RESULTS OF POSTERIOR LAMELLAR KERATOPLASTIES IN PHAKIC EYES.

PURPOSE: To evaluate the results of posterior lamellar keratoplasties (DMEK and PDEK) in phakic eyes. MATERIAL AND METHODS: Retrospective analysis of surgeries performed in our department between June 2016 and December 2019. The main focus was put on postoperative visual acuity, corneal endothelial cell density and possible peroperative and postoperative complications including cataract formation. RESULTS: We performed 12 surgeries on 11 eyes of 7 patients. The most prevalent primary diagnosis was Fuchs endothelial dystrophy (7 eyes), followed by bullous keratopathy after phakic anterior chamber IOL implantation (2 eyes) and ICE syndrome (2 eyes). The average length of follow-up was 12.5 months. Clinically significant complicated cataract had developed and was removed in 3 eyes, one eye required rebubbling due to graft detachment and one eye required rePDEK due to graft failure. At the end of follow-up, the average visual acuity was 0.87, while 82% of eyes achieved VA 0.8 or better, and the average endothelial cell density was 1589 cells/mm2. CONCLUSION: Posterior lamellar keratoplasties (DMEK and PDEK) can be performed on phakic eyes. When performed by an experienced surgeon, these are safe procedures with good postoperative results and significant advantage in preserving younger patients accommodation.

[Risk factors for diabetic retinopathy]. / Rizikové faktory diabetické retinopatie.

Risk factors for diabetic retinopathy can be divided into modifiable and non modifiable. Non modifiable include the type of diabetes, age of the patient at the time of onset, duration, and genetic factors. Primarily it can be influenced by glycemic control, as well as systemic factors such as blood pressure, serum lipids. Concomitant diseases also affect diabetic retinopathy. The article also mentions the risk of rapid compensation and iatrogenic influences.

[Lasik after corneal ulcer]. / Lasik po rohovkovém vredu.

Our case report presents successful treatment of corneal ulcer caused by the most common pathogen of infectious keratitis--Pseudomonas aeruginosa. Treatment was followed by LASIK as a final refractive error solution. 20 year old patient (contact lens wearer) was admitted for acute infectious corneal ulcer in her left eye. Her visual acuity was 0.5 partial with full correction. Intensive local treatment with Tobramycin, Ofloxacin and Scopolamin was started. After healing of infectious focuses, local steroids (Fluorometholonin acetas) were used to clear residual stromal haze. Refractive error was corrected after stabilisation using LASIK. Longstanding visual acuity is thanks to the early and intensive therapy 1.0 bilaterally.

[Keratoconjunctivitis sicca during folicular conjunctivitis in adult patients with Chlamydia pneumoniae etiology (summarizing twelve years study)]. / Keratoconjunktivitis sicca (KCS) pri folikulární konjunktivitide u dospelých pacientu s etiologií Chlamydia pneumoniae (souhrnná dvanáctiletá studie).

