[Acute posterior multifocal placoid pigment epitheliopathy - case report]

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) affects individuals between 20 to 30 years of age and ocular manifestations are often preceded by flu-like illness. Symptoms of the disease include acute vision decrease associated with central and paracentral scotoma. Impairment of vision is usually bilateral, but may be asymmetric. We report the case of a man at the age of twenty-one, who was treated for APMPPE. Due to the involvement of the macula, low visual acuity and related immunogenetic predisposition (HLA-B27 positivity) was recommended corticosteroid therapy with a good therapeutic effect. Key words: acute posterior multifocal placoid pigment epitheliopathy (APMPPE), white dot syndromes, macular edema.

[Long term results of phakic 6 refractive implantation for myopia correction]

OBJECTIVE

To evaluate the safety and the long term results of anterior chamber phakic lens, Phakic 6 Refractive, for myopia correction.

METHODS

In this retrospective study we reviewed the charts of 35 myopic patients (62 eyes) who had implantation of anterior chamber phakic lenses (Phakic 6 Refractive, Ophthalmic Innovations International, California, USA) for correction of myopia. The mean age of patients was 26 years (18 to 45 years). The mean spherical refraction was -9.9 (-4 to -18 D). The best corrected distant visual acuity (BCDVA) was 0.92 (1.2 to 0.3) before surgery. The mean follow-up was 8 years (4 to 10). The mean endothelial cell count was 2481 cells/mm2 and the mean pachymetry was 540 μm before surgery. In those patients who needed a second surgical intervention (explantation or lens reposition) the last follow-up visit is the visit before the lens explantation or reposition. The same surgeon (P. R.) performed all surgeries and used the same technique in each surgery.

RESULTS

On the final follow up visit the BCDVA was in the mean 1.02 (1.5 to 0.5). The spherical refraction was in the mean - 0.53 D (-3.0 to +1.0). We noticed a 16% decrease in the mean number of corneal endothelial cells, and no change in the pachymetry values. We had to explant the lenses in 7 eyes (12 %) because of the decreased endothelial cells count. 2 eyes (3.0 %, 1 patient) had to receive treatment for glaucoma, 4 eyes (6.5 %) had to have the artificial lens repositioned, 1 patient had to have photocoagulation therapy for a retinal tear. 93 % of the study eyes had stable refraction during the study period. There was a 10 % increase in the average BCDVA, and there was a 95 % improvement of the original refractive error.

CONCLUSIONS

In selected cases, the implantation of Phakic 6 Refractive anterior chamber lens is a viable option despite it is currently largely abandoned. Key words: Phakic 6 Refractive implantation, myopia correction.

[Cytomegalovirus infection (CMV) in patients with acquired immunodeficiency syndrome]

Cytomegalovirus infection (CMV) in patients with acquired immunodeficiency syndrome (Acquired Immune Deficiency Syndrome, AIDS) is the most common opportunistic infection. This infection is harmless for healthy individuals, but for weakened individuals cause disease. The most common form of CMV-infection in patients with AIDS is cytomegalovirus retinitis, which occurs in 15% to 40% of cases. We report the case of aman twenty-five year old, treated for CMV retinitis and retinal vasculitis vessels. Prescribed Valcyte 900mg tbl. twice daily for 21 days with agood therapeutic effect. In patients with AIDS and decreased visual acuity is need be primarily thinking about the possible presence of CMV-infection and in time to start treatment.Key words: Cytomegalovirus (CMV) retinitis, AIDS, valganciklovir.

[Subjective visual perception after laser treatment of myopia on two types of lasers]

AIM

Comparison of subjective evaluation of patients with low and moderate myopia undergoing photorefractive keratectomy (PRK) and Laser in Situ Keratomileusis (LASIK) on two types of excimer lasers: Schwind Esiris and Schwind Amaris.

