In essential hypertension, a change in the renal resistive index is associated with a change in the ratio of 24-hour diastolic to systolic blood pressure.

An increase in the renal resistive index (RRI) in patients with essential hypertension (EH) predicts deterioration in renal function. In patients with EH, changes in hemodynamic parameters significantly affect the RRI. This study aimed to define changes in Ambulatory Blood Pressure Monitoring (ABPM) parameters that are significantly associated with a change in RRI in patients with EH. We evaluated ABPM and the RRI in 96 patients with EH without organ extrarenal changes at baseline and after two years of follow-up. The relationships between changes in ABPM parameters and the RRI over the period were evaluated. After two years of follow-up, the increase in RRI was consequential. Simultaneously, 24-h systolic blood pressure increased significantly and 24-h diastolic blood pressure decreased. In the whole group and in the group with calculated cystatin C clearance (eGFRcyst) >/=90 ml/min/1.73 m2, the change in RRI significantly negatively correlated with the change in the ratio of 24-h diastolic to systolic blood pressure (D/S ratio), but also with the change in 24-h pulse blood pressure. However, in patients with eGFRcyst>90 ml/min/1.73 m2, only the change in the 24-h D/S ratio significantly correlated with the change in RRI. Based on the backward stepwise regression analysis, the change in RRI was significantly dependent only on the change in 24-h D/S ratio and not on the change in 24-h pulse pressure. A change in the ratio of diastolic to systolic pressure better reflects a change in RRI than a change in pulse pressure.

Effective Tissue Layer Separation of Donor Cornea for DMEK by Fluid Injection Between Descemet Membrane and Corneal Stroma: Results of First Series of Operations

AIM: To evaluate clinical outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) using a novel hydro-separation of donor Descemet membrane (DM) endothelial graft with 6 months follow up. MATERIAL AND METHODS: In this retrospective single-center; single surgeon cohort study, 16 consecutive eyes underwent DMEK or combined DMEK and cataract surgery with DMEK donor graft hydro-separation. The hydroseparation method used Ringer's solution injected by a syringe with a flat end cannula between DM and corneal stroma to separate DMEK graft from donors' cornea. Endothelial cell count, corrected and uncorrected distance visual acuities (CDVA, UDVA), corneal astigmatism and keratometric values were evaluated before and 6 months after the surgery. RESULTS: DMEK grafts were successfully hydro separated, without a membrane tear in all cases and successful adhesion to recipient corneas was achieved in all cases. Overall CDVA improved significantly (p < 0.0001) from preop.0.69 logMAR (0.45­0.92, 95%CI) to 0.1 logMAR (0.04­0.15) 6 months postop. However UDVA was slightly worse in cataract combined cases 0.38 logMAR (0.18­0.43) vs 0.3 logMAR (0.14­0.61) in DMEK cases at 6 months. Corneal astigmatism K2-K1 improved significantly (p=0.0137) from preop. mean 2.89 D (0.19­0.43) to 0.98 D (0.48­1.48) 6 months postop. CONCLUSION: Hydro-separation is fast and effective donor graft preparation method for DMEK. The DMEK using donor graft hydro-separation results in improved vision and induces a low amount of astigmatism at 6 months follow up. Further clinical data are needed to confirm the success rate and to explore optimization of the selection of IOLs in combined cataract cases

Hyponatremia in spinal cord injury patients: new insight into differentiating between the dilution and depletion forms.

