[General health state of premature children treated for retinopathy of prematurity from 2007 to 2009]. / Celkový stav nedonosenvch detí osetienych pro retinopatii nedonosených v letech 2007-2009.

The aim of this study is to characterize in detail the general health state in infants with retina treated due to retinopathy of prematurity and so to specify the group of premature infants at the highest risk, in which the closest ophthalmologist's attention needs to be paid in the screening for retinopathy in prematurely born babies. The study group consists of seven patients treated in the Perinatological Center of the Children Clinic of the Faculty Hospital in Hradec Králové, Czech Republic, E.U. during the period 2007-2009, in whom the retina was treated for retinopathy of prematurity. In all infants, who had to undergo the retinal treatment, the birth weight was less than 1000 g and a combination of bronchopulmonary dysplasia and infectious disease was present. In infants with the birth weight less than 1000 g, this combination was present in the range from 13.33 % to 23.68 %, which specifies the patients at the most risk. Unfavorable condition after the treatment was caused especially by serious infections and pulmonary complications presented before and after the treatment. Albeit we perform the screening of premature infants according to the current rules, the development shows that the highest attention should be paid to the infants with the birth weight less than 1000 g with complicating diseases as bronchopulmonary dysplasia and infections. For the ophthalmologist, these may be another clue to the presupposition of retinopathy of prematurity prognosis and seriousness besides the birth weight and gestational age.The complicating diseases facilitate to determine accurately the group of premature infants, which is at higher risk of higher grade of retinopathy.

[Triamcinolone in the treatment of the diabetic macular edema--one-year results]. / Triamcinolon v lécbe diabetického makulárního edému--rocní výsledky.

AIM: To evaluate the efficacy of the 4 mg triamcinolone acetonide injection into the vitreous in patients with diabetic macular edema not responding to the laser treatment after one-year follow-up. PATIENTS AND METHODS: In a prospective study, 20 eyes with diffuse diabetic macular edema, not responding to the previous laser treatment were evaluated. The group consists of 20 patients; the mean age was 61.5 (29-76) years. The mean duration of diabetes was 14.5 (2-28) years. Twelve patients (60%) were treated by means of insulin, and eight patients (40%) by means of oral agents; the blood levels of glucose ranged between 3.2 - 22 mmol/L. In all patients, the treatment by means of intravitreal injection of triamcinolone started at least 3 months after the previous unsuccessful laser therapy of the macular region. Before the application, and at 1, 3, 6, 9 and 12 months after the application the visual acuity at the EDCRS optotypes was examined, the intraocular pressure was measured, the macula was examined by means of biomicroscopy, the photography of the fundus was performed by the funduscamera, and the macular thickness and its volume were measured by means of optic coherence tomography. The intravitreal injection of 4 mg of triamcinolone was performed on the outpatient's basis under aseptic circumstances at the operation theatre. RESULTS: The starting best-corrected visual acuity was 0.17 +/- 0.09 and after 12 months it improved to 0.22 +/- 0.14. During the 12 months follow-up period, the visual acuity improved in 11 eyes (55%), stabilized in 5 eyes (25%) and decreased in 4 eyes (20%). The improvement of the visual acuity was significant in all follow-up controls. In the first month p = 0.001, in the 12th month p = 0.038. The macular thickness decreased from the mean value 506.2 +/- 91.4 microm (range, 389 -719) in the beginning of the study, to the mean 362.4 +/- 92.6 microm (range, 211 - 569) after 12 months. During the follow-up period of twelve months, the macular thickness reduced in 18 eyes (90%), and increased in 2 eyes (10%). The decrease of the macular thickness is significant in all follow-up controls. In the 1st, 3rd, and 6th months, p < 0.0005, in the 9th and 12th months, p = 0.001. The correlation coefficient between the best-corrected visual acuity and the macular thickness is -0,467, and the probability (p= 0.038) is statistically significant. In 6 patients, the intravitreal injection of triamcinolone was repeated, and in one of them twice. CONCLUSION: The intravitreal injection of triamcinolone reduces the macular thickness and improves the visual acuity in patients with diabetic macular edema, in whom the laser treatment did not established the improvement. The best effectiveness is observed in the first three months after the application. After 12 months, we observed the reduction of the macular thickness in 90% of patients, and improvement of the visual acuity in 55% of patients. In some cases, it is necessary to repeat the application of triamcinolone to keep its effect.

