Changes in tear film osmolarity after 25G+ PPV.

BACKGROUND: The aim of our study was to assess changes of tear film osmolarity after micro-incision 25G+ pars plana vitrectomy (PPV) in a prospective study. METHODS: The group consisted of 21 patients (17 women, 4 men) with an average age of 70,52 years [48; 85]. All patients underwent 25G + PPV surgery due to a disorder of the vitreomacular interface (macular hole or epimacular membrane). Only patients who did not use artificial tears before the surgery and who had not been diagnosed with dry eye syndrome at ours or another institution were included in the study. Except cataract surgery, all ocular surface diseases, intraocular diseases, trauma or surgery were exclusion criterias. Tear film osmolarity was measured in both eyes in every patient before surgery, 10 days after surgery and 30 days after surgery. A paired test was used for statistical evaluation. RESULTS: No statistically significant change in osmolarity was found in the operated eyes (p > 0.05). No statistically significant changes in time (p > 0.05) were found when both eyes were compared. There were no postoperative complications or failure to observe the study protocol. CONCLUSION: Micro-incision 25G + PPV does not affect the osmolarity of the tear film.

[One-day simultaneous bilateral cataract surgery]. / Jednodenní oboustranná operace katarakty. Vlastní výsledky.

INTRODUCTION: Effectiveness Evaluation of One-Day Simultaneous Bilateral Cataract Surgery (SBCS) Comparing to the Cataract Surgery Performed on Each Eye Separately After a Lapse of Time. MATERIAL AND METHODS: The cohort of 100 patients (200 eyes) consisted of two groups: In the Group1, there were 50 patients (100 eyes) who underwent One-day Simultaneous Bilateral Cataract Surgery (SBCS). The Group 2 consisted 50 patients (100 eyes) who had the surgery on one eye first, and later on the fellow eye. The course of the surgery, peroperative and postoperative complications were evaluated. The patients from the Group 1 were examined at the first postoperative day. In the next course, all patients were examined one week, one month, and 3 months after the surgery. In the postoperative phase were, besides the complications, the final visual acuity and refraction and its deviations from the target refraction followed up. RESULTS: Course of the surgery, peroperative and postoperative complications are comparable in both groups. Endophthalmitis, or other more serious postoperative complications did not appear in either group. Three months after the surgery, the uncorrected visual acuity (UCVA) 0.8 and better in the Group 1 had 75 % of patients, and in the Group 2 also 75 % of patients. The UCVA 0.5 and better in the Group 1 had 95 % of patients; in the Group 2 it had 90 % of patients. The best-corrected visual acuity 0.8 and better had in both groups 95 % of patients. The final refraction after 3 months in the Group 1 was -0.15 ± 0.91 (-0.12); -3.37; 2.00. In the Group 2 the final refraction after 3 months was -0.08 ± 0.91 (0.00); -3.25; 2.75. CONCLUSION: The results are showing that both groups of our cohort are comparable. The One-Day Simultaneous Bilateral Cataract Surgery (SBCS) is, from the surgical point of view, equally safe and effective as classically performed cataract surgery.Key words: One-Day Simultaneous Bilateral Cataract Surgery (SBCS), refraction, visual acuity, postoperative complications, intraocular pressure.

[Treatment Results of the Diabetic Macular Edema by Means of the PASCAL Laser System]. / Výsledky lécby diabetického makulárního edému laserovým systémem PASCAL.

