EN BLOC RESECTION OF RETINAL VASOPROLIFERATIVE TUMOR USING 23G VITRECTOMY. A CASE REPORT.

PURPOSE: Retinal vasoproliferative tumor is one of the benign vascular tumors which in advanced stages leads to exudative retinal detachment with the formation of epiretinal and subretinal membranes. In such advanced stages, one of the therapeutic options is pars plana vitrectomy. This article presents the case of a patient on whom was performed 23-gauge pars plana phacovitrectomy with en bloc resection of the tumor followed by histological confirmation. CASE REPORT: A 70-year-old patient with a one-year history of unilateral loss of vision in his left eye was admitted to our clinic for examination in February 2018. At admission, the best corrected visual acuity in the right eye was 1.0, and in the left eye was light perception. Based on the clinical picture, sonographic examination of the eye, and fluorescein angiography, the patient was diagnosed with a retinal vasoproliferative tumor. Due to the advanced stage of disease, we proceeded with surgical intervention. We performed 23-gauge phacovitrectomy with a bloc resection of the tumor. Subsequent histological examination confirmed the presence of the presumed tumor. The follow-up exam a few months later showed a completely attached retina with silicone oil tamponade, without exudative retinopathy. However, the best corrected visual acuity improved only slightly to the ability to count fingers at one meter. CONCLUSION: Pars plana vitrectomy with en bloc resection of retinal vasoproliferative tumor is one of the therapeutic modalities in advanced stages.

Current antiangiogenic agents in oncology and ophthalmology.

UNLABELLED: Antiangiogenic drugs are approved for many cancer types for longer than a decade. Furthermore, several antiangiogenic agents are approved for local application in ophthalmology for treatment of macular degeneration, venous retinal occlusion and diabetic retinopathy. Knowing that antiangiogenic agents are active in ocular system, we reviewed the current literature, whether antiangiogenic drugs may cause ocular side effects in cancer patients by systemic application. Furthermore, we searched in published papers, if systemic application of antiangiogenic agents in cancer patients may simultaneously treat their ocular disorders, if they have such. Finally, we emphasized cooperation between an oncologist and ophthalmologist when treating patients with antiangiogenic drugs. KEYWORDS: angiogenesis inhibitors, vascular diseases, eye, drug-related side effects and adverse reactions.

Minireview on current antiangiogenic agents in oncology and ophthalmology.

Antiangiogenic drugs are approved for many cancer types for longer than a decade. Furthermore, several antiangiogenic agents are approved for local application in ophthalmology for treatment of macular degeneration, venous retinal occlusion and diabetic retinopathy. Knowing that antiangiogenic agents are active in ocular system, we reviewed the current literature, whether antiangiogenic drugs may cause ocular side effects in cancer patients by systemic application.   Furthermore, we searched in published papers, if systemic application of antiangiogenic agents in cancer patients may simultaneously treat their ocular disorders, if they have such.  Finally, we emphasized cooperation between an oncologist and ophthalmologist when treating patients with antiangiogenic drugs.

[The potential use of honey in ophthalmology]. / Moznosti vyuzitia vcelieho medu v oftalmológii.

Honey is considered to be a natural product with antibacterial and anti-inflammatory properties. Its successful application in the treatment of chronic wounds and burns has promoted its further clinical use in other clinical departments, including ophthalmology. One of the major advantages of honey is its multi-factorial antibacterial action and the fact that there is no risk of developing bacterial resistance to it. In this work we discuss the current knowledge and new perspectives for honey therapy in treatment of eye diseases such as dry eye disease, age-related macular degeneration, cataracts and bullous keratopathy. Key words: honey, eye diseases, natural product, treatment.

Current therapy for retinal vein occlusion.

Retinal vein occlusion is a common retinal vascular disorder causing visual deterioration in the elderly. Vision-threatening complications include macular ischemia, neovascularisations, and vitreous hemorrhages. There are central and branch retinal vein occlusions as well as their ischemic and nonischemic subtypes. Branch occlusion and nonischemic cases are associated with better prognosis, often with good recovery of visual acuity. There have been various modes of therapy used for this disease but with little or poor effect. Due to the lack of effective monotherapy for retinal vein occlusions, there is probably a need to combine the therapy approaches (Fig. 4, Ref. 24). Full Text in PDF www.elis.sk.

Fundus autofluorescence in age-related macular disease imaged with a laser scanning ophthalmoscope.

