[Clinical results of the aphakia correction by means of secondary implantation of the iris-fixated anterior chamber intraocular lens]. / Klinické výsledky korekce afakie sekundární implantací na duhovku fixované prednekomorové cocky.

The authors refer about the results of the secondary implantation of the anterior chamber intraocular lens (AC IOL) Artisan Aphakia. Those specially constructed iris claw lenses for aphakia correction, fixated on the iris, were implanted at the Department of Ophthalmology in Hradec Králové (Königgrätz, Czech Republic) during the period August 2002-May 2005 in 51 cases (51 eyes, 48 patients). The most common indication (33 % of cases) was the previous trauma with lens damage and consequent postoperative aphakia. The second most common cause (in 29 %) of AC IOL use was the absence of the lens after the posterior segment surgery due to the retinal detachment. In 18 % of cases the aphakia was as a result of the complicated intracapsular or extracapsular cataract extraction. The other indications (20 %) for the AC IOL implantation are patients with subluxated their own (natural) lens in Marfan's syndrome; after posterior segment surgery due to the intravitreal hemorrhage with primary cataract extraction without the IOL implantation; and after the luxation of the artificial intraocular lens or the lens remnants as a primary complication after the cataract surgery. The average patients' age at the time of surgery was 59 years (range, 8-86 years). Men participated in 70.6 % of cases. In the group of patients, there was one child as well. Before the surgery, the average spherical refractive error was +9.8 +/- 2.2 diopters (D) (range, 3-15 D), the average uncorrected visual acuity was 0.05 +/- 0.09; the best-corrected visual acuity was 0.42 +/- 0.29. No complication during the surgeries was noticed. The followed parameters were visual acuity, refraction, AC IOL position, and occurrence of complications. The average follow-up period was 13.0 months (range, 2-30 months). After the surgery, the average spherical refraction decreased to -0.5 +/- 1.62 D. The uncorrected visual acuity was 0.27 +/- 0.23 and the best-corrected visual acuity was 0.43 +/- 0.28. As complications, we noticed the secondary glaucoma in three cases, in two cases bleeding into the anterior chamber, in 5 cases iritis, and in one case the subluxation of the artificial lens.

[The use of the toric intraocular lens in treatment of complicated cataract and high degree astigmatism]. / Vyuzití torické nitroocní cocky pri re- sení komplikované katarakty a vyso- kého stupne astigmatismu.

The authors refer about highly effective and in our ophthalmology not yet described method of surgical treatment of complicated cataract in patients with high degree of preexisting astigmatism over 3.0 cylindrical diopters. According to the etiology of astigmatism, in the group, there are patients with cataract and high ametropia after previous corneal transplantation and patients with cataract and preexisting high ametropia without any previous surgery. The referred group consists of 14 patients (19 eyes), and 9 of them (9 eyes) underwent in the past penetrating keratoplasty (PK) due to keratoconus at our department. The common sign of this subgroup was unsatisfactory postoperative refraction and later on the progressive cataract development. The other part of the group consisted of 5 patients (5 eyes) and they underwent no surgery in the past. For the surgical treatment of cataract and astigmatism at once we have used the individually manufactured silicone toric intraocular lens made by the company Human Optics (type MS 6116 TU). The average age of the whole group at the time of the cataract surgery was 51.5 +/- 6.8 years (range, 39-66 years). The group consisted of 8 women (57.1%) and 6 men (42.9%). The average duration of the period between the keratoplasty and the cataract surgery was 4.8 +/- 3.6 years. The uncorrected visual acuity before the cataract surgery was 0.10 +/- 0.11, and the best-corrected visual acuity was 0.39 +/- 0.22. The average value of the preoperative refractive error was +3.4 +/- 5.0 dioptres (range, -11.0 to +10.0 dioptres) and -6.4 +/- 2.3 cylindrical dioptres (range, -12.0 to -3.0 cylindical dioptres). The average follow up period was 9.6 months (range, 4-18 months). In the postoperative period we noticed improving of the uncorrected visual acuity to the value 0.50 +/- 0.26, and the best-corrected visual acuity improved finally to 0.56 +/- 0.26. The final average refractive error decreased to 0.44 +/- 0.86 dioptres and -1.8 +/- 0.77 cylindrical dioptres.

[The use of accommodative lenses for surgical correction of the presbyopia using the Prelex method]. / Pouzití akomodacních cocek k chirurgické korekci presbyopie metodou Prelex.

