SHORT-WAVELENGTH AUTOMATED PERIMETRY IN DIABETIC PATIENTS WITHOUT RETINOPATHY.

AIM: To compare the results of short-wavelength automated perimetry (SWAP) in diabetic patients without retinopathy and healthy subjects and show if it is possible to detect an abnormal function of the retina in diabetic patients before vascular changes on the retina develop. Further, the effect of diabetes duration and long-term glycaemic control on the visual field was examined. METHODS: The study group included 22 patients with diabetes type 1 or 2, without any signs of retinopathy. The control group consisted of 21 healthy subjects. Short-wavelength automated perimetry was performed on the Humphrey Field Analyzer (HFA 860, Carl Zeiss Meditec), SITA SWAP, 24-2 test. In diabetic patients, the duration of diabetes and the level of glycohemoglobin (HbA1c) was registered. The visual field indices MD (mean deviation) and PSD (pattern standard deviation) were compared between both groups by the Mann-Whitney test. The correlation between the visual field indices, HbA1c and duration of diabetes was assessed by the Spearman correlation coefficient. RESULTS: The mean value of MD in the study and control group was -3.64±3.66 dB and -1.48±2.12 dB respectively, the values in the study group were significantly lower (p < 0.05). Mean PSD in the study group was 2.92±1.04 dB and 2.23±0.33 dB in the control group, again the difference was statistically significant (p < 0.05). Patients in the study group suffered from diabetes for 17±9.4 years in average. The mean value of HbA1c in the study group was 60.64±16.63 mmol/mol. A significant correlation was found only for PSD and HbA1c (p > 0.05). The duration of diabetes had no effect on either of the visual field indices. CONCLUSION: Short-wavelength sensitivity of retina seems to be affected in diabetic patients without clinically significant retinopathy suggesting a neuroretinal impairment at early stages of the retinopathy. We found no association between the visual field and the control or duration of diabetes.

[The Effect of Cataract Surgery on the Reproducibility and Outcome of Optical Coherence Tomography Measurements of Macular and Retinal nerve Fibre Layer Thickness]. / Vliv operace katarakty na merení tloustky sítnice a vrstvy nervových vláken pomocí optické koherentní tomografie a na reprodukovatelnost optické koherentní tomografie.

INTRODUCTION: Optical coherence tomography (OCT) is a non-invasive imaging technique used for the examination of the macula and peripapillary retinal nerve fibre layer (RNFL), the result of which may be affected by the quality of the scanned image. The aim of our study was to assess the influence of uncomplicated cataract extraction on the measurement of macular and RNFL thickness with OCT and to determine the reproducibility of this method before and after cataract surgery in a group of healthy people. We also evaluated the effect of different intraocular lenses (IOL) (with/without yellow filter) on the reproducibility of the OCT examination. METHODS: The study group included 51 eyes of 51 patients who underwent cataract surgery with posterior chamber IOL implantation. Macular and RNFL thickness were measured with spectral domain OCT (Optovue, Model RT 100) one week before surgery, and postoperatively after one and six months. Three OCT scans were performed at each visit to assess the reproducibility of the measurement. Data were statistically processed. RESULTS: Analysis of the changes in macular and RNFL thickness showed a significant increase in retinal thickness, with the maximum increase one month after surgery, and regression of this thickening six months after surgery. Reproducibility of OCT examination improved significantly after cataract surgery, even though the preoperative values were of low coefficient of variance and therefore of high accuracy. No difference was found in the use of different intraocular lenses on the reproducibility of the OCT examination. CONCLUSION: The presence of cataract affects the OCT measurement of macular and RNFL thickness. The reproducibility of the method significantly improves after cataract surgery. It is likely that the increase in macular and RNFL thickness after cataract removal is partly due to improvement in the quality of the scanned image and thus to the greater accuracy of the OCT examination. KEY WORDS: optical coherence tomography, glaucoma, cataract, macular thickness, retinal nerve fibre layer thickness.

[Pharmacological Tests for Horner Syndrome - Case Report]. / Farmakologické testy u Hornerova syndromu.

