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Univerzita Karlova 1. lékařská fakulta Studijní program: Zobrazovací metody v lékařství (P5150) Studijní obor: Zobrazovací metody v lékařství (5103V000) MUDr. Adam Kopecký Změny na předním segmentu po 25G+ PPV Changes in the Anterior Segment after 25G+ PPV Abstract Vedoucí závěrečné práce/Školitel: doc. MUDr. Jiří Pašta, CSc., FEBO Praha, 2019 Abstract: Pars plana vitrectomy is a dominant surgical method in posterior segment surgery of the eye. The principle of this method is the surgical approach via the pars plana anatomical region. With this approach, surgeon performs the posterior segment surgery without directly affecting the anterior segment of the eye. Short-term effect of pars plana vitrectomy on the anterior segment of the eye has been repeatedly proven. That might be an important factor both in assessing the complications of this method and planning the surgery in complicated patients. Generally, it is presumed that we do not observe long-term effects on anterior segment after pars plana vitrectomy. The aim of our work is to evaluate the long-term changes in the anterior segment after the uncomplicated 25G + PPV with gas tamponde. The group of 20 patients was selected according to strict indication criteria. Using a series of examinations, we examined specific parameters such as: intraocular...

During the period of the last six years (2010-2016), the authors performed Selective Laser Trabeculoplasty (SLT) in 32 women (64 eyes); pregnant women patients with primary open angle glaucoma were referred to the Department of Ophthalmology, First Medical Faculty, Charles University, and Central Military Hospital in Prague, Czech Republic, European Union, to perform this procedure with the goal to interrupt their antiglaucomatic treatment by means of eye drops during the pregnancy and the breastfeeding period. In other 7 cases (14 eyes), they performed the SLT with the goal to terminate the local medicament treatment before planned pregnancy. The procedure was performed on the outpatient basis, during one session, always in both eyes, after one-shot local anesthesia, following their own protocol in the range of 270° of the iridocorneal angle circumferentially, with the parameters 1.0 mJ, 80 shots, 400 μm, using the Tango laser device. All the current local antiglaucomatic treatment was after the performing of the procedure stopped. During the period of pregnancy and breastfeeding, no subjective ophthalmologic problems were neither present, nor objective worsening of visual functions was noticed. According to their own experience, the authors offer the possibility to get over the period of pregnancy and breastfeeding in women patients with primary open angle glaucoma by means of performing the selective laser trabeculoplasty, so without the risk of medicament antiglaucomatic treatment adverse effects.Key words: glaucoma, selective laser trabeculoplasty (SLT), treatment, pregnancy, breastfeeding.

The cribriform plate is a threshold of the intraocular pressure (VOT) and of the intracranial pressure (IKT). The difference between the VOT and IKT is referred to as translaminar gradient (TLG). The goal was to evaluate the Glaucoma progression (visual field, fundus examination, HRT) with / without topical anti-glaucomatous therapy) in relation to the TLG.the significance of TLG has been studied in two groups. I. Group: 57 patients diagnosed and treatment of Primary Open-Angle Glaucoma (PGOU), 10 patients with Ocular hypertension (OH), 7 patients with Normal-Tension Glaucoma (NTG), and 75 healthy without glaucoma. The examinations of TLG were carried out once and retrospectively. In II. group there were prospectively studied 14 patients with OH and 24 patients with newly detected PGOU without local therapy. The examinations were performed 4 times at intervals of 10 to 11 months. All tests included a basic eye examination, ORA tonometry, HRT examination, gonioscopy, Color Doppler sonography of blood vessels of the eye and orbit. Venous pulsation pressure (VPT) has been recorded by the Ophthalmodynamometer Meditron (D-ODM). In case of spontaneous retinal venous pulsation, VPT was considered as the same pressure as the VOT. The TLG was calculated with formula of Querfurth: ICT = 0.29 + 0.74 (VOT / PI (AO)). [PI(AO) - Pulsatility index of the Ophthalmic artery (AO)].I. group: TLG was in the control group without Glaucoma: 12.2 ± 2.0 torr. The NTG group: 9.0 ± 1.70 mm Hg. PGOU: 11.1 ± 1.91 mm Hg. OH: 12.6 ± 0.85 mm Hg. IKT alone does not show a significant relationship to the presence of glaucoma, ocular hypertension. II. Group: The average TLG in Ocular Hypertension (14 patients) has been 3.8 ± 1.2 torr. 2 patients (OH) had TLG 10 torr. and 15 torr. After 4 years in one of them (TLG = 15 torr.) there was recorded Glaucoma progression. In the PGOU group before antiglaucoma therapy, TLG was 15.0 ± 4.8 torr for all patients. After setting up local anti-glaucoma therapy and decreasing VOT, the TLG in 20 patients reduced to 3.6 ± 1.3 mm Hg.TLG showed a significant relationship to the Glaucoma progression. The risk of glaucomatous damage increases proportionally with increasing Translaminar gradient. Translaminar gradient can be use to refine the so-called. "Target VOT". TLG has a role in ocular damage (ocular hypertension, glaucoma, vascular occlusion, optic neuropathy), intracranial damage, orbitopathy, selection of appropriate antiglaucomatous therapy.Key words: color Doppler ultrasonography, glaucoma, ocular hypertension, ophthalmodynamometry, translaminar gradient, venous pulsation pressure, venous pulsation.

The authors present case reports of two young women, who visited the outpatient Department of Ophthalmology clinic, University Hospital in Hradec Králové with lacklustre subjective eye complaints lasting over few weeks. It the beginning high values of intraocular pressure in both eyes and severe glaucomatous damage of the optic nerve head were find out, which was confirm using perimetry and OCT (optical coherence tomography). The anamnesis has shown that both patients have been treated for atopic eczema since their childhood. The skin disease is controlled by local application of corticosteroids preparations. The aim of this report is to highlight the issue of steroid induced glaucoma during local steroid therapy of chronical skin diseases with the maximum of expression in the face. Wrong and long-term using of corticosteroids can lead to the distinct and permanent reduction of visual field or even the loss of vision. The relevance of this eye disease is also depends on the initial, inconspicuous development of eye complaints. However, regular ophthalmology checks can prevent serious deteriorating of visual functions in patients with steroid therapy.Key words: secondary open-angle glaucoma, corticosteroids, atopic eczema.

The value of ICT is important in diagnosis of the diseases of the eye and orbit Methods for direct measurement of intracranial pressure (ICT) are exact, but they are invasive and there is some risk of infection and damage of the tissue. Currently there are 2 valid indirect methods of mesurement of IKT. Digital Ophthalmodynamometry (D-ODM) and Transcranial Doppler ultrasonography (TDU). D-ODM is a non-invasive method for measuring of the Pulsating Venous Pressure (VPT). We can measure VPT by the pulse phenomena. Physiologically (to be maintained blood flow) VPT not be less than the ICT and intraorbital pressure (IorbitT). If we raise the VPT to compensate the current IKT (or IorbitT) - there is a pulsation VCR. We can calculate aproxymative IKT with the formula: IKT = 0.903 - (VPT) - 8.87, or IKT = 0.29 + 0.74 (VOT / PI (AO)). [VOT = intraocular pressure. PI - pulsatility index arteriae ophthalmic from Color Doppler ultrasonography.] IKT can be approximate calculate with mathematical formulas: IKT = 0:55 × BMI (kg / m2) + 0.16 × KTD (mmHg) - 0:18 x age (years) - 1.91. [KTD - diastolic blood pressure, BMI - Body master index] or: IKT = 16.95 x 0.39 x OSASW09 + BMI + 0.14 + TKS - 20.90. [OSASW095: width of the orbital arachnoid space at a distance of 9 mm behind the eyeball (nuclear magnetic resonance). BMI: Body Mass Index. TKS: mean arterial pressure]. Normal values of VPT are under 15 torr. The risk of increased intracranial pressure is above 20 torr. Under physiological conditions, there is intraocular pressure lower in about 5 torr than VPT.D-ODM is a useful screening method in the evaluation of IKT for hydrocephalus, brain tumors, cerebral hemorrhage after brain trauma and also in ocular diseases: Glaucoma, Ocular hypertension, orbitopathy (endocrine orbitopathy), ischemic / non-ischemic occlusion of blood vessels of the eye, indirect detection ICT carotid artery-cavernous fistula, amaurosis fugax, optic neuropathy. D-ODM is suitable for immediate evaluation of IKT, but is not suitable for continuous monitoring. As it can be repeated, it is useful for a patient suspected of having an increased ICT.Key words: central retinal artery, central retinal vein, colour Doppler ultrasonography, digital ophthalmodynamometry, intracranial pressure, pressure of cerebrospinal fluid, transcranial Doppler ultrasonography, intraocular pressure, venous pulsation pressure, venous outflow pressure, retinal venous pressure.

