[The potential use of honey in ophthalmology]. / Moznosti vyuzitia vcelieho medu v oftalmológii.

Honey is considered to be a natural product with antibacterial and anti-inflammatory properties. Its successful application in the treatment of chronic wounds and burns has promoted its further clinical use in other clinical departments, including ophthalmology. One of the major advantages of honey is its multi-factorial antibacterial action and the fact that there is no risk of developing bacterial resistance to it. In this work we discuss the current knowledge and new perspectives for honey therapy in treatment of eye diseases such as dry eye disease, age-related macular degeneration, cataracts and bullous keratopathy. Key words: honey, eye diseases, natural product, treatment.

[The cataract surgery survey in Slovakia, E.U., in 2008-2010]. / Stav chirurgie katarakty na Slovensku v rokoch 2008-2010.

Authors in retrospective study give the results of cataract surgery in Slovak Republic since 2008 to 2010. There are compiled results of the filled forms from all ophthalmology centers where cataract surgery were done, in this study.

[Comparison of topic mydriasis and mydriasis achieved by soaked cellulose in the conjunctival sac]. / Porovnanie topickej mydriázy a mydriázy pomocou nasiaknutej celulózy vo fornixe.

AIM: To compare mydriasis before the cataract surgery after the local application of mydriatics in to the conjunctival sac with mydriasis achieved using the mydriatic solution in soaked piece of cellulose applied in to the lower fornix. The same mydriatics (tropicamide 0.5 %, phenylephrine 10%, and homatropine 4 %) were used. METHODS: In a prospective, non-randomized study the authors measured maximal artificial mydriasis in 100 patients (60 women, 40 men) in 100 eyes before the cataract surgery. The mean age of the patients was 70.17 years (range, 42 - 91 years). The patients were divided into two groups (A, B), each of 50 persons: In the group A, during the 10 - 15 minutes period, the mydriatics, tropicamide 0.5%, phenylephrine 10%, and homatropine 4%, were topically applied three times. In the patients of the B group, the conjunctival sac was anesthetized by oxybuprocaine 0.4%; and afterwards, a cut piece of cellulose (Kettenbach) soaked in to the mydriatics solution was applied for 30 - 40 minutes in to the conjunctival sac and the eyelids were taped together. The mydriatic solution was mixed by tropicamide 0.5%, phenylephrine 10%, and homatropine 4%, of equal doses. On the surgery table, before the operation, th soaked cellulose was removed, and thereafter the achieved preoperative horizontal size of the pupil was measured with caliper under the operation microscope. The achieved preoperative pupillary width in the group A and B were compared. The authors noticed also subjective symptoms and objective signs in both groups of patients. For statistical comparison of the average mydriasis between the A and B group of patients, the unpaired Student t test was used. As statistically significant we considered p < 0.05. RESULTS: The average mydriasis in the A group (mydriatic drops topically) was 7.84 +/- 0.99 mm. In the B group of patients (cut piece of cellulose soaked in to the mydriatics solution), the average mydriasis was 7.94 +/- 1.03 mm. The authors did not found significant difference in the diameters between the A and the B group of patients (p = 0.622; p > 0.05). In the B group of patients, subjective symptoms as well as objective signs appeared (burning sensation, sticking, pain, and corneal epithelium erosion); these problems were caused by the triangle shape and the size of the cut cellulose piece. CONCLUSION: Artificial preoperative mydriasis in patients in both our groups was very good. Topic classically introduced preoperative mydriasis has its stable place also in contemporary modern cataract surgery; the mydriasis achieved by soaked cellulose may save the nurses' time.

[Morphologic changes of anterior segment of the eye after cataract surgery]. / Morfologické zmeny prednéh segmentu oka po operácii katarakty.

