Torpedo Maculopathy. A Case Report.

AIM: Torpedo maculopathy is an incidental, congenital retinal lesion. The typical clinical finding is a unilateral, symmetric, oval, hypopigmented lesion in the inferotemporal macula. In most cases, the lesion is along the horizontal raphe, is torpedo-shaped, and the nasal edge is directed into the foveola. The diagnosis is determined on the basis of its characteristic shape, localization and findings on optical coherence tomography (OCT). The etiology and pathogenesis of torpedo maculopathy is unclear, but it is believed to be a congenital defect of the retinal pigment epithelium (RPE). The aim of this publication is  highlight this diagnosis and to present an incidental finding of torpedo maculopathy in an adult patient. CASE REPORT: A 30-year-old female patient reported for a routine eye examination. Fundus examination of the right eye revealed an oval hypopigmented lesion with a size of 1 disk diameter inferotemporally from the fovea, which was followed by a satellite lesion in the same axis directed into the foveola. Based on OCT, OCT angiography, fundus autofluorescence, and the typical shape and location of the lesion, the patient was diagnosed with torpedo maculopathy in the right eye. CONCLUSION: In general, torpedo maculopathy is an asymptomatic, congenital, benign retinal lesion, which is mostly diagnosed accidentally during a routine fundus examination. TM is non-progressive retinal finding with a minimal risk of deterioration of visual functions, which does not require any treatment. Nevertheless, due to the rare risk of a choroidal neovascular membrane, it is recommended to examine patients once a year. It is necessary to consider this diagnosis when a unilateral hypopigmented lesion is found inferotemporally from the fovea, and to distinguish it from chorioretinal atrophy, scar, vitelliform dystrophy, or other RPE lesions as part of the differential diagnosis.

GIANT PROLACTINOMA. A CASE REPORT.

AIM: Prolactinoma is a pituitary adenoma that secretes prolactin. Approximately 40% of all pituitary adenomas are prolactinomas. According to size, they are divided into micro, macro and giant prolactinomas. In women, prolactinomas cause irregularities of the menstrual cycle such as amenorrhea, galactorrhea, weight gain, in both sexes they cause sterility, hypogonadism, decreased libido and depression. In macroadenomas, symptoms due to the compression of the surrounding structures are also manifested, such as headache, vomiting, lower chiasmatic syndrome and ophthalmoplegia. Loss of the visual field due to compression of the optic chiasm is caused by a tumor larger than 10-15 mm with suprasellar spreading, which breaks through the diaphragma sellae. Giant prolactinomas are larger than 40 mm and make up 1-5% of all prolactinomas. CASE REPORT: In this article I present the case of a 38-year-old woman from Ukraine with advanced chiasmatic syndrome caused by a giant prolactinoma. The tumor is infiltrating the left cavernous sinus, causing left-sided amaurosis and right-sided temporal hemianopsia. CONCLUSION: Inferior chiasmatic syndrome is characterized by bitemporal hemianopsia, a deterioration of visual acuity, bilateral bow-tie descendent atrophy of the optic nerve disc, and hemianopic rigidity of the pupils. Macroprolactinomas occur more frequently in men than in women. The diagnosis is often delayed, probably because the symptoms of hyperprolactinemia are less obvious in men, while women tend to present earlier due to menstrual cycle irregularities. Prolactinomas usually have a good prognosis. Effective medical treatment with dopamine agonists is available. Knowledge of the prolactinoma symptoms could help the diagnosis of compressive lesions of the optic chiasm.

CHANGE OF SURGICALLY INDUCED CORNEAL ASTIGMATISM AND POSITION OF ARTIFICIAL INTRAOCULAR LENS OVER TIME.

