Ceska a Slovenska Oftalmologie最新文献

Aim: The incidence of cataract surgery in patients after previous laser refractive surgery is increasing worldwide. However, the resulting uncorrected distance visual acuity (UDVA) after cataract surgery in these patients is less frequently satisfactory. The aim of this article is to present the results of cataract surgery in a group of patients who had undergone previous laser refractive surgery, in whom the IOL power was calculated only according to the currently measured values, and to compare them with the results from other workplaces.

Material and methods: Our group incorporates 69 eyes of 43 patients. The data collection took place over a period of 33 months. The group included patients who attended at least one follow-up examination in the postoperative period. The resulting postoperative vision was considered to be vision determined at least 1 month after cataract surgery. Data were collected retrospectively.

Results: The resulting postoperative average monocular best corrected distance visual acuity (BCDVA) in the patients from our cohort was 0.024 LogMAR in the group of initially myopic patients and 0.030 LogMAR in the group of initially hypermetropic patients. Thus, BCDVA in myopic was better than in hypermetropic patients, without a statistically significant difference. Conversely, the resulting mean manifest spherical equivalent (MSE) was higher for myopic patients (-0.844) than for hypermetropic patients (-0.658), and this difference was evaluated as statistically significant. A refractive result above ±0.5 Dsf was present in 14 eyes, above ±1.0 Dsf in 6 eyes.

Conclusion: In 90% of patients we achieved an average MSE up to ±1.0 Dsf postoperatively. The results from our report regarding postoperative monocular BCDVA, BCNVA, mean SE and MSE are consistent with those from other reports dealing with this issue, although our cohort included a much smaller group of patients.

Aims:  To determine the incidence of Fuchs' endothelial corneal dystrophy (FECD) in patients undergoing cataract surgery in the Czech population.

Material and methods:  Consecutive group of 2804 eyes of 1499 patients undergoing cataract surgery at the Lexum Karlovy Vary clinic in the period from 4/2022 to 9/2024. The corneal endothelium was examined preoperatively using a slit lamp and an endothelial microscope. The corneas were divided into 6 grades (0-5) according to the Krachmer scale, or 4 clinical stages of the disease.

Results:  The incidence of FECD in our group of patients undergoing cataract surgery was 29.6% (total 840 eyes). In 578 cases this concerned stage 1 of the disease, which had no effect on the outcome of the operation. In 81 cases it concerned a stage 3-5 disease, in which potential postoperative complications must be taken into account. In 13 cases (0.46%) we primarily performed a combined procedure of cataract surgery and DMEK (Descemet's membrane endothelial keratoplasty).

Conclusion:  FECD in the population of cataract patients is probably often under-diagnosed. In our cohort of patients we registered some signs of the disease in more than a quarter of the patients.

Aim:  To evaluate the three-year survival rate, local tumor control rate and complications of stereotactic radiosurgery in patients with uveal melanoma and compare the outcomes with the available literature.

Material and methods:  In this study, data were evaluated from 122 patients treated for uveal melanoma, of whom 33 met the inclusion criteria for retrospective analysis of stereotactic radiosurgery outcomes using the CyberKnife system. These patients received radiotherapy for uveal melanoma during the period of 2016-2021. The data were collected during regular follow-up visits consisting of best-corrected visual acuity assessment, slit-lamp examination, indirect ophthalmoscopy, intraocular pressure measurement and ultrasound measurement of tumor prominence. As part of the metastases screening, abdominal ultrasound, chest X-ray, and magnetic resonance imaging (MRI) of the brain and orbits were performed regularly, with additional positron emission tomography (PET) combined with MRI performed as required.

Results:  In our cohort, the three-year eye preservation rate was 72.7%, while the three-year local tumor control reached the level of 75.8%. The three-year survival was 81.8%. Overall, metastases were detected in 30.3% of patients with the liver being affected in 44% of cases, the bones in 28%, and the lungs in 17%. The most common ocular complications of radiotherapy included cataracts (58.3% of phakic patients), neovascular glaucoma (39.4%), radiation maculopathy (27.3%) and radiation retinopathy (18.2%).

Conclusion:  Stereotactic radiosurgery is a safe treatment method for uveal melanoma with the potential for eye preservation. However, it carries the risk of tumor recurrence and ocular complications. Three-year survival and the incidence of ocular complications in our study were consistent with the data reported in the literature. By contrast, three-year local tumor control reached lower values compared to the relevant studies. Some results may be limited due to the small number of subjects in our cohort.

Aims: The purpose of this study is to evaluate an Altmetric analysis of the 50 most cited refractive surgery articles in Ophthalmology journals and to compare them with traditional metrics.