OBJECTIVES: The goal of our study was to evaluate the changes of the anterior chamber and how these changes influence the intraocular pressure in patients, with diagnosed cataract only and with patients with cataract and angle closed glaucoma. MATERIAL AND METHODS: In this study 82 eyes in 82 patients were involved, who were divided into two groups. The first one, consists 60 of patients only with cataract and the second one consists 22 of patients with cataract and closed-angle glaucoma. We have measured the depth of the anterior chamber and the width of the iridocorneal angle with the help of anterior chamber optic coherent tomography and the intraocular pressure before and five weeks after the cataract surgery. RESULTS: Anterior chambers of all patients were deeper after cataract surgery. In the first group, patients only with cataract, the anterior chamber were deeper of 1.4 mm and in the second group the anterior chamber were deeper of 1.5 mm. The iridocorneal angle has opened at 3 o'clock from 23.2 +/- 9.5 degrees to 35.5 +/- 6.8 degrees and at 9 o'clock from 23.7 +/- 8.8 degrees na 36.4 +/- 7.9 degrees in the first group. Same changes were evaluate in patients with angle closed glaucoma at 3 o'clock the angle deepened from 18.5 +/- 10.0 degrees to 31.7 +/- 7.0 degrees and at 9 o'clock from 20.3 +/- 10.2 to 34.6 +/- 7.6 degrees. The values of intraocular pressure decreased from 14.8 +/- 3.6 mmHg to 13.3 +/- 2.9 mmHg in cataract only group and from 17.9 +/- 4 mmHg to 15.9 +/- 3.8 mmHg in the second group respectively. The deepening of the anterior chamber and opening of the iridocorneal angle with decreasing of the intraocular pressure after the cataract surgery are statistically significant P < 0.001. CONCLUSIONS: Cataract surgery deepen the anterior chamber significantly, it wides the iridocorneal angle and lowers intraocular pressure.

[Posterior capsule opacification in long-term follow-up of patients after implantation of hydrophilic/hydrophobic intraocular lens Acri.Smart]. / Opacifikácia zadného puzdra pri dlhodobom sledovaní pacientov po implantácii hydrofilnej/hydrofóbnej sosovky Acri.Smart.

AIM: The aim of the retrospective study was to establish the frequency of the posterior lens capsule opacification after the cataract surgery and artificial intraocular lens (IOL) Acri.Smart 46S (Acri.Tech Zeiss) implantation. MATERIAL AND METHODS: The study group consisted of 72 eyes (30 men and 28 women), their average age was 65.4 +/- 8.4 years, with performed cataract surgery and implanted IOL Acri.Smart 46S (Acri.Tech Zeiss). After the average period of 32.4 +/- 7.3 months after the surgery, the patients underwent the examination with refractive error measurement, uncorrected and best-corrected visual acuity for for, and posterior lens capsule transparency examination with dilated pupils and with retroillumination photography taken by NIDEK EAS-100 device. RESULTS: After the average follow-up period of 32.4 +/- 7.3 months after the surgery, the refractive error was -0.32 +/- 0.8 diopters and average cylindrical error -0.8 +/- 0.6 Dcyl. The uncorrected visual acuity (UCVA) was 0.72 +/- 0.3, and the best-corrected visual acuity (BCVA) 0.95 +/- 0.2. The average diameter of the examined posterior capsule was 5.89 +/- 2.1 mm, and the transparency of the posterior capsule was 98.41 +/- 8.5%. In two eyes (2.7%) only, the YAG capsulotomy was performed. CONCLUSION: The IOL Acri.Smart is safe, easy to implant IOL, which meets the requirements of the microincision surgery. The IOL had very low incidence of posterior lens capsule opacification, and in two eyes (2.7%) only the YAG capsulotomy was performed.

[Treatment of angioid streaks with anti-VEGF]. / Liecba angioid streaks (lakové trhliny) pomocou anti-VEGF.

PURPOSE: To evaluate the possibility to treat the chorioidal neovascularisation in angioid streaks with the help of Bevacizumab. Chorioidal neovascularisation is here the main reason responsible for destroying the vision and affects about 70-85% of patients with this disease. MATERIAL AND METHODS: 50 years old woman with 2 weeks anamnesis of worsening of vision on left eye. She claims deformed view in the middle of the visual field and mild decrease of visual acuity. BCVA was 0.9 and examination with Amsler grid showed line distorsion in the central part. After fundus examination, angiography and OCT we set diagnosis: angioid streaks complicated by subfoveal chorioidal neovascularisation. We proposed patient treatment with intravitreal Bevacizumab and subsequently started the therapy. RESULTS: One week after bevacizumab application, patient claims vanishing of vision distortion. In four weeks metamorphopsis completely disappeared and BCVA reached 1.2. OCT and FAG showed less leakage. After initial improvement and 7 months of stand still there comes again to vision deterioration (BCVA 0.7). We were obliged to reinject 1.25 mg of Bevacizumab and VA improved to 0.9 and also the deformation was less. Three months after second injection VA was again decreased and patient was treated with third injection. Patient is followed up for period of 12 months with mild deformation of picture and VA 0.7. It was not observed any side effect of treatment. CONCLUSIONS: The treatment of the chorioidal neovascularisation in angioid streaks is another possibility with the help of Bevacizumab.With this treatment can be delayed the devastation of VA with subfoveal neovascularization. It seems that the treatment is only temporally and during the 12 months follow up came to a few relapse.

