Secondary glaucoma in small versus large uveal melanoma patients treated with stereotactic radiosurgery on linear accelerator.

AIM: Secondary radiation-related side effects like secondary glaucoma (SG) of different modalities of treatment in uveal melanoma patients can appear in certain interval after therapy. This study describes the incidence of SG in patients after stereotactic radiosurgery (SRS). METHOD: The data of 230 patients treated by SRS were reviewed for SG. Group of 83 patients who were observed 5 years after treatment in one center with follow-up regularly at least 4 times per year were analyzed. RESULTS: In group of 83 patients with the median age 59 years, the median tumor volume at baseline was 0.41 cm3. The survival without SG after single dose SRS was 94 % in 1.5 year, 77 % in 2 years, 57 % in 3 years, 43 % in 3.5 years, and 18 % in 4.5 year after irradiation. In 6 patients (7.2 %) secondary enucleation was necessary due to SG. Both predictors (tumor volume and age of patient) at the time of SRS were not statistically significant by Cox proportional-hazards regression. CONCLUSIONS: Complications like SG in 5 year interval after irradiation can lead to secondary enucleation of the eye globe (Fig. 3, Ref. 44).

[The importance of HRT II (Heidelberg retina tomography) and perimeter Octopus 101 in glaucoma diseases]. / Význam HRT II (Heidelberg retina tomograph) a perimetra Octopus 101 pri glaukómovom ochorení.

PURPOSE: To follow up and statistically evaluate the importance of HRT II (Heidelberg retina tomograph) and perimeter Octopus 101 in glaucoma diseases. MATERIAL AND METHODS: There were 154 eyes (77 patients) enrolled into prospective study. The follow up period was 3 years, from January 2003 to December 2005. Patients were divided into 3 groups: (1) the primary open angle glaucoma (PGOU) group and the preperimetric form of PGOU group (88 eyes), (2) the ocular hypertension (OH) group with medical therapy and without medical therapy (44 eyes) and (3) the group of persons with large optic disc areas (22 eyes). The structural optic nerve head (ONH) changes were interpreted by means of HRT II equipment and the functional changes were evaluated by means of perimeter Octopus 101 every 6 months. The statistic analysis was performed with the program Statgraphics plus. RESULTS: HRT II is a reproducible method to follow up the structural changes of the ONH for its low variability of achieved results in all evaluated groups. Low correlation between MD (mean defect) and CLV (corrected lose variance) parameters in the first and the third groups occurred. The standard automated perimetry was accompanied by greater long-term variability, making it less reproducible, but it is useful method comparing to HRT II. In the group of PGOU patients, significant correlations between MD perimetric parameter and the mean RNFL (retinal nerve fibre layer) thickness parameters were observed by means of HRT II. CONCLUSION: HRT II is not able to replace visual field examination with perimetry, both methods are important in the evaluation of glaucoma patients.

[Evaluation of glaucoma progression by means of HRT II results]. / Hodnotenie progresie glaukómového ochorenia pomocou HRT II (Heidelberg retina tomograph)--výsledky.

PURPOSE: To follow up and statistically evaluate structural and functional changes in primary types of glaucoma, ocular hypertension and persons with large optic disc areas. MATERIAL AND METHODS: There were 154 eyes (77 patients) enrolled into the prospective study. The follow up period was 3 years, from January 2003 to December 2005. Patients were divided into 5 groups: the primary open angle glaucoma group (PGOU) (54 eyes), the preperimetric form of PGOU group (34 eyes), the ocular hypertension group (OH) with drug therapy (26 eyes), the OH group without drug therapy (18 eyes) and the group of persons with large optic disc areas (22 eyes). The structural optic nerve head (ONH) changes were interpreted by means of HRT II equipment and the functional changes were evaluated by means of Octopus 101 perimeter. Patients from all groups were tested every 6 months. The statistic analysis was performed with the program Statgraphics plus. RESULTS: During 3 years follow up, the significant progression in the HRT II topographic parameters were recorded in the PGOU group (C/D parameter in 41.8 % eyes) and in the preperimetric PGOU group (C/D parameter in 35.3 % eyes). The significant progression was recorded also in the perimetric parameters in the PGOU group (MD parameter in 42.5 % eyes, CLV parameter in 33.3 % eyes). There were no significant changes in the HRT II and perimetric parameters in the OH groups and in the group of persons with large optic disc area during the follow up period. It was found out, the most important topographic HRT II parameters (with high statistical correlation) are C/D ratio, Disc area, Rim area, and Rim volume. CONCLUSION: In spite of local medical therapy and stabilization of IOP values, in advanced stages of glaucoma, the progression of the disease occurred. The 3 years follow up period was too short to reveal any significant changes in the ONH topography in the group with ocular hypertension. HRT II was a reproducible method in the follow up of structural changes of the ONH in all evaluated groups.

