Ceska a Slovenska Oftalmologie最新文献

Purpose:  To compare the anatomical and functional outcomes, surgical duration, and complication rates between chandelier-assisted segmental scleral buckling (SB) and conventional SB in the treatment of primary rhegmatogenous retinal detachment (RRD).

Material and methods:  This retrospective comparative study included 19 phakic patients with primary RRD who underwent either conventional SB (Group 1, n = 9) or chandelier-assisted segmental SB (Group 2, n = 10). Patients were selected based on specific inclusion criteria including presence of anterior retinal breaks and PVR ≤ Grade C1. Group 1 underwent standard 360-degree SB with indirect ophthalmoscopy, while Group 2 underwent segmental SB with limited peritomy and chandelier-assisted wide-angle visualization under a surgical microscope. Primary outcomes included best-corrected visual acuity (BCVA) and anatomical reattachment at 1-year follow-up. Secondary outcomes included surgical duration and epiretinal membrane (ERM) formation.

Results:  Both groups demonstrate successful retinal reattachment in all cases and significant improvement in BCVA at one year, with no statistically significant intergroup difference. Mean surgical duration was significantly shorter in the chandelier-assisted group (35.1 ±21.2 minutes) compared to the conventional group (70.2 ±23.2 minutes, p.

Aims: To evaluate the prevalence of uveitis and ocular complications in children with juvenile idiopathic arthritis (JIA) and "JIA-like" form. To determine the onset of ocular symptoms in relation to the diagnosis of the underlying disease and identify the most common predictive factor preceding the onset of uveitis.

Materials and methods: Retrospective analysis of medical records of children with JIA and JIA-like uveitis monitored at the Pediatric Rheumatology and Ophthalmology Clinic at the University Hospital Ostrava between 2016-2024. Observed parameters included the child's age at the time of diagnosis of JIA or JIA-like uveitis, laboratory tests, ocular findings, age at the onset of uveitis symptoms, time correlation with the diagnosis of the underlying disease, ocular complications of recurrent uveitis attacks and overall treatment of the underlying disease.

Results: There were 27 children in the group with confirmed JIA, with an average age of 5 years. Ten patients were diagnosed with anterior or posterior uveitis. The average age at the time of JIA diagnosis was 6 years. The mean time interval from JIA diagnosis to the appearance of pathological ocular findings was 38 months. Ocular complications were recorded in 50% of children, most commonly cataracts (40%). All children with uveitis were laboratory positive for ANA antibodies. There were 8 patients with JIA-like uveitis, with an average age of 9 years. All children showed signs of anterior or posterior uveitis, which was manifested on average at 8.5 years of age. Exclusion of JIA diagnosis was established on average 6 months after the appearance of ocular pathology. Ocular complications were observed in 88% of children, most frequently posterior synechiae (63%). Laboratory findings showed ANA antibody positivity in 88% of children with uveitis.

Conclusion: Regular ophthalmological examinations in JIA patients are essential due to the potential occurrence of complications, which are more frequent in young females with JIA-like uveitis and ANA antibody positivity.

Objective: The aim of this study was to evaluate the outcomes of Ozurdex® (DEX) implant in patients with diabetic macular edema (DME) in real-world clinical practice, and to determine the correlation between known OCT biomarkers and the effect of treatment.

Material and methods: This retrospective study included 42 eyes of 33 patients (16 women, 17 men) treated with DEX at the Department of Ophthalmology, Faculty of Medicine and Dentistry of Palacký University and University Hospital Olomouc for DME indication between 2020 and 2023. Follow-up examinations were conducted at 1, 3, and 6 months after the first DEX application. The main assessed parameters were: best-corrected visual acuity (BCVA), intraocular pressure (IOP), central retinal thickness (CRT), OCT biomarkers. The results were subsequently statistically evaluated.

Results: At the first follow-up after DEX application, there was an average decrease in CRT of 186 ±146µm and a gain of 3 ±7 letters. Positive morphological and functional responses were observed in 39 eyes (92.9%) and 23 eyes (54.8%) respectively. The disorganization of retinal inner layers (DRIL) biomarker was initially present in 41 eyes (97.6%), with reduction or disappearance observed in 13 eyes (31%) post-application. Eyes with ellipsoid zone disruption (EZ disruption) had an average initial BCVA of 49.6 letters, compared to 57.8 letters in the group without this biomarker. The mean gain in BCVA was +8.7 letters in treatment-naive eyes and +2.1 letters in previously treated eyes. Chronic DME was less frequent in treatment-naive (n = 1, 14.3%) compared to previously treated eyes (n = 28, 84.8%). All these results were statistically significant (p < 0.05). An increase in IOP post-DEX application occurred in 9 patients (21.4%).