To determine, if in the group of hypertensive (HTG) and normal-tension glaucomas exists correlation among ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) in the same altitudinal half of the retina and sum of sensitivities of the visual fields opposite half (hemifield test) of the same eye.In the HTG group, there were 25 patients; thereof 12 women of the average age 53.23 years (range, 34 - 69 years) and 13 men of the average age 60.38 years (37 - 74 years). In the second group with NTG were 17 women of the average age 55.35 years (25 - 75 years) and 8 men of the average age 55.5 years (32 - 69 years). The including criteria in the study were: visual acuity 1.0 with possible correction smaller than ± 3 dioptres, approximately the same extent of changes in visual fields in all patients (with beginning stage of the disease), no other ophthalmologic or neurological disease. In patients with NTG, the diagnosis was confirmed by means of electrophysiological examination. The thicknesses of the GCC, as well as the RNFL were measured by means of SD-OCT RTvue - 100. The visual fields were examined by fast threshold glaucoma program with the Medmont M 700 perimeter. Th e summation of sensitivities in apostilbes (asb) was counted in the extent 0 - 22 degree in the upper as well as in the lower half of the visual field. Afterwards, the results of the sensitivities summations were compared to the opposite altitudinal half of the retina of the same eye (GCC and RNFL). To compare the dependence among selected parameters, the Pearsons correlative coefficient r was used.To compare the dependence among selected parameters, the Pearsons correlative coefficient was used. Comparing GCC and the sensitivity in the hemifield test we determined medium-strength correlation in NGT-patients only. Similar correlation we noticed also between RNFL and visual field, except of RNFL in the upper half of the retina and lower hemifield test (r=0.3, p=0.1). In HTG, we did not determine any statistically significant correlation.Comparing GCC, RNFL, and visual fields, we determined medium-strength correlation in NTG only, which shows the evidence of difference of both diagnostic groups.Key words: GCC, RNFL, visual field, hypertensive glaucoma (HTG), normal-tension glaucoma (NTG).

Iris melanomas are very rare in children. The paper presents the case of a 12-year-old boy with iris melanoma of spindle-cell type A and pre-operatively associated with uncontrolled secondary glaucoma. Tumour resection was complicated by lens extraction and consecutive PC IOL implantation. Antiglaucomatous surgery was performed due to the persistently elevated intraocular pressure. Currently, the intraocular pressure is within the normal range and the patient has no signs of the presence of tumour cells or metastases.Key words: iris melanoma, spindle-cell type, secondary glaucoma.

The aim of this study was to evaluate the ocular surface in patients treated with prostaglandin analogues considering contained preservative agent.60 patients with glaucoma or ocular hypertension treated with prostaglandin analogue monotherapy were enrolled in this observational study. 20 patients with glaucoma suspect or ocular hypertension without local or systemic glaucoma medication formed the control group. Demographic data and medical history were recorded for each participant. Patients filled in the Ocular surface disease index© (OSDI) questionnaire and underwent an ophthalmological examination including assessment of conjunctival hyperaemia according to Efron, tear film break up time (BUT) and fluorescein staining according to the Oxford grading scheme. Treated participants were divided into 3 groups according to the preservative contained in the currently used prostaglandin analogue: the preservative-free group (18 patients), the polyquaternium group (17 patients) and the benzalkonium chloride (BAK) group (25 patients).The control group had significantly lower fluorescein staining than the preservative-free group (p=0.001), the polyquaternium group (p=0.007) and the BAK group (p=0.002). The conjunctival hyperaemia was significantly lower in the preservative-free group compared to the polyquaternium group (p=0.011). There was no significant difference among the other groups. The difference neither in the OSDI score nor in the BUT was statistically important.This study confirmed that the ocular surface is worse in patients treated with prostaglandin analogue monotherapy than in people without glaucoma medication. A significant difference among treated patients depending on a preservative agent was not proved.Key words: benzalkonium chloride, glaucoma, ocular surface disease, preservatives, prostaglandin analogues.

In the case report, bilateral cystoid macular edema with optic disc edema on the left side in young man is described. As etiology out of the systemic diseases, we considered the hypertension. The results of the neurological examination, including the brain CT examination were physiological. The patient was examined by the internal specialist, the hypertension was treated - and it was the presumed etiology of the ophthalmologic findings. Due to the repeated worsening of the ophthalmologic findings, we searched for other etiology. Bilateral buried optic disc drusen were found by means of ultrasound. Bilateral cystoid macular edema and optic disc edema were evaluated as signs of circulatory disturbance of the posterior ciliary arteries and macular choroid caused by optic disc drusen. The antiglaucomatic treatment was started with - alpha 2 adrenergic receptors agonist - brimonidine - which increases the blood supply of the optic nerve and decreases the intraocular pressure with presumed delay of axons dysfunction.macular edema, optic disc drusen, intraocular pressure, visual field, ultrasound.

The aim of the study was to analyze the group of patients with optic disc drusen focusing on possible complications of this disease.In our group of patients, we examined 46 eyes of 23 patients with the suspicion of optic disc drusen during the period from May 2013 until January 2014. In all adult patients, we examined the anterior and posterior segment of the eye biomicroscopically, established the visual acuity, measured the intraocular pressure, examined the visual field, performed the ultrasound examination of the eye (A and B-scan), analyzed the retinal nerve fiber layer (RNFL) by means of optic coherence tomography (OCT), and color and red-free photography. According to the biomicroscopical findings, the drusen were divided into invisible drusen (buried drusen) (verified by ultrasound only) - grade 0, visible delicate drusen - grade I, and multiple drusen (conglomerates) - grade II.Out of 23 patients, 14 were women and 9 were men. The age of the patients ranged from 8 to 82 years, the mean age was 44.4 years. In the group, there were 3 children (8, 11, and 13 years). In twenty-two patients, the drusen were present bilaterally, and one female patient had drusen on the right eye only. The grade of the drusen was set from 0 to II in all 45 eyes according to their amount, location, and visibility. As grade 0 were evaluated drusen in 11 patients; out of them, 10 patients had drusen bilaterally, and one female patient unilaterally. Out of these 11 patients, three were children. Grade I optic disc drusen bilaterally had nine patients, and three patients had drusen grade II bilaterally. In grade 0 drusen, no defect of the visual field was noticed. In drusen grade I, it was noticed the defect of the visual field in two patients (four eyes) out of nine patients, and in grade II the defect was present in two out of three patients (three eyes). The evaluation of the RNFL, by means of OCT, was performed among all three groups according to their grade 0 - II. In higher grades, the thickness of the RNFL was lower. Comparing to drusen grade 0, the drusen grade I, and II presented serious thinning of the RNFL superiorly. In three patients (drusen grade 0 and I) other complications of the optic disc drusen were observed. In one female patient with drusen grade I, there was decrease of the visual acuity due to the partial intravitreal hemorrhage in her left eye and parapapillary located retinal hemorrhages. In one male patient with drusen grade 0 was bilateral decrease of the VA due to cystoid macular edema caused by drusen. This patient had also retinal hemorrhages located near the papilla and partial intravitreal hemorrhage in his worse left eye. In one female patient with the drusen grade 0, the tortuous veins were noticed.Drusen of the optic disc are present in 0.3 - 1.0 % of the population, and are bilateral in approximately 75 - 91 % of the cases. It is important to distinguish optic nerve disc drusen from the papiledema. Drusen of the optic nerve can cause severe defects of the visual field, decrease of the retinal nerve fiber layer, and may be accompanied by vessels complications. Patients with the optic disc drusen should regularly undergo ophthalmologic examinations focused on the intraocular pressure, visual field testing, and retinal fiber layer analysis. In patients with visual field defect and borderline values of intraocular pressure, the antiglaucomatic therapy is recommended.optic disc drusen, intraocular pressure, visual field, ultrasound, retinal nerve fiber layer analysis, complications of the optic disc drusen.

