ASSESSMENT OF CORNEAL ENDOTHELIAL LAYER IN CONTACT LENS WEARERS WITH THE AID OF AN ENDOTHELIAL MICROSCOPE.

AIMS: The main aim of our study was to demonstrate the difference in endothelial cell density between a group of keratoconus contact lens users and non-contact lens users (without keratoconus). MATERIAL AND METHODS: In our study we had data from 96 subjects with an average age of 40.5 ±14.05 years. For the purposes of our study, we worked with each eye separately for each subject (n = 192). Keratoconus (research group) was diagnosed in 97 eyes. The mean age of the patients in the research group was 41.9 ±10.6 years. Keratoconus was not diagnosed in the remaining 95 eyes (control group). The mean age of the patients in the control group was 39.5 ±16.6 years. In the keratoconus group, the patients wore hard contact lenses (HCL) in a total of 43 eyes, hybrid contact lenses (HbCL) in 48 eyes and soft contact lenses (SCL) in 6 eyes. The average total period of contact lens use in the research group was 10.6 ±2.36 years. RESULTS: The average number of endothelial cells in the research group was 2607.11 ±298.45 cells per mm2. The average number of endothelial cells in the control group was 2831.94 ±523.51 cells per mm2. We tested these two variables using a T-test, which showed a statistically significant difference (p < 0.001). A statistically significant difference in the mean endothelial cell count related to patient age and use / non-use of contact lenses of two types was demonstrated only in the under-40 group in a comparison of the non-contact and keratoconus group with the keratoconus group using HCL (p = 0.02). A statistically significant difference in the length of contact lens wear was demonstrated between the keratoconus-free group with or without SCL and the keratoconus group when wearing HCL or HbCL for more than 20 years (p = 0.01 and p = 0.02). For HbCL users, this difference was demonstrated also after 15 years of wearing (p = 0.001). CONCLUSION: From our results we can conclude that there is a difference in endothelial cell density between patients with and without keratoconus.

[The ERG contribution in early diagnosis of chloroquine and hydroxychloroquine maculopathy]. / Prínos ERG v casné diagnostice chlorochinové a hydroxychlorochinové makulopatie.

Derivates of chloroquine (Plaquenil, Delagil), used for long-term treatment of rheumatic diseases, may cause clinically proven irreversible maculopathy, which may progress even after the discontinuation of their application. The optimal early diagnosis of ocular toxicity of chloroquine or hydroxychloroquine drug remains controversial up to now. The aim of this review paper was to evaluate how appropriate is the indication of the electroretinographic (ERG) examination due to the early diagnosis of cumulative drug-related maculopathy. Photopic, pattern, and multifocal ERG (Retiscan, according to the ISCEV methodology) were examined in 10 patients (20 eyes) treated by means of antimalarics, 9 due to the rheumatoid arthritis (RA) and 1 due to the systemic lupus erythremathodes (SLE). The average age of the patients was 60 +/- 15 years, the treatment period was 10 +/- 11 years; the median of the treatment period was 5 years. The control group consisted of 12 healthy, age matched patients (20 eyes) without any obvious ocular pathology. In all of them, the complete ophthalmologic examination was performed: the best corrected visual acuity (BCVA) for far using the Snellen charts, intraocular pressure (IOP) measured by means of the non contact tonometer NIDEK NT-2000, the Amsler grid test, examination of the anterior segment and the posterior segment with the slit lamp. The entry criteria in both groups were BCVA 5/7,5 (0.67) and better, the IOP in the normal range, negative Amsler grid test, anterior segment without significant decrease of the transparency, and physiological posterior segment or with subtle granular pigment dysgrupancies in the macula only. The significant difference between the group treated with chloroquine or hydrochloroquine and the control group at the 1% level of significance was found in following parameters: in the photopic ERG the value of the b wave latency [ms], in pattern ERG, the values of the waves N35 - P50 [microV] and P50 - N95 [microV] amplitudes, and at the 5 % level of significance in photopic ERG, the wave a amplitude value [microV] and in multifocal ERG, the value of the P1 [ms] a N1 [ms] parts latency in the pericentral ring. It follows from the results, that the ERG examination is suitable for the early diagnosis drug cumulative maculopathy caused by chloroquine derivates. Optimal is the individual comparison of the ERG values of the patient before and in certain time intervals after the beginning of the chloroquine derivates treatment.

[The influence of the idiopathic macular hole (IMH) surgery with the ILM peeling and gas tamponade on the electrical function of the retina]. / Vliv operace idiopatické makulární díry s peelingem MLI a plynnou tamponádou na elektrickou funkci sítnice.

