Peripheral exudative hemorrhagic chorioretinopathy.

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is relatively rare and especially less known and therefore less often diagnosed condition of the retina periphery predominantly in patients of higher age. Usually temporal periphery is affected. The finding is bilateral in approximately  30 %. Clinically it manifests by multibulbar prominences in periphery, which can sometimes resemble choroidal melanoma. It concerns exudations and hemorrhages under retina (sub-retinal) or under retinal pigment epithelium (sub-RPE). Within weeks or months hemorrhagy is resorbed and flattened and chorioretinal atrophy of various grade remains in affected area, sometimes combined with retinal fibrosis. If the affected area remains limited to the periphery, the central visual acuity does not have to be reduced. Affection is considered to be peripheral form of wet age-related macular degeneration or peripheral form of idiopathic polypoidal choroidal vasculopathy. By differential diagnosis is necessary to exclude especially malignant choroidal melanoma and choroidal detachment. Case report: Own case of 83 years old patient with bilateral PEHCR is described and photo documented. Creation of new prominence - fresh bleeding under retina and RPE in superior periphery - had been captured. Photo documentation of lesion in early stage and in stage of resorbtion after several weeks. Affected areas remained limited to periphery and did not have influence on central vision. That was influenced by degeneration of macula and vitreomacular traction syndrome with distinct epiretinal membrane. Conclusion: PEHCR is less frequent or less diagnosed condition of the retina periphery in old patients. Ongoing exudation and sub-retinal or sub-RPE bleeding. Within weeks heals with chorioretinal scars and subretinal fibrosis. Central vision does not have to be damaged, if lesions do not spread to macula.

[Intraoperative floppy iris syndrome versus lens-iris diaphragm retropulsion syndrome]. / Syndrom vlající duhovky versus o koduhovkový retropulsní syndrom.

Intraoperative floppy iris syndrome (IFIS) as well as lens-iris diaphragm retropulsion syndrome (LIDRS) may negatively influence the course of the modern cataract procedure. In case of simultaneous presence of both syndromes, the LIDRS may paradoxically ease the surgery by means of partial or transient elimination of the IFIS. It causes the dilatation of the pupil, pushes the iris back, and deepens the anterior chamber and this way reduces the fluttering of the iris and makes possible to perform important phases of the surgery, during that we are working in the proximity of the pupil. In case of coincidence with the IFIS, after the spontaneous interruption of the LIDRS, we can repeatedly induce it by means of switching the irrigation off and after shallowing of the anterior chamber by turning the irrigation on again.

[Intraoperative floppy iris syndrome]. / IFIS-syndrom "vlající" duhovky.

In the year 2005, Chang and Cambell described unusual reaction of the iris during the cataract surgery in patients treated with tamsulosine. This was named as IFIS, an acronym for the Intraoperative Floppy Iris Syndrome. In its advanced stage, the syndrome is characterized by insufficient mydfiasis before the surgery, narrowing of the pupil during the surgery, its impossible dilatation during the surgery by means of stretching, unusual elasticity of the pupilar margin, surging and fluttering iris with tendency to prolapse. The same manifestations we observed in our patients and we confirm the direct connection with tamsulosine hydrochloride treatment. Tamsulosine is the antagonist of alpha 1A adrenergic receptors whose are present, except in the smooth musculature of the prostate gland and the urinary bladder, in the iris dilator as well. At the same time we observed this syndrome rarely in some patients not using tamsulosine. In most cases, these patients were treated with antipsychotic drugs.

[Cataract surgery via 1.5 mm microincisions]. / Operace katarakty mikroincizemi 1.5 mm.

A new technique of cataract surgery via two microincisions of 1.5 mm and a phacotip without silicone sleeve is described in this paper. The irrigation is performed via a service incision (port) with a supporting device of the diameter of 20 G. Main problems of this method are discussed: the risk of the wound burns, and the insufficient stability of the anterior chamber. Based on author's own experience from 80 operations performed, and on the data in the literature, the suggestions how to perform this surgery safely using the conventional phaco machine are outlined. The author uses microtip--micro Kelman, pulse mode 5-10 pulses/sec, flow ratio about 20 mL/min, vacuum up to 200 mm Hg, an overpressure cuff to increase the irrigation volume, and a thin walled supporting irrigation device of the inner diameter of 0.7 mm minimum. In the conclusion, it is discussed, if this may be regarded as a progressive method and if it will be widely used. A precondition for its extended use is the wider commercial offer of intraocular lenses, which could be easily implanted trough the micro-incision just described.

[Chirocaine in ophthalmology]. / Chirokain v oftalmologii.