To assess the effect of the ProVens® dietary supplement administration on intraocular pressure in patients with glaucoma and ocular hypertension.The patients included in the trial were given the ProVens® dietary supplement once daily. One ProVens® tablet contains: 50 mg of maritime pine bark extract, 100 mg of green tea extract, and 3 mg of blueberry extract. The main ProVens® components are proanthocyanins from the bark of the maritime pine tree Pinus pinaster, polyphenols from green tea, and anthocyanins from blueberries. The total number of patients included in the trial was 46. Out of these, 35 patients were monitored for asymptomatic ocular hypertension and 11 patients for open-angle glaucoma treated with prostaglandin analogs. Intraocular pressure was measured by applanation tonometry in the beginning of the trial, after one month, and after three months of their inclusion in the trial, always at the same time of the day.In the group of patients with ocular hypertension, there was a statistically significant reduction in the intraocular pressure from the baseline values of 24.2 ± 2.1 mm Hg to 20.9 ± 2.5 mm Hg within the period of three months (p0.0001). In the group of patients with open-angle glaucoma, there was a statistically significant reduction of the intraocular pressure from the baseline values of 18.4 ± 3.2 mm Hg to 17.0 ± 3.1 mm Hg within the period of three months since the beginning of administration of the product (p = 0.022). When comparing both groups, we observed a significantly higher reduction in intraocular pressure (p = 0.0001) in the group of patients with ocular hypertension. In the whole group, no adverse effects were reported during the intake of this dietary supplement.Intake of the ProVens® dietary supplement containing proanthocyanins from the bark of the maritime pine tree Pinus pinaster together with a mixture of herbal antioxidants appears to be one of the methods of how to improve the control of intraocular pressure, particularly in patients with ocular hypertension.glaucoma, ocular hypertension, ProVens®, proanthocyanins, antioxidants, maritime pine bark extract.

This thesis deals with the quality of life of patients with glaucoma. Its aim is to introduce professional and general public with difficulties and changes that these patients throughout their lives restricted. The theoretical part briefly defines quality of life describes the basic characteristics of glaucoma. The practical part describes its own investigation, which took place from June to November 2015 in the eye clinic Regional hospital Kladno. A total of 83 patients were enrolled. For data collection method was chosen a questionnaire which included items the standardized questionnaires NEI-VFQ-25 and GQL-15 and items characterizing the respondent. From his own survey shows that in the sample of respondents can be observed significant differences in responses by gender, age, treatment with glaucom disease and the level of the highest educational attainment. The thesis also gives a brief description and results of studies already exist on the same or similar subject.

To evaluate and compare the impact of long-term use of intraocular pressure lowering medication on the biomechanical properties of the cornea.Group of 305 eyes of 154 patients newly diagnosed with primary open angle glaucoma (POAG, n = 68) or ocular hypertension (OH, n = 6) was enrolled in prospective cohort study. The control group was established of 80 untreated eyes of 40 patients with ocular hypertension and 80 eyes of 40 patients with no ocular pathology. Following parameters were evaluated: intraocular pressure (IOPg,IOPcc), hysteresis (CH), corneal resistance factor (CRF) and central corneal thickness (CCT). The parameters were evaluated at baseline (untreated) and in follow up periods of 3, 6, 9 and 12 months. The same schedule was used for eyes in the control group. Eyes with POAG or OH were sorted into two groups depending on the type of applied medication: prostaglandin analogues, carboanhydrase inhibitors alone or combined with betablockers.We did not prove any statistically significant difference in hysteresis in patients with newly diagnosed POAG (yet untreated) in comparison with normal eyes in control group (p = 0.238). We proved significantly higher values of CRF (p = 0.032) and CCT (p = 0.013) in the control group of untreated patients with ocular hypertension. This result confirms higher number of patients with stiffer and thicker corneas. Statistically significant difference of CH and CRF was proved (p0.0001) in eyes treated by prostaglandin analogues during follow up period. In these eyes we also demonstrated reduction of CCT (p0.001). We did not record any other statistically significant change in remaining followed parameters.Increase of CH and CRF can show change of biomechanical properties of the cornea after long-term use of prostaglandin analogues. The biomechanical properties of the cornea were not impacted by carboanhydrase inhibitors. Further studies are required to establish the effect of long-term use prostaglandin analogues on accuracy of IOP measurements.

in English Intitution : Institute of Social medicine LF UK in HK Department of nursing Title of the thesis: Well informed patient - better colleague for glaucoma treatment Supervisor: Prof. PhDr. Jiří Mareš, CSc. Number of pages: 72 Year of the presentation: 2015 Key words: glaucoma, intraocular pressure, glaucous, glaucoma medication, education, role of the nurse, questionnaire, range of question, research My bachelor's thesis deals with the glaucoma disease which appears in the population all over the world. Literature states that it is the second-leading cause of blindness of people over 40 years old in the world. The most important prevention of such an impact as blindness is to detect and treat the glaucoma as soon as possible. The theoretical part of my work describes this disease, its subtypes, methods of investigation, diagnosis, and medical treatment.

The author calculated the daily dose of Benzalkonium Chloride (BAC) in eye drops used in glaucoma treatment from the patients point of view, which means the real amount of BAC applied in the conjunctival sac. The information about BAC concentration in 1 milliliter (mL) do not offer sufficient picture about real circumstances, because the size of the drop, especially after the introducing of the use of generic products in clinical practice in specific anti-glaucomatic drugs, differs significantly. The daily dose of BAC may have substantial significance in the patients treatment tolerance. The overview of BAC daily dose in single therapeutic groups and drugs follows: betablockers: Timo-COMOD 0, Arutimol 2.6, Vistagan 2.8, Timolol-POS 3.0, Arteoptic 3.7, Betoptic S 4.8, Timoptol MSD 6.3, Betoptic 10.0; alpha-mimetics: Alphagan 3.5, Luxfen 3.5, Aruclonin 7.1; derivates of prostaglandine, prostamides: Taflotan 0, Monopost 0, Lumigan 1.4, Unilat 3.1, Travatan 3.9, Latanoprost Apotex 4.3, Rescula 5.8, Latanoprost POS 5.9, Xalatan 6.0, Latanoprost Ratiopharm 6.0, Latanoprost Actavis 6.0, Latanoprost Arrow 6.0, Arulatan 5.4, Latalux 6.0, Glaucotens 6.0, Xaloptic 6.0, Solusin 6.1; carboanhydrase inhibitors: Batidor 3.8, Azopt 4.8, Trusopt 5.4, Oftidor 8.1; fixed combinations: Ganfort 1.4, Dorzolamid/timolol TEVA 2.8, Combigan 3.2, Duotrav 4.3, Cosopt 5.6, Xalacom 6.0, Glaucotima 6.0, Latanoprost/timolol Apotex 6.3, Azarga 6.4, Dorzogen Combi 6.5, and Dozotima 8.8 µl.

