[Purtscher-like retinopathy in acute alcoholic pancreatitis: fluorescein angiography and optical coherence tomography findings]. / Purtscher-like retinopatia pri akútnej alkoholovej pankreatitíde: nález na fluoresceínovej angiografii a optickej koherentnej tomografii.

27 year old patient with a history of alcohol abuse after consumption of fat meal and wine following epigastric pain noticed sudden bilateral visual loss: right eye logMAR 0, 94, left eye logMAR 1, 22. Retinal examination revealed massive edema in the central part of the retina, multiple cotton wool spots in the posterior pole peripapillary and flame-shaped hemorrhages. On the OCT, there was edema most of all in the inner part of the retina, but also subretinal, hyperreflectivity in the nerve fibre layers corresponding to massive cotton wool spots. Fluorescein angiography in the early phases showed hypofluorescent ischemic areas of the retina subsequently leakage developed in the late phases. Immediately after antibiotic and spasmoanalgetic treatment of the pancreatitis visual acuity improved and 2 months after beginning of the therapy visual acuity is logMAR 0 bilateraly. We proposed that the most suspected cause of Purtscher-like retinopathy in this case is fat embolism.

[Purtscher-like retinopathy--a rare complication of acute pancreatitis]. / Purtscher-like retinopatia--zriedkavá komplikácia akútnej pankreatitídy: kazuistika.

The article reports the case of a 27-year old woman hospitalised in the internal medicine ward for acute pancreatitis after eating fat food and drinking alcohol. In addition to acute pancreatitis, the patient complained of vision problems. The ophthalmologist detected bilateral occurrence of large whitish nidi located primarily around the optic disc, intraretinal hemorrhage and a massive retinal oedema in the central field and diagnosed Purtscher-like retinopathy. After a month of treatment of acute pancreatitis, the clinical picture improved, the patient's vision sharpness improved and the laboratory parametres returned to normal. The finding on the ocular fundus also improved. Even though similar cases are rare, more patients with acute pancreatitis should be checked for eventual vision disorders. Ocular fundus examination should be included in the set of tests performed for acute pancreatitis, similarly to the practice in arterial hypertension or diabetes mellitus patients.

[The therapy for acute acquired syphilitic uveitis]. / Liecba akútnych získaných syfilitických uveitíd.

PURPOSE: In retrospective study (analysis) to report the effectiveness of therapy on anatomic and functional outcomes in patients with acute acquired syphilitic uveitis. DESIGN: Retrospective case-control study. PARTICIPANTS: 3 patients (4 eyes) with symptoms of ocular acute inflammation which occurred in latent stage of syphilis are included in our study. In all patients uveitis was the first clinical symptom of syphilis. METHODS: In all 3 patients the infection of acquired syphilis was diagnosed using specific and non-specific tests for treponemal antibody. In 2 eyes we performed diagnostic and therapeutic pars plana vitrectomy. The management of ocular syphilis in all patients consisted of mega units of aqueous penicillin intravenously or intramusculary, in 2 patients we used the combination with steroids. RESULTS: In 2 eyes with perioperatively obtained material of vitreous (during pars plana vitrectomy) specific treponemal antibody was detected using specific (TPHA) test. In the third patient infection was verified serologically. The final visual acuity of all 4 eyes is better than or equal to 6/12. The visual acuity of one exe is 6/6. CONCLUSION: Uveitis and neuroretinitis may be the first symptom of acquired syphilis in latent stage. Early antibiotic treatment significantly improves anatomical reparation of infection and visual outcomes.

Life-threatening renal failure caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drugs.