The case report presents a patient, who was examined at our department due to anisocoria that was present for more than one year. Besides the anisocoria the patient had no other pathological symptoms. The pupil on the right eye was larger than on the left eye by more than 1mm. Photoreaction was present on both eyes with a dilatation deficit on the left eye. There was also a slight ptosis on the left. The anterior and posterior eye segment was normal, only the iris of the left eye was slightly decoloured. The ophthalmological finding was pointing to Horner syndrome on the left side. The cause of the syndrome was not found. The case report discusses current problems of pharmacological pupillary tests used in Horner syndrome. Alternatives to the standard cocaine test are proposed, with respect to substances currently available in the Czech Republic.

[Intrinsically Photosensitive Retinal Ganglion Cells]. / Vnitrne fotosenzitivní gangliové bunky sítnice.

Recently discovered intrinsically photosensitive melanopsin-containing retinal ganglion cells contribute to circadian photoentrainment and pupillary constriction; recent works have also brought new evidence for their accessory role in the visual system in humans. Pupil light reaction driven by individual photoreceptors can be isolated by means of the so called chromatic pupillography. The use of chromatic stimuli to elicit different pupillary responses may become an objective clinical pupil test in the detection of retinal diseases and in assessing new therapeutic approaches particularly in hereditary retinal degenerations like retinitis pigmentosa. In advanced stages of disease, the pupil light reaction is even more sensitive than standard electroretinography for detecting residual levels of photoreceptor activity. This review summarizes current knowledge on intrinsically photosensitive retinal cells and highlights its possible implications for clinical practice.

[Vaginal breech delivery after 36 week of pregnancy in a selected group of pregnancy - analysis of perinatal results in years 2008-2011]. / Vaginální vedení porodu koncem pánevním po ukonceném 36. týdnu gravidity u selektované skupiny tehotenství - analýza perinatálních výsledku let 2008-2011.

OBJECTIVE: To determine intrapartum mortality, neonatal mortality and serious neonatal morbidity in selected group of planed vaginal breech deliveries after 36 week of pregnancy. Compare vaginal breech deliveries with primary cesarean deliveries.Designe: Retrospective study. SETTINGS: Department of Obstetrics and Gynaecology, Masaryk University, University Hospital Brno; Department of neonatology, University Hospital Brno; Faculty of Economics and Management, University of Defence in Brno. METHODS: Retrospective analysis of 1013 births of singleton pregnancies with breech position of the fetus after 36 completed week of pregnancy at University Hospital Brno in the years 2008-2011. Vaginal delivery was planed for 430 women (42.4%). Elective caesarean section was performed in 583 women (57.6%). An assessment of intrapartum and neonatal mortality and serious neonatal morbidity and incidence of umbilical artery pH < 7.00. We also evaluated non-serious neonatal morbidity. RESULTS in the group of vaginal breech deliveries, including births completed by acute caesarean section, were compared with results in the group of elective caesarean sections. RESULTS: In the group of 430 women with planned vaginal breech delivery, 347 delivered vaginally (80.7%), by acute caesarean section 83 women (19.3%). In the group of planned vaginal births, including births completed by acute caesarean section, pH < 7.00 in umbilical artery occurred in 9 cases (2.1%). In the group of elective caesarean deliveries pH < 7.00 does not occurred. Death of the fetus during labor or before 28 day after birth does not occurred. A statistically significant difference in the incidence of serious neonatal morbidity between the group of planned vaginal births and births by elective caesarean section was found in Apgar score in 5th minute < 5 (2 versus 0), peripheral nerve injury persisting at discharge (2 versus 0) and admission to the neonatal intensive care unit for longer than 24 hours (2 versus 10). When comparing all cases of serious neonatal morbidity between the two groups, the difference was not statistically significant (1.2% versus 1.9%, NS). CONCLUSION: When strict criteria are met during selection of women appropriate for vaginal breech delivery and during labor, planned vaginal breech delivery at term is save option. The incidence of severe neonatal morbidity when compared with elective caesarean section is not increased. KEYWORDS: breech presentation, vaginal delivery, caesarean section, neonatal morbidity, neonatal mortality.

[Comparison of central corneal thickness and keratometric measurements using the Scheimpflug HR imaging system, laser interferometry, automatic keratometry and ultrasound pachymetry]. / Srovnání merení tloustky a zakrivení rohovky pomocí Scheimpflugovy kamery, laserové interferometrie, automatické keratometrie a ultrazvukové pachymetrie.

