[IN VIVO CORNEAL CONFOCAL MICROSCOPY: BASIC PRINCIPLES AND APPLICATIONS Corneal confocal microscopy is a new, non-invasive imaging]. / In vivo konfokální mikroskopie rohovky: princip metody a soucasné moznosti.

Corneal confocal microscopy is a new, non-invasive imaging method. It provides serial images of a face optical sections through the full-thickness of the living cornea, avoiding artefacts associated with ex vivo study. It provides qualitative as well as quantitative analysis of the corneal layers, nerves, and cells. It also allows longitudinal examination of the corneal structure changes over time. The purpose of this article is to describe the principles and capabilities of the currently available corneal confocal microscopes, and possible applications of this tool.Key words: confocal microscopy, cornea.

[The Tear Osmolarity of PATIENTS with Lagophthalmos]. / Osmolarita slz u pacientu s lagoftalmem.

INTRODUCTION: Lagophthalmos can be characterized as the dysfunction of the eye aperture and in some cases even by the disruption of tear production. Dry eye syndrome can consequently develop. Instability of the tear film, hyperosmolarity and inflammatory reaction are considered as the key mechanisms of dry eye syndrome. In our report we monitored the tear osmolarity of patients with postsurgical unilateral lagophthalmos. Results were compared with tear osmolarity of the non-lagophthalmic eyes. METHODS: We examined 10 patients (6 women, 4 men) with postsurgical facial nerve palsy and lagophthalmos complicating management of either cerebellopontine (8 patients) or salivary gland tumors (2 patients). Only patients without severe corneal defects enrolled the study. The tear osmolarity was measured in lower tear meniscus by TearLab Osmolarity System device. The lagophthalmic eye was always examined first. The results are presented as mean plus/minus the standard deviation. The paired t-test was used for statistical data processing. The p-value 0,05 was considered as statistically significant. RESULTS: The mean tear osmolarity of the lagophthalmic eyes was 296 ± 15,0 mosmol/l (275-315 mosmol/l). In case of healthy eyes the mean osmolarity was 310 ± 12 mosmol/l (292-336 mosmol/l). The tear osmolarity in case of lagophthalmos was significantly lower than in the healthy eyes (p = 0,05). CONCLUSION: In contrary to the studies demonstrating higher tear osmolarity under the scenario of dry eye syndrome, we found lower tear osmolarity in the lagophthalmic eyes than in the healthy eyes. The possible reason could be the changes in tear dynamics of the lagophthalmic eye due to disturbance of eye lid function. Our results also stress the need of evaluation of the actual tear osmolarity in the view of complex clinical eye findings. The place of tear collection should also be considered.Key words: lagophthalmos, dry eye syndrom, tear osmolarity.

[Corneal foreign bodies in children]. / Rohovková cizí telíska u detí

UNLABELLED: The purpose of the study was to answered three questions. Which part of all patients with diagnosis of corneal foreign body (CFB) diagnosed in period from 2006 to 2010 were children? Is there any dependence on sex like in adults? Is there any typical mechanism of injury in children? METHODS: Retrospective study analyzed data of 2381 patients with diagnosis of CFB, 2225 men and 156 women. There were in the group 0-17 years 154 patients, 82 boys and 72 girls, in group 18-64 years 2103 men and 80 women and in group patients older than the age of 65 years 40 men and 4 women. Mechanism of injury was analyzed in the group of children. RESULTS: CFB is a common condition in working-age adult men due to occupational exposure, eg grinding, drilling or cutting. CFB is very rare in adult women. Similar dominance of men was in the group of patients older then the age of 65 years. The results demonstrate, that both sex in group of children occurred equally. The majority of the mechanism of injury in children wasnt recognized (115 children). The biggest recognised group was use of swing in case-history of 17 children with corneal metallic foreign body, 15 of them were children younger than the age of 7 years. Seven children suffered injury by part of plants such as thorns or bark from branch of tree. Three boys had in case-history common mechanism of grinding. Remaining mechanisms of injury were less frequent. CONCLUSION: From 2006 to 2010, 154 (6.5 %) pediatric eye injuries of CFB were treated in Department of Ophthalmology for Children and Adults. Both sex in group of children occurred equally. Although majority of mechanism of injury remained unrecognised, use of swing is among children younger then the age of 7 years important unknown mechanism of injury. Is possible to prevent it, eg rust prevention of metallic suspensions of swing, protective eyeweare, cap.