AIMS: To analyze changes in surgically induced corneal astigmatism and articial intraocular lens (IOL) stability over time following cataract surgery. To compare the interchangeability of measurements between an automatic keratorefractometer (AKRM) and a biometer. MATERIAL AND METHODS: In this prospective observational study, the above-mentioned parameters were collected from 25 eyes (25 subjects) on the first day, first week, first and third month after uncomplicated cataract surgery. We used IOL-induced astigmatism (difference between refractometry and keratometry) as an indirect indicator of IOL stability change. We used the Blant-Altman method to analyze consistency between devices. RESULTS: At the above time points, surgically induced astigmatism (SIA) decreased as follows: 0.65 D; 0.62 D; 0.60 D and 0.41 D (in the first day, week, month and third month respectively). Astigmatism induced by changes of the position of the IOL varied as follows: 0.88 D; 0.59 D; 0.44 D and 0.49 D. Changes in both parameters were statistically significant (p0.05). CONCLUSION: Both surgically induced astigmatism and astigmatism induced by IOL decreased over time, in which both changes were statistically significant. The decrease in SIA was most pronounced between the first and third month after surgery. For IOL-induced astigmatism, the greatest decrease was within the first month after surgery. The differences in measurement between the biometer and AKRM were statistically insignificant, but the clinical interchangeability between the given methods is questionable, especially with regard to measurement of the astigmatism angle.

ACUTE RETINAL NECROSIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT. A CASE REPORT.

INTRODUCTION: Ozurdex® (Allergan Pharmaceuticals, Castlebar Road, Westport, Ireland) is an intravitreal implant containing 0.7 mg of dexamethasone. It is indicated in adult patients for the treatment of diabetic macular edema, cystoid macular edema due to central retinal vein occlusion, and in patients with non-infectious uveitis. Common complications after Ozurdex® administration include an increase in intraocular pressure, cataract progression or conjunctival suffusion. Acute retinal necrosis after Ozurdex® administration is a very rare and serious complication. According to our current research, this is the fourth published case. Extreme caution must be exercised when treating immunosuppressed patients with Ozurdex®. CASE REPORT: This is case report about an immunosuppressed 68-year-old patient with diabetic macular edema, who developed acute retinal necrosis 74 days after Ozurdex® implantation. He suffers from chronic myeloid leukemia and takes the cytostatic imatinib 400 mg once per day. Urgent pars plana vitrectomy (PPV) with silicone oil instillation was performed and antiherpetic drugs were initiated intravenously. Serological examination confirmed an active infection of cytomegalovirus etiology (CMV). CONCLUSION: Acute retinal necrosis is a rare necrotizing retinitis. Corticosteroids administered intravitreally reduce the local immune response, which may cause a primary infection or reactivation of a latent viral infection.

IDIOPATHIC SCLEROCHOROIDAL CALCIFICATIONS. A CASE REPORT.

AIM: Sclerochoroidal calcifications (SCHC) are an uncommon benign ocular condition that occurs in elderly patients. SCHC usually manifest as multiple placoid yellow lesions in the midperipheral fundus, most often in the upper temporal quadrant. They are asymptomatic and often discovered during routine eye examinations in a patient with good visual acuity and visual field. According to the etiology, SCHC are divided into idiopathic, metastatic and dystrophic. CASE REPORTS: This is case report of 2 patients with idiopathic SCHC, who underwent basic eye examinations, fundus photography, optical coherence tomography, ultrasonography, fluorescein angiography, fundusautofluorescence, laboratory screening and in the second case also CT head scan. CONCLUSION: The aim of this publication is to point out the typical features of SCHC and their distinction from more serious conditions that they may resemble.

ENDOTHELIAL CELL LOSS AFTER PARS PLANA VITRECTOMY.