INTRODUCTION: The aim of our study was to compare keratometry and central corneal thickness measurements obtained with three different ophthalmic devices and to decide if they can be used interchangeably in clinical practice. METHODS: 43 healthy persons were included in the study (29 women and 14 men, average age 25 ± 3.5 years). Central corneal thickness (CCT) was measured with the Scheimpflug HR imaging system (Pentacam), Allegro BioGraph and with ultrasound pachymetry (RXP OcuScan). Keratometry in two main meridians of the cornea (K1, K2) was measured with Pentacam, Allegro BioGraph and automated keratometry. RESULTS: The mean difference in K1-readings was 0.01 ± 0.31 D for BioGraph vs. automated keratometry, 0.06 ± 0.23 D for BioGraph vs. Pentacam and 0.05 ± 0.34 D for automated keratometry and Pentacam. The mean difference in K2-readings was 0.29 ± 0.45 D for BioGraph vs. automated keratometry, 0.11 ± 0.28 D for BioGraph vs. Pentacam and 0.19 ± 0.44 D for automated keratometry and Pentacam. The interdevice differences were in all cases statistically significant (p < 0.05). The mean difference in CCT was 4.57 ± 7.84 µm for BioGraph vs. ultrasound, 4.33 ± 7.55 µm for BioGraph vs. Pentacam and 8.90 ± 7.49 µm for ultrasound vs. Pentacam. The interdevice differences in CCT were also statistically significant (p < 0.05). CONCLUSION: Our results suggest that the measurements of keratometry and CCT may differ significantly between the tested machines and therefore should not be used interchangeably in clinical practice.

[Glaucoma screening by means of pupil campimetry]. / Glaukomerkennung mittels der Pupillenkampimetrie.

BACKGROUND: The aim of the study was to find out if pupillographic assessment of the visual field by means of pupil campimetry can identify glaucomatous visual field defects and as such be used for glaucoma screening purposes. PATIENTS AND METHODS: 20 patients with open angle glaucoma and 30 healthy persons were examined by means of pupil campimetry. All glaucoma patients had a glaucomatous visual field defect in at least one eye. The stimulus pattern consisted of 17 white-light stimuli which were presented within the 30° visual field, particularly in the Bjerrum region. The stimulus diameter was 6°. Each stimulus was presented for 200 ms and the interval between the stimuli was 1800 ms. Three stimulus intensities (16.4 cd/m2; 27.1 cd/m2 and 40.5 cd/m2) were tested. The individual pupil light reaction (PLR) amplitudes at all examined locations in the visual field, their sums and partial sums were compared between both groups by the two-sided two-sample t test. The diagnostic performance of the method in glaucoma diagnosis was evaluated by ROC curves (receiver operating characteristics). RESULTS: The average PLR at all locations in the visual field was reduced in glaucoma patients compared to healthy persons. The sums of the PLR were reduced in glaucoma patients as well. Significant differences in the PLR were found especially in the central and paracentral visual fields. The best AUC values (area under the curve) were reached with the highest stimulus intensity, the highest AUC value overall was 0.769. CONCLUSION: Although the difference in PLR between glaucoma patients and the control group was significant, the reached AUC values fell short of being ideal for screening purposes. A surprising finding was that the most central pupil response was reduced by the same amount as that in the Bjerrum region.

[Current state of pupil-based diagnostics for glaucomatous optic neuropathy]. / Aktueller Stand der pupillenbasierten Diagnostik der glaukomatösen Optikusneuropathie.

There are considerable differences between pupillary reactions to light in glaucoma patients and healthy subjects which can be identified by various techniques. These methods are based on the early asymmetry of the afferent conduction in the visual pathway, on the examination of the visual field by focal light stimuli or on visual stimuli in analogy with multifocal electrophysiological tests. Latest findings in pupillary research also suggest a possible use of the intrinsically photosensitive (melanopsin expressing) retinal ganglion cells in glaucoma diagnostics. The current results of pupillary experiments in glaucoma patients are encouraging for further research in this field because suitable objective screening methods for glaucoma are continually being sought.

