Ceska a Slovenska Oftalmologie最新文献

Purpose: To describe the clinical course, treatment, and subsequent care of a full-term newborn with atypical, unilateral, recurrent cytomegalovirus chorioretinitis.

Case report: The perinatal period of a full-term newborn girl was complicated by the development of petechiae on the skin. The initial laboratory findings were notable for thrombocytopenia, hyperbilirubinemia, and polycythemia. An ultrasound of the brain revealed cystic changes in the area of the lateral ventricles. MRI confirmed pseudocystic periventricular changes with periventricular calcifications. PCR testing confirmed CMV positivity, and the condition was diagnosed as congenital CMV infection requiring systemic treatment with ganciclovir. Indirect ophthalmoscopy revealed nonspecific lucency in the central area of the right eye, with several small hemorrhages on the retinal periphery. Although systemic therapy was initiated promptly, the original lesion reactivated multiple times on its periphery over the following months. The lesions were gradually healed, with pigmented scarring limiting the visual function of the affected eye.

Conclusion: In contrast with the focal changes in the peripheral retina observed in adults, congenital CMV infection affecting children is characterized by macular involvement. The degree of visual impairment is directly proportional to the extent of reparative scarring affecting the central retina. From the perspective of prognosis and prevention of potential late retinal complications, screening and regular ophthalmological examinations are essential.

Aim: To report a case of progressive corneal thinning and spontaneous corneal perforation in the setting of recurrent keratoconjunctivitis of undetermined etiology in a 20-year-old female patient.

Material and methods: Longitudinal follow-up of the reported case was performed with regular slit-lamp examination, anterior segment optical coherence tomography, and laboratory evaluation. Relevant scientific literature was reviewed to discover potential etiologies and causes of the reported case.

Case report: Recurrent bilateral keratoconjunctivitis was detected and followed up in a 20-year-old female patient. Long-standing blepharitis and several ocular inflammatory episodes were observed involving the conjunctiva and cornea causing corneal thinning and irregular astigmatism on both eyes. Patient's history, physical and laboratory examination did not reveal any systemic inflammatory or dermatological disorder. After 4 years from the onset of symptoms, spontaneous corneal perforation was observed on the right eye and treated with amniotic membrane transplantation. At that time, eyelid margin culture was positive for Streptococcus mitis. The graft healed completely with paracentral stromal scarring. Best spectacle corrected visual acuity was 20/25 OD and 20/40 OS a month after the procedure.

Conclusion: Corneal and ocular surface inflammation is a potential multifactorial disease. Bacterial hypersensitivity, atopy and dermatological disorders such as atopic dermatitis and rosacea may play a role in recurrent keratitis, corneal thinning and eventually corneal perforation. Frequent and regular follow-ups are required to detect complications early as well as to discover all possible local and systemic contributing factors of keratoconjunctivitis.

Aim: The aim of the study is to evaluate the simultaneous effect of mild myopia and glare on contrast sensitivity under mesopic conditions corresponding to the conditions of night driving.

Material and methods: The study included 22 volunteers (11 women and 11 men) aged between 20 and 42 years (mean age 26.5 years, standard deviation 5.2 years) with normal or corrected to normal binocular and monocular vision acuity and normal healthy eyes. The study was designed as a prospective study. After adaptation to mesopic conditions, three series of contrast sensitivity measurements (with fully corrected refractive error, with induced myopia -0.50 D and -1.0 D) were performed in random order using the Mesotest II device. In each series, measurements were performed with and without glare. All measurements were performed twice, and their average was considered as the result. The effect of induced myopia and glare was assessed using the analysis of variance method for repeated measures.

Results: Significant effects of myopia (p.

Aim: To retrospectively evaluate the anatomical and functional success of surgical treatment of rhegmatogenous retinal detachment (RRD) in the only remaining seeing eye.