Methods: The term "refractive surgery" was searched, using a time filter between 2010-2020 in the Web of Science core collection database. The 50 most cited articles between 2010 and 2020 were recorded. Descriptive statistics were performed. The Spearman correlation test was used to evaluate the correlation between traditional metrics and Altmetrics.

Results: The Altmetric scores of the top 50 articles ranged from 0 to 25, and the median Altmetric score was 4. The citation numbers of the 50 articles ranged from 83 to 523, and the median citation number was 119.5. The most cited article topic was "Toric Intraocular Lens"; the topics with the highest Altmetric scores were "Toric Intraocular Lens" and "Trifocal Intraocular Lens". There was no significant correlation between Altmetric scores and number of citations. There was a weak correlation between Altmetric scores and the average citation per year.

Conclusion: The Altmetric score is insufficient, compared with traditional metrics, to show the scientific value of articles on refractive surgery. Altmetrics can be used to supplement traditional metrics.

Aim: The primary aim of this study is to evaluate the repeatability of noninvasive break-up time (NIBUT) measurement by keratograph when it is determined from one, two or three partial measurements, and to recommend a suitable methodology for practice. Another goal is to verify that repeated measurements do not affect the measured value.

Material and methods: Thirty-eight healthy volunteers (30 women and 8 men) aged between 19 and 50 years old were included in the study, in which only one eye of each volunteer was measured. The study was designed as a prospective one. Each subject adapted to the local conditions of the laboratory for 15 minutes and subsequently underwent two series of NIBUT measurements (test, retest) on an OCULUS 3 Keratograph. The minimum time interval between the two series was 10 minutes, in which each series contained three partial measurements approximately 3 three measurements in the given series. Repeatability was assessed by a Bland-Altman analysis and expressed as a repeatability coefficient. In every case, only the time of the first break-up of the tear film was monitored.

Results: The statistical analysis did not show statistically significant differences both between partial measurements of NIBUT in the individual series (p = 0.92, p = 0.81) and when comparing all six measurements (p = 0.95). The mean values of the partial measurements ranged from 13.6 s to 14.4 s. The repeatability coefficients were found to be 15.0 s, 12.1 s and 10.0 s for methodologies A, B and C, respectively. A supplementary analysis for 12 eyes with low NIBUT (< 10 s) showed statistically significantly better repeatability in this group, with coefficients of 7.0 s (methodology A), 6.0 s (B) and 4.6 s (C).

Conclusion: Determination of NIBUT from three consecutive measurements (with a sufficient interval of ideally a few minutes) significantly improves repeatability. Such repeated NIBUT measurements do not have a significant effect on the measured value. The mentioned methodology for measuring NIBUT on a keratograph can be recommended for use in practice.

The purpose of this study is to present the possibilities and benefits of ultrasonography (US) of the orbit in the diagnosis and treatment of thyroidassociated orbitopathy (TAO). Methods: US examination of the orbit is an essential addition to clinical and laboratory examination in TAO patients. Nevertheless, it is often neglected in clinical practice or indicated with delay. Based on previously published studies and our experience with the diagnosis and treatment of TAO patients, we aim to highlight the clear benefit of US examination of the orbit and oculomotor muscles, not only for correct TAO diagnosis but also in the monitoring of the disease over time. However, knowledge of the drawbacks and limitations of this method is also essential, as we shall point out. It is always necessary to remember that US examination must be evaluated in connection with the clinical findings. A detailed recommendation for US examination of the extraocular muscles and the orbit based on our experiences with diagnosing and treating TAO patients in daily practice is also included. Conclusion: According to our experience, US examination of the orbit is an excellent and irreplaceable tool for timely TAO diagnosis and further disease monitoring. However, considerable examiner experience and detailed knowledge of the clinical and ultrasound manifestations of TAO are essential.

Aim: To determine the effect of repeated intravitreal injections of aflibercept on the corneal endothelium in patients with diabetic macular edema (DME) and macular edema due to retinal vein occlusion (RVO).

Methods: In a prospective study conducted between January 2021 and November 2023, a total of 87 treatment-naive eyes with DME and RVO were evaluated. The exclusion criteria were surgery or laser intervention during the follow-up period, contact lens wear, cataract surgery in the last 6 months, dystrophy, or other corneal condition that may cause endothelial damage. In addition to routine examinations on the day of application, we also measured the corneal endothelium using specular microscopy on the 1st, 4th and 8th day of injection. We evaluated 4 parameters: endothelial cell density (CD), hexagonality (HEX), coefficient of variability (CV) and central corneal thickness (CCT). First of all, we evaluated the entire cohort of eyes, and then divided it according to 2 criteria; the diagnosis into DME/RVO and according to the lens status into phakic/pseudophakic eyes.

