ACUTE KERATOUVEITIS WITH CORNEAL GRAFT MELTING AS A LATE COMPLICATION OF MILD CHEMICAL BURN POTENTIALLY ASSOCIATED WITH COVID-19 INFECTION: A CASE REPORT.

Chemical burns are sight-threatening injuries that require immediate management. The main goal of the initial treatment is prompt and copious irrigation to neutralize and eliminate the chemical, followed by various therapeutic options (conservative and surgical) according to the individual patient's postinjury findings. PURPOSE: In this case report, we describe the course and treatment of a patient with chemical alkali burns of both eyes. This study reports the outcomes of an ocular alkali burn patient who became infected with COVID-19 and where severe keratouveitis with corneal graft melting and hypopyon occurred, ultimately resulting in evisceration of the eye. OBSERVATIONS: We report the case of a 35-year-old woman, after an alkali burn of both eyes. Complete re-epithelialization of both corneas occurred within three weeks. Due to this observation, we assumed a satisfactory healing prognosis. However, corneal lysis occurred in the left eye over time. The condition was managed, but subsequently severe keratouveitis with hypopyon and corneal lysis occurred in the left eye, apparently in connection with the COVID-19 infection, which ultimately led to the evisceration of the affected eye. CONCLUSIONS AND IMPORTANCE: In the case report, we describe the management of a mild chemical alkali burn of the right eye and a complicated moderate burn of the left eye with an alkaline chemical. Both eyes were completely healed within three weeks. However, the findings on the left eye became complicated, which ultimately led to the evisceration of the affected eye. The disease of COVID-19 could have contributed to the deterioration of the findings on the cornea, or it could have just been a coincidence of two diseases, with the keratouveitis having a serious course due to the previous difficult course of healing and many complications after the chemical burn.

LASER THERAPY OF RETINAL TEARS.

AIM: To report the clinical results of treatment of patients with retinal tears or holes, including rhegmatogenous retinal detachment, who were treated primarily with laser retinopexy. MATERIAL AND METHODS: The effect and results of the therapy of patients with one or more retinal tears who underwent therapy with the green laser IQ 532 IRIDEX between December 2019 and August 2022 at our center with a follow-up observation period of at least 3 months were retrospectively evaluated. RESULTS: A total of 14 eyes of 14 patients were treated by this method during the monitored period. All the tears found were primarily successfully repaired. The overall success rate of prophylaxis of rhegmatogenous retinal detachment was 93% in our cohort. In one patient, subsequent pars plana vitrectomy was required due to the progression of retinal detachment from another biomicroscopically inaccessible hole, which was part of lattice degeneration in the peripheral part of the retina. This pathology was only verified during intraocular surgery. Postoperatively, the retina was attached with a very good anatomical and functional effect. The other patients did not require any adjuvant therapy. Visual functions improved or remained stable in all patients in the cohort. The follow-up observation period ranged from 3 to 36 months. CONCLUSION: Laser retinopexy is a sparing, safe and effective method of retinal tear therapy. From our clinical experience, the technique is also applicable in the case of partial vitreous hemorrhage or incipient rhegmatogenous detachment. We did not record any complications of perioperative or postoperative treatment among our patients.

CHELATION OF BAND KERATOPATHY IN LONG-TERM MONITORING.

AIM: To report the clinical results of chelation of band keratopathy in long-term follow-up. MATERIAL AND METHODS: The long-term results of 5 patients (5 eyes) with symptomatic band keratopathy with a follow-up period of at least 6 months, in whom 2% EDTA was chelated on the affected eye in the study period from April 2018 to March 2021, were retrospectively evaluated. The follow-up period was 9-37 months. RESULTS: In all patients, there was a significant improvement in the local findings and an increase in the transparency of the cornea. The effect of therapy was verified on a color photograph of the anterior segment and on AS-OCT by the disappearance of subepithelial hyperreflective foci and accompanying optical shadows. Postoperatively, this enabled a more detailed visualization of the deeper layers of the cornea and other structures of the anterior segment. In a patient with the potential to improve vision, it was also possible to significantly improve visual functions. In the other three patients with pain in the affected eye, the pain subsided, and they also benefited cosmetically from the operation. CONCLUSION: Based on our experience and previously published reports, EDTA corneal chelation is able to causally resolve the pathology and improve vision in eyes with visual potential. At the same time, it reduces discomfort and has an analgesic effect in long-term irritated eyes. The operation is also suitable for amaurotic, cosmetically unsightly bulbs, as a successful intervention preserving the eye and improving the appearance of such eyes leads to satisfaction and a subjective increase in the quality of life of the patients.