PATIENTS AND METHODS

Patients were divided into two groups according to the type of laser that was used. Group A comprised of 23 patients (14 females, 9 males) of average age 33.1 years (range 21-51 years), with an average spherical equivalent before operation of -3.5D. Using the excimer laser Esiris (Schwind, Germany), 10 patients had undergone PRK and 13 LASIK. Group B comprised of 32 patients (21 females, 11 males), of average age 31.9 years (range 22-48 years). Median spherical equivalent before operation was -3.05D. With the excimer laser Amaris (Schwind, Germany) 17 patients had undergone PRK and 15 LASIK. For the subjective evaluation we set up a questioner consisting of 21 questions that were aimed on the quality of vision under various illumination types and intensities, vision under various distances, activities and also questions concerning superficial sensitivity of the anterior segment of the eye.

RESULTS

We detected a 100% satisfaction one year after refractive laser treatment with both laser types. Statistical improvement was evident by one month after treatment in both patient groups and upto 12 months it progressively increased. Statistically significant differences were noted one month after treatment, where patients in group B were more satisfied in questions concerning quality of vision, distance vision, while watching TV and driving during daytime and during the night. During further follow-up, results were comparable between both groups.

CONCLUSIONS

Temporary patient satisfaction treated with laser Amaris is apparently due to the result of a more sparing treatment and thus fewer changes in the corneal stroma.

[Inflammatory diseases of the eye]

Inflammatory diseases of the eye represent a non-homogenous group of diseases that can lead to impaired vision or even the loss of the eye. In her work the author gives a brief and self-contained overview of the most frequent diseases, including their symptoms and clinical image.

[The use of the toric intraocular lens in treatment of complicated cataract and high degree astigmatism]

The authors refer about highly effective and in our ophthalmology not yet described method of surgical treatment of complicated cataract in patients with high degree of preexisting astigmatism over 3.0 cylindrical diopters. According to the etiology of astigmatism, in the group, there are patients with cataract and high ametropia after previous corneal transplantation and patients with cataract and preexisting high ametropia without any previous surgery. The referred group consists of 14 patients (19 eyes), and 9 of them (9 eyes) underwent in the past penetrating keratoplasty (PK) due to keratoconus at our department. The common sign of this subgroup was unsatisfactory postoperative refraction and later on the progressive cataract development. The other part of the group consisted of 5 patients (5 eyes) and they underwent no surgery in the past. For the surgical treatment of cataract and astigmatism at once we have used the individually manufactured silicone toric intraocular lens made by the company Human Optics (type MS 6116 TU). The average age of the whole group at the time of the cataract surgery was 51.5 +/- 6.8 years (range, 39-66 years). The group consisted of 8 women (57.1%) and 6 men (42.9%). The average duration of the period between the keratoplasty and the cataract surgery was 4.8 +/- 3.6 years. The uncorrected visual acuity before the cataract surgery was 0.10 +/- 0.11, and the best-corrected visual acuity was 0.39 +/- 0.22. The average value of the preoperative refractive error was +3.4 +/- 5.0 dioptres (range, -11.0 to +10.0 dioptres) and -6.4 +/- 2.3 cylindrical dioptres (range, -12.0 to -3.0 cylindical dioptres). The average follow up period was 9.6 months (range, 4-18 months). In the postoperative period we noticed improving of the uncorrected visual acuity to the value 0.50 +/- 0.26, and the best-corrected visual acuity improved finally to 0.56 +/- 0.26. The final average refractive error decreased to 0.44 +/- 0.86 dioptres and -1.8 +/- 0.77 cylindrical dioptres.

