Ceska a Slovenska Oftalmologie最新文献

Aim: To evaluate the safety and efficacy outcomes of PRESERFLO™ MicroShunt implantation in patients with primary open-angle glaucoma.

Material and methods: Retrospective data analysis of 19 eyes of 12 patients, comprising 5 females and 7 males. The patients underwent surgery between August 2020 and February 2022. The follow-up period was 24 months after surgery. During the follow-up period, intraocular pressure (IOP), the need to apply topical antiglaucoma medication and its spectrum, visual field status, optic nerve target findings and postoperative complications were recorded. The indication for PRESERFLO™ MicroShunt implantation was primary open angle glaucoma (POAG), poorly controlled with maximum tolerated medical therapy.

Results: Average IOP was reduced from 19.05 ±5.58 mmHg preoperatively to 11.47 ±2.48 mmHg at 3 months postoperatively, 12.26 ±2.48 mmHg at 6 months postoperatively, 14.0 ±2.43 mmHg at 12 months postoperatively, 11.78 ±2.37 mmHg at 18 months postoperatively, and 12.73 ±2.51 mmHg at 24 months postoperatively (p.

Objective: To report a case of mitochondrial retinopathy, highlighting its clinical and imaging findings, the importance of genetic confirmation, and the possible implications of heteroplasmy in this disease.

Material and methods: Case report of a mitochondrial retinopathy secondary to m.3243A>G mutation in the MT-TL1 gene.

Results: A 32-year-old woman presented with bilateral vision loss, photophobia, and sensorineural hearing loss for more than 3 years. Best corrected visual acuity (BCVA) was 20/60 in the right eye (OD) and 20/25 in the left eye (OS). Fundus examination revealed multiple macular subretinal yellow-white deposits and central chorioretinal atrophy, without edema, hemorrhage, or subretinal fluid in the RE, and juxtafoveal atrophy with retinal pigment epithelium (RPE) metaplasia in the OS. Multimodal imaging raised suspicion of retinal dystrophy, and genetic testing confirmed a mitochondrial retinopathy secondary to the m.3243A>G mutation in the MT-TL1 gene.

Conclusions: Bilateral and symmetric RPE atrophic changes in young individuals, especially when associated with systemic symptoms, should prompt a comprehensive evaluation, including multimodal imaging and genetic testing. Identifying causative mutations and understanding the dynamics of mitochondrial DNA in the pathogenesis of these diseases is crucial for improving diagnosis and suggesting potential therapeutic strategies, including gene therapy.

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.

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.

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.

Aim: To evaluate the long-term impact of accelerated corneal cross-linking (A-CXL) on selected refractive and topographical parameters in eyes with progressive keratoconus.

Methods: 77 eyes with keratoconus in 54 patients treated with A-CXL (10 min "epi-off" protocol) were included in the analysis. Preoperative and postoperative (1, 3 and 5 years after A-CXL) values of the studied parameters were compared.

Results: In the cohort, there was an improvement in best corrected central visual acuity (BCCVA) 1 year (p = 0.004) and 3 years (p.

Aims:  The aim of the study was to describe a cohort of patients reoperated on for persistent primary macular hole, and to evaluate the anatomical and functional results of the reoperated patients.

Material and methods:  459 eyes of 390 patients were operated on for primary macular hole at Department of Ophthalmology, 3rd Faculty of Medicine, Charles University, Kralovske Vinohrady University Hospital between January 1, 2013, and December 31, 2023. We included 33 eyes of 33 patients in our retrospective case series, in which macular hole persisted after the primary surgery. Preoperative, perioperative and postoperative data of these patients were recorded, as well as initial and resulting best corrected visual acuity (BCVA), surgical technique, whether the first or second reoperation was successful. The minimum follow-up time was 90 days after the revision surgery. The statistical analysis included descriptive statistics to characterize the demographic and clinical parameters. Qualitative and quantitative variables were analyzed using means, medians and standard deviations.

Results:  Primary surgery for macular holes was successful in 426 eyes of 357 patients (92.8%). The surgery was unsuccessful in the remaining 33 eyes of 33 patients (7.2%), with persistent macular hole. These patients underwent reoperation, which led to closure of the hole in 27 of 33 eyes (reoperation success rate 81.8% and total success rate of primary surgery and reoperation altogether 98.7%). Reoperation was unsuccessful in 6 eyes (18.2% of reoperated eyes and 1.3% of all operated macular holes). In 4 eyes a second reoperation was performed; in 3 eyes the reoperation was successful and led to an improvement of BCVA. The average BCVA of the successfully reoperated eyes was 65.2 ± 11.9 letters (ETDRS ±SD). In the eyes of patients after a successful second reoperation, BCVA was 56.7 ±8.4 letters, while in the eyes of patients who did not undergo further surgery (n = 3), average BCVA was only 39.0 ±11.0 letters.

Conclusion:  Reoperation of macular holes has a very good success rate and usually leads to an improvement of visual acuity. Improvement of visual acuity can also be achieved in patients who only achieved success after a second reoperation.

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.