RHEOPHERESIS IN THE TREATMENT OF AGE-RELATED MACULAR DEGENERATION.

PURPOSE: Evaluation of the long-term effect of rheopheresis treatment of dry form of age-related macular degeneration (AMD). MATERIALS AND METHODS: The treatment group consisted of 65 patients and 55 patients in the control group, with a minimum follow-up period of 60 months. The basic treatment consisted of 8 rheopheresis procedures, and the additional treatment (booster therapy) of 2 rheopheresis procedures 1.5-2 years after the basic treatment. We evaluated changes in best corrected visual acuity, anatomical effect, electrical activity of the retina, haematological, biochemical and immunological parameters. RESULTS: Rheopheresis treatment contributed significantly: 1) to stabilisation of best corrected visual acuity of the treated patients, which initially showed an insignificant increased during the 2-years follow-up period, and then slightly decreased. By contrast, visual acuity decreased in the control group, to an insignificant degree up to 4 years, then statistically significantly. 2) to an improvement of the morphological findings in 62.4% of treated patients compared to 7.5% in the control group, while disease progression to stage 3 (neovascular form of the disease or geographic atrophy) with a significant decrease of visual acuity occurred in only 7.1% of treated patients, versus 37.0% in the control group. 3) to regression, even to the attachment of drusenoid pigment epithelial detachment (DPED). To a reduction of the area of DPED in 80.4% of treated patients, in contrast with an steaincrease in the area of DPED in 47.1% of patients in the control group, and the development of new DPED in only 2 eyes of treated patients compared with 16 eyes of patients in the control group. 4) to a preservation of the integrity of the ellipsoid layer in the fovea in 68.2% of the treated patients, while by contrast we found a damaged ellipsoid layer in the fovea in 66.6% of the control patients. 5) to a stabilisation of the activity of ganglion cells, the pineal system and the activity of the central area of the retina, with eccentricity between 1.8° and 30° in the treated patients, compared to alteration in the control group manifested mainly after 3.5 years of the follow-up period. 6) to a statistically significant improvement in rheological parameters, thereby increasing flow in microcirculation and positively influencing the metabolism in the retina. Also to a positive effect on the classical, alternative and lectin pathway of complement activation, a reduction in the level of proprotein convertase subtilisin kexin 9 (PCSK9), and thus also the level of LDLcholesterol, and 7) Additional treatment with 2 RHF procedures (so-called "booster therapy") seems to be a safe and suitable method of prolonging the stabilisation phase, or even improving visual acuity, anatomical and functional findings. CONCLUSION: We demonstrated positive changes in anatomical, functional and humoral parameters upon rheopheresis treatment of AMD. Their correlation provides a real possibility to identify patients at risk and to manage an individualised regime of rheopheresis therapy. This method of treatment is effective and safe, with a low percentage of non-serious adverse effects.

Detection of allergenic parvalbumin of Atlantic and Pacific herrings in fish products by PCR.

The conventional polymerase chain reaction (PCR) method to detect the major allergenic protein parvalbumin beta 2 of Atlantic herring (Clupea harengus) and Pacific herring (Clupea pallasii) was developed. The specific set of primers for the amplification of the partial genomic sequence of the pvalb 2 gene encoding the main fish allergen of both herrings was designed and applied to the investigation of 24 commercial fish products. The targeted amplicon size was 189 bp of pvalb 2 gene of Atlantic herring and Pacific herring. As the internal amplification control, the DNA of 18S rRNA gene for eukaryotes (141 bp) was successfully used. The specificity of designed primer pair using 26 various fish species was assessed. The intrinsic detection limit was 10 pg µl(-1) of the present specific DNA. Atlantic herring or Pacific herring allergenic parvalbumins were detected in 22 investigated fish products in conformity with the package declaration. Two fish products were negative in spite of the declaration. The proposed PCR method is specific enough and can be used for the detection of Atlantic and Pacific herrings' major allergen parvalbumin beta 2 in fish food products.

Rheohaemapheresis in the treatment of nonvascular age-related macular degeneration.

