Purpose: To retrospectively evaluate the use of cyclocryocoagulation (CCC) in secondary neovascul... more Purpose: To retrospectively evaluate the use of cyclocryocoagulation (CCC) in secondary neovascular glaucomas performed at the Department of Ophthalmology, Faculty of Medicine, Charles University and University Hospital Hradec Králové in the years 2016–2019. Material and methods: In a retrospective study, 30 procedures of 26 eyes of 24 patients were evaluated. All patients underwent CCC surgery. The main entry criteria were the presence of secondary neovascular glaucoma in diabetes or on the basis of occlusion of the retinal artery or vein and subsequent dispensarization of the patient in the 1st and 6th month after the operation. The parameters evaluated were: the best-corrected visual acuity (BCVA), intraocular pressure value (IOP), data of pain and change in the number of active substances of antiglaucoma therapy. Results: The mean age of patients at the time of the procedure was 62 years (range 22–85 years). The average number of procedures per eye was 1.15 out of a total of 30 ...
Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2019
PURPOSE The aim of the study was evaluation and comparison of clinical results of two types of ro... more PURPOSE The aim of the study was evaluation and comparison of clinical results of two types of rotationally asymmetric multifocal intraocular lens (LENTIS Mplus and LENTIS MplusX). MATERIAL AND METHODS The study included 247 eyes of 124 patients aged 25 - 76 years (mean, 58 years). After phacoemulsification multifocal intraocular lens LENTIS Mplus (group A, n = 141) or LENTIS MplusX (group B, n = 106) was implanted. Patients were divided into two groups according to the type of intraocular lens. Patients were evaluated at 1 month, 3 months and 6 months after surgery. We assessed the uncorrected visual acuity, best corrected visual acuity, subjective refraction, contrast sensitivity and subjective satisfaction. RESULTS Mean preoperative monocular uncorrected distance visual acuity (UCDVA) in the group A was 0,40 ± 0,27; in the group B 0,34 ± 0,25. Postoperatively UCDVA was statistically significant improved in both groups (group A: 1,01 ± 0,20; group B: 0,90 ± 0,15). Mean preoperativ...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti
We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for id... more We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for idiopathic macular hole, with peeling MLI (membrana limitans interna) and instillation of gas tamponade (20% SF6 - sulfur hexafluoride). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). There was no other ocular pathology besides idiopathic macular holes (IMD). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT, Carl Zeiss). For examination of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, BCVA in the near (Jaeger charts), multifocal electroretinography (MfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. ANATOMICAL RESULTS: The primary closure of the IM...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2007
In a randomized prospective open study the authors followed up the influence of latanoprost 0.005... more In a randomized prospective open study the authors followed up the influence of latanoprost 0.005 % on the changes of the ciliary body thickness by means of ultrasound biomicroscopy. The study group consisted of 40 eyes of 24 patients with primary open angle glaucoma not treated with latanoprost before. At the entry visit and further after 2 and 8 weeks, according to the study protocol, a complex ophthalmologic examination was performed; especially anatomical relation between the cornea and the iris, configuration of the anterior chamber angle, and furthermore the best visual acuity for far and near, intraocular pressure measurement by means of applanation method, anterior chamber depth, and the pupil size. The thickness of the ciliary body was measured in the distance of 1,500 microm (T1), 2,000 microm (T2), and 2,500 microm (T3) from the scleral spur. A slight decrease of T1 comparing with the initial values was found: from 668 +/- 117 microm in the beginning, to 633 +/- 127 micro...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2010
A 73-year-old woman presented with a best-corrected visual acuity of 6/9 in her right eye and 6/3... more A 73-year-old woman presented with a best-corrected visual acuity of 6/9 in her right eye and 6/36 in her left eye. Fundus examination revealed signs of age related macular degeneration in both eyes. In her right eye it was just dry form of the disease, in left one an elevated lesion associated with retinal cystoid edema was detected. Ocular coherence tomography and fluorescein angiogram confirmed a subfoveal occult choroidal neovascular membrane. We decided for intravitreal ranibizumab (Lucentis, 0.5 mg) treatment. One month after first injection, best-corrected visual acuity improved to 6/15 in her left eye. After six months, best-corrected visual acuity further improved to 6/12, with complete resolution subretinal fluid on ocular coherence tomography.