[Wegener's granulomatosis--a case report]. / Wegenerova granulomatóza (WG) --kazuistické sdelení.

UNLABELLED: Authors present an unusual eye finding in a 56 years old patient with Wegener's granulomatosis, who was followed up at the Department of Pulmonary Diseases, School of Medicine Hospital, Hradec Králové (Königgrätz), Czech Republic. From the point of view of the internal medicine, there are granulomas of the upper and lower airways and renal affection (minimally LK form). It consists of the affections of lungs and bronchi (histologically verified), kidneys (erytrocytouria with normal functions), eyes (ophthalmoscopically verified), weight loss about 10%, and possible nose involvement (suspect). The eye finding consists of severe anterior and posterior scleritis bilaterally, protrusion of the eyeball, and restricted movement of the left eye temporally with diplopia, and changing retinal findings bilaterally with the final improvement of consequently appearing foci of the serous retinal detachment. CONCLUSION: The paper demonstrates variety of ocular findings in Wegener's granulomatosis, and simultaneously emphasizes the importance of multidisciplinary collaboration in diagnosis and treatment of this serious disease.

[The quality of vision in premature infants--first results]. / Kvalita videní u nedonosených detí--první výsledky.

In last years, thanks to the development in neonatology, the numbers of saved premature children with high co-morbidity are rapidly growing. Contrary to great advances in contemporary neonatology, the saved premature children are not spared different health's problems in the future life, including the vision. The main cause remains the retinopathy of prematurity and neurological diseases. In the study the authors present first results of their examinations of visual functions in premature children at the school age comparing with the group of healthy, mature children of the same age.

[Surgical treatment of submacular hemorrhage combined with tissue plasminogen activator (a case report)]. / Chirugické resení submakulární hemoragie v kombinaci s tkánovým aktivátorem plazminogenu (kazuistické sdelení).

Authors present the possibilities of extensive submacular hemorrhage surgery in a patient after serious eye injury with bleeding into the vitreous and underneath the retina. The combination of vitrectomy with tissue plasminogen activator application into the subretinal space allows better to dissolve the coagulated blood and facilitates its removal. This procedure with correct operation technique decreases the damage of the retinal tissue and consequently preserves the photoreceptors' function. In this report, a result of surgical treatment in a 22-year-old man is presented. In the presence of intravitreal bleeding and submacular hemorrhage, during the vitrectomy the tissue plasminogen activator was used, which during few minutes dissolved the already coagulated hemorrhage and facilitated its whole removal from the subretinal space.

[Visual functions' detailed evaluating in patients with Sjögren's syndrome before and after intracanalicular implants' (Smart Plug) insertion--(first results)]. / Podrobné zhodnocení zrakových funkcí pacientu se Sjögrenovým syndromem pred a po zavedení intrakanalikulárních implantátu (typ Smart Plug) (první výsledky).