AIMS: To analyse the changes in endothelial cell density (ECD) after pars plana vitrectomy (PPV) and to identify the factors implicated. PATIENTS AND METHODS: This was a prospective, consecutive, and non-randomised, case-control study. All 23-gauge vitrectomies were performed by a single surgeon at a tertiary centre. ECD was measured at baseline before surgery and on postoperative Days 30, 90, and 180. The fellow eye was used as the control eye. The primary outcome was a change in ECD after PPV. RESULTS: Seventeen patients were included in this study. The mean age of the patients was 65 years. The mean ECD count at baseline was 2340 cells/mm2. The median ECD loss in the vitrectomised eye was 3.6 %, 4.0 %, and 4.7 % at Days 30, 90, and 180, respectively, compared to +1.94 %, +0.75 %, +1.01 %, respectively, in the control eye. The relative risk of ECD loss after PPV was 2.48 (C.I. 1.05-5.85, p = 0.0247). The pseudophakic eyes lost more ECD than the phakic eyes, but this was not statistically significant. There were no significant differences in diagnosis, age, surgical time, or tamponade used after surgery. CONCLUSIONS: Routine pars plana vitrectomy had an impact on the corneal endothelial cells until Day 180 post-op. The phakic status was slightly protective against ECD loss after PPV, although it was not statistically significant. The pathophysiology of corneal cell damage after routine PPV remains unclear. Further studies are required to confirm these findings.

SCOTOMAS IN THE VISUAL FIELD AS THE FIRST SIGN OF INTRACRANIAL EXPANSION. CASE REPORT.

The most common cause of visual field loss in ophthalmology is glaucoma. Other causes of visual field damage include local damage to the eye itself in intrabulbar or retrobulbar neuritis or injuries. However, they can also be caused by general diseases, e.g. in endocrine orbitopathy, toxic and nutritional neuropathy, or in diseases that are localized intracranially. Each of these findings in itself suggests the nature of the lesion, its intracranial location, lateral occurrence, as well as in which part of the visual pathway the lesion is located. The use of perimeter has therefore become the primary examination method, which is available, is not demanding and will quickly allow a diagnosis to be made. When found on a perimetric examination, it is necessary to indicate targeted imaging examinations, such as computed tomography or magnetic resonance imaging. The article describes a patient who was primarily examined at the Department of Ophthalmology, Faculty of Medicine, Comenius University and the University hospital of Bratislava. The patient reported visual field outages, and after subsequent computed tomography, she was interdisciplinary managed and surgery was done on at the Neurosurgical Department. After the operation, there was a significant improvement without a pathological finding on the perimeter.

PRES SYNDROME.

The aim of this review, as well as the case report, is to become familiar with the syndrome, although it is not very common, but may still be encountered by an ophthalmologist during clinical practice. It is also interesting to point out how the clinical unit can be independent and unchangeable in medicine and, on the other hand, in the context of the reversible posterior leukoencephalopathy syndrome (PRES syndrome), the name can be changed. As such, cortex blindness arises after complete destruction of the visual cortex of both occipital lobes, often as a result of vascular circulatory disorders. PRES syndrome is characterized by magnetic resonance imaging or computed tomography, where bilateral irregular hypodensive arteries are present in the occipital lobes that cause transient cortex blindness within the syndrome, which in its name carries the word reversible. Case report: A patient who was hospitalized at the Pneumology Department in which PRES syndrome and transient cortex blindness were diagnosed.

EFFECT OF MULTIPLE VARIABLES ON THE REFRACTIVE ERROR AFTER CATARACT SURGERY.

PURPOSE: To analyze refractive results after cataract surgery in relation to used type of monofocal intraocular lens, calculation formula, to age, gender and laterality. SETTINGS: Department of Ophthalmology, Comenius University and University hospital in Bratislava, Slovakia Methods: We analyzed 173 eyes (118 patients) after uneventful cataract surgery. We calculated prediction error (PE) and mean absolute error (MAE) of postoperative refraction. RESULTS AND CONCLUSION: We found no statistically significant differences in PE and MAE in relation to types of used IOL, calculation formulas, gender, age or laterality. Key words: Optical biometry, monofocal IOL, IOL calculation, refractive error.

The optic nerve drusen and haemodynamics.