[The first experience with gold eyelid implants in facial nerve palsies]. / První zkusenosti s aplikací zlatých víckových implantátu pri obrne lícního nervu.

The authors in a clinical study refer about their first experience of gold eyelid implants application in lagophthalmos treatment in facial nerve (cranial nerve VII) palsies. The implant, thanks its weight and the gravitation, facilitates to the patients to close their interpalpebral fissure. The implants are implanted in to the subcutis of the upper eyelid and are sutured to the anterior surface of the tarsal plate. The aim of the surgery is to lower the risk of the damage of the eye due to the exposure keratopathy and to allow the patients to control better the eyelid function. The gold as a material is well tolerated by the human body. The shape of the implant and the way of application ensure good functional results. Altogether 5 adult patients were operated on at the Department of Ophthalmology. The House-Brackmann score was used to evaluate the effectiveness of the surgery, or the stage of the closing of the interpalpebral fissure before and after the surgery. This score evaluates the palpebral sphincter function according the grade of involvement. The selection of the implants, their indication and surgery procedure are discussed.

[Clinical appearance and outcome of zone 1 retinopathy of prematurity (ROP)]. / Klinický obraz a výsledky léby u retinopatie nedonosených v zóne 1 sítnice.

The goal of this clinical trial was to evaluate outcomes of the treatment of retinopathy of prematurity (ROP) located in zone 1 (Zone 1 ROP). This disease has a specific clinical appearance and poor prognosis. Usually it is difficult to identify particular stages of ROP and to indicate treatment while following progression of the disease. In the group of zone 1 ROP it is necessary to separate transient forms (TF), in which vascularizations reach edges of zone 2, from very posterior forms (VPR), in which vascularizations and pathological changes are present only in zone 1. There were 24 eyes with zone 1 ROP (15 children) treated with combination of transcleral laser photocoagulation and cryotherapy during the years 2000 till 2005 in our series. Five eyes suffered from VPR, 19 eyes from TF. Average follow -up was 24 months. We found better outcomes in eyes with TF treated in pre-threshold stage of ROP (10 eyes) than in threshold stage of ROP (9 eyes). All 5 eyes with VPR developed unfavourable ROP stage IV or V. Zone 1 ROP becomes diagnostic and therapeutic challenge considering growing incidence of surviving of newborns with low or very low birth weight. Treatment initiation during prethreshold stage of ROP as it is supported by ETROP study (Early treatment of ROP) seems to be promising.

[Hemi-hangback recession (retroposition) of extraocular muscles]. / Hemihang-back retropozice okohybných svalu.

In a small clinical study the author evaluates the efficiency of the hemi-hangback recession (retroposition) procedure. This surgical procedure, which weakens extraocular muscles, proceeds from the hangback recession (retroposition) technique (hanging the muscle on a resorbable suture), which combines with the traditional recession. Hemi-hangback recession procedure is suitable in cases when a recession of more than 7 mm is needed. It is experimentally and clinically as well demonstrated in extra large recessions, that a shift towards the original insertion of the muscle occurs. The combination of the classical and hangback recession has its advantages in specific indications. More convenient surgical access and a reduction of the objectionable shift of the muscle backwards are main advantages of this procedure. The surgical procedure is described in this article and results in the group of patients from the Children's and Adult's Department of Ophthalmology at the Faculty Hospital in Motol, Prague, Czech republic. The hemi-hang-back muscles recession is indicated in third and sixth nerve palsies, restrictive forms of strabismus and complicated or successive forms of strabismus.

[Transcleral laser photocoagulation and cryocoagulation of the retina in children with retinopathy of prematurity]. / Transklerální laserová fotokoagulace a kryokoagulace sítnice u retinopatie predcasne narozených detí.