[The use of accommodative lenses for surgical correction of the presbyopia using the Prelex method]

The authors refer about their experience with the surgical correction of the presbyopia by means of the Prelex (presbyopic lens exchange) method. Patients, who underwent this type of refractive surgery procedure to decrease their dependency on glasses correction for far as well as for near vision (12 patients, 23 eyes) and 1 young female patient (2 eyes) with juvenile cataract and high hyperopia, were included in the study. The average age at the time of the surgery was 51.0 +/- 5.5 years (range, 19-77 years). The average follow up period of the whole group of patients is 9.8 months (range, 1-13 months). Depending on the type of the lens implanted, the group was divided into subgroup A with the accommodative lens 1 CU produced by Human Optics Company implanted, and subgroup B with the accommodative lens Kellan TetraFlex KH 3500 produced by LensTec Company implanted. The subgroup A consists of 8 patients (15 eyes) with the average preoperative refractive error +2.35 +/- 3.45 diopters. The average uncorrected visual acuity of this group was 0.24 +/- 0.18, and the average best-corrected visual acuity was 0.77 +/- 0.22 at the time before the surgery. The average glasses correction for near was +4.1 dioptres, and the uncorrected vision for near was Jaeger's table Nr. (J) 13. The B subgroup consists of 5 patients (10 eyes). The average preoperative refractive error was +2.23 +/- 0.93 diopters. The average value of the uncorrected visual acuity before the surgery was 0.43 +/- 0.28, and the average corrected visual acuity was 0.82 +/- 0.25. The average value of the glasses correction for near was +5.25 and uncorrected vision for near J 13. The final average postoperative error at the time of the last visit was in the A subgroup +0.06 +/- 1.17 dioptres. The average uncorrected visual acuity was 0.69 +/- 0.24, and the average best-corrected visual acuity 0.96 +/- 0.12. The average vision of the patients of this subgroup for near was J 3. In the B subgroup we found at the last visit the average final value of the postoperative refractive error -0.2 +/- 0.72 dioptres. The average uncorrected visual acuity 0.57 +/- 0.22 and the average corrected visual acuity 0.95 +/- 0.12. Average uncorrected vision for near was J 5. We did not notice any serious per- or postoperative complication of this procedure.

[Correction of the astigmatism with the Artisan phakic toric lens]

The implantation of the intraocular anterior chamber phakic toric lens (PTIOL) Artisan, a product of the Ophtec company, is one of the most up-to-date methods of the correction of higher degree of myopic as well as hyperopic astigmatism. The authors refer about the results of PTIOL Artisan implantation in 6 patients (10 eyes). The major indication was the hyperopic astigmatism--in 5 patients (8 eyes); in one patient the indication was myopic astigmatism. In the followed up group of patients, there is the preponderance of men (5), and one woman only. The patients were divided into two subgroups: one with myopic astigmatism (1 patient, 2 eyes) and other with hyperopic astigmatism (5 patients, 8 eyes). The average age of the whole group at the time of the surgery was 27.7 +/- 2.8 years (range 23-38 years) and the average follow up period was 13.0 +/- 6.9 months (range 6-22 months). In the group the patients with follow up period shorter than 6 months were not included. The average preoperative spherical refractive error was +4.8 +/- 2.25 dioptres (D) and the average astigmatic error was -5.15 +/- 2.82 cylinders (Dcyl). In one case of myopia, the preoperative refractive error in both eyes was -7.0 D and -3.5 Dcyl. The target refraction was emetropia +/- 1.0 D. The authors evaluate the final uncorrected and best-corrected visual acuity (UCVA, BCVA), final postoperative refractive error, presence of intra- as well as postoperative complications, and changes of endothelial cells' density over time. The average final postoperative error in patients with hyperopic astigmatism was +0.72 +/- 0.93 D and -1.08 +/- 0.60 Dcyl. In the only patient with myopic astigmatism the final postoperative error of both eyes was +0.5 D and -0.5 Dcyl. The advantage of the PTIOL implantation is fast visual recovery, potential reversibility of the procedure, maintaining of the accommodation, and stability of the postoperative refraction.

[Specific chorioretinitis--a case report]

The authors present an uncommon case of ocular involvement in extrapulmonary form of tuberculosis with cutaneous manifestation. A case of a patient who was treated for skin efflorescences on legs for several months is demonstrated. The eye examination showed the picture of chorioretinitis of suspicious tuberculous etiology. A prompt healing of cutaneous lesions occurred and retinal finding stabilized under the specific therapy. The authors emphasize that this infectious etiology should not be omitted in differential diagnostic considerations of uveitis.