[Visual functions and quality of life in patients with keratoconus]. / Zrakové funkce a kvalita zivota u pacientu s keratokonem.

PURPOSE: To evaluate quality of life and visual functions in patients with keratoconus wearing rigid gas permeable (RGP) contact lenses. METHODS: Keratometry and objective refraction, uncorrected visual acuity, visual acuity with RGP contact lens, high order aberrations and letter contrast sensitivity before and after RGP application were measured in 22 keratoconus patients. Vision-related quality of life was examined by the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) RESULTS: The average spherical equivalent in the study group was -7.28 (+/- 5.53), the average keratometry was 50.04 D (+/- 4.24) and the average corneal astigmatism -3,44 Dcyl (+/- 2,72). The uncorrected visual acuity was 0.20 (+/- 0.18), the corrected visual acuity 0.78 (+/- 0.22). The improvement of visual acuity after RGP fitting was statistically significant (p < 0.001). The RGP fitting didn't cause significant changes in high order aberrations and in contrast sensitivity. The NEI-VFQ overall score was 79.2. Keratoconus was associated with lower scores in these categories: dependency, mental health and ocular pain. CONCLUSION: Keratoconus is a disease which may have a marked impact on the quality of life beacuse it affects young adults in their active years. The use of RGP correction can significantly improve visual acuity but, at least in our study group, did not lead to significant improvement in contrast sensitivity and corneal aberrations.

[Corneal ulceration complicating surgical correction of ptosis in patient with Kearns-Sayre syndrome--a case report]. / Rohovková ulcerace po operaci ptózy u pacienta s Kearns-Sayreovým syndromem.

UNLABELLED: The aim is to report a rare complication of surgical ptosis correction in a patient with Kearns Sayre syndrome and the therapeutic possibilities of its treatment. METHODS: Exposure corneal ulceration caused by lagophtalmos developed gradually in a 30-year-old woman after an upper eyelid ptosis surgery of the right eye performed at another eye clinic. During an examination a limited movement of both eyes and retinal pigmentary changes (salt-pepper-like appearance) were diagnosed. A suspicion of the Kearns Sayre syndrome was expressed according to the clinical picture, the diagnosis was confirmed by molecular analyses in muscle biopsy, which revealed 5.2 kb deletion of mitochondrial DNA. RESULTS: Corneal ulceration was treated by partial external tarsorrhaphy and frequent instillation of lubricants. The upper eyelid ptosis of the left eye was treated with a spectacle with ptosis support. CONCLUSION: During the correction of upper eyelid ptosis in patients with progressive external ophtalmoplegia it is necessary to be aware of the risk of surgical exposure keratopathy and corneal ulceration due to the atony of musculus orbicularis oculi muscle and only slightly expressed Bell's phenomenon.

[Afferent pupillary disorders in postchiasmal lesions of the visual pathways]. / Afferente Pupillenstörungen bei postchiasmalen Läsionen der Sehbahn.

Classically, the pupillary pathway is considered as a simple reflex arc comprising retinal ganglion cells, midbrain interneurons, oculomotor nerve and short ciliary nerves. However, there are some specialties in the construction of the pupillary pathways that have to be kept in mind when dealing with diseases involving pupillary disorders. This may help to localise lesions. Additionally, studies in patients with lesions of the retrogeniculate pathways have shown that pupillary disorders are possible even with lesions not involving the classical reflex arc. The pupil is therefore not only controlled subcortically, some components are influenced by the visual cortex. The aim of this article is to clarify various findings and terms such as relative afferent pupillary defect and pupillary hemihypokinesia.

[Awareness and quality of life in patients with glaucoma]. / Informovanost a kvalita zivota pacientu s glaukomem.