Age-related macular degeneration (ARMD) as the most common cause of legal blindness in industrialized countries remains an incompletely understood, complex retinal disease. Prophylactic and therapeutic options are still limited. Sensitive diagnostic tools and prognostic markers to evaluate disease stage and progression in the individual patient are needed. The retinal pigment epithelium (RPE) plays a key role in the disease process both in early and late variants of AMD. An excessive accumulation of lipofuscin granules in the lysosomal compartment of RPE cells represents a common downstream pathogenetic pathway in various retinal diseases including AMD. Fundus autofluorescence (FAF) imaging allows the visualization of the topographic distribution of lipofuscin over large retinal areas (Fig. 3, Ref. 13).

[Morphologic changes of anterior segment of the eye after cataract surgery]. / Morfologické zmeny prednéh segmentu oka po operácii katarakty.

OBJECTIVES: The goal of our study was to evaluate the changes of the anterior chamber and how these changes influence the intraocular pressure in patients, with diagnosed cataract only and with patients with cataract and angle closed glaucoma. MATERIAL AND METHODS: In this study 82 eyes in 82 patients were involved, who were divided into two groups. The first one, consists 60 of patients only with cataract and the second one consists 22 of patients with cataract and closed-angle glaucoma. We have measured the depth of the anterior chamber and the width of the iridocorneal angle with the help of anterior chamber optic coherent tomography and the intraocular pressure before and five weeks after the cataract surgery. RESULTS: Anterior chambers of all patients were deeper after cataract surgery. In the first group, patients only with cataract, the anterior chamber were deeper of 1.4 mm and in the second group the anterior chamber were deeper of 1.5 mm. The iridocorneal angle has opened at 3 o'clock from 23.2 +/- 9.5 degrees to 35.5 +/- 6.8 degrees and at 9 o'clock from 23.7 +/- 8.8 degrees na 36.4 +/- 7.9 degrees in the first group. Same changes were evaluate in patients with angle closed glaucoma at 3 o'clock the angle deepened from 18.5 +/- 10.0 degrees to 31.7 +/- 7.0 degrees and at 9 o'clock from 20.3 +/- 10.2 to 34.6 +/- 7.6 degrees. The values of intraocular pressure decreased from 14.8 +/- 3.6 mmHg to 13.3 +/- 2.9 mmHg in cataract only group and from 17.9 +/- 4 mmHg to 15.9 +/- 3.8 mmHg in the second group respectively. The deepening of the anterior chamber and opening of the iridocorneal angle with decreasing of the intraocular pressure after the cataract surgery are statistically significant P < 0.001. CONCLUSIONS: Cataract surgery deepen the anterior chamber significantly, it wides the iridocorneal angle and lowers intraocular pressure.

[Posterior capsule opacification in long-term follow-up of patients after implantation of hydrophilic/hydrophobic intraocular lens Acri.Smart]. / Opacifikácia zadného puzdra pri dlhodobom sledovaní pacientov po implantácii hydrofilnej/hydrofóbnej sosovky Acri.Smart.

AIM: The aim of the retrospective study was to establish the frequency of the posterior lens capsule opacification after the cataract surgery and artificial intraocular lens (IOL) Acri.Smart 46S (Acri.Tech Zeiss) implantation. MATERIAL AND METHODS: The study group consisted of 72 eyes (30 men and 28 women), their average age was 65.4 +/- 8.4 years, with performed cataract surgery and implanted IOL Acri.Smart 46S (Acri.Tech Zeiss). After the average period of 32.4 +/- 7.3 months after the surgery, the patients underwent the examination with refractive error measurement, uncorrected and best-corrected visual acuity for for, and posterior lens capsule transparency examination with dilated pupils and with retroillumination photography taken by NIDEK EAS-100 device. RESULTS: After the average follow-up period of 32.4 +/- 7.3 months after the surgery, the refractive error was -0.32 +/- 0.8 diopters and average cylindrical error -0.8 +/- 0.6 Dcyl. The uncorrected visual acuity (UCVA) was 0.72 +/- 0.3, and the best-corrected visual acuity (BCVA) 0.95 +/- 0.2. The average diameter of the examined posterior capsule was 5.89 +/- 2.1 mm, and the transparency of the posterior capsule was 98.41 +/- 8.5%. In two eyes (2.7%) only, the YAG capsulotomy was performed. CONCLUSION: The IOL Acri.Smart is safe, easy to implant IOL, which meets the requirements of the microincision surgery. The IOL had very low incidence of posterior lens capsule opacification, and in two eyes (2.7%) only the YAG capsulotomy was performed.