PURPOSE: The optic nerve drusen (DON) are precisely described in many papers. But fewer papers evaluate real haemodynamics parameters (HP) in DON. Clinically, it has been shown, that the development and progression of visual field changes in DON is closely related to the hemodynamics of the ocular vascular supply - the optic nerve. DON can visually overlap the excavation optic disc, making it difficult to evaluate scotomas of the visual field in glaucoma. METHODS: HP was prospectively evaluated in 54 patients with compensated intraocular pressure and DON. The drusen at the optic nerve head have been detected by fundus examination and B-scan ultrasonography (USG). DON were divided into 3 groups according to the size of the individual drusen or the drusen complex. I. Group: area size up to 1.9 mm. II. Group: area size: 1.9 - 3.9 mm. III. Group: area size: 4,0 mm. HP - maximum systolic velocity (MSV), minimal diastolic velocity (MDV) and resistance indices (IR) and index pulsatility (IP) - were recorded at the central retinal artery (CRA), at the central retinal vein (CRV), at ciliares posteriores arteries breves (CPAb) and at the ophthalmic artery (AO). The values were divided into 3 groups: 1 - Physiological: CRA: 8.7 ± 0.9 / 2.9 ± 0.6 cm/s or RI: 0.70 ± 0.05. 2 - Slightly impaired: CRA: 6.6 ± 0.8 / 2.0 ± 0.5 cm/s, or RI: 0.75 ± -0.04. 3 - Significantly impaired: CRA: 5.2 ± 1.2 / 1.9 ± 0.7 cm/sec or RI: 0.79 ± 0.03. RESULTS: There was no linear relationship between size of DON and HP. Slight worsening of HP at the CRA was in I. Group (28.6 %), II. Group (48.3 %) and III. Group (62.4 %). Significant worsening of HP at the CRA was I. group (28.6 %), II. Group (48.3 %) and in III. Group (62.4 %). HP of the CPA and of the OA were not significant due to the presence and size of drusen. The relationship between individual variables was evaluated using the Pearson correlation coefficient 0.213. I. Group P: 0.354, II. Group P: 0.073, III. Group P: 0.287. CONCLUSIONS: HP is more often impaired in „large“ DON (Group III), rarely in Group I, but this is not a rule. HP cannot be predicted according to the size of the druse formation at the optic nerve. It seems that the deterioration of HP depends not only on the DON size but also on the location (the distance from the lamella cribriformis) and also to the vascular system intrapapillary.

INTRAVITREAL THERAPY OF ENDOGENOUS ENDOPHTALMITIS DUE TO UROSEPSIS - A CASE REPORT.

A case report of 58-year-old man with endogenous endophtalmitis due to urosepsis and bronchitis. Patient was hospitalized in Department of Internal Medicine another hospital. He was sent to consiliar examination to our Ophtalmology Department with worsening vision and pain in left eye one day after onset. The diagnose endogenous endophtalmitis was set. Visual aquity was a hand movement on the first visit. Intravitreal therapy was realized promptly that day, a combination of two antibiotic drugs (ceftazidim 2mg/ 0.1 ml a vankomycin 1 mg/ 0.1 ml) and antifungal agent (amfotericin B 10 μg/ 0.1 ml). This therapy was applicated 3x totally, in two weeks. Humour from anterior chamber was taken during first intravitreal application and was negative. Blood culture was positive for staphylococcus aureus. Intravenous treatment with antibiotics (gentamycin 240 mg i.v. á 24hours a amoxicilin with clavulan acid 1.2 g i.v. á 8 hod) was set for two weeks then continued antibiotic (ciprofloxacin 500 mg á 12 hours) and antifungal therapy (itrakonazol 100 mg á 12 hod) per os two months. Visual aquity of the left eye was 20/100 after four weeks and 20/40 after two months. We would like to highlight advantage of multidisciplinary co-operation.

Combination of Intravitreal Corticosteroid with Anti-vegf in Macular Edema Secondary to Retinal Vein Occlusion.

