[Corneal ulceration complicating surgical correction of ptosis in patient with Kearns-Sayre syndrome--a case report]. / Rohovková ulcerace po operaci ptózy u pacienta s Kearns-Sayreovým syndromem.

UNLABELLED: The aim is to report a rare complication of surgical ptosis correction in a patient with Kearns Sayre syndrome and the therapeutic possibilities of its treatment. METHODS: Exposure corneal ulceration caused by lagophtalmos developed gradually in a 30-year-old woman after an upper eyelid ptosis surgery of the right eye performed at another eye clinic. During an examination a limited movement of both eyes and retinal pigmentary changes (salt-pepper-like appearance) were diagnosed. A suspicion of the Kearns Sayre syndrome was expressed according to the clinical picture, the diagnosis was confirmed by molecular analyses in muscle biopsy, which revealed 5.2 kb deletion of mitochondrial DNA. RESULTS: Corneal ulceration was treated by partial external tarsorrhaphy and frequent instillation of lubricants. The upper eyelid ptosis of the left eye was treated with a spectacle with ptosis support. CONCLUSION: During the correction of upper eyelid ptosis in patients with progressive external ophtalmoplegia it is necessary to be aware of the risk of surgical exposure keratopathy and corneal ulceration due to the atony of musculus orbicularis oculi muscle and only slightly expressed Bell's phenomenon.

[Iris metastasis as the first sign of small-cell lung carcinoma with metastatic involvement of the mediastinum]. / Duhovková metastáza jako iniciální manifestace bronchogenního malobunecného karcinomu diseminovaného do mediastina.

BACKGROUND: We present the case of small-cell lung carcinoma metastatic to the iris, the course of the disease and management options. CASE: A 69-year-old female was diagnosed with a solid, amelanotic iris mass in her left eye. Differential diagnostics and ancillary tests subsequently led to the diagnosis of disseminated small-cell lung carcinoma. Systemic chemotherapy was indicated after fine needle biopsy verification of metastatic lung cancer. Iris metastasis responded well to the chemotherapy, its regression was observed and secondary open-angle glaucoma was controlled as well. Good visual functions were preserved during the treatment. CONCLUSIONS: Metastatic carcinoma of the iris may be the first sign of disseminated malignant disease. Small-cell lung carcinoma iris metastasis can be treated with chemotherapy. This treatment preserved visual functions, which enhanced the patient's quality of life.

[Analysis of prognostic factors of anatomical and functional results of idiopathic macular hole surgery]. / Analýza prognostických faktoru anatomického a funkcního výsledku operace idiopatické makulární díry.

PURPOSE: Analysis of preoperative prognostic factors in idiopathic macular hole surgery and determination of their significance for the final postoperative visual functions. METHODS: Ninety-one patients with idiopathic macular hole were enrolled into this study. The best-corrected visual acuity, macular hole staging according to Gass classification and duration of macular hole symptoms were evaluated preoperatively. Pars plana vitrectomy with internal limiting membrane peeling and expanding gas (C3F8) tamponade was subsequently performed in all patients. Macular hole closure rate--anatomical success of the surgery--and visual acuity (functional results) were postoperatively assessed. RESULTS: Positive correlation between the duration of the macular hole symptoms and the final postoperative visual functions (Kruskal-Wallis; P = 0.003) as well as between the duration of the macular hole symptoms and the postoperative macular hole closure rate (Man-Whitney; P = 0.001) were found in patients with idiopathic macular holes. Postoperative significant improvement of visual acuity depends on the preoperative macular hole stage according to Gass classification (Pearsovov xhi2; P = 0.05). CONCLUSION: Macular hole symptoms duration and preoperative macular hole stage are the two significant prognostic factors for postoperative functional and anatomical results.

[Giant cell arteritis manifested by bilateral arteritic Anterior Ischaemic Optic Neuropathy (AION)]. / Obrovskobunecná arteriitida manifestující se oboustrannou arteriitickou prední ischemickou neuropatií zrakového nervu (AION).

Giant cell arteritis (GCA) is a systemic vasculitis of unknown etiology affecting medium and large calibre vessels by granulomatous panarteritis with the formation of giant multinucleate cell granulomas. Vision is affected in 25-50% of GCA patients. Affection of vision may be the first GCA symptom or a symptom which occurs weeks or months after the initial symptoms of the disease. Eye symptoms of the disease are mostly a manifestation of occlusion of ocular and orbital blood vessels. Permanent damage to the patient's vision is a serious consequence of visual affection provoked by GCA. Arteritic Anterior Ischaemic Optic Neuropathy (AION) is the most frequent and most serious visual manifestation of GCA. It is manifested by partial or total loss of vision. Arteritic AION therapy in GCA uses high doses ofglucocorticoids, but glucocorticoid therapy has a number of adverse effects. The proofs of the effect of the therapy on the improvement of the vision of patients with visual affection in GCA are not convincing. We report a case of a 76-year old man with biopsy-verified GCA whose primary manifestation was bilateral arteritic AION resulting in a complete loss of vision in one eye and dramatic worsening of visual acuity in the other eye. Glucocorticoid therapy only improved vision in one eye, and had adverse effects. Methotrexate was added to the therapy to achieve a glucocorticoid saving effect. Glucocorticoid therapy could be discontinued after 3 years. In the course of the therapy and for the subsequent 12 months after it was finished, there was no relapse of the underlying disease.

[Macular edema after an uncomplicated cataract surgery]. / Makulární edém po nekomplikované operaci katarakty.