[The cooperation between the ophthalmologist and the endocrinologist in the treatment of the endocrine orbitopathy]. / Spolupráca oftalmológa a endokrinológa pri liecbe endokrinnej orbitopatie.

Authors of this study emphasize the requirement of the cooperation between the ophthalmologist and the endocrinologist in diagnostics and treatment of moderate and severe forms of endocrine orbitopathy (EO). Examinations necessary for diagnosis and possibilities of the systemic treatment are reported. Twenty patients within the group of 70 patients with EO, who had severe form of disease and underwent different combinations of corticosteroid therapy, immunosuppressive therapy, radiotherapy (RA) and orbital decompression were followed up. Authors recommend a dosage of Methylprednisolon (7-9 g) divided into pulses of 1000mg followed by pulses of 500 mg given during 3 to 4 weeks (2-3 infusions per week). They recommend administering Prednison in 60-90 mg doses per day depending on weight of a patient. After daily maximum dose during the first two weeks, the authors recommend to decrease gradually the dose with the total treating period of minimum of a half a year. Decrease of visual acuity depending on EO appeared by 7 patients. It has been stabilized in 6 patients after the treatment of EO. Hand movement remained in one patient with severe neuropathy in spite of urgent orbital decompression. The intraocular pressure has been stabilized in 16 patients after treatment of EO (six patients do not require further antiglaucomatic therapy). The decrease of protrusion occurred in 8 patients after corticosteroid therapy (1-5 mm) and in 5 patients after orbital decompression (6-10 mm). Severe adverse events (herpetic infection, osteoporosis, steroid DM) were reported in 3 patients after repeated courses of corticosteroid therapy. Authors recommend early administration of intensive systemic corticosteroid therapy in active stage of the moderate forms of EO.

[Surgical treatment of the optic disc pit maculopathy]. / Chirurgická liecba makulopatie pri jamke terca zrakového nervu.

PURPOSE: To evaluate long-term effects of anatomic and functional changes after the surgical treatment of the optic disc pit maculopathy in a retrospective study. MATERIALS AND METHODS: Six patients with unilateral optic disc pit maculopathy were included in this study. Four were females and 2 males, age ranged from 13 to 35 years (mean, 26 years). All patients underwent the pars plana vitrectomy, internal limiting membrane peeling and the intraocular tamponade with the air-gas mixture. These 6 patients were divided into two groups: group A, the surgical treatment without aimed argon laser photocoagulation, and group B, the surgical treatment with aimed argon laser photocoagulation during 2 months after the pars plana vitrectomy. The follow-up period ranged from 41 to 73 months (mean, 53.3 months). RESULTS: In the group A, the best-corrected visual acuity improved by 2 and more lines (Snellen optotype) in all 3 patients. In the group B, the improvement by 2 and more lines was found out in 2 patients and the decrease by 2 lines was observed in one patient. The recurrence of the maculopathy occurred in 2 patients from the group A. In the group B, the recurrence of the maculopathy was recorded in one patient 53 months after pars plana vitrectomy and aimed argon photocoagulation. CONCLUSION: The surgical intervention by pars plana vitrectomy for the optic disc pit maculopathy improves the anatomic and functional prognosis. The suitable aimed argon laser photocoagulation after the surgical treatment in selected patients improves outcome and reduce the recurrence of the optic disc pit maculopathy.

[Epidemiology of the endocrine orbitopathy]. / Endokrinná orbitopatia-- epidemiologické súvislosti.