Conclusion: Our results confirm DEX as a safe and effective treatment option for DME. Treatment-naive patients achieved better functional outcomes. We confirmed ellipsoid zone disruption (EZ disruption) as a negative biomarker. Additionally, we demonstrated the capacity of DEX to reduce disorganization of the retinal inner layers (DRIL).

Aims: To demonstrate the relationship of dependency between the thickness of the retinal nerve fiber layer and the functional sensitivity of the retina in healthy young individuals. We also secondarily investigated the relationship between refractive error and mean retinal thickness in the macula.

Material and methods: The basic cohort contained 30 subjects with an average age of 23.4 ±4.2 years. These were young, generally healthy individuals without serious ocular pathologies. The average value of spherical equivalent in both eyes of all individuals was -1.2 ±2.5 D. We measured the thickness of the retinal nerve fiber layer (RNFL) in the papilla area and the average thickness of the retina in the area of the macula using the device OPKO Spectral OCT SLO Combination Imaging System (Opko Health, USA). We performed a functional examination of the retina within an area up to 30° using a perimeter with a stimulus with a Frequency Doubling Technology (FDT) from the company Humphrey (Carl Ziess Meditec, Inc., Dublin, CA). As a significant variable for comparison, we determined the mean value of retinal sensitivity deviation (MD).

Results: In our study, we did not demonstrate a statistically significant relationship between the average thickness of the retinal nerve fiber layer (RNFL) and the average value of retinal functional sensitivity (r = 0.18, p = 0.34) in either right eyes or the left eyes of the examined subjects (r = 0.20, p = 0.29). We also did not find a statistically significant relationship secondarily between the variable called the spherical equivalent of refractive error (SE) and the average retinal thickness in the macula in either the right eyes (r = 0.34, p = 0.06) or the left eyes (r = 0.18, p = 0.32).

Conclusion: When comparing the average thickness of the nerve fibers in the papilla with the help of OCT examination and the functional sensitivity of the retina measured on an FDT perimeter, we did not find a statistically significant dependence in the group of right eyes or in the group of left eyes. We also achieved a similar result when examining the interdependence of the variables of spherical equivalent of refractive error of the eye and the average thickness of the retina in the macula.

Aim: The aim of the article is to summarize observations on cytomegalovirus (CMV) anterior uveitis, and in short case reports present cases of patients treated at our Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague.

Material and methods: Retrospective analysis of patients at the Centre for diagnosis and treatment of uveitis from 2003 to 2024. Presentation of our experiences with CMV anterior uveitis confirmed by polymerase chain reaction (PCR) in aqueous humor in case reports.

Results: From a cohort of 3844 patients with uveitis, 3 patients were diagnosed with CMV anterior uveitis, confirmed by PCR in the aqueous humor. The clinical presentation was as acute recurrent hypertensive anterior uveitis in all patients, with a switch to chronic form with elevated intraocular pressure (IOP). Despite local anti-inflammatory and antiglaucomatous therapy, there was high recurrence of uveitis with decompensation of IOP when the medication was reduced. Patients underwent antiglaucoma surgery because of persistent high IOP despite maximal local antiglaucomatous therapy. An anterior chamber tap was taken for PCR analysis, with a CMV-positive result. After the initiation of antiviral therapy with local ganciclovir, patients manifested compensated IOP and a pronounced reduction of recurrences of uveitis and progression of glaucoma.

Conclusions: CMV anterior uveitis is a rare pathology in our geographic region, but it is important to consider this etiology in cases of recurrent anterior hypertensive uveitis with a low response to local anti-inflammatory medication. Timely verification of the etiological agent with prompt diagnosis and treatment is essential in order to achieve a favorable prognosis. Long-term, low maintenance doses of antiviral therapy with local ganciclovir for several months reduce relapses of uveitis and lead to compensation of IOP.

A 70-year-old woman was examined with a 10-day history of photopsia and floaters in her left eye. Her best-corrected visual acuity was 20/25 in both eyes, with a normal intraocular pressure and some nuclear sclerosis. Spectral-domain optical coherence tomography revealed a separated posterior vitreous, with a rolled internal limiting membrane flap and inner retinal dimples in the left eye. Optical coherence tomography angiography demonstrated reduced vessel density in both the superficial and deep capillary plexuses of the left fundus. Sixteen months earlier, she had received a single intravitreal Dexamethasone implant injection, due to inferotemporal branch retinal vein occlusion-related macular edema. A diagnosis of internal limiting membrane tear following an uneventful posterior vitreous detachment was reached and no treatment was recommended.

