Silent Sinus Syndrome.

Silent sinus syndrom is rare and slow progressive disorder associated with asymptomatic chronic maxillary sinusitis and collapse of the orbital floor. The most common manifestations are enophtalmos, hypoglobus and pseudoretraction upper eyelid. Silent sinus syndrome is almost a unilateral condition and is usually diagnosed in patients in their 30´s and 40´s. The largest risk factors is underlaying aberrant nasal anatomy. The subsequent osteomeatal complex obstruction leads to hypoventilation of the maxillary sinus and negative pressure development. The sinus cavity is filed with a combination of mucus and acellular transudate. This proces create a chronic mucosal inflammation with demineralization and collapse of the orbital floor. CT imaging is pathognomonic and shows ipsilateral maxilar sinusitis and the orbital floor is inferiorly displaced. The differential diagnosis includes chronic sinusitis, osteomyelitis, malignat sinus infiltration and orbital trauma. The endoscopic antrostomy is the gold standard to re-establish normal sinus aeration. In this article we describe patient with silent sinus syndrome, who has been treated at our clinic and his symptoms were corrected ad integrum after the surgery.

[ProVens® in the Therapy of Glaucoma and Ocular Hypertension]. / ProVens® v lécbe glaukomu a ocní hypertenze.

OBJECTIVE: To assess the effect of the ProVens® dietary supplement administration on intraocular pressure in patients with glaucoma and ocular hypertension. MATERIAL AND METHODS: The patients included in the trial were given the ProVens® dietary supplement once daily. One ProVens® tablet contains: 50 mg of maritime pine bark extract, 100 mg of green tea extract, and 3 mg of blueberry extract. The main ProVens® components are proanthocyanins from the bark of the maritime pine tree Pinus pinaster, polyphenols from green tea, and anthocyanins from blueberries. The total number of patients included in the trial was 46. Out of these, 35 patients were monitored for asymptomatic ocular hypertension and 11 patients for open-angle glaucoma treated with prostaglandin analogs. Intraocular pressure was measured by applanation tonometry in the beginning of the trial, after one month, and after three months of their inclusion in the trial, always at the same time of the day. RESULTS: In the group of patients with ocular hypertension, there was a statistically significant reduction in the intraocular pressure from the baseline values of 24.2 ± 2.1 mm Hg to 20.9 ± 2.5 mm Hg within the period of three months (p < 0.0001). In the group of patients with open-angle glaucoma, there was a statistically significant reduction of the intraocular pressure from the baseline values of 18.4 ± 3.2 mm Hg to 17.0 ± 3.1 mm Hg within the period of three months since the beginning of administration of the product (p = 0.022). When comparing both groups, we observed a significantly higher reduction in intraocular pressure (p = 0.0001) in the group of patients with ocular hypertension. In the whole group, no adverse effects were reported during the intake of this dietary supplement. CONCLUSION: Intake of the ProVens® dietary supplement containing proanthocyanins from the bark of the maritime pine tree Pinus pinaster together with a mixture of herbal antioxidants appears to be one of the methods of how to improve the control of intraocular pressure, particularly in patients with ocular hypertension. KEY WORDS: glaucoma, ocular hypertension, ProVens®, proanthocyanins, antioxidants, maritime pine bark extract.

Analytic methods in assessment of optic nerve cupping.

The intent of this paper is to provide a systems-based analysis of the methods used to evaluate optic nerve cupping, identify potential flaws in these systems, and propose alternatives better to assess this anatomic quantity. Estimation of optic nerve cupping requires an analytic understanding of both the psychophysical as well as the mathematical bases inherent in this measure. When the (decimal-based) cup-to-disc ratio is used to quantitate optic nerve cupping, a one-dimensional, linear estimate is produced, which in turn is derived from two- or three-dimensional, non-linear physical quantities of area or volume, respectively. When extrapolating from volume, to area, to linear measures, due to the psychophysical constraints which limit this task, such a data-compressed estimate of optic nerve cupping may neither accurately reflect, nor correctly represent, the true amount of cupping actually present in the optic nerve head. This type of one-dimensional metric (when comparing calculations from two- or three-dimensional measures over a range of optic nerve cupping), appears to introduce errors which, while most pronounced earlier on in the disease progression, often overestimate the amount of relative cupping (percent cupping) present in a pathological process like glaucoma. The same systemic errors can also lead to overestimation of the progression in cupping, especially in optic nerves with low cup-to disc values. To provide clinically meaningful estimates of optic nerve cupping, the practitioner needs to be aware of psychophysical and mathematical limitations inherent in using a linear cup-to-disc ratio to estimate the amount of cupping observed in a physical structure like the optic disc. The resultant flaws introduced by observer extrapolation from three, to two, to one dimensions (volume, area, and linear); transposition from non-linear to linear quantities; and optical illusions, caused by factors like disc topology, morphology, and ametropia, can all influence subjective-based estimates of optic nerve cupping. To improve clinical outcomes, a non-linear mathematical technique is proposed which utilizes two- or three-dimensional objective measures of optic nerve cupping to describe, more accurately and more precisely, the anatomic quantities (disc, cup, and rim) under discussion. The authors acknowledge that any proposed technique is only a beginning to the work required to improve the clinical value of this type of measure.