The objective of the work was to compare the effectiveness of transscleral laser photocoagulation and cryocoagulation of the retina in the treatment of retinopathy of premature infants (ROP). During the period from March 1999 to April 2001 at the Ophthalmological Clinic for children and adults in the Motol Faculty Hospital 80 eyes of 40 children with the borderline stage of ROP were treated. In 40 eyes cryocoagulation was performed, in 40 transcleral photocoagulation of the retina. The mean gestation age of the infants on delivery was 28.7 weeks, the postconception age at the time of operation 36.7 weeks. The follow up period varied from 1 to 24 months. All therapeutic provisions were made with premedication and under local anaesthesia. For a stabilized finding without progression we took an adherent retina without subsequent traction changes. Cryocoagulation was successful in 87.5%, laser photocoagulation in 85%. Both methods proved equally effective. In photocoagulation the authors recorded a lower incidence of local complications. General undesirable effects were not recorded in any of the treated children. Transscleral photocoagulation extends contemporary therapeutic possibilities in patients with ROP.

[Hang-back retroposition as a variation in oculomotor muscle weakness]. / Hang-back retropozice jako varianta oslabení okohybných svalu.

In a clinical study the authors evaluate efficiency of the operation on oculomotoric muscles by the hang-back retroposition method. A total of 70 children have been operated on, 52 of the patients suffering from esotropia and 18 from exotropia. The mean preoperation deviation in esotropia was 30 +/- 12 pdpt, the postoperation deviation was in the range of 6 +/- 7 pdpt. In the exotropia cases the preoperation deviation improved from original 76.9%, in the exotropia group being 77.8%. The overall success rate of the hang-back retroposition in all these patients was 77.1%. Ina group of children operated on by a traditional retroposition there was an overall success rate 78.7% (77.6% in esotropia and 82.4% in exotropia cases). Hang-back retroposition has been equally effective as the traditional retroposition of oculomotoric muscles. Its main advantages include visibility of the operation field, minimum risk of perforation of sclera and a fair time factor of the intervention. The authors discuss the development, indications, further advantages but also possible disadvantages or limitations of this acknowledged surgical procedure in strabology.

[New views on aberrant innervation of oculomotor muscles ]. / Nový pohled na aberantní inervace okohybných svalu.

Aberrant innervations of oculomotor muscles are a special group of clinical entities, the common sign of which is an abnormal innervation of the oculomotor muscles with nerve fibres which originally were not meant for this purpose. The majority of these anomalies develops during the embryonic period of lesions at the level of nuclei of cranial nerves or peripheral fibres. Congenital aberrations affect most frequently n. VI, less frequently n. III and rarely n. IV. Acquired affections are most frequent in n. III. Abnormal innervation connections concern not only oculomotor muscles but also muscles engaged in mastication and those of the upper eyelid. Clinically they are manifested as eyelid and facial synkinesias. Among aberrant innervations which lack an uniform terminology belong according to the more recent classification the following clinical units: Duan's syndrome, synergic divergence, double-elevator palsy, misdirection syndrome, Marcus Gunn phenomenon, some forms of congenital fibrous syndrome, trigemino-abducens synkinesia, pseudohyperfunction of the lower oblique muscle, crocodile tears syndrome, and aberrant affection of n. III. The authors describe the course, possible etiology of these anomalies and demonstrate, based on their own observations, clinical cases which can be explained by these mechanisms.

[Screening for threshold stages in retinopathy of prematurity]. / Screening prahového stadia retinopatie predcasne narozených detí.

The authors evaluated retrospectively the examination protocols of 208 children (400 eyes) treated by cryocoagulation on account of active retinopathy of premature infants (ROP). The objective was to assess the optimal timing for the onset of examination to record in time the threshold stages of ROP in children with different grades of maturity. The baseline point was the finding that before the 5th postnatal (pnt) and 31st postconception week (pcw) the threshold stage was not diagnosed in any child of the group. The highest incidence of threshold stages in all children was between the 36th and 37th postconception week. The first examination made between the 5th-6th postnatal or at first during the 31st postconception week is sufficient to cover initial threshold stages of ROP in children with different birth weights. Screening based on combination of the postnatal and postconception age is more accurate than evaluation by one criterion. Premature examinations are misleading and not valid for screening.

[Time factors and instrumental treatment of lacrimal duct obstruction in childhood]. / Casový faktor a instrumentální lécba nepruchodnosti slzných cest v detském veku.