Selective angiography with the possibility of thrombolysis in patients with central retinal artery occlusion.

PURPOSE: Describe the clinical finding and course of treatment in patients with a sudden decrease in visual function due to an acute occlusion of the arteria centralis retinae. Patients were primarily indicated for selective angiography with thrombolysis of the ophthalmic artery. MATERIALS AND METHODS: Medical documentation of two patients with acute central retinal artery occlusion with a time duration of up to 5 hours was evaluated retrospectively. The diagnosis of central retinal artery occlusion was determined on the basis of a detailed ophthalmological examination in arteficial mydriasis. The initial best-corrected visual acuity (BCVA) were hand movement in front of the eye with uncertain light projection in first patient and no light perception in the second patient. In both cases a relative afferent pupillary defect of the 4th degree was present with the onset of the ischemic macular edema and an incipient development of the cherry red spot. After evaluation of the overall condition, laboratory findings, exclusion of cancer and surgery in the last three months, a selective angiography of ophthalmic artery and thrombolysis in collaboration with the intervention radiologist were performed.   Results: First patient with a better initial visual acuity, selective angiography demonstrated a decrease in flow in the central retinal artery with subsequent improvement in haemodynamic ratios after application of 12 ml of recombinant tissue plasminogen activator (Alteplase). The BCVA improved to 1/ 60 after interventional procedure. We did not experience any serious treatment side effects during or after intervention. In the second patient, selective angiography of the intracranial arteries and internal carotids revealed the presence of an aneurysm before the ophthalmic artery. Due to the normal flow of the contralateral carotid and the filling of the intracranial vessels on the affected side via the circle of Willis, the internal carotid ligation was performed under the aneurysm. Three months after the surgery BCVA was no light perception and patient had no neurological symptomatology. CONCLUSION: Selective angiography in combination with thrombolysis appears to be a useful imaging as well as therapeutic method for acute central retinal artery occlusion. This technique allows not only to confirm the diagnosis but it can also solve problem causally and improve the visual acuity of the affected person. Sometimes it also helps to clear the cause of the closure and prevent next potential embolization into the intracranial space and possible fatal consequences of CNS involvement or even death.

Corticosteroid Induced Posterior Subcapsular Cataract.

OBJECTIVE: A description of the development of a clinical ocular finding of 23 patients (35 eyes) with steroid-induced posterior subcapsular cataract of different source, focusing on its character and mechanism of origin. METHODS: The medical records of 23 patients, 14 women, 9 men, median age 44.5 years (median 44 years, interval 29 - 52 years) were evaluated retrospectively and had undergone surgery from 5/2016 to 5/2018 at Gemini Eye Clinic Bělský les. All patients underwent a complex eye examination and cataract surgery with artificial intraocular lens implantation. RESULTS: In all of these patients, the incidence of the various stages of the posterior subcapsular cataract was correlated with the use of steroid therapy locally, generally per os, inhaled or combined, mainly in pre-adolescent patients. Postoperatively, a significant improvement in CDVA (corrected distance visual acuity) was observed in all patients in the set. CONCLUSION: Steroid-induced cataract is a clinical diagnosis reserved for conditions of cataract formation in relation to the dose and duration of use of corticosteroid medication. The diagnostic diagram of this process seems to be unambiguous, requires a thorough examination of the ocular finding and carefuly obtain internal and pharmacological history of the patient. The basic treatment approach is cataract surgery, which should be performed by an experienced surgeon for a higher risk of possible complications.

[One-day simultaneous bilateral cataract surgery]. / Jednodenní oboustranná operace katarakty. Vlastní výsledky.