[The treatment of the rubeosis of the iris and the neovascular glaucoma in proliferative diabetic retinopathy by means of anti-VEGF]. / Liecba rubeózy dúhovky a neovaskulárneho glaukómu pri proliferatívnej diabetickej retinopatii pomocou anti-VEGF.

The rubeosis of the iris is a serious complication especially in diabetic retinopathy and retinal veins occlusion. Cytokines, especially the vascular growing factor (VEGF), are responsible for the forming of new vessels. The treatment that inhibits the effect of the VEGF presents new possibilities in the neovascular diseases treatment. Bevacizumab (Avastin) is an anti-VEGF antibody that blocks all forms of VEGF-A. In three eyes with proliferative diabetic retinopathy and neovascularization of the iris and the anterior chamber angle, the dose of 1.25 mg of Avastin was applied intravitrealy. Just one week after the application of the drug, the decrease of the leakage on the iris, and the total disappearance of the neovascularization in three weeks were visible on the fluorescein angiogram. The recurrence of the neovascularization was found in one eye after three months and the treatment had to be repeated. Nine months after the second application, the disease is stabilized without the neovascularization. The intraocular pressure was elevated in two eyes before the application of Avastin, and was refractive to the treatment. After the disappearance of the neovascularization, the intraocular pressure was normalized and it was possible to terminate the antiglaucomatous therapy. The bevacizumab intravitreal treatment of the neovascularization of the iris and the anterior chamber angle was proved to be efficient, the neovascularization disappeared and the intraocular pressure was normalized. There were no side effects after the bevacizumab applications in any of our patients.

[The intraocular lens dioptric power calculation after refractive procedures in myopia]. / Výpocet vnútroocnej sosovky po myo- pických refrakcných operáciách.

AIM: To evaluate the efficiency of the intraocular lens (IOL) dioptric power calculation before the cataract surgery in patients after photorefractive keratectomia (PRK) in myopia. METHODS: Six eyes of three patients were included in a prospective, non-randomized study. In all six eyes, the exact values of the preoperative corneal curvature, and in some of them, the exact value of the removed myopia were not available. The IOL power was calculated by means of formula, which is based on data not affected by the refractive surgery: axial length of the eyeball, depth of the anterior camber, and visual acuity for far corrected with glasses after the cataract surgery. The last value we can achieve not until after the surgery, so because of this reason, the surgery is divided into two stages. In stage one, the cataract is removed only, and on the next day, after the IOL power calculation, in the second stage, the IOL implantation is performed. RESULTS: Three months after the cataract surgery, the refractive error was up to +/- 1.0 diopter in all eyes, and the corrected as well as uncorrected visual acuity improved in every single eye. CONCLUSION: For patients, who previously underwent refractive procedure and no exact preoperative values are available, the method of two stages' cataract surgery is method of choice. Disadvantage of this method is that the patients must go two times to the operation theatre; the advantage is very exact IOL power calculation and the patient's satisfaction.

[Pigmentary glaucoma after implantation of the iris claw intraocular lens]. / Pigmentový glaukóm po negatívnej iris claw VOS.

The authors refer about a female patient with pigmentary glaucoma after implantation of iris claw intraocular negative dioptric power lens. Because of high myopia, eight years ago, a phakic iris claw intraocular negative dioptric power lens was implanted in the right eye and a photorefractive keratectomy (PRK) was performed in the left eye in a 32 years old woman. During the postoperative examinations the patient complained about headaches, and in the right eye elevated intraocular pressure was detected. On the intraocular lens surface, as well as in the anterior chamber angle, a dispersion of pigmented cells was detected and the perimetric examination revealed visual field defects characteristic for glaucoma. Findings in the left eye were normal. In the literature, reports about secondary glaucoma in eye with implanted iris claw lens and functional iridectomy are not so common. With growing number of implanted phakic iris claw intraocular lenses, the long-term follow up of those patients will be useful.

