BILATERAL EYE INJURY WITH BILATERAL BLOWOUT FRACTURE CAUSED BY A HIGH-PRESSURE WATER JET IN 16-YEARS-OLD FIREMAN GIRL. CASE REPORT.

PURPOSE: The aim is to present a report of a case of bilateral eye injury with bilateral blowout fracture caused by a high-pressure water jet from a fire hose in a 16-year-old girl during a competition for young firefighters. METHODS: We present a case report of a 16-year-old female patient with bilateral extensive eyelid contusion, oedema and lacerations of upper eyelids, lacerations of bulbar conjunctiva, contusion of both eyes, left optic nerve and bilateral blowout fractures of orbits.  Results: The initial ocular examination revealed "hand motion" in the right eye and no light perception in the left eye. Intraocular pressure was low in both eyes. Motility of both eyes was reduced, especially in the left eye. Lacerations of the eyelids and conjunctiva required a surgical procedure. No repair of the upper canaliculus of the left eye was attempted. Paralytic mydriasis and loss of lens accommodation in both eyes did not change throughout the follow-up period. A surgical procedure was applied to resolve the left blowout fracture, ocular motility of the right eye improved spontaneously. Traumatic cataract developed in the left eye within 1 year after injury, requiring cataract surgery and posterior capsule lens implantation, the right lens remained clear. Massive scarring of the retina and choroid in the lower parts of the eyes and in the macula reduced best corrected visual acuity in the right eye to 0.15 and in the left eye to 0.08. Intraocular pressure is within normal limits without any glaucoma therapy. The follow up period is three years. CONCLUSION: This is the first reported case of child with an eye injury caused by a high-pressure water jet during a sports activity.

THE EFFECT OF THERAPY ON THE OCULAR SURFACE IN PATIENTS WITH UNILATERAL PEDIATRIC GLAUCOMA Purpose: The aim of the study was to evaluate ocular surface and.

PURPOSE: The aim of the study was to evaluate ocular surface and tear film in patients with pediatric (primary or secondary) unilateral glaucoma and compare results obtained from the treated eye and untreated healthy eye. METHODS: Patients with unilateral pediatric glaucoma, followed in the outpatient department of the Department of Ophthalmology, Motol University Hospital, were included in this study. Tear osmolarity, corneal epithelial thickness, lower tear meniscus area, Schirmer test, corneal fluorescein staining and tear break-up time test (TBUT) were evaluated in both healthy and treated eye. The Ocular Surface Disease Index (OSDI) was used to establish subjective impairment. The values obtained through testing the healthy and treated eye were compared. RESULTS: Thirteen patients met the inclusion criteria of the study. The mean age of the patients was 17.2 ± 8.1 years. There was statistically significant decrease in corneal epithelial thickness and TBUT in the treated eye (45.9 ± 5.3 µm, 6.0 ± 1.7 second resp.) compared to the healthy eye (50.2 ± 2.6 µm, 8.8 ± 3.2 second resp.; p = 0.0106, p = 0.0015 resp.). Fluorescein staining score of the ocular surface was higher in the treated eye (1.7 ± 2.1) than in the healthy eye (0.5 ± 0.8; p = 0.0243). We found no statistically significant difference in the other evaluated parameters between the treated and the healthy eyes. CONCLUSION: The results confirmed signs of ocular surface damage in treated eyes. The damage may be induced by chronic topical antiglaucoma therapy, but that could be a consequence of the previous ocular surgery as well. The possible damage of the ocular surface should be taken into account when selecting appropriate treatment in these patients.

[Central corneal thickness, intraocular pressure and their correlation in healthy Czech children aged 7-17 years]. / Centrální tloust'ka rohovky, nitroocní tlak a jejich vzájemný vztah u zdravých ceských detí ve veku 7 az 17 let.