The paper compares a concordance in measuring the intraocular pressure (IOP) using two different tonometers, Goldman applanation tonometer (GAT) and ICARE PRO® tonometer. GAT is nowadays considered a standard device for measuring the IOP at the offices of ophthalmologists. Options of the measurements are however limited by necessary installation as well as use of a slit lamp where the evaluation is made subjectively by the examiner. The ICARE PRO® tonometer is a light and mobile device that allows to perform the measurement horizontally as well as vertically. The results are calculated automatically. The data for the paper was collected by IOP measurements in right and left eye in 45 individuals at the age range of 8-84 years. They were all diagnosed for glaucoma or were suspected to have glaucoma. The measurements were carried out always at the same day time. The acquired data was compared by a double select paired t-test with a significance level p = 0.05 and then analyzed by Bland-Altman method. There was no statistically important difference (p0.26) between the two devices. The average IOP measured by the ICARE PRO® tonometer was 18.19 mm Hg with standard deviation 3.70 mm Hg, whereas the average IOP measured by GAT was 17.94 mm Hg with standard deviation 3.66 mm Hg. It was observed that the difference in the measurements was not related to the IOP. The results show an acceptable concordance of measurements performed by the two devices. The ICARE PRO® tonometer, in comparison with its predecessor ICARE® TA01 evaluated in the past, shows a much smaller average difference in collected values compared with GAT. Based on the analysis of the collected data it may be stated that measuring the IOP by ICARE PRO® tonometer is clinically acceptable alternative to the use of GAT.

The aim of the study was to evaluate the decrease of intraocular pressure and reduction of local as well as total therapy by patients with uncontrolled secondary glaucoma after antiglaucomatous surgery with mini implant ExPRESS. From the total of 61 eyes with this implant, operated in our clinic between years 2009-2012, were 20 patients (22 eyes) with secondary glaucoma. Of which 7 eyes with neovascular glaucoma, 4 eyes with posttraumatic, 6 eyes with postuveitic, 4 with postoperative and 1 patient with pseudo-exfoliative glaucoma. 10 patients were after pars plana vitrectomy. In our group of patients was proven significant reduction of IOP and reduction of local and total therapy after surgery with the implant ExPRESS.

To evaluate the long-term compensation and efficacy after non-penetrating deep sclerectomy using different types of implants.Patients were divided in 3 groups: deep sclerectomy without implant (DS): 34 eyes, deep sclerectomy with Staar implant (DS+STAAR): 31 eyes, deep sclerectomy with T-flux implant (DS+T): 27 eyes. Postoperatively was evaluated: IOP, therapy and efficacy.The data are described by the relative quantity, continuous data by median, 5th and 95th percentile, always in order of groups: DS; DS+STAAR; DS+T, resp. Age at the time of surgery was 65.6 (44.9; 77.9); 64.5 (44.8; 85.0); 72.1 (51.8; 77.0) years. Follow-up period was 84 (36; 145); 96 (36; 141); 81 (36; 134) months. IOP was 26 (20; 32); 26 (20; 34); 26 (21,34) mmHg postoperatively. IOP was 14 (4; 18); 14 (4; 22); 8 (2; 16) mmHg at 1 month postoperatively. IOP was 17 (13; 23); 17 (12; 21); 14 (12; 18) mmHg at 96 months. IOP was 18 (1; 20); 18 (10; 22); 15 (13; 16) mmHg at 132 months. Completely without therapy were 0; 7.1; 42.9 % of eyes at 120 months. Complete success rate was 0; 7.1; 18.2 % at 96 months. Qualified success rate was 87.5; 89.5; 100 % at 96 months.Deep sclerectomy is a good surgical technique to reduce the IOP in patients with glaucoma. Use of T-flux implant provides the best results in our groups.

Authors introduced current possibilities of measuring intraocular pressure (IOP). A list of available methods of monitoring IOP is published; contact measurement method IOP directly on the cornea, but also over upper lid, methodology of minimal contact and non-contact measurement. Following contact methods are described; former measurements of IOP by impression Schiotz tonometer and the current methodology applanation. So far as the gold standard measurement Goldmann applanation tonometer (GAT) is considered, another methodology with applanation measurements are compared: Pascal dynamic contoured tonometer (DCT ), BioResonator - resonant applanation tonometer (ART ), digital applanation tonometer Tonopen and last hit: continuous measurement of IOP by Sensimed Triggerfish. Orientation and rapid assessment is palpation pressure control over the lid and measuring by tonometer Diaton. Rebound tonometer (RBT) iCare belongs to measurements with minimal contact, no need anesthetic drops and fluorescein, therefore a self - home version of IOP measurements (Icare ONE) is developed. Non-contact measurement of IOP by different pneumotonometers is popular for screening assessment of IOP. Reichert Ocular Response Analyzer (ORA) is a non-contact applanation IOP measurement and reveals additional properties of the cornea. In the discussion of a range methodology is evaluated, the experience of other authors and their own experience is compared. For monitoring of patients is necessary to select the most suitable methodology, measure repeatedly and accurately to allow long-term monitoring of intraocular pressure.

The aim of the study was to evaluate the efficacy, safety and local tolerability of preservative-free tafluprost 0.0015% (Taflotan®) in patients with glaucoma and ocular hypertension.Multicentric, prospective observation study was performed in the Czech Republic from October 2010 to April 2011. A total of 78 centers participated and 754 patients were included. After the doctors decision to start the treatment with Taflotan®, the patients demographic data, previous treatment, intraocular pressure and the reason for switching the medication were recorded. At the follow-up visit after 6-12 weeks, the intraocular pressure, local tolerability (a 5-level scale), the patients and doctors satisfaction (a 4-level scale), and the patients preference were recorded.Altogether, data of 496 patients were evaluated. The majority of them were women (64.9 %). The patients mean age was 58.5 years. The most common diagnosis was primary open angle glaucoma (79.2 %), followed by ocular hypertension (7.3 %), normal tension glaucoma (4.2 %), and pseudoexfoliation glaucoma (3.6 %). In 140 patients, tafluprost 0.0015% was the first antiglaucomatous medication started, 261 patients switched from another monotherapy, and 95 patients were treated with fixed- or nonfixed combinations before starting tafluprost 0.0015%. The most common reason for switching to Taflotan® was local intolerability to the current antiglaucomatous therapy (most often irritation of the eye and hyperemia). The intraocular pressure decreased significantly from 19.9 ± 4.5 mm Hg to 16.3 ± 3.0 mm Hg (p0.001). The subjective tolerability of the antiglaucomatous therapy improved rapidly, with 57.4 % of patients rating the tolerability of Taflotan® as "very good" and 34.5 % as "good". In addition, 94.4 % of patients and 96.0 % of ophthalmologists were "very satisfied" or "satisfied" with the treatment. At the final visit, 79.8 % of patients preferred Taflotan® to the previous treatment.Taflotan® significantly decreased the intraocular pressure. It was well tolerated even in patients with previous intolerability to another antiglaucomatous therapy, including prostaglandins. The patients and ophthalmologists satisfaction with Taflotan® was high.

