[Trends in indications of perforating keratoplasty at the Department of Ophthalmology, Faculty Hospital, Brno, Czech Republic, E.U., during the period 2008-2012]. / Trendy v indikáciách k perforujúcej keratoplastike na Ocnej klinike FN Brno v rokoch 2008-2012.

INTRODUCTION: The aim of the study is retrospective analysis of perforating keratoplasty (PKP) indications at the Department of Ophthalmology, Faculty Hospital, Masaryk University, Brno, Czech Republic, E.U., during the period of 5 years, from January 1st, 2008 to December 31st, 2012. MATERIAL AND METHODS: We performed the PKP indications retrospective analysis at the Department of Ophthalmology, Faculty Hospital, Masaryk University, Brno, Czech Republic, E.U., during the period of 5 years, from January 1st, 2008 to December 31st, 2012, with complex evaluation of demographic and clinical data. The clinical diagnoses indicating the perforating keratoplasty were divided into 6 groups (keratoconus, bulous keratopathy, keratitis, corneal dystrophies, injuries, corneal transplant failure, and others) according to Cunningham et al. 2011 (2) and Boimer et al. 2012(1) methods. RESULTS: Our results correspond to data in the literature published abroad, where the majority of recently published papers refer significant increase of corneal transplant failure in the last years of follow-up.Key words: perforating keratoplasty, indications.

[DMEK (Descemet membrane endothelial keratoplasty)--early and late postoperative complications]. / DMEK (transplantace Descemetovy membrány s endotelem)--casné a pozdní pooperacní komplikace.

UNLABELLED: The authors refer to the cross-sectional study of surgical technique, operation, early and late postoperative complications in the first 30 patients after DMEK (Descemet membrane endothelial keratoplasty). SETTING AND METHODS: The group comprised 17 women and 13 men with an average age of 62 years (SD 12.2). The follow up period 1-12 months, average 4.2 months. The DMEK were indicated in patients with boullous keratopathy, Fuchs' endothelial dystrophy and endothelial insufficiency after repeated corneal transplantation. RESULTS: In half of the patients had to undergo DMEK surgery and the other half DMEK surgery combined with cataract surgery. One patient dropped from the Descemet membrane transplantation because of insufficient donor cornea and was indicated re DMEK. SURGICAL COMPLICATIONS: 4 times difficulty of the striping of Descemet membrane, 2 times operating decentration plates, 1 times bleeding the implementation of peripheral iridectomy. Early postoperative complications in 10 patients: 3x pupillary block, 1x fibrin reaction in anterior chamber, 1 curled strip of anterior chamber in 1st postoperative day, 3x coiled plate with localized corneal oedema, 1 residual membrane size 2 x 2 mm Descemet slats off the optical axis. Late postoperative complications were recorded in a total of 7 patients. 4 occurred secondary glaucoma and 2 corneal edema localized outside the optical zone. Once there was a bridging of traction plates. Visual acuity in uncomplicated patients were arranged within 21 days after surgery, patients with complications within 3 months. 1 times was made re DMEK rolled plates with the removal of the anterior chamber, 3 by 5 days to reposition scrolling border membranes by repeated big bubble technique. CONCLUSION: DMEK seems like a good option to remedy endothelium defects. About 70% of patients have fewer complications when used alone DMEK than cataract surgery combined with DMEK. For knowledgeable surgeon, starting with Descemet membrane transplantation, it is appropriate to separate transplants without combination with other procedures (cataract surgery, iriedktomy). Laser iridotomies before operation seems an appropriate procedure to avoid bleeding while surgery.

[The use of confocal corneal microscopy in the Cogan microcystic dystrophy diagnosis and follow-up of the ultrastructural changes after phototherapeutic keratectomy]. / Vyuzití konfokální mikroskopie rohovky v diagnostice Coganovy mikrocystické dystrofie a sledování ultrastrukturálních zmen po fototerapeutické keratektomii.

