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Aims: Autoantibodies against hexokinase 1 (HK1) were recently proposed to be associated with diabetic macular edema (DME). We hypothesized that anti-HK1 autoantibodies can be used as DME markers and to predict DME onset., Materials and Methods: Serum from patients with 1) DME, 2) diabetes mellitus (DM), 3) allergies or autoimmunities, and 4) control subjects was tested for anti-HK1 and anti-hexokinase 2 (HK2) autoantibodies by immunoblotting. Patients with DM were prospectively followed for up to nine years, and the association of anti-HK1 antibodies with new-onset DME was evaluated. The vitreous humor was also tested for autoantibodies., Results: Among patients with DME, 32 % were positive for anti-HK1 autoantibodies (42 % of those with underlying type 1 DM and 31 % of those with underlying type 2 DM), and 12 % were positive for anti-HK2 autoantibodies, with only partial overlap of these two groups of patients. Anti-HK1 positive were also 7 % of patients with DM, 6 % of patients with allergies and autoimmunities, and 3 % of control subjects. The latter three groups were anti-HK2 negative. Only one of seven patients with DM who were initially anti-HK1 positive developed DME., Conclusions: Anti-HK1 autoantibodies can be used as DME markers but fail to predict DME onset., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: The aim of the study is to retrospectively evaluate the anatomical success rate and functional results of 25G+ PPV in the treatment of newly diagnosed rhegmatogenous retinal detachment (RRD)., Material and Methods: The set consists of 152 eyes of 152 patients, of which 71 (47%) were men, average age 54 years, operated on by one surgeon for RRD at the Eye Clinic of the University Hospital and Medical Faculty of Masaryk University Brno from 1.7.2019 to 4.5.2021 using the 25G+ PPV technique. 25G+ PPV with pre-equatorial cerclage was performed on 7 patients. The patients' anamnesis included blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens. The cause of RRD was retinal tear/s, regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grade A-D2 was admissible. Patients with a history of penetrating ocular trauma were excluded. The postoperative findings and functional outcomes of the patients were evaluated 1-3 months after PPV. The operation was anatomically successful if the retina was fully attached. Final visual acuity (VA) was evaluated for each patient. The final visual acuity examination was carried out typically on a Snellen optotype, either without correction, with the patient's own spectacle correction or with correction according to the current values on the autorefractometer. The arithmetic average was used for the numerical expression of the attained results, and the numerical values were also expressed in percentages. Since the different groups were not compared with each other, no statistical test was necessary to analyze the results., Results: In 150 (98.7%) of the 152 patients in the group, we achieved complete retinal reattachment, in 2 (1.3%) patients the retina remained detached, and we recorded anatomical failure of the treatment. Fifty (33%) patients achieved VA ≥ 4/8., Conclusion: In 133 (87.5%) patients, we are able to state anatomical success even without the presence of intraocular tamponade in the operated eye. These patients can be considered completely cured. 25G+ PPV has demonstrated its contribution to resolving RRD.

Aim:  To retrospectively evaluate the anatomical and functional success of surgical treatment of rhegmatogenous retinal detachment (RRD) in the only remaining seeing eye., Material and Methods:  The study included 28 eyes of 28 patients, 19 (68%) of whom were men, with an average age of 46 years. They were operated on by a single surgeon for RRD at the Eye Clinic of the University Hospital and Faculty of Medicine, Masaryk University in Brno, from July 1, 2019, to April 30, 2023, using cryosurgical techniques and/or 25G+ pars plana vitrectomy (PPV). In 11 patients, 25G+ PPV was performed with the application of a pre-equatorial cerclage. The Blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens were admissible within the patient histories. The cause of RRD was retinal tear(s) regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grades A-D2 were acceptable. Patients with a history of penetrating eye injury were excluded. Patients were evaluated 1-3 months after the performance of PPV. The surgery was considered anatomically successful if the retina was completely reattached. Each patient's final visual acuity (VA) was assessed using a Snellen chart. Numerical results were expressed as arithmetic means and percentages. Since the different groups were not compared, no statistical tests were needed., Results:  Retinal reattachment was achieved in 27 patients (97%), while 1 patient (3%) experienced retinal detachment, resulting in anatomical failure of the treatment. 9 patients (32%) achieved VA ≥ 4/8., Conclusion:  We consider cryosurgical techniques using episclerally fixed cerclage bands and buckles, 25G+ PPV, and possibly a combination thereof, to be suitable methods for treating RRD in the only remaining seeing eye.