OBJECTIVE: To evaluate functional, anatomical and clinical efficacy, and safety of the pattern scanning laser (PASCAL®) photocoagulation in patients with diabetic macular edema and absence of proliferative diabetic retinopathy. METHODS: From 2008 to 2013 84 eyes of 58 patients (30 men, 28 women) were treated with pattern laser photocoagulation at the Ophthalmology Department at University Hospital Ostrava. Average age at the baseline visit was 65 years. The inclusion criteria included nonproliferative diabetic retinopathy (84 eyes), focal DME (14 eyes), diffuse exudative DME (70 eyes). All the eyes were "treatment naive". The average duration of diabetes was 18 years, average baseline HbA1c value was 8,4%. Either focal laser photocoagulation or grid photocoagulation was performed with the PASCAL photocoagulator. Best corrected visual acuity (BCVA), central retinal thickness (CRT), fundus photography, biomicroscopy and complications were evaluated during the minimum 12months follow-up period. Statistical analysis using parametrical and nonparametrical tests with p less than 0,05 was done. RESULTS: Mean baseline BCVA was 0,43 logMAR. Values 0,38, 0,37, 0,38 a 0,38 logMAR were observed in the follow-up intervals in the 4th, 6th, 12th and 18th month. In 4 eyes (5%) improvement of more than 3 lines was observed, in 26 eyes (31%) improvement from 0 to 3 lines was observed, in 52 eyes (62%) decrease from 0 to 3 lines was observed and in 2 eyes (2%) decrease of more than 3 lines was observed. Mean baseline CRT was 398 µm, values 370 µm, 362 µm, 349 µm and 338 µm were observed in the follow-up intervals in the 4th, 6th, 12th and 18th month. At the 12th month visit 76 eyes (90%) were stabilized, and in 8 eyes (10%) progression of the disease was observed. No complications were observed during the first 12 monhts follow up. CONCLUSION: Pattern scanning laser photocoagulation of DME lead to BCVA and clinical stabilization. In addition to this, it lead to decrease of the CRT. The efficacy was comparable to traditional laser systems with no apparent benefit to the traditional systems. The efficacy was inferior to modern intraocular anti-VEGF (vascular endothelial growth factor) drugs.

[Eye Myiasis - a Case Report]. / Ocní myiáza.

The authors describe a case of 47 years old patient who came to the department of ophthalmology with eye discomfort, ear bleeding and itching of both legs. The diagnosis of ophthalmomyiasis was made after an eye examination. Manual extraction of maggots from upper and lower fornix of the left eye was performed and symptomatic therapy was given. The patient was sent to otolaryngology and dermatology departments and MRI. The maggots were also found in both external auditory meatus and between the toes. MRI excluded affection of the deeper structures of the head. Improvement of the local condition was observed since the first follow-up visit.

[The cell phones as devices for the ocular fundus documentation]. / Mobilní telefony jako nástroj pro dokumentaci ocního pozadí

OBJECTIVE: To present our experience with "smart phones" when examining and documenting human eyes. METHODS: From September to October 2013 fifteen patients (8 men, 7 women) eye fundus was examined, an average age during the examination was 58 year (ranging from 20-65 years). The photo-documentation was performed with dilated pupils (tropicamid hydrochloridum 1% eye drops) with mobile phone Samsung Galaxy Nexus with the operating system Android 4.3 (Google Inc., Mountain View, CA, USA) and iPhone 4 with the operating system 7.0.4 (Apple Inc., Loop Cupertino, CA, USA), and with 20D lens (Volk Optical Inc., Mentor, OH, USA). RESULTS: The images of the retina taken with a mobile phone and the spherical lens are of a very good quality, precise and reproducible. Learning this technique is easy and fast, the learning curve is steep. CONCLUSION: Photo-documentation of retina with a mobile phone is a safe, time-saving, easy-to-learn technique, which may be used in a routine ophthalmologic practice. The main advantage of this technique is availability, small size and easy portability of the devices.

[Screening ROP in the University Hospital Ostrava]. / Screening ROP ve FN Ostrava.

