[TNM classification of malignant ocular tumors]. / TNM klasifikace zhoubných ocních nádoru.

The article presents contemporary TNM classification of malignant ocular tumors. This classification allows to establish the prognosis of the disease correctly and to choose proper treatment strategy. According to this classification, it is possible to compare results of the treatment and to communicate with the doctors and hospitals at the national and international level as well. It is necessary to acquaint the doctors especially in postgraduate courses with this classification, although the malignant ocular tumors represent only 0.2-0.5% of all tumors.

[Evaluation of permanent sequelae of eye injuries in relation to the duration of work disability and degree of invalidism]. / Hodnocení trvalých následku ocních úrazu vzhledem k délce pracovní neschopnosti a stupni invalidity.

The authors evaluated the sequelae of 200 eye injuries based on forensic attests during the investigation period from 1983-1997. The group comprised 166 men and 34 women, mean age 37.5 years, incl. 25 children under 18 years. They classified the injuries in-to groups with regard to their origin and mechanism. Attention was paid to evaluation of visual acuity at distance, the number of operations of the eyes and the authors classified the group with regard to ophthalmological diagnosis and complications. The mean period of hospitalization was 32.8 days, the mean period of work incapacity 117.7 days. In the whole group there were 75 monoculi, 6 bilaterally blind subjects, one quarter had 6/6 vision on both eyes. Almost half the injured subjects had a reduced work capacity, there were 66 partial invalids, 22 full invalids, 13 subjects had an altered work capacity. The discussion is focused on better collaboration of the ophthalmologist and physician assessing the work capacity in evaluation of permanent sequelae of eye injuries.

[Changes in psychovisual function after central serous chorioretinopathy]. / Zmeny psychovizuálních funkcí po centrální serózní chorioretinopatii.

Psychovisual examination methods detect macular changes better and more subtly then hitherto commonly used examination methods, in particular in dynamic investigations. The authors used this method in a series of investigations of diabetes, glaucoma and haemodialysis. The group is formed by 19 eyes of 16 patients with a first attack of central serous chorioretinopathy. Two thirds of the patients were treated by conservative methods, one third by photocoagulation with an argon laser. The observation period was 3 months to 13 years, the mean being 3.5 years. The control group was formed by a group of healthy subjects of corresponding age. The authors proved a statistically significant (5%) reduction of the contrast sensitivity at medium spatial frequencies (6 and 12 c/dg) in patients with one or several attacks of CSCHR. Statistically significant deterioration of colour discrimination (5%) was proved in patients with one attack of CSCHR in 20% of the patients. In patients with two or more attacks of the disease the authors recorded a statistically significant deterioration of colour discrimination (1%) in 44% of the patients. They did not reveal, using psychovisual examination methods, statistically significant differences between groups of patients treated conservatively or by laser. In all cases of impaired colour discrimination a disorder in the blue-yellow region was involved, i.e. in the region of retinal receptors.

[Changes in the conjunctiva and cornea in dialyzed patients]. / Zmeny spojivky a rohovky u dialyzovaných nemocných.

The author examined 119 patients having regular dialyzation treatment and a control group of 90 healthy subjects, divided into groups by decades. Depending on the intensity of pathological changes, they created four categories; the fifth comprised normal findings. The prepared from the bioptic material of the conjunctiva of two patients preparations which were examined for calcium and amyloid deposits. Pathological changes were found in 74.8%. The authors try to explain the cause of conjunctival and corneal changes, consistent with the theory of hastened ageing in chronic renal failure of patients treated by regular haemodialysis. The so far unique findings of amyloid of the conjunctiva could be possibly used in future for the diagnosis of amyloidosis instead biopsies.

Early changes of serum N-acetyl-beta-glucosaminidase, tissue plasminogen activator and erythrocyte superoxide dismutase in relation to retinopathy in type 1 diabetes mellitus.