PURPOSE: To test the Czech version of a validated questionnaire in assessing health-related quality of life in patients with glaucoma and also determine the level of understanding of their disease. METHODS: Quality of life was assessed using the NEI-VFQ 25 (National Eye Institute - Visual Function Questionnaire) in 20 patients with open-angle glaucoma. Results of the questionnaire were processed by standardized methods and a score between 0 and 100 was assigned to each of the 12 subscales, where 100 represents the best possible score on the scale and 0 represents the worst. The awareness of patients about glaucoma was elicited by 9 questions concerning the origin, course, diagnostic methods and prognosis of glaucoma. RESULTS: The lowest scores in our study group were associated with the subscales of general vision (61.4 +/- 19.7), mental health (61.4 +/- 17.4), role limitations (72.1 +/- 26.7), and dependency (58.3 +/- 23). Our knowledge inquiry revealed poor level of knowledge about glaucoma in our study group. CONCLUSIONS: in our study, the NEI-VFQ 25 proved to be useful and the scores comparable to the results published abroad. The results of our knowledge inquiry suggest that there is an urgent need for patients to receive more information. Patients who are more knowledgeable of their condition are more likely to be adherent to treatment.

[Comparison of intraocular pressure lowering efficacy of bimatoprost / timolol fixed combination and other glaucoma medications in the treatment of glaucoma]. / Srovnání fixní kombinace bimatoprostu 0.03% a timololu 0.5% s jinými kombinacemi antiglaukomatik v lécbe glaukomu.

AIM: To compare intraocular pressure (IOP) lowering efficacy of bimatoprost 0.03% / timolol 0.5% fixed combination (BTFC) and other combinations of glaucoma drugs (bimatoprost, latanoprost 0.005% / timolol 0.5% fixed combination, separate use of travoprost 0.004 % and timolol 0.5 %) in patients with glaucoma. PATIENTS AND METHODS: Fifty-three patients with glaucoma were divided into 3 groups according to their original glaucoma therapy. BTFC was used by the patients for a period of 3 months. After 1 week, 1, 2 and 3 months, the diurnal IOP curves were performed. Side effects of the new treatment were recorded and compared to the original therapy. RESULTS: The mean diurnal IOP reduction in the group of patients switching from bimatoprost to BTFK reached 4.4 +/- 2.28 mm Hg (p < 0.01). In the group of patients initially on latanoprost / timolol fixed combination, the IOP decreased with BTFK by 2.3 +/- 1.5 mm Hg (p < 0.01). Changing therapy from travoprost / timolol seperate combination to BTFK caused an IOP decrease by 2.3 +/- 1.5 mm Hg on average (p < 0.01). Conjunctival hyperemia with initial therapy was experienced in 33% of patients in our study group. With BTFK application, the hyperemia improved in 69% of these patients, got worse in 12.5% and remained unchanged in 19% of the patients. Patients found the BTFK better than the original medication in 37.5% of cases, the same in 52% and worse in 10.5%. Five patients terminated the study earlier due to poor IOP compensation or marked side effects of BTFK. CONCLUSION: In all three groups of glaucoma patients there was a significant and prolonged decrease in IOP after treatment with BTFK. The use of BTFK was accompanied by smaller incidence of conjunctival hyperemia compared to isolated bimatoprost or travoprost / timolol combination.

[Importance of structural examination methods in the follow-up of patients with ocular hypertension]. / Význam strukturálnich vysettovacích metod pri sledování pacientu s ocní hypertenzi.

PURPOSE: To evaluate the contribution of Heidelberg Retina Tomograph (HRT) and blue-on-yellow perimetry (B-Y) for the follow-up and early diagnosis of glaucoma in patients with ocular hypertension (OHT). We also dealed with the comparison of visual field (VF) examination by means of the B-Y and white-on-white perimetry, correlation between VF indexes and HRT parameters, importance of the central corneal thickness (CCT) and the comparison of other characteristics of the study and control groups during the 3-year-study-period. PATIENTS AND METHODS: Both eyes of 28 patients with OHT (study group, SG) and 15 control subjects (control group, CG) were included in the study. Subjects in both groups were examined annually. At each visit complete ophthalmological examination was carried out, including the biomicroscopic evaluation of the optic disc, aplanation tonometry, HRT II analysis of the optic nerve head (ONH) and B-Y perimetry. Pachymetry was performed only once at the beginning of the study. RESULTS: During the 3-year-follow-up structural changes of the ONH developed in 2 patients with OHT only. They were not accompanied by VF defects on B-Y perimetry. Intraocular pressure and CCT were higher in the SG (p < 0.01). CCT significantly and positively correlated with the level of intraocular pressure in both groups. Mean sensitivity (MS) of the B-Y VF was repeatedly smaller in the SG compared to the CG (p < 0.01). Difference between MS a mean defect (MD) of the B-Y and white-on-white VF in the SG was significant (p < 0.01). The B-Y perimetry test lasted much longer than standard perimetry. A marked learning effect was found with B-Y perimetry. Despite significant correlations of follow-up B-Y perimetry examinations, high test-retest variability was found. No significant change in topographic parameters of the ONH occurred during the follow-up period. HRT displayed low variability of follow-up examinations. No significant correlation between topographic parameters of the ONH and VF indexes on B-Y perimetry was found. CONCLUSION: In 2 cases of OHT the HRT preceded VF changes on B-Y perimetry. HRT showed high reproducibility, on the contrary, B-Y perimetry was accompanied by high variability making the distinction of fluctuation and progression more difficult. Pachymetry is a very useful tool in patients with OHT.