OBJECTIVE: To analyze the group of premature infants who were examined by an ophthalmologist in screening for ROP (retinopathy of prematurity) at the University Hospital in Ostrava. METHODS: A retrospective observational case series. We reviewed and analyzed clinical records of all the premature infants born before the 32nd gestational week examined by ophthalmologist in ROP screening at the University Hospital in Ostrava in the period from 1. 9. 2011 to 31. 8. 2012. Childrens gestational age at birth, birth weight, postconceptional age (PCA) of the child at the time of the first ocular inspection, at the time of diagnosis ROP and at the time of any intervention, possible risk factors of ROP (Apgar score in the 1st minute, duration of oxygen therapy, FiO2 (%) (percentage fraction of oxygen in the inspired gas mixture), duration of mechanical ventilation, transfusion of erythrocytes (resuspended leukodepleted), presence of sepsis / infection in the perinatal period and duration of phototherapy) were evaluated. Eye examination was performed in local anesthesia with the use of an eyelid retractor, in artificial mydriasis, using an indirect ophthalmoscope and digital imaging system RetCam 3. RESULTS: 138 premature infants with an average gestational age at birth of 29.8 weeks, average birth weight 1385 g, were included in this study. Thirty-four children (24.6 %) were diagnosed with ROP, in all cases 1st stage at the time of diagnosis. An ophthalmologist indicated and subsequently implemented intervention (cryotherapy / laser treatment) in the case of five children (14.7 %) with ROP under general anesthesia. Average duration of oxygen therapy at infants with ROP was 371 hours, in the group without ROP 84 hours. The difference between the average values was statistically significant [t (37) = -3.69, P <= 0.0007]. Average time of mechanical ventilation in the case of children with ROP were 229 hours, in the group without ROP 41 hours [t (35) = -2.99, P <0.005]. In the case of children with ROP, we noticed on average 3 transfusions of erythrocytes, in the group without ROP 1 transfusion [t (40) = -3.94, P <= 0.0003]. The average value of the Apgar score in the 1st minute of children with ROP group was 6.3 and children without ROP 7.8. The difference between the average values of Apgar score in the 1st minute was between both groups statistically significant [t (136) = 4.06, P <= 0.00008]. Sepsis / infection in the perinatal period occurred in 30 (88.2 %) children with ROP, in comparison with 46 (44.2 %) children with sepsis / infection without ROP. Average duration of phototherapy in infants with ROP was 42.4 hours, in the group without ROP 53.6 hours [t(136) = 1,21, P<= 0,2]. CONCLUSION: This study demonstrated statistically significant correlation of Apgar score in the 1st minute, duration of oxygen therapy, duration of mechanical ventilation, transfusion of erythrocytes and presence of sepsis / infection on the onset and progression of ROP at premature infants in our group. No effect of FiO2 (%) and duration of phototherapy on the onset and progression of ROP was demonstrated.

[Ocular trauma in childhood at the University Hospital Ostrava in the years 2007-2011]. / Úrazy ocí a periokulární krajiny u detí ve FN Ostrava v letech 2007-2011.

OBJECTIVE: to investigate and analyze the group of child patients with ocular trauma in the Ostrava region in the Czech Republic. METHODS: A retrospective observational case series. We reviewed and analyzed clinical records of all the paediatric patients with ocular trauma treated at the University Hospital Ostrava in the years 2007 - 2011. Age, sex, mechanism of injury, type of ocular trauma, the consequences of injury and period of the year when the accident occurred were evaluated. BETT classification used in this study was modified and extended by chemical and thermal injuries and orbital trauma. Ocular burns, including thermal and chemical burns, were graded using the classification for ocular surface burns by Dua. RESULTS: 448 children (309 boys, 139 girls), aged from 3 months to 17 years (median 10 years) were included in this study. The most common ocular injury was closed globe injury (253 patients, 56,5 %), the next common were orbital injuries (149 patients, 33,3 %), burns injuries (39 patients, 8,7 %), the least frequent were open globe injuries (7 patients, 1,6 %). The most common mechanism of ocular trauma was hit by object (34,6 %), followed by trauma caused by blows and falls (15,2 %) and hit by another person (10,3 %). The 50,9 % of injuries occurred in days of school attendance. 10,3 % of injuries occurred directly at the school or preschool facilities. 6,5 % of the injuries were polytraumas, which required interdisciplinary cooperation. CONCLUSION: This study demonstrated that the incidence of eye injuries is greater in boys, mainly adolescents. Closed globe injuries are the predominant type of ocular trauma in childhood. The mechanism of ocular trauma is variable. Nonetheless there is a relation between the mechanism and the age of the child. Further research in terms of how the preventive measures would affect the incidence and severity of ocular trauma in children would be beneficial. The modified BETT classification of ocular trauma, including chemical and thermal injuries and orbital trauma may better address current requirements.

[Cataract surgery in 2000]. / Operace katarakty v roce 2000.