Aim: To determine risk factors associated with keratoconus in Bucaramanga, Colombia.

Material and methods: A paired case-control study was conducted at Bucaramanga, Colombia, between November 2022 and December 2023. The controls were age- and sex-matched. Patients answered a questionnaire designed for this study regarding their family history of keratoconus, eye rubbing, atopy, sun exposure, and sleeping habits. Information from medical records was also obtained. Univariate and multivariate conditional analyses were used to test the significance of associations.

Results: One hundred fifty-six patients with a diagnosis of keratoconus and 312 controls were included. Univariate analyses revealed significant differences between cases and controls in the following factors: very frequent eye rubbing (OR = 20.9, 95% CI 6.2-70.1), a positive family history of keratoconus (OR = 13.0, 95% CI 5.5-30.8), a personal history of atopy (OR = 2.2), and nocturnal eye compression (OR = 1.7, 95% CI 1.0-2.7). Multivariate analysis showed a statistical significance for eye rubbing (OR = 6.9, 95% CI 3.8-12.5), and family history of keratoconus (OR = 10.3, 95% CI 2.3-44.9). There was a significant mild interaction between both, since when the two coincided the OR increased up to 74.1 times.

Conclusion: Eye rubbing and family history of keratoconus were the most important risk factors for keratoconus in our population. Although it is impossible to establish causal relationships, our results suggest that controlling eye rubbing could be a potentially useful preventive measure, particularly in individuals with a family history of keratoconus. Other factors, such as sun exposure, sleeping position, and atopy, may play a role in the pathophysiology of the disease.

Aim:  To report long-term postoperative outcomes of external dacryocystorhinostomy (Ext-DCR) with U-flap and nasolacrimal intubation in adult patients with small lacrimal sac and primary nasolacrimal duct obstruction (NLDO).

Material and methods:  This case series was conducted in a tertiary health care center of North India and included 26 patients who underwent Ext-DCR with U-flap with nasolacrimal intubation for primary NLDO and small lacrimal sac from June 2021 to January 2024 with a minimum follow-up period of 12 months.

Results:  Out of 26 patients, 22 were females with a mean age of 50 years (range 21-60). All patients had a history of purulent discharge from the affected eye. Excessive bleeding was the most common intraoperative challenge faced in most of the cases (6, 23%). The intubation set was removed 12 weeks after surgery. Two female patients had tube-related complications in the form of granuloma formation, and two patients had tube retraction, one had slitting of the punctum, and another acquired an infection. The remaining 20 patients had an uneventful postoperative period. The outcomes of only 2 patients were reported as failures (8%), and the remaining 24 reported successful outcomes (92%) after 12 months of follow-up.

Conclusion:  Ext-DCR with U-flap and nasolacrimal intubation is an effective procedure with a high long-term success rate in adult patients with a small lacrimal sac and primary NLDO.

Glaucoma is a chronic, progressive and irreversible neuropathy of the optic nerve, characterized by morphological changes in the optic nerve papilla and defects in the visual field. Although the precise pathogenesis is not fully understood, the current concept of glaucoma development incorporates the deformation of the lamina cribrosa caused by elevated intraocular pressure, leading to axonal damage, subsequent apoptosis of retinal ganglion cells and loss of the nerve fiber layer. This review article discusses the current possibilities of using minimally invasive glaucoma surgery, specifically focusing on the micro-invasive implants iStent and Preserflo, their efficacy and safety in the surgical treatment of primary open-angle glaucoma.

Aims: Vogt-Koyanagi-Harada (VKH) disease is an autoimmune disorder affecting multiple systems and characterized by bilateral granulomatous uveitis, frequently together with neurological, auditory, and integumentary manifestations. Prompt diagnosis and intervention are a must to prevent irreversible vision loss and possible systemic complications. Fundus imaging plays a pivotal role in the management of VKH, not only to reach the diagnosis but also to monitor  disease activity and response to treatment. Fundus photography, fundus autofluorescence imaging, fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) are among the imaging modalities. These methods provide invaluable insights into the different phases of the disease. In addition, OCT angiography enables clinicians to visualize associated retinal and choroidal microvascular changes. Continuous advances in imaging technology assist ophthalmologists to comprehend the VKH pathophysiology and to facilitate its differential diagnosis. Thus, clinical outcomes are improving with timely interventions and personalized treatment approaches. This mini-review provides an overview of VKH disease, with a particular focus on the fundus imaging techniques utilized in its management.