[Influrence of age, gender, refraction, keratometry and disc area on the topographic parameters of the optic nerve head]. / Vliv veku, pohlaví, refrakce, keratometrie a plochy terce na topografické parametry terce zrakového nervu.

Optic nerve head (ONH) examination using the Heidelberg Retina Tomograph II was carried out in a study group of 39 healthy persons aged 42-79 years. Refraction and keratometry were measured by means of the autorefractometer. The following topographic parameters of the ONH were tested: disc area, rim area and cup area, cup/disc ratio, rim/disc ratio, rim volume, cup volume, mean and maximum cup depth, height variation contour, cup shape measure, mean RNFL thickness and RNFL cross sectional area. Influence of gender on the topographic parameters of the ONH was not found. The age significantly influenced values of the disc area, rim area, rim volume and RNFL cross sectional area. Refraction significantly influenced the parameters disc area and rim area, keratometry significantly correlated with the disc area and cup shape measure. Disc area significantly influenced most parameters of the ONH (cup area, rim area, C/D ratio, R/D ratio, cup volume, rim volume, mean and maximum cup depth, cup shape measure, RNFL cross sectional area). Our study showed that refraction, keratometry, age and disc area significantly influence many topographic parameters of the optic nerve head in the Heidelberg Retina Tomograph ONH analysis.

[Structural analysis of the optic nerve head in healthy eyes and in eyes with glaucoma]. / Strukturální analýza terce zrakového nervu zdravých ocí a ocí s glaukomem.

PURPOSE: Assess the possibilities of structural analysis of the optic nerve head by Heidelberg Retina Tomograph (HRT) and its use in detection of glaucomatous changes of the optic nerve in particular. Indicate the topographical parameters that are most influenced by glaucoma and are therefore vital in early diagnosis of glaucomatous changes of the optic nerve. PATIENTS AND METHODS: Laser scanning tomography (HRT II) was used to examine 68 healthy eyes (control group) and 42 eyes with open angle glaucoma (study group). All the examined subjects were older than 35 years of age. The analysis concerned the following topographical parameters of the optic nerve head: disc area, cup area and rim area, cup volume, rim volume, cup/disc area ratio, mean cup depth, maximum cup depth, mean retinal nerve fiber layer thickness (RNFL), RNFL cross sectional area, height variation contour and cup shape measure and discriminant functions used for classification of the optic nerve head finding according to F. S. Mikelberg and R. Burk. Statistical analysis was employed to ascertain the significant difference in these topographical parameters for the healthy eyes and the eyes with glaucoma. This method was used for both the whole optic disc and the 6 sectors of the optic nerve head. Another aim of the analysis was also to find out the correlation between the topographical parameters and age. RESULTS: Significant difference in the topographical parameters for the whole optic disc was spotted in the following parameters: rim volume, mean RNFL thickness, RNFL cross sectional area and discriminant function FSM. Significant differences were also found in between individual sectors of the optic nerve head, except for the upper temporal and upper nasal sector. The parameter, which varied most frequently between the groups, was rim volume. Significant correlations between age and topographical parameters were found for the following parameters: rim area, cup shape measure and mean RNFL thickness. CONCLUSION: Results of our study showed, that HRT is able to distinguish between normal and the pathological findings of optic nerve head according to topographical parameters significantly different between the two examined groups. These parameters are important in the diagnosis of glaucoma and also in the follow-up of patients with open angle glaucoma.