PURPOSE: functional and anatomical results after combination of intravitreal dexamethasone implant with anti-VEGF bevacizumab in macular edema secondary to retinal vein occlusion. METHODS: Retrospective analysis of 50 patients, average age 72 years, 15 men and 35 women. Inclusion criteria for treatment were retinal vein occlusion, best corrected visual acuity (BCVA) more than 20/200 and macular edema more than 250 µm. Algorithm of treatment was dexamethason, anti-VEGF (bevacizumab), dexamethason. Application of anti-VEGF bevacizumab was in interval between two applications of dexamethasone, for the first time in every patient. If there were nonperfusion areas on fluoresceine angiography (FA), or ischemia on slit lamp, repeatedly. Patients observed for 12 months at least. This cohort included patients with branch retinal vein occlusion together with central retinal vein occlusion. This is an evaluation of nonperfusion areas based on FA, BCVA, macular edema on optical coherence tomography (OCT) and number of reapplication of anti-VEGF bevacizumab. Observed adverse effects are elevation of intraocular pressure and number of patients who underwent cataract surgery. RESULTS: The gain of 8 letters in 1st month after 1st application of dexamethasone, central retinal thickness (CRT) reduced from 512 µm to 318 µm in average. 33 patients get 1, 3 patients get 2 and 14 patients 3 injections of bevacizumab. On the day of 2nd application of dexamethasone, in 7th month in average, the CRT increased on 465 µm, and 1th month after, the gain from the baseline was 10 letters and CRT reduced on 380 µm. All the patients were phackic at the baseline, 18 (36 %) patients underwent cataract surgery with intraocular lens implantation. Transient elevation of intraocular pressure in 15 (30 %) eyes, treated by local therapy. CONCLUSION: Combination of intravitreal dexamethasone implant with anti-VEGF bevacizumab is functionally and anatomically effective. Key words: retinal vein occlusion, macular edema, dexamethasone, bevacizumab.

Uveal melanoma survival rates after single dose stereotactic radiosurgery.

This paper presents the long-term results of single dose stereotactic radiosurgery for intraocular uveal malignant melanoma, and summarizes the results of the retrospective study in 170 Slovak patients. A group of uveal melanoma patients (149 choroidal melanoma, 21 ciliary body melanoma) from 20 to 92 years of age with 59 year median were treated in 2001-2016. There were 81males (47.7%) and 89 females 89 (52.3%). The median overall follow-up time was three years. The median tumor volume at baseline was 0.5 cm³ (ranging from 0.2 to 1.6 cm³). The therapeutic dose was 35.0 Gy by 99% of dose volume histogram. The survival after single dose stereotactic radiosurgery was 96% in one year, 93% in two years, 84% in five years, 80% in seven years and 52% in eleven years. Secondary enucleation was necessary for 22 patients because of secondary glaucoma complication. The enucleation free interval ranged from one to six years. The survival rates in five year intervals and necessity of secondary enucleation due to complications after single dose stereotactic radiosurgery is comparable to other techniques.

Ophthalmological finding in a patient with lowe syndrome.

The authors present the ophthamological finding in a patient who at the age of 4.5 months was admitted due to a finding of total bilateral congenital cataract. The patient was observed by a neurologist for central hypotonia and mental retardation. Upon a complex examination of the patient, suspicion of Lowe syndrome was stated, which was confirmed by a metabolic examination and also by genetic tests. Upon an examination of the family, a genetic defect (mutation of OCRL1 gene) was confirmed also in the mother of the patient. A mild subcapsular opacification was present in the mother, beneath the posterior capsule. The patient was operated on for bilateral congenital cataract. Upon an examination under general anaesthesia, trabeculodysgenesis was diagnosed. Intraocular pressure remains within the norm. The patient is now aged 8 years, regularly monitored with regard to metabolic compensation, and by a neurologist and ophthalmologist, with satisfactory visual functions. Early diagnosis of the Lowe syndrome was determined on the basis of a complex examination of the patient within the framework of etiological diagnosis of bilateral congenital cataract. Key words: Lowe syndrome, oculo - cerebro - renal syndrome, congenital cataract, glaucoma, nystagmus.

Marshall and stickler syndrome in one family.