Biochemical markers of early changes that are characteristic for diabetic microangiopathy are not completely understood. We investigated activities of serum N-acetyl-beta-glucosaminidase (NAG), tissue plasminogen activator and erythrocyte superoxide dismutase in well defined groups of type 1 diabetic patients. Patients were selected on the basis of 4 year follow-up observation. Forty-two type 1 diabetic patients were subdivided into those without retinopathy (n = 13) throughout the study, those with newly developed or worsened retinopathy (n = 12) during 4 years and those with retinopathy already established at the beginning of the study and without evidence of its progression (n = 17). All diabetic patients had albustix-negative urine. A significant increase of the mean serum NAG activity during 4 years was found only in patients without retinopathy (P < 0.01) whereas no changes of the altered enzyme activities were present in patients with developing and established retinopathy. The mean activity of tissue plasminogen activator was elevated in all groups of diabetic patients compared with healthy subjects (P < 0.001). A significant positive correlation was found between plasminogen activator and serum NAG (r = 0.51, P < 0.01). Erythrocyte superoxide dismutase was higher in diabetic patients than in healthy persons (P < 0.01) but no differences were observed between the patients with or without retinopathy. Superoxide dismutase positively correlated with NAG (r = 0.57, P < 0.01). We conclude that early functional changes precede a morphological development of diabetic retinopathy as was evident from the altered enzyme activities.

[Ophthalmologic and psychophysiologic changes in patients in long-term dialysis treatment]. / Oftalmologické a psychofyziologické zmeny u pacientu v dlouhodobém dialyzacním lécení.

In 14 patients (7 men and 7 women), mean age 48 and 50 years resp. with chronic renal failure, having regular dialyzation treatment for more than 10 years (2 patients more than 20 years) the authors made ophthalmological and psychophysiological examinations in order to assess complications after prolonged dialysis. In three patients dialysis was discontinued while a graft was functional. In addition to known complications, calcification of the conjunctiva, osmotic cataract and retinal changes and changes of the optic disc the authors detected also changes of the visual field, contrast sensitivity and colour differentiation. They revealed changes of contrast differentiation in all spatial frequencies with a maximum in medium and upper frequencies. They revealed in more than 60% disorders of colour differentiation with a maximum in the blue-yellow and blue area of the spectrum. Ophthalmic complications the frequency of which is declining only rare by endanger the function of the eye.

[Albuminuria and N-acetyl-beta-glucosaminidase activity in a prospective study of type I diabetics]. / Albuminurie a aktivita N-acetyl-beta-glukosaminidázy v prospektivní studii u diabetiku I. typu.

The authors investigated a group of 47 type I diabetics in a prospective study extending over 8 years. Every year they evaluated the albuminuria and the N-acetyl-beta-glucosaminidase (NAG) activity in serum and urine and the results were compared with the state of compensation of diabetes and with the clinical finding on the ocular fundus. During the eight-year period newly manifested microalbuminuria developed in 8 of 32 patients (25%) who at the onset had a normal finding. In patients with newly manifested microalbuminuria the authors found a significant rise of the fructosamine serum concentration (p < 0.05) and at the same time a rise of serum NAG activity (p < 0.05). A positive correlation was proved between the serum NAG activity and glycated haemoglobin (r = 0.67, p < 0.01). In 13 patients (28%) in the course of the eight-year period the finding on the ocular fundus deteriorated. In these patients the NAG serum activity was elevated already at the onset of the investigation, while albuminuria rose in the course of the mentioned period. Dynamic changes of the NAG serum activity along with albuminuria can serve as bio-chemical markers of developing microangiopathy the manifestation of which is hastened by deteriorated compensation of diabetes.

Glycosaminoglycans in urine of type 1 diabetic patients.

Diabetic nephropathy is accompanied by changes of glomerular and tubular functions manifesting already in the early stages by an increase of glycosaminoglycans excretion into urine. We evaluated urinary glycosaminoglycan excretion in 38 Type 1 diabetic patients with no markers of developed nephropathy. Glycosaminoglycan excretion related to creatinine concentration was significantly higher in diabetic patients with or without retinopathy than in healthy persons (3.9, 1.2-12.7 or 3.7, 0.9-15.9 vs 2.0, 0.8-5.1 micrograms/mumol creatinine, p < 0.01). A positive correlation between glycosaminoglycan excretion and albuminuria was observed in all diabetic patients (r = 0.60, p < 0.01). Urinary glycosaminoglycan excretion did not correlate with serum fructosamine concentration.

[Changes in intraocular pressure during hemodialysis and hemofiltration]. / Zmeny nitroocního tlaku behem hemodialýzy a hemofiltrace.