Monitoring of the impact of modern surgical procedures on the central portion of retina using ele... more Monitoring of the impact of modern surgical procedures on the central portion of retina using electrophysiological methods. Libor Hejsek We evaluate annual anatomical and functional results of 20G pars plana vitrectomy for idiopathic macular hole, with peeling of the membrana limitans interna and instillation of gas tamponade (20% SF6). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT ™, Carl Zeiss). Function of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, multifocal electroretinography (mfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. Anatomical results: the primary closure of the IMD occurr...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2012
To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-... more To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-related macular degeneration (ARMD) indicated for the intravitreal application of Ranibizumab (Lucentis, Novartis Pharma AG). To evaluate the efficacy of combined local preparation with broad-spectrum antibiotic moxifloxacine 0.5% (Vigamox, Alcon) and povidone iodine solution, 5% (Betadine, Egis Pharmaceuticals, LTD.) and to evaluate subjective toleration of moxifloxacin. In a prospective, non-randomized study were evaluated 20 eyes of 20 patients treated by means of intravitreally-applied ranibizumab. In all patients, the swabs from the conjunctival sac of the treated eye were repeatedly taken in a given time-schedule--before the start of using moxifloxacin, on the day of the intravitreal application of ranibizumab--before the irrigation of the conjunctival sac with povidone iodine solution, 5%, further after the irrigation--immediately before the injection and the control was token thr...
Background and Aims. Currently around 67 million people in Europe are affected by some form of ag... more Background and Aims. Currently around 67 million people in Europe are affected by some form of age-related macular degeneration (AMD). As most known types of vitreoretinal (VR) interface disorders can coexist with AMD and as we can favourably affect the former with vitreoretinal surgery, our goal was to evaluate the results of vitreoretinal interface disorder surgery with macular peeling in relation to coincident intermediate stage AMD. Methodology. This was a retrospective evaluation of eyes operated with 25-gauge pars plana vitrectomy (PPV). The monitored parameters were anatomical and functional findings and, safety of the procedure. The surface of the macula was stained with trypan blue and treated (peeling) with a disposable microforceps. 10% perfluoropropane, or the air tamponade was used. Distance visual acuity was examined on the ETDRS chart, the macular finding was monitored by OCT and photodocumented. The post-operative face-down position was 3-5 days. The follow-up period was 6 months. Results. 17 eyes (14 patients, woman 86%) mean age 74 years. The primary indications for the procedure were: idiopathic macular hole (IMD) 59%, epiretinal membrane 29% and vitreomacular traction syndrome 12%. Ophthalmoscopic and OCT findings of intermediate dry form of AMD (100%), in 24% was drusoid ablation of the pigment leaf. In all cases of IMD, primary closure occurred. Input visual acuity 0.1-0.6 improved to 0.2-0.9 at the end of the follow-up period (P<0.05). No complications during surgery or progression of AMD in the follow-up period were observed. Conclusion. PPV for vitreoretinal interface disorders have similar anatomical results, whether the outer part of the retina is disrupted by intermediate AMD or not. Functional results are affected by possible disruption of the RPE or the outer layers of the neuroretina by AMD. The PPV procedure has a standard security profile. It is safe and does not affect the progression of AMD in the short term.
Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2019
INTRODUCTION The aim of this work is to evaluate our own results of surgical treatment of retinal... more INTRODUCTION The aim of this work is to evaluate our own results of surgical treatment of retinal detachment in immature newborns. Retinopathy of prematurity (ROP) is one of the most complicated ocular disorders, both in terms of diagnosis and therapy. It is a potentially blinding illness that arises from the incomplete development of the bloodstream of the neuroretina of preterm infants. Currently, the most effective therapy is ablation of the avascular retina by laser photocoagulation or cryocoagulation. Despite this treatment, the immature retina may develop it´s detachment. METHODOLOGY We report 2 case-reports, retrospective results of 4-eyes in 2 patients with severe ocular and overall complications of prematurity. The ocular background of preterm babies was investigated in arteficial mydriasis by an indirect ophthalmoscope, and later with the RetCam photographic device. The ROP stages were evaluated according to the ICROP classification. All eyes were treated with cryo-retinop...