UNLABELLED: The aim of the study was to determine exact visual functions (log MAR [minimal angle of resolution] and CS [contrast sensitivity]) and to evaluate corneal topographic maps in patients with established (by means of laboratory and biopsy examinations) Sjogren's Syndrome, and to determine the difference in subjective symptoms before and after insertion of the intracanalicular implants as well. PATIENTS AND METHODS: Twelve eyes (1 man, 6 women) with established Sjogren's syndrome were examined before and during two months after the insertion of the plugs. The best-corrected visual acuity (BCVA) was assessed on Landolt C rings optotypes. CS was measured on computer-controlled device (Neuroscientific Corp., U.S.A.) in 6 space-frequencies (0.74-29.55 c/deg). The corneal topographic changes (Keraton Opticon) were established by means of comparing total aberrations values before and after the intracanalicular implants' (Smart Plugs type) insertion. The control group for visual functions assessment consisted of 10 woman (20 eyes) of similar middle age. RESULTS: The BCVA on log MAR optotypes was 0.84 (0.69-0.95) before and 0.88 (0.52-1.23) after the insertion, on both occasions, it was lower than in the control group. The CS was before the insertion in all of the spatial frequencies lower, the largest differences were in the frequencies range 1.97-7.29 c/deg (p < 0.01). After the treatment, the values grow but they don't reach the values of the control group. Subjective complains of the patients decreased markedly; in 100% they had relief, in 3 cases they referred improvement up to 50%; no patient observed tearing. The frequency of drops' application has decreased by 63%. The Schirmer test, in 100% positive before the treatment, was after the insertion in 75% negative; the height of the tear-meniscus was positive in 100% before the procedure, and after that, its measurement improved to 1 mm in 91%; in 9% it was 1.5 mm. We also noticed changes of the ocular surface by means of lissamine green staining; this test was before the procedure positive in 100%, the improvement after that was in 63%. The regularity of the corneal surface is the determining factor of visual functions in "dry eyes". The measurement of the corneal topography is useful in differential diagnosis and helps to distinguish mild and more serious conditions of dry eye. The improvement of BCVA and CS values after insertion corresponds with patients' subjective evaluating. The best value of the treatment is improvement of the patients' comfort; furthermore, after insertion of the permanent plugs they feel pronounced subjective relief and lowering of the frequency of drops application.

[Transpupillary thermotherapy in the treatment of choroidal neovascularization in age-related macular degeneration--one year's results]. / Transpupilární termoterapie v lécbe choroidální neovaskularizace u vekem podminené makulární degenerace--rocní výsledky.

THE AIM OF THE STUDY: Authors refer to one year's results of the study of 56 eyes of 50 patients with the exsudative form of the age-related macular degeneration treated by means of transpupillary thermotherapy at the Department of Ophthalmology, School of Medicine, Charles University, Hradec Králové (Königgrätz), Czech Republic, EU. PATIENTS AND METHODS: In all patients, the best-corrected visual acuity (BCVA) before treatment was established. Beside the ordinary examination methods, the digital color photography of the fundus with topography of the lesion, fluoresceine angiography (FAG), or possibly indocyanine green angiography and optical coherence tomography (OCT) were performed. After the treatment, in given intervals, the BCVA was established, and retinal findings were evaluated by means of biomicroscopic examination, comparative color photography of the fundus, optical coherence tomography, fluoresceine angiography, or possibly indocyanine green angiography. RESULTS: During one year after the treatment, the visual acuity decreased by 2 or more lines on Snellen optotypes in 38.2% of patients, remained stable in 52.9%, and improved in 8.8% of patients. The FAG findings improved in 83.9% and the OCT findings in 84.8% of patients. This improvement was statistically significant. In patients with classical choroidal membrane, the BCVA decreased in 35.8%, remained stable in 57.1% and improved in 7.1% of patients. The FAG finding improved in 78.7%, and the OCT finding improved in 90.8% of patients. The improvement of the OCT findings was statistically significant. In patients with occult choroidal membrane, the visual acuity decreased in 45 %, remained stable in 45%, and improved in 10% of patients. The FAG findings improved in 88.9%, and the OCT findings in 78.9% of patients. The improvement was statistically significant. CONCLUSION: Our results show that transpupillary themotherapy belongs to important methods of treatment of the classical and occult membranes of the choroid in exsudative forms of the ARMD.

[The intravitreal application of triamcinolone in the treatment of the macular edema]. / Intravitreálni aplikace triamcinolonu v lécbe makulárního edému.