The purpose of this study was to evaluate the prevalence of life-threatening renal failure (RF) caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drug (NSAID) treatment (NSAID-RF) and risk factors for this renal impairment in an inception cohort of patients with recently diagnosed uremia treated by emergency hemodialysis in a prospective regional study. There are few published data on this phenomenon. Two hundred fifty-six patients (137 men, 119 women, mean age 68 years [22-95 years]) with acute uremia were treated with emergency hemodialysis in the intensive care unit over a period of 70 months. The patients were from an area of 231,000 inhabitants. Of the 256 patients, clinical data from a group of 79 patients with medical-type renal failure were analyzed in detail. The prevalence of NSAID-RF was 8%. This prevalence decreased to 4% when patients without any other medication affecting compensatory renal hemodynamics were considered. Moreover when nonpharmacological insults were not taken into account the prevalence decreased to only 1.6%. In 80% of the patients with NSAID-RF, nonpharmacological insults contributed to renal impairment. Both hypotension of cardiac etiology and dehydration/hypovolemia were present in 25% of the patients with this type of RF while urinary tract obstruction was seen in 1%. In 75% patients with NSAID-RF the underlying nephropathies were identified. NSAID-RF was not frequent. The population at greatest risk for renal functional alteration associated with NSAID therapy included patients with dehydration/hypovolemia, hypotension of cardiac etiology and those with pre-existing renal impairment, especially with vascular and analgesic nephropathy.

[Central salt-wasting diuresis syndrome as a cause of hyponatremia in patients at the internal medicine department]. / Syndrom centrálne navozené solné diurézy jako prícina hyponatrémie u nemocných na interním pracovisti.

Hyponatremia is a common electrolyte disorder related to central nervous system diseases and is often attributed to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and on the other hand to the cerebral salt wasting syndrome (CSWS). This syndrome is characterized by hyponatremia due to excessive renal sodium excretion resulting from a centrally mediated process. Given the divergent nature of the treatment it is of paramount importance for a clinician to be able to recognize and differentiate between these two entities. Thus the monitoring of renal function tests, which are needed for earlier diagnosis of effective osmolality disorders, is important to do in intensive care units, which are caring for patients with central nervous system lesons. Two patients successfully treated for CSW due to ischemic stroke caused by arterial embolism from heart cavities are described.

[Pharmacologic insult as a cause of acute kidney failure with a need for acute hemodialysis therapy]. / Farmakologický inzult jako prícina "akutního" selhání ledvin s nutností akutní hemodialyzacní lécby.

Acute renal failure is a heterogeneous disease. In advanced countries the incidence of acute renal failure is rising steadily in the elderly population. One of the serious causes of renal failure in this age group are pharmacological preparations and iodine radiocontrast diagnostic substances. It was revealed that also commonly used drugs may have a nephrotoxic potency in subjects with pre-existing renal disease and/or in certain clinical risk situations. In a group of 133 acutely haermodialyzed patients at the medical department we made a detailed clinical and economic analysis of treatment in a group of patients haemodialyzed on account of acute drug induced renal failure. These patients accounted for 28% of all acutely haemodialyzed patients and 65% of them were older than 65 years. The drugs which were involved as the cause or partial cause of renal failure had a negative effect on intrarenal haemodynamics. They comprised in the first place inhibitors of the angiotensin converting enzyme and non-steroid antirheumatic drugs, frequently in combination with diuretics or an iodine contrast substance. A risk factor was preexisting nephropathy defined by the presence of renal perfusion depending on increased formation of angiotensin II and renal vasodialatating prostaglandins. Risk is ascribed also to pathological conditions associated with systemic hypotension and a reduced effective circulating volume. Costs of treatment per patient with drug induced renal failure were calculated as 127,000 Czech crowns. The sum was calculated as the cost of the diagnosis related group.

[Age-related macular degeneration in fluoroangiographic findings]. / Vekom podmienená makulárna degenerácia vo fluoroangiografickom náleze.

Age-related macular degeneration has become the leading cause of severe visual loss in people over 60 years of age. The authors are reporting on characteristic fluorescein angiography findings obtained by fluorescein angiography of patients with age-related macular degeneration diagnosis.

[Surgical treatment of macular hole and maculopathy associated with optic disk pits]. / Chirurgická liecba makulárnej diery a makulopatie v spojení s jamkou terca zrakového nervu.

PURPOSE: To inform about the successful surgical treatment of the retinal detachment of the macula and macular hole, as a complication of the optic disc pit. PATIENT: The authors report about 32 years old patient with optic disc pit complicated with the retinal detachment and the macular hole. After pars plana vitrectomy with intraocular gas injection (20% C3F8) associated with the application of the autologous serum and follow up face down positioning, the retinal attachment of the macula and the closure of the macular hole were present. In the period 9 months after the operation the relapse of the retinal detachment was observed and the closure of the macular hole is still remained. Condition was treated by intraocular gas injection (1 ml C3F8) and argonlasercoagulation. During the period of more than a 13 months after the first operation and 5 months after the reoperation the retina is attached and the macular hole is closed. In campimetry, a detailed development of the central scotoma is documented. The final visual acuity with correction is 6/9, that is improvement in 3 lines in comparison to preoperative condition. CONCLUSION: The surgical treatment of macular hole by optic disc pit is currently the methods of choice. Using this methods successful anatomical as well as functional results could be obtained.