Pregnancy is a risk factor for the development of diabetic retinopathy and diabetic macular edema... more Pregnancy is a risk factor for the development of diabetic retinopathy and diabetic macular edema. Ideally, it is appropriate to perform laser treatment of advanced forms diabetic retinopathy before pregnancy, but in case of progression of diabetic retinopathy during pregnancy is laser treatment also indicated. The authors present a case of a young diabetic, who unexpectedly became pregnant. During pregnancy were accelerated changes of diabetic retinopathy. The visual acuity improved in both eye after repeated retinal laser treatment and pars plana vitrectomy in the left eye. The course of disease was documented with digital color fundus pictures, fluorescein angiography and optical coherence tomography.
on behalf of the INTREPID Study Group* Purpose: To determine the safety and efficacy of low-volta... more on behalf of the INTREPID Study Group* Purpose: To determine the safety and efficacy of low-voltage, external-beam, stereotactic radiotherapy (SRT) for patients with neovascular age-related macular degeneration (AMD). Design: Randomized, double-masked, sham-controlled, multicenter, clinical trial. Participants: A total of 230 participants with neovascular AMD who received !3 ranibizumab or bevacizumab injections within the preceding year and requiring treatment at enrollment. Methods: Participants received 16 Gray, 24 Gray, or sham SRT. All arms received pro re nata (PRN) ranibizumab for 12 months, with PRN bevacizumab or ranibizumab thereafter. Main Outcome Measures: Mean number of PRN injections; best-corrected visual acuity (BCVA); loss of <15 Early Treatment of Diabetic Retinopathy Study letters; change in optical coherence tomography central subfield thickness; and change in angiographic total lesion area and choroidal neovascularization (CNV) area. Results: At year 2, the 16 and 24 Gray arms received fewer PRN treatments compared with sham (mean 4.5,
The authors present an unusual case and clinical case report of a 21 year old patient who sustain... more The authors present an unusual case and clinical case report of a 21 year old patient who sustained a penetrating gunshot injury of his head (and both orbits). The left eye was dislocated in front of the eyelids and heavily damaged. The right eye looked normal. The place where the bullet entered the scull was located near the temporal margin of the right orbit, the exit wound was close to the temporal margin of the left orbit. After the accident the patient was conscious but his visual functions were not examined. The patient was consequently given sedatives and intubated. After his transportation to the hospital, he has undertaken several procedures under a complex intensive care and continual sedation. These included primary enucleation of the left eye, reconstruction of the margin of the left orbit and bilateral revision of the medial area of the orbits with the removal of bone fragments. After the completion of all imaging examinations there was no other pathology found except f...
The objective of this article is to provide an overview of the current situation with the use of ... more The objective of this article is to provide an overview of the current situation with the use of intraoperative optical coherence tomography (iOCT), and to present our own experience with this technology. retrospective evaluation of case reports of typical pathologies of the retina which were resolved by means of standard pars plana vitrectomy (PPV) with the use of intraoperative optical coherence tomography (iOCT) integrated into the surgical microscope OPMI Lumera 700 / Rescan 700 (Zeiss). Auxiliary techniques: best corrected visual acuity (BCVA) was tested on ETDRS tables, biomicroscopy was performed with a 78D lens and optical coherence tomography (OCT) with a Zeiss Cirrus instrument. The operations were performed in retrobulbar anaesthesia, three-port 23G PPV and with the aid of the surgical unit Constellation (ALCON). we present three case reports of 2 women (pathology of type of disorder of the vitreoretinal interface) and 1 man (proliferative diabetic retinopathy), with an a...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2014
Arterial hypertension is a serious health problem. Decompensation of blood pressure may cause man... more Arterial hypertension is a serious health problem. Decompensation of blood pressure may cause many ocular complications. We present three case reports of men with decompensated blood pressure and associated ocular complications. Successful compensation of blood pressure leads to objective improvement of fundus changes and vision.
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2013
Every eye surgery has its pitfalls and possible complications. Even after properly and noncomplic... more Every eye surgery has its pitfalls and possible complications. Even after properly and noncomplicated orbital or intraocular surgery there can develop a loss of visual acuity or visual field. In the perioperative period was on the operated eye for epimacular membrane (23G pars plana vitrectomy) retinal arterial occlusion with fatal consequences for visual function. Entrance visual acuity decreased from 20/63 to counting fingers. Risk factors for age-related and underlying diseases were accompanied by systemic hypotension and mild anemia. Commonly available topical and general therapy did not lead to any significant improvement.
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2014
Cytomegalovirus infection (CMV) in patients with acquired immunodeficiency syndrome (Acquired Imm... more Cytomegalovirus infection (CMV) in patients with acquired immunodeficiency syndrome (Acquired Immune Deficiency Syndrome, AIDS) is the most common opportunistic infection. This infection is harmless for healthy individuals, but for weakened individuals cause disease. The most common form of CMV-infection in patients with AIDS is cytomegalovirus retinitis, which occurs in 15% to 40% of cases. We report the case of aman twenty-five year old, treated for CMV retinitis and retinal vasculitis vessels. Prescribed Valcyte 900mg tbl. twice daily for 21 days with agood therapeutic effect. In patients with AIDS and decreased visual acuity is need be primarily thinking about the possible presence of CMV-infection and in time to start treatment.Key words: Cytomegalovirus (CMV) retinitis, AIDS, valganciklovir.