PURPOSE: To evaluate the experience with rheohaemapheresis (RH) in the treatment of age-related macular degeneration (AMD). METHODS: Thirty-eight patients were each treated with 8 procedures of RH (14 males, 24 females). The control group consisted of 34 random patients (30 females, 4 males) with the dry form of AMD but not treated by RH. Our modification of the cascade method (named rheohaemapheresis) was used for plasma separation. After plasma separation (blood cell separator, Cobe Spectra, Denver, CO, USA), the separated plasma was pumped through a rheofilter (Evaflux 4A, Kuraray, Osaka, Japan) to remove lipoproteins and other high-molecular-weight rheologic factors. RESULTS: In treated patients, best-corrected visual acuity (BCVA) increased significantly from 0.61 (0.06-1.00) to 0.68 (0.35-1.00) after 2.5 years (p = 0.035). We found no significant changes or differences in scotopic activity, whereas cone response and paramacular activity in the more peripheral region between 14° and 22° of eccentricity were significantly higher in treated patients after 2.5 years. CONCLUSION: RH therapy favourably influenced BCVA. During 2.5 years after the therapy, no progression of dry to wet AMD was observed in our patients. RH reduced the area of drusenoid retinal pigment epithelium detachment (which increased during the natural course of dry form AMD). RH influenced rheological markers and probably improved metabolism in the affected retinal areas which lead to the aforementioned positive results.

[Wet form age-related macular degeneration two years treatment results using anti VEGF drugs]. / Dvouleté výsledky lécby vlhké formy vekem podmínené makulární degenerace s pouzitím léku proti vaskulárnímu endotelovému rustovému faktoru.

AIM: The aim of the study was to establish the efficacy of anti VEGF (Vascular Endothelial Growing Factor) drugs in the treatment of wet form ARMD (Age-Related Macular Degeneration) in everyday clinical practice in the Department of Ophthalmology, Faculty Hospital, Hradec Králové, Czech Republic, E.U., in patients registered in the Czech national registry AMADEUS. MATERIAL AND METHODS: Retrospective study with 24 months follow-up period. In the group were evaluated 143 eyes of 140 patients, out of them were 77 women (65.8 %), of average age 73.09 (71.69 - 74.48) years, and 40 men (34.2 %) of average age 74 (58 - 85) years. All of the patients were completely examined before the beginning of the treatment; during the treatment were, except the standardized eye examination, in patients treated with ranibizumab the color fundus photography and Optical Coherence Tomography (OCT) with measuring of the central retinal thickness performed every three months at least. The patients treated by pegaptanib were examined every six weeks before the drug application. The fluorescence angiography (FA) was performed at the beginning of the treatment to establish the type and extension of the choroidal neovascularization and during the treatment in case of necessity to establish the activity of the choroidal neovascular membrane (CNV). The treatment by ranibizumab was in the regimen PRN (pro re nata), and pegaptanib was applied every six months during the first year with the follow-up evaluation of the findings. The treatment evaluations were performed at 12 and 24 months. RESULTS: During the two years follow - up period, the authors noticed in patients treated with ranibizumab loss of 5.12 letters of ETDRS optotypes in case of mostly classical CNV, in occult CNV loss of 5.45 letters, and in minimally classical CNV loss of 2.83 letters. In three evaluated eyes with classical CNV in patients treated with pegaptanib we noticed after 2 years loss of 6.67 letters, in eleven eyes with occult CNV we established loss of 9.91 letters, and in two eyes with minimally classical CNV the average best-corrected visual acuity (BCVA) remained unchanged. The pegaptanib treatment results may be influenced by small number of evaluated patients. The visual acuity changes during the two years treatment were not statistically significant. We noticed the decrease of average CRT (central retinal thickness) in all types of CNV treated both with ranibizumab and pegaptanib after the two years follow up. To reach these results, an average of 5.51 applications of ranibizumab and 9 applications of pegaptanib during the two years were used. CONCLUSION: In the followed-up group we found, comparing to the natural course of neovascular form of ARMD, retarding of the BCVA decrease during the two years treatment with VEGF inhibitors in everyday clinical practice. Better results were achieved with ranibizumab treatment, however the differences were not statistically significant. Key words: age related macular degeneration, AMADEUS Czech national registry, ranibizumab, pegaptanib.