[Statistical analysis of the nerve fiber layer in color digital images of the retina]. / Statistická analýza vrstvy nervových vláken v barevných digitálnich snímcích sítnice.

The topic of the article is to inform about the analysis of the nerve fiber layer in color digital images of the retina. The study group consists of 11 eyes (9 patients) with marked focal losses in the nerve fiber layer of the retina. The control group consists of 14 eyes (7 patients). The basic statistical parameters, which may distinguish the loss in the nerve fiber layer from the healthy nerve fiber layer, are suggested and evaluated. The study is focused particularly to detect the focal losses.

[Digital images of the retinal nerve fiber layer in healthy eye and in glaucoma]. / Digitální snímky vrstvy nervových vláken sítnice u zdravého oka a u glaukomu.

The authors describe the procedure how to take pictures of the retinal nerve fiber layer with the fundus camera CANON CF-60UV connected to the digital camera EOS 20D. They attach practical instructions how to modify taken digital pictures with the Photoshop CS2 software, to make the nerve fiber layer and its losses more visible. They present modified pictures of the nerve fiber layer in healthy eye and in glaucoma where the losses are compared to the scotomas in the visual field.

[Subjective examination of the nerve fiber layer of the retina and its evaluation in a healthy eye and in glaucoma]. / Subjektivni vysetrení vrstvy nervových vláken sítnice a její hodnocení u zdravého oka a u glaukomu.

The authors describe the advantage of subjective examination of the nerve fiber layer in everyday outpatient praxis of the ophthalmologist. The objective examination of the nerve fiber layer is performed on specialized clinics by means of expensive instruments as are OCT, GDX or HRT. Every ophthalmologist may analyze the retinal nerve fiber layer subjectively with the basic equipment of the praxis. The aim of this paper is to present a recommendation how to expand the routine technique of the direct ophthalmoscope examination and biomicroscopy examination on the slit lamp, to make possible to observe subjectively the retinal nerve fiber layer and to distinguish its changes in glaucoma.

[Adenoma of the pituitary gland in the ophthalmologist's out-patient practice]. / Adenom hypofýzy v ambulantní praxi ocního lékare.

Authors describe eye and general symptoms in five patients with the adenoma of the pituitary gland, detected on the results of the ophthalmological examination. Identical symptoms in all patients were the decrease of central visual acuity or visual field defects. The general somatic manifestations of the disease were different.

[Influence of intracranial pressure decrease in the pseudotumor cerebri syndrome on visual function]. / Vliv snízení nitrolebního tlaku u syndromu pseudotumoru mozku na zrakové funkce.

Authors describe ocular and neurological findings in a 68 years old female patient with the intracranial hypertension (pseudotumor cerebri). For developing edema of the optic nerve head on the fundus (oedema papillae), accompanied with lowered visual acuity and visual field defects, an urgent surgical treatment was indicated--the lumboperitoneal shunt was introduced. After the operation, although the atrophy of the optic nerve head atrophy occurred, the visual acuity was maintained and visual fields sensitivity improved.

[Effect of TLT absorptive eyeglasses on progression of myopia in children]. / Vliv absorpcních brýlových skel TLT na progresi krátkozrakosti u detí.

The incidence of myopia is increasing worldwide. At the last VIIIth international conference on myopia held in June 2000 in Boston attention was aroused by the work of Quin et al. on the influence of noctural illumination in rooms where children slept on their subsequent development of myopia. Our working hypothesis presented in Hakone in 1996 presumes also a negative effect of light and heat which initiate the development of myopia but on eyes with an inborn disposition. We considered as a solution wearing spectacles with glass which allow to penetrate only visible light and absorb the other wavelengths. These glasses were supplied by Karel Kubena-TL Technologies. The authors followed up for four years two groups of children with progressive myopia. The progression of myopia during the first two years of the follow up was almost identical in the two groups: in the group with the absorption glasses 0.75 D/year and in the control group 0.77 D/year. After two years of wearing the absorption glasses the progression in the group with the absorption glasses was 0.34 D/year and in the control group 0.59 D/year.