The authors present the ocular finding in a patient sent to the Department of Paediatric Ophthalmology at the Children's University Hospital - Faculty of Medicine, Comenius University in Bratislava at the age of 3 months, with congenital glaucoma in her right eye and bilateral high myopia. The family anamnesis of the patient shows repeated occurrence of stunted growth, myopia, facial dysmorphia and cataract. The child's mother had high myopia, the mother's brother underwent cataract surgery, the child's grandmother and her sisters and the child's great grandmother had high myopia and glaucoma, and probably underwent cataract surgery at a young age. The child's mother and grandmother underwent a genetic examination, with a conclusion of Marshall syndrome. Within the framework of neonatal screening, poor cortical auditory evoked potential, a defect of the interventricular septum and bifid uvula were diagnosed in the child. With regard to the overall finding in the patient and the genetic family history, we suspected Marshall syndrome. A genetic examination determined Stickler syndrome type 1 with the presence of mutation in the COL2A gene (variant c.2710C >T (p.Arg904Cys,rs121912882)). Due to high intraocular pressure with the impossibility of compensation by medication, bilateral trabuculectomy was performed on the patient. At present the patient has intraocular pressure compensated with adjuvant medicamentous therapy. With regard to high myopia and pronounced degenerative changes on the periphery of the retina in the sense of lattice degeneration, preventive cryopexy of the retinal periphery is planned. A molecular genetic analysis helped diagnose the pathology as Stickler syndrome type 1, which manifested phenotype symptoms of Marshall syndrome or Stickler syndrome type 2. Key words: Marshall syndrome, Stickler syndrome, mid-facial dysmorfism, myopia, glaucoma, cataract.

Prognostic value of apoptosis inducing factor in uveal melanoma.

In malignant tumors including uveal melanoma there is a continuous effort in search for additional and relevant factors with predictive value and possible therapeutic indications. In the present work we evaluated the 5-year mortality in a group of patients with surgically treated uveal melanoma and its relation to selected demographic, clinical and histopathological parameters, including the expression of apoptosis inducing factor (AIF) in the neoplastic tissue.We analyzed retrospectively the clinical data of patients with uveal melanoma treated surgically (enucleation, endoresection, exenteration) in the period from 2001 to 2007 (n=54). Immunohistochemical detection of AIF expression in formalin fixed and in paraffin embedded tissue samples was evaluated semiquantitatively, intensity and percentage multiplicative Quick Score (QS) was calculated and compared between patients with over 5 year (n=32) and less than 5 year (n=22) survival. In the analyzed group of 54 patients the 5 year mortality was 41 %. We confirmed the negative prognostic significance of some of the known prognostic factors as the tumor size and volume, T3 and T4 stage in the TNM classification and the mixed histological type of the tumor. Immunohistochemistry performed on 49 melanoma specimens showed AIF cytoplasmic positivity, no nuclear translocation was detected. The cut-off value of AIF expression QS ≥ 4 (18) in tumor cells separated the 5 year survival of patients (P = 0.018), odds ratio 5.2 (1.24 - 21.73). Moderate and strong expression of AIF in tumor cells also correlated with less favorable prognosis. Confocal microscopy proved colocalization of AIF with mitochondrial marker in neoplastic cells.The prognosis of patients with uveal melanoma can be more accurate with inclusion of immunohistochemical detection of AIF expression. Increased expression of the AIF protein appears as a new negative prognostic factor predicting the 5 year survival.

Prevalence of refractive errors in the Slovak population calculated using the Gullstrand schematic eye model.

