[AMNIOTIC MEMBRANE APPLICATIONS - OUR EXPERIENCE]. / MOZNOSTI POUZITIA AMNIOVEJ MEMBRÁNY - NASE SKÚSENOSTI.

INTRODUCTION: Amniotic membrane is the innermost part of the fetal and packaging for its exceptional qualities likes to be used in treating many ocular pathologies. Amniotic membrane has improved the ability to treat ocular surface disease. It has unique features like support conjunctival and corneal epithelialization. MATERIAL AND METHODS: Retrospective analysis of group patients who underwent amniotic membrane transplantation at the Department of Ophthalmology Faculty of Medicine and UN Bratislava in 2013-2015. We evaluated indications amniotic membrane transplantation, the percentage, the number of transplants and the number of failures and retransplantation of the membrane. RESULTS: In group of 71 patients (amniotic membrane covering defects of conjunctiva and cornea) male patients formed a slight predominance of males in the number of patients a slightly larger preponderance in 38 women (53.5 %) - 52 surgeries (59.09 %) and 33 male (46.5 %) in 36 interventions (40.91 %). The left eye was affected in 40 interventions (45.45 %), 48 interventions were on the right eye (54.54 %). The most common cause application of 30.68 % in 27 eyes was corneal ulcer, bullous keratopathy followed by the 11.36 % in 10 eyes, and the ulcer herpetic keratitis in 9.10 % in 8 eyes. Injury or vulnus penetrans 6.82 % in 6 eyes, ulcers caused by paresis n. facialis 6.82 % in 6 eyes and sicca syndrome 5.68 % in 5 eyes.In 2015 we applied amniotic membrane covering the defect of eyelids after trauma in one patient. CONCLUSION: Amniotic membrane is the appropriate treatment in a number of diseases of ocular surface when conservative methods of treatment fail. In corneal application can prevent the execution of more aggressive treatment, such as keratoplasty, or to soothe inflammation and keratoplasty is not performed as emergent, but elective.Key words: amniotic membrane transplantation, eye diseases.

[Purtscher-like retinopathy in acute alcoholic pancreatitis: fluorescein angiography and optical coherence tomography findings]. / Purtscher-like retinopatia pri akútnej alkoholovej pankreatitíde: nález na fluoresceínovej angiografii a optickej koherentnej tomografii.

27 year old patient with a history of alcohol abuse after consumption of fat meal and wine following epigastric pain noticed sudden bilateral visual loss: right eye logMAR 0, 94, left eye logMAR 1, 22. Retinal examination revealed massive edema in the central part of the retina, multiple cotton wool spots in the posterior pole peripapillary and flame-shaped hemorrhages. On the OCT, there was edema most of all in the inner part of the retina, but also subretinal, hyperreflectivity in the nerve fibre layers corresponding to massive cotton wool spots. Fluorescein angiography in the early phases showed hypofluorescent ischemic areas of the retina subsequently leakage developed in the late phases. Immediately after antibiotic and spasmoanalgetic treatment of the pancreatitis visual acuity improved and 2 months after beginning of the therapy visual acuity is logMAR 0 bilateraly. We proposed that the most suspected cause of Purtscher-like retinopathy in this case is fat embolism.

[Influence of spheric and aspheric IOLs on visual acuity and contrast sensitivity]. / Vplyv sférických a asférických umelých vnútroocných sosoviek na kvalitu centrálnej ostrosti zraku a kontrastnej citlivosti.