The authors compare changes of intraocular pressure during haemodialysis and haemofiltration in six patients. The measurements were made with the patients in a sitting position, using an applanation tonometer according to Perkins, during both operations every hour. A rise to 25 torr was recorded in one patient repeatedly during haemofiltration in both eyes one hour after the blood pressure had risen to 220/120 and 210/110. In the other patients the variations of the intraocular pressure were within the physiological range. Based on data in the literature the authors recommend the use of haemofiltration in patients with glaucoma and after eye surgery.

[Legal judgements in ophthalmic traumatology]. / Soudní posudky v ocní traumatologii.

The author elaborated between 1983 and 1990 100 expert opinions. Based on analysis of these expert opinions he draws attention to less well known problems of legal expert opinions. By criticism of a decree which is 25 years old (no. 32/1965) he wants to help not only patients who are frequently damaged by the strictness of the decree, but also doctors who assess the sequelae of injuries.

[Changes in the visual field after laser coagulation in type I diabetics]. / Zmeny zorného pole po laserové koagulaci u diabetiku I. typu.

The authors examined 41 eyes of 22 compensated type I diabetics 1 - 2 years after laser photocoagulation, using an automatic static perimeter Peritest. One fifth of the investigated patients had marked changes - DR20. The patients are not aware of the diminution of the visual field. Even the most extensive diminution of the visual field in this group did not restrict the ability to drive motor vehicles.

[Treatment of chronic uveitis with long-term administration of penicillin]. / Lécba chronických uveitid dlouhodobou aplikací penicilínu.

The authors followed up a group of 20 patients with chronic uveitis (10 men and 10 women), mean age 36.5 years. Despite treatment of the foci, they suffered on average from seven relapses of the disease, frequently several times in the course of one year. From the anamnestic aspect there was a significantly high number of spells of tonsillitis, respiratory infections and arthralgia. Half the cases of uveitis, mainly anterior, were bilateral. The patients suffered from dysimmunoglobulinaemia with low values of FW, ASLO, Latex. HLA B 27 was positive in five subjects. After one-year of Pendepon or Penclen administration (in half the patients with NORG) 18 patients did not develop a relapse for a period of 2-3 years. The method is simple, cheap, easy to use in field practice, in particular in junior patients. The clinical effect of treatment justifies the use of this method as an alternative of intermittent immunosuppression.

[Ocular changes in Gardner syndrome]. / Ocní zmeny u Gardnerova syndromu.

In hereditary adenomatosis of the large bowel (familial polyposis) extraintestinal manifestations of the disease are common: hyperostosis, dental anomalies, soft tissue tumours, desmoid tumours etc. Patients with marked extracolic signs are described as patients with Gardner's syndrome. Recently a further sign is described--foci of congenital hypertrophy of the pigmented retinal epithelium. The authors examined 22 patients with confirmed hereditary adenomatosis (Gardner's syndrome). The typical finding of pigmented foci on the fundus was recorded in 18 subjects (82%) incl. 9 subjects (50%) where the finding was bilateral. The authors examined also 25 children of these patients. In those a positive finding was recorded in 11 (44%). Ophthalmological examination can contribute in a significant way to detection of an asymptomatic subject with hereditary adenomatosis, in particular when seeking risk patients in an affected family. Evaluation of ophthalmological changes can also contribute to the solution of some special genetic problems of this disease.

A six-year follow-up of the relationship between N-acetyl-beta-glucosaminidase and albuminuria in relation to retinopathy.

Fifty patients with Type 1 diabetes mellitus were observed over 6 years. Serum and urinary N-acetyl-beta-glucosaminidase (NAG) activity, and albuminuria were measured in groups of patients subdivided according to ophthalmological findings. Significantly higher mean serum NAG activity was found at the beginning of the study in patients who later developed diabetic retinopathy in comparison with those who did not (geometric mean (2SD range) 19.7 (12.4-31.2) vs 14.4 (9.5-22.7) U l-1, p less than 0.01). Urinary NAG activity was significantly higher in all groups of diabetic patients than in healthy control subjects (p less than 0.05). A significant increase in albumin:creatinine ratio during the study was found in patients with newly developed diabetic retinopathy compared with patients who did not (at 6 years 1.33 (0.40-4.43) vs 0.75 (0.24-2.31) g mol-1, p less than 0.01). No differences in either biochemical variable were found between hypertensive and normotensive diabetic patients at the end of the study. The results suggest that both serum NAG activity and albuminuria may serve as early functional indicators of diabetic retinopathy.

Plasma free N-terminal fibronectin 30-kDa domain as a marker of endothelial dysfunction in type 1 diabetes mellitus.