The goal of this paper was to evaluate epidemiological data of the endocrine orbitopathy in a group of 126 patients (250 eyes) during the 5-years period (1999-2004). The prevalence of endocrine orbitopathy was at the age 46.5 +/- 11.4 years, predominantly in females: 5.3 times more often than in males. In most cases (94%) and independently on the sex, hyperthyroidism accompanied the endocrine orbitopathy. Hyperthyroidism mostly (91%) preceded the appearance of the endocrine orbitopathy. Most patients with endocrine orbitopathy had eyelid signs (91% females and 85% males respectively), protrusion or exophtalmos (77% females, 75% males). 69% patients (68% females, 70% males) had elevated intraocular pressure (pseudoglaucoma, primary glaucoma). During the active stage of the endocrine orbitopathy with protrusion (52% patients), pseudoglaucoma was detected in 7% of patients. During the inactive stage of the endocrine orbitopathy with protrusion (34% patients), pseudoglaucoma was detected in 4% of patients. Primary glaucoma was found in 2% (active stage) and 1% (inactive astage).

[The therapy for acute acquired syphilitic uveitis]. / Liecba akútnych získaných syfilitických uveitíd.

PURPOSE: In retrospective study (analysis) to report the effectiveness of therapy on anatomic and functional outcomes in patients with acute acquired syphilitic uveitis. DESIGN: Retrospective case-control study. PARTICIPANTS: 3 patients (4 eyes) with symptoms of ocular acute inflammation which occurred in latent stage of syphilis are included in our study. In all patients uveitis was the first clinical symptom of syphilis. METHODS: In all 3 patients the infection of acquired syphilis was diagnosed using specific and non-specific tests for treponemal antibody. In 2 eyes we performed diagnostic and therapeutic pars plana vitrectomy. The management of ocular syphilis in all patients consisted of mega units of aqueous penicillin intravenously or intramusculary, in 2 patients we used the combination with steroids. RESULTS: In 2 eyes with perioperatively obtained material of vitreous (during pars plana vitrectomy) specific treponemal antibody was detected using specific (TPHA) test. In the third patient infection was verified serologically. The final visual acuity of all 4 eyes is better than or equal to 6/12. The visual acuity of one exe is 6/6. CONCLUSION: Uveitis and neuroretinitis may be the first symptom of acquired syphilis in latent stage. Early antibiotic treatment significantly improves anatomical reparation of infection and visual outcomes.

[Pars plana vitrectomy for diabetic pseudophakic macular edema]. / Pars plana vitrektómia pre edém makuly u diabetikov po operácii katarakty.

PURPOSE: In retrospective study to evaluate the anatomical and functional results of pars plana vitrectomy (PPV) with peeling of the inner limiting membrane (ILM) on pseudophakic eyes with diabetic macular edema. MATERIAL AND METHOD: PPV with peeling of the ILM was performed in 5 eyes (5 diabetic patients) after cataract surgery with posterior chamber intraocular lens implantation. Group of patients enrolled 4 female and one male aged from 44 to 62 years (average 56.2 y.). 2 eyes had undergone focal fotocoagulation previously for clinically significant macular edema. The macular edema was diagnosed by clinical examination and by retinal fluorescein angiography from 3 to 8 months (mean 6 m.) after cataract surgery. Visual acuity (VA) and angiographic changes were monitoring. RESULTS: In pseudophakic eyes with diabetic macular edema that underwent surgery, the angiography documented decrease of hyperfluorescens in all cases. VA improved in 3 eyes (80%) more than +2 lines of Snellen test, stabilized in one eye (20%). VA detoriated in one eye by -1 line of Snellen test. CONCLUSION: Our results demonstrated that PPV with ILM peeling is effective surgical procedure on pseudophakic diabetic macular edema.

[Initial experience with the EAS-1000 (NIDEK) anterior segment analyzer]. / Nase prvé skúsenosti s analyzátorom predného segmentu EAS-1000 (NIDEK).

The analyzer of anterior segment EAS-1000 is one of recently developed diagnostic devices, used for digital photography for the analysis and storage of data about the anterior segment of the eye. The aim of the contribution is to inform the public about possible use of the apparatus in clinical and field practice.

[Antimetabolites in glaucoma surgery--long-term results]. / Antimetabolity v chirurgii glaukómu--dlhodobé výsledky.