PURPOSE: A substantial part of the population suffers from some kind of refractive errors. It is envisaged that their prevalence may change with the development of society. The aim of this study is to determine the prevalence of refractive errors using calculations based on the Gullstrand schematic eye model. METHODS: We used the Gullstrand schematic eye model to calculate refraction retrospectively. Refraction was presented as the need for glasses correction at a vertex distance of 12 mm. The necessary data was obtained using the optical biometer Lenstar LS900. Data which could not be obtained due to the limitations of the device was substituted by theoretical data from the Gullstrand schematic eye model. Only analyses from the right eyes were presented. The data was interpreted using descriptive statistics, Pearson correlation and t-test. The statistical tests were conducted at a level of significance of 5%. RESULTS: Our sample included 1663 patients (665 male, 998 female) within the age range of 19 to 96 years. Average age was 70.8 ± 9.53 years. Average refraction of the eye was 2.73 ± 2.13D (males 2.49 ± 2.34, females 2.90 ± 2.76). The mean absolute error from emmetropia was 3.01 ± 1.58 (males 2.83 ± 2.95, females 3.25 ± 3.35). 89.06% of the sample was hyperopic, 6.61% was myopic and 4.33% emmetropic. We did not find any correlation between refraction and age. CONCLUSION: Females were more hyperopic than males. We did not find any statistically significant hypermetopic shift of refraction with age. According to our estimation, the calculations of refractive errors using the Gullstrand schematic eye model showed a significant hypermetropic shift of more than +2D. Our results could be used in future for comparing the prevalence of refractive errors using same methods we used.Key words: refractive errors, refraction, Gullstrand schematic eye model, population, emmetropia.

[Exenteration of the Orbit for Basal Cell Carcinoma]. / Exenterácia ocnice pre bazocelulárny karcinóm.

AIM: Primary treatment of basal cell carcinoma of the lower eyelid and the inner corner is essentially surgical, but advanced lesions require extensive surgical interventions. In some cases it is necessary to continue with the mutilating surgery--exenteration of the orbit. In this work we evaluate the indications of radical solutions in patients with basal cell carcinoma invading the orbit and the subsequent possibility for individually made prosthesis to cover the defect of the cavity. MATERIALS AND METHODS: Indications to exenteration of the orbit in patients with basal cell carcinoma findings in 2008-2013. Case report of 2 patients. RESULTS: In period 2008-20013 at the Dept. of Ophthalmology, Comenius University in Bratislava totally 221 patients with histologically confirmed basal cell carcinoma of the eyelids and the inner corner were treated. In 5 cases (2.7 %) with infiltration of the orbit the radical surgical procedure, exenteration was necessary. In 3 patients exenteration was indicated as the first surgical procedure in the treatment of basal cell carcinoma, since they had never visited ophthalmologist before only at in the stage of infiltration of the orbit (stage T4). In one case was indicated exenteration after previous surgical interventions and relapses. After healing the cavity patients got individually prepared epithesis. CONCLUSION: Surgical treatment of basal cell carcinoma involves the radical removal of the neoplasm entire eyelid and stage T1 or T2 can effectively cure virtually all tumors with satisfactory cosmetic and functional results. In advanced stages (T4 stage) by infiltrating the orbit by basal cell carcinoma exenteration of the orbit is necessary. This surgery is a serious situation for the patient and also for his relatives. Individually made prosthesis helps the patient to be enrolled to the social environment.

[Malignant Choroidal Melanoma in T4 Orbital Stage; Prosthesis of the Orbit]. / Exenterácia ocnice pre malígny melanóm choroidey v stádiu T4; moznosti epitetického riesenia.

