Ceska a Slovenska Oftalmologie最新文献

Introduction: The term "pachychoroid" (greek pachy- [παχύ] - thick) was first used by Warrow et al. in 2013. It is defined as an abnormal and permanent increase in choroidal thickness ≥ 300 μm, which is caused by dilatation of the choroidal vessels of the Haller's layer, thinning of the Sattler's layer and the choriocapillaris layer.

Methodology: Literary research focused on the current view of pachychoroid spectrum diseases, including clarification of the pathophysiological theories of the formation of "pachychoroid".

Results: It is assumed that "pachychoroid" disease has an autosomal dominant type of heredity. Depending on the further activity of various exogenous and/or endogenous factors, pachychoroid diseases may appear. According to the current knowledge, the spectrum of pachychoroid disease covers six clinical entities: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoid choroidal vasculopathy, focal choroidal excavation and peripapillary pachychoroid syndrome. In this study, we describe the clinical symptoms and objective findings of focal choroidal excavation and peripapillary pachychoroid syndrome. The current pathophysiological theory of pachychoroid diseases is based on impaired venous outflow from the choroid ("venous overload choroidopathy") and thickening of the sclera in the eyes of affected patients.

Conclusion: Pachychoroid diseases should be included in the differential diagnosis of characteristic features observed during multimodal imaging analysis of choroidal changes.

Chemical burns are sight-threatening injuries that require immediate management. The main goal of the initial treatment is prompt and copious irrigation to neutralize and eliminate the chemical, followed by various therapeutic options (conservative and surgical) according to the individual patient's postinjury findings.

Purpose: In this case report, we describe the course and treatment of a patient with chemical alkali burns of both eyes. This study reports the outcomes of an ocular alkali burn patient who became infected with COVID-19 and where severe keratouveitis with corneal graft melting and hypopyon occurred, ultimately resulting in evisceration of the eye.

Observations: We report the case of a 35-year-old woman, after an alkali burn of both eyes. Complete re-epithelialization of both corneas occurred within three weeks. Due to this observation, we assumed a satisfactory healing prognosis. However, corneal lysis occurred in the left eye over time. The condition was managed, but subsequently severe keratouveitis with hypopyon and corneal lysis occurred in the left eye, apparently in connection with the COVID-19 infection, which ultimately led to the evisceration of the affected eye.

Conclusions and importance: In the case report, we describe the management of a mild chemical alkali burn of the right eye and a complicated moderate burn of the left eye with an alkaline chemical. Both eyes were completely healed within three weeks. However, the findings on the left eye became complicated, which ultimately led to the evisceration of the affected eye. The disease of COVID-19 could have contributed to the deterioration of the findings on the cornea, or it could have just been a coincidence of two diseases, with the keratouveitis having a serious course due to the previous difficult course of healing and many complications after the chemical burn.

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computer tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included. Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

Aim: To introduce the topic of pediatric keratoconus, highlighting the importance of routine corneal topography and tomography in children and adolescents from predisposed groups. To attempt to ensure the early detection of keratoconus and its subclinical form, enabling early treatment, which brings better expected postoperative results.  Material and methods: Using the corneal tomograph Pentacam AXL we examined children and adolescents with astigmatism equal or greater than  2 diopters (in at least one eye) and patients with at least one risk factor such as eye rubbing in the case of allergic pathologies, positive family history of keratoconus or certain forms of retinal dystrophy. In total, we included 231 eyes (116 patients), of which 54 were girls and 62 were boys.

Results: The Belin-Ambrósio deviation index parameter was evaluated, in which we classified a total of 41 eyes as subclinical keratoconus and 12 eyes as clinical keratoconus. Next, the corneal maps were evaluated individually, in which we included a total of 15 eyes as subclinical keratoconus and 6 eyes as clinical keratoconus. In our group, compared to the control group, subclinical and clinical keratoconus occurred most often in the group of patients with astigmatism and in the group of so-called "eye rubbers". After individual evaluation, keratoconus occurred more frequently in boys than in girls in our cohort.

Conclusion: Most patients with keratoconus are diagnosed when there is a deterioration of visual acuity and changes on the anterior surface of  the cornea. Corneal topography and tomography allows us to monitor the initial changes on the posterior surface of the cornea, and helps us to detect the subclinical form of keratoconus and the possibility of its early treatment. Therefore, it is important to determine which groups are at risk and groups in which corneal topography and tomography should be performed routinely.