The authors evaluate a questionnaire survey concern to cataract surgery in the Czech Republic. They present the results of all 58 ophthalmological departments where cataract is operated. In the CR in 2000 a total of 49,804 eyes were operated. In 94.4% of operations the technique of phacoemulsification was used. Primary implantation of an intraocular lens was used in 99% of the operated patients. In more than 27% for correction of aphakia a soft intraocular lens was used. Almost 30% of the operated patients had one-day surgery. In coming years a greater need for these operations may be foreseen. To avoid longer waiting periods more financial means will be needed for new types of materials or a solution of the problem of financial participation of the patient in meeting the costs of surgery.

[Primary polypseudophakia in patients with cataracts and hypermetropia]. / Primární polypseudofakie u pacientu s kataraktou a hypermetropií.

The authors present clinical results of 22 cataract surgeries of hypermetropic eyes in 18 patients (mean age 74 years, range 58-95 years) with primary piggyback implantation of two PMMA IOLs both in capsular bag. The surgeries have been performed in The Eye Department of The Municipal Hospital in Ostrava. Intraocular lens calculations were performed using the SRK II formula. The follow-up period was 5 to 36 month (mean 15 month). The mean stabilised postoperative refraction was -0.24 D (range -3.5 D to +3.12 D). The mean best corrected visual acuity, that reached 0.23, is limited especially by amblyopia and other eye diseases. We noticed four secondary cataracts in two patients. There was found no interlenticular opacification. Primary implantation more posterior chamber intraocular lenses is a good choice for correction hypermetropia during cataract surgery.

[Cataract surgery in the Czech Republic 1988-1997]. / Operace sedého zákalu v Ceské republice v letech 1988-1997.

The author presents the results of a questionnaire survey where all ophthalmological departments in the Czech Republic which operate cataract were addressed every year with eight or fifteen questions resp. pertaining to the frequency of operations, surgical technique and implantation of intraocular lenses. The results covering 10 years were evaluated. The number of cataract operations increased during the follow-up period from 11,339 to 46,175 eyes. The number of implantations of intraocular lenses increased from 13.50 to 98.80%. The number of operations made by the phacoemulsification technique was in 1991 283 eyes (1.80%) and increased to 36,543 eyes (79.10%) in 1997. Of the contemporary 137 phacosurgeons 12 are so-called high volume surgeons, i.e. they operate more than 50 cataracts per month.

[Development of cataract surgery and implantation of artificial intraocular lenses in Czecho-Slovakia 1988-1992]. / Vývoj chirurgie katarakty a implantácie umelých vnútorných sosoviek v Cesko-Slovensku v rokoch 1988-1992.

After a brief introduction on the history of implantations of synthetic intraocular lenses in Czechoslovakia the authors present an analysis of surgery of cataract and implantation of artificial intraocular lenses during the past five years in Czechoslovakia. The number of operations of cataract increases every year, a substantial increase was recorded in particular in 1992. During the other years there is also a change from intracapsular to extracapsular extraction of cataract and a slow onset of phacoemulsification. The number of departments where artificial lenses are implanted is increasing as well as the ratio of implantations in relation to the total of cataract surgery. In particular during the remaining three years a marked rise of implantation of posterior chamber lenses was recorded and a decline in implantations of iris-clip lenses. Almost 95% of implantations of posterior chamber lenses is considered satisfactory, while less than 60% implantations from the total number of cataract surgery is still insufficient.

[Fluorescein and its adverse effects]. / Fluorescein a jeho nezádoucí úcinky.

The authors investigated physical and chemical properties of fluorescein, a substance widely used in ophthalmology. In view of the increased application of fluorescein angiography in the diabetological programme, the authors draw attention to possible undesirable effects of fluorescein and submit an account of complications recorded after application of this substance to 576 patients examined by this method at the Ophthalmological Clinic in Brno.

[Personal experience with modern extracapsular cataract extraction]. / Nase zkusenosti s moderní extrakapsulární extrakcí katarakty.

In the group of 42 eyes with extracapsular cataract extraction the postoperative results were very favourable differing conditions. There did not occur any more serious postoperative complications. Authors verified that for a skillful ophthalmic surgeon this operation is easily performed, on the other hand many of them have to overcome some accustomed aversion and to use at present time the needed extracapsular extraction, in spite of the previous routinely used intracapsular technique, which was successfully performed for many years. Present trend of extracapsular cataract extractions is based on the aim to decrease the number of the postoperative complications and to make possible the implantation of the intraocular lenses into the posterior chamber of the eye.