The aim of this study was to evaluate the efficacy of intravitreal application of triamcinolone in macular edema of different etiology. In this prospective study, 20 eyes were evaluated: 12 with diabetic macular edema, 6 with macular edema due to venous occlusion, 1 with pseudophakic cystoid macular edema, and 1 with cystoid macular edema in case of uveitis. Four milligrams of tramcinolon acetonide were injected in to the vitreous cavity. Before and in one month intervals after the application, the intraocular pressure was measured, visual acuity on the ETDRS optotypes was established, the macula was examined biomicroscopically, examination of the photography of the fundus was performed, and macular thickness was measured by means of optical coherence tomography. The follow-up period was 3 months. The mean visual acuity was 0.16 at the beginning of the study, 1 month after the application 0.32, and after 3 months 0.31. The mean thickness of the macula decreased from the initial value 537 microm by 249 microm after one month (improvement by 46.6%) and by 203 miceom after three month (improvement by 39.7%). As a complication, the elevation of the intraocular pressure was noticed in 20% of eyes, and this was compensated in all cases by means of local therapy. The intravitreal injection of triamcinolon seems to be a promising part of treatment of the macular edema of different origin.

[Contribution to differential diagnosis of intraocular tumors--case report]. / Príspevek k diferenciální diagnostice nitroocních tumoru--kazuistické sdelení.

Authors present the possibilities of different examination methods in cases of intraocular expansions and specific diagnostic methods to determine the actual etiology of the intraocular process in the posterior segment in particular. Of special concern to authors are cases, as is e.g. vitreous hemorrhage, in whose the standard examination methods are not useful. Pars plana vitrectomy with intraocular biopsy of the tissue for histological and cytological examination is very effective method to determine the proper diagnosis. The case report concerns with a 58 years old woman with vitreous hemorrhage and suspect tumor-like lesion, diagnosed by means of ultrasound examination. The pars plana vitrectomy revealed extensive preretinal organized hemorrhage with intravitreal hemorrhage. Samples for cytological examination were taken.

[Electroretinoraphic findings in age-related macular degeneration (ARMD) before and after radiotherapy]. / Elektroretinografické nálezy u vekem podmínené makulární degenerace pred a po radioterapii.

Standard ERG examinations were performed in 61 patients with ARMD before and after radiotherapy. Before the radiotherapy, a significant decrease in the cone b- wave amplitude and a significant reduction of the sum of oscillatory potentials (OP1-OP4) were found. At 24 months after the first dose of radiotherapy, a significant decrease in the rod response and 30-Hz flicker response were described. A possible explanation for the findings is an influence of radiotherapy onto primary circulatory disturbances in the whole retina in ARMD.

[The surgical management of macular hole]. / Chirurgické regení makulární díry.

The authors evaluate results of the vitrectomy with the internal limiting membrane (ILM) peeling staining membrane blue by 49 patients. 81% (40) patients had idiopathic macular hole, 13% (6) traumatic case, 6 % (3) epimacular membrane. Anatomic closure of macular hole was achieved in 59% (29) of 49 patients by the operation. Visual acuity improved 2 or more Snellen lines in 28% (14) patients. Vitrectomy with peeling of the limiting membrane staining membrane blue of the better identification MLI is the effective operating technique to treat the macular hole.

[The results of radiotherapy 24 months after treatment by patients with age-related macular degeneration]. / Výsledky radioterapie 24 mesícu po lébe u pacientu s vekem degeneraci makulárni degenerací.

The authors evaluate results of the radiotherapy by age- related macular degeneration. 114 patients (123 eyes) were examined. According to the total dose, we have divided the patients in 3 groups. Group A (12 Gy) consisted of 68 patients (74 eyes) and group B consisted of 46 patients (49 eyes), group C was designated as a control group, consisting of 21 patients (22 eyes). They have been performed in Department of Ophthalmology of Teaching Hospital of Charles University in Hradec Králové from February 1999 to April 2003. All examinations were performed before and at 24 months- follow up the radiotherapy. Radiotherapy seems to be a very promising and efficient method for treatment of the wet form of ARMD.

