[Drainage implants in surgical management of pediatric glaucoma]. / Drenázní implantáty v chirurgii detského glaukomu.

PURPOSE: To evaluate the effectiveness and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy. PATIENTS AND METHODS: Retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9 5.3 years (range: 4months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, and the absence of visually threatening complications, no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1 6.5 years (range: 1.6 to 15.2 years). RESULTS: Mean preoperative and postoperative IOP was 33.6 11.4 mmHg and 17.1 6.5 mmHg (p 0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years and 65% at six years. There was no difference between primary (n = 31 eyes) and secondary glaucoma (n = 45 eyes) patients in terms of cumulative success (p = 0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed with these causes: 10 eyes with uncontrolled IOP, 2 eyes of retinal detachment and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure. CONCLUSION: Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractive to the initial surgical procedure and medical therapy.

[Long term outcomes of chronic abducens palsy surgical treatment in children and adults]. / Dlouhodobé výsledky chirurgické lécby chronické obrny n. VI u detí a dospelých.

Abducent nerve palsy is the most frequent of the acquired palsies and occurs rarely on congenital basis. It is widely recommened to wait at least 6 mohths for possible return of sixth nerve function. After this period we consider surgical management. Our retrospective comparative study evaluated long-term results of two methods for surgical treatment of chronic six nerve palsy in 118 pediatric and adult patiens who undergone surgery in the period from January 1990 to December 2005. Group A had 56 patients, in whom we performed a large recession of the medial rectus combined with a supramaximal resection of the lateral rectus. The Hummelsheim transposition procedure with or without resection of transposed half-tendon vertical muscle was performed in 62 patients of the B group. This procedure was always combined with recession of medial rectus. The augmented version of the transposition surgery resulted in a significantly better primary position of eyes postoperatively, than single graded recession-resection procedure of the horizontal muscles. The transposition surgery resulted in visible improvement in head posture and ocular alignment in the primary position, with partial restoration of abduction.

[Anterior transposition or myectomy of the inferior oblique muscle in vertical deviation--long-term results]. / Dlouhodobé výsledky anteriorizace a myektomie dolního sikmého svalu u vertikálních deviací.

Anterior transposition of the inferior oblique muscle (ATIO) and myectomy of the inferior oblique muscle (MIO) are favorite methods for surgical correction of dissociated vertical deviation (DVD), including patients with simultaneous inferior oblique muscle overaction (IOOA). In our comparative, randomized study we evaluated whether anterior transposition improves the surgical outcome compared to myectomy of the inferior oblique muscle. We included 82 eyes of 46 patients, 44 eyes treated with ATIO and 38 treated with MIO. We observed the size of the preoperative and final DVD, grade of the preoperative and final IOOA, rates of reoperation, and complications. We found out that ATIO is an effective surgical approach in the treatment of DVD and it can be used in patients with or without IOOA. We found no statistically significant difference in postoperative outcomes between anterior transposition and myectomy of the inferior oblique muscle. Despite of it, we prefer unilateral ATIO to manage IOOA for its minor incidence of secondary hyperfunction of contralateral inferior oblique muscle.

[Surgery of Duane retraction syndrome I: comparison of unilateral recession and resection versus bilateral medial rectus recessions]. / Chirurgie Duanova retrakcního syndromu I: Srovnání jednostranné retropozice a resekce s oboustrannou retropozici mediálních prímých svalu.

The purpose of this comparative study was to evaluate a long-term efficacy of lateral rectus muscle resection in the affected eye of patients with Duane retraction syndrome (DRS) with esotropia and limited abduction and to compare it with bilateral medial rectus recessions. We reviewed and compared the data of the group A with 23 patients who underwent a recession-resection procedure and the group B with 26 patients in whom we performed medial rectus recessions. In each group, we evaluated pre- and postoperatively the ocular alignment, head position, ocular ductions, severity of retraction, and binocular visual field. Statistical analysis of the data was performed. Postoperatively, both groups had similar mean esotropia and mean face turns. However, the mean limitation of abduction in the affected eye was greater in the group B, mean adduction was also significantly worse in the group B. Globe retraction improved in all subjects of the group B, but worsened in 6 patients of the group A. Seventeen of 23 patients with Duane retraction syndrome, selected on the basis of esotropia, limited abduction, and mild retraction, benefited from a recession-resection procedure in the affected eye. The ability of abduction achieved higher level than in the group B after bilateral medial rectus recessions. We assume that unilateral recession-resection procedure should be performed in patients with mild retraction of the globe and good preoperative adduction.