[Posterior scleritis--a case report]

Authors present clinical manifestation and therapeutic possibilities in posterior scleritis, a disease, which may cause diagnostic dilemma. They also give an account of new examination methods which amend the diagnostic schema and safely confirm this diagnosis. In the article, a disease of a seventeen years old man is presented, in which posterior scleritis of unknown etiology was diagnosed. Following the systemic corticosteroid treatment the visual acuity of the affected eye improved, subjective signs disappeared, and the clinical manifestation returned to normal.

[Implantation of multifocal intraocular lenses]

The authors refer to the first experience in implantation of multifocal intraocular lens (MIOL) AMO ARRAY (model SA 40 N) produced by Allergan to a group of 35 patients (69 eyes). The proportion of men in the group was 42.9%, women being 57.1%. The mean age of the group was 50.9 +/- 4.3 year, range 36-71 years. The implantation of this type of intraocular lens was made due to a refractory intervention on a clear lens in 84.0% eyes and operation on cataract in 16.0%. The study was aimed at evaluation of the results of visual acuity for short and long distances, resulting refraction after the operation, the occurrence of side visual phenomena and their tolerance by the patient, necessary supplementary eyeglass correction especially in patients after refraction lensectomy. Uncorrected visual acuity for long distances 0.7 or better was in 75.9% of patients. Sixty one % of patients with MIOL in both eyes do not require glasses for vision into short distances (No 1-3).

[Photorefractive keratectomy in hypermetropia]

AIM

To evaluate the results in patients with hypermetropia having undergone photoreactive keratectomy (PRK).

GROUP AND METHODS

The authors present a retrospective analysis of the results in 40 eyes operated on PRK in the period of September 1997 to November 2002 at the Eye Clinic of the Faculty Hospital in Hradec Králové. The mean preoperation spherical refraction was 2.90 +/- 0.98 dioptry (D), the mean astigmatism being -0.82 +/- 0.78 D, visual uncorrected visual acuity (NZO) 0.37 +/- 0.37, the mean corrected visual acuity (KZO) 1.28 +/- 0.27).

RESULTS

One year after the operation on 31 eyes, the resulting mean spherical refraction was 0.76 +/- 1.10 D, the mean astigmatism being -1.01 +/- 0.80 D, NZO 0.77 +/- 0.18, KZO 0.99 +/- 0.21, NZO 6/12 and better was detected in 94% of surgically treated eyes.

CONCLUSION

The PRK method has been found sufficiently effective for the correction of low and medium hypermetropia.

[Visual function in high myopia corrected with anterior chamber phakic lens (PK PIOL). Initial results]

20 eyes (12 women, 8 men) undergoing implantation of anterior chamber phakic IOL (PIOL) for correction of the refractive error were examined before and 1 and 6 months after surgery. Median of preoperative spherical equivalent of refraction was -9.75 D (range -19.00 to -6.00 D). Contrast sensitivity (CS) was tested on a computerized system of the Contrast sensitivity 8010 type in 6 spatial frequencies (range 0.74 to 29.55 c/deg) and using the Ginsburg's charts also in 6 spatial frequencies (range 1.15 to 27.25 c/deg), the best corrected visual acuity (BCVA) was measured on the normalized charts with Landolt rings, influence of glare of 342 cd/m2 was examined using Brightness Acuity Tester. At 6 months postoperatively, median of spherical equivalent of refraction was 0.00 (-1.00 to 0.00). BCVA increased from 0.79 (range 0.50 to 0.97) preoperatively onto 0.96 (range 0.83 to 1.00). Median of CS increased in all spatial frequencies tested using both methods, significantly in the middle and high frequencies and CS almost, reached lower border of CS normal range. Glare had only nonsignificant influence on both BCVA and CS. Quality of vision postoperatively improved significantly.

