[Comparison of visual acuity and higher-order aberrations after standard and wavefront-guided myopic femtosecond LASIK]. / Porovnání zrakové ostrosti a aberací vyssích rádu u myopických ocí po Femto-LASIK pri pouzití standardní a wavefront-guided ablace.

PURPOSE: To analyze and compare visual acuity, refractive outcomes and higher-order aberrations after standard and wavefront-guided Femto-LASIK at 1, 3, and 12 months postoperatively. METHODS: Study of 95 consecutive eyes of myopic patients (-0.5 to -7.0 D), who underwent Femto-LASIK with standard ablation profile (STA) (49 eyes) or wavefront-guided ablation (WFG) (46 eyes) using femtosecond laser LDV Ziemer and excimer laser MEL 80 Zeiss with iris registration. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction and higher-order ocular aberrations (HOAs). HOAs were measured with Hartmann-Shack wavefront aberrometer WASCA, HOAs analyzed at 6 mm pupil, assessed total HOAs root mean square (RMS HOAs) and individual Zernike coefficients. RESULTS: Preoperatively, there were no significant differences between STA and WFG groups in UDVA, CDVA, manifest refraction or HOAs. As compared with preoperative values, spherical aberration Z(4,0) increased by 0.24 µm in both groups and it is the main increasing factor of RMS HOAs (0.05 µm in STA group and 0.08 µm in WFG group). Safety and efficacy index is 1.0 in both ablation profiles. Postoperatively, median UDVA and CDVA achieved 1.2. No patient lost line of CDVA at 12 month postoperatively. All patients were within ± 0,5 D of emmetropia at 12 months. Significant differences were not found between STA and WFG in UDVA, CDVA, manifest refraction or HOAs at 1, 3 and 12 month. CONCLUSIONS: Both wavefront-guided and standard Femto-LASIK with LDV and MEL 80 platform have shown very good efficacy and safety. Myopic Femto-LASIK only slightly increases RMS HOAs, especially by induction of spherical aberration. Both methods have equivalent postoperative aberration score one year postoperatively.Key words: femtosecond LASIK, higher-order aberrations, wavefront-guided, visual accuity.

[Comparison of the threshold interpolation and whole-line method on logMAR chart and Snellen chart for visual acuity testing]. / Porovádní prahové interpolacní a celorádkové metody pri testování zrakové ostrosti na optotypových tabulich logMUR ETDRS a Snellen.

The main goal of our study was to prove the statistical significant difference between the threshold interpolation logMAR method on ETDRS chart and the whole-line method on Snellen chart with Sloan letters. We had 108 measurements with the threshold interpolation method and the whole-line method on ETDRS chart and the whole-line method on Snellen chart. The average value measured with the threshold method in ETDRS was 1,132 (min. 0,660, max. 1,580), with the whole-line method on ETDRS it was 1,134 (min. 0,630, max. 1,580) and with the whole-line method on Snellen chart it was 1,183 (min. 0,630, max. 1,600). We have proved statistical significant difference between the threshold interpolation method made on ETDRS chart and the whole-line method made on Snellen chart (p < 0.001). The values measured with the whole-line method on Snellen chart were overvalued. The exact and reliable measuring of visual acuity is an important component of further examinations (e.g. contrast sensitivity, perimetry, tonometry), which enable us to make a correct diagnosis of pathological changes on human eye structures.

[Macular edema after an uncomplicated cataract surgery]. / Makulární edém po nekomplikované operaci katarakty.