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The objectives of this study were to present a new model for differentiating between the dilution and depletion forms of hyponatremia in patients in the postacute phase after spinal cord injury (SCI), and to identify possible etiological factors contributing to hyponatremia in these patients. SETTING: University Hospital Motol, Prague, Czech Republic. METHODS: Eighty-seven of 352 patients hospitalized in 2008-2012 in the Spinal Cord Unit were hyponatremic. Seventy-four patients had SNa+=130-135 mmol l(-1) and 13 patients had SNa+ below 130 mmol l(-1). We propose a simple model of an electrolyte solution in which the Na(+) concentration is higher than the Cl(-) concentration, making it possible to compare the effects of dilution and depletion of Na(+) and Cl(-) on the Na(+) concentration. The depletion of Na(+) and Cl(-) leads to a significant increase in the Na(+)/Cl(-) ratio, with the Na(+)-Cl(-) value remaining unchanged. Dilution with water results in a decrease of Na(+)-Cl(-) with the Na(+)/Cl(-) ratio remaining unchanged. RESULTS: In patients with SNa+ below 130 mmol l(-1), hyponatremia was consistent with the depletion model in 46% and with the dilution model in 32%. In patients with SNa+ ranging between 130 and 135 mmol l(-1), the respective rates were 34 and 12%. CONCLUSION: Examination of SNa+-SCl- and SNa+/SCl- in patients with SCI could be helpful in considering whether hyponatremia is consistent either with the NaCl dilution model or with the NaCl depletion model. Further studies are needed for more accurate interpretation of the results, particularly with respect to volume and acid-base disorders.

Cluster of patients with Familial Mediterranean fever and heterozygous carriers of mutations in MEFV gene in the Czech Republic.

Familial Mediterranean fever (FMF) is a well-described monogenic autosomal recessive disorder with highest occurrence in the Mediterranean region. In this article, we describe the experience of a center in the Czech Republic that follows four families with members bearing mutations in MEFV gene without provable ancestry from the Mediterranean region. We also discuss the clinical picture of the heterozygous variants that were present in our cohort. The typical clinical presentation in heterozygotes corresponds to data described in the international literature. The possibility of combination of mutations and/or polymorphisms in different genes and epigenetic or environmental influences on the clinical symptoms are taken into account.

Plasma adrenomedullin and subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

OBJECTIVE: To evaluate whether plasma adrenomedullin is involved in the previously reported significant inverse correlation between left ventricular (LV) end-diastolic pressure (peak velocity of early transmitral flow/peak velocity of early diastolic mitral annular motion ratio [E/E' ]) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus, mild-to-moderate renal function impairment and LV relaxation impairment (E'≤7.1 cm/s). METHODS: Plasma adrenomedullin concentration, E/E' and eGFR were assessed in 82 patients with type 2 diabetes. RESULTS: Plasma adrenomedullin concentration was positively correlated with eGFR in patients with or without LV relaxation impairment, and inversely correlated with E/E' in patients with LV relaxation impairment. Multivariate linear regression analysis supported a role for plasma adrenomedullin in the association between E/E' and eGFR. CONCLUSION: These results support the hypothesis that adrenomedullin modulates the interaction between the heart and kidneys in early subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

[DMEK (Descemet membrane endothelial keratoplasty)--early and late postoperative complications]. / DMEK (transplantace Descemetovy membrány s endotelem)--casné a pozdní pooperacní komplikace.

UNLABELLED: The authors refer to the cross-sectional study of surgical technique, operation, early and late postoperative complications in the first 30 patients after DMEK (Descemet membrane endothelial keratoplasty). SETTING AND METHODS: The group comprised 17 women and 13 men with an average age of 62 years (SD 12.2). The follow up period 1-12 months, average 4.2 months. The DMEK were indicated in patients with boullous keratopathy, Fuchs' endothelial dystrophy and endothelial insufficiency after repeated corneal transplantation. RESULTS: In half of the patients had to undergo DMEK surgery and the other half DMEK surgery combined with cataract surgery. One patient dropped from the Descemet membrane transplantation because of insufficient donor cornea and was indicated re DMEK. SURGICAL COMPLICATIONS: 4 times difficulty of the striping of Descemet membrane, 2 times operating decentration plates, 1 times bleeding the implementation of peripheral iridectomy. Early postoperative complications in 10 patients: 3x pupillary block, 1x fibrin reaction in anterior chamber, 1 curled strip of anterior chamber in 1st postoperative day, 3x coiled plate with localized corneal oedema, 1 residual membrane size 2 x 2 mm Descemet slats off the optical axis. Late postoperative complications were recorded in a total of 7 patients. 4 occurred secondary glaucoma and 2 corneal edema localized outside the optical zone. Once there was a bridging of traction plates. Visual acuity in uncomplicated patients were arranged within 21 days after surgery, patients with complications within 3 months. 1 times was made re DMEK rolled plates with the removal of the anterior chamber, 3 by 5 days to reposition scrolling border membranes by repeated big bubble technique. CONCLUSION: DMEK seems like a good option to remedy endothelium defects. About 70% of patients have fewer complications when used alone DMEK than cataract surgery combined with DMEK. For knowledgeable surgeon, starting with Descemet membrane transplantation, it is appropriate to separate transplants without combination with other procedures (cataract surgery, iriedktomy). Laser iridotomies before operation seems an appropriate procedure to avoid bleeding while surgery.