Glaucoma drainage implants in the treatment of refractory glaucoma in pediatric patients.

PURPOSE: The aim of this study is to report the clinical course, effectiveness, and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy. METHODS: This retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9+/-5.3 years (range: 4 months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications, and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, the absence of visually threatening complications, and no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1+/-6.5 years (range: 1.6 to 15.2 years). RESULTS: Mean preoperative and postoperative IOP was 33.6+/-11.4 mmHg and 17.1+/-6.5 mmHg (p<0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years, and 65% at 6 years. There was no difference between patients with primary (n=31 eyes) and secondary glaucoma (n=45 eyes) in terms of cumulative success (p=0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed: 10 eyes with uncontrolled IOP, 2 eyes with retinal detachment, and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure. CONCLUSIONS: Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractory to the initial surgical procedure and medical therapy.

[Optimal combined therapy in retinoblastoma]. / Optimalizace kombinované lécby retinoblastomu.

Eighteen patients suffering of retinoblastoma during three years period (1999-2001) were treated in two departments of ophthalmology in the Czech Republic. In four cases, the involvement was bilateral. In six eyes, because of very late stage of the disease at the time of diagnosis, the initial treatment was the enucleation. The rest, (sixteen eyes) was treated by chemoreduction (chemotherapy) and different combinations of local therapeutic methods according to their respective findings. Nine eyes from this cohort were enucleated in different period of time after the beginning of the treatment because of the relapse of the disease, its continuing or complications of the treatment. In the remaining seven eyes there are no sings of tumor activity. The fractioned radiotherapy was used in the treatment in one eye only and this eye was enucleated subsequently. So the maintaining therapy was successful in seven eyes of sixteen involved, or in 43.75% of cases.

Long-term results of transscleral cyclophotocoagulation in refractory pediatric glaucoma patients.

We evaluated efficacy and complications of diode laser cyclophotocoagulation in pediatric patients with refractory glaucomas. The retrospective study comprised 69 eyes of 53 pediatric patients with uncontrolled refractory glaucoma treated by transscleral diode laser cyclophotocoagulation. The mean age was 6.1 +/- 4.29 (range 0.9-15) years. The main parameters evaluated were: intraocular pressure (IOP), visual acuity, and complications. The mean follow-up period was 5.6 +/- 2.8 (range 2.2-9.5) years. Treatment success was defined as a postoperative IOP of

[Retinoblastoma in monozygotic twins]. / Retinoblastom u monozygotních dvojcat.

Retinoblastoma is one of the most frequent ophthalmological tumours in children. It is an embryonic tumour originating in the retina. It is caused by abnormalities in the RB1 gene and deletions in the region 13q14. The authors present a bilateral non-hereditary retinoblastoma in monozygotic twins, associated with deletion in the region 13q14, stigmatization, psychomotor and somatic retardation.

[Phototherapeutic keratectomy in the treatment of corneal surface disorders in children]. / Prínos PTK v lécbe povrchových afekcí rohovky u detí.

Retrospective clinical trial evaluated efficacy and safety of phototherapeutic keratectomy (PTK) within 35 children (35 eyes) aged 8 to 18 years (mean 12.6 years). All children had a long time postoperative follow-up ranged from 2 to 5 years (mean 3.2 years). Indications for PTK in children were: recurrent corneal epithelial erosion syndrome, superficial scars after keratitis "e lagophthalmo", dry spots and mucous plaques after atopic- vernal eye disease, band keratopathy, anterior corneal dystrophies, corneal scars secondary to post-infectious keratitis (post-herpes simplex corneal scarring) and following trauma. The aim of treatment were to improve visual acuity and to reduce or eliminate subjective ocular discomfort-pain, lacrimation and photophobia. Fully informed parents consent was done at all cases. There was increased the best spectacle corrected visual acuity (BSCVA) in all Children, and episodes of ocular pain, lacrimation and photophobia diminished. The mean preoperative BSCVA 6/36 (ranged from 6/9 to 1/60) improved to mean value 6/12 (ranged from 6/6 to 6/60) as 2-5 years follow-up postoperatively. Seven children had 5 or more Snellen's lines gain of the BSCVA, ten children gained 4 lines, eight children gained 3 lines and five children gained 2 lines postoperatively in comparison to their preoperative values. At four cases were evaluated only 1 line gain of BSCVA, one eye unchanged, and no eye had BSCVA worsened after PTK. Phototherapeutic keratectomy in children seems to be an effective and safety procedure in the management of suitable anterior corneal disorders. Our clinical results suggest the most suitable diagnoses for treatment include recurrent corneal epithelial erosions, band keratopathy, dry spots, mucous plaques, anterior corneal dystrophies, and anterior post-keratitis and post-traumatic scars.