PURPOSE: To characterize the macular thickness changes after an uncomplicated cataract surgery measured by means of optical coherence tomography (OCT), to specify the incidence of cystoid macular edema (CME), and to attempt to establish a correlation between the retinal thickening after an operation and possible risk factors for its development. PATIENTS AND METHODS: This study comprised 100 patients (64 women and 36 men) with the mean age of 70 (70.08 +/- 9.37 [SD] years; range, 44-85 years). All patients underwent uneventful phacoemulsification, which was followed by in the bag intraocular lens implantation. The real phacoemulsification time and the duration of the entire surgical procedure were recorded. The operated eye was set into the study group; the contralateral, non operated eyes formed a control group. The patients were clinically assessed with Stratus OCT examination preoperatively, and on day 1, in week 1, and in months 1, 2, 3 and 6 postoperatively. Foveal (central area 1mm in diameter), inner macular (ring area between 1mm and 3mm in diameter), outer macular (ring area between 3mm and 6mm in diameter) thickness and macular volume were analyzed. RESULTS: An increase in retinal thickness and macular volume after the cataract surgery reached the maximum in months 1 and 2 in all examined areas. Since month 3 on, there was a progressive decrease of abnormal retinal thickness and macular volume. An increase in retinal thickness was proved to be most prominent in the inner macular area. An increase in macular volume and retinal thickness in inner and outer macular area were statistically significant in months 1, 2 and 3 (Student t-test, p < 0.001; [p = 0.01 for the data in month 3]), while an increase in retinal thickness in foveal area was statistically significant in months 1 and 2 (Student t-test, p < 0.05). Six months after the surgery, the difference was not statistically significant in any of the examined areas. Three patients (3 %) developed CME after the phacoemulsification, but in one patient (1 %) only the clinical CME with some degree of a visual loss 1 month after the surgery (BCVA = 0.5) was diagnosed. There was a positive statistical correlation between the real phacoemulsification time and the increase in macular volume and retinal thickness in fovea and inner macular area in week one, and in months one and two after the surgery (Spearman's correlation test, p < 0.05). A positive statistical correlation was also found between the overall duration of the surgical procedure and the increase in macular volume and retinal thickness in all areas one month after the surgery (Spearman's correlation test, p < 0.05). CONCLUSION: The results indicate that changes in retinal thickness in macular area must be taken into account even after an uncomplicated cataract surgery. The increase in retinal thickness and macular volume reached the maximum in months 1 and 2 and tends to decrease since month 3 on. There is a positive statistical correlation between the retinal thickness increase and the real phacoemulsification time as well as between the retinal thickness increase and the overall duration of the surgical procedure. The incidence of CME was 3 %, but clinically significant CME was detected in 1 % of the cases only. Topical application of non-steroid, anti-inflammatory drugs can be important to effectively prevent the CME development after an uneventful cataract surgery.

[Macular edema after cataract surgery in diabetic patients without retinopathy]. / Makulární edém po operaci katarakty u diabetiku bez diabetické retinopatie.

PURPOSE: To study the effect of phacoemulsification on the development of macular edema and diabetic retinopathy in diabetic patients without preoperative retinopathy. PATIENTS AND METHODS: This study comprised 86 patients; 26 diabetics, who had no clinically detectable diabetic retinopathy preoperatively, formed a study group and 60 non-diabetics were included into the control group. Diabetes mellitus duration, preoperative hemoglobin A1c level, and diabetes treatment method were recorded in diabetics. Monocular cataract surgery was performed in all patients. The patients were clinically assessed with OCT examination preoperatively, and postoperatively on day 1, in week 1, and in months 1, 2, 3 and 6 respectively. Foveal, inner macular, outer macular thickness, and macular volume were analyzed. RESULTS: The increase of the retinal thickness after the cataract surgery reached maximum in both groups in months 1 and 2. Since month 3 on, there was a progressive decrease in abnormal retinal thickness. There was a significant major increase in retinal thickness in diabetics in all examined areas in month 2 (p < 0.05 for fovea and inner macula; p = 0.001 for outer macula and p = 0.005 for macular volume changes). Trend toward major increase in retinal thickness in diabetics was still evident even three months after the surgery. In no case did a diabetic eye develop clinically detectable diabetic retinopathy during the follow-up period. The correlation between hemoglobin A1c level and retinal thickness changes in diabetics was not significant. There was also no significant difference in final visual acuity between diabetics and non-diabetics. CONCLUSION: We can expect similar induced retinal thickness changes in diabetics without retinopathy as in non-diabetics after uneventful cataract surgery, though there was a trend toward major increase in retinal thickness in diabetics.

[The influence of IOL implantation on visual acuity, contrast sensitivity and colour vision 2 and 4 months after cataract surgery]. / Vliv implantace IOL na zrakovou ostrost, kontrastní citlivost a barvocit za 2 a 4 mesíce po operaci katarakty.