UNLABELLED: The purpose of this prospective study was to determine normal central corneal thickness (CCT) and intraocular pressure (IOP) in healthy white children aged 7-17 years and to analyze their possible correlation to age and gender. Further, the possible correlations between CCT and IOP were analyzed. METHODS: CCT and IOP were assessed in 248 eyes of 124 healthy children aged 7-17 years (mean, 12.7 years). Fifty-four boys and 70 girls were included into the study. Further, the analyzed cohort was divided into subgroups of younger (7-12.4 years) and older (12.5-17 years) boys and girls. The data obtained from the whole cohort were statistically analyzed to assess normal CCT and IOP in healthy youth. Relation of CCT and IOP to age and gender, as well as relation between CCT and IOP were studied. The CCT was measured using ultrasonic pachymetry and IOP by means of Goldmann applanation tonometry. RESULTS: The mean CCT +/- SD in 124 children was 554 +/- 33 microm (range, 437-641 microm); no influence of age or gender was detected. The mean IOP +/- SD in the whole cohort was 14.5 +/- 2.6 mm Hg (range, 10-25 mm Hg). Statistically significant difference of 0.7 mm Hg was found between boys and girls, where the mean IOP was 14.1 +/- 2.3 mm Hg in boys and 14.8 +/- 2.8 mm Hg in girls respectively (p = 0.03). Age had no influence on IOP for the age range of 7-17 years (p = 0.67). The positive correlation between CCT and IOP was found. The calculated correction was 1.55 mm Hg change of IOP for 100 microm change of CCT. CONCLUSION: CCT and IOP values in healthy children aged 7-17 years are similar to values in adults. The positive correlation between both parameters seems to be of minimal clinical importance.

[Clinical appearance and outcome of zone 1 retinopathy of prematurity (ROP)]. / Klinický obraz a výsledky léby u retinopatie nedonosených v zóne 1 sítnice.

The goal of this clinical trial was to evaluate outcomes of the treatment of retinopathy of prematurity (ROP) located in zone 1 (Zone 1 ROP). This disease has a specific clinical appearance and poor prognosis. Usually it is difficult to identify particular stages of ROP and to indicate treatment while following progression of the disease. In the group of zone 1 ROP it is necessary to separate transient forms (TF), in which vascularizations reach edges of zone 2, from very posterior forms (VPR), in which vascularizations and pathological changes are present only in zone 1. There were 24 eyes with zone 1 ROP (15 children) treated with combination of transcleral laser photocoagulation and cryotherapy during the years 2000 till 2005 in our series. Five eyes suffered from VPR, 19 eyes from TF. Average follow -up was 24 months. We found better outcomes in eyes with TF treated in pre-threshold stage of ROP (10 eyes) than in threshold stage of ROP (9 eyes). All 5 eyes with VPR developed unfavourable ROP stage IV or V. Zone 1 ROP becomes diagnostic and therapeutic challenge considering growing incidence of surviving of newborns with low or very low birth weight. Treatment initiation during prethreshold stage of ROP as it is supported by ETROP study (Early treatment of ROP) seems to be promising.

Nd:YAG laser membranotomy treatment of premacular hemorrhage in two children with hematologic disease.

PURPOSE: Nd:YAG laser membranotomy is considered a safe treatment of premacular hemorrhage (PMH) in adult patients, enabling rapid enhancement of visual functions. For children, however, pars plana vitrectomy (PPV) performed under general anesthesia has been the accepted treatment. In this report, the authors describe Nd:YAG laser membranotomy (LM) in two children with PMH complicated by hematologic disease. METHODS: Size of lesions was measured in optic disc diameters (DD). The authors performed three openings in the anterior surface of PMH with immediate intravitreal drainage of blood in both patients. RESULTS: Rapid enhancement of visual functions was followed. The authors observed no complications in 1 year of follow-up. CONCLUSIONS: LM may be a safe method of treatment of PMH in children in selected cases.

[Hemi-hangback recession (retroposition) of extraocular muscles]. / Hemihang-back retropozice okohybných svalu.

In a small clinical study the author evaluates the efficiency of the hemi-hangback recession (retroposition) procedure. This surgical procedure, which weakens extraocular muscles, proceeds from the hangback recession (retroposition) technique (hanging the muscle on a resorbable suture), which combines with the traditional recession. Hemi-hangback recession procedure is suitable in cases when a recession of more than 7 mm is needed. It is experimentally and clinically as well demonstrated in extra large recessions, that a shift towards the original insertion of the muscle occurs. The combination of the classical and hangback recession has its advantages in specific indications. More convenient surgical access and a reduction of the objectionable shift of the muscle backwards are main advantages of this procedure. The surgical procedure is described in this article and results in the group of patients from the Children's and Adult's Department of Ophthalmology at the Faculty Hospital in Motol, Prague, Czech republic. The hemi-hang-back muscles recession is indicated in third and sixth nerve palsies, restrictive forms of strabismus and complicated or successive forms of strabismus.

