Ceska a Slovenska Oftalmologie最新文献

Aims: This study was planned to explore the efficacy of autologous blood as a stabilizing agent for graft surgery in pterygium.

Material and methods: For this observational, non-comparative, interventional study, the hospital data of patients who underwent pterygium surgery with autografting using autologous blood between October 2021 to March 2022 were retrospectively analyzed. The graft stability post-surgery and recurrence was studied. There were 37 eyes of 37 patients undergoing pterygium surgery with autograft using autologous serum. The mean age was 53.5 ±10.10 years.

Results: Pterygium included were nasal sided primary grade 3 pterygium, double-head pterygium and recurrent pterygium. Postoperatively, there were 4 cases of graft loss (10.8%). The mean time of follow up was 1.8 ±1.4 months (range 1 to 5 months). There was no recurrence seen in patients with graft intact.

Conclusion: Autologous blood is a good and cost-effective stabilizing agent for graft surgery in pterygium.

Aims: To analyze determinants affecting the selection of trifocal intraocular lenses (IOLs) and to evaluate patient satisfaction and adaptation patterns post-implantation in a Turkish cohort.

Material and methods: A cross-sectional study was conducted using a 17-item questionnaire administered to 96 patients who underwent phacoemulsification with PanOptix trifocal IOL implantation. Demographics, IOL selection factors, surgeon trust, visual adaptation, and satisfaction metrics were analyzed across various patient subgroups.

Results: The cohort (mean age 60.62 ±11.94 years; 58.3% male) demonstrated 96.9% overall satisfaction post-implantation. Significant findings included higher satisfaction rates among patients under 65 years (98.3% vs 94.7%, p = 0.042), among tertiary-educated patients (98% vs 75%, p = 0.03), and 82.3% complete spectacle independence. Visual phenomena were reported at contemporary rates (glare: 18.8%, halos: 22.9%). Ninety-one percent of patients achieved visual adaptation within three months. Preoperative counseling participation (86.7% vs 71.4%, p = 0.035) and consistent follow-up attendance (88.9% vs 73.3%, p = 0.028) emerged as significant predictors of satisfaction.

Conclusion: Patient satisfaction with trifocal IOLs correlates significantly with age, educational background, and engagement in the treatment process. While overall satisfaction rates are high, outcomes appear influenced by demographic factors and healthcare engagement patterns. These findings emphasize the importance of comprehensive preoperative assessment, patient education, and tailored follow-up protocols in optimizing trifocal IOL outcomes across diverse population segments.

Objective: To characterize and compare the efficacy and safety of trabeculectomy and Preserflo microshunt (PMS) implantation in patients with openangle glaucoma.

Material and methods: This retrospective 6-month study included 100 eyes (100 patients). The 100 patients were divided into two groups of 50 patients, who were randomly assigned to either trabeculectomy or PMS implantation with mmC (0.4 mg/ml) applied using saturated sponges. The patients attended follow-up checks at 1, 8, 30, and 90 days postoperatively and at 6 months postoperatively. Endothelial cells were assessed at 3 and 6 months respectively. The main observed parameters were intraocular pressure (IOP), best corrected visual acuity (BCVA), anterior chamber depth (ACD), corneal hysteresis (CH), corneal endothelial cell density (CECD), coefficient of variation (CV), and antiglaucoma treatment.

Results: In patients after trabeculectomy and after PMS implantation a comparable reduction in mean IOP values of 40.2% and 45.8% respectively was recorded for both surgical approaches in comparison with the preoperative mean IOP values. In all the studied patients, regardless of the type of surgical procedure, a significant reduction of CECD values was recorded 6 months after surgery. However, PMS implantation led to a greater reduction in antiglaucoma treatment postoperatively compared to trabeculectomy. Qualified success was almost identical in the case of both operations throughout the entire course, complete success was higher in favor of PMS at the beginning of the observation, but their values converged or met from approximately day 90 to month 6.

Conclusion: The performed clinical evaluation of the efficacy and safety of PMS implantation compared to the classical surgical approach using trabeculectomy showed positive results related primarily to the reduction of postoperative complications, while maintaining the effectiveness of the surgical procedure. However, further clinical studies with a longer follow-up period are needed in order to provide long-term evidence of clinical efficacy.