PURPOSE: To compare best corrected visual acuity and contrast sensitivity in patients with aspheric and spheric intraocular lens (IOL) after uncomplicated cataract surgery in photopic and mesopic conditions. METHODS: 38 eyes after uncomplicated cataract surgery were divided in two groups. A (18 eyes, average 69,5 +/- 6,89 years, spheric IOLs Softec 1, Lenstec, Inc. USA); B (20 eyes, average 69,47 +/- 9,44 years, aspheric IOLs Softec HD, Lenstec, Inc. USA). Follow up 3.-5. day and 4.-5. week postoperatively. RESULTS: Best corrected visual acuity in group A was 20/23, in group B was 20/22. Contrast sensitivity in photopic conditions between group A and B were nonsignificant. Contrast sensitivity in scotopic conditions was in group B (aspheric IOLs) significant in comparison to group A (spheric IOLs). CONCLUSIONS: Aspheric IOLs in scotopic light conditions provide patients with significant better contrast sensitivity than in patients with spheric IOLs.

[Purtscher-like retinopathy--a rare complication of acute pancreatitis]. / Purtscher-like retinopatia--zriedkavá komplikácia akútnej pankreatitídy: kazuistika.

The article reports the case of a 27-year old woman hospitalised in the internal medicine ward for acute pancreatitis after eating fat food and drinking alcohol. In addition to acute pancreatitis, the patient complained of vision problems. The ophthalmologist detected bilateral occurrence of large whitish nidi located primarily around the optic disc, intraretinal hemorrhage and a massive retinal oedema in the central field and diagnosed Purtscher-like retinopathy. After a month of treatment of acute pancreatitis, the clinical picture improved, the patient's vision sharpness improved and the laboratory parametres returned to normal. The finding on the ocular fundus also improved. Even though similar cases are rare, more patients with acute pancreatitis should be checked for eventual vision disorders. Ocular fundus examination should be included in the set of tests performed for acute pancreatitis, similarly to the practice in arterial hypertension or diabetes mellitus patients.

Conjunctival nevus and melanoma.

The conjunctival nevus is one of the most common benign tumors of the ocular surface. Melanomas are rare; they can arise without a preexisting conjunctival nevus, or due to malignant transformation in case of PAM (primary acquired melanosis). The retrospective study analyzed 70 patients with pigmented lesion of the conjunctiva in period 1996-2006 at the Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, with the aim to determine the frequency of change in size and pigmentation of these benign lesions. Epibulbar pigmented lesions are rare, recognition of their precursors lesions at an early stage is important. Surgical excision is usually effective in eradicating these lesions. Extensive cases of flat primary acquired melanosis with atypia may be managed with mitomycin C. Multifocal and advanced melanoma, especially showing intraocular or orbital invasion, may require exenteration and/or radiotherapy to adequately extirpate the neoplasm locally. However, systemic metastases might have already develop in patients with advanced stage of disease (Fig. 7, Ref 13). Full Text (Free, PDF) www.bmj.sk.

[Reduction of astigmatism after perforating keratoplasty by adjustment of single running sutures and its influence on visual acuity]. / Redukcia astigmatizmu po perforujúcej keratoplastike úpravou jednotlivého pokracujúceho stehu a jej vplyv na zrakovú ostrost'.

The authors assess the outcomes of postkeratoplasty single running suture adjustment in 14 eyes (16 adjustments) of 14 patients (4 women, 10 men). The average age of patients was 39.68 year (ranging from 19 to 70 years). The suture adjustment was done in time span 2 to 39 weeks following after perforating keratoplasty (PKP), average 7.5 weeks. Follow up time was from 1 to 12 months, average 10.8 months. The value of keratometric and topographic astigmatism before suture adjustment were compared to the value of keratometric and topographic astigmatism 1, 6 and 12 months after suture adjustment. The changes of corneal refractive power and changes of uncorrected and best-corrected visual acuity were noticed as well. The mean value of keratometric astigmatism 7.47 +/- 2.69 D and mean topographic astigmatism 7.75 +/- 3.25 D before suture adjustment was decreased to 4.92 +/- 2.41 D and 4.83 +/- 1.46 D respectively one month after suture adjustment. These reductions of keratometric and topographic astigmatism (2.55 D and 2.92 D respectively) were statistically significant (p = 0.0416, and p = 0.0211 respectively). The mean keratometric astigmatism was still significantly lower (p < 0.05) after 6 and 12 months after suture adjustment in comparison to status before suture adjustment. In assessment of topographic changes we noticed small continuous increasing of astigmatism (1.27 D after 6 months and 0.2 D after 12 months after suture adjustment). These changes of topographic astigmatism were not statistically significant. The changes of mean corneal refractive power were not statistically significant as well. The mean uncorrected visual acuity increased significantly (from 0.13 to 0.34, p < 0.05) 1 month after suture adjustment. This improvement of uncorrected visual acuity was not significant after 6 and 12 months after suture adjustment. The best-corrected visual acuity improved from 0.37 to 0.61 after one month after suture adjustment but was not statistically significant and stayed still at the same level with minimal changes during follow up time.