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2010
The choroidal neovascularization (CNV) is the leading cause of blindness in industrial countries.... more The choroidal neovascularization (CNV) is the leading cause of blindness in industrial countries. CNV in age-related macular degeneration (AMRD) is dynamic, multifactor process, which cause wasn't revealed until now. It is obvious that in multifactorial disease no single treatment is optimal, and that the monotherapy can't cover all factors leading to the CVN development. The contemporary modern and variably effective treatment techniques have common characteristic--the treatment is very expensive and it is necessary to repeat it to obtain the treatment effect. The authors refer about 18 months lasting period of follow-up of the group of 25 patients (9 men and 16 women, average age was 68 years, range, 59-76 years of age) who underwent the photodynamic therapy followed by ranibizumab intravitreal injections due to an active CNV. Mostly classical membranes were diagnosed in 18 cases (72%), minimally classical membranes in 5 cases (20%) and occult CNV in 2 patients (8%). The a...
Background. Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) ap... more Background. Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) appears in approx. 12% of cases. It is, therefore, one of the most common complications. IMH re-operation results tend to be better in eyes where IMH had been closed, while IMH re-operations in cases when the initial surgery had failed tend to be less suc-cessful: IMH often becomes even larger and visual acuity decreases, anatomical success rate of closure is about 60% and the resulting postoperative visual acuity is about 20/100. Aims. To establish anatomical and functional success rate of repeated operations of recurrent idiopathic macular hole. Materials and Methods. We evaluated the retrospective results of re-operations of persisting IMH that is cases in which the initial surgery did not result in closure: 6 eyes in 6 patients out of the overall 55 operated on IMH (primary PPV failed in almost 11 % of cases). The follow-up period was 18 months (since the first surgery). Results and Co...
Úvod: Diabetický makulární edém (DME) je nejčastější příčinou poklesu vidění u pacientů s diabete... more Úvod: Diabetický makulární edém (DME) je nejčastější příčinou poklesu vidění u pacientů s diabetem mellitem (DM) 2. typu. Naše studie má za cíl zhodnotit výsledky léčby mikropulzním laserem o vlnové délce 577 nm u pacientů s DME s tříměsíční a roční dobou sledování. Metodika a pacienti: Retrospektivní sledování pacientů se sledovací dobou 1 roku po léčbě zahrnuje 63 očí 37 pacientů s DME léčených v období od 09/2015 do 01/2017. V souboru převažovali diabetici s DM 2. typu (34 pacientů), DM 1. typu byl zastoupen u 3 pacientů. Difuzní DME byl přítomen u 54 očí, fokální DME u 9 očí. Většina (42 očí) měla neproliferativní formu diabetické retinopatie, 21 očí vykazovalo známky proliferativní diabetické retinopatie. Průměrná délka trvání DME celého souboru byla 29 měsíců (medián 21 měsíců). Pacienti byli kontrolováni většinou každé 3 měsíce. U všech pacientů byla provedena fotokoagulace makuly mikropulzním laserem o vlnové délce 577 nm (IQ 577 TM IRIDEX). Byl použit mikropulzní 5% duty cycle mód. Průměrná hodnota glykovaného hemoglobinu (HbA1c) v souboru byla 66,8 mmol/mol, max. hodnota 100 mmol/mol. Zjištěná data v souboru byla statisticky zpracována pomocí Friedmanova a Dunnova testu. Výsledky: Na konci ročního sledovacího období jsme dokumentovali zlepšení nejlépe korigované zrakové ostrosti (NKZO) o alespoň 5 písmen ETDRS optotypů u 20 očí a stabilizaci u 25 očí (45 očí, 71 % souboru), u 18 očí nastal pokles NKZO o více než 5 písmen ETDRS optotypů. Ve sledovaném období jeden rok jsme také zjistili, že v celém souboru v průměru poklesla NKZO ze vstupní hodnoty 62 písmen na 61,1 písmen (p › 0,05). Po jednom roce se centrální retinální tloušťka (CRT) snížila v průměru o 63 μm ze 442 μm na 379 μm (p= 0,0124). Závěr: V našem souboru jsme po ročním zhodnocení prokázali téměř u ¾ z celkového počtu očí zlepšení a stabilizaci NKZO u pacientů s DME léčených mikropulzním laserem. Statisticky signifikantního poklesu makulárního edému jsme dosáhli u všech očí sledovaného souboru.