The authors refer about their experience with the surgical correction of the presbyopia by means of the Prelex (presbyopic lens exchange) method. Patients, who underwent this type of refractive surgery procedure to decrease their dependency on glasses correction for far as well as for near vision (12 patients, 23 eyes) and 1 young female patient (2 eyes) with juvenile cataract and high hyperopia, were included in the study. The average age at the time of the surgery was 51.0 +/- 5.5 years (range, 19-77 years). The average follow up period of the whole group of patients is 9.8 months (range, 1-13 months). Depending on the type of the lens implanted, the group was divided into subgroup A with the accommodative lens 1 CU produced by Human Optics Company implanted, and subgroup B with the accommodative lens Kellan TetraFlex KH 3500 produced by LensTec Company implanted. The subgroup A consists of 8 patients (15 eyes) with the average preoperative refractive error +2.35 +/- 3.45 diopters. The average uncorrected visual acuity of this group was 0.24 +/- 0.18, and the average best-corrected visual acuity was 0.77 +/- 0.22 at the time before the surgery. The average glasses correction for near was +4.1 dioptres, and the uncorrected vision for near was Jaeger's table Nr. (J) 13. The B subgroup consists of 5 patients (10 eyes). The average preoperative refractive error was +2.23 +/- 0.93 diopters. The average value of the uncorrected visual acuity before the surgery was 0.43 +/- 0.28, and the average corrected visual acuity was 0.82 +/- 0.25. The average value of the glasses correction for near was +5.25 and uncorrected vision for near J 13. The final average postoperative error at the time of the last visit was in the A subgroup +0.06 +/- 1.17 dioptres. The average uncorrected visual acuity was 0.69 +/- 0.24, and the average best-corrected visual acuity 0.96 +/- 0.12. The average vision of the patients of this subgroup for near was J 3. In the B subgroup we found at the last visit the average final value of the postoperative refractive error -0.2 +/- 0.72 dioptres. The average uncorrected visual acuity 0.57 +/- 0.22 and the average corrected visual acuity 0.95 +/- 0.12. Average uncorrected vision for near was J 5. We did not notice any serious per- or postoperative complication of this procedure.

[Correction of the astigmatism with the Artisan phakic toric lens]. / Korekce astigmatismu pouzitím cocky Artisan Phakic Toric.

The implantation of the intraocular anterior chamber phakic toric lens (PTIOL) Artisan, a product of the Ophtec company, is one of the most up-to-date methods of the correction of higher degree of myopic as well as hyperopic astigmatism. The authors refer about the results of PTIOL Artisan implantation in 6 patients (10 eyes). The major indication was the hyperopic astigmatism--in 5 patients (8 eyes); in one patient the indication was myopic astigmatism. In the followed up group of patients, there is the preponderance of men (5), and one woman only. The patients were divided into two subgroups: one with myopic astigmatism (1 patient, 2 eyes) and other with hyperopic astigmatism (5 patients, 8 eyes). The average age of the whole group at the time of the surgery was 27.7 +/- 2.8 years (range 23-38 years) and the average follow up period was 13.0 +/- 6.9 months (range 6-22 months). In the group the patients with follow up period shorter than 6 months were not included. The average preoperative spherical refractive error was +4.8 +/- 2.25 dioptres (D) and the average astigmatic error was -5.15 +/- 2.82 cylinders (Dcyl). In one case of myopia, the preoperative refractive error in both eyes was -7.0 D and -3.5 Dcyl. The target refraction was emetropia +/- 1.0 D. The authors evaluate the final uncorrected and best-corrected visual acuity (UCVA, BCVA), final postoperative refractive error, presence of intra- as well as postoperative complications, and changes of endothelial cells' density over time. The average final postoperative error in patients with hyperopic astigmatism was +0.72 +/- 0.93 D and -1.08 +/- 0.60 Dcyl. In the only patient with myopic astigmatism the final postoperative error of both eyes was +0.5 D and -0.5 Dcyl. The advantage of the PTIOL implantation is fast visual recovery, potential reversibility of the procedure, maintaining of the accommodation, and stability of the postoperative refraction.

[Effect of adjustment of corneal running sutures on cylindrical refraction after perforating keratoplasty]. / Vliv adjustace pokracujícího rohovkového stehu na cylindrickou refrakci po perforující keratoplastice.