Many contemporary clinical papers establish positive influence of the pars plana vitrectomy (PPV) with the ILM (internal limiting membrane) peeling and gas tamponade in macular hole to the macular morphology. They prove diminishing or disappearing of the central scotoma and metamorphopsia and especially also improvement of the BCVA for far and near. The evaluation of the objective functional condition of the retina is still a discussed question. This paper concerns with the comparison of the electric functions of the retina before and after the IMH surgery with the ILM peeling and the gas tamponade. In the group 19 patients (8 men, 11 women), or 19 eyes with IMH were included. The average age was 69 +/- 6 years. The group consisted of patients with transparent optical media. In none of these patients was found other macular pathology than IMH. Nobody underwent other retinal surgery. The patients were examined 1 day before and 1 and 3 months after the surgery. During each control, the following examinations were performed: the Amsler grid examination, the best corrected visual acuity (BCVA) for far (EDRTS chart) and near (Jaeger optotypes), intraocular pressure measurement (non contact tonometer NIDEK NT-2000), examination of the anterior segment on the slit lamp, examination of the posterior segment biomicroscopically and by means of indirect ophthalmoscopy, examination of the photopic, pattern, and multifocal ERG (Retiscan, according to the ISCEV methodology), and OCT examination (Stratus OCT). If necessary, the ultrasound examination (Ultrascan Alcon) was performed as well. For the statistical evaluation of the ERG component values among the data files before the surgery (data file 1), 1 month after the surgery (data file 2), and 3 months after the surgery (data file 3), the non-parametric Wilcoxon pair test was used. In the photopic ERG, there was statistically significant prolongation of the latency b in data file 2 and 3 comparing to the data file 1 (p < 0.05). Comparing latency b of data file 1 to data file 2, there was found no statistical significance. Comparing other parameters of photopic ERG found no statistically significant difference among data files 1,2, and 3. In the multifocal ERG, there was found statistically significant elevation of the P1 amplitude according to the response density of given unit and the P1 amplitude in the central ring in data file 3 comparing to the data file 1 (p < 0.05). Comparison of other parameters was not statistically significant. In the paracentral ring, there was found statistically significant extension of the N1 and P1 latency in data file 3 comparing to the data file 1 (p < 0.05). Comparison of other parameters in the paracentral ring was not statistically significant. Statistically significant improvement of the retinal electric function in the central 4 degrees 3 months after the surgery, confirms the positive functional effect of the surgery to the fovea. In the fovea, the increase of the number of functional nerve cells of the outer layers of the retina occurs. On the other hand, in the parafoveolar region, as well as in the whole retina, 3 months after the surgery, statistically significant decrease of the function of the retina, meaning the time prolongation of the conduction in the outer layers of the retina, occurs. According also to our results, the peeling of the ILM in the IMH surgery remains, despite its unquestionable contribution, still a controversial technique. During the short, three months lasting, follow-up period, the functional improvement in the fovea occurred, but the functional decrease in the parafoveolar region which correlates in the large extent with area of the ILM peeling was found. The discussion about the ILM peeling indication in the earlier stages is adequate. We will further follow-up the development of the retinal electric function after the IMH surgery with ILM peeling and gas tamponade.

[If you say "better than with the wire into the eye ..." a case report]. / Kdyz se rekne "lepsí nez drátem do oka" ... kazuistické sdelení.

The open eye injury, caused by the penetration of the wire from the rotating steel wire brush is relatively frequent eye injury. In the Czech language, the phrase "better than with the wire into the eye ..." is used as the adage to compare the seriousness of the moment. In a case report, the authors describe a penetrating injury caused by a wire from the steel wire brush, its course, surgical treatment, complications, and final finding. The authors correlate the meaning of the phrase with their own case of injury and its anatomical and functional results.

[Computer modeling correlation between the entering wound and the final position of the metallic intraocular foreign body]. / Korelace vstupní rány a výsledného ulozeni kovového nitroocního telesa pomocí pocítacového modelování.

AIM: The aim of this study was to establish the correlation coefficient between given parameters of the entering wound and final position of the metallic intraocular foreign body. MATERIAL AND METHODS: Fifty patients (50 eyes) with a penetrating injury of the eye and present metallic intraocular foreign body were included in this study. Clinically found data of the entering wound and final position of the intraocular foreign body (IFB) as well were transformed with a computer model into the three-dimensional parameters. Both parameters were statistically evaluated by means of correlation analysis, and correlation coefficient and determination coefficient were calculated. RESULTS: The extent of correlation between two variables is called correlation coefficient. The coefficient values range between -1 to +1. The closer is the calculated value to ranges (to -1 or to +1) the more are the two variables more correlated. The coefficient of determination values range from 0 to +1. The closer the results are to +1, the better the model describes the dependence between the two variables. The results obtained by means of correlation analysis were for the correlation coefficient 0.454, and for the coefficient of determination 0.6411 respectively. CONCLUSION: Results of the correlation analysis show that the knowledge of coordinates of the entering wound has no prediction value for final position of the foreign body in the eye. These two variables are not correlated and so the accurate final position of the foreign body cannot be predicted. The final position of the intraocular metallic foreign body is probably influenced by biophysical factors not included in this study.