INTRODUCTION: Effectiveness Evaluation of One-Day Simultaneous Bilateral Cataract Surgery (SBCS) Comparing to the Cataract Surgery Performed on Each Eye Separately After a Lapse of Time. MATERIAL AND METHODS: The cohort of 100 patients (200 eyes) consisted of two groups: In the Group1, there were 50 patients (100 eyes) who underwent One-day Simultaneous Bilateral Cataract Surgery (SBCS). The Group 2 consisted 50 patients (100 eyes) who had the surgery on one eye first, and later on the fellow eye. The course of the surgery, peroperative and postoperative complications were evaluated. The patients from the Group 1 were examined at the first postoperative day. In the next course, all patients were examined one week, one month, and 3 months after the surgery. In the postoperative phase were, besides the complications, the final visual acuity and refraction and its deviations from the target refraction followed up. RESULTS: Course of the surgery, peroperative and postoperative complications are comparable in both groups. Endophthalmitis, or other more serious postoperative complications did not appear in either group. Three months after the surgery, the uncorrected visual acuity (UCVA) 0.8 and better in the Group 1 had 75 % of patients, and in the Group 2 also 75 % of patients. The UCVA 0.5 and better in the Group 1 had 95 % of patients; in the Group 2 it had 90 % of patients. The best-corrected visual acuity 0.8 and better had in both groups 95 % of patients. The final refraction after 3 months in the Group 1 was -0.15 ± 0.91 (-0.12); -3.37; 2.00. In the Group 2 the final refraction after 3 months was -0.08 ± 0.91 (0.00); -3.25; 2.75. CONCLUSION: The results are showing that both groups of our cohort are comparable. The One-Day Simultaneous Bilateral Cataract Surgery (SBCS) is, from the surgical point of view, equally safe and effective as classically performed cataract surgery.Key words: One-Day Simultaneous Bilateral Cataract Surgery (SBCS), refraction, visual acuity, postoperative complications, intraocular pressure.

[Treatment Results of the Diabetic Macular Edema by Means of the PASCAL Laser System]. / Výsledky lécby diabetického makulárního edému laserovým systémem PASCAL.

OBJECTIVE: To evaluate functional, anatomical and clinical efficacy, and safety of the pattern scanning laser (PASCAL®) photocoagulation in patients with diabetic macular edema and absence of proliferative diabetic retinopathy. METHODS: From 2008 to 2013 84 eyes of 58 patients (30 men, 28 women) were treated with pattern laser photocoagulation at the Ophthalmology Department at University Hospital Ostrava. Average age at the baseline visit was 65 years. The inclusion criteria included nonproliferative diabetic retinopathy (84 eyes), focal DME (14 eyes), diffuse exudative DME (70 eyes). All the eyes were "treatment naive". The average duration of diabetes was 18 years, average baseline HbA1c value was 8,4%. Either focal laser photocoagulation or grid photocoagulation was performed with the PASCAL photocoagulator. Best corrected visual acuity (BCVA), central retinal thickness (CRT), fundus photography, biomicroscopy and complications were evaluated during the minimum 12months follow-up period. Statistical analysis using parametrical and nonparametrical tests with p less than 0,05 was done. RESULTS: Mean baseline BCVA was 0,43 logMAR. Values 0,38, 0,37, 0,38 a 0,38 logMAR were observed in the follow-up intervals in the 4th, 6th, 12th and 18th month. In 4 eyes (5%) improvement of more than 3 lines was observed, in 26 eyes (31%) improvement from 0 to 3 lines was observed, in 52 eyes (62%) decrease from 0 to 3 lines was observed and in 2 eyes (2%) decrease of more than 3 lines was observed. Mean baseline CRT was 398 µm, values 370 µm, 362 µm, 349 µm and 338 µm were observed in the follow-up intervals in the 4th, 6th, 12th and 18th month. At the 12th month visit 76 eyes (90%) were stabilized, and in 8 eyes (10%) progression of the disease was observed. No complications were observed during the first 12 monhts follow up. CONCLUSION: Pattern scanning laser photocoagulation of DME lead to BCVA and clinical stabilization. In addition to this, it lead to decrease of the CRT. The efficacy was comparable to traditional laser systems with no apparent benefit to the traditional systems. The efficacy was inferior to modern intraocular anti-VEGF (vascular endothelial growth factor) drugs.