[Ultrasonic diagnosis of retinal detachment after internal tamponade with silicone oil]. / Ultrazvuková diagnostika amócie sietnice po vnútornej tamponáde silikónovým olejom.

The authors evaluate the results of ultrasound examination of 20 patients with retinal detachment (20 eyes) after pars plana vitrectomy with silicone oil tamponade. Ultrasound diagnostic method is necessary in cases with non-transparent optic media. Silicone oil in the space of vitreous cavity has a character of a swimming water-drop and his physical properties can change the echography results. Between the eye-wall and silicone oil is a virtual space, which could be well visualised by ultrasound. The patients are divided into 2 groups. In the 1st group there were 7 eyes with transparent optic media and retina was detached under the silicone oil. By ultrasound the retina detachment echo was localised between the echos of silicone oil and eye wall. In the 2nd group there were 13 eyes with non-transparent optic media. In 6 cases (41.6%) the retinal detachment echo was visualised. The retinal detachment was confirmed by vitreo-retinal surgery.

[5-years' experience with transvitreal extraction of subretinal neovascular membranes]. / 5-rocné skúsenosti s transvitreálnou extrakciou subretinálnych neovaskulárnych membrán.

Over the period between June 1992 and November 1997, 15 subretinal neovascular membranes were removed in the Department of Ophthalmology of the Comenius University in Bratislava. The age of patients ranged between 57 and 72 years. In 13 patients the membrane was caused by age-related macular degeneration, in one patient the cause was choroiditis of unclear etiology and in one patient the membrane was caused probably by age related changes combined with myopic changes in the macular region. In three eyes only subretinal membrane was present. In all other eyes were also subretinal haemorrhages, hemophthalmus, or retinal detachment present. The visual acuity ranged between light perception and 1/50. After membrane removal the retina was tamponated by silicone oil in 10 eyes and by expanding gases in four eyes. In one eye peroperatively occurred profuse bleeding from choroidal vessels and this procedure was interrupted. The follow-up period ranged form 5-52 months. During this period in nine patients were performed additional 12 surgical procedures. The visual acuity achieved is 0 in three eyes and in other eyes it ranged between hand movement and 5/50. Two eye atrophied. In one eye retinal detachment is present. Three eyes are still filled with silicone oil. In two of them the tamponade will be probably permanent. In nine eyes large areas of retinal pigment epithelium atrophy are present and in two eyes also subretinal fibrous membranes are present.

Surgical removal of large subretinal neovascular membranes: results and complications.

Over the period from June 1992 to January 1994, six subretinal neovascular membranes were removed in our department. In five patients the damaged membranes were caused by age-related macular degeneration and in one patient the cause was choroiditis of unclear etiology. The diameter of the membranes ranged between 3 and 20 mm. The largest membrane was removed translimbally after previous lensectomy. In all patients internal silicone oil tamponade was performed. Subretinal hemorrhage was the most common peroperative complication observed. Early postoperatively, transitory corneal edema and serofibrinous reaction were recorded in some patients. Cataract formation in connection with the silicone oil tamponade, chronic uveitis, formation of epi- and subretinal membranes, retinal pigment epithelium and choroidal atrophy were also subsequently observed. Relevant additional operations were performed with the exception of one patient with internal silicone oil tamponade and cortical cataract who refused all further procedures. After a follow-up period of 24-36 months, one eye atrophied. In one eye retinal detachment in one large subretinal membrane, in one atrophy of the pigment epithelium and in another epiretinal membranes under silicone oil were present. The visual acuity achieved is 0 in two eyes and it ranged between light perception and 0.5/60. Removal of large subretinal neovascular membranes is feasible, but the results are not justified by the surgeon's effort and the patient's psychic stress.

[Ultrasonic imaging of the anterior segment of the eye]. / Zobrazenie predného segmentu bulbu ultrazvukom.