[The use of confocal corneal microscopy in the Cogan microcystic dystrophy diagnosis and follow-up of the ultrastructural changes after phototherapeutic keratectomy]. / Vyuzití konfokální mikroskopie rohovky v diagnostice Coganovy mikrocystické dystrofie a sledování ultrastrukturálních zmen po fototerapeutické keratektomii.

UNLABELLED: Confocal microscopy represents modern, non-invasive, semi-contact examination method making possible to visualize separate corneal layers (from the endothel to the epithel) in high resolution. Phototherapeutic keratectomy (PTK) is a method using argon-fluoride laser with 193 nm wavelength to treat corneal surface diseases. AIM: To evaluate the use of confocal microscopy for epithelial basal membrane dystrophy diagnosis (Cogan microcystic dystrophy) and following corneal ultra-structural changes in vivo after PTK. MATERIAL AND METHODS: The group consisted of 14 eyes of 9 patients (6 men and 3 women) of average age 45.8 +/- 14.4 years who underwent in the department in last two years phototherapeutic keratectomy for recurrent erosion in Cogan microcystic corneal dystrophy. For the diagnosis of this disease, the confocal corneal microscope (Confoscan 4, Nidek, probe x 40) was used. Computer controlled laser photoablation was in all patients performed; the average depth was 14.8 +/- 3.3 microm (Technolas 217, Bausch & Lomb). The follow-up visits were scheduled always day 5 and 12, and month 1, 3, 6, and 12 after the PTK. The reactive processes in all corneal layers, the subepithelial inervation restoration velocity and recurrence of the primary disease detectable by means of the confocal corneal microscope were followed-up. RESULTS: Cogan microcystic dystrophy was diagnosed in all followed-up patients by means of confocal microscope according to the findings of the area thickening and corneal epithelium basal membrane irregularities. These patients were indicated to the PTK. After the treatment, the healing of the epithelial layer was finished as early as the fifth day. The subepithelial nervous plexus average regeneration period was 6.2 +/- 2.8 months. In all patients, the edema of the anterior stroma was found at the day 5. The beginning of the re-popularization of the anterior stroma by keratocytes from deeper layers we diagnosed, on average, at the day 11.5 +/- 1.9 after the treatment and the following reduction after 5.1 +/- 1.4 months. In the posterior stroma and in the endothel, no changes were found. During the follow-up period, in none of the followed-up patients, the recurrence of the primary disease was found. CONCLUSION: The confocal microscopy may be recommended for superficial corneal dystrophies quality and accurate diagnosis and to follow up changes after phototherapeutic keratectomy as suitable treatment method of these diseases.

The association between left ventricular diastolic function and a mild-to-moderate decrease in glomerular filtration rate in patients with type 2 diabetes mellitus.

This prospective study evaluated the relationship between echocardiography parameters of left ventricular (LV) diastolic function and mild-to-moderate renal function impairment in 82 patients with type 2 diabetes mellitus. The mean age of the patients was 61.1 years. A significant correlation was found between estimated glomerular filtration rate (eGFR) and the ratio of peak velocity of early transmitral flow (E) to peak velocity of early diastolic mitral annular motion (E'). Cluster analysis revealed two subgroups of patients with different E' values but comparable eGFRs. The correlation between eGFR and E/E' was significant in 38 patients with E' ≤ 7.1 cm/s, but not significant in 44 patients with E' > 7.1 cm/s. The results suggest that the deterioration of LV relaxation (E') represents the underlying condition for the association between mild-to-moderate renal function impairment and the non-invasive parameter of LV end-diastolic pressure (E/E'), in patients with type 2 diabetes without any previous cardiovascular event and with well-controlled blood pressure.