In this work the effect by interaction in vitro free amino acid L-arginine.HCl and selected antiglaucomatic drugs prepared mixtures on the physiological IOP values in rabbits is compare.The experimental works were performed on 5 female rabbits of the New Zealand White species. After instillation 2 drops of in vitro prepared 10% solution of the amino acid L-arginine.HCl with antiglacoma drugs (0.5% Timoptol, 0.005% Xalatan or 2% Trusopt) alone or in double combination mixtures at 8:00 am. into the left conjunctival sac the IOP was measured before and in 15th, 30th, 60th, 120th, 180th, 240th min. and 24 hours after instillation. The right eye was used as control.The amino acid 10% L-arginine.HCI solution separately decrease the physiologic IOP in rabbit's in confrontation with control eyes -2.9 torr. After antiglaucomatics separetly the decrease of the IOP were constated -0.69 torr by 0.5% Timoptol, -2.1 torr by 0.005% Xalatan, resp. -2.45 torr by 2% Trusopt. 10% L-arginine.HCl with combination of mono antiglaucomatics mixture decrease the physiologic IOP by 0.5% Timoptol -3.32 torr, by 2% Trusopt -4.45 torr, by 0.005% Xalatan only 2.91 torr. Application of 10% L-arginine-HCl in double combination of antiglaumatics decrease the physiologic IOP by 0.5% Timoptol0.005% Xalatan -2.96 torr, by 2% Trusopt0.005% Xalatan -4.32 torr and COSOPT (fixed combination of 0.5% Timolol maleat2% Dorsolamide.HCl) only -1.8 torr.We assume that the mentioned mixtures were able to decrease the physiologic IOP in rabbits through their better penetration to the receptors of the ciliary body. The mixture of the L-arginine.HCI with antiglaucomaticum Timoptol or Trusopt, resp. double combination of TimoptolXalatan or TrusoptXalatan was twice as effective as any of the mentioned antiglaucamatic drugs used separately. We conclude that the increased effectivity of the mixtures compared with the separate components is related to the instillation of the by now ready "bioantiglaucomatic".

The purpose of the study was to compare the levels of the intraocular pressure (NOT) measured in one eye at the same moment by three different methods: by Goldmann applanation tonometer (AT), non-contact tonometer (BT) and Tono-Pen (TP). It was further set the average variability of the performed measurements for particular tonometric methods.NOT was assessed in 106 eyes of 106 subjects aged 7-77 years (average 34.3 +/- 17.1 years). NOT was measured at the same moment with BT, TP and AT. The obtained data were statistically analyzed.The average NOT was 16.55 +/- 2.95, 17.95 +/- 4.47 and 16.13 +/- 3.4 mmHg when AT, BT and TP were applied. Average variability of three measurements for AT, BT and TP was 1.51 +/- 0.96, 1.78 +/- 1.08 and 1.47 +/- 0.9 mmHg. Average NOT levels of the measured AT and TP were almost identical with a difference of 0.42 mmHg (p = 0.236). Average level of the intraocular pressure measured by BT was higher by 1.40 mmHg and 1.82 mmHg in comparison with AT and TP (p = 0.00002), respectively.NOT measurement produced almost identical average levels at AT and TP, whereas at BT the levels were much higher. Average variability of the three subsequent NOT measurements was the highest at BT, whereas at AT and TP the average variability was lower and nearly identical.

The purpose of the study was to determine the dependence of intraocular pressure (IOP) measured by Goldmann applanation tonometer (AT), non-contact tonometer (BT) and Tone-Pen (TP) on central corneal thickness (CCT) as well as the respective comparison in relation to the central corneal thickness.CCT and IOP were assessed in 106 eyes of 106 subjects aged 7-77 years (mean 34.3 +/- 17.1 years). IOP was measured with BT, TP and AT. Central corneal thickness was assessed using ultrasound pachymetry. The obtained data were statistically analyzed.The mean CCT in 106 eyes was 572 +/- 46 microm (range 455-701 microm). A positive correlation between IOP and CCT was found in all types of tonometry. The change in measured IOP for a 100 microm of CCT was 2.0, 2.5 and 5.6 mmHg for TP, AT and BT, respectively.IOP measurement by all three methods is affected by CCT. The BT is influenced by CCT significantly more than are AT and TP.

To evaluate a long term efficiency of a deep sclerectomy with T-Flux implant on intraocular pressureRetrospective noncomparative analysis of glaucomatic patients from our ambulance who underwent deep sclerectomy combined with T-flux implantation. The main postoperative outcome measures were intraocular pressure (IOP), number of treatments and Nd:YAG goniopunctures.Mean preoperative IOP was 26.7 (+/- 0.8) mmHg, mean postoperative IOP was 17.4 (+/- 0.8) at month 6, 16.5 (+/- 0.7) at month 12, 16.9 (+/- 0.9) at month 24, 17.2 (+/- 1.0) at month 36, 18.6 (+/- 1,1) at month 48, 17.6 (+/- 1.1) at month 60 and 18.3 (+/- 1.8) at month 72. Mean preoperative number of medications per patient was reduced from 2.5 (+/- 0.13) to 0.73 (+/- 0.13) at month 6, 1.02 (+/- 0,13) at month 12, 1.1 (+/- 0.15) at month 24, 1.0 (+/- 0.18) at month 36, 1.22 (+/- 0.18) at month 48, 1.68 (+/- 0,2) at month 60, 1.8 (+/- 0.3) at month 72. Four patients (10%) underwent early goniopuncture and six patients (15%) late goniopuncture.Deep sclerectomy combined with T-Flux implant appears to be a relatively safe antiglaucomatic surgery with a minimum number of complications, high predictability of the result and a very good long term effectivity.

The aim of this retrospective study was to establish intraocular pressure (IOP) values in patients after deep perforating trabeculectomy (TE) in time periods after the surgery (one month, 3 months, 1 year, 3 years, and 6 years). Furthermore, the pharmacotherapy after TE and complications after TE, especially consecutive cataract surgeries, were followed-up.Altogether 110 patients were included into the study, which underwent TE in the years 2003 - 2008 at the Department of Ophthalmology, Kyjov Hospital, Czech republic. The TE procedure was performed in the standard manner with the base of the conjunctival flap located at the limbus. The non-parametric Wilcoxon pair test was used for the statistical evaluation.In all time periods after the surgeries, statistically significant decrease of the IOP comparing to the preoperative values occurred (test significance p0.0001 for all comparisons). The pharmacotherapy after the TE was reduced significantly: after 6 years, there were 27% of patients without any therapy, 39% of patients used the neuroprotective monotherapy only, 32% used combined therapy with two medications, and two patients only were treated by combined therapy with three medications. In two patients in which the target IOP was not reached, another TE was performed and the target IOP was achieved.TE is safe and effective method in the glaucoma therapy. After 6 years, two thirds of patients are without any therapy, or with neuroprotective monotherapy respectively.

To evaluate the effectiveness and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy.Retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9 5.3 years (range: 4months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, and the absence of visually threatening complications, no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1 6.5 years (range: 1.6 to 15.2 years).Mean preoperative and postoperative IOP was 33.6 11.4 mmHg and 17.1 6.5 mmHg (p 0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years and 65% at six years. There was no difference between primary (n = 31 eyes) and secondary glaucoma (n = 45 eyes) patients in terms of cumulative success (p = 0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed with these causes: 10 eyes with uncontrolled IOP, 2 eyes of retinal detachment and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure.Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractive to the initial surgical procedure and medical therapy.