Subhyaloid hemorrhage is defined as bleeding between the internal limiting membrane (ILM) and the posterior hyaloid membrane. The condition typically manifests itself in acute visual impairment. Causes include the Valsalva maneuver, Terson's syndrome, age-related macular degeneration (ARMD), trauma, hypercoagulable and hyperviscosity states, uncontrolled blood pressure, diabetes mellitus and leukemia. Prolonged presence of blood in the macular region can lead to the development of an epiretinal membrane and toxic damage to the retinal pigment epithelium and photoreceptors due to iron ions. In this case report we present a 32-year-old patient who was treated at the ophthalmology outpatient clinic of the Regional Hospital in Mladá Boleslav for subhyaloid hemorrhage in the right eye following a bungee jumping experience. The patient was successfully treated with Nd -YAG hyaloidotomy, which resulted in a good therapeutic outcome and full restoration of visual acuity.

Preeclampsia, eclampsia and HELLP syndrome are serious pregnancy-related complications associated with significant morbidity and mortality. These pathological conditions are related to placental dysfunction, systemic endothelial dysfunction and various clinical and biochemical abnormalities. Exudative retinal detachment as a rare but clinically significant ophthalmologic complication of preeclampsia occurs in 0.2-2% of cases, more frequently affecting primigravidas and often presenting bilaterally. This article presents two case reports of patients with preeclampsia complicated by exudative retinal detachment. The first case describes a 22-year-old primigravida at 35 weeks of gestation with preeclampsia, bilateral visual impairment and exudative retinal detachment. The second case involves a 38-year-old primigravida at 31 weeks of gestation with preeclampsia and incompletely expressed HELLP syndrome, in whom visual impairment and unilateral exudative retinal detachment developed after delivery. In both patients, the exudative retinal detachment was resolved and visual acuity improved within a month after delivery and with stabilization of blood pressure.

Aims: This pilot study aims to present a novel method for quantitatively assessing the decentration of a trifocal intraocular lens (IOL) (Acrysof IQ PanOptix®) relative to three ocular reference points: the visual axis (first Purkinje reflex), the photopic pupil center, and, for the first time, the corneal geometric center. Additionally, the study evaluates the influence of postoperative chord mu, chord alpha, and the distances of the IOL from these reference points on visual outcomes.

Materials and methods: This retrospective, observational study included 18 eyes from 12 patients who underwent cataract surgery with PanOptix® IOL implantation. Postoperative IOL positioning was assessed using OPD-Scan III images, applying a novel approach that combines diffuse frontal and retroillumination views. Distances between the IOL center and three ocular reference points, including the corneal geometric center, were measured, and postoperative patient satisfaction was evaluated using the Catquest-9SF survey. Statistical analyses were performed to assess correlations among reference distances, chord measurements, and visual performance.

Results: The study found that in 72.2% of cases, the IOL center was closer to the visual axis than to the corneal geometric center. A greater distance between the IOL and the corneal geometric center was associated with an improved near-vision area under the visual acuity defocus curve. However, no significant correlations were found between chord mu or chord alpha and visual outcomes, patient symptoms, or satisfaction.

Conclusion: This new approach to determining IOL centration proved practical, showing that the PanOptix® IOL tends to remain close to the visual axis over time, aligning with the surgeon's initial placement. No clear associations were found between chord mu, chord alpha, or most IOL distances (except the distance to the corneal geometric center) and visual quality or patient satisfaction. Further studies are needed to confirm these findings and to refine selection criteria for multifocal IOLs to enhance patient satisfaction and visual outcomes.

Aims: To investigate the efficacy and safety of intravitreal Dexamethasone implant (DEX-I) therapy in the treatment of diabetic macular edema (DME) refractory to intravitreal bevacizumab (IVB).

Material and methods: This retrospective and cross-sectional study included 37 eyes of 37 patients who received 3 loading doses of IVB injections for DME with no response and underwent DEX-I implant. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurements and central foveal thickness (CFT) measured by spectral domain optical coherence tomography (SD-OCT) were recorded and compared before DEX-I, at the first week, first, second, third and sixth months. Duration of DME, glycated hemoglobin (HbA1c) levels, DME types and lens status (phakic, pseudophakic) were also recorded.

Results: The mean age of the patients was 61.14 ±8.69 years (59.5% male, 40.5% female). 35.1% of the patients had cystoid macular edema, 64.9% had diffuse macular edema and 73 % were phakic and 27% were pseudophakic. BCVA, CFT and IOP values before DEX-I injection were 0.78 ±0.16 LogMAR, 493.73 ±107.6 µm and 13.05 ±2.59 mmHg, respectively. At 6 months after DEX-I, BCVA, CFT and IOP values were 0.64 ±0.11 LogMAR, 397.35 ±59.72 µm and 16.3 ±2.51 mmHg, respectively. In all follow-ups, there was a significant improvement in BCVA, a significant decrease in CFT and a significant increase in IOP compared to pre-injection. Ocular hypertension was observed in 0.8 % of patients and progression of cataract progression in 1% of patients after treatment.