[Corneal cross-linking--modern method of keratoconus treatment]. / Corneal cross-linking--moderná metóda liecby keratokónusu.

PURPOSE: The aim of research study was to evaluate the effect of corneal cross-linking (CXL) in the frame of patients with progressive keratoconus 1 year after treatment. METHODS: There were 40 eyes of 35 patients with mean age 28, 45 +/- 9.3 (SD) (15 to 48 years) included in the study. Patients were treated with standard protocol of CXL with abrasion of corneal epithelium. Complete ophthalmological examination included best corrected spectacles visual acuity (BCSVA), slit-lamp microscopic finding, corneal topography and corneal thickness measured with ultrasound method was performed before, on the 5-th day, 1. 6., 12. month after CXL. We divided patients according to the stage of keratoconus into 2 groups (stage I. and stage II.) and according to the age into 3 groups (until 20, from 21 to 39, over 40 years). RESULTS: In all treated eyes, the CXL was without relevant complications. The only complication was stromal haze of cornea. In the evaluation based on stage of keratoconus, in the first group any patient became a haze of cornea in 1 year after CXL. In the second group 35.7% of patients had a haze of cornea. The average BCSVA 1 year after treatment was improved in the 1. group about 5.38 letter and in the 2. group about 1.25 letter. Topographic analysis showed decrease of simulated keratometry and refraction (1. group--0.1 D, 2. group--0.17 D), maximal keratometry and refraction (1. group--0.67 D, 2. group--0.76 D). Minimal keratometry and refraction in the 1. group decreased (1.17 D) and increased in the 2. group (1.09 D). In the evaluation based on the age was haze monitored in the first group one year after CXL in 12.5% of researched eyes. In the second group was haze of cornea in 20% of eyes and in the third group consisting of patients over 40 years old, in 50% of eyes. The average BCSVA was improved in the 1. group (2.85 letter), and in the 2. group (3.68 letter).The average BCSVA was decreased in the oldest patients in about 1.43 letter. In the 1. and 2. group the topographic analysis showed decrease of simulated keratometry and refraction (1. group--0.12D, 2. group--0.21D), maximal keratometry and refraction (1. group--1.13 D, 2. group--0,68D), minimal keratometry and refraction (1. group--1.17D, 2. group--0,69 D). In the 3. group the topography analysis showed increase of simulated keratometry and refraction (0,8D), maximal keratometry and refraction (0,98D), minimal keratometry and refraction (0,28D). Corneal pachymetry remained stable in all researched groups of patients. CONCLUSIONS: CXL is considered as safe procedure to stop progression of keratoconus also for patients until 19 years old. The best effect and minimal complications were by patients until 40 years old and by patients with the I. grade.

[Pathophysiology of metabolic acidosis in patients with reduced glomerular filtration rate according to Stewart-Fencl theory]. / Patofyziologie vzniku metabolické acidózy u pacientu se snízenou glomerulární filtrací z hlediska Stewartovy-Fenclovy teorie.

AIM: Metabolic acidosis is a regular sign of renal insufficiency. Conventional assessment of acid-base balance using Henderson-Hasselbalch equation does not make identification of the cause of metabolic disorders possible as the serum HCO3- concentration might only reflect changes to the overall plasma ion spectrum. Therefore, we used the Stewart-Fencl approach that is based on a more detailed physical and chemical analysis and that showed that changes to serum HCO3- concentration are closely related to parameters not usually monitored in connection to acid-base balance. PATIENT GROUP AND METHODOLOGY: We performed a single measurement of arterial or capillary blood pH and pCO2 in 69 non-dialysed patients with glomerular filtration rate ranging from 0.04 to 0.88 ml/s/1.73 m2 according to MDRD, standard calculation of serum HCO3- concentration using Henderson-Hasselbalch equation was carried out, and serum albumin and ion concentrations (Na+, K+, Cl, Pi) plus creatinine and urea concentrations were determined from venous blood. RESULTS: Metabolic acidosis was present in 47 patients ([S-HCO3-] < 22 mmol/l) with the mean [S-HCO3-] value of 19.6 mmol/l for the entire group. We proved a statistically significant correlation between [S-HCO3-] and [SID] (p < 0.001), and between [S-HCO3-] and the individual [SID] determining factors: [Na+-Cl-], [UA- ], [Pi-], [K+] (p < 0.01). CONCLUSION: Reduction in [S-HCO3-] in non-dialysed patients with reduced glomerular filtration is predominantly associated with a decrease in [Na+-Cl-] difference, the quantitative contribution of which to metabolic acidosis is more significant than the strong acids retention. In addition to [S-Cl-] increase, [S-Na+] reduction too has a major role in reducing the [Na+-Cl-] difference.