Our survey of the anterior segment of the eye by the ultrasound, is based in the usage of the Kitecko, the eye covering gadget, made by Laboratories 3M. The Kitecko opened a new possibilities for us in the localization of the intraocular, RTG noncontrast foreign bodies of the anterior segment, as well obscure optical medium.

[The CT image of the eyeball after pars plana vitrectomy using silicone oil for internal tamponade of the retina]. / CT obraz ocnej gule po pars plana vitrektómii s vnútornou tamponádou sietnice silikónovým olejom.

Cerclage and silicon oil induce significant changes in the CT image after the vitreous and the retina microsurgery. It is important to get to know the right estimation of the CT image. Cerclage has mainly effect on characteristic shape changes of eyeball. Hyperdensity shadow of the vitreous cavity in the CT image of the eye after silicon oil tamponade creates different physical quality among silicone oil, vitreous and aqueous humor.

[Effective extraction of intraocular foreign bodies]. / Efektívna extrakcia cudzích vnútroocných telies.

In 39 patients was removed an intraocular foreign body in the years 1989-1991. 12 of them in the anterior segment of the eye, 14 in the vitreous body, 11 in the retina and 2 in the posterior part of the sclera. From the anterior segment were all bodies removed with forceps. From the vitreous body and the retina were foreign bodies removed mostly by forceps after previous vitrectomy. Functionally the worst results were achieved in foreign bodies where pre-, or peroperatively retinal detachment was present. Visual acuity under hand movement was present in 12 eyes.

[An unusual finding on the eyelid]. / Prekvapujúci nález na mihalnici.

The authors describe an unusual case of tick on the patient's eyelid. The ophthamologist considers the case as being benign. From the epidemiologic point of view it is necessary to consider the possibility of transmission of some infectious diseases by this mode. Ticks transmit the early summer meningocephalitis and Lym borreliosis. (Ref. 4.)

[Surgical treatment of subretinal neovascular membranes. Initial experience]. / Moznosti chirurgickej liecby subretinálnych neovaskulárnych membrán. Prvé skúsenosti.

Since june 1992 to march 1993 we removed the subretinal neovascular membranes in 4 patients. In three of them, aged 72-75 years, the membrane was diagnosed by age-related macular degeneration. In 57-y. old woman the membrane originated presumable in an ethiologically uncleared choroiditis. In the last two patients we used technique after Thomas and Kaplan with special instruments from DORC. In one patients the visual acuity improved and in three patients remained same, or a little worse than before. The chirurgical removal of the subretinal neovascular membrane is an alternative mode in the treatment of these membranes.

[Ostensible ultrasonic changes after internal tamponade of the retina with silicone oil]. / Zdanlivé zmeny v echografickom obraze po vnútornej tamponáde sietnice silikónovým olejom.

Echographic control after pars plana vitrectomy (PPV) and internal tamponade of the retina with silikon oil (SO) is necessary in case of opaque optical media (bulous keratopathy, bleeding and exsudation within anterior chamber, complicated cataract). In interpretation of echographic image some difficulties or errors may be caused by physical properties of SO, as for example reduced speed of propagation of ultrasound in this media, ultrasound absorption coefficient, acoustic impedance and reflection coefficient.

[Diabetic retinopathy in children and adolescents under 18 years of age]. / Diabetická retinopatia u detí a mladistvých s diabetom 1. typu vo veku do 18 rokov.

We found ophthalmoscopically microaneurysms in 22 patients from 189 diabetics (11.6%). The youngest patients with microaneurysms were two 11-years-old girls with 3 and 5 years lasting disease. The chance of retinopathy was growing with the duration of the diabetes. By fluorescein angiography we discovered retinopathy in 52 patients out of 126 diabetics (41.3%). The retinopathy was more often found among girls. Just in one case we found the early stage of preproliferative retinopathy. The retinopathy was more often found in diabetics with higher levels of glyconated hemoglobin. The extent of foveolar avascular zone is decreasing with the longer course of the diabetes. We recorded lower occurrence of diabetic retinopathy in patients treated at the Ist Department of Pediatrics in Bratislava. In the group evaluated in the years 1986-89 the occurrence of the diabetic retinopathy diagnosed ophthalmoscopically was lower than in the group of 1981-84.