PURPOSE: To assess the change in visual acuity, contrast sensitivity and colour vision in relation to the time after cataract surgery and to the type of implanted IOL, and to compare visual functions by patients with one and two pseudophakic eyes. METHODS: 45 cataract patients were examined before and then 2 and 4 month after the cataract surgery. Visual acuity (VA) was tested on logMAR optotype chart with Landolt rings, contrast sensitivity (CS) was tested on the Pelli-Robson chart and the SWCT chart. For colour vision (CV) testing, the standard Farnsworth D-15 test and the desaturated Lanthony D-15 test were used. The patients were divided into two groups--a group with one pseudophakic eye and a group with two pseudophakic eyes, and also according to the type of IOL--PMMA or hydrophobic acrylate that had been implanted. Control group was composed of phakic subjects with no ocular pathology. RESULTS: After the cataract surgery, in both groups there was a significant improvement in monocular and binocular VA (p < 0.05), in monocular and binocular CS using both types of charts--Pelli-Robson (p < 0.05) and SWCT in all the spatial frequencies (p < 0.05). Also, a significant decrease in the number of minor errors in the standard Farnsworth D-15 test (p < 0.05) as well as a substantial decrease in the number of minor and major errors in the desaturated Lanthony D-15 test (p < 0.05) and an overall improvement of CV (p < 0.05) were detected. There was no difference between the results 2 and 4 month after the surgery, except for CS in 12 c/deg (p < 0.05). The patients with two pseudophakic eyes had postoperatively better binocular VA and CS in the spatial frequencies of 12 c/deg and 18 c/deg and attained postoperative values comparable to those of control subjects. No significant difference in VA, CS or CV was found between the PMMA and hydrophobic acrylate intraocular lenses. CONCLUSION: After the cataract surgery, the visual functions tested by means of psychophysical methods of VA, CS and CV significantly improve and are stable 2 month after the surgery. The second eye surgery improves binocular visual functions the level of which doesn't differ from that of normal phakic subjects. There was no influence of the type of IOL on final state of VA, CS or CV.

[The influrence of visual acuity and contrast sensitivity on subjective evaluation of visual function before and after cataract surgery]. / Vliv zrakové ostrosti a kontrastní citlivosti na subjektivní hodnocení zrakových funkcí pred a po operaci katarakty.

PURPOSE: To assess the influence of visual acuity and contrast sensitivity on subjective evaluation of visual function investigated by means of questionnaires in patients before and after cataract surgery. METHODS: Visual acuity was tested on Snellen projection optotypes and logMAR optotype chart with Landolt rings, contrast sensitivity was tested on Pelli-Robson chart. The questionnaire included Visual Functioning Index VF-14, Cataract Symptom Score and Global Measures of Vision--self-reported trouble and satisfaction with vision. 37 cataract patients were examined, including completing the questionnaire, 1 day before and 7 weeks after the surgery. RESULTS: Most patients (65%) suffer from moderate troubles with their vision and are moderately dissatisfied (51%) before cataract surgery. After the surgery, a majority of patients have no troubles (51%) and are very satisfied (54%). Visual acuity (VA) correlates only with VF-14, namely only VA of non-operated eye (p < 0.01), binocular VA before (p < 0.001) and after surgery (p < 0.05). Contrast sensitivity (of non-operated eye, operated eye, binocular) correlates with more subjective parameters (VF-14, self-reported trouble and satisfaction with vision), namely both before and after the surgery (p < 0.05, p < 0.01, p < 0.001). CONCLUSION: After cataract surgery, visual acuity, contrast sensitivity and subjective parameters of visual functions significantly improve. Subjective parameters correlate more with contrast sensitivity then with visual acuity. Contrast sensitivity is more related than visual acuity to real world in patients with cataract.

A concurrent occurrence of cutis laxa, Dandy-Walker syndrome and immunodeficiency in a girl.

UNLABELLED: We report on a 17-y-old girl with inherited cutis laxa, immunodeficiency and Dandy-Walker syndrome. Immunodeficiency manifested itself by decreased and fluctuating levels of IgG, IgA and IgM and intermittent leucopenia causing increased susceptibility to respiratory tract infections. Dandy-Walker syndrome (agenesis of the cerebellar vermis with a large posterior fossa cyst communicating with an enlarged 4th ventricle) was shown on a CT scan but with the exception of macrocrania, no typical signs or symptoms were observed at the age of 17. Loose hyperextensible skin with pendulous skinfolds as a manifestation of cutis laxa was observed from birth. Anomalies of the right pulmonary artery, abnormal branching of the left arteria subclavia (arteria lusoria) from the left aortic arch and bicuspidal aortic valve were also present. CONCLUSION: The combination of the rare disorders cutis laxa, Dandy-Walker syndrome and immunodeficiency is reported here for the first time.