PURPOSE: To characterize the macular thickness changes after an uncomplicated cataract surgery measured by means of optical coherence tomography (OCT), to specify the incidence of cystoid macular edema (CME), and to attempt to establish a correlation between the retinal thickening after an operation and possible risk factors for its development. PATIENTS AND METHODS: This study comprised 100 patients (64 women and 36 men) with the mean age of 70 (70.08 +/- 9.37 [SD] years; range, 44-85 years). All patients underwent uneventful phacoemulsification, which was followed by in the bag intraocular lens implantation. The real phacoemulsification time and the duration of the entire surgical procedure were recorded. The operated eye was set into the study group; the contralateral, non operated eyes formed a control group. The patients were clinically assessed with Stratus OCT examination preoperatively, and on day 1, in week 1, and in months 1, 2, 3 and 6 postoperatively. Foveal (central area 1mm in diameter), inner macular (ring area between 1mm and 3mm in diameter), outer macular (ring area between 3mm and 6mm in diameter) thickness and macular volume were analyzed. RESULTS: An increase in retinal thickness and macular volume after the cataract surgery reached the maximum in months 1 and 2 in all examined areas. Since month 3 on, there was a progressive decrease of abnormal retinal thickness and macular volume. An increase in retinal thickness was proved to be most prominent in the inner macular area. An increase in macular volume and retinal thickness in inner and outer macular area were statistically significant in months 1, 2 and 3 (Student t-test, p < 0.001; [p = 0.01 for the data in month 3]), while an increase in retinal thickness in foveal area was statistically significant in months 1 and 2 (Student t-test, p < 0.05). Six months after the surgery, the difference was not statistically significant in any of the examined areas. Three patients (3 %) developed CME after the phacoemulsification, but in one patient (1 %) only the clinical CME with some degree of a visual loss 1 month after the surgery (BCVA = 0.5) was diagnosed. There was a positive statistical correlation between the real phacoemulsification time and the increase in macular volume and retinal thickness in fovea and inner macular area in week one, and in months one and two after the surgery (Spearman's correlation test, p < 0.05). A positive statistical correlation was also found between the overall duration of the surgical procedure and the increase in macular volume and retinal thickness in all areas one month after the surgery (Spearman's correlation test, p < 0.05). CONCLUSION: The results indicate that changes in retinal thickness in macular area must be taken into account even after an uncomplicated cataract surgery. The increase in retinal thickness and macular volume reached the maximum in months 1 and 2 and tends to decrease since month 3 on. There is a positive statistical correlation between the retinal thickness increase and the real phacoemulsification time as well as between the retinal thickness increase and the overall duration of the surgical procedure. The incidence of CME was 3 %, but clinically significant CME was detected in 1 % of the cases only. Topical application of non-steroid, anti-inflammatory drugs can be important to effectively prevent the CME development after an uneventful cataract surgery.

[Macular edema after cataract surgery in diabetic patients without retinopathy]. / Makulární edém po operaci katarakty u diabetiku bez diabetické retinopatie.

PURPOSE: To study the effect of phacoemulsification on the development of macular edema and diabetic retinopathy in diabetic patients without preoperative retinopathy. PATIENTS AND METHODS: This study comprised 86 patients; 26 diabetics, who had no clinically detectable diabetic retinopathy preoperatively, formed a study group and 60 non-diabetics were included into the control group. Diabetes mellitus duration, preoperative hemoglobin A1c level, and diabetes treatment method were recorded in diabetics. Monocular cataract surgery was performed in all patients. The patients were clinically assessed with OCT examination preoperatively, and postoperatively on day 1, in week 1, and in months 1, 2, 3 and 6 respectively. Foveal, inner macular, outer macular thickness, and macular volume were analyzed. RESULTS: The increase of the retinal thickness after the cataract surgery reached maximum in both groups in months 1 and 2. Since month 3 on, there was a progressive decrease in abnormal retinal thickness. There was a significant major increase in retinal thickness in diabetics in all examined areas in month 2 (p < 0.05 for fovea and inner macula; p = 0.001 for outer macula and p = 0.005 for macular volume changes). Trend toward major increase in retinal thickness in diabetics was still evident even three months after the surgery. In no case did a diabetic eye develop clinically detectable diabetic retinopathy during the follow-up period. The correlation between hemoglobin A1c level and retinal thickness changes in diabetics was not significant. There was also no significant difference in final visual acuity between diabetics and non-diabetics. CONCLUSION: We can expect similar induced retinal thickness changes in diabetics without retinopathy as in non-diabetics after uneventful cataract surgery, though there was a trend toward major increase in retinal thickness in diabetics.

[The cases of penetrating eye injuries with large intraocular foreign body]. / Prípady poranení oka s velkým cizím nitroocním telesem.

AIM: Three consecutive cases of penetrating eye injuries complicated with large (size 9-12 mm) intraocular foreign body are presented as such. PATIENTS AND METHODS: The initial findings, management, surgical procedures and final anatomical and functional outcomes of each particular case are given. Corneal entrance laceration was seen in all three patients. Second scleral full-thickness eye wall laceration was found just posterior to the horizontal muscle insertions in two eyes. Full-thickness exit posterior eye wall laceration obturated with foreign body was diagnosed in one case. This metallic foreign body projected into posterior orbit. Two eyes were injured with metallic radio opaque foreign body. Glass fragment was removed from posterior segment of the eye in one patient. Following primary wound closure pars plana vitrectomy was performed to remove all posterior segment intraocular foreign bodies. RESULTS: Silicone oil was used to fill the vitreous cavity at the end of the surgery in two eyes. Gas bubble (perfluoropropane, C3F8) was injected into the vitreous space at the end of the vitrectomy in one eye. The authors observed following complications: vitreous cavity haemorrhage, traumatic cataract formation, cystoid macular oedema and peripheral stationary traction retinal detachment. CONCLUSION: Good anatomical results and restoration of good visual functions of injured eye were achieved in all patients despite some inferior initial prognostic factors.