Material and methods: The study included 28 eyes of 28 patients, 19 (68%) of whom were men, with an average age of 46 years. They were operated on by a single surgeon for RRD at the Eye Clinic of the University Hospital and Faculty of Medicine, Masaryk University in Brno, from July 1, 2019, to April 30, 2023, using cryosurgical techniques and/or 25G+ pars plana vitrectomy (PPV). In 11 patients, 25G+ PPV was performed with the application of a pre-equatorial cerclage. The Blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens were admissible within the patient histories. The cause of RRD was retinal tear(s) regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grades A-D2 were acceptable. Patients with a history of penetrating eye injury were excluded. Patients were evaluated 1-3 months after the performance of PPV. The surgery was considered anatomically successful if the retina was completely reattached. Each patient's final visual acuity (VA) was assessed using a Snellen chart. Numerical results were expressed as arithmetic means and percentages. Since the different groups were not compared, no statistical tests were needed.

Results: Retinal reattachment was achieved in 27 patients (97%), while 1 patient (3%) experienced retinal detachment, resulting in anatomical failure of the treatment. 9 patients (32%) achieved VA ≥ 4/8.

Conclusion: We consider cryosurgical techniques using episclerally fixed cerclage bands and buckles, 25G+ PPV, and possibly a combination thereof, to be suitable methods for treating RRD in the only remaining seeing eye.

Aim: To report the results of treatment of patients with central serous chorioretinopathy treated with a Navilas laser.

Material and methods: We retrospectively evaluated the results of the treatment of 39 eyes of 37 patients with acute form of central serous chorioretinopathy, who did not respond to conventional treatment. In these patients we performed focal laser treatment at the point of leakage (hotspot) using a Navilas guided laser.

Results: 3 patients did not report for the check-up, of the remaining 36 eyes, complete liquid absorption was achieved in 32. Retreatment was necessary in 2 patients, choroidal neovascularization developed in one patient, and in one patient fluid absorption was not achieved even after retreatment.

Conclusion: Focal laser treatment of hotspots in patients with central serous chorioretinopathy is still a very effective treatment method. Juxtafoveolar lesions can also be treated with a high degree of safety using a Navilas navigation laser.

Aim: A systematic review of surgical procedures on eyelids and the conjunctival sac in the case of instability of an ocular prosthesis from the author's own experience.

Material and methods: In a prospective follow-up conducted from March 2022 to July 2024, the study comprised 51 patients with an unstable prosthesis who were referred by a prosthetist. The study examined the demographic data, cause of enucleation of the eyeball, the time interval between the onset of prosthesis instability and the surgical procedure of enucleation, and the surgical methods of correction to provide functional and aesthetic improvement.

Results: The 49 patients included 13 women with a mean age of 61.4 years (39-78) and 36 men with a mean age of 56.3 years (22-82). The most common causes of enucleation were trauma and malignant melanoma. The time interval from surgery/enucleation was 24.4 years for trauma etiology. After enucleation for malignant melanoma, the time interval was 4.2 years. In the 49 patients, 61 surgical procedures were performed to improve stability of the prosthesis. Lateral tarsorrhaphy was performed in 10 cases, 4 of which were combined with an orbital periosteal sling. Horizontal shortening of the lower eyelid was performed in 24 cases, 18 times separately and 6 times in combination with another procedure on the lower eyelid. Upper eyelid droop surgery was performed 8 times, including 5 times separately. Surgery for increasing the volume of the conjunctival sac with amniotic membrane transplantation was performed in 17 cases, 7x separately and 9x in combination with procedures on the lower eyelid . 44 patients underwent 1 surgical procedure, 4 patients underwent 2 procedures, and 3 patients underwent 3 procedures. Three patients also underwent hyaluronic acid injection to supplement the volume of the conjunctival sac. Cosmetically, the result and stability of the ocular prosthesis was achieved in 47 patients out of 49, 2 patients did not attend further procedures.

Conclusion: Conjunctival sac changes with instability of the ocular prosthesis have a significant functional and psychological consequences. The causes of instability are varied, which influences the choice of surgical procedures. The surgical procedures presented in this paper may be effective separately, or a combination of them may be required.

Introduction:  Chorioretinitis is an inflammatory disorder affecting the choroid and the retina, classified among posterior uveitis conditions. It is clinically manifested in central visual impairment, visual field defects, and in more severe cases may lead to irreversible loss of vision. Accurate differentiation between infectious and non-infectious etiologies is essential, as treatment strategies differ significantly. The prognosis depends on early diagnosis and timely initiation of targeted therapy.

Purpose:  To present a case of a rare form of chorioretinitis associated with HSV-1 reactivation following a recent parvovirus B19 infection.