[Peroperative use of mitomycin C in excision of primary pterygia]. / Peroperacné pouzitie Mitomycinu C u excízie primárneho pterygia.

The authors in a retrospective study assess the recurrence rate of pterygium after the application of a single intraoperative dosage of topical Mitomycin C during the pterygium excision. The group involves 21 eyes of 19 patients with primary pterygia. When using technique of simple pterygium excision followed by application 0.02% MMC onto a bare sclera in duration 3 minutes, pterygium recurred in 5 patients (23.8%). The authors noticed a distinct difference in pterygium recurrence relating to the age of patients. Under the age 50 the recurrence occurred in each of 4 patients, above the age 50 only in one out of 17 patients (5.9%).

[The TNM classification system in malignant conjunctival neoplasms]. / Uplatnenie TNM-klasifikácie u zhubných novotvarov spojoviek.

The authors submit a review of histological findings and classification according to the TNM-classification of conjunctival tumours in patients under dispensary care at the First Ophthalmological Clinic of the Faculty Hospital and Medical Clinic of the Comenius University in Bratislava during a 10-year period (1989-1998). They included in the group 75 patients with clinically assessed conjunctival tumours (0.4% of the hospitalized patients). As to histological findings, 61 times (80.3%) a benign process was involved (naevus of the conjunctiva 12x) and 14x (19.7%) a malignant tumour, (7x times a primary malignant melanoma of the conjunctiva, 3x carcinoma). The authors recorded two relapses (one malignant melanoma of the conjunctiva, one melanoma penetrating into the orbit). The mean age of the patients was 47 years (from 1 to 82 years). In malignant melanoma of the conjunctiva stage T1 was detected in as many as 3/4 of the patients (6 times), whereby stage pT1, 2 was found in 7 patients. In carcinoma the authors did not detect stage T1, only stage T2 in 2 patients, T3 (pT3) in one patient.

[Perforation keratoplasty after pars plana vitrectomy and use of a temporary keratoprosthesis]. / Perforacná keratoplastika po pars plana vitrektómii a pouzití docasnej keratoprotézy.

In 12 eyes of 12 patients with vitreoretinal abnormalities due to reduced transparency of the cornea perforation keratoplasty was performed after pars plana vitrectomy with the use of a temporary keratoprosthesis. The corneal transplant remained clear after a mean follow up period of 15.5 months in 5 patients (41.7%). The visual acuity improved in 7 patients (58.3%), however only three patients had a postoperative visual acuity better than or equal to 3/60 (6/18, 6/60, 3/60). The retina remained attached in 8 patients (66.7%).

[Changes in the corneal endothelium after penetrating keratoplasty]. / Zmeny endotelu rohovky po perforacnej keratoplastike.

The authors examined 114 corneal transplants after perforating keratoplasty (PK) in 95 patients by a non-contract endothelial microscope. In 86 eyes after PK where the density of endothelial cells before operation was known, they investigated the damage of endothelial transplant cells. The mean follow up period after operation was 3.8 years. Losses of endothelial cells of the central portion of the transplant were highly significant after the first year 34.4% (p < 0.05) and significant after second year following operation-7.7% (p < 0.05). In the investigated group two transplants remained crystal clear despite an endothelial cell density of 500 cells/mm2.