Purpose: To retrospectively evaluate the use of cyclocryocoagulation (CCC) in secondary neovascul... more Purpose: To retrospectively evaluate the use of cyclocryocoagulation (CCC) in secondary neovascular glaucomas performed at the Department of Ophthalmology, Faculty of Medicine, Charles University and University Hospital Hradec Králové in the years 2016–2019. Material and methods: In a retrospective study, 30 procedures of 26 eyes of 24 patients were evaluated. All patients underwent CCC surgery. The main entry criteria were the presence of secondary neovascular glaucoma in diabetes or on the basis of occlusion of the retinal artery or vein and subsequent dispensarization of the patient in the 1st and 6th month after the operation. The parameters evaluated were: the best-corrected visual acuity (BCVA), intraocular pressure value (IOP), data of pain and change in the number of active substances of antiglaucoma therapy. Results: The mean age of patients at the time of the procedure was 62 years (range 22–85 years). The average number of procedures per eye was 1.15 out of a total of 30 ...
Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2019
PURPOSE The aim of the study was evaluation and comparison of clinical results of two types of ro... more PURPOSE The aim of the study was evaluation and comparison of clinical results of two types of rotationally asymmetric multifocal intraocular lens (LENTIS Mplus and LENTIS MplusX). MATERIAL AND METHODS The study included 247 eyes of 124 patients aged 25 - 76 years (mean, 58 years). After phacoemulsification multifocal intraocular lens LENTIS Mplus (group A, n = 141) or LENTIS MplusX (group B, n = 106) was implanted. Patients were divided into two groups according to the type of intraocular lens. Patients were evaluated at 1 month, 3 months and 6 months after surgery. We assessed the uncorrected visual acuity, best corrected visual acuity, subjective refraction, contrast sensitivity and subjective satisfaction. RESULTS Mean preoperative monocular uncorrected distance visual acuity (UCDVA) in the group A was 0,40 ± 0,27; in the group B 0,34 ± 0,25. Postoperatively UCDVA was statistically significant improved in both groups (group A: 1,01 ± 0,20; group B: 0,90 ± 0,15). Mean preoperativ...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti
We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for id... more We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for idiopathic macular hole, with peeling MLI (membrana limitans interna) and instillation of gas tamponade (20% SF6 - sulfur hexafluoride). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). There was no other ocular pathology besides idiopathic macular holes (IMD). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT, Carl Zeiss). For examination of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, BCVA in the near (Jaeger charts), multifocal electroretinography (MfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. ANATOMICAL RESULTS: The primary closure of the IM...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2007
In a randomized prospective open study the authors followed up the influence of latanoprost 0.005... more In a randomized prospective open study the authors followed up the influence of latanoprost 0.005 % on the changes of the ciliary body thickness by means of ultrasound biomicroscopy. The study group consisted of 40 eyes of 24 patients with primary open angle glaucoma not treated with latanoprost before. At the entry visit and further after 2 and 8 weeks, according to the study protocol, a complex ophthalmologic examination was performed; especially anatomical relation between the cornea and the iris, configuration of the anterior chamber angle, and furthermore the best visual acuity for far and near, intraocular pressure measurement by means of applanation method, anterior chamber depth, and the pupil size. The thickness of the ciliary body was measured in the distance of 1,500 microm (T1), 2,000 microm (T2), and 2,500 microm (T3) from the scleral spur. A slight decrease of T1 comparing with the initial values was found: from 668 +/- 117 microm in the beginning, to 633 +/- 127 micro...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2010
A 73-year-old woman presented with a best-corrected visual acuity of 6/9 in her right eye and 6/3... more A 73-year-old woman presented with a best-corrected visual acuity of 6/9 in her right eye and 6/36 in her left eye. Fundus examination revealed signs of age related macular degeneration in both eyes. In her right eye it was just dry form of the disease, in left one an elevated lesion associated with retinal cystoid edema was detected. Ocular coherence tomography and fluorescein angiogram confirmed a subfoveal occult choroidal neovascular membrane. We decided for intravitreal ranibizumab (Lucentis, 0.5 mg) treatment. One month after first injection, best-corrected visual acuity improved to 6/15 in her left eye. After six months, best-corrected visual acuity further improved to 6/12, with complete resolution subretinal fluid on ocular coherence tomography.
