REPORT ON AMNIOTIC MEMBRANE FOR SURGERY OF PERSISTENT MACULAR HOLE.

PURPOSE: To evaluate the results of 3 cases with persistent macular holes (MH) treated by 23-gauge vitrectomy, extension of internal limiting membrane peeling, a human amniotic membrane (hAM) plug insertion into the subretinal space through MH and expanding gas endotamponade. MATERIAL AND METHODOLOGY: The diagnosis of persistent MH in three patients was unilaterally confirmed using SD-OCT. In the first patient a primary MH was present. In the second patient a secondary MH occurred after cystoid macular edema because of central retinal vein occlusion. The third patient suffered with sustained atrophy of the retinal pigment epithelium (RPE) in the foveola several years before the development of MH. All patients were females. The first two patients underwent reoperation four months after the primary surgery, the third patient underwent two previous pars plana vitrectomies (PPVs), the last one 11 years ago. First a revision of the periphery and removal the vitreous was performed, the ILM peeling zone was extended. The plug from the dehydrated hAM was prepared. Subsequently, the hAM plug was inserted via MH subretinally. Standard cryopexy behind the sclerotomies, fluid-for-air exchange, and vitreous cavity tamponade with expansile gas were performed. RESULTS: Two patients achieved MH closure, in the third patient surgery significantly reduced cystoid edema of the MH edges and the MH diameter, but the MH remained open. All patients experienced a mild improvement in visual acuity and loss of disturbing visual phenomena. CONCLUSION: We have confirmed that hAM plug insertion is feasible for persistent MH even of large sizes. It is essential to orient the basal membrane of the plug towards the neurosensory part of the retina and the chorionic side to the RPE due to growth factors but also for the concavity of the plug towards the RPE. It is possible that the use of tamponade with perfluoropropane (C3F8) is preferable to tamponade with sulfur hexafluoride (SF6). The time of reoperation approximately 3-4 months after the first failed vitrectomy can be considered optimal.

[Orbital Exenteration in Patient with Metastatic Choroidal Melanoma - a Case Report]. / Exenterácia orbity u pacienta s generalizovaným choroidálnym melanómom.

INTRODUCTION: Uveal melanoma is the most common primary intraocular tumour in adults in Caucasians and in 75% is arising from choroid. It threatens not only the patients loss of vision and eye, but also 50% of patients after 5-year interval after therapy die due to distant metastases. The treatment of small and medium-sized melanoma are methods preserving eye globe. Almost half of the total number of patients is still unavoidable enucleation. Considerably rarer is indicated exenteration of an orbit. These tumors metastasize only hematogenous, while the most frequent place of localization of distant metastases is the liver. Generalized disease prognosis is poor, and our current treatment options in this stage are ineffective. MATERIAL AND METHODS: Case report of 59 years old patient with choroidal melanoma stage T4 N1 M1 massively infiltrating the orbit. At the time of diagnosis of the primary tumor distant metastases were present. The patient underwent exenteration of the orbit and systemic chemotherapy. DISCUSSION: Although choroidal melanomas with extrascleral extension and infiltration into the orbit have no better prognosis after exenteration of the orbit, surgery is providing us local tumour control. Good cosmetic effect after this mutilating procedure is offered by individually made prosthesis (epithesis). All patients with uveal melanoma require lifelong dispensation, distant metastases may occur even after many years. In the treatment of generalized disease is available systemic chemotherapy and immunotherapy only palliative. The best effect on survival has complete surgical resection of single metastasis. Uveal melanoma has a different genetic profile as cutaneous melanoma. The biological nature of uveal melanoma seems to be the key to determining risk patients, as well as the development of targeted systemic therapy. CONCLUSION: Treatment of patients with generalized large uveal melanoma with extrascleral extension is difficult. A better understanding of biological interest may be the key to the detection of patients at higher risk of distant metastases formation, and to an effective systemic treatment. KEY WORDS: large uveal melanoma, extrascleral extension, orbital exenteration, the treatment of generalized disease.

[Perforated punctum plugs in treatment lacrimal punctal stenosis]. / Perforované zátky v liecbe stenózy slzných bodov.