Results: A total of 87 eyes of 68 patients were evaluated. The average age of the patients at the time of diagnosis was 66.8 ±9.3 years. Within the cohort 51 (59%) eyes were phakic and 36 (41%) pseudophakic. A total of 61 (70%) eyes with a diagnosis of DME were treated, and 26 (30%) with RVO. During the follow-up, there were no significant changes in the average values of CD, HEX, CV, CCT due to aflibercept treatment, either in the whole group or in subgroups according to diagnosis or lens condition.

Conclusions: The results of this study suggest that intravitreal administration of aflibercept in patients with DME and RVO did not have an impact on corneal endothelial parameters, including CCT, HEX, CD and CV. These parameters were measured using endothelial microscopy during an 8-injection observation period.

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.

Aims: We present the clinical spectrum, the initial clinical presentation with management trends in treating 14 Vogt-Koyanagi-Harada (VKH) disease cases in a tertiary center in the Northern part of Malaysia.

Case series: There were 14 cases of Vogt-Koyanagi-Harada (VKH) disease retrospectively reviewed over five years (from 2015 to 2020). The mean age at presentation was 37.7 years (range 21-64 years), with female predominance (85.7%). All cases presented with acute uveitic stage and bilateral eye involvement. Of them, 11 (78.6%) were probable VKH, and three (21.4%) were incomplete VKH. All patients attended with acute panuveitis at first presentation. The main posterior segment involvement was disc edema in 57.1% (16 out of 28 eyes) and exudative retinal detachment (ERD) in 35.7% (10 out of 28 eyes). Most of them presented with blindness (3/60 and worse) and moderate visual impair- ment (6/18-6/60); 35.71% each, followed by mild visual impairment (6/12-6/18), and severe visual impairment (6/60-3/60); 7.1% each. Ten patients (71.4%) required combination second-line immunomodulatory treatment during subsequent visits, and only four patients (28.6%) responded well to corticosteroid therapy. Most of the cases achieved no visual impairment (64.3%), followed by mild visual impairment (21.4%) and moderate visual impairment (14.3%), and none were severe or blind at the end of follow-up.

Conclusion: VKH is a potentially blinding illness if there is inadequate control of the disease in the acute stage. Most of our patients achieved good visual outcomes with early immunomodulatory treatment and systemic corticosteroids.

The authors present a case of a thirty-eight-year-old patient with Alport syndrome. The patient had several ocular symptoms of the disease and has been treated for systemic problems in connection with Alport syndrome since he was fifteen years old. At that age the patient also underwent a kidney transplant in order to deal with renal insufficiency. To date, he still uses immunosuppressants and antihypertensives. Furthermore, the patient suffers from perceptive deafness. The patient visited our clinic in 2021 with a request to solve his high refractive error, in which the diopters were so high that it was not possible to place them in spectacles. The patient's best corrected visual acuity was 0.6 with -8.0sph/-4.0cyl/ax15 in the right eye and 0.7partim with -8.0sph/-4.0cyl/ax155 in the left eye. The autorefractometer values were -6.25sph/-6.75cyl/ax17 in the right eye and -6.75sph/-6.5cyl/ax155 in the left eye. During the eye examination we found a number of ocular manifestations that are typical of Alport syndrome. On the cornea there were opacities as a residue of corneal erosions, and at one of the following check-ups we also found a newly developed corneal erosion. Subsequently, we found an anterior lenticonus and incipient cataract. Upon performing OCT, a typical temporal macular atrophy was evident. Fundus examination in artificial mydriasis showed just a minimal manifestation of fleck retinopathy. Due to the clinical manifestation we decided to perform cataract surgery and implant a monofocal toric intraocular lens in both eyes. There were no complications during the operations, however the surgeon registered a non-standard structure of the lens capsule. The capsule was more fragile, and performing capsulorhexis was much more complicated. A week after the surgery, higher cylinder diopters were still present. A decrease of the higher diopters was noticeable one month after surgery. The time interval between the first operation and the second operation was one month. The patient was highly satisfied with result, and uncorrected visual acuity improved by over four lines. After surgery the patient needed low diopters for near as well as far distance. In the case of this patient, the ocular manifestations were detected and treated in adulthood. Nevertheless, early detection of ocular symptoms of Alport syndrome in young patients before renal failure could lead to timely start of the treatment and delay a possible renal transplant. In case of any suspicion of Alport syndrome it is advised to send the patient to a pediatrician, and at an older age to an internal medicine specialist, for further examination.