Conclusion: DEX-I therapy is an effective and safe treatment option for DME refractory to IVB treatment.

Patients with dry eye syndrome form a significant proportion of those treated in everyday ophthalmology practice. Diabetes mellitus is a major risk factor for the development of dry eye syndrome. Changes in tear film homeostasis, chronic inflammation and subsequent corneal nerve fiber pathology play a key role in its progression. The aim of this study was to describe the status of modern biomarkers of ocular surface damage in patients with type 1 diabetes and asses their utility in early diagnosis of dry eye syndrome.

Material and methods: In total the pilot study included 19 patients with type 1 diabetes (T1D) and 15 patients in the control group. All patients underwent a detailed ocular surface examination, sample collection for matrix metalloproteinase-9 (MMP-9) laboratory analysis and epithelial HLA-DR expression evaluation, and in-vivo corneal confocal microscopy.

Results: T1D patients showed statistically significantly reduced corneal nerve fiber length (p = 0.0482). The differences between the groups in terms of osmolarity, corneal sensitivity, Oxford score, tear break-up time and MMP-9 level were not statistically significant (p = 0.8272, p = 0.6029, p = 0.3507, p = 0.7561 and p = 0.0826 respectively). HLA-DR expression was examined in 10 T1D patients and 8 patients in the control group. Both groups showed minimal or no expression (p > 0.9999).

Conclusion: The previously published literature supports our finding of corneal nerve fiber length reduction in T1D patients compared to controls. However, we did not find any significant changes in standard or modern ocular surface markers (MMP-9 levels, HLA-DR expression) measured in patients with dry eye syndrome.

Aims:  To report a case of punctate inner choroidopathy (PIC) with pachychoroid disease features and active choroidal neovascular membrane.

Materials and methods:  Case report Results: A 33-year-old female patient with a history of myopic neovascular membrane in the right eye (OD), who had received multiple doses of intravitreal Aflibercept, consulted our retina service. Best-corrected visual acuity was 20/40 in OD. Fundus examination revealed small, well-defined, yellow-gray spots with subretinal fluid limited to the posterior pole. Optical coherence tomography scans from the OD showed subretinal fluid and a hyperreflective material between the epithelium/Bruch membrane (RPE/ BrM) complex, associated with loss of normal choroidal architecture and focal conformational choroidal excavation. There was also diffuse choroidal thickening in the macula, with pachyvessels compressing the inner choroid. Fundus autofluorescence showed active PIC lesions. With these findings, the diagnosis of punctate inner pachychoroidopathy associated with active choroidal neovascular membrane was made and Aflibercept therapy was restarted.

Conclusions:  A subset of patients with PIC exhibits features associated with pachychoroid disease. This subtype of PIC is determined by unique demographics, multimodal image findings, and complications that differ from classic PIC, due to the potential influence of choroidal venous insufficiency on PIC manifestations and secondary complications.

Aims: To confirm current knowledge about the causes of refractive errors in adults. To evaluate the influence of systemic, i.e., primary curvature and, on the other hand, axial causes of refractive errors of the eye, in comparison with the Gullstrand model of the eye expressed by axial length and corneal curvature ratio.

Material and methods: The basic sample included 60 eyes of 30 subjects with an average age of 22.3 ±1.1 years. There were 3 men and 27 women in the group. They were young, generally healthy individuals, without serious eye pathologies. The basic sample was divided into research (n = 36) and control group (n = 24). We measured the axial length of the eye using the IOL MASTER 500 optical biometer (Carl Zeiss Meditec, Jena, Germany). We measured the topographic and keratometric values ​​of the cornea using the Pentacam HR device (Oculus GmbH, Wetzlar, Germany). We obtained the objective refraction values ​​by measuring them on a standard instrument automatic refractometer TRK-1P (Topcon Corp., Tokyo, Japan). We determined the axial length of the eye (AXD), the average value of keratometry (KRT) and the spherical equivalent of the refractive error (SE) as significant variables. The evaluation of variables was carried out by comparison with the Gullstrand model of the eye.

Results: We calculated the ratios of the median axial length of the eye and the median keratometry in the research group with myopia (AXD/KRTM = 3.18 with IQR 0.1) and the control group (AXD/KRTK = 2.93 with IQR 0.1). The difference between the two groups was statistically significant (p.