The authors introduced into the clinical practice their own modification of the treatment by means of selective laser trabeculoplasty (SLT) in glaucoma patients. The SLT spots are burn in the extent of 270 degrees circumferentially in the anterior chamber angle (1.0 mJ, 80 spots, 400 microm). In the first group of 569 eyes with primary open angle glaucoma (POAG), followed up retrospectively and irregularly, at the control visit one year after the treatment, it was in 357 eyes possible, due to favorable decrease of the intraocular pressure (IOP), to decrease the medication from combined therapy to monotherapy, or to decrease the frequency of the application of antiglaucomatics, or to decrease their concentration. In other 197 eyes, the IOP was stabilized, but it was not possible to change the therapy, and in 15 cases, due to dissatisfactory effect of the treatment, the trabeculectomy was necessary. In the second group of POAG patients (133 eyes) followed up prospectively 1, 3, 6 and 12 months after the treatment, the decrease of the IOP from 21.1 +/- 4.5 mm Hg to 17.8 +/- 3.2 mm Hg after one month (P0.0001), to 18.6 +/- 3.6 mm Hg after 3 months, to 17.8 +/- 3.1 mm Hg after 6 moths, and to 17.7 +/- 2.8 mm Hg after 12 moths was established. Good effect to the decrease the IOP was proved in pseudoexfoliative glaucoma as well. In the pigmentary glaucoma, the decrease of the IOP was found to be temporary, and on the contrary, in two cases, shortly after the SLT, considerable elevation of the IOP was found with the necessity to perform the trabeculectomy. The SLT may be used as the primary treatment in newly diagnosed POAG with advance, as well as possibility to terminate the treatment in cases when the glaucoma diagnosis is dubious.

The purpose of this prospective study was to determine normal central corneal thickness (CCT) and intraocular pressure (IOP) in healthy white children aged 7-17 years and to analyze their possible correlation to age and gender. Further, the possible correlations between CCT and IOP were analyzed.CCT and IOP were assessed in 248 eyes of 124 healthy children aged 7-17 years (mean, 12.7 years). Fifty-four boys and 70 girls were included into the study. Further, the analyzed cohort was divided into subgroups of younger (7-12.4 years) and older (12.5-17 years) boys and girls. The data obtained from the whole cohort were statistically analyzed to assess normal CCT and IOP in healthy youth. Relation of CCT and IOP to age and gender, as well as relation between CCT and IOP were studied. The CCT was measured using ultrasonic pachymetry and IOP by means of Goldmann applanation tonometry.The mean CCT +/- SD in 124 children was 554 +/- 33 microm (range, 437-641 microm); no influence of age or gender was detected. The mean IOP +/- SD in the whole cohort was 14.5 +/- 2.6 mm Hg (range, 10-25 mm Hg). Statistically significant difference of 0.7 mm Hg was found between boys and girls, where the mean IOP was 14.1 +/- 2.3 mm Hg in boys and 14.8 +/- 2.8 mm Hg in girls respectively (p = 0.03). Age had no influence on IOP for the age range of 7-17 years (p = 0.67). The positive correlation between CCT and IOP was found. The calculated correction was 1.55 mm Hg change of IOP for 100 microm change of CCT.CCT and IOP values in healthy children aged 7-17 years are similar to values in adults. The positive correlation between both parameters seems to be of minimal clinical importance.

To compare intraocular pressure (IOP) lowering efficacy of bimatoprost 0.03% / timolol 0.5% fixed combination (BTFC) and other combinations of glaucoma drugs (bimatoprost, latanoprost 0.005% / timolol 0.5% fixed combination, separate use of travoprost 0.004 % and timolol 0.5 %) in patients with glaucoma.Fifty-three patients with glaucoma were divided into 3 groups according to their original glaucoma therapy. BTFC was used by the patients for a period of 3 months. After 1 week, 1, 2 and 3 months, the diurnal IOP curves were performed. Side effects of the new treatment were recorded and compared to the original therapy.The mean diurnal IOP reduction in the group of patients switching from bimatoprost to BTFK reached 4.4 +/- 2.28 mm Hg (p0.01). In the group of patients initially on latanoprost / timolol fixed combination, the IOP decreased with BTFK by 2.3 +/- 1.5 mm Hg (p0.01). Changing therapy from travoprost / timolol seperate combination to BTFK caused an IOP decrease by 2.3 +/- 1.5 mm Hg on average (p0.01). Conjunctival hyperemia with initial therapy was experienced in 33% of patients in our study group. With BTFK application, the hyperemia improved in 69% of these patients, got worse in 12.5% and remained unchanged in 19% of the patients. Patients found the BTFK better than the original medication in 37.5% of cases, the same in 52% and worse in 10.5%. Five patients terminated the study earlier due to poor IOP compensation or marked side effects of BTFK.In all three groups of glaucoma patients there was a significant and prolonged decrease in IOP after treatment with BTFK. The use of BTFK was accompanied by smaller incidence of conjunctival hyperemia compared to isolated bimatoprost or travoprost / timolol combination.

In a randomized prospective open study the authors followed up the influence of latanoprost 0.005 % on the changes of the ciliary body thickness by means of ultrasound biomicroscopy. The study group consisted of 40 eyes of 24 patients with primary open angle glaucoma not treated with latanoprost before. At the entry visit and further after 2 and 8 weeks, according to the study protocol, a complex ophthalmologic examination was performed; especially anatomical relation between the cornea and the iris, configuration of the anterior chamber angle, and furthermore the best visual acuity for far and near, intraocular pressure measurement by means of applanation method, anterior chamber depth, and the pupil size. The thickness of the ciliary body was measured in the distance of 1,500 microm (T1), 2,000 microm (T2), and 2,500 microm (T3) from the scleral spur. A slight decrease of T1 comparing with the initial values was found: from 668 +/- 117 microm in the beginning, to 633 +/- 127 microm after two weeks, and 614 +/- 147 microm after eight weeks of treatment. In the case of T2 measurement, the situation is similar; the decrease of the values was smaller than in T1. The above-mentioned differences were not statistically significant. Practically no differences were found in the T3 measured values. The intraocular pressure during the follow-up decreased markedly - from 21.3 +/- 4.2 mm Hg to 18.8 +/-3.3 mm Hg (week 2) and 17.6 +/- 3.7 mm Hg (week 8). The average lowering of the intraocular pressure (IOP) by 2.5 mm Hg (i.e. by 11.7%) found between the initial values and values after two weeks of treatment was found as statistically significant (P-value = 0.0001) as well as the difference between the initial values and values after eight weeks of treatment. No statistical significant difference was found between IOP values measured after two and eight weeks of treatment. All other followed-up parameters (anterior chamber depth, size of the pupil, visual acuity, and external finding) remained during the eight weeks period unchanged. Our results are in the congruity with one of hypotheses of the latanoprost acting - compacting of the interstitium and following opening of the porosities among the muscles fibers bundles of the ciliary body cause the increase of the intraocular fluid outflow and marked decrease of the intraocular pressure. To explain the mechanisms affecting the ciliary body in detail, more studies are needed.

The authors evaluated their five years experience with 0.005% latanoprost (Xalatan) glaucoma treatment. They monitored the latanoprost efficiency to lower the intraocular pressure (IOP) and its capability to maintain the target IOP in the long term.The group consisted of 118 patients (231 eyes) who are treated for glaucoma with latanoprost. The follow up period was at least 3 years. The patients were checked each three months and the results of the IOP measurement for the study purpose were included once a year.The IOP before the latanoprost treatment was 23.4 +/- 5.3 mm Hg. The IOP after 1-year latanoprost treatment was 17.6 +/- 3.2 mm Hg, after 2 years 17.7 +/- 3.9 mm Hg, after 3 years 17.1 +/- 3.1 mm Hg, after 4 years 17.1 +/- 3.2 mm Hg, and after 5 years 17.6 +/- 3.8 mm Hg. The average IOP during the latanoprost treatment was 17.4 +/- 3.4 mm Hg, the average lowering of the IOP after the start of the latanoprost treatment was by 6.0 mm Hg. The IOP lowering by 30 % against the IOP value at the time of glaucoma diagnose was reached after 3 years in 82 % (189 out of 231) eyes, after 5 years in 83 % (54 out of 65) eyes.Our five years experience confirmed, that latanoptost is a drug significantly lowering and in the long term maintaining the IOP level. As a great advantage, we appreciate the simple application and good compliance.