The author presents an account on the properties and initial own experience with a new long acting amide local anaesthetic levobupivacaine. Levobupivacaine supplied under the name Chirocaine is a laevorotatory enanciomere of racemic bupivacaine known this country under the name Marcaine. Contrary to racemic bupivacaine levobupivacaine has a lower cardiotoxicity and neurotoxicity while it has the same anaesthetic and analgetic effect. The author tested the anaesthetic in 100 patients using the same dosage as in hitherto commonly used bupivacaine. Based on data in the literature and their own experience the authors consider levobupivacaine very suitable also for ophthalmosurgery, in particular in risk patients and in long operations where a larger amount of anaesthetic is necessary.

[Implantation of a silicone lens through a sutureless 4.1 mm. scleral tunnel]. / Implantace silikonové cocky bezstehovým sklerálním tunelem 4.1 mm.

The author evaluates the visual acuity and postoperative astigmatism in 78 implantations of intraocular silicone lenses SI26NB of Allergan Co. via a scleral tunnel incision of 4.1 mm without suture. In 96% patients the induced astigmatism after 4-6 weeks was maximally 1 dpt. The vision was at that time in 93% 5/5-5/7.5. The authors consider the results with this lens very good. At present the firm provides a new type made from high-index silicone. Therefore the optic portion is thinner, bends more easily and can be implanted through an even smaller incision.

[A year of experience with phacoemulsification]. / Rocní zkusenosti s fakoemulzifikací.

The author presents the results of 470 phacoemulsifications used in surgery of cataract in the course of one year. He investigated early and late astigmatism and visual acuity and the main peroperative complications. His experience with phacoemulsification performed for one year is very good and the patients in their great majority are very satisfied.

[Diode lasers in ophthalmology]. / Diodový laser v oftalmologii.

The authors present an account of diode lasers based on publications in the literature and their initial own experience. A brief physical characteristic of diode lasers is given.

[Manual phacofragmentation in extracapsular cataract extraction]. / Manuální fakofragmentace pri extrakapsulární extrakci katarakty.

The author describes three different techniques of manual phacofragmentation in extracapsular extraction of cataract. Based on the experience with the first 60 operations made by these techniques, the author recommends some principles which should be respected. In the mentioned group only once the posterior capsule was damaged in conjunction with division of the nucleus. When adequate care is not taken or when a poor techniques is used, k. striata occurs more frequently but disappears within one week. The author considers the described technique as a possible and suitable alternative of classical extracapsular extraction of cataract in departments where FAKO is not available.

[The floppy eyelid syndrome]. / The floppy eyelid syndrom.

The floppy eyelid syndrome is a disease characterized by chronic papillary conjunctivitis which practically does not respond to common local treatment. Obese men are most frequently affected. The cause is degeneration of collagenous connective tissue which causes an abnormal consistency of the tarsus, floppy eyelids, in particular the upper ones and thus during sleep eversion of the eyelids occurs with subsequent drying up and mechanical irritation of the mucosa. The complaints are most severe closely after awakening. Improvement is achieved by mechanical protection of the eyelids during sleep. Surgical treatment of the eyelids would be a permanent solution.

[Eye disease in pulmonary fibrosis]. / Postizení oka pri plicní fibróze.

The author describes a case of ocular affection in pulmonary fibrosis with an obscure aetiology and subsequent secondary polyglobulia. In addition to cyanosis of the mucosae and conjunctive the authors detected also cyanosis of the retina of both eyes and thrombosis of the central retinal vein on the right and prethrombosis on the left. The author gives an account of the differential diagnosis of diseases with a similar ophthalmological finding.

[Coaxial illumination in the Zeiss Jena 310 and 311 microscopes]. / Koaxiální osvetlení u mikroskopu Zeiss Jena 310 a 311.

Safe implementation of planned cataract extraction calls for perfect instruments but also for a high standard surgical microscope with coaxial illumination to produce a red reflex on the pupil. Microscopes of Zeiss Jena 310 and 311, which are used in the majority of ophthalmological departments, lack this type of illumination and this impedes wider application of extracapsular cataract extractions. The author gives an account on the possibility of installing coaxial illumination ex post. He mentions briefly a design presented in Decín and suggests his own modification which he tested. As optic conductors are not available and are the basis of the equipment, the author elaborated a solution of his own and uses the proposed equipment during operations. It does not require optic cables with optic terminals, nor a new source of light.

[Experience with the extracapsular extraction of cataracts in a community facility]. / Zkusenosti s extrakapsulární extrakcí katarakty na okresním pracovisti.

The author discusses briefly the advantages and disadvantages of planned extracapsular extraction of cataract which in conjunction with implantations of retropupillary intraocular lenses had its renaissance in recent years. If precise microsurgical procedures are used, the functional results can be very good with a low incidence of peroperative and postoperative complications, in particular in risk eyes. The author describes the procedure at the author's department, using a simple and safe aspiration and irrigation system which is described. The author gives the main indications and contraindications for operation as well as the most serious complications. Based on experience with 70 operations, the author recommends his simple aspiration-irrigation equipment for departments which do not have the opportunity to use some special imported apparatus.