[Contrast sensitivity and higher order aberration after conventional LASIK treatment]. / Kontrastní citlivost a aberace vyssích rádu po konvencním LASIKu.

AIM: The aim of the prospective study was to evaluate photopic high-contrast visual acuity, mesopic contrast sensitivity, and high order aberrations, to compare changes and post-operative development of those parameters and to analyze the dependence among aberrations and contrast sensitivity after conventional LASIK treatment. MATERIALS AND METHODS: The authors followed-up patients treated by means of refractive LASIK treatment during the period from November 2006 to November 2007. The authors analyzed 51 eyes (31 patients). The average age of the group was 28.5 +/- 5.4 years (range, 18 - 41 years), preoperative average spherical equivalent was -4.95 +/- 1.24 D (from -3 to -8,25 D). Before the treatment and 1, 3, 6, and 12 months after LASIK treatment we evaluated the visual acuity (Snellen optotypes), contrast sensitivity under mesopic circumstances (CSV-1000E, VectorVision) and monochromatic aberrations (aberometer Zywave, Bausch & Lomb). RESULTS: One year after the treatment the average uncorrected visual acuity was 1.07 +/- 0.15, index of effectiveness 0.99, and index of safety 1.02. The contrast sensitivity was in month 12 significantly decreased comparing to the preoperative level at the frequency 12 c/deg, in other already tested frequencies after 3-6 moths did not differed from preoperative values. During the follow-up period the curvature of contrast sensitivity average values was in the upper half of the normal interval range. Conventional LASIK treatment significantly induced the higher order aberration (twice), as well as the spherical aberration (four times).The same level of higher order aberrations root mean square (HOA-RMS), or increased maximally by 0.1 microm was detected by 10 % of cases; the spherical aberration was, compared to the preoperative value, lower, or increased maximally by 0.05 microm in almost one half of the cases. The increase of the higher order aberrations depended directly proportionally to the preoperative value of the spherical equivalent. Before the treatment, the values of total aberrations correlated to the contrast sensitivity of low space frequencies; however, there was not found any correlation between the higher order aberrations and contrast sensitivity. Six months after the LASIK treatment the values of higher order aberrations correlated to the contrast sensitivity except of the lowest frequency tested. The higher order aberrations increased together with decreasing contrast sensitivity. The data from the one-year follow up control did not show statistically significant correlation between the contrast sensitivity and the higher order aberrations. There was not found any correlation between the contrast sensitivity and the spherical aberration at any follow-up control after the surgery. CONCLUSION: Although after the conventional LASIK treatment the curve of mesopic contrast sensitivity was located in the upper half of the normal range, in the medial space frequency it remained decreased comparing to the preoperative stage. The induction of higher order aberrations was twice as much and was directly correlated to the degree of the laser correction. The spherical aberration was four-times higher comparing to the preoperative values and was independent to the level of the initial refractive error. Significant correlation between the contrast sensitivity and the higher order aberrations was not proven.

[Changes of higher order aberrations and contrast sensitivity after standard photorefractive keratectomy]. / Zmeny aberací vyssích rádu a kontrastní citlivosti po standardní fotorefrakcní keratektomii.