Monitoring of the impact of modern surgical procedures on the central portion of retina using ele... more Monitoring of the impact of modern surgical procedures on the central portion of retina using electrophysiological methods. Libor Hejsek We evaluate annual anatomical and functional results of 20G pars plana vitrectomy for idiopathic macular hole, with peeling of the membrana limitans interna and instillation of gas tamponade (20% SF6). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT ™, Carl Zeiss). Function of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, multifocal electroretinography (mfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. Anatomical results: the primary closure of the IMD occurr...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2012
To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-... more To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-related macular degeneration (ARMD) indicated for the intravitreal application of Ranibizumab (Lucentis, Novartis Pharma AG). To evaluate the efficacy of combined local preparation with broad-spectrum antibiotic moxifloxacine 0.5% (Vigamox, Alcon) and povidone iodine solution, 5% (Betadine, Egis Pharmaceuticals, LTD.) and to evaluate subjective toleration of moxifloxacin. In a prospective, non-randomized study were evaluated 20 eyes of 20 patients treated by means of intravitreally-applied ranibizumab. In all patients, the swabs from the conjunctival sac of the treated eye were repeatedly taken in a given time-schedule--before the start of using moxifloxacin, on the day of the intravitreal application of ranibizumab--before the irrigation of the conjunctival sac with povidone iodine solution, 5%, further after the irrigation--immediately before the injection and the control was token thr...
Background and Aims. Currently around 67 million people in Europe are affected by some form of ag... more Background and Aims. Currently around 67 million people in Europe are affected by some form of age-related macular degeneration (AMD). As most known types of vitreoretinal (VR) interface disorders can coexist with AMD and as we can favourably affect the former with vitreoretinal surgery, our goal was to evaluate the results of vitreoretinal interface disorder surgery with macular peeling in relation to coincident intermediate stage AMD. Methodology. This was a retrospective evaluation of eyes operated with 25-gauge pars plana vitrectomy (PPV). The monitored parameters were anatomical and functional findings and, safety of the procedure. The surface of the macula was stained with trypan blue and treated (peeling) with a disposable microforceps. 10% perfluoropropane, or the air tamponade was used. Distance visual acuity was examined on the ETDRS chart, the macular finding was monitored by OCT and photodocumented. The post-operative face-down position was 3-5 days. The follow-up period was 6 months. Results. 17 eyes (14 patients, woman 86%) mean age 74 years. The primary indications for the procedure were: idiopathic macular hole (IMD) 59%, epiretinal membrane 29% and vitreomacular traction syndrome 12%. Ophthalmoscopic and OCT findings of intermediate dry form of AMD (100%), in 24% was drusoid ablation of the pigment leaf. In all cases of IMD, primary closure occurred. Input visual acuity 0.1-0.6 improved to 0.2-0.9 at the end of the follow-up period (P<0.05). No complications during surgery or progression of AMD in the follow-up period were observed. Conclusion. PPV for vitreoretinal interface disorders have similar anatomical results, whether the outer part of the retina is disrupted by intermediate AMD or not. Functional results are affected by possible disruption of the RPE or the outer layers of the neuroretina by AMD. The PPV procedure has a standard security profile. It is safe and does not affect the progression of AMD in the short term.
Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2019
INTRODUCTION The aim of this work is to evaluate our own results of surgical treatment of retinal... more INTRODUCTION The aim of this work is to evaluate our own results of surgical treatment of retinal detachment in immature newborns. Retinopathy of prematurity (ROP) is one of the most complicated ocular disorders, both in terms of diagnosis and therapy. It is a potentially blinding illness that arises from the incomplete development of the bloodstream of the neuroretina of preterm infants. Currently, the most effective therapy is ablation of the avascular retina by laser photocoagulation or cryocoagulation. Despite this treatment, the immature retina may develop it´s detachment. METHODOLOGY We report 2 case-reports, retrospective results of 4-eyes in 2 patients with severe ocular and overall complications of prematurity. The ocular background of preterm babies was investigated in arteficial mydriasis by an indirect ophthalmoscope, and later with the RetCam photographic device. The ROP stages were evaluated according to the ICROP classification. All eyes were treated with cryo-retinop...