[Congenital stationary night blindness (CSNB)--a case report]. / Kongenitální stacionární nocní slepota (KSNS)--kazuistické sdelení.

PURPOSE: To document occurrence of the congenital stationary night blindness type Schubert-Bornschein in some members of one family, to put together the family tree, and to evaluate the examination methods. Among others the electroretinogram (ERG) is substantial in the diagnosis of the disease and to distinguish different types of CSNB. In the affected family, only in men the disease is expressed, females are transmitters. This corresponds to the X-linked inheritance. Simultaneously with CSNB, in this family, high myopia occurs not only in men, but also in women. CONCLUSION: CSNB is an inherited disease, mostly with X-linked inheritance. Affected are predominantly males, females are transmitters. This disease is not possible to treat. Despite this, to determine proper diagnosis is important and use of ERG is mandatory.

[Nodular faciitis--rare localization on the eye (a case report)]. / Fasciitis nodularis--vzácná lokalizace na oku (kazuistika).

GOAL: To contribute to differential diagnosis of changes of the outer segment of the eye. CASE REPORT: A 43-years old woman with three weeks long history of fast growing painless focus in the nasal part of the sclera of the left eye, which caused, except of visible tubercle and moderate feeling pressure, no problems. It is an unusual localization of non-malignant disease of unknown etiology originating from the Tenon's capsule. The literature quotes the same histological finding in different organs; the localization in the eye is rare. The author considers difficulties of the differential diagnosis in the unusual ocular diagnosis. CONCLUSION: The diagnosis was specified on the basis of the ocular and following histological findings. The treatment is surgical.

[Terson syndrome. A case report]. / Tersonuv syndrom--kazuistické sdelení.

OBJECTIVE: To explain the mechanism of the origin of unilateral retrohyaloid and vitreous hemorrhage in case of subdural haematom after a severe brain injury. METHODS: A detail examination by help of fluorescein angiography and funduscopy revealed a fluorescein leakage site in lamina limitans interna into the vitreous. RESULTS: Fluorescein angiography revealed a fluorescein leakage site at the margin of the optic disc. It was possible to find the source of hyperfluorescence that increased its intensity over a time after vitreous hemorrhage had been removed. CONCLUSION: The diagnosis of Terson syndrome was started on the base of eye examination. The damage to peripapillary tissues demonstrated by fluorescein leakage suggests that intracranial hypertension affects peripapillary structures through the intervaginal space of the optic nerve sheath.

[Transparency of the intraocular lens and its influence on distinguishing ability of the eye]. / Vliv transparence nitroocní cocky na rozlisovací schopnost oka.

PURPOSE: To compare logMAR best corrected visual acuity (BCVA) and contrast sensitivity (CS) in four types of early cataract and to evaluate influence of cataract surgery on visual functions. PATIENTS AND METHODS: 53 eyes (14 men, 39 women) with early cataract (BCVA 20/30 and 20/20 using Snellen charts) were examined before and within 3 and 12 months after cataract surgery. BCVA was tested using logMAR charts with Landolt rings. CS was examined on computerized system of 8010 type (Neuroscientific corp., USA) in 6 spatial frequencies between 0.74 d/deg and 29.55 c/deg. Influence of glare of 342.6 cd/m2 was tested using Brightness Acuity tester. The cataract was divided into 4 types: a) cortical (n=19); b) posterior subcapsular (n=9); c) nuclear (n=9) and d) corticonuclear (n=16). Twenty subjects were examined in the control group. RESULTS: BCVA using logMAR charts was 0.52 (0.22-1.05) preoperatively, and 0.83 (0.37-1.26) at 12 months postoperatively in the whole group of 53 patients. BCVA in patients before and after cataract surgery was significantly lower compared to the control group (p<0.001, p<0.05). Postoperative improvement of BCVA was markedly higher on logMAR charts (up to 4 lines) than using Snellen charts (1 line). CS in patients before and after cataract surgery was significantly lower compared to the control group (p<0.05 to p<0.001) in spite of significant improvement postoperatively (p<0.05 to p<0.001), first of all at intermediate and high spatial frequencies. Glare had only nonsignificant influence. The values of both BCVA and CS did not differ between 4 types of the cataract. CONCLUSIONS: The significant improvement of both BCVA and CS suggest that cataract surgery improve quality of life in early cataract.