[Cryotherapy and photocoagulation in the treatment of retinopathy of prematurity]. / Kryoterapie a fotokoagulace v lécbe ROP.

In a retrospective clinical trial is compared efficacy of transscleral cryotherapy versus diode laser photocoagulation in the treatment of threshold stage 3 retinopathy of prematurity (ROP) in zone II-III. 40 eyes were treated with cryotherapy and 32 eyes were treated with diode laser photocoagulation. All children have been followed up for 5 to 9 years after treatment. The long-term best-corrected visual acuity (BCVA) and refractive errors were evaluated. BCVA from 6/6 to 6/18 in last examination had 53% of eyes with cryotherapy and 56% of eyes with photocoagulation. The difference was not statistically significant (P = 0.094). Myopia over -6.0 D were at 32.5% of eyes with cryotherapy and at 22% of eyes with photocoagulation. This difference was statistically significant (P < 0.05). In the second part of this study is evaluated the long-term visual acuity and structural outcome in Zone 1 ROP (Very posterior Zone 1 disease, rush disease). 20 eyes with cryotherapy and 24 eyes with photocoagulation of this severe form ROP were followed up for 5 to 11 years. BCVA of 6/36 and better had 30% eyes of cryotherapy and 37.5% eyes of laser photocoagulation (P < 0.05). Unfavourable structural fundus outcomes had 55% eyes of cryotherapy and 33% eyes of photocoagulation (P < 0.05). These differences were statistically significant. Our results support the long-term efficacy and safety of cryotherapy and diode laser photocoagulation in the treatment of threshold 3 stage ROP. Visual acuity results suggest that diode laser photocoagulation is as effective as cryotherapy in treatment of this ROP stage. In the group of posterior Zone 1 ROP was achieved better visual acuity results and reduced unfavourable structural outcomes with diode laser photocoagulation as compared to cryotherapy.

[Effect of early surgery in essential infantile esotropia on the quality of binocular vision]. / Efekt casné operace esenciální infantilní ezotropie na kvalitu binokulárního videní.

In a retrospective study of 397 children operated in the course of 10 years (1985-1995) on account of essential infantile esotropia the authors evaluate the effect of early surgery implemented before the age of two years on the quality of binocular vision as compared with a later operation. The group of children was divided into three sub-groups. Group A comprised 75 children with the operation during the first six months of life (mean 3.8 months), sub-group B 194 children with the operation at the age of 6-24 months and in group C 128 children operated at the age of 2-6 years (mean 3.56 years). In group A binocular vision was recorded in 80% children (15% superposition, 60% fusion, 5% stereopsy). In groups B binocular vision was recorded in 76% children (18% superposition, 50% fusion, 8% stereopsy). In group C simple binocular vision in the form of superposition was present in 24% and fusion only in 21% children. The results of binocular vision after surgery of essential infantile esotropia are in favour of early surgery, preferably by the age of 6 months, not later than at the age of 2 years. An essential part of comprehensive treatment is active and positive pleoptic and orthoptic care incl. supplementary surgical correction of residual horizontal or vertical deviations. Early surgery of an adequate extent with a safeguarded parallel position of the eyes implies in the long run more frequent achievement of a higher quality of binocular vision incl. stereopsy.

[Binocular vision after cataract surgery in children--long-term results]. / Binokulární videní po operaci katarakty u detí--dlouhodobé výsledky.