AIM: Following the previous study observing keratoconjunctivitis sicca (KCS) after treated follicular conjunctivitis of chlamydial etiology from the years 1999-2002, at this time the authors would like to point out the possible connection between KCS appearance and Chlamydia pneumoniae infection. MATERIAL: In the Department of Ophthalmology, during the period of 12 months (in the years 2009 - 2010), there were treated 11 adult patients (6 women and 5 men) in the age of 28 - 81 years (median, 50 years) with follicular conjunctivitis lasting on average 2.5 years and caused by Chlamydia pneumoniae, and simultaneously were diagnosed the symptoms of KCS, out of the total number of 37 examined patients with similar clinical findings. METHODS: The diagnosis of chlamydial infection in clinical symptoms of follicular conjunctivitis and simultaneous signs of KCS was established partly according to the serologic positivity of chlamydial genus (anti-LPS) and/or species (anti-Ch. pneumoniae and anti-Ch. trachomatis) IgG, IgM, and IgA antibodies together with simultaneous anti-cHSP60 IgG positivity, further using conjunctival prints examined by means of indirect immunofluorescence method using specific monoclonal antibodies; in conjunctival smears and peripheral leucocytes was tested also the presence of Chlamydia pneumoniae DNA. The main subjective complaints of the patients were burning sensation, sticking, or foreign-body sensation; the itching and lacrimation were less common. Among clinical signs dominated the hyperemia and the edema of the lower fornix; the tortuosity of the vessels and the follicles were not always present. The KCS diagnosis was confirmed by Bengal rose staining. RESULTS: In 10 patients, the positive IgA and/or IgM anti-Ch. pneumoniae antibodies were detected. Simultaneously, the positive anti-cHSP60 IgG were confirmed, out of them medium- and high-positive findings were in 7 patients, and anti-LSP antibodies IgA and/or IgM in 8 of them. Positive smears were found in 6 patients. In 2 persons of this group of treated patients, the general serologic findings were not significant, but the Chlamydia pneumoniae infection was confirmed by Chlamydia pneumoniae DNA positivity in peripheral leucocytes; in these 2 patients, the symptoms lasted for one half of the year. As the side findings were the confirmations of active Chlamydia trachomatis infection in other 4 patients of the whole group. The patients with Chlamydia pneumoniae infection were treated systemically by macrolide antibiotic azithromycine for 12 days. After the treatment, above all else the clinical signs of conjunctival inflammation disappeared, but remained KCS symptoms, which were disappearing only slowly. The optimal supporting therapies were lubricant drops with different concentration of sodium hyaluronide without preservatives. Control microbiological examinations during 6 months after the treatment termination confirmed negative smears findings, but the antibody levels were not decreased significantly. CONCLUSION: This study confirmed the possible connection between the KCS and Chlamydia pneumoniae infection in simultaneous clinical signs of follicular conjunctivitis. Along with that the study pointed out the necessity of simultaneous evaluating of the microbial findings and clinical symptoms to consider the systemic antibiotic treatment.

[Chlamydia pneumoniae in the etiology of the keratoconjunctivitis sicca in adult patients (a pilot study)]. / Chlamydia pneumoniae v etiologii keratoconjunctivitis sicca u dospelých pacientu (pilotní studie).

AIM: In the pilot study the authors refer to the possible connection between the appearance of keratoconjunctivitis sicca (KCS) and Chlamydia pneumoniae (CP) infection. MATERIALS AND METHODS: At the Department of Ophthalmology, 10 adult patients older than 45 years were followed up during the period of 5.5-7 years, where in the chronic folicular conjunctivitis caused by CP, the KCS was revealed as the same time. METHODS: The chlamydial infection diagnosis was established due to the positivity to the familiar (anti-LPS) and species (anti-CP) immunoglobulins (IgG, IgM, and IgA) and to the conjunctival impression specimen, using the indirect immunofluorescence of specific monoclonal antibodies. The patients were treated by means of systemically administered macrolide antibiotics Azithromycine. After the termination of the treatment, the signs of the clinical inflammation of the conjunctival inflammation subsided but the KCS problems remained. After 6 years, the control examinations of the familiar and species antibodies of the CP were performed and the clinical findings of the KCS and its treatment were evaluated. RESULTS: The decrease of the antibody levels was proved and objective findings and subjective symptoms of KCS in all patients subsided. Altogether 7 patients were without clinical signs of the KCS and without regular application of local artificial tears treatment. At the same time, in two thirds of the patients, the levels of the antibodies decreased or remained unchanged. In the last three patients, the signs of the dry eye decreased, but they didn't disappeared permanently. These patients had to apply artificial tears several times a day. The suspect signs of this serologically active infection persisted despite the antibodies levels' decrease. CONCLUSION: This pilot study until now didn't confirm the direct dependence between the KCS and CP, but it didn't exclude it as well.