[Is it possible to accurately measure intraocular pressure after refractive surgery?]. / Je mozné presné meranie vnútroocného tlaku po refrakcných operáciách?

OBJECTIVE: To evaluate how the change of thickness or curving of the cornea after refraction operations (PRK or LASIK) influences the intraocular pressure (IOP) during assessment with a noncontact tonometer. PLACE OF INVESTIGATION: Ophthalmological Clinic SPAM and Ophthalmological ambulance EXCIMER. MATERIAL AND METHODS: With regard to the performed refraction operation the patients were divided into two groups. The first group comprised 87 patients where PRK was performed to correct myopia. The mean myopia in this group was -5.27 D +/- 2.32. The second group comprised 62 patients where LASIK surgery was performed to correct myopia. The mean myopia in this group was -10.18 +/- 4.36. IOP was assessed by means of a noncontact tonometer before and 6 months after surgery. RESULTS: In the first group a mean reduction of IOP by 4.8 +/- 2.1 mm Hg occurred. The central thickness of the cornea declined on average by 55.69 +/- 28.9 micros and the curving of the cornea diminished on average by 3.72 D +/- 1.76 D. In the second group of patients the IOP declined on average by 7.97 +/- 2.04 mm Hg. The central thickness of the cornea diminished by 78.75 microns +/- 42.26 and the curving of the cornea by 4.65 D +/- 2.07. In both groups a significant correlation was found between the reduction of IOP and the central thickness and curving of the cornea. CONCLUSION: Diminution of the thickness of the central cornea and diminution of the curving lead to lower values of the IOP. There is a direct correlation between thinning of the cornea and the decline of IOP.

[Treatment of severe caustic injuries of the anterior segment of the eye with limbal stem cell transplantation, penetrating keratoplasty and amnionic membrane transplantation]. / Liecba t'azkých poleptaní predného segmentu oka transplantáciou kmenových limbálnych buniek, perforujúcou keratoplastikou a transplantáciou amniovej blany.

The concept of limbal stem cells (LSC) opened new possibilities for the treatment of severe caustic damage of the anterior segment. These possibilities include transplantation of LSC, perforating keratoplasty, possibly transplantation of the amniotic membrane. In three patients with severe caustic damage of the anterior segment of the eye the authors implemented transplantation of LSC, perforating keratoplasty and in one patient also transplantation of the amniotic membrane. Where only one eye was damaged LSC for transplantation were obtained from the sound eye (autotransplantation, in case of damage of both eyes LSC were obtained in one case from a close relative in the second case from a cadaverous eye from a corneal bank (Allotransplantation). In the patient with autotransplantation of LSC, perforating keratoplasty and transplantation of the amniotic membrane the result was very good. The corneal disc remained clear 1.5 years after operation, the conjunctival sac was free from synbleropharons and vision improved from movement of the hand to 0.5. In the two patients with allotransplantation of LCS and perforating keratoplasty, LCS did not become incorporated despite immunosuppressive treatment and the corneal disc became turbid. Restored activity of LCS in severe caustic damage of the anterior segment opened new therapeutic opportunities.

[Clinical experience with the preparation Uniflox Unimed Pharma in ophthalmology]. / Klinické skúsenosti s prípravkom UNIFLOX UNIMED PHARMA v oftalmológii.

The authors investigated in a group of 186 adults and 46 children the effect of antibiotic drops UNIFLOX UNIMED PHARMA. The drops contain the effective substance ofloxacine and were used in different inflammations of the eye and adnexa as well as before and after surgery of the eye. Of 110 patients where before surgery from the conjunctival sac pathogenic microorganisms were cultivated, after 7 days following administration of the drops in 105 patients the finding was negative. The marked effect on staphylococci was remarkable. During the postoperative period, in particular after operations of the cornea, a positive prophylactic effect was found and the authors did not observe any effect on healing of the surgical wounds or epithelization of the cornea. The drug had a high antimicrobial effect also in children where it was administered in suppurative dacrocystitis of neonates, acute inflammations of the conjunctiva or bacterial superficial keratitis. All patients tolerated the drug very well, no side-effects were observed.

