of fat from the subcutaneous layer leaving a more desirable body contour and leaving a smooth transition between the suctioned and nonsuctioned areas. Metabolic syndrome is epidemiologically important medical condition that includes insulin resistance, dyslipidemia, central obesity, hypertension, impaired glucose tolerance or diabetes mellitus, and high rates of atherosclerotic disease. According to the latest findings, liposuction reduces the amount of subcutaneous fat, which changes the abdominal - superficial adipose tissue ratio and thus might affect the potential of metabolic syndrome by the means of its separate parameters and clinical manifestations. Results that can be found in the published literature remain controversial and often contradictory, thus leaving enough space for further investigations regarding the relation of these two clinical entities (Ref. 33).

Nasoalveolar molding in complete cleft lip nasal deformity patients.

OBJECTIVES: The aim of this study was to compare nostril height, width, collumelar length, interalar distance and nostril symetry between unilateral complete cleft lip/palate patients undergoing nasoalveolar moulding (NAM) and incomplete cleft lip patients/palate with no need of presurgical moulding before and after cheiloplasty with primary nasal correction. Our study group included 18 patients from whom 9 were NAM cleft lip/palate nasal deformity cases and 9 incomplete cleft lip/palate cases. All measurements were obtained by two independent investigators and averaged, standard deviations and symetry ratios were calculated, and paired and unpaired t-test was performed to compare the groups. RESULTS: Our study results showed no statistically significant difference in nostril height, width, collumelar lenght, interalar distance in unilateral cases in preoperative and postoperative measurements between these two groups. Symetry measurements included nostril width on the affected and nonaffected side, nostril height on the affected and nonaffected side before (T1) and after (T2) cheiloplasty. The nostril height ratio was 1.2 and 1.03 for T1 to T2 and the nostril width revealed a ratio of 0.5 and 0.8 for T1 to T2 in unilateral NAM cases. In the incomplete cleft lip group the height ratio was 1.04 and 1.03 for T1 to T2 and the width ratio was 0.59/0.93 in pre-/postoperative measurements. These symetry values showed also no statistical significance between NAM and incomplete cleft lip cases. CONCLUSION: Our study results showed no statistical significant difference in nostril height, width, collumelar lenght, interalar distance and nostril symetry between unilateral complete cleft lip/palate patients undergoing NAM and incomplete cleft lip patients/palate with no need of presurgical moulding, proving NAM combined with primary nasal correction is a very efficient management for cleft lip/palate children with outstanding results (Tab. 5, Fig. 4, Ref. 25). KEYWORDS: nasoalveolar molding, complete cleft lip nasal deformity, cleft lip, nostril height, width, collumelar lenght, interalar distance, nostril symetry.

Prevalence of cleft lip and palate in western Slovakia in the years 2001-2007.

OBJECTIVES: The aim of this study was to investigate the prevalence of orofacial clefts (OC) in live newborns from 2001 to 2007 in Western Slovakia and correlate their occurrence with a number of relevant seasonal and geographical factors and epidemiological trend of this condition. In this study we used retrospective active survey collecting clinical data of 220 children with OC registered and operated at the cleft centre in Bratislava. Our study group included 67 patients from Bratislava region and 151 patients from the remaining Western Slovakia (Nitra, Trnava, Trencín regions). Data of live births was obtained from Health Statistics of the Slovak Republic. RESULTS: Total incidence (TI) of 1.49/1000 live births (LB) in the region of Western Slovakia in 2001-2007 marked a decrease of prevalence compared to 1.64/1000 LB in the years 1985-2000. Bratislava region dominated in total prevalence of 1.82/1000 LB compared to the rest of Western Slovakia regions with 1.37/1000 LB. Most observed cleft type was the CP with 38.6 % frequency, followed by CLP with 35.5 % and CL with a frequency of 24.1 %. The frequency of AM with 1.82 % was the lowest. CONCLUSION: The results showed that the frequency risk rate of a birth of a child with OC was 1 to 671 LB in Western Slovakia. The data proved a higher prevalence of OC in Bratislava region with 1 child with this type of congenital anomaly to 549 LB compared with 1 child with OC to 730 LB in the rest of the Western Slovakia regions (Tab. 7, Ref. 16).

Timing of primary lip repair in cleft patients according to surgical treatment protocol.

OBJECTIVES: The goal of this article is to focus on the results of meeting the primary lip repair timing in compliance with the surgical treatment protocol used at the Cleft Center, Bratislava. METHODS: Retrospective analysis of 45 initial lip repairs among all cleft operations in a period of 3 years (2006-2008). The object of the analysis was the "day of surgery after birth". The defined time period was that of 90th-180th day (3-6 months) for the initial lip surgery according to surgical protocol. Histories of patients who underwent surgery before the 90th or after the 180th day were examined. RESULTS: 40 patients (89%) underwent primary lip surgery in the defined time period of 3-6 months following the surgical treatment protocol. 5 patients (11%) underwent primary lip surgery at a later age than 6 months only because of pediatric reasons: recurrent bronchopneumonia (3 patients), recurrent respiratory infections plus prematurity (1 patient) and sideropenic anaemia (1 patient). There were no operative and postoperative surgical or anesthesiological complications. There were only serious pediatric reasons for surgery delays. CONCLUSION: The determined timing of primary lip closure in 3-6 months is considered adequate according to the achieved results. In most of the cases this timing offers reliable conditions to perform early surgery in baby patients. The successfull realisation of the primary lip repair in the defined time period of 3-6 months is very important for proper timing of subsequent surgeries as well as for that of consecutive completion of treatment (Tab. 1, Fig. 1, Ref. 8).

Conditions responsible for small bowel resection.

The authors deal with the problems of surgery of small intestine. They analyze causes leading to small bowel resection, including small intestinal obstructions, tumors, diverticles, Crohn's disease and traumas of small intestine, in a group of patients operated at Ist Department of Surgery, University Hospital, Commenius University, Bratislava, during the last 30 years. Authors also discuss the problems of short bowel syndrome (SBS) as the consequence of an extensive small bowel resection, reporting the surgical approach to its therapy. (Tab. 1., Ref. 5.)