To asses the relation between the level of intraocular pressure (IOP) and central corneal thickness (CCT), and to examine the dependence of CCT on age, sex and refraction in the control group of healthy persons (CG) and the group of patients with POAG.The control group was formed by 42 eyes of healthy people and 20 eyes of patients with POAG. There were 26 women and 16 men in CG with a median age of 27.5 years and a median refraction of 0 D. The study group with POAG included 9 women and 11 men, with a median age of 71 years and median refraction of 0 D. The corneal thickness was measured with an ultrasonic pachymeter and the IOP with an applanation tonometer.A mean IOP level in CG was 15,4 +/- 5,6 mm Hg and a mean CCT level 558 +/- 42 microm. In the study group of POAG there was a mean IOP level 19,6 +/- 4,6 mm Hg, and a mean CCT level 562.7 +/- 35.7 microm. In the CG a significant positive correlation was found between CCT and IOP (p = 0.01). The dependence of CCT on sex (p = 0.92), refraction (p = 0.99) and age (p = 0.41) was not statistically significant. On the contrary, in the study group of POAG no significant correlation between CCT level and IOP level was found (p = 0.15). The dependence of CCT level on sex (p = 0.43), refraction (p = -0.08) and age (p = -0.17) was also not statistically significant. The difference in the CCT level between CG and the study group of POAG was not significant (p = 0.81). The IOP level appeared to be the only significant difference between both groups (p = 0.007).The level of IOP was influenced by CCT only in the control group of healthy persons. This dependence was not significant in the group of persons with POAG.

The Influence of the Type of Viscoelastic Substances on the Level of Intraocular Pressure after Phacoemulsification The aim of study was to asses the influence of the type of viscoelastic substances on the level of intraocular pressure (IOP) after cataract surgery and intraocular lens (IOL) implantation. In the study group of 100 patients Viscoat was used at 32 operated eyes, Provisc at 14 eyes and Duovisc in 54 eyes during phacoemulsification and IOL implantation. IOP was measured before surgery, one day after surgery and one week after surgery. Mean IOP level 1. day postoperatively was 24.94 mmHg in the Viscoat group of eyes, 24.65 mmHg in the Provisc group and 21.09 mmHg in the Duovisc group. The type of viscoelastic substance used during the surgery significantly influenced the level of IOP in the first postoperative day. The level of IOP was significantly lower in the Duovisc group comparing to Viscoat and Provisc. The level of IOP did not differ significantly between the Viscoat and Provisc group. One week after surgery the level of IOP was not significantly different between all types of viscoelastic device. Duovisc was the most profitable viscoleastic substance in the point of view of the course of phacoemulsification, IOL implantation and postoperative level of IOP.

The prospective clinical study of the selective laser trabeculoplasty (SLT) by means the Coherent Selecta 7000 laser (wave length 532 nm) was conducted. Totally 108.7 +/- 18.3 laser non-overlapping spots (mean energy level 1.04 +/- 0.22 mJ) along the whole circle of the trabecular meshwork in the anterior chamber angle were applied. The study included 258 eyes of 146 patients (50 of them were men) with glaucoma. The mean age of the whole group was 55.9 +/- 13.7 years. The group of unsuccessfully treated patients (30 patients, 41 eyes) in whom the intraocular pressure (IOP) elevated from 23.2 +/- 3.7 mm Hg in 4.7% (measured 493 +/- 474 days after the treatment) during the follow up, was removed from the study. In the group with good response to the SLT, 116 patients (217 eyes) were evaluated 650 +/- 405 days after treatment. Before treatment, in this group the IOP was 23.9 +/- 3.0 mm Hg, at the end of the study the IOP was lowered by 4.5 +/- 2.9 mm Hg, in total by 18.6%. IOP decrease was more pronounced in patients with higher level of IOP at the beginning. Immediately after SLT, no significant rising of the IOP level was recorded. Selective laser trabeculoplasty preserves the integrity of the trabecular meshwork of the anterior chamber angle, and is a safe and clinically effective method of treatment of different forms of glaucoma and ocular hypertension.

The intraocular pressure (IOP) rise is one of the complications after the application of viscoelastic material during the cataract surgery. The maximum of the elevation occurs between the second and eighth hours after the surgery. Twenty-four hours after the surgery, the IOP decreases to normal values. Because of possible early IOP changes, a group of 52 eyes (39 patients) with Duo-Bonharen Dispersive and Cohesive used, was followed. The IOP was measured at 2, 8, and 24 hours after the surgery. Not a remarkable IOP increase was marked.

In the 1995-2000 period, data of interest concerning preoperative and postoperative intraocular pressure (IOP) and the best corrected visual acuity (BCVA) in the group of eyes in which the brand name methylcellulose--Adatocel, Ocucoat, Metocel--(n=378) and Viscoat (n=526) was used during the surgery, were statistically evaluated. They were compared to those results obtained from the prospective clinical study performed in 2001-2002 (n=275) by using the new viscoelastic material Duo-Bonharen, which is the Czech product, manufactured on the basis of the hyaluronic acid. All groups were evaluated in a retrospective manner. In the comparative study, statistically significant differences in functional results of cataract surgery in favor of Duo-Bonharen were demonstrated. The cohesive type of the substance used tends to decrease the IOP, the dispersive materials tend to increase the IOP.

To determine whether preoperative anatomical and functional results have an influence on the postoperative decrease in intraocular pressure (IOP) and therapy two years after trabeculectomy (TE).In a retrospective study 40 patients (80 eyes) with primary open angle glaucoma were followed. They underwent TE with two releasable sutures on both eyes performed by the same method and the same surgeon. The preoperative and postoperative levels of IOP (as measured by the Goldmann tonometer) and therapy (according to target pressure) were compared with preoperative gonioscopy (Shaffer's scale 0-4), the excavation of the optic nerve (c/d ratio) and preoperative results of the visual field (threshold tests and Aulhorn's classification 0-V).The preoperative size of the angle of the anterior chamber has no expressive influence on the postoperative decrease in IOP (p = 0.079), there is an even smaller influence on decrease on therapy (p = 0.619). As well the preoperative excavation of the optic disc had no influence on the postoperative decrease in IOP (p = 0.179) and therapy (p = 0.467). There is an analogy with the visual fields; preoperative changes had no influence on the postoperative decreasee IOP (p = 0.502) and therapy (p = 0.247).Preoperative anatomical and functional status had no the influence on the success of TE.

To evaluate the level of IOP and clinical status the first day after trabeculectomy (TE) with releasable sutures (RS), to follow up the extraction of RS in correlation with early and late postoperative level of IOP.In a retrospective study, 40 patients with open angle glaucoma were followed. They underwent TE with two RS on both eyes.Hypotony (IOP less than 6 mmHg) was noted in 15 eyes (19%) the first day after the operation, shallow anterior chamber in 5 (6%). An IOP level higher than 20 mmHg was found in 11 eyes (13%) one day after surgery. No RS were extracted in the first group of 26 eyes. The early mean IOP was 10.15 +/- 7.1 mmHg the 1st day after surgery. IOP increased to a mean level of 15.3 +/- 3.8 mmHg two years after TE, 65% of eyes were without glaucoma therapy. One RS was extracted in the second group of 28 eyes. The early mean level of IOP was 10.7 +/- 6.5 mmHg, the late level 13.9 +/- 3.7 mmHg. The target pressure was maintained in 68% of the eyes without additional glaucoma therapy. The third group had 26 eyes and two RS were extracted after TE. The early mean level of IOP was 14.7 +/- 6.9 mmHg, the mean level of IOP was 15.8 +/- 3.9 mmHg two years after surgery, 39% of eyes were without glaucoma therapy.A level of IOP the first day after the operation, lower than 6 mmHg or higher than 20 mmHg, must not be an indicator for failure of the surgery. Observing the level of IOP 3-5 days after surgery determines whether the RS is to be removed or not. The use of RS prevents short-term complications and the extraction of RS during the postoperative period can positively influence the evaluation of filtration.