Pregnancy is a risk factor for the development of diabetic retinopathy and diabetic macular edema... more Pregnancy is a risk factor for the development of diabetic retinopathy and diabetic macular edema. Ideally, it is appropriate to perform laser treatment of advanced forms diabetic retinopathy before pregnancy, but in case of progression of diabetic retinopathy during pregnancy is laser treatment also indicated. The authors present a case of a young diabetic, who unexpectedly became pregnant. During pregnancy were accelerated changes of diabetic retinopathy. The visual acuity improved in both eye after repeated retinal laser treatment and pars plana vitrectomy in the left eye. The course of disease was documented with digital color fundus pictures, fluorescein angiography and optical coherence tomography.
on behalf of the INTREPID Study Group* Purpose: To determine the safety and efficacy of low-volta... more on behalf of the INTREPID Study Group* Purpose: To determine the safety and efficacy of low-voltage, external-beam, stereotactic radiotherapy (SRT) for patients with neovascular age-related macular degeneration (AMD). Design: Randomized, double-masked, sham-controlled, multicenter, clinical trial. Participants: A total of 230 participants with neovascular AMD who received !3 ranibizumab or bevacizumab injections within the preceding year and requiring treatment at enrollment. Methods: Participants received 16 Gray, 24 Gray, or sham SRT. All arms received pro re nata (PRN) ranibizumab for 12 months, with PRN bevacizumab or ranibizumab thereafter. Main Outcome Measures: Mean number of PRN injections; best-corrected visual acuity (BCVA); loss of <15 Early Treatment of Diabetic Retinopathy Study letters; change in optical coherence tomography central subfield thickness; and change in angiographic total lesion area and choroidal neovascularization (CNV) area. Results: At year 2, the 16 and 24 Gray arms received fewer PRN treatments compared with sham (mean 4.5,
The authors present an unusual case and clinical case report of a 21 year old patient who sustain... more The authors present an unusual case and clinical case report of a 21 year old patient who sustained a penetrating gunshot injury of his head (and both orbits). The left eye was dislocated in front of the eyelids and heavily damaged. The right eye looked normal. The place where the bullet entered the scull was located near the temporal margin of the right orbit, the exit wound was close to the temporal margin of the left orbit. After the accident the patient was conscious but his visual functions were not examined. The patient was consequently given sedatives and intubated. After his transportation to the hospital, he has undertaken several procedures under a complex intensive care and continual sedation. These included primary enucleation of the left eye, reconstruction of the margin of the left orbit and bilateral revision of the medial area of the orbits with the removal of bone fragments. After the completion of all imaging examinations there was no other pathology found except f...
The objective of this article is to provide an overview of the current situation with the use of ... more The objective of this article is to provide an overview of the current situation with the use of intraoperative optical coherence tomography (iOCT), and to present our own experience with this technology. retrospective evaluation of case reports of typical pathologies of the retina which were resolved by means of standard pars plana vitrectomy (PPV) with the use of intraoperative optical coherence tomography (iOCT) integrated into the surgical microscope OPMI Lumera 700 / Rescan 700 (Zeiss). Auxiliary techniques: best corrected visual acuity (BCVA) was tested on ETDRS tables, biomicroscopy was performed with a 78D lens and optical coherence tomography (OCT) with a Zeiss Cirrus instrument. The operations were performed in retrobulbar anaesthesia, three-port 23G PPV and with the aid of the surgical unit Constellation (ALCON). we present three case reports of 2 women (pathology of type of disorder of the vitreoretinal interface) and 1 man (proliferative diabetic retinopathy), with an a...
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2014
Arterial hypertension is a serious health problem. Decompensation of blood pressure may cause man... more Arterial hypertension is a serious health problem. Decompensation of blood pressure may cause many ocular complications. We present three case reports of men with decompensated blood pressure and associated ocular complications. Successful compensation of blood pressure leads to objective improvement of fundus changes and vision.
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2013
Every eye surgery has its pitfalls and possible complications. Even after properly and noncomplic... more Every eye surgery has its pitfalls and possible complications. Even after properly and noncomplicated orbital or intraocular surgery there can develop a loss of visual acuity or visual field. In the perioperative period was on the operated eye for epimacular membrane (23G pars plana vitrectomy) retinal arterial occlusion with fatal consequences for visual function. Entrance visual acuity decreased from 20/63 to counting fingers. Risk factors for age-related and underlying diseases were accompanied by systemic hypotension and mild anemia. Commonly available topical and general therapy did not lead to any significant improvement.
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2014
Cytomegalovirus infection (CMV) in patients with acquired immunodeficiency syndrome (Acquired Imm... more Cytomegalovirus infection (CMV) in patients with acquired immunodeficiency syndrome (Acquired Immune Deficiency Syndrome, AIDS) is the most common opportunistic infection. This infection is harmless for healthy individuals, but for weakened individuals cause disease. The most common form of CMV-infection in patients with AIDS is cytomegalovirus retinitis, which occurs in 15% to 40% of cases. We report the case of aman twenty-five year old, treated for CMV retinitis and retinal vasculitis vessels. Prescribed Valcyte 900mg tbl. twice daily for 21 days with agood therapeutic effect. In patients with AIDS and decreased visual acuity is need be primarily thinking about the possible presence of CMV-infection and in time to start treatment.Key words: Cytomegalovirus (CMV) retinitis, AIDS, valganciklovir.
Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2010
The choroidal neovascularization (CNV) is the leading cause of blindness in industrial countries.... more The choroidal neovascularization (CNV) is the leading cause of blindness in industrial countries. CNV in age-related macular degeneration (AMRD) is dynamic, multifactor process, which cause wasn't revealed until now. It is obvious that in multifactorial disease no single treatment is optimal, and that the monotherapy can't cover all factors leading to the CVN development. The contemporary modern and variably effective treatment techniques have common characteristic--the treatment is very expensive and it is necessary to repeat it to obtain the treatment effect. The authors refer about 18 months lasting period of follow-up of the group of 25 patients (9 men and 16 women, average age was 68 years, range, 59-76 years of age) who underwent the photodynamic therapy followed by ranibizumab intravitreal injections due to an active CNV. Mostly classical membranes were diagnosed in 18 cases (72%), minimally classical membranes in 5 cases (20%) and occult CNV in 2 patients (8%). The a...
Background. Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) ap... more Background. Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) appears in approx. 12% of cases. It is, therefore, one of the most common complications. IMH re-operation results tend to be better in eyes where IMH had been closed, while IMH re-operations in cases when the initial surgery had failed tend to be less suc-cessful: IMH often becomes even larger and visual acuity decreases, anatomical success rate of closure is about 60% and the resulting postoperative visual acuity is about 20/100. Aims. To establish anatomical and functional success rate of repeated operations of recurrent idiopathic macular hole. Materials and Methods. We evaluated the retrospective results of re-operations of persisting IMH that is cases in which the initial surgery did not result in closure: 6 eyes in 6 patients out of the overall 55 operated on IMH (primary PPV failed in almost 11 % of cases). The follow-up period was 18 months (since the first surgery). Results and Co...
Úvod: Diabetický makulární edém (DME) je nejčastější příčinou poklesu vidění u pacientů s diabete... more Úvod: Diabetický makulární edém (DME) je nejčastější příčinou poklesu vidění u pacientů s diabetem mellitem (DM) 2. typu. Naše studie má za cíl zhodnotit výsledky léčby mikropulzním laserem o vlnové délce 577 nm u pacientů s DME s tříměsíční a roční dobou sledování. Metodika a pacienti: Retrospektivní sledování pacientů se sledovací dobou 1 roku po léčbě zahrnuje 63 očí 37 pacientů s DME léčených v období od 09/2015 do 01/2017. V souboru převažovali diabetici s DM 2. typu (34 pacientů), DM 1. typu byl zastoupen u 3 pacientů. Difuzní DME byl přítomen u 54 očí, fokální DME u 9 očí. Většina (42 očí) měla neproliferativní formu diabetické retinopatie, 21 očí vykazovalo známky proliferativní diabetické retinopatie. Průměrná délka trvání DME celého souboru byla 29 měsíců (medián 21 měsíců). Pacienti byli kontrolováni většinou každé 3 měsíce. U všech pacientů byla provedena fotokoagulace makuly mikropulzním laserem o vlnové délce 577 nm (IQ 577 TM IRIDEX). Byl použit mikropulzní 5% duty cycle mód. Průměrná hodnota glykovaného hemoglobinu (HbA1c) v souboru byla 66,8 mmol/mol, max. hodnota 100 mmol/mol. Zjištěná data v souboru byla statisticky zpracována pomocí Friedmanova a Dunnova testu. Výsledky: Na konci ročního sledovacího období jsme dokumentovali zlepšení nejlépe korigované zrakové ostrosti (NKZO) o alespoň 5 písmen ETDRS optotypů u 20 očí a stabilizaci u 25 očí (45 očí, 71 % souboru), u 18 očí nastal pokles NKZO o více než 5 písmen ETDRS optotypů. Ve sledovaném období jeden rok jsme také zjistili, že v celém souboru v průměru poklesla NKZO ze vstupní hodnoty 62 písmen na 61,1 písmen (p › 0,05). Po jednom roce se centrální retinální tloušťka (CRT) snížila v průměru o 63 μm ze 442 μm na 379 μm (p= 0,0124). Závěr: V našem souboru jsme po ročním zhodnocení prokázali téměř u ¾ z celkového počtu očí zlepšení a stabilizaci NKZO u pacientů s DME léčených mikropulzním laserem. Statisticky signifikantního poklesu makulárního edému jsme dosáhli u všech očí sledovaného souboru.
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