[Comparison of clinical results between LASIK method and ICL implantation in high myopia]. / Srovnání klinických výsledku metody LASIK a implantace ICL u vysoké myopie.

In a retrospective study the authors evaluate clinical results of the LASIK (laser in situ keratomileusis) and the implantation of the implantable posterior chamber contact lens phakic IOL (ICL) (STAAR Surgical) to correct high myopia. The purpose of the study was to assess which of those two methods is more reliable in patients to correct myopia in the range -10.0 to -23.0 diopters. The LASIK method was presented of a group of 70 eyes of 48 patients with preoperative spherical equivalent average of -12.9 +/- 3.8 diopters (Dsf) and average astigmatism of -0.99 +/- 1.2 cylindrical diopters (Dcyl). The group was divided into two parts: one part was with the desired postoperative emmetropia--46 eyes (65.7%), and part two was with the desired postoperative residual myopia up to -3.0 Dsf--24 eyes (34.3%). The method of ICL implantation was presented of a group of 36 eyes of 21 patients with preoperative spherical equivalent average of -15.21 +/- 4.0 Dsf and average astigmatism of -0.92 +/- 0.69 Dcyl. Also this group was divided into two parts: One part was with the desired postoperative emmetropia--25 eyes (69.4%), and part two was with the desired postoperative residual myopia up to -3.0 Dsf--11 eyes (30.6%). The developments of postoperative refraction in time (1 week to 3 years after the surgery), the final postoperative refraction and its stability and (6 months to 3 years after the surgery) as well as the occurrence of complications in both studied groups were evaluated. In the assessment of the postoperative refraction development in groups of desired emmetropia, the average uncorrected visual acuity (UCVA), average postoperative spherical equivalent and astigmatism were evaluated. In the groups with desired residual myopia the average best-corrected visual acuity (BCVA), average postoperative spherical equivalent, and astigmatism were followed. Three years after the surgery in groups with desired emmetropia, the average postoperative spherical equivalent was -0.99 Dsf and reduction of myopia by 92.0% in the LASIK method, and -0.52 Dsf and reduction of myopia by 96.1% in ICL implantation respectively. In cases of desired residual myopia those final values were -1.74 Dsf with reduction of myopia by 86% for LASIK, and -1.58 Dsf with reduction myopia by 90.7% for ICL implantation. Final postoperative BCVA (given in lines of Snellen optotypes) was in 1.7% (1 eye) loss of 2 lines, in 17.1% (12 eyes) 1 line loss, in 55.7% (39 eyes) without change, in 22.9% (16 eyes) improvement by one line. In ICL implantation, the BCVA was unchanged in 25% (9 eyes), in 72.3% (26 eyes) improved by 1 line, and in 1 eye improved by 2 lines. In the group with LASIK method, in 17.1% (12 eyes) a reoperation followed, and in the group with ICL implantation, in 2.7% (1 eye) the other operation followed (ICL explantation). From the results emerged that for high myopia over -10 Dsf is the ICL implantation more appropriate because of its faster postoperative visual rehabilitation, more stabile and better final postoperative refraction and lower complications ratio.

[Phototherapeutic keratectomy in the treatment of superficial corneal diseases]. / Význam fototerapeutické keratektomie v lécbe povrchových onemocnení rohovky.

In the retrospective study the authors evaluate clinical results of phototherapeutic keratectomy (PTK) that is one of the alternative methods used in treatment of some of the superficial corneal diseases. The authors present the group of 89 eyes of 63 patients with diagnose: dry spot corneae in 69 eyes (77.5%), recurrent corneal erosion in 13 eyes (14.5%), corneal dystrophy in 2 eyes (1.8%), recurrent herpes simplex keratitis in 3 eyes (2.7%), recurrent pterygium in 2 eyes (1.8%), atopic keratoconjunctivitis with mucous plaque in 1 eye (0.9%). The average age was 45.2 years (14-84 years) and average follow-up period was 29 months (3-52 months). The operation was done with the use of device Keracor 117 (ArF excimer laser) in topical anaesthesia, with the average zone of ablation 4.1 mm and average depth of ablation 24 mu in one go. In ten cases was the operation carried out repeatedly. We evaluated the postoperative complications, postoperative changes of refraction and final the best corrected visual acuity. For low percentage of postoperative complications, decrease or disappearance of subjective difficulties and improvement of visual acuity with minimal stress for the patient we can recommend PTK as save and efficient method in treatment of corneal diseases mentioned above.

[Implantation of the Starr Surgical intraocular posterior chamber lenses for phakic eyes in medium and higher levels of myopia and hyperopia]. / Implantace intraokulární zadnekomorové cocky pro fakické oko firmy STAAR surgical u stredních a vyssích stupnu myopie a hyperopie.

Implantation of an Intraocular Posterior-chamber Lens for a Phacik Eye from STAAR Surgical Co. in Medium and Higher Grades of Myopia and Hyperopia Implantation of an intraocular Collamer lens for a phacic eye produced by STAAR Surgical (ICL) co. is a modern method of correction of medium and high-grade refractive defects--myopia and hyperopia. The authors evaluate the results of implantation of ICL Staar Surgical in 20 eyes of 13 patients (1 man and 12 women). Their mean age was 31.36 +/- 9.21 years and the follow-up period 1-54 months (mean 28.8 months +/- 12.42). The group was divided into two sub-groups--hyperopia (8 eyes) and myopia (12 eyes). The mean value of refraction before surgery was 28 D +/- 2.03 and +0.25 Dcyl manifest (in cycloplegia +7.6 +/- 2.28 D) (from 3.75 D to 10.0 D) in the group of hyperopia and -14.25 D +/- 5.68 and -1.81 Dcyl (from -5.5 D to -25.0 D) in the myopic group. The required postoperative refraction was in 17 eyes emmetropia and in 3 eyes residual myopia up to -3.0 D with regard to incipient presbyopia. The authors evaluate the resultant best corrected visual acuity (BCVA), the resultant postoperative refraction, the incidence of postoperative complications and changed density of endothelial cells in the centre of the cornea in the course of time. In the group of hyperopia improvement of the BCVA as compared with the preoperative value occurred by one line in two eyes (25%), in 5 eyes (62.5%) BCVA remained unchanged. In one instance deterioration by one line occurred due to a diminution of endothelial cells in the centre of the cornea after surgery. In the group of myopia in 7 eyes (58.3%) improvement by 1 line occurred, in 2 eyes (16.7%) by 2 lines and in 3 cases (25%) BCVA remained unchanged. The mean value of postoperative refraction in the myopic group in required emmetropia (9 eyes) was -0.77 +/- 1.62 D and in required residual myopia (3 eyes) -1.5 +/- 1.32 D. The mean value of postoperative refraction in the group of hyperopia was +0.57 +/- 0.5 D for far sight and +1.28 +/- 0.58 D for near sight. The most frequent early postoperative complications included keratitis striata in 5, epithelopathy in 3 and residues of viscoelastic material behind the ICL in 3 eyes. As to late postoperative complications, in 2 eyes a change in endothelial cell density was involved, in 12 eyes the syndrome of pigment dispersal and in one eye late decentration of ICL occurred with subsequent anterior subcapsular cataract. The change in density of endothelial cells was most markedly expressed 3 months after surgery in the hyperopic group. The advantage of ICL implantation is rapid postoperative visual rehabilitation, reversibility of the operation, preserved accommodation and satisfactory stability of the postoperative refraction.