To evaluate the level of intraocular pressure (IOP) and glaucoma therapy during two years after trabeculectomy (TE) with two releasable sutures (RS) on the first and the second operated eye.In a retrospective study, preoperative and postoperative IOP and glaucoma therapy in 40 patients with open angle glaucoma, were evaluated. Patients underwent standardized TE with two RS on both eyes performed by the same surgeon. The first (worse) eye was operated on an average of three years after the diagnosis of glaucoma, and after 8.2 +/- 6.9 months the second (better) eye was operated on.TE with RS significantly decreased the level of IOP (p0.0001) and therapy (p0.0001) during a two year follow up period. There was no significant difference in IOP (p = 0.226) and glaucoma therapy (p = 0.086) between the first and the second operated eye. IOP was stabilised within 2-3 months after surgery for most patients, however glaucoma therapy was added for some to keep the target pressure. After one year IOP and therapy were stable for all patients.There is no difference between the first-worse and the second-better operated eye regarding IOP and glaucoma therapy during a two year period.

The authors describe their experience with the first three glaucoma drainage implants. All patients had previously several antiglaucomatous operations and a greatly reduced vision. The intraocular pressure was resistant to conservative treatment. In all patients the authors recorded postoperative complications reported in the literature. Glaucoma drainage implants extend possibilities in patients with refractory glaucoma.

The cytostatic 5-fluorouracil (5-FU) is used at present in the postoperative treatment of glaucoma. In 1993-6 we administered by the subconjunctival route at the Ophthalmological Clinic in Hradec Králové 5-FU to a group of 158 eyes after trabeculectomy (TE). The basic indication was ingrowth of the filtration vesicle or a rise of intraocular tension to 20 torr and more in 148 eyes. Preventively 5-FU was administered during operation during revisions of TE in 10 eyes. In the mentioned group with an unfavourable course of postoperative scar formation in the wound we achieved during the investigation period of two years after surgery normalization of the intraocular pressure to less than 16 torr without further treatment (we consider the value and condition without treatment as the optimal condition) in 37% of cases and in 81% less than 20 torr with treatment. Side-effects of administration of 5-FU (most frequently erosion of the corneal epithelium were transient. For the mentioned indications 5-FU appears, being a cytostatic where the dosage can be exact, sufficiently safe for administration and it exerts an optimal effect.

The authors investigated a group of 406 healthy eyes of children aged 4 to 15 years to test the effect of the local carboanhydrase inhibitor TRUSOPT on natural previously assessed intraocular pressure. The measurements made by means of an air-puff contact-free tonometer NT 1100 NIDEK revealed a highly significant decline of intraocular pressure--from 16.08 mm Hg to 14.07 mm Hg on average in the whole group. The tolerance of the drug after a single administration caused no problems, no undesirable effect was recorded. This is the first and only report on the effect of TRUSOPT on normal intraocular pressure of the child eye reported in the literature in a statistically significant group. The authors are surprised by the fact that the possibility of favourable pharmacological treatment of child glaucoma with clinically widely used Trusopt is not used so far.

To assess normal intraocular pressure values of the child population the authors examined a group of 215 children aged 4 to 15 years with a normal ophthalmological finding, a total of 406 eyes. All tonometric examinations were made without general anaesthesia or other pharmacological measures influencing the air-puff contact-free tonometer NT 1100 NIDEK, always the mean of three reliable results. Although there were certain variations of the intraocular pressure, they were not correlated to the child's age after the age of 4 years. The mean intraocular pressure in the whole group of 406 eyes was 16.08 +/- 3.08 mm Hg. Knowledge of normal values of the IOP in children is important for diagnosis as well as for monitoring of already verified glaucoma.

To evaluate the effect of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) in normal myopic eyes before and after LASIK refractive surgery.To determine CCT (by ultrasonic pachymeter NIDEC) and IOP (by Goldmann tonometer) in 27 patients (48 myopic eyes from -4 to -14 D) before LASIK (on Chiron Technolas 117) and 3 months after LASIK surgery.Mean CCT before LASIK was 543.8 microns (480-612), 3 months after was 430.6 microns (371-511), the difference--113.2 microns (48-157) is highly significant (p0.0001). Similar significant is also the decrease of mean IOP 3 months after surgery--about 5.4 mmHg (p0.0001). After LASIK surgery decrease IOP is 4.8 mmHg/100 microns. CCT is an important factor for accuracy of the Goldmann measurement. Myopic eyes need more attention, especially after photorefractive surgery, when CCT is decreased and therefore Goldmann IOP measurement is permanently underestimated.

The author followed up the medium-term results of cataract operations in five patients with decompensated closed angle glaucoma. From the results ensues that in patients with an intraocular pressure of less than 30 mm Hg surgery of cataract alone has a positive effect on the compensation of glaucoma. An advantage is also the standard surgical technique. The operation is made on an eye with a narrower pupil and requires an experienced ophthalmosurgeon.

The objective of the prospective randomized study is to evaluate the effect of surgery of an idiopathic macular hole (IMH) on intraocular pressure (IOP). The study comprised 60 primary pars plana vitrectomies (PPV) on account of IMH using 16% perfluoropropane (C3F8). Stage III according to Gass predominated in 65% and stage IV in 28.3%. Furthermore the authors enlisted in the study 15 secondary PPV on account of a patent IMH. A total of 75 primary and secondary PPV were performed. In 43 PPV an autologous thrombocyte concentrate (ATC) was used. With regard to the IOP after PPV the patients were subdivided into the following groups. Group A: IOP under 24 mm Hg was recorded throughout the investigation period in 24 of 75 PPV (32%). The total mean value of IOP in group A was 17.4 mm Hg. Group B: Early increase of IOP during the first week after surgery was recorded in 51 of 75 PPV (68.0%) This group was divided into two sub-groups according to the maximum postoperative deviation of IOP during that period. Sub-group B1 comprised a total of 34 PPV (45.3%) where the maximum postoperative deviation of IOP was between 25-35 mm Hg. The total mean value of IOP in sub-group B1 was 23.5 mm Hg. In sub-group B2 there was a total of 17 PPV (22.7%) and the maximum postoperative deviation of IOP was above 35 mm Hg. The total mean value of IOP in sub-group B2 was 28.6 mm Hg. Moreover the authors investigated the effect of ATC administration on the IOP after primary and secondary PPV. They did not reveal a significant relationship between administration of ATC and postoperative glaucoma.1. Glaucoma after PPV in IMH can in individual cases cause deterioration of the functional results of the operation. PPV in IMH has an increased risk: a) in a monoculus, b) in advanced primary glaucoma with an open angle, c) in primary glaucoma with a narrow angle.

In the introduction the authors describe a portable electronic tonometer Tono-pen XL and explain the principle of its function. After this follows a comparative study with Goldmann's applanation tonometry (AT) on 240 eyes in children aged 7 to 18 years. The mean value of the intraocular pressure (IOP) was 17.09 torr +/- 4.35 SD with AT and 16.46 torr +/- 4.04 SD when using the Tono-pen. Regression analysis revealed a very close correlation between the two methods of assessment (r = 0.925) with a high statistical significance (p0.0005). The difference as compared with AT values was constant, on average close to -0.68 torr in the whole range from 7 to 35 torr. The authors found also a significantly greater variability of values obtained by means of the Tono-pen (p = 0.0009), the mean scatter of individual values being 1.55 torr as compared with 1.25 torr in AT. However 97.1% of the eyes were within a range of 3 torr. The authors did not find a significant relationship between assessment by means of the Tono-pen and the doctor's experience. The unique advantage of Tono-pen as compared with all other methods of routine tonometry is the relatively accurate assessment of the IOP under irregular conditions of the cornea. It is also possible to take measurements in children where AT cannot be used.