[Posterior scleritis--a case report]. / Zadní skleritida--kazuistické sdelení.

Authors present clinical manifestation and therapeutic possibilities in posterior scleritis, a disease, which may cause diagnostic dilemma. They also give an account of new examination methods which amend the diagnostic schema and safely confirm this diagnosis. In the article, a disease of a seventeen years old man is presented, in which posterior scleritis of unknown etiology was diagnosed. Following the systemic corticosteroid treatment the visual acuity of the affected eye improved, subjective signs disappeared, and the clinical manifestation returned to normal.

[Visual function in high myopia corrected with anterior chamber phakic lens (PK PIOL). Initial results]. / Zrakové funkce pri vysoké myopii korigované fakickou prednekomorovou cockou (PK PIOL). První výsledky.

20 eyes (12 women, 8 men) undergoing implantation of anterior chamber phakic IOL (PIOL) for correction of the refractive error were examined before and 1 and 6 months after surgery. Median of preoperative spherical equivalent of refraction was -9.75 D (range -19.00 to -6.00 D). Contrast sensitivity (CS) was tested on a computerized system of the Contrast sensitivity 8010 type in 6 spatial frequencies (range 0.74 to 29.55 c/deg) and using the Ginsburg's charts also in 6 spatial frequencies (range 1.15 to 27.25 c/deg), the best corrected visual acuity (BCVA) was measured on the normalized charts with Landolt rings, influence of glare of 342 cd/m2 was examined using Brightness Acuity Tester. At 6 months postoperatively, median of spherical equivalent of refraction was 0.00 (-1.00 to 0.00). BCVA increased from 0.79 (range 0.50 to 0.97) preoperatively onto 0.96 (range 0.83 to 1.00). Median of CS increased in all spatial frequencies tested using both methods, significantly in the middle and high frequencies and CS almost, reached lower border of CS normal range. Glare had only nonsignificant influence on both BCVA and CS. Quality of vision postoperatively improved significantly.

[Ocular subclinical changes in significant carotid stenosis]. / Ocní subklinické zmeny pri významné stenóze karotid.

58 patients (40 men, 18 women) affected by high-grade carotid stenosis were examined using automated perimetry and electroretinography. Patients' ages ranged from 53 to 83 years with a mean of 67 years. We examined 29 patients with unilateral and 29 patients with bilateral symptomatic stenosis of carotid arteries and cerebrovascular alterations, without ocular changes. Visual field defects were found by 41 patients (70.6%), by 51.3% patients there were mild or middle defects, by 48.7% hard defects. The results using electroretinography showed significant amplitude decrease and prolonged latencies of the oscillatory potentials on ipsilateral side in unilateral cases. Significant decrease of amplitudes OP2 in patients after the attack of amaurosis fugax has been observed too. The critical value of this amplitude was estimated to 37 muV. High-grade stenosis of carotid arteries are accompanied by visual field defects and electric retinal functions disorders at the time when objective finding on the fundus is normal. The cause of these disorders might be decreased arterial perfusion or microembolization. The perimetry and ERG findings didn't correlate, nevertheless both tests can be useful for detection of early retinal alterations and represent a help-method to determine indications for carotid endarterectomy.