Aim: The aim of this study was to examine possible changes in the conventionally undiagnosed nasal visual field in patients diagnosed with early primary open angle glaucoma.

Material and methods: Examination of the far nasal part of the visual field was performed in 30 patients (60 eyes) with early stage of primary open angle glaucoma (preperimetric stage of changes). The cohort consisted of 16 women (mean age 46.5 years) and 14 men (mean age 44.7 years). In all eyes, the glaucoma program (rapid threshold program of 50 degrees nasally and 22 degrees temporally) was performed with the Medmont M700 instrument to determine the physiological visual field. Visual acuity was 1.0 with a possible correction less than or equal to ±3 diopters and they had no other ocular defect except glaucoma disease. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli and a range of 0-120 degrees nasally.

Results: The far nasal limit of the visual field reached 100° in 13.33% of eyes, 105° in 20% of eyes and up to 110° in 66.67% of eyes.

Conclusion: In all eyes, depression of the distal periphery of the nasal part of the visual field was found to range from 50 to 95 degrees, with a normal visual field examined by the glaucoma program.

Central serous chorioretinopathy (CSC) is a disease characterized by serous detachment of the neuroretina, especially in the posterior pole of the eye. It is often accompanied by serous detachment of the retinal pigment epithelium (RPE) and associated with the leakage of fluid into the subretinal space through the defective RPE. CSC most often affects men of working age. The exact pathophysiology of the disease is not completely known. Based on indocyanine green angiography (ICG), which revealed increased permeability of choroidal vessels, and optical coherence tomography (OCT) showing increased choroidal thickness, choroidal vasculopathy is assumed to be the primary cause of CSC. In most cases, CSC has a good prognosis with spontaneous resorption of the subretinal fluid (SRF) and improvement of visual functions. However, in a small percentage of patients the disease progresses to a chronic or recurrent course, and can lead to irreversible functional and anatomical changes of the retina with a final clinical picture of diffuse retinal pigment epitheliopathy (DRPE). The optimal treatment approach for patients with CSC remains controversial. In recent decades, myriad therapeutic approaches have been used in the treatment of chronic forms of CSC (cCSC); these included for example laser photocoagulation, pharmaceutical treatment, standard photodynamic therapy (PDT) or anti-VEGF. In recent years a less destructive method, specifically PDT in reduced dose regimens, either with a reduced dose of verteporfin or the laser beam energy used, has been preferred in the treatment of cCSC. Comparable efficacy and safety has been demonstrated using reduced-dose or reduced-fluence PDT regimens in patients with cCSC, with an improvement in best-corrected visual acuity and reduction of SRF.

Introduction: Intraocular pressure (IOP) measurement in patients with thyroid-associated orbitopathy (TAO) can be difficult and misleading, particularly in patients with diplopia and eye deviation (esotropia or hypotropia). However, when measuring IOP, it is also necessary to pay sufficient attention to TAO patients without diplopia in primary gaze direction and without motility disorder that might not be readily apparent.

Purpose: The aim of this study was to evaluate the accuracy of measurement of intraocular pressure (IOP) using three different types of tonometers: the rebound tonometer (iCARE), the Goldmann applanation tonometer (GAT) and the non-contact airpuff tonometer (NCT) in patients with inactive TAO.  Materials and Methods: A total of 98 eyes of 49 adult patients with TAO were examined. The study group included 36 females and 13 males, with an age range of 19-70 years and a median age of 55.0. All the patients had evidence of thyroid disease,  a history of mild to moderate TAO, no clinical signs or symptoms of active disease, and no diplopia in direct gaze direction. In addition to a comprehensive eye examination, all the patients underwent measurement of intraocular pressure with three tonometers: NCT, iCARE, and GAT. The measurements with these three devices were compared.