[Solar Maculopathy after Watching the Partial Solar Eclipse]. / Solární makulopatie po sledování cástecného zatmení slunce.

AIM: To describe clinical findings in patients with sudden decrease of visual functions according to the solar maculopathy appearance after watching the partial solar eclipse and results of the changes follow-up after 7 weeks. MATERIAL AND METHODS: Medical records of five women (6 eyes) with solar maculopathy associated with watching partial solar eclipse on March 20th, 2015 were retrospectively evaluated. The diagnosis of solar maculopathy was established according to the medical history, ophthalmologic examination of the fundus in artificial mydriasis, and confirmed by means of spectral domain optic coherence tomography examination of the macula. The follow-up period of the patients in the study group was 7 weeks. RESULTS: All patients described the presence of relative central scotoma and decrease of the central visual acuity (VA) of different extension in the involved eye. The average best-corrected visual acuity (BCVA) of women in our group was 6/9 (range, 6/6 partially - 6/18). In one patient, the involvement was bilateral, in the other cases the involvement was unilateral. The biomicroscopic examination of the fundus revealed yellowish to yellow-whitish lesions with brightness of the pigment layer in the center of the foveola in all patients. The optic coherence tomography examination of the macula confirmed the irregularities of the retinal pigment layer and photoreceptors outer segment with hyper-reflective focus of the neuroretina in the center of the foveola. CONCLUSION: During the follow-up period, we recorded improvement of the central visual acuity in all women with unilateral involvement. In the woman with bilateral retinal involvement, the best-corrected visual acuity of the right eye remains without any improvement. The optic coherence tomography examination after 7 weeks shows regression of the findings in three eyes. In all other cases, slight structural changes in the center of the macula persist.

[Actual state of the one day simultaneous bilateral cataract surgery issue]. / Soucasný stav problematiky jednodenní oboustranné operace katarakty.

One-day Simultaneous Bilateral Cataract Surgery (SBCS) is not common routine procedure; nevertheless many surgeons all over the world perform it. During the history, SBCS was always performed, but due to the phacoemulsification development making the small incision surgery possible, more papers in the scientific literature are appearing. Besides the SBCS indications and contraindications, the intraoperative and postoperative complications are discussed, especially the danger of bilateral postoperative endophthalmitis. In this paper, an overview of the most important publications concerning the SBCS is presented.

[Screening ROP in the University Hospital Ostrava]. / Screening ROP ve FN Ostrava.

OBJECTIVE: To analyze the group of premature infants who were examined by an ophthalmologist in screening for ROP (retinopathy of prematurity) at the University Hospital in Ostrava. METHODS: A retrospective observational case series. We reviewed and analyzed clinical records of all the premature infants born before the 32nd gestational week examined by ophthalmologist in ROP screening at the University Hospital in Ostrava in the period from 1. 9. 2011 to 31. 8. 2012. Childrens gestational age at birth, birth weight, postconceptional age (PCA) of the child at the time of the first ocular inspection, at the time of diagnosis ROP and at the time of any intervention, possible risk factors of ROP (Apgar score in the 1st minute, duration of oxygen therapy, FiO2 (%) (percentage fraction of oxygen in the inspired gas mixture), duration of mechanical ventilation, transfusion of erythrocytes (resuspended leukodepleted), presence of sepsis / infection in the perinatal period and duration of phototherapy) were evaluated. Eye examination was performed in local anesthesia with the use of an eyelid retractor, in artificial mydriasis, using an indirect ophthalmoscope and digital imaging system RetCam 3. RESULTS: 138 premature infants with an average gestational age at birth of 29.8 weeks, average birth weight 1385 g, were included in this study. Thirty-four children (24.6 %) were diagnosed with ROP, in all cases 1st stage at the time of diagnosis. An ophthalmologist indicated and subsequently implemented intervention (cryotherapy / laser treatment) in the case of five children (14.7 %) with ROP under general anesthesia. Average duration of oxygen therapy at infants with ROP was 371 hours, in the group without ROP 84 hours. The difference between the average values was statistically significant [t (37) = -3.69, P <= 0.0007]. Average time of mechanical ventilation in the case of children with ROP were 229 hours, in the group without ROP 41 hours [t (35) = -2.99, P <0.005]. In the case of children with ROP, we noticed on average 3 transfusions of erythrocytes, in the group without ROP 1 transfusion [t (40) = -3.94, P <= 0.0003]. The average value of the Apgar score in the 1st minute of children with ROP group was 6.3 and children without ROP 7.8. The difference between the average values of Apgar score in the 1st minute was between both groups statistically significant [t (136) = 4.06, P <= 0.00008]. Sepsis / infection in the perinatal period occurred in 30 (88.2 %) children with ROP, in comparison with 46 (44.2 %) children with sepsis / infection without ROP. Average duration of phototherapy in infants with ROP was 42.4 hours, in the group without ROP 53.6 hours [t(136) = 1,21, P<= 0,2]. CONCLUSION: This study demonstrated statistically significant correlation of Apgar score in the 1st minute, duration of oxygen therapy, duration of mechanical ventilation, transfusion of erythrocytes and presence of sepsis / infection on the onset and progression of ROP at premature infants in our group. No effect of FiO2 (%) and duration of phototherapy on the onset and progression of ROP was demonstrated.