[Long-term results of photorefractive keratectomy in myopia up to -6 D]

OBJECTIVE

To present clinical results of patients with myopia up to -6 dioptres (D) after photorefractive keratectomy (PRK) and evaluate their stability during a 4-year period.

MATERIAL AND METHODS

The authors evaluated retrospectively the refraction before and after surgery in patients with myopia up to -6 D during the period from September 1997 till December 2000. The group comprised a total of 847 eyes. The mean spherical refraction during the whole follow up period was before surgery -3.61 +/- 1.17 D, the mean astigmatism was -0.65 +/- 0.63 D, non-corrected visual acuity (UCVA) 0.09 +/- 0.09, the visual acuity with optimal correction (BCVA) 1.21 +/- 0.30.

RESULTS

One year after PRK we achieved in our group a mean spherical refraction of -0.17 +/- 0.74 D, a mean astigmatism of -0.61 +/- 0.43 D, UCVA 0.92 +/- 0.25, BCVA 1.02 +/- 0.19.

CONCLUSION

Photorefractive keratectomy is an effective and safe method for correction of myopia up to -6 D. The results as regards refraction were comparable with other departments and did not differ much during individual years. Stabilization occurs 3-6 months after the operation.

[Refractive surgery in myopia up to -6D]

OBJECTIVE

To evaluate the clinical results in patients with myopia up to -6 dioptres (D) after refraction surgery, evaluate their stability and compare photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

MATERIAL AND METHODS

The authors evaluated before and after surgery the refraction values in patients with myopia up to -6 D operated in 1999 and 2000. The patients were subjected to standard examination before operation, one week, 1, 3, 6 and 12 months after operation. The group comprised a total of 542 eyes, 452 PRK eyes and 90 LASIK eyes.

RESULTS

After PRK surgery the mean spherical refraction after one year was -0.35 +/- 0.71 D, the mean astigmatism -0.63 +/- 0.38 D, UCVA 0.90 +/- 0.19, BCVA 0.98 +/- 0.11. After LASIK surgery after one year the mean spherical refraction was -0.10 +/- 0.81. D, the mean astigmatism -1.05 +/- 0.65 D, UCVA 0.80 +/- 0.24, BCVA 0.86 +/- 0.21.

CONCLUSION

Both methods proved effective and safe for correction of myopia up to -6 D. The results at our clinic are comparable with other departments and are stable in different years. PRK and LASIK achieve equal postoperative results after an interval of 3 to 6 months following surgery.

[PRK and LASIK in patients with myopia ranging from -6 to -9 D] ]

OBJECTIVE

Observing of effectiveness, safety and short-term stability of patients with myopia ranging from -6.0 to -9.0 diopters (D) after surgery and their comparison.

PARTICIPANTS AND METHOD

We were retrospectively analyzing pre- and postoperative outcomes of patients with myopia ranging from -6.0 to -9.0 D. 90 eyes were examined before laser in situ keratomileusis (LASIK) with mean spherical equivalent refraction -7.64 +/- 0.84 D and mean cylinder -1.23 +/- 1.1 D. 56 eyes were examined before photorefractive keratectomy (PRK) with mean spherical equivalent refraction -6.92 +/- 0.72 D and mean cylinder -0.60 +/- 0.55 D. Patients were examined before operation, one week, one month, three months, six months, nine months and one year after operation. Data were collected and analyzed by the computer programme.

RESULTS

We observed the patients who underwent the operation and six months after surgery we received following results: After PRK mean spherical equivalent refraction was -0.23 +/- 1.24 D, mean cylinder -0.83 +/- 0.42 D, uncorrected visual acuity (UCVA) 0.86 +/- 0.35, best spectacle-corrected visual acuity (BCVA) 1.13 +/- 0.33. After LASIK mean spherical equivalent refraction was -0.29 +/- 1.19 D, mean cylinder -1.14 +/- 0.77 D, UCVA 0.65 +/- 0.25, BCVA 0.83 +/- 0.25. One year after PRK mean spherical equivalent refraction was -0.44 +/- 1.26 D, mean cylinder -0.80 +/- 0.57 D, UCVA 0.81 +/- 0.31, BCVA 0.97 +/- 0.21. After LASIK mean spherical equivalent refraction was -0.14 +/- 0.86 D, mean cylinder -1.26 +/- 0.89 D, UCVA 0.75 +/- 0.25, BCVA 0.89 +/- 0.20.