UNLABELLED: The aim of the prospective study was to evaluate higher order aberrations and contrast sensitivity after photorefractive keratectomy (PRK) using the standard photoablation profile. MATERIALS AND METHODS: The group consisted of 37 patients (69 eyes), the mean age 27.2 +/- 4.5 years, who underwent PRK with target emetropia during the period January 2007 -December 2007. In 19 cases, it was correction of myopia, in 50 cases myopia with astigmatism.The preoperative spherical equivalent was -3.14 +/- 0.95 D. The PRK was performed by means of excimer laser system Technolas 217 (Bausch & Lomb) with the standard phoptoablation profile (PlanoScan 2000), using the 6.5 mm optical zone. The visual acuity, contrast sensitivity (CS; CSV-1000E, VectorVision) under mesopic circumstances and monochromatic aberrations (Zywave, Bausch & Lomb) were evaluated before the surgery, and 1,3, 6, and 12 months thereafter. The pair t-test, Wilcoxon test, and the Mann - Whitney U test (alpha = 0.05) were used for the statistical analysis. RESULTS: The PRK showed high index of effectiveness and safety (0.98, respectively 1.03 in the first year after the procedure). The contrast sensitivity under mesopic circumstances was not significantly involved after the PRK. The main value of the CS remained during the whole follow-up period within the physiological range in all spatial frequencies. Postoperatively, the part of spherical aberration on the higher order aberrations increased from 13.1% preoperatively to 16.6% one year after the PRK. In one half of the cases, the change of the higher order aberrations was within the range +/- 0.1 microm. In 66% of cases, the change of the spherical aberration was +/- 0.05 microm. The higher order aberrations comparing to the preoperative values decreased or remained unchanged approximately in one third of the cases, and the spherical aberration in one quarter of the cases. There was not established dependence between monochromatic aberrations values and the contrast sensitivity. CONCLUSION: Although the conventional RPK for low myopia treatment induces higher order aberrations including the spherical aberration, the impact on the contrast sensitivity under mesopic circumstances in our group were not significant. The contrast sensitivity of the most of patients was near the upper limit of the normal range.

[Possibilities of evaluation of changes of glomerular filtration rate estimated on the basis of predicting formulas]. / Moznosti posouzení zmen glomerulární filtrace na podklade predikcních formulí.

INTRODUCTION: Estimation of changes of glomerular filtration rate based on accurate measurement (GFR) and that based on predicting formulas (eGFR) could differ significantly. In this study we have tried to analyse the relationship between (eGFR)t2/(eGFR)t1 and (GFR)t2/(GFR)t1 (where t1 and t2 denote the time at the beginning and the end of the follow-up interval). METHODS: Renal clearance of inulin (Cin) was repeatedly examined in 32 patients suffering from chronic renal impairment (S(Cr) = 231 +/- 70 micromol/l). Estimated GFR (eGFR) was calculated on the basis of Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (CG) equations. RESULTS: A significant relationship between (MDRD)t2/(MDRD)t1 and (Cin)t2/(Cin)t1 (r = 0.544, p = 0.0028, R2 = 0.295) as well as between (CG)t2/(CG)t1 and (Cin)t2/(CG)t1 (r = 0.556, p = 0.0026, R2 = 0.309) was found. Average difference between (MDRD)t2/(MDRD)t1-(Cin)t2 /(Cin)t1 was 0.017 +/- 0.17 and that of (CG)t2 /(CG)t1-(Cin)t2/ (Cin)t1 was 0.024 +/- 0,18. Within +/- 0.20 of the difference (eGFR)t2/(eGFR)t1-(Cin)t2 /(Cin)t1 59 % values were found and within +/- 0.30 of this difference 75% values were recorded. Highly significant relationship was found between (MDRD)t2/(MDRD)t1 and (CG)t2/(CG)t1 (r = 0.991; p = 0.0001; R2 = 0.983). CONCLUSION: Considering these preliminary findings, predicting formulas are not sensitive sufficiently to by able to detect GFR changes lower than 30% of initial value.

[Applying the DNA diagnostics in patients with superficial keratitis of viral origin]. / Vyuzití DNA diagnostiky u pacientu s povrchovou keratitidou virového puvodu.