Purpose:  To analyze patients with optic disc drusen (ODD), with emphasis on modern diagnostics., Materials and Methods:  Research of the literature was conducted, together with a retrospective statistical analysis of patients with ODD. The group included individuals with ODD diagnosed using at least one of the following (ultrasound - USG, optical coherence tomography - OCT, fundus autofluorescence - FAF)., Results:  The group consisted of 12 patients (23 eyes), 7 women and 5 men. The mean age was 25 years. The mean observation period was 73 months. In total, 11 patients (22 eyes) had a bilateral finding and 1 patient (1 eye) had a unilateral finding. The mean age was 25 years. Buried drusen were confirmed in 69.6% of cases (8 patients, 16 eyes), superficial drusen were confirmed in 30.4% of cases (4 patients, 7 eyes). Mean best corrected visual acuity (BCVA) and mean intraocular pressure were stable over time (BCVA p = 0.236, IOP p = 0.855). The aforementioned diagnostic methods proved to be equally effective (p = 0.768). In 11 patients (21 eyes) a depression of the retinal nerve fiber layer (RNFL) was recorded. We found a statistically significant decrease of the RNFL over time in reference to the normative database in the superior temporal (p = 0.015), temporal (p = 0.026) and nasal segments (p = 0.011). After separation of superficial and buried drusen the same significant change was found in nasal segment in superficial drusen (p = 0,031). We found no statistically significant difference over time between superficial and buried drusen (p = 0.109-0.999 for individual segments)., Conclusion:  ODD are common and visual functions remain stable. Their presence can be confirmed using modern paraclinical methods.

Purpose: The aim of this study was to investigate whether there is any association between the levels of the angiogenic growth factors and the vascular oxygen saturation in eyes with diabetic retinopathy., Methods: The study was designed as a prospective trial. The cohort consisted of 29 diabetic patients with scheduled vitreous procedures (intravitreal injection or pars plana vitrectomy). The control group included 30 patients scheduled for macular surgery (macular hole or epiretinal membrane). Nine patients (four from the diabetic maculopathy [DM] group and five from the control group) were excluded from the study because of unsuccessful vitreous samples. Retinal oximetry was performed several hours before the vitreous procedure was performed, and vitreous samples were obtained during the procedure. The concentrations of VEGF, Serpin F1/pigment epithelium-derived factor (PEDF), and placental growth factor (PlGF) were measured by ELISA., Results: A negative correlation between level of VEGF and arteriovenous (AV) saturation difference was determined in the DM group (Pearson correlation coefficient r = -0.607; two-tailed test, P = 0.002). Also a negative correlation between level of PlGF and AV saturation difference was determined in the DM group (Pearson correlation coefficient r = -0.521; two-tailed test, P = 0.011) A positive correlation between PlGF level and the vein saturation was not statistically significant (Pearson correlation coefficient r = 0.325; two-tailed test, P = 0.130). We did not find any correlation between vitreous level of PEDF and vascular saturation within the DM group., Conclusions: Our findings in diabetic patients suggests a correlation between the intravitreal level of proangiogenic factors and the AV difference measured by retinal oximetry.

Purpose: The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients., Material and Methods: The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test., Results: Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 μm (median -37.5 μm), -84.3 μm (median -85 μm) and -109.3 μm (median -81 μm) in patients treated with ranibizumab, and -46.3 μm (median -30 μm, p = 0.389), -127.7 μm (median -104 μm, p = 0.096) and -204.4 μm (median -163 μm, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891)., Conclusion: We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.