The plasma free N-terminal fibronectin 30-kDa domain was measured in 44 type 1 diabetic patients and in 20 healthy subjects. A significantly raised mean concentration of a free N-terminal fibronectin 30-kDa domain was found in plasma of diabetic patients with proliferative retinopathy as compared with healthy persons (P less than 0.001). A positive correlation was observed between free N-terminal fibronectin 30-kDa domain and von Willebrand factor in plasma of all examined subjects (r = 0.62, P less than 0.01). A similar correlation was present between 30-kDa domain and albuminuria (r = 0.56, P less than 0.01). However, no relationship was found between fibronectin 30-kDa domain and control of diabetes as assessed by fructosamine concentration. The free N-terminal fibronectin 30-kDa domain may be used as a marker of actual endothelial cell dysfunction in diabetes.

[Laser therapy of diabetic retinopathy in pregnancy]. / Laserová lécba diabetické retinopatie tehotných.

During the regular follow-up of risk pregnancies in the Central Bohemian region, concentrated at the First Obstetric Clinic in Prague, the authors detected 34 women with retinopathies. In nine they performed panretinal photocoagulation by means of an argon laser and recorded favourable results. The authors consider early laser therapy of retinopathies in pregnant diabetics useful and essential. Advanced forms of diabetic retinopathy in pregnant women still remain a contraindication of pregnancy. Pregnancy in diabetic women is always a risk and it would be a mistake not to take this fact into account.

[Changes in the ocular fundus in patients with chronic kidney failure on regular dialysis therapy]. / Zmeny ocního pozadí nemocných s chronickým selháním ledvin v pravidelném dialyzacním lécení.

Investigation of changes of the ocular fundus by ophthalmoscopy, coloured photography and fluoroangiography confirmed assumptions that the most frequent finding is hypertonic angiopathy and angiosclerosis. Hypertonic retinopathy and neuroretinopathy were recorded only in one quarter of the cases, most frequently during the initial years of dialysation treatment. The part played by a high blood pressure in chronic renal failure before and during dialyzation treatment is important. Under the influence of many metabolic changes in dialysed patients a general affection of the blood vessels and tissues of the retina, choroid and optic nerve develops. The appearance of the ocular fundus in the patient reminded of findings in subjects by two or more decades older and supported thus the theory of hastened ageing in chronic renal failure with regular dialysation treatment.

[Changes in the lens and cataract surgery in dialyzed patients]. / Zmeny cocky a operace katarakty u dialyzovaných nemocných.

In the course of a 15-year investigation period we recorded among 119 patients with chronic renal failure who had regular dialysation treatment cataract in 17 subjects, i.e. in 14.3%. The authors did not observe during the investigation period changes of refraction nor reversibility of the cataract. Seven patients were operated on one or both eyes, i.e. 5.8%. The paper contains a detailed analysis of surgical complications and aetiopathogenetic reflections on possible causes of dialysation cataracts. In 10 operated eyes the authors achieved very good functional results, the patients survived with good vision on average for 2.25 years. One failure was due to atrophy of the disc of the optic nerve after hypertonic neuroretinopathy. Because of frequent complications during and after operation the authors recommend to perform cataract operations in dialysed patients in selected departments with the possibility of constant nephrological consultant services.

[Ocular complications in treatment with antitubercular agents in patients with chronic kidney failure on regular dialysis therapy]. / Ocní komplikace lécby antituberkulotiky u pacientu s chronickým selháním ledvin v pravidelném dialyzacním lécení.

A 22 years old woman suffering from renal insufficiency has been treated for 4 years by means of regular dialysis. Two years after the beginning of this therapy the renal transplantation was performed, but the graft was removed after 3 weeks. The hypertonic neuropathy was diagnosed. Patient was treated with antituberculotics, Imuran and Prednisone. After Ethambutol treatment indicated for pulmonar tbc (daily dose 11 mg per kg, the total dose of 33,6 g) the ocular side effects were pronounced: the toxical damage of both optical nerves, bilateral decrease of vision for distance and near, minute scotoma in the retinal centre of the left eye, deterioration of the vision of colours in the sense of deuteranopia. Complications were reversible, when the therapy with Ethambutol was discontinued and patient was treated with vitamins and Prednison in the total dose of 1,420 g. Authors mention also some other signs of ocular toxicity of antituberculotics.