[Evaluation of bacterial colonization of the conjunctival sac in ranibizumab intravitreal injections treated patients]. / Hodnocení bakteriálni kolonizace spojivkového vaku pacientu lécených intravitreálními injekcemi anibizumabu.

AIM: To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-related macular degeneration (ARMD) indicated for the intravitreal application of Ranibizumab (Lucentis, Novartis Pharma AG). To evaluate the efficacy of combined local preparation with broad-spectrum antibiotic moxifloxacine 0.5% (Vigamox, Alcon) and povidone iodine solution, 5% (Betadine, Egis Pharmaceuticals, LTD.) and to evaluate subjective toleration of moxifloxacin. MATERIALS AND METHODS: In a prospective, non-randomized study were evaluated 20 eyes of 20 patients treated by means of intravitreally-applied ranibizumab. In all patients, the swabs from the conjunctival sac of the treated eye were repeatedly taken in a given time-schedule--before the start of using moxifloxacin, on the day of the intravitreal application of ranibizumab--before the irrigation of the conjunctival sac with povidone iodine solution, 5%, further after the irrigation--immediately before the injection and the control was token three days after the intravitreal injection. At the same time, the moxifloxacine toleration was evaluated by a questionnaire. RESULTS: The samples taken from the conjunctival sac of the treated eye before the application of moxifloxacine had positive bacterial culture in 17 eyes (85%) and negative culture in 3 eyes (15 %). Furthermore, in 2 eyes with positive culture, there was established resistance to moxifloxacine. After 3 days of moxifloxacine application, there was negative culture in 13 eyes (65%), in 7 eyes (35%) was the bacterial cultivation positive. After the irrigation with povidone iodine 5% solution was the cultivation negative in 17 eyes (85%), positive cultivation was in 3 eyes (15%); in all three cases, the cultures were susceptible to moxifloxacine. Three days after the intravitreal injection, the negative cultivation from the conjunctival sac was found in 13 eyes (65%), and in 7 eyes was the cultivation positive; the cultivated bacteria were moxifloxacine susceptible. Subjective symptoms after moxifloxacine application were reported by 10 patients altogether; 5 patients were without symptoms and 5 patients did not return the questionnaire. On average, the symptoms started the second day of moxifloxacine treatment and the average grade of symptoms was 1.6 on the scale from 0 to 5. CONCLUSION: In our group we found a broad spectrum of microorganisms colonizing the conjunctival sac of patients indicated to the ARMD intravitreal treatment. After the prophylaxis with moxifloxacine, the incidence of positive bacterial cultivation decreased and the povidone iodine 5% solution irrigation this effect increased. The most common pathogen species was Staphylococcus coagulasis negative. Although the resistance to moxifloxacine in two different bacteria in two eyes in the beginning of observation was established, after moxifloxacine treatment, the cultivation of these bacteria in both eyes was negative, and in all other cases the cultivated bacteria were susceptible to moxifloxacine.

[The coincidence of the junction layer of inner and outer photoreceptors segments (IS/OS) defects localization on SD OCT and functional defects in case of Stargardt disease--a case report]. / Koincidence lokalizace defektu vrstvy junkce IS/OS fotoreceptoru na SD OCT s funkcními poruchami v prípade Stargardtovy choroby.

Case report of the different visual functions of the right and left eye of 60-years old man with Stargardt disease is presented. The difference in best corrected visual acuity between both eyes is accompanied with corresponding various alteration of the central retinal activity using multifocal electroretinography (mfERG) and asymmetrical defects of the IS/OS photoreceptor junction using HD-OCT.

Comparison of immunohistochemical, histochemical and immunochemical methods for the detection of wheat protein allergens in meat samples and cooked, dry, raw and fermented sausage samples.