AIM: Diagnosis and treatment of tumors of the eye is extremely difficul; surgical treatment in advanced stages, when the tumor grows in the orbit, leads to extensive radical surgery of the face. The extent and nature of surgical procedures depends on the nature of the tumor process, in advanced stages is indicated mutilating surgery--exenteration of the orbit. Exenteration of the orbit due to the extrascleral extension of malignant melanoma of the uvea is very rare, unfortunately, even today in certain cases it is necessary to make such a mutilating surgery. MATERIALS AND METHODS: Case report--65 year old female patient, sent to our Departement in 2008 with the finding of the pigment deposits on the posterior pole of the left eye. Ultrasound study found elevations of up to 3 mm, she was asked to come for further control in three months interval. She did not coma, furthermore she sporadically attended another eye clinic. In 2011 she was treated for secondary glaucoma--cyclocryopexia. Due to pain another surgery--tarzoraphia was indicated. In 2012 she underwent surgery at St. Elisabeth Cancer Institute in Bratislava--Nefrectomia transperitoneally l. dx., excision hepatis. Histological examination in addition to the primary papillary renal carcinoma--mucinous tubular T1 Nx Mx type, found the metastasis of malignant melanoma to the liver and right kidney. She underwent the diagnostic procedure to find the origo of the melanoma. The patient was subsequently admitted to our clinic with blind painfull eye for enucleation. During the surgery the was found retrobulbar tumor ingrowth. Histopatholigical findings confirmed malignant melanoma. Indicated was exenteration of the orbit due to malignant melanoma T4 N0 M2 stage in June 2012. After healing of the cavity she was recommended to design an individual prosthesis. After completing several courses of palliative chemotherapy during a recent review in January 2015 the patient is without recurrence of the melanoma in the orbit RESULTS: Histological examination confirmed malignant melanoma in stage G2, predominantly epithelioid type, spindle cell type in part B of pips, tumor fills the entire back and part of the anterior chamber, grows through the sclera and optic nerve is completely overgrown by tumor mass and spreads into orbit. The immunophenotype is suggesting a better prognosis (S100+, melanoma+, +HMB45, cyklin D1 3%, 10% of p53, Ki67 3%). Tissue eyelashes were infiltrated by numerous micrometastases. The patient after exenteration of the orbit after 3 months got an individual epithesis. Local orbit cavity is more than 24 months after exenteration without recurrence of melanoma. The patient is still undergoing outpatient chemotherapy and feels good. CONCLUSION: The treatment of malignant tumors of the orbit and the eye is difficult, in most cases surgical treatment is indicated, with the additional radiation therapy and chemotherapy. Malignant tumors at an advanced stage should to be solved radically. Exenteration of the orbit leads to produce a large defect in the orbit and this part of the face. Patients in the active age after surgery followed by facial defects after such procedures have disadvantage in work and thie defect leads to serious socio-economic challenges. Patients with individually made prosthesis comprising a refund of the eyeball and the surrounding soft tissues allow active life and full application of the private as well as professional life.

[The Changes of the Spectrum in Primarily Indicated Surgeries due to Retinal Detachment during the Period of 15 Years]. / Zmena spektra primarne indikovaných operácií pre odlúpenie sietnice pocas 15 rokov.

PURPOSE: To evaluate the effectiveness of surgery for the rhegmatogenous retinal detachment, depending upon changes in the type of the primary surgery in the last 15 years. MATERIALS AND METHODS: There were 991 patients with primary rhegmatogenous retinal detachment operated (in total 1020 eyes) at the Department of Ophthalmology Faculty of Medicine and University Hospital Bratislava. In the prospective part, in A group concerning the years 1999-2001, there were 346 eyes, 339 patients included. In the first retrospective part, in B group concerning the years 1994-1998 there were 464 eyes, 455 patients. In the second retrospective part, in C group concerning the years 2009-2010, 210 eyes, 197 patients were enrolled. We have analyzed the anatomical and functional results, focusing on the primary indicated surgical procedure of retinal detachment. The primary pars plana vitrectomy was in A group indicated in 54,6%, in group B in 27,6% and in group C in 90,4%. RESULTS: We have recorded the improvement of visual acuity after retinal detachment surgery in A group in 54.7% of eyes, in B group in 58.2% of eyes and in C group in 57% of eyes. The same visual acuity as it was before the first surgery for retinal detachment was recorded in A group in 26.8%, in B group in 19.8% and in C group C in 28% of eyes. Attached retina has been achieved in 75 % in A group after the first surgery and after the last surgical procedure the success rate increased to 98%. The anatomical success was 72% of eyes after the first surgery in B group and after the last surgery it was 94%, in C group the retina was attached in the 74% after primary surgery and 99% after the last surgery. CONCLUSION: The changing of spectrum indicated by primary retinal detachment surgeries for the last 15 years has not brought the expected major functional and anatomical improvement.