[Angiography of the iris in the diagnosis of pigmented tumors of the anterior uvea]. / Angiografia dúhovky v diagnostike pigmentových nádorov prednej uvey.

Authors present their observation of 28 pigmented tumors of the iris and iridociliary region during 8 years. While deciding whether to continue in observation or to indicate surgery, they were concentrated on observation of blood supply's abnormalities of pigmented mass and defect of blood-aqueous barrier during the iris angiography. Melanoma--mostly celullar type of high malignity--was confirmed in 11 cases, pigmented meduloepithelioma in 1 case, pigmented naevus in 2 cases out of 14 patients indicated for surgery. Authors correlated angiographical pictures with clinical observation and histopathological findings.

[Surgical treatment of pigmented tumors of the iris and iridociliary region]. / Chirurgická liecba pigmentových nádorov dúhovky a iridociliárnej oblasti.

The authors present a group of six patients with pigmented tumours of the iris and the iridocorneal angle where they performed excision of the tumour by iridectomy (3 patients) or iridiocycletomyy (3 patients). In all six patients with a pigmented tumour of the iris an impaired blood-ocular fluid barrier was found and colouration of the tumour mass by fluorescein. In one patient a heavily pigmented tumour was detected which masked the vascular network. Impaired permeability was found more markedly at the margins. Histological examination confirmed in five instances melanoma of the iris, in one instance a pigmented naevus was involved. During the mean observation period of 32.5 months none of the patients developed a relapse or metastases. Consistent with the extent of the surgical intervention, within 6 months at the latest in all patients the disorder of the blood-ocular fluid barrier improved.

[Use of computer-assisted corneal topography in ophthalmology]. / Vyuzitie pocítacovej rohovkovej topografie v oftalmológii.

The authors give an account of the possible application of corneal computer topography in some diseases of the cornea and in particular in refraction surgery.

[Bimanual irrigation/aspiration]. / Bimanuálna irigácia/aspirácia.

Bimanual irrigation/aspiration is a safe method for the removal of lenticular mass from the eye and can be used in some complicated cases. As it is a perfectly closed system, oscillation of the posterior capsule does not occur and this prevents prolapse of the vitreous body. If the pupil is narrow, the margin of the pupil can be shifted by means of the irrigation cannula and thus suction of the lenticular mass up to the equator is made possible. In subluxed lenses by gently pushing back the lenticular capsule its adherence to the aspiration cannula is prevented. It is relatively easy to clean the anterior lenticular capsule from epithelial cells by bimanual I/A.

[Comparison of corneal endothelial cells after ECCE and phacoemulsification of the lens]. / Porovnanie nálezu endoteliálnych buniek rohovky po ECCE a fakoemulzifikácii sosovky.

The authors evaluate the finding on the corneal endothelium before and after operation of cataract. For examination of the endothelium they used a specular microscope SP 1.000 of Topcon Co. The group comprised 64 eyes of 64 patients. The patients were divided at random into two groups. The first group comprised 26 patients, where ECCE was performed. The second group comprised 38 patients and the opaque lens was removed by phacoemulsification. The mean age in the first group was 69.3 years and in the second group 70.7 years. The same viscoelastic material (methylcellulose) was used and the same synthetic lens from PMMA material was implanted into the capsule. The endothelium was examined one day after operation and on the 7th to 10th day after operation. The following parameters were evaluated: density of the endothelial cells in the centre, mean cell size, polymegethism, coefficient of variation, pleomorphism. In the group of patients who had ECCE the loss of endothelial cells was 18.53%, in the group with phacoemulsification of the nucleus the loss was 16.43%. This difference is not statistically significant. After operation in both groups enlargement of the minimal, maximal as well as mean cell size was observed, the coefficient of variation increased while the grade of cell hexagonality decreased. However these differences in endothelial cells were not statistically significant. After operation of cataract not only endothelial cells are lost but also significant changes in cell morphology occur.

[Treatment of recurrent pterygia]. / Liecba recidivujúceho pterýgia.

The author's work confirmed that a single administration of 0.02% mitomycin C with exposure for 3.5 minutes during surgical excision of a pterygium is an effective treatment, which reduces the percentage of recurrences of pterygium and does not induce negative effects of mitomycin C.