Nowadays is it a common practice to add vegetable protein in the production of meat products. Because of the possible substitution of high-quality raw meat with vegetable protein without the labelling the product package and because of the allergenic potential of many vegetable proteins, it is important to develop accurate methods for its detection. The objective of the study was to compare histochemical, immunochemical (ELISA, ALERT gliadin screening test) and immunohistochemical methods for the detection of wheat protein in meat samples and sausages. Histochemical methods were useful for the detection of flour in meat samples, but the immunohistochemical method was better for the detection of wheat protein. ALERT gliadin screening test detected gliadin from 10 mg kg(-1), while an immunohistochemical method detected wheat protein concentrations from 1 g kg(-1) and an ELISA method detected wheat protein concentrations from 4 g kg(-1). ALERT gliadin screening test showed results within 1 day, whilst an ELISA detection method took 2 days, and an immunohistochemical procedure took 5 days at the soonest, all including sample preparation. This study also focused on optimisation of an immunohistochemical method for samples of cooked sausage. In addition, three samples were sufficient for wheat protein detection at a concentration of 1 g kg(-1) (and greater) with a confidence level greater than 95%.

[Innovations in the treatment of the macular edema in retinal venous occlusions]. / Novinky v lécbe makulárního edému pri zilních sítnicových okluzích.

The authors present new possibilities in the treatment of the macular edema caused by the retinal venous occlusions; these occlusions are the second most common retinal vessel disease. The earlier possibilities of the treatment were focused on the macular edema laser treatment, laser panretinal photocoagulation in case of retinal or iris neovascularization presence, and the disease's risk factors compensation. In the presence, the intravitreal application of corticosteroids or anti VEGF A preparations are more used for the treatment because of better results, as proved by means of randomized, clinical studies.

[Angiopathy and the eye]. / Angiopatie a oko.

INTRODUCTION: Diabetic retinopathy is an important microvascular complication of diabetes as it threatens the vision. Diabetic maculopathy is the main cause of legal blindness in the adult population in western countries. The examination method involves digital fundus photography that enables comparison of the incidence, number as well as the size and the shape of pathological foci on the retina during patient visits. It, however, does not depict one important change--chronic retinal ischemia. This is identified using contrast imaging--fluorescein angiography (FAG). Administration of a contrast medium--fluorescein--into cubital vein enables depiction of non-perfused regions of the retina that form the basis for laser therapy indication as part of the prevention of proliferative diabetic retinopathy. Optical coherence tomography (OCT), during which an optical beam makes a cross-section through all 10 layers of the retina, is an important advance in the diagnostics of diabetic macular oedema. The spectral OCT (S-OCT) in particular is an analogy of a histological examination of retina but on a living tissue. RESULTS: Owing to the advances in examination techniques and treatment methods, diabetic neuropathy can now be diagnosed and treated. Early diagnosis of vascular and, consequently, tissue changes in the retina, and in its midsection in particular, is a prerequisite. Tight control of diabetes and the risk factors is sufficient to maintain good visual acuity in patients with intact inner blood-retinal barrier. In collaboration with a diabetologist, fenofibrates are used as the first line treatment when the inner blood-retinal barrier is disturbed (damaged tight junctions between endothelial cells of retinal vessels). To reduce focal macular oedema, the sources of fluid leakage into central retina are occluded using laser interventions on microaneurysms. In diffuse macular oedema, a more intensive laser technique using grid laser coagulation is applied to the central region as well as the surrounding areas of non-perfused retina. It is our view that major macular oedemas often result from an occlusion of a branch of retinal or macular venule. This is why we recommend complementing, in collaboration with a diabetologist, laser treatment of macular oedema with trombolytics. The aim of diabetic macular oedema treatment is its early elimination to avoid irreversible damage to the outer segments and later to photoreceptor cells. These changes are the main cause of the previously mentioned legal blindness in diabetic patients and are well identifiable on S-OCT. DISCUSSION: Laser therapy is the gold standard in the treatment of diabetic macular oedema as well as diabetic retinopathy. However, efficacy is lacking if diabetes and the risk factors are not tightly controlled. Instead of laser therapy to treat diabetic macular oedema with or without macular traction, some authors use a more expensive and more complicated surgery technique (pars plana vitrectomy with internal limiting membrane peeling) performed at early stages of the disease. CONCLUSION: Prevention of microangiopathy of retinal vessels through tight compensation of diabetes and the risk factors form the basis of successful treatment of diabetic retinopathy and maculopathy. At present, we are able to successfully treat developed diabetic retinopathy as well as maculaopathy, including stabilisation of visual function, subject to early diagnosis of retinal changes.