PURPOSE: Retrospective evaluation of treatment of epiphora due to punctal stenosis with application of perforated plugs as well as evaluation of complications. MATERIAL AND METHOD: There were inserted perforated plugs into inferior lacrimal puncta to twelve patients with epiphora due to proximal stenosis in efferent lacrimal ducts. Their size were predeterminated by caliper measuring. Patients were followed for an average of eighteen months, at least one year. RESULTS: Patients ceased to suffer from epiphora shortly after the application of perforated plugs, the plugs stayed firmly anchored in correct position and didnt cause foreign body sensation. Two patients showed temporary edema surrounding the plug after its insertion and one patient a small corneal erosion with rapid healing. There was no plug loss within one year. CONCLUSION: Punctal plug insertion presents a simple, less invasive, effective and safe method to treat epiphora due to punctal stenosis.

[Ocular signs and symptoms after scoliosis surgery (a case report)]. / Ocné príznaky po operácii skoliózy.

Scoliosis surgery offers the only resolution of this orthopedic problem. Regarding to important structures, orthopedist maneuvers during surgery around, surgeon's great concentration is demanded. Curious complication after scoliosis surgery is the combination of unilateral Horner's syndrome in conjunction with contralateral Pourfor du Petit's syndrome, which occurred after reoperation with supermounting into the 1. thoracic spondyle of 13-years old girl. It was accompanied by general weakness while patient's trying to get up. Excluding other neurological disorders irritation of cervical sympathicus is accepted like a etiology factor. The inconvenience disappeared spontaneously and gradually 3 months after the reoperation, mobility is in good order and x- ray documents firm fixation of supermounting.

[Spontaneous closure of idiopathic macular hole (presentation of 4 cases)]. / Spontánne uzavretie idiopatickej diery makuly (prezentácia 4 prípadov).

PURPOSE: To describe the cases of spontaneous closure of idiopathic macular hole. MATERIAL AND METHOD: OCT findings were retrospectively searched for cases of macular hole closure. Based on the corresponding documentation it was checked, if they were idiopathic macular holes and if the closure was spontaneous. RESULTS: The authors present two cases of macular hole closures in phase IB, in one of which the closed hole reopened again in full thickness after 15 months. In further two cases of the phase II, one hole closed after posterior vitreous detachment after cataract surgery and once quite spontaneously. CONCLUSION: Four cases of spontaneous closure of idiopathic macular hole were documented by three ophthalmology departments during the period of nearly four years. Based on this result we suppose that this process is not as rare, as stated in the literature.

[Bacillus cereus keratitis--case report]. / Bacillus cereus, pôvodca keratitídy--kazuistika.

Bacillus cereus is a gram-positive, rod-shaped, beta hemolytic bacterium which rarely causes eye infections. We present a case of 15 year old boy with unilateral keratitis. He was treated for two months by his ophthalmologist who suspected herpetic keratitis. Patient most probably suffered secondary infection by Bacillus cereus. After bacillus was identified and targeted treatment given clinical picture improved rapidly. Until now there are only few cases of bacillus cereus keratitis published.

[Oclusion of upper ophthalmic vein--a case report]. / Oklúzia hornej zily ocnice--kazuistika.

Thrombosis of upper ophthalmic vein is both rare and serious pathologic event. Authors present a case of isolated unilateral upper ophthalmic vein thrombosis in 76-year-old woman, who despite treatment ended with amaurosis and secondary neovascular glaucoma. In differential diagnosis authors focused on searching for inflammatory process of orbit with adjacent structures as well as local and general causes leading to venous thrombosis. None of these were proven; it was a rare case of a patient with isolated upper ophthalmic vein thrombosis.

[Combined occlusion of central retinal vein]. / Kombinované cievne oklúzie sietnice.

Combined occlusion of central retinal vein and cilioretinal artery represents 40% of all cilioretinal artery occlusions. Pathogenesis of this uncommon occlusion remains controversial. We present three cases id combined vascular occlusion that were diagnosed at our department from 2003 until 2008. Our patients, all productive age, had undergone complete clinical examinations and investigations to determine the cause of this condition. One patient had been diagnosed to have heterozygous form of protrombine mutation. Curious is also possible connection of vascular occlusion and application of anti-Hepatitis A and B vaccine.