[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.

[Immunohistochemical detection of the gene p53 and p21 expression in cells of the malignant melanoma of the uvea]. / Imunohistochemická detekce exprese genu p53 a p21 v bunkách maligního melanomu uvey.

AIM: To examine by means of immunohistochemistry the expression of the tumor suppressing gene p53 and gene p21 in cells of malignant melanoma of the uvea from formalin-paraffin material from patients, who were during the period 2000 - 2006 surgically treated due to malignant melanoma of the uvea at the Department of Ophthalmology in the University Hospital in Brno (Brunn), Czech Republic, E.U., and to correlate the results of the immunohistochemical detection with clinical signs of the tumor of each patient. METHODS: Twenty-nine malignant melanomas of the uvea were examined by means of monoclonal antibody DO-1 (Novocastra company) and all 29 samples of malignant melanoma of the uvea were immunohistochemically examined for the p21 gene expression by means of the monoclonal antibody SX 118 (DAKO company). We evaluated the percentage of positive nuclei and the intensity of the staining in immunohistochemically detected p53 and p21 genes expression. RESULTS: Results suitable for evaluation we obtained in 28 samples of malignant melanomas, one sample was not suitable for evaluation due to extremely high presence of melanin pigment. In 3 patients, weak nuclear p53 gene expression was detected in 5-15% of cells, in 1 patient, the very weak intensity of staining in 5-15% of cells was found. In three patients, in 5-15% of cells, weak expression of p21 gene, and in one patient, very weak expression of p21 gene in 5-15% of cells (in all 4 cases, the p53 expression was established) were found. In one of those 4 patients with p53 gene expression it was the malignant melanoma of the iris, in one of them it was malignant melanoma of the ciliary body, and in 2 of them it was malignant melanoma of the choroid. CONCLUSION: The expression of the p53 gene and the expression of the gene p21 were established in 4 out of 28 patients (14.3%). From the above-mentioned results we can assume that stabilizing mutations of p53 gene are rare in the melanoma of the uvea. The proved expression p53 in 4 patients is probably result of the expression of the standard (wild-type) p53 gene, especially according to the ability to induce the expression of p21 gene. In our group, there were not proved marked nuclear accumulation of p53, which would suggest the presence of p53 gene mutation.

[Malignant melanoma of the uvea in the Department of Ophthalmology, Faculty Hospital Brno Bohunice, Czech Republic, EU]. / Maligní melanom uvey na Ocní klinice FN Brno Bohunice.

PURPOSE: The malignant melanoma of the uvea (MMU) is the most common intraocular tumor among adults. The aim of the retrospective study was to evaluate the stage of the malignant melanoma of the uvea (MMU) at the time of diagnosis in a group of patients, to whom it was diagnosed in the Department of Ophthalmology, Faculty Hospital Brno. In the years 2005 and 2006, there had been diagnosed the MMU in 19 patients (11 women and 8 men) with the average age of 64.6 +/- 9.0 years. METHODS: The group of 19 patients was analyzed in accordance to various criteria: age, sex, location of MMU (iris, ciliary body, and choroid), size of MMU at the time of diagnosis, clinical signs of MMU, methods used in the diagnostic evaluation of the MMU, its treatment, histological type, TNM classification, and metastases. RESULTS: MM of the choroid was diagnosed in 14 cases, MM of the ciliary body in 4 cases and MM of the iris in 1 patient. The MMU was asymptomatic in 3 patients, in 2 patients manifested with the pain, and in all other cases (in 14 patients) manifested with the decrease of the visual acuity. The patient with MM of the iris was treated by means of therapeutic partial iridectomy and lamelar keratectomy, 5 patients were treated by means of brachytherapy, 3 patients were treated by means of Leksell gama knife and 10 patients underwent the enucleation because of large size of the tumor. At the time of the MMU diagnosis, there were no metastases present in any of the 19 patients. CONCLUSION: Despite to the currently diagnostic possibilities available, the majority of MMU is diagnosed at late stage, which requires radical surgical treatment. The variety of MMU clinical signs' knowledge may help to the early diagnosis of MMU, which will contribute to the opportunity to use the treatment, which particulary spares the visual functions.