UNLABELLED: Confocal microscopy represents modern, non-invasive, semi-contact examination method making possible to visualize separate corneal layers (from the endothel to the epithel) in high resolution. Phototherapeutic keratectomy (PTK) is a method using argon-fluoride laser with 193 nm wavelength to treat corneal surface diseases. AIM: To evaluate the use of confocal microscopy for epithelial basal membrane dystrophy diagnosis (Cogan microcystic dystrophy) and following corneal ultra-structural changes in vivo after PTK. MATERIAL AND METHODS: The group consisted of 14 eyes of 9 patients (6 men and 3 women) of average age 45.8 +/- 14.4 years who underwent in the department in last two years phototherapeutic keratectomy for recurrent erosion in Cogan microcystic corneal dystrophy. For the diagnosis of this disease, the confocal corneal microscope (Confoscan 4, Nidek, probe x 40) was used. Computer controlled laser photoablation was in all patients performed; the average depth was 14.8 +/- 3.3 microm (Technolas 217, Bausch & Lomb). The follow-up visits were scheduled always day 5 and 12, and month 1, 3, 6, and 12 after the PTK. The reactive processes in all corneal layers, the subepithelial inervation restoration velocity and recurrence of the primary disease detectable by means of the confocal corneal microscope were followed-up. RESULTS: Cogan microcystic dystrophy was diagnosed in all followed-up patients by means of confocal microscope according to the findings of the area thickening and corneal epithelium basal membrane irregularities. These patients were indicated to the PTK. After the treatment, the healing of the epithelial layer was finished as early as the fifth day. The subepithelial nervous plexus average regeneration period was 6.2 +/- 2.8 months. In all patients, the edema of the anterior stroma was found at the day 5. The beginning of the re-popularization of the anterior stroma by keratocytes from deeper layers we diagnosed, on average, at the day 11.5 +/- 1.9 after the treatment and the following reduction after 5.1 +/- 1.4 months. In the posterior stroma and in the endothel, no changes were found. During the follow-up period, in none of the followed-up patients, the recurrence of the primary disease was found. CONCLUSION: The confocal microscopy may be recommended for superficial corneal dystrophies quality and accurate diagnosis and to follow up changes after phototherapeutic keratectomy as suitable treatment method of these diseases.

[Corneal cross-linking--modern method of keratoconus treatment]. / Corneal cross-linking--moderná metóda liecby keratokónusu.

PURPOSE: The aim of research study was to evaluate the effect of corneal cross-linking (CXL) in the frame of patients with progressive keratoconus 1 year after treatment. METHODS: There were 40 eyes of 35 patients with mean age 28, 45 +/- 9.3 (SD) (15 to 48 years) included in the study. Patients were treated with standard protocol of CXL with abrasion of corneal epithelium. Complete ophthalmological examination included best corrected spectacles visual acuity (BCSVA), slit-lamp microscopic finding, corneal topography and corneal thickness measured with ultrasound method was performed before, on the 5-th day, 1. 6., 12. month after CXL. We divided patients according to the stage of keratoconus into 2 groups (stage I. and stage II.) and according to the age into 3 groups (until 20, from 21 to 39, over 40 years). RESULTS: In all treated eyes, the CXL was without relevant complications. The only complication was stromal haze of cornea. In the evaluation based on stage of keratoconus, in the first group any patient became a haze of cornea in 1 year after CXL. In the second group 35.7% of patients had a haze of cornea. The average BCSVA 1 year after treatment was improved in the 1. group about 5.38 letter and in the 2. group about 1.25 letter. Topographic analysis showed decrease of simulated keratometry and refraction (1. group--0.1 D, 2. group--0.17 D), maximal keratometry and refraction (1. group--0.67 D, 2. group--0.76 D). Minimal keratometry and refraction in the 1. group decreased (1.17 D) and increased in the 2. group (1.09 D). In the evaluation based on the age was haze monitored in the first group one year after CXL in 12.5% of researched eyes. In the second group was haze of cornea in 20% of eyes and in the third group consisting of patients over 40 years old, in 50% of eyes. The average BCSVA was improved in the 1. group (2.85 letter), and in the 2. group (3.68 letter).The average BCSVA was decreased in the oldest patients in about 1.43 letter. In the 1. and 2. group the topographic analysis showed decrease of simulated keratometry and refraction (1. group--0.12D, 2. group--0.21D), maximal keratometry and refraction (1. group--1.13 D, 2. group--0,68D), minimal keratometry and refraction (1. group--1.17D, 2. group--0,69 D). In the 3. group the topography analysis showed increase of simulated keratometry and refraction (0,8D), maximal keratometry and refraction (0,98D), minimal keratometry and refraction (0,28D). Corneal pachymetry remained stable in all researched groups of patients. CONCLUSIONS: CXL is considered as safe procedure to stop progression of keratoconus also for patients until 19 years old. The best effect and minimal complications were by patients until 40 years old and by patients with the I. grade.

[Contrast sensitivity and higher order aberration after conventional LASIK treatment]. / Kontrastní citlivost a aberace vyssích rádu po konvencním LASIKu.