[Influence of haemorheopheresis in the dry form of the age related macular degeneration]. / Moznost ovlivnení suché formy vekem podmínené makulárni degenerace hemorheoferézou.

INTRODUCTION: The age related macular degeneration (ARMD) is the most common cause of practical blindness in the population older than 60 years of age. Usually it starts as a dry form with soft drusen.The progression of the dry form is difficult to control-promising seems to be the influence of rheologic factors in the choroid and the retina and thus improvement of their blood flow. AIM: By means of haemorheopheresis to improve blood rheology and thus micocirculation in the choroid and retina. The authors describe the development of the dry form of the ARMD in the sensitive stage with soft drusen and the eventual presence of retinal pigment epithelium detachment (RPED) after haemorheopheresis. The treated patients were compared with a control group (natural course of the ARMD) with the same number of patients. METHODS: In a prospective, randomized study, comprising of 16 patients with the dry form of ARMD were treated with haemorheopheresis (cascade filtration) and 16 patients in the control group. Haemorheopheresis treatment comprised of 8 cycles in 10 weeks. Plasma obtained by separator was filtered by the Evaflux 4A (Japan) separator, where, the defined spectrum of high molecular proteins was captured. This lead to a decrease in blood and plasma viscosity and thus to improvement of rheologic conditions of the retina. RESULTS: Results show a positive influence on the absorption of soft drusen, reduction of the retinal pigment epithelium detachment, and the possibility to improve the visual acuity of the treated patients. CONCLUSION: Comparing to the worsening of clinical signs and visual functions in natural course of the ARMD development, the rheopheresis as well tolerated method may cause the retardation or stop of the unfavorable course of the disease.

The importance of rheological parameters in the therapy of microcirculatory disorders.

Rheological conditions basically influence tissue perfusion, oxygen and nutrient supply, tissue regeneration and in its consequence the course of pathological processes, especially in microcirculation and partially even in macrocirculation. Haemorheotherapy has shown to be successful in several indications (critical disorders in microcirculation) when other methods of therapy have failed. In this study we describe the changes of effectivity indicators in haemorheopheresis treatment and their clinical importance in cases of eye microcirculation, statoacoustic apparatus and disorders of the lower extremities. We treated with haemorheopheresis (separator Cobe.Spetra + Evaflux filter) 24 patients (16 patients with age related macular degeneration, 5 with critical peripheral arterial foot disease, and 3 with acute hearing loss). After the procedures alpha2-macroglobulin decreases by about 58%, fibrinogen by about 69%, IgM by about 61%, LDL-cholesterol by about 77%, apolipoprotein B by about 76% and lipoprotein(a) by about 63%. It corresponds with a decrease in blood and plasma viscosity and clinical improvement in the observed patients, i.e. visual improvement, acceleration of tissue defect healing and improvement in hearing. We noticed 7.1% clinically insignificant side-effects. The method of haemorheopheresis was safe. It led to improvement in patients' clinical condition in the above mentioned indications when other methods of treatment failed.

[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.

[Diabetic ophthalmopathy]. / Diabetická oftalmopatie.

Diabetic ophthalmopathy implicates complications of diabetes mellitus such as diabetic retinopathy, diabetic maculopathy, rubeosis of the iris, secondary glaucoma, complicated cataract, diabetic neuropathy of cerebral nerves supporting ocular muscles, diabetic neuropathy of optic nerves. We present the complications and the options for treating them.

[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.

[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.

[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.

[Specific chorioretinitis--a case report]. / Specifická chorioretinitis--kazuistické sdelení.

The authors present an uncommon case of ocular involvement in extrapulmonary form of tuberculosis with cutaneous manifestation. A case of a patient who was treated for skin efflorescences on legs for several months is demonstrated. The eye examination showed the picture of chorioretinitis of suspicious tuberculous etiology. A prompt healing of cutaneous lesions occurred and retinal finding stabilized under the specific therapy. The authors emphasize that this infectious etiology should not be omitted in differential diagnostic considerations of uveitis.

[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.