PURPOSE: To evaluate quality of binocular vision in dependence on type of cataract, time of surgery and type of aphakic correction with minimal 5 years follow up. METHODS: 127 children divided into 3 groups: Group A--24 children with monolateral congenital cataract, Group B--56 children with bilateral congenital cataract, Group C--47 children with traumatic cataract. Binocular vision results were evaluated 5-10 years after cataract surgery subordinated on the type of aphakic correction-PC IOL, contact lenses, spectacles, type of cataract (congenital mono or bilateral, traumatic) and time of cataract surgery. RESULTS: Group A: Binocular vision in 56% children with cataract surgery in the first 3 months of age and only 20% of binocular vision in children operated later. Binocular vision results in dependence on aphakic correction (46% in contact lens subgroup, 44% in PCIOL subgroup without statistically significant differences. Group B: Binocular vision in 76% of children operated in the first 3 months of age, and 79% of children operated later. Binocular vision in 68% of children in spectacle aphakic correction subgroup, 67% of children in contact lenses subgroup, and 75% of children in primary or secondary implanted PC IOL subgroup. Group C: Binocular vision in 80% of children with contact lenses subgroup, and in 84% of children with implantation PC IOL. CONCLUSION: Better results of binocular vision quality have children with cataract extraction in the first three months of age then children operated later in group with monolateral congenital cataract. Primary or secondary implantation of PC IOL was find to the better aphakic correction for the binocular visual results in the groups with bilateral congenital cataract and traumatic cataract than other types of aphakic correction. Amblyopia is a major determinate of visual outcome in childhood cataract. The timing of surgery--the early cataract removal will continue to be more important than the method of aphakic optical correction, especially in the case of monolateral congenital cataract.

[Bilateral megalopapilla]. / Oboustranná megalopapila.

The authors present an account on the unusual finding of enlarged optic discs in a nine-year-old boy. The clinical finding is consistent with bilateral megalopapilla with preserved intact central and peripheral vision. The authors draw attention to possible mistakes and errors which may be associated with this uncommon clinical finding.

[Intraocular lens implantation in children]. / Implantace nitroocních cocek u detí.

OBJECTIVE: To evaluate the results of primary and secondary implantations of intraocular lenses (IOL) in children--visual acuity, binocular function, resulting refraction and complications after operation. METHODS: The group comprises 47 eyes of 36 children operated in 1993-1997, aged 5-16 years (mean age of operated children 10.3 years). The follow up period after operation was 18-60 months. The mean follow period was 37 months. Twenty-two primary implantations of posterior chamber IOL were made and 25 secondary implantations, incl. 13 posterior chamber IOL and 12 anterior chamber IOL. From the total number of cataracts 26 were traumatic and 21 congenital (16 bilateral and 5 unilateral). RESULTS: A visual acuity of 6/12 or better was recorded after operation in 31 (67%) eyes, incl. vision 6/6 in 7 eyes. Vision 6/15 to 6/24 was found in 8 (18%) eyes. Binocular function after operation was recorded in 26 (73%) children. Of these 11 have stereopsis and 15 have fusion I-III. Nine children (27%) do not have binocular functions. Half the eyes have after operation a refraction within the interval +/- 1.0 D SE. Fifteen eyes (33%) are within the range of +/- 2 D SE from emetropy. Eight eyes had a refraction in the interval of +/- 3 D SE during the last check-up examination. The most frequent postoperative complication was a slight (48%) or more serious (23%) inflammatory reaction, decentration of the IOL (23%), and in case posterior capsulotomy was not performed during primary implantation, the complication in almost 8% of eyes was secondary cataract which had to be treated by capsulotomy with a NdYAG laser. One intraocular lens had to be explanted. CONCLUSION: Implantation of an intraocular lens in children aged 5-16 years is according to the results of postoperative visual acuity and binocular functions a suitable alternative of correction of child aphakia.

[The Hallgren syndrome]. / Hallgrenuv syndrom.

Hallgren syndrome is a hereditary disease with autosomal recessive inheritance. Its exact genetic background has not been elucidated so far. From the clinical aspect is comprises association of retinitis pigmentosa, atrophy of the optic nerve, nystagmus and congenital hearing damage combined with neurological and psychiatric symptoms. The authors describe two siblings with the clinical picture of this syndrome. It is a finding not published so far in the Czech literature.

[Normal values of intraocular pressure in children]. / Fyziologické hodnoty nitroocního tlaku u detí.

To assess normal intraocular pressure values of the child population the authors examined a group of 215 children aged 4 to 15 years with a normal ophthalmological finding, a total of 406 eyes. All tonometric examinations were made without general anaesthesia or other pharmacological measures influencing the air-puff contact-free tonometer NT 1100 NIDEK, always the mean of three reliable results. Although there were certain variations of the intraocular pressure, they were not correlated to the child's age after the age of 4 years. The mean intraocular pressure in the whole group of 406 eyes was 16.08 +/- 3.08 mm Hg. Knowledge of normal values of the IOP in children is important for diagnosis as well as for monitoring of already verified glaucoma.