[Surgical treatment of combined injuries of the anterior and posterior segment of the eye with intraocular metallic foreign body]. / Chirurgické resení kombinovaných poraneni predního a zadního segmentu s kovovým nitroocním telesem.

GOAL: The aim of this study was to establish anatomical and functional results of combined injuries of the anterior and posterior segment of the eye caused by penetration of the metallic foreign body. MATERIAL AND METHODS: The group consisted of 25 eyes with penetrating injury caused by metallic intraocular body. The age at time of the injury in the group was 14-68 years (36.8 +/- 10.9) and the average follow up period was 21.0 +/- 10.7 months. All injuries were treated by means of suture of the entering wound with immediate or postponed treatment of the pathologic findings in both segments during one or more procedures. The metallic foreign bodies were extracted with forceps or endomagnetic device during the pars plana vitrectomy. Traumatic changes of the retina were treated by means of endodiathermy and endolaser. Silicone oil tamponade was performed, where indicated. The partial or total traumatic cataract was removed by phacoemulsification through the scleral admittance or by endophaco fragmentation with or without intraocular lens implantation. RESULTS: The most common pathological findings were the penetrating wound of the cornea (72%) and traumatic changes of the iris (56%). The total cataract was present in 56 % of cases. In the posterior segment, vitreous hemorrhage was most frequent (36%). Signs of endophtalmitis were present in 12% of cases. The period between the primary suture and combined procedure at the anterior and posterior segment was mostly 5-14 days (56%). In ten cases (40%), the intraocular lens (IOL) was implanted, 9 times in the posterior and once in the anterior chamber. Out of the early postoperative complications, the fibrin in the anterior chamber was noticed most frequently (16%), and out of the late ones, the retinal detachment (32%) and proliferative vitreoretinopathy (24) were most common. CONCLUSION: Anatomical and functional result of the combined injury with the foreign intraocular body depends not only on the choice of the surgical technique, but predominantly on the extent of the initial injury and risk of the present infection's spreading.

[Evaluation of results of the penetrating injuries with intraocular foreign body with the Ocular Trauma Score (OTS)]. / Hodnocení výsledkiu penetrujících poranení s kovovým nitroocním telesem dle Ocular Trauma Score.

UNLABELLED: The goal of the study was to correlate the final functional status with the initial prediction of the OTS in the eyes following the penetrating injury with metallic intraocular body. The group consisted of 20 men (20 eyes), the average age was 35.4 +/- 10.8 years. The average follow up period was 21.0 +/- 10.7 months. In all cases, the penetrating injury with the metallic intraocular foreign body was present. To evaluate the prediction of the final functional status of the organ, the OTS tables were used, and according to their criteria, the initial clinical findings in all 20 eyes were scored. A half of the year after the injury the achieved visual acuity was compared with proportional prediction in given group according to the final OTS table. RESULTS: In the original prediction according to the score, 6 patients were classified in group 2, 8 patients in the group 3, 4 patients in the group 4, and 2 patients in the group 5. In the final evaluating of the functional status, in the group 2, we achieved in 3 cases 13% of probability of the presumed final visual acuity, in 2 cases 26% of probability, and in one case 18% of probability. In the group 3, we achieved in 7 cases 28% of probability and in 2 cases 44% of probability of the achieved visual acuity. In the group 4, in 3 cases we achieved 21% of probability and in one case 1% of probability. In the group 5, in one case we achieved 92% of the probability and in one case 5% of probability of the final functional status. Introducing the Ocular Trauma Score evaluating system into the practice offers the possibility of simple approximation of the final functional result after six months after the injury.

[Initial experience with toric intraocular lenses]. / První zkusenosti s torickými IOL.

The aim of cataract extraction with implantation of intraocular lens is the astigmatically neutral result. This neutral cataract incision is reached by the method of phacoemulsification with a small incision and implantation of foldable intraocular lens. In case of preoperative astigmatism is an effective method the implantation of a toric intraocular lens. The authors evaluate the first results of pre and postoperative refraction after implantation of ten toric intraocular lenses.

[Results of implantation of endocapsular distance rings]. / Výsledky implantací endokapsulárních distancních prstencu.

Endocapsular distance ring increases possibilities of extraction subluxated cataract. Its importance consists of stabilisation of capsular bag and with the possibility of implantation posterior intraocular lens. In the group there are 20 patients with implanted 21 distance rings. The period of follow up was 4-24 months. We used of a polymethyl methacrylate distance ring from firms Erilens, Morcher and IOLTechnology. Indication for the implantation of a distance ring was dialysis less than 2 quadrants, it depends on size and type of distance ring. The authors evaluate complications during the operation and early and later results after operation.

[Problems with secondary implantations of intraocular lenses]. / Problematika sekundárních implantací nitroocních cocek.

The authors focus their attention on the problem of secondary implantations of posterior chamber lenses. In a group of 20 patients they compare the peroperative and postoperative complications of secondary implantation into the sulcus ciliaris with and without fixation of the lens.