Authors refer about the effect of adjusting (adjustment of the suture tension) of the running corneal suture on the final cylindrical refraction in patients who underwent penetrating keratoplasty due to keratoconus. In our article we evaluate two groups of patients. The group I consists 76 patients (76 eyes) who regularly visited our department of ophthalmology. There were 52.6% of females and 47.4% of males. The average age at the time of surgery was 33.5 +/- 5.2 years (range, 18-52 years). In this group of patients, the adjusting was performed during the surgery. In the group II 35 patients (40 eyes) underwent the adjusting procedure of the running corneal suture in the early postoperative period. There were 19 (54.0%) women and 16 (46.0%) men. The average age of the whole group at the time of surgery was 34.6 +/- 3.8 years (range, 18-50 years). The indication to carry out the adjusting was topographically verified astigmatism of more then 3.5 cylindrical diopters (D cyl). The purpose of this study was to find the ultimate surgery technique to get not only the clearness and good healing of the corneal graft, but first of all to prevent extensive ametropia already during the surgery. In the early stage after the surgery we are trying to reduce emerged refractive error and to get faster recovery of good visual acuity of the operated eye. In the sense of the least final postoperative astigmatism, the best results we have reached in cases where the donor corneal graft was 0.25 mm larger in diameter and the suture was adjusted during the surgery using light circles according to Serdarevic. In this group of patients the average final cylindrical refractive error after the surgery was 2.00 +/- 0.81 D cyl. When adjusting the corneal suture in postoperative period, the mean final refractive error decreased of about 3.09 +/- 1.62 D cyl.

[Implantation of multifocal intraocular lenses]. / Implantace multifokální nitroocní cocky.

The authors refer to the first experience in implantation of multifocal intraocular lens (MIOL) AMO ARRAY (model SA 40 N) produced by Allergan to a group of 35 patients (69 eyes). The proportion of men in the group was 42.9%, women being 57.1%. The mean age of the group was 50.9 +/- 4.3 year, range 36-71 years. The implantation of this type of intraocular lens was made due to a refractory intervention on a clear lens in 84.0% eyes and operation on cataract in 16.0%. The study was aimed at evaluation of the results of visual acuity for short and long distances, resulting refraction after the operation, the occurrence of side visual phenomena and their tolerance by the patient, necessary supplementary eyeglass correction especially in patients after refraction lensectomy. Uncorrected visual acuity for long distances 0.7 or better was in 75.9% of patients. Sixty one % of patients with MIOL in both eyes do not require glasses for vision into short distances (No 1-3).

[Photorefractive keratectomy in hypermetropia]. / Fotorefrakterní keratektomie u hypermetropie.

AIM: To evaluate the results in patients with hypermetropia having undergone photoreactive keratectomy (PRK). GROUP AND METHODS: The authors present a retrospective analysis of the results in 40 eyes operated on PRK in the period of September 1997 to November 2002 at the Eye Clinic of the Faculty Hospital in Hradec Králové. The mean preoperation spherical refraction was 2.90 +/- 0.98 dioptry (D), the mean astigmatism being -0.82 +/- 0.78 D, visual uncorrected visual acuity (NZO) 0.37 +/- 0.37, the mean corrected visual acuity (KZO) 1.28 +/- 0.27). RESULTS: One year after the operation on 31 eyes, the resulting mean spherical refraction was 0.76 +/- 1.10 D, the mean astigmatism being -1.01 +/- 0.80 D, NZO 0.77 +/- 0.18, KZO 0.99 +/- 0.21, NZO 6/12 and better was detected in 94% of surgically treated eyes. CONCLUSION: The PRK method has been found sufficiently effective for the correction of low and medium hypermetropia.

[Refractive surgery in myopia up to -6D]. / Refrakcní operace u myopu do -6 D.

OBJECTIVE: To evaluate the clinical results in patients with myopia up to -6 dioptres (D) after refraction surgery, evaluate their stability and compare photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). MATERIAL AND METHODS: The authors evaluated before and after surgery the refraction values in patients with myopia up to -6 D operated in 1999 and 2000. The patients were subjected to standard examination before operation, one week, 1, 3, 6 and 12 months after operation. The group comprised a total of 542 eyes, 452 PRK eyes and 90 LASIK eyes. RESULTS: After PRK surgery the mean spherical refraction after one year was -0.35 +/- 0.71 D, the mean astigmatism -0.63 +/- 0.38 D, UCVA 0.90 +/- 0.19, BCVA 0.98 +/- 0.11. After LASIK surgery after one year the mean spherical refraction was -0.10 +/- 0.81. D, the mean astigmatism -1.05 +/- 0.65 D, UCVA 0.80 +/- 0.24, BCVA 0.86 +/- 0.21. CONCLUSION: Both methods proved effective and safe for correction of myopia up to -6 D. The results at our clinic are comparable with other departments and are stable in different years. PRK and LASIK achieve equal postoperative results after an interval of 3 to 6 months following surgery.

[Long-term results of photorefractive keratectomy in myopia up to -6 D]. / Dlouhodobé výsledky fotorefraktivní keratektomie u myopu do -6 D.