[Transcleral laser photocoagulation and cryocoagulation of the retina in children with retinopathy of prematurity]. / Transklerální laserová fotokoagulace a kryokoagulace sítnice u retinopatie predcasne narozených detí.

The objective of the work was to compare the effectiveness of transscleral laser photocoagulation and cryocoagulation of the retina in the treatment of retinopathy of premature infants (ROP). During the period from March 1999 to April 2001 at the Ophthalmological Clinic for children and adults in the Motol Faculty Hospital 80 eyes of 40 children with the borderline stage of ROP were treated. In 40 eyes cryocoagulation was performed, in 40 transcleral photocoagulation of the retina. The mean gestation age of the infants on delivery was 28.7 weeks, the postconception age at the time of operation 36.7 weeks. The follow up period varied from 1 to 24 months. All therapeutic provisions were made with premedication and under local anaesthesia. For a stabilized finding without progression we took an adherent retina without subsequent traction changes. Cryocoagulation was successful in 87.5%, laser photocoagulation in 85%. Both methods proved equally effective. In photocoagulation the authors recorded a lower incidence of local complications. General undesirable effects were not recorded in any of the treated children. Transscleral photocoagulation extends contemporary therapeutic possibilities in patients with ROP.

[Hang-back retroposition as a variation in oculomotor muscle weakness]. / Hang-back retropozice jako varianta oslabení okohybných svalu.

In a clinical study the authors evaluate efficiency of the operation on oculomotoric muscles by the hang-back retroposition method. A total of 70 children have been operated on, 52 of the patients suffering from esotropia and 18 from exotropia. The mean preoperation deviation in esotropia was 30 +/- 12 pdpt, the postoperation deviation was in the range of 6 +/- 7 pdpt. In the exotropia cases the preoperation deviation improved from original 76.9%, in the exotropia group being 77.8%. The overall success rate of the hang-back retroposition in all these patients was 77.1%. Ina group of children operated on by a traditional retroposition there was an overall success rate 78.7% (77.6% in esotropia and 82.4% in exotropia cases). Hang-back retroposition has been equally effective as the traditional retroposition of oculomotoric muscles. Its main advantages include visibility of the operation field, minimum risk of perforation of sclera and a fair time factor of the intervention. The authors discuss the development, indications, further advantages but also possible disadvantages or limitations of this acknowledged surgical procedure in strabology.

[Calculation for emmetropic intraocular lenses in hypermetropia]. / Výpocet emetropické IOC u hypermetropu.

Authors evaluated postoperative refractive errors after implantation of intraocular lens at the set of 429 eyes. There predominated eyes with short axial length (AL) at this set: 304 eyes had AL < 22 mm, average AL was 21.54 mm. The basic point was to correct the linearity of SRK formula by different way from SRK II formula, while keeping the new formula simple to use. Authors reached following modification of A-constant in SRK formula: new A-constant = original A-constant + C, where C = 0,146*AL2 - 7,702*AL + 100,130.

[Screening for threshold stages in retinopathy of prematurity]. / Screening prahového stadia retinopatie predcasne narozených detí.

The authors evaluated retrospectively the examination protocols of 208 children (400 eyes) treated by cryocoagulation on account of active retinopathy of premature infants (ROP). The objective was to assess the optimal timing for the onset of examination to record in time the threshold stages of ROP in children with different grades of maturity. The baseline point was the finding that before the 5th postnatal (pnt) and 31st postconception week (pcw) the threshold stage was not diagnosed in any child of the group. The highest incidence of threshold stages in all children was between the 36th and 37th postconception week. The first examination made between the 5th-6th postnatal or at first during the 31st postconception week is sufficient to cover initial threshold stages of ROP in children with different birth weights. Screening based on combination of the postnatal and postconception age is more accurate than evaluation by one criterion. Premature examinations are misleading and not valid for screening.