AIM: The aim of the prospective study was to evaluate photopic high-contrast visual acuity, mesopic contrast sensitivity, and high order aberrations, to compare changes and post-operative development of those parameters and to analyze the dependence among aberrations and contrast sensitivity after conventional LASIK treatment. MATERIALS AND METHODS: The authors followed-up patients treated by means of refractive LASIK treatment during the period from November 2006 to November 2007. The authors analyzed 51 eyes (31 patients). The average age of the group was 28.5 +/- 5.4 years (range, 18 - 41 years), preoperative average spherical equivalent was -4.95 +/- 1.24 D (from -3 to -8,25 D). Before the treatment and 1, 3, 6, and 12 months after LASIK treatment we evaluated the visual acuity (Snellen optotypes), contrast sensitivity under mesopic circumstances (CSV-1000E, VectorVision) and monochromatic aberrations (aberometer Zywave, Bausch & Lomb). RESULTS: One year after the treatment the average uncorrected visual acuity was 1.07 +/- 0.15, index of effectiveness 0.99, and index of safety 1.02. The contrast sensitivity was in month 12 significantly decreased comparing to the preoperative level at the frequency 12 c/deg, in other already tested frequencies after 3-6 moths did not differed from preoperative values. During the follow-up period the curvature of contrast sensitivity average values was in the upper half of the normal interval range. Conventional LASIK treatment significantly induced the higher order aberration (twice), as well as the spherical aberration (four times).The same level of higher order aberrations root mean square (HOA-RMS), or increased maximally by 0.1 microm was detected by 10 % of cases; the spherical aberration was, compared to the preoperative value, lower, or increased maximally by 0.05 microm in almost one half of the cases. The increase of the higher order aberrations depended directly proportionally to the preoperative value of the spherical equivalent. Before the treatment, the values of total aberrations correlated to the contrast sensitivity of low space frequencies; however, there was not found any correlation between the higher order aberrations and contrast sensitivity. Six months after the LASIK treatment the values of higher order aberrations correlated to the contrast sensitivity except of the lowest frequency tested. The higher order aberrations increased together with decreasing contrast sensitivity. The data from the one-year follow up control did not show statistically significant correlation between the contrast sensitivity and the higher order aberrations. There was not found any correlation between the contrast sensitivity and the spherical aberration at any follow-up control after the surgery. CONCLUSION: Although after the conventional LASIK treatment the curve of mesopic contrast sensitivity was located in the upper half of the normal range, in the medial space frequency it remained decreased comparing to the preoperative stage. The induction of higher order aberrations was twice as much and was directly correlated to the degree of the laser correction. The spherical aberration was four-times higher comparing to the preoperative values and was independent to the level of the initial refractive error. Significant correlation between the contrast sensitivity and the higher order aberrations was not proven.

[Changes of higher order aberrations and contrast sensitivity after standard photorefractive keratectomy]. / Zmeny aberací vyssích rádu a kontrastní citlivosti po standardní fotorefrakcní keratektomii.

UNLABELLED: The aim of the prospective study was to evaluate higher order aberrations and contrast sensitivity after photorefractive keratectomy (PRK) using the standard photoablation profile. MATERIALS AND METHODS: The group consisted of 37 patients (69 eyes), the mean age 27.2 +/- 4.5 years, who underwent PRK with target emetropia during the period January 2007 -December 2007. In 19 cases, it was correction of myopia, in 50 cases myopia with astigmatism.The preoperative spherical equivalent was -3.14 +/- 0.95 D. The PRK was performed by means of excimer laser system Technolas 217 (Bausch & Lomb) with the standard phoptoablation profile (PlanoScan 2000), using the 6.5 mm optical zone. The visual acuity, contrast sensitivity (CS; CSV-1000E, VectorVision) under mesopic circumstances and monochromatic aberrations (Zywave, Bausch & Lomb) were evaluated before the surgery, and 1,3, 6, and 12 months thereafter. The pair t-test, Wilcoxon test, and the Mann - Whitney U test (alpha = 0.05) were used for the statistical analysis. RESULTS: The PRK showed high index of effectiveness and safety (0.98, respectively 1.03 in the first year after the procedure). The contrast sensitivity under mesopic circumstances was not significantly involved after the PRK. The main value of the CS remained during the whole follow-up period within the physiological range in all spatial frequencies. Postoperatively, the part of spherical aberration on the higher order aberrations increased from 13.1% preoperatively to 16.6% one year after the PRK. In one half of the cases, the change of the higher order aberrations was within the range +/- 0.1 microm. In 66% of cases, the change of the spherical aberration was +/- 0.05 microm. The higher order aberrations comparing to the preoperative values decreased or remained unchanged approximately in one third of the cases, and the spherical aberration in one quarter of the cases. There was not established dependence between monochromatic aberrations values and the contrast sensitivity. CONCLUSION: Although the conventional RPK for low myopia treatment induces higher order aberrations including the spherical aberration, the impact on the contrast sensitivity under mesopic circumstances in our group were not significant. The contrast sensitivity of the most of patients was near the upper limit of the normal range.