[Clinical features and therapy of giant cell temporal arteritis]. / Klinický obraz a terapie obrovskobunecné temporální arteriitidy.

Giant-cell temporal arteritis is an urgent condition in ophthalmology as successful treatment depends on early diagnosis and effective therapy before the development of ophthalmological symptoms. The authors investigated on a long-term basis five patients. In the first one complete regression of general and ocular symptoms occurred and vision was preserved. The second patient was admitted already with loss of vision of one eye and despite intensive treatment it did not prove possible to save vision of the second eye. The third patient developed, after clinical recovery, a relapse which was again brought under control. In another patient of relatively younger age it proved possible to arrest the progress of the disease without loss of vision. In the last patient visual acuity improved after treatment.

[Methods in optic nerve disk digital planimetry]. / Technika digitální planimetrie terce zrakového nervu.

The authors define the term planimetry in general and planimetry of the optic disc in particular and present a brief review of the history of planimetric evaluation of the optic disc. They describe a digital analyzer of their own design, the method of examination of the optic disc and further processing and recording of data. They define the indications and contraindications of examination, summarize the asset and limitations of the method used. The authors examined so far by digital planimetry 1575 optic discs of 856 patients.

[The optic nerve disk in myopic children with elevated intraocular pressure]. / Terc zrakového nervu u krátkozrakých detí s vyssím nitroocním tlakem.

The optic nerve disc of short-sighted children with elevated intraocular pressure was investigated to achieve early assessment of glaucoma and to detect signs which differentiate changes in the disc caused by short-sightedness from changes caused by glaucoma. The authors examined 16 eyes of 8 short-sighted children with elevated intraocular pressure. In addition to the basic ophthalmological examination they made a digital analysis of the optic nerve disc incl. planimetric evaluation of the dimensions of the disc, excavation and the neuroretinal rim. In two patients despite the higher intraocular pressure the area of the rim was supraliminal. In three patients the narrower area of the neuroretinal rim increased the probability of glaucoma In two patients with anisometropia on the eye with greater myopia the intraocular pressure was higher and the neuroretinal rim narrower as compared with the other eye. In one patient the area of the rim was very narrow and the diagnosis of glaucoma was confirmed also by arcuate scotoma in the lower part of the visual field corresponding to the narrow rim on top.

[Effect of infrared rays on the eye in progressive myopia]. / Vliv infracerveného zárení na oko s progresivní krátkozrakostí.

In the submitted paper the authors pay attention to infrared radiation close to visible light is intensely absorbed by haemoglobin, melanin and xanthophyll whereby part of the radiation energy is transformed into heat. The authors present three series of experiments where they investigated by different methods changes in the vitreous body after exposure to light, infrared radiation or raised temperature. They assume that on the defocused eye with a myopic conus which developed as a result of an inborn inadequate closure of the optic cup the light can cause a rise of temperature in the vitreous body. This leads to metabolic changes characterized by increased activity of lysosomal enzymes causing loss of the spatial structure of hyaluronic acid and collagen biomolecules. Penetration of the altered vitreous fluid thought the conus can lead to degradation of the interstitial substances of the sclera. Suitable absorption glasses filtering infrared light close to visible light could reduce the hyperthermia of the vitreous body.

[Visual perceptions in ophthalmic migraine]. / Zrakové vjemy pri oftalmické migréne.

The number of patients with ophthalmic migraine is steadily increasing. The symptoms of their attacks are dominated by typical visual aura, followed by major or minor headache. The authors present the experience of three physicians who observed the symptoms on themselves. The first one has suffered from the disease already for fifty years, the second and third one 25 years each. In the discussion the authors deal with the differential diagnosis of the disease and its possible treatment.

[Functional disorders of the visual field]. / Funkcní poruchy zorného pole.

The author describes a group of 12 patients with concentric narrowing of the visual field which was not elucidated, with the exception of one patient, even after all indicated clinical and paraclinical examinations. He describes diagnostic methods providing evidence of the functional character of the impaired visual field and presents typical findings of changes of the visual field in functional disorders.