CONCLUSIONS

Both methods are effective and their results after 3 to 6 months after laser treatment in patients with myopia ranging from -6.0 to -9.0 D were comparable. Based on the complex evaluation, we prefer LASIK nowadays.

[Comparison of visual function in myopia over -6.0 dpt after photorefractive keratectomy and laser in situ keratomileusis]

1. 41 myopes undergoing PRK and 31 patients undergoing LASIK for correction of spherical refractive error were examined before and 1, 3, 6 a 12 months after surgery on Schwind Multiscan with ablation zone between 5 and 7 mm. Mean preoperative spherical equivalent of refraction was -8.0 +/- 1.7 D in PRK group and -9.2 +/- 2.1 D in LASIK one. 2. Contrast sensitivity (CS) was tested on a computerized system of the Contrast sensitivity 8010 type in 6 spatial frequencies (0.74; 1.97; 3.69; 7.39; 14.77; 29.55 c/deg) and the best corrected visual acuity (BCVA) was measured on the normalized charts with Landolt rings. 3. At 12 months postoperatively, mean spherical equivalent of refraction was -0.6 +/- 1.0 D (PRK) and -1.0 +/- 0.8 D (LASIK). A refractive error within +/- 0.5 D had 31.5% (PRK) and 57.5% (LASIK) patients. Increasing of BCVA was measured in 51.5% (PRK) and 41.9% (LASIK) patients about 1 optotype to 2.5 lines. Mean CS in 6 frequencies reached 99.4; 102; 105; 109; 115 and 140% of preoperative values in PRK group and only 96; 95.8; 96.3; 95.8; 97.8 and 94.6% in LASIK one. 4. At 12 months after surgery, mean spherical equivalent, CS was better and number of patients with increased BCVA was significantly higher after PRK, than those attained with LASIK. On the other hand, a number of patients with a refractive error within +/- 0.5 D was higher and percentage of reoperations was lower in LASIK group.

Retreatment after photorefractive keratectomy for low myopia

OBJECTIVE

The purpose of the study was to evaluate the results of retreatment for low myopia after primary photorefractive keratectomy (PRK).

DESIGN

A prospective study.

PARTICIPANTS

A total of 48 eyes of 37 patients from 566 eyes of 331 patients originally treated for myopia of up to -6 diopters (D) were studied.

INTERVENTION

Photorefractive keratectomy by the Coherent Schwind Keratom II excimer laser was performed.

MAIN OUTCOME MEASURES

The parameters evaluated were visual acuity, refraction, and corneal clarity.

RESULTS

Of the 566 eyes with myopia up to -6 D, 48 eyes (8.5%) required retreatment. The sphere (mean +/- standard deviation) was -0.88 +/- 1.24 D before second surgery. At 6 months, the mean was -0.04 +/- 0.91; at 1 year, it was -0.33 +/- 0.75 D. At 6 months, 75% of sphere value was within +/- 1 D. The preoperative uncorrected visual acuity (UCVA) was 20/200 or worse in 12.8% of eyes and 20/40 or better in 40.4% of eyes. Six months after reoperation, 20/60 UCVA was obtained in 17.4% of eyes. All others (82.6%) had UCVA of 20/40 or better, 26.1% better than 20/20. The proportion of eyes with best spectacle-corrected visual acuity better than 20/20 decreased from 60.0% to 47.1% 6 months after reoperation. Six months after reoperation, haze 1 was present in 42.9% and haze 2 in 4.7% of eyes, and in no eye was haze worse.

CONCLUSION

Retreatment after PRK for low myopia can significantly increase UCVA and decrease residual refractive error without significant complications.