Case presentation:  A 35-year-old female patient reported to our center in June 2024 with acute deterioration of vision in her left eye. Her medical history revealed that approximately 10 days prior to the examination, the patient had suffered a viral illness with exanthematous manifestations, diagnosed as parvovirus B19 infection, which was managed symptomatically. A fundoscopic examination revealed inflammatory changes in the macular region. As part of differential diagnostics, fluorescein angiography, OCT, perimetry, serological testing and lumbar puncture were performed. A molecular analysis of cerebrospinal fluid confirmed HSV-1 by PCR. Antiviral treatment with acyclovir (750 mg i.v. every 8 hours, followed by 400 mg orally twice daily for 6 weeks) led to clinical stabilization and improvement of central visual acuity to 20/25.

Conclusion:  The presumed association between parvovirus B19 infection and subsequent HSV-1 reactivation indicates a potential immunomodulatory effect. This case underscores the importance of a multidisciplinary approach and prompt therapeutic intervention in the case of viral neuro-ophthalmic complications.

Purpose:  To describe atypical biomicroscopical and histological changes in corneal and conjunctival structures in multiple endocrine neoplasia type 2 (MEN2b) and bring attention to common characteristics and atypical features.

Methods:  Retrospective case series.

Results:  Two patients, female, and male, with previously confirmed MEN2B diagnosis were examined at our clinic to evaluate corneal and conjunctival pathologies using in vivo corneal confocal microscopy (IVCM). The female patient showed all hallmark signs of MEN2b features despite a recent unilateral herpetic infection. The male was examined at a very late stage of the disorder and showed only partial features of typical ocular MEN2b manifestations. Two notable deviations were observed: an opaque corneal mass of the right eye and absence of prominent corneal nerves in both eyes IVCM conjunctival neuroma scans correlated with scans of the corneal mass, ascertaining its histological nature.

Conclusions:  This case series is, to our knowledge, the first to describe the absence of prominent corneal nerves in MEN2b. It also highlights the utility of IVCM in superficial lesion analysis. Its non-invasive nature is of great benefit to the patient.

The aim of the study is to present the possible development of proliferative secondary cataracts in the unique case of a patient having undergone premium cataract surgery with preventive primary posterior continuous curvilinear capsulorhexis (PCCC). Due to the negative effect on visual functions, it was decided to treat the patient with an Nd:YAG laser, which was successful with minimal energy but resulted in damage to the anterior hyaloid membrane. Case report In 2020, a 65-year-old man underwent uncomplicated cataract surgery in both eyes at our clinic bilaterally with primary PCCC with implantation of a tension ring and an artificial intraocular lens into the capsule. In February 2023, on the recommendation of the area ophthalmologist, he was examined at our outpatient clinic due to a decrease of visual acuity in the right eye. Blurred vision predominated. A diagnosis of proliferative form of secondary cataract was confirmed and documented using a photo of the anterior segment in retroillumination and anterior segment OCT (Optovue, Avanti RTVue XR). The patient was indicated for Nd:YAG laser disruption by proliferation in the PCCC space in the right eye. The return of visual acuity to its original state confirmed the correct diagnosis. The literature review and discussion summarize the current issue of secondary cataracts and the use of primary PCCC. Conclusion: Secondary cataract is the main long-term complication of modern cataract surgery. One of the possible solutions is the preventive implementation of a simple PCCC, which may be accompanied by isolated failure.

Optical coherence tomography (OCT) has become a key tool in the differential diagnosis of optic neuropathies (ON), particularly in differentiating between glaucomatous and non-glaucomatous ON. Correct diagnosis is an essential factor for effective treatment management and prevention of progressive loss of vision. While glaucomatous ON is characterized by specific structural changes in the optic nerve head and retinal layers, non-glaucomatous neuropathies can be caused by a wide range of other causes, including inflammatory, ischemic or compressive processes. OCT allows visualization of the fine anatomical details of the optic nerve head and retina, providing valuable information for differential diagnosis. The importance lies in the physician's ability to correctly interpret these images and integrate them into the patient's overall clinical picture. This review focuses on the key features of glaucomatous and non-glaucomatous ON that can be detected early with OCT and highlights the importance of using this technique in everyday clinical practice.