[Ocular trauma in childhood at the University Hospital Ostrava in the years 2007-2011]. / Úrazy ocí a periokulární krajiny u detí ve FN Ostrava v letech 2007-2011.

OBJECTIVE: to investigate and analyze the group of child patients with ocular trauma in the Ostrava region in the Czech Republic. METHODS: A retrospective observational case series. We reviewed and analyzed clinical records of all the paediatric patients with ocular trauma treated at the University Hospital Ostrava in the years 2007 - 2011. Age, sex, mechanism of injury, type of ocular trauma, the consequences of injury and period of the year when the accident occurred were evaluated. BETT classification used in this study was modified and extended by chemical and thermal injuries and orbital trauma. Ocular burns, including thermal and chemical burns, were graded using the classification for ocular surface burns by Dua. RESULTS: 448 children (309 boys, 139 girls), aged from 3 months to 17 years (median 10 years) were included in this study. The most common ocular injury was closed globe injury (253 patients, 56,5 %), the next common were orbital injuries (149 patients, 33,3 %), burns injuries (39 patients, 8,7 %), the least frequent were open globe injuries (7 patients, 1,6 %). The most common mechanism of ocular trauma was hit by object (34,6 %), followed by trauma caused by blows and falls (15,2 %) and hit by another person (10,3 %). The 50,9 % of injuries occurred in days of school attendance. 10,3 % of injuries occurred directly at the school or preschool facilities. 6,5 % of the injuries were polytraumas, which required interdisciplinary cooperation. CONCLUSION: This study demonstrated that the incidence of eye injuries is greater in boys, mainly adolescents. Closed globe injuries are the predominant type of ocular trauma in childhood. The mechanism of ocular trauma is variable. Nonetheless there is a relation between the mechanism and the age of the child. Further research in terms of how the preventive measures would affect the incidence and severity of ocular trauma in children would be beneficial. The modified BETT classification of ocular trauma, including chemical and thermal injuries and orbital trauma may better address current requirements.

[Lyell's disease--a case report]. / Lyelluv syndrom.

Lyell's disease is a rare, life-threatening, acute dermatologic disease. The mucous membranes are also often involved. Nearly all cases are induced by medications. There is currently no specific treatment and interdisciplinary cooperation is very important. The authors present a case report of a 15 year old boy with the ocular manifestations of Lyell's disease, triggered by lamotrigine. He was admitted to the burn unit with involvement of 85% of his body surface area. Ocular manifestations documented during hospitalization were classified as mild (lid edema, conjunctival injection) and later severe (multiple symblepharons). The patient was treated with antibiotic eyedrops/ointment, corticosteroid eyedrops/ointment, topical lubricants and a glass rod was used to lyse the symblepharons. At 23 months of follow-up our patient had a symblepharon which blocked the superior and inferior punctum in both eyes, without conjunctival fornix foreshortening or corneal abnormalities, minimal ocular discomfort.