[The treatment of the rubeosis of the iris and the neovascular glaucoma in proliferative diabetic retinopathy by means of anti-VEGF]. / Liecba rubeózy dúhovky a neovaskulárneho glaukómu pri proliferatívnej diabetickej retinopatii pomocou anti-VEGF.

The rubeosis of the iris is a serious complication especially in diabetic retinopathy and retinal veins occlusion. Cytokines, especially the vascular growing factor (VEGF), are responsible for the forming of new vessels. The treatment that inhibits the effect of the VEGF presents new possibilities in the neovascular diseases treatment. Bevacizumab (Avastin) is an anti-VEGF antibody that blocks all forms of VEGF-A. In three eyes with proliferative diabetic retinopathy and neovascularization of the iris and the anterior chamber angle, the dose of 1.25 mg of Avastin was applied intravitrealy. Just one week after the application of the drug, the decrease of the leakage on the iris, and the total disappearance of the neovascularization in three weeks were visible on the fluorescein angiogram. The recurrence of the neovascularization was found in one eye after three months and the treatment had to be repeated. Nine months after the second application, the disease is stabilized without the neovascularization. The intraocular pressure was elevated in two eyes before the application of Avastin, and was refractive to the treatment. After the disappearance of the neovascularization, the intraocular pressure was normalized and it was possible to terminate the antiglaucomatous therapy. The bevacizumab intravitreal treatment of the neovascularization of the iris and the anterior chamber angle was proved to be efficient, the neovascularization disappeared and the intraocular pressure was normalized. There were no side effects after the bevacizumab applications in any of our patients.

[The intraocular lens dioptric power calculation after refractive procedures in myopia]. / Výpocet vnútroocnej sosovky po myo- pických refrakcných operáciách.

AIM: To evaluate the efficiency of the intraocular lens (IOL) dioptric power calculation before the cataract surgery in patients after photorefractive keratectomia (PRK) in myopia. METHODS: Six eyes of three patients were included in a prospective, non-randomized study. In all six eyes, the exact values of the preoperative corneal curvature, and in some of them, the exact value of the removed myopia were not available. The IOL power was calculated by means of formula, which is based on data not affected by the refractive surgery: axial length of the eyeball, depth of the anterior camber, and visual acuity for far corrected with glasses after the cataract surgery. The last value we can achieve not until after the surgery, so because of this reason, the surgery is divided into two stages. In stage one, the cataract is removed only, and on the next day, after the IOL power calculation, in the second stage, the IOL implantation is performed. RESULTS: Three months after the cataract surgery, the refractive error was up to +/- 1.0 diopter in all eyes, and the corrected as well as uncorrected visual acuity improved in every single eye. CONCLUSION: For patients, who previously underwent refractive procedure and no exact preoperative values are available, the method of two stages' cataract surgery is method of choice. Disadvantage of this method is that the patients must go two times to the operation theatre; the advantage is very exact IOL power calculation and the patient's satisfaction.

[Is it possible to accurately measure intraocular pressure after refractive surgery?]. / Je mozné presné meranie vnútroocného tlaku po refrakcných operáciách?

OBJECTIVE: To evaluate how the change of thickness or curving of the cornea after refraction operations (PRK or LASIK) influences the intraocular pressure (IOP) during assessment with a noncontact tonometer. PLACE OF INVESTIGATION: Ophthalmological Clinic SPAM and Ophthalmological ambulance EXCIMER. MATERIAL AND METHODS: With regard to the performed refraction operation the patients were divided into two groups. The first group comprised 87 patients where PRK was performed to correct myopia. The mean myopia in this group was -5.27 D +/- 2.32. The second group comprised 62 patients where LASIK surgery was performed to correct myopia. The mean myopia in this group was -10.18 +/- 4.36. IOP was assessed by means of a noncontact tonometer before and 6 months after surgery. RESULTS: In the first group a mean reduction of IOP by 4.8 +/- 2.1 mm Hg occurred. The central thickness of the cornea declined on average by 55.69 +/- 28.9 micros and the curving of the cornea diminished on average by 3.72 D +/- 1.76 D. In the second group of patients the IOP declined on average by 7.97 +/- 2.04 mm Hg. The central thickness of the cornea diminished by 78.75 microns +/- 42.26 and the curving of the cornea by 4.65 D +/- 2.07. In both groups a significant correlation was found between the reduction of IOP and the central thickness and curving of the cornea. CONCLUSION: Diminution of the thickness of the central cornea and diminution of the curving lead to lower values of the IOP. There is a direct correlation between thinning of the cornea and the decline of IOP.