AIM: The authors evaluate the significance of the DNA diagnostics in patients with superficial keratitis of viral origin and their capability to be used for monitoring of the treatment effectiveness in the follow-up. The presence of herpes simplex virus 1 and 2, varicella zoster virus (HSV 1, HSV 2, VZV), and adenoviruses was assessed by means of the DNA analysis. MATERIAL AND METHODS: The group consisted of 54 patients (33 men and 21 women), mean age 45.6 +/- 9.5 years, who were treated at the Eye Department for superficial keratitis or keratouveitis of viral origin. A sample from the involved place was taken with a cotton swab and a sample of approx. 50 microL of tears was taken from the conjunctival sac with a single-use micropipette. The cotton swab and the tears were shaken with the EliDNA Store Kit (ELISABETH PHARMACON, Czech Republic) buffer, which prevents the DNA degradation and allows the storage and transport of samples at the room temperature. After the transportation in to the laboratory, the DNA was isolated by means of the UltraClean DNA Tissue Kit (MoBio, U.S.A.). The isolated DNA was used for HSV 1, HSV 2, VZV, and adenoviruses detection by means of PCR (polymerase chain reaction). All samples were screened for the HSV1 presence using the in-house RealTime method with TaqMan probe and the Applied Biosystems RealTime System 7300 device. In case of positive result of the DNA analysis, control samples were taken in 7 - 10 days periods until negative result was obtained; another sample was taken in case of suspected relapse. The control examination was also performed by means of cultivation from the same sample by another laboratory. RESULTS: Altogether 82 samples were taken and 230 DNA analyses were performed. The DNA diagnostics proved the presence of HSV 1 DNA in 28 patients, in one case, VZV DNA was detected, and 16 patients were positive on adenoviruses. The HSV 1 positive samples were confirmed by means of in-house RealTime PCR method as well as commercially available in vitro diagnostic healthcare device End-Point PCR HSV1/2 (Nanogen Advanced Diagnostics, Italy). All cultivation control examinations performed in another laboratory were negative. The samples were taken repeatedly in 9 patients to monitor the efficacy of the treatment. SUMMARY: The DNA diagnostics seem to be a fast and reliable method to determine the etiological agent in patients with superficial keratitis and allow very accurate monitoring of the treatment efficacy.

[GDx before and after LASIK in middle and high myopia]. / GDx pred a po LASIK u strednej a vyssej myopie.

AIM: To evaluate, if there are statistically significant changes in the RNFL (retinal nerve fibre layer) after LASIK. To evaluate, if the changes in the corneal structure caused by LASIK involve the results of the RNFL by means of GDx VCC. MATERIAL AND METHODS: The group consisted of 100 eyes of 51 patients (32 women, 19 men); the mean age was 28.55 +/- 5.1 years (18-50 years). The average refractive error in spherical equivalent (SE) was -5.46 +/- 1.40 D (dioptres). The group was divided into two subgroups: subgroup A (69 eyes with SE from -3.25 D to -6.0 D), and subgroup B (31 eyes with SE from -6.25 D to -12 D). The patients underwent the LASIK procedure to correct the myopia. The thickness of the RFNL was measured by means of GDx analyzer with variable corneal compensator. The measurements were performed before and 1, 3, 6, and 12 months after the LASIK procedure. The results of the measurements were statistically evaluated by means of the Mann-Whitney U test. RESULTS: The statistically significant difference in the RNFL thickness (p < 0.05) was found in "Superior Average" 3 and 12 months after LASIK (p = 0.016, p = 0.018), in "Inferior Average" in all controls (p = 0.047, p = 0.0001, p = 0.0003, p = 0.001) and in "NFI" after 12 months (p = 0.039). The values of difference in RNFL thickness in separate measurements after LASIK between both subgroups A and B were evaluated by means of Mann-Whitney U nonparametric test. Statistically significant difference in "Inferior Average" was found 1,6, and 12 months after LASIK (p = 0.01, p = 0.01, p = 0.04); in "TSNIT Average" after 6 months (p = 0.01); in "NFI" values after 1 month (p = 0.03). In "Superior Average, no statistically significant difference was found. SUMMARY: In our group we have found statistically significant decrease of RNFL thickness after LASIK in every single quadrant. Clinically, the differences in RNFL thickness before and after LASIK were minimal. We suppose the measurements by means of GDX are influenced by changes in the polarization features of the cornea caused by LASIK procedure.