OBJECTIVE: To present clinical results of patients with myopia up to -6 dioptres (D) after photorefractive keratectomy (PRK) and evaluate their stability during a 4-year period. MATERIAL AND METHODS: The authors evaluated retrospectively the refraction before and after surgery in patients with myopia up to -6 D during the period from September 1997 till December 2000. The group comprised a total of 847 eyes. The mean spherical refraction during the whole follow up period was before surgery -3.61 +/- 1.17 D, the mean astigmatism was -0.65 +/- 0.63 D, non-corrected visual acuity (UCVA) 0.09 +/- 0.09, the visual acuity with optimal correction (BCVA) 1.21 +/- 0.30. RESULTS: One year after PRK we achieved in our group a mean spherical refraction of -0.17 +/- 0.74 D, a mean astigmatism of -0.61 +/- 0.43 D, UCVA 0.92 +/- 0.25, BCVA 1.02 +/- 0.19. CONCLUSION: Photorefractive keratectomy is an effective and safe method for correction of myopia up to -6 D. The results as regards refraction were comparable with other departments and did not differ much during individual years. Stabilization occurs 3-6 months after the operation.

[Results of 32 cataract operations using the capsular ring]. / Výsledky 32 operací katarakty s pouzitím kapsulárního prstence.

The authors present results of 32 operations with capsular tension ring performed in eyes with zonular dehiscence. There were 14 women (50%) and 14 men (50%), altogether 28 patients (32 eyes). Mean patient age was 47.1 years (range 22-89 years). The reason for zonular weakness was trauma in 15 eyes (46.9%), Marfan's syndrome in 8 eyes (25.0%), pseudoexfoliation syndrome in 6 eyes (18.7%) and high myopia in 3 eyes (9.4%). Anterior vitrectomy was done if the vitreous appeared in the anterior chamber. Early postoperative complications were fibrinoid reaction in 2 eyes (6.3%), intraocular pressure elevation in 5 eyes (15.6%), hyphaema in 2 eyes (6.3%). Best corrected visual acuity was 0.5 or better in 18 eyes (56.3%) on the first postoperative day and in 17 eyes (53.1%) at the time of the last examination. Our results have shown the high efficiency of the capsular tension ring in managing zonular problems during cataract surgery.

[Results of a prospective clinical study of 150 implanted AcrySof lenses]. / Výsledky prospektivní klinické studie 150 implantovaných AcrySof cocek.

The authors present results of a prospective clinical study with 150 foldable acrylic intraocular lenses AcrySof (Alcon Pharmaceuticals, Ltd.). There were 70 women and 63 men, altogether 133 patients (150 eyes). All lenses were implanted in the bag through 3.5 mm corneal self sealing tunnel incision. Best corrected visual acuity was 6/9 or better in 119 eyes (79.3%) on the first postoperative day and in 128 eyes (85.3%) one year after surgery. Induced astigmatism was up to 0.5 D in 91 eyes (60.7%) on the first postoperative day and in 125 eyes (83.3%) six months after surgery. Posterior capsule fibrosis occurred only in 4 eyes one year after surgery and in 2 eyes Nd:YAG kapsulotomy was done. We have not seen any serious complications. Assessment of the results with AcrySof implantation has shown excellent results, especially very low rate of secondary cataract.

[Clinical results in 100 corneal transplantations]. / Klinické výsledky 100 transplantací rohovky.

The authors refer clinical results of 100 consensual penetrating keratoplasties performed at the Department of Ophthalmology, University Hospital, Hradec Králové, in the year 1997. There were 55 women (55%) and 45 men (45%). The mean age of the patients was 58 years (range 18-84). The operation was performed for keratoconus in 24 eyes (24%), pseudophakic or aphakic endothelial failure in 18 eyes (18%), primary endothelial failure in 14 eyes (14%), traumatic changes in 18 eyes (18%), post-inflammatory changes in 7 eyes (7%). The repeated transplantation was performed in 19 cases (19%), for rejection of the previous graft in 18 eyes (94.7%) and for refractive error in 1 eye (5.3%). The average follow-up period was 10 months (range 6-17 months). For the control analysis 74 patients (74%) were available. The best corrected visual acuity was 6/6-6/18 in 21 eyes (28.4%) and 6/24-6/60 in 15 eyes (20.3%). Postoperative complications comprised rejection of the graft in 17 patients (23.0%), endophthalmitis in 3 patients (4.1%) and secondary glaucoma in 4 patients (5.4%). The results of this study indicate that despite the advantages achieved on this field, there is still scope for improvement.