The authors evaluate the effectiveness of probing and rinsing of the lacrimal system in a group of 155 infants and young children (300 eyes) with congenital obstruction of the lacrimal pathways. The mean age during the first treatment was 3.7 months--range 21 days to 24 months. Patency of the lacrimal pathways was achieved in 83.49% of the group. In children treated before the 6th month the passage was restored in 91.30%. The effectiveness of procedures declines with advancing age. In the author's opinion it is best to make the operation between the 4th and 6th month of age. The operation under local anaesthesia ensures in the majority of children a rapid and permanent regression of complaints and a relatively small number of required repeated probings. At a later age the effectiveness of probes or rinsing declines and the solution is rather an indication for intubation of the lacrimal pathways or DCRS. One of the main still open questions for discussion is the optimal age for the operation. The author discusses also views of adverseries of probing and the problem of spontaneous canalization of the lacrimal pathways.

[Treatment of paralysis of cranial nerve VI: evaluation of the Hummelsheim method of transposition surgery of the oculomotor muscles]. / Lécba paralýzy n. VI: zhodnocení transpozicní operace okohybných svalu dle Hummelsheima.

The authors evaluated in a retrospective study the results of surgery in 28 patients with paralysis of the VIth cranial nerve. The standard surgical procedure which was selected as primary achieved orhtophoria in 21 patients. In 7 patients with persisting esotropia and diplopia transposition of the oculomotor nerves according to Hummelshein was indicated. After stabilization of the postoperative finding in all patients parallel position of the eyes and a improved compensatory position of the head was found. Markedly restored motility in abduction was observed only in patient. The method of first choice in treatment of paralysis of the sixth nerve but also of other oculomotor nerves are standard surgical procedures. By retro-position and resection of oculomotor muscles usually a satisfactory state in the primary position is achieved. Transposition operations are rather useful as supplementary operations in previously operated eyes. Indications are persisting diplopia and esotropia. Postoperative results as regards the primary position of the eyes are satisfactory but usually marked improvement of the motility cannot be foreseen.

[Pars plana vitrectomy in retinopathy of prematurity]. / Pars plana vitrektomie u retinopatie predcasne narozených detí.

UNLABELLED: Retinopathy of prematurity (ROP) is a proliferative retinopathy which affects pre-term infants. ROP occurs primarily at the advancing edge of vascularization and consists of arrested spread of vessels, proliferation of endothelial cells, formation of arteriovenous shunt and in some cases, neovascularization. To date only the surgical approach for advanced ROP is acceptable, other ways are still in experimental stages of development. PURPOSE: Because of the early development of fibrovascular proliferative tissue, vitreous surgery before the fovea is pulled anteriorly, may lead to successful results. METHODS: Data from literature and own experiences lead the authors to use retinal re-attachment procedures to restore normal anatomic relation between the retina and choroid in affected eyes. RESULTS: 6 cases demonstrated that retinal detachments caused by fibrous proliferations that pull the retina upward to a fibrotic membrane on the posterior lens capsule can be treated successfully. CONCLUSION: Stages ROP when the retinal detachment threatening fovea are recommended for successful surgical repair of retinal detachment in ROP only.

[Treatment of scleral staphyloma by fixation of a fascial graft with Tissucol]. / Osetrení sklerálního stafylomu fixací fasciálního stepu Tissucolem.

The authors describe the successful procedure used in treatment of a scleral staphyloma which developed on the hydrophthalmic bulbus of a three-year-old child three months after pars plana lensectomy. They covered the defect by an allogenic fascial graft and fixed it with the fibrin tissue glue Tissucol. The method is quick, simple and reliable.

[Results of treatment of glaucoma associated with aniridia]. / Výsledky lécby glaukomu u aniridie.

The authors evaluate retrospectively the therapeutic results in secondary glaucoma with aniridia in 11 children (22 eyes) investigated since 1985. The mean age of the patients was 6.8 years. The examination under general anaesthesia was made in 10 children already during their first year and check-up examinations followed after 3-6 month intervals. Treatment of glaucoma was started by medicamentous therapy. If the effect was inadequate, cyclocryotherapy and trabeculectomy were used. Thirteen eyes are compensated by medicamentous treatment only, while surgical intervention was necessary in nine eyes of five children. A total of 20 operations were made, 12 times cyclocryotherapy and 8 times trabeculectomy, whereby the glaucoma is at present compensated in six operated eyes. A total of 19 eyes are compensated. The mean follow up period is 47 months in the operated patients and seven years in patients having medicamentous therapy. The analysis revealed that secondary glaucoma in aniridia can be compensated by mere medicamentous treatment for a number of years. If surgery is inevitable, cyclocryotherapy and trabeculectomy are only relatively successful.