[Evaluation of the quality of a donor cornea before transplantation]. / Hodnotenie kvality darcovskej rohovky pred transplantáciou.

UNLABELLED: Transplantation of the cornea is often the only possible treatment of many ophthalmological diseases and injuries. The quality of the donor cornea determines in a major way the success of transplantation and therefore the demands on its quality must be high. OBJECTIVE: Assess how the vitality of the endothelium changes in relation to the time which elapsed since the donor's death after storage of the cornea in the medium (death/preservation time, DPT). If the vitality of the endothelium is poor, the oedema of the cornea persists at room temperature. METHODS: The endothelium of the donor cornea was examined before transplantation under a specular microscope Bio Optics (USA). According to DPT the corneae were divided into three groups: 1st group--22 corneae where DPT is shorter than 5 hours 2nd group--33 corneae where DPT is 6-10 hours 3rd group--46 corneae where DPT was longer than 10 hours. RESULTS: In the first group the corneae got rid of the oedema after 20 minutes at room temperature and endothelial cells could be observed in detail. In the second group the corneae got rid of the oedema after 20 minutes but there were rare oedematous sites where the endothelial function was not adequate. In the third group even after long time at room temperature the cornea did not get rid of the oedema, and on examination it was very difficult to find a group of endothelial cells for evaluation. CONCLUSION: Corneae from group 1 have a totally vital endothelium, in the second group there are sites on the cornea where the vitality of the endothelium is already impaired, in the third group the vitality of the entire endothelium is impaired. For transplantation corneae with a DPT shorter than 10 hours are suitable. With a DPT longer than 10 hours they are less suitable or unsuitable for transplantation.

[Treatment of severe caustic injuries of the anterior segment of the eye with limbal stem cell transplantation, penetrating keratoplasty and amnionic membrane transplantation]. / Liecba t'azkých poleptaní predného segmentu oka transplantáciou kmenových limbálnych buniek, perforujúcou keratoplastikou a transplantáciou amniovej blany.

The concept of limbal stem cells (LSC) opened new possibilities for the treatment of severe caustic damage of the anterior segment. These possibilities include transplantation of LSC, perforating keratoplasty, possibly transplantation of the amniotic membrane. In three patients with severe caustic damage of the anterior segment of the eye the authors implemented transplantation of LSC, perforating keratoplasty and in one patient also transplantation of the amniotic membrane. Where only one eye was damaged LSC for transplantation were obtained from the sound eye (autotransplantation, in case of damage of both eyes LSC were obtained in one case from a close relative in the second case from a cadaverous eye from a corneal bank (Allotransplantation). In the patient with autotransplantation of LSC, perforating keratoplasty and transplantation of the amniotic membrane the result was very good. The corneal disc remained clear 1.5 years after operation, the conjunctival sac was free from synbleropharons and vision improved from movement of the hand to 0.5. In the two patients with allotransplantation of LCS and perforating keratoplasty, LCS did not become incorporated despite immunosuppressive treatment and the corneal disc became turbid. Restored activity of LCS in severe caustic damage of the anterior segment opened new therapeutic opportunities.

[Bimanual irrigation/aspiration]. / Bimanuálna irigácia/aspirácia.

Bimanual irrigation/aspiration is a safe method for the removal of lenticular mass from the eye and can be used in some complicated cases. As it is a perfectly closed system, oscillation of the posterior capsule does not occur and this prevents prolapse of the vitreous body. If the pupil is narrow, the margin of the pupil can be shifted by means of the irrigation cannula and thus suction of the lenticular mass up to the equator is made possible. In subluxed lenses by gently pushing back the lenticular capsule its adherence to the aspiration cannula is prevented. It is relatively easy to clean the anterior lenticular capsule from epithelial cells by bimanual I/A.

[Tonic pupil]. / Pupilotonia.

Authors evaluated the group of 21 patients (22 eyes) with pupillotonia. There were 2 postraumatic pupillotonias, 1 bilateral pupillotonia with systematic polyneuropathy in alcoholism, 6 Adie's pupillotonias and 9 postviral pupillotonias. In 4 one-sided pupillotonias there were finded no traumatic, viral or neurological cause. 2 patients (2 eyes) with traumatic cause, 2 patients with Adie's pupillotonia and 9 patients with viral cause had indicated the marked subjective difficulties in the eyes with pupillotonia--blurred vision, cephalea. After local application of Pilocarpin in 0.05%-0.1% concentration, these patients were indicating the marked improvement of their subjective troubles of the eyes.