PURPOSE: To observe the long term success of antimetabolites used in glaucoma filtering surgery in eyes with high risc of failure. MATERIAL AND METHOD: Two groups of patients undergone trabeculectomy with the use of antimetabolites 5-Fluorouracil (5-FU) and Mitomycin C (MMC) are included in this retrospective study. 5-FU was administered postoperatively 1-10 times in the dose of 5 mg/ml in subconjunctival injection on 32 eyes. Follow up time ranged from 8 months to 9 years. Mitomycin C was administered intraoperatively in the dose of 0.2 mg/ml, on subconjunctival sponge with application time from 3 to 5 minutes on 15 eyes. Follow up time ranged from 7 month to 4.5 years. RESULTS: Intraocular pressure (IOP) before operation with the use of 5-FU was in average 28.8 mmHg (22-50 mmHg) at the end of therapy with 5-FU was 17.6 mmHg (10-30 mmHg) and in the last examination was on average 19.5 mmHg (14-28 mmHg). IOP before operation with the use of MMC was in average 30.3 mmHg (22-40 mmHg), the seventh day after administration of MMC 12.7 mmHg (6-20 mmHg) and in the last examination was in average 18 mmHg (9-28 mmHg). During the long term observation of IOP values in the 5-FU group there was 79.2% success and in the MMC group there was 83.3% success (IOP up to 20 mmHg with or without therapy). Decrease of IOP was statistically significant. CONCLUSION: Antimetabolites improve the success of filtering surgery in high risc glaucomas. The long term follow up shows that failure of filtration in these types of glaucomas is still a serious clinical problem.

[Endophthalmitis after lens surgery]. / Endoftalmitídy po operáciách sosovky.

At the University Eye Clinic Bratislava we performed a retrospective study on the occurrence of endophthalmitis after lens operations. Over the years 1993-1995 we performed 2374 lens operations. Endophthalmitis occurred in 20 eyes (0.84%). Endophthalmitis occurred after uncomplicated as well as after surgical procedures with various perioperative complications. All patients were treated with antibiotics locally and parenterally. Nine patients were treated with steroids. In these patients we did not performed pars plana vitrectomy. Owing to endophthalmitis one eye was eviscerated. In one eye after previous vitrectomy for proliferative diabetic retinopathy developed later inoperable retinal detachment. In one eye was present an old retinal detachment before the cosmetic cataract extraction was performed. Without any complications were cured nine eyes. In eight eyes are remained iris synechiae and vitreous opacities. Two eyes lost light perception and one eye was without light perception already before cataract extraction. The final visual acuity was better than 2/60 in 70% of the eyes and better than 6/36 in 50% of the eyes.

[Endophthalmitis after intraocular interventions]. / Endophthalmitiden nach intraokularen Eingriffen.

BACKGROUND: Endophthalmitis is serious complication of intraocular surgery. At the University Eye Clinic Bratislava we performed a retrospective study on the occurrence of endophthalmitis after various intraocular procedures. MATERIAL AND METHODS: Over the years 1993-1995 we performed 2374 cataract extractions, 305 anti-glaucoma operations, 106 perforating keratoplasties and 926 pars plana vitrectomies. The charts of all patients were reviewed. The occurrence of endophthalmitis, type of surgery, perioperative complications, elapsed time between surgery and start of endophthalmitis, results of preoperative conjunctival smear cultures, final anatomical and functional results were evaluated. RESULTS: The frequency of endophthalmitis after cataract extraction was 0.84%, after antiglaucoma surgery 1.31% and 0.97% after pars plana vitrectomy. No endophthalmitis was found after penetrating keratoplasties. In most cases endophthalmitis began in the first three days after surgery. Endophthalmitis occurred after uncomplicated as well as after surgical procedures with various perioperative complications. The preoperative conjunctival smear cultures were sterile in 22 patients. Staphylococcus epidermidis was the most commonly cultured germ. All patients were treated with antibiotics parenterally and locally. Pars plana vitrectomy and intravitreal application of antibiotics was performed only exceptionally. Enucleation was required in two eyes and two other eyes become phthitical. 22 eyes recovered without serious complications. Five eyes were blind and in 11 eyes the final visual acuity was better than 6/36. CONCLUSIONS: Pre-, peri-, and postoperative measures must be improved to prevent postoperative endophthalmitis. In cases of endophthalmitis all therapeutical options have to be performed as soon as possible to save the patient's eye and sight.