Results: The mean IOP was 18.1 ± 2.4 mmHg (range 13-25 mmHg) with GAT, 22.3 ±5.0 mmHg (range 13-35 mmHg) with NCT, and 18.0 ±2.4 mmHg (range 13.3-26 mmHg) with iCARE. The mean difference between the GAT and iCARE measurements (using the Bland-Altman analysis) was -0.1 ±1.16 mmHg (limits of agreement -2.4 to 2.1). The mean difference between the GAT and NCT measurements was 4.2 ±3.6 mmHg (limits of agreement -2.8 to 11.2). The mean difference between the iCARE and NCT measurements was -4.3 ±3.7 mmHg (limits of agreement -11.6 to 2.9). No significant difference was found between GAT and iCARE (p = 1.000). However, there was a significant difference between GAT and NCT (p < 0.0001), as well as between iCARE and NCT (p < 0.0001).  Conclusions: In patients with TAO, NCT significantly overestimates IOP values compared to the GAT and ICare. By contrast, the iCARE rebound tonometer provides IOP measurements comparable to the gold standard GAT in these patients.

Aims: Professional polo-water athletes are exposed to chlorine in the swimming pool. Chlorine is an irritant agent, so polo-water athletes commonly experience irritative eye symptoms. Hyaluronic acid and glycuronate enoxolone exert anti-inflammatory and cytoprotective activity. Therefore, the present practical experience explored the efficacy and safety of eye drops containing both components.

Material and methods: The current study included 59 professional polo-water athletes. The ocular surface disease index (OSDI) and dry eye-related quality of life (QoL) score (DEQS) questionnaires were used to assess the efficacy. Subjects took the eye drops for one month. The study consisted of a baseline visit (T0) and an end-treatment one (T1).

Results: Athletes experienced a significant improvement in symptoms and QoL as assessed by OSDI and DEQS scores (p < 0.001 for both).

Conclusion: The present study showed that professional polo-water athletes frequently experience ocular discomfort associated with swimming pool attendance. Eye drops with hyaluronic acid and glycuronate enoxolone can significantly relieve eye symptoms and improve the quality of life in these athletes.

Aims: The aim of this study is to retrospectively evaluate the use of a transconjunctival surgical approach in maxillofacial surgery on the fractures of the infraorbital rim and the orbital floor by analyzing the operating time, the incidence of perioperative and postoperative complications, as well as the functional and aesthetic outcomes of transconjunctival surgical treatment.

Materials and methods: All the patients on whom we used a transconjunctival approach from December 2017 to December 2021 were included in this retrospective study. The epidemiological causes of fractures of the midface skeleton were analyzed. The length of the operating time of the transconjunctival approach with lateral canthotomy was compared with a control group in which the supraorbital eyebrow approach was performed. In addition, we analyzed the incidence of perioperative and postoperative complications in comparison with publications from other centers.

Results: We used the transconjunctival approach 103 times on 89 patients (in 14 patients the transconjunctival approach was performed bilaterally). In cases where the lateral canthotomy was used to extend the transconjunctival approach, there was no prolongation of the operating time. Perioperative complications included the perforation of the lower eyelid in 2 patients. In the postoperative period we recorded complications in 3 patients. Ectropion of the lower eyelid was present in one patient and entropion of the lower eyelid was observed in two patients. The percentage of perioperative and postoperative complications does not exceed the incidence of complications in transcutaneous approaches on the infraorbital rim.

Conclusion: Based on the results of our study, we can consider the transconjunctival approach, either alone or in combination with lateral canthotomy.

Introduction: The term "pachychoroid" (greek pachy- [παχύ] - thick) was first used by Warrow et al. in 2013. It is defined as an abnormal and permanent increase in choroidal thickness ≥ 300 μm, which is caused by dilatation of the choroidal vessels of the Haller's layer, thinning of the Sattler's layer and the choriocapillaris layer.

Methodology: Literary research focused on the current view of pachychoroid spectrum diseases, including clarification of the pathophysiological theories of the formation of "pachychoroid".

Results: It is assumed that "pachychoroid" disease has an autosomal dominant type of heredity. Depending on the further activity of various exogenous and/or endogenous factors, pachychoroid diseases may appear. According to the current knowledge, the spectrum of pachychoroid disease covers six clinical entities: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoid choroidal vasculopathy, focal choroidal excavation and peripapillary pachychoroid syndrome. In this study, we describe the clinical symptoms and objective findings of focal choroidal excavation and peripapillary pachychoroid syndrome. The current pathophysiological theory of pachychoroid diseases is based on impaired venous outflow from the choroid ("venous overload choroidopathy") and thickening of the sclera in the eyes of affected patients.

Conclusion: Pachychoroid diseases should be included in the differential diagnosis of characteristic features observed during multimodal imaging analysis of choroidal changes.