[Effect of Trusopt on normal intraocular pressure values in children]. / Vliv Trusoptu na fyziologické hodnoty nitroocního tlaku u detí.

The authors investigated a group of 406 healthy eyes of children aged 4 to 15 years to test the effect of the local carboanhydrase inhibitor TRUSOPT on natural previously assessed intraocular pressure. The measurements made by means of an air-puff contact-free tonometer NT 1100 NIDEK revealed a highly significant decline of intraocular pressure--from 16.08 mm Hg to 14.07 mm Hg on average in the whole group. The tolerance of the drug after a single administration caused no problems, no undesirable effect was recorded. This is the first and only report on the effect of TRUSOPT on normal intraocular pressure of the child eye reported in the literature in a statistically significant group. The authors are surprised by the fact that the possibility of favourable pharmacological treatment of child glaucoma with clinically widely used Trusopt is not used so far.

[Photorefractive keratectomy in high myopic anisometropia in children]. / Fotorefrakcní keratektomie pri vysoké myopické anizometropii u detí.

The authors evaluate the results of photorefractive keratectomy in children with high myopic anisometropia proved by intolerance of a contact lens and intolerance of full correction by glasses. The objective was to maintain or improve the already achieved binocular vision without or with feasible correction by glasses. The group is formed by 13 children, mean age 11.5 years at the time of surgery (range 7-15 years). The mean preoperative value of myopia was -8.9 dpt (SE), within the range of -7.0 to -11.75 dpt (SE) on the operated eye. The preprequisite condition for surgery was confirmed intolerance of a contact lens, intolerance of complete correction by glasses and previous systematic pleoptic treatment with training of binocular functions. The operation was always implemented during hospitalization. The follow-up after surgery in all children of the group is more than 2 years. The mean value of the refraction defect two years after surgery is -1.12 dpt (SE). The mean non-corrected visual acuity improved from 0.021 before surgery to 0.48 two years after surgery and the mean best corrected visual acuity improved from 0.51 before surgery to 0.61 two years after surgery. The authors compare results of binocular functions before and after operation. Two years after surgery all children had superposition and a normal Bagolini test, 12 children had fusion I, 9 children fusion II, and 6 children fusion III and stereopsis. Based on the results of the trial PRK appears to be an effective and safe method for correction of high myopic anisometropia in intolerance of contact lenses or complete correction by glasses. This operation thus makes it possible to preserve further the degree of binocular vision practised in advance or to improve it. This is the first group, though small, of thus treated children published in our professional literature.

[Scleroplasty surgery in the treatment of progressive myopia in children]. / Skleroplastické operace v lécbe progresivní myopie u detí.

The authors evaluate the results of 257 scleroplastic operations performed in 145 children with progressive myopia in 1989-1995. The age range of the operated children was 5-17 years. The mean age at the time of operation was 10.4 +/- 3.9 years. The children were followed up for at least two years before and two years after operation. All children met the condition of progressive myopia, minimal refraction -6.0 D and progression of at least 1 D per year during the last two years before surgery. The authors investigated the axial length of the bulbus by biometry, objective and subjective refraction, the best corrected visual acuity before and after surgery. The mean progression of myopia two years after the scleroplastic operation declined to a mean value of 0.29/year. No serious complications were recorded. Scleroplasty can be considered a safe surgical method which can help to improve the unfavourable development of progressive myopia.

[Trusopt, a local carboanhydrase inhibitor, in the treatment of glaucoma in children (preliminary report)]. / Lokální inhibitor karboanhydrázy (TRUSOPT) v lécbe glaukomu detského oka. (Predbezné sdelení).

The authors investigated in a group of six children with glaucoma persisting for a long time the possibility to use locally applied carbonic anhydrase inhibitor, 2% dorsolamide hydrochloride in the form of eye drops (TRUSOPT, Merck Co.). In the submitted preliminary study they evaluate the effectiveness of the drug in glaucoma in children very favourably, previous essential treatment with oral acetazolamide could be discontinued in all patients without a deleterious effect. The authors did not encounter any undesirable effects of the drug nor manifestations of intolerance calling for discontinuation of TRUSOPT treatment. This is so far the first communication on TRUSOPT treatment of child glaucoma in the available literature.