Purpose: To evaluate the influence of pupil dilation on ocular parameters measured by optical biometry and the influence of pupil dilation on intraocular lens (PC IOL) power calculation by using the third-generation (SRK/T) and the fourth-generation (Haigis) formula., Methods: 40 eyes of patients indicated for cataract surgery were included in this study. Each patient was examined by optical biometer firstly without artificial mydriasis (AM) and then after AM, which was achieved using local application of short-term acting mydriatics. Biometric data were measured by Lenstar LS 900 optical biometer, we recorded axial length of the eye (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and corneal astigmatism and optical power of cornea. These data we measured were used for calculation of the PC IOL optical power using both the SRK/T and the Haigis formula. The target postoperative refraction was set to emmetropia. Statistical analysis was performed for evaluation of influence of AM on each ocular parameter and influence of AM on the recommended PC IOL power calculated by the SRK/T and the Haigis formula., Results: No statistically significant effect of AM on AL, LT and keratometry was demonstrated. On the contrary we demonstrated significant effect on CCT and ACD. No effect of AM on the PC IOL power calculation using the SRK/T formula was proved - the PC IOL optical power before AM and after AM did not differ in any case. When using the Haigis formula for the PC IOL power calculation, the recommended optical power of the PC IOL changed by +0.5 Dpt in 9 eyes, i.e., 22.5 % of the whole group, but statistical analysis did not show this change as statistically significant., Conclusion: Pharmacological dilation of the pupil significantly affects some intraocular parameters measured by optical biometer and in the case of using the Haigis formula it can influence recommended power of the PC IOL. Conversely, when using the SRK/T formula, pharmacological dilation of pupil does not affect the recommended PC IOL power.

Pregnancy is associated with increased risk of progression of diabetic retinopathy (DR), the greatest risk of worsening occurs during the second trimester of pregnancy and persists as long as one year after the childbirth. The risk factors include duration of the diabetes, insufficient metabolic control, severity of DR at the time of conception and presence of coexisting vascular disease, such as arterial hypertension, and pregnancy itself. The recommendations for retinopathy screening in pregnancy vary significantly. A dilated fundus exam should be done in the beginning of pregnancy, the next follow-up throughout pregnancy depends on the severity of ocular findings. The cooperation of multi-disciplinary team consisting of ophthalmologist, obstetrition and endocrinologist is essential to provide the best health care. The authors present a case report of a pregnant woman with type 1 diabetes mellitus (DM), who had a progression of DR and diabetic macular edema (DME) in both eyes during pregnancy. She has had DM for 24 years and has been treated with insulin. The patient was examined at the 23rd week of the second pregnancy (first pregnancy was terminated because of missed miscarriage). The diagnosis of advanced proliferative DR and advanced DME in both eyes was made so we performed panretinal laser photocoagulation of the retina of both eyes. Despite that the ocular findings got worse and we found vitreous haemorrhage in the left eye. We performed pars plana vitrectomy (PPV) of the left eye at the 28th week of pregnancy, nevertheless the DME got worse in both eyes, so we recommended to terminate the pregnancy at the 31st week because of the risk of loss of vision. The visual acuity of the left eye improved, but suddenly there was vitreous haemorrhage in the right eye after the delivery. We indicated PPV of the right eye, the outcome of the surgery was satisfying. We still take care about this patient.

Objective: To evaluate the anatomical and functional outcome of ranibizumab therapy in patients with idiopathic choroidal neovascularization (CNV). File and Methodology: The group consists of 6 patients. Patients were older 18 years but they were under 50 years of age. The monitoring period lasted 12 months. We confirmed active idiopathic CNV in subfoveal position with fluorescein angiography (FAg) and optical coherence tomography (OCT). The activity of idiopathic CNV we demonstrated with leakage of dye by FAg examination. The presence of serous retinal pigment epithelium detachment and / or subretinal fluid and / or intraretinal edema in the form of intraretinal cysts demonstrated activity of CNV on OCT scans. A decrease of the visual acuity under 85 letters was observed at the ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart. After the initial administration of ranibizumab a pro re nata regimen was used. We indicated repeated injection of ranibizumab in patients with signs of activity of idiopathic CNV on OCT scans or by FAg. Also we indicated repeated injection of ranibizumab in patients with new loss of visual acuity on the ETDRS visual acuity chart connected with signs of activity of CNV on OCT scans or by FAg., Results: On average, we observed the gain of +11 letters on the ETDRS visual acuity chart after 12 months of the follow-up period. On average we observed reduction of central macular thickness -233μm. At the 12th month of follow-up we observed in all patients of our group only inactive scar without exudation. No serous retinal pigment eithelium detachment, subretinal fluid or intraretinal cysts were observed. Only 3 injections of ranibizumab were administered on average to each patient during the 12 months of the follow-up period., Conclusion: In our study, we observed the positive effect of ranibizumab on the course of idiopathic CNV. With ranibizumab treatment we achieved regression of CNV with resorption of macular edema in all patients of our group. With the disappearance of the activity of idiopathic CNV ranibizumab gives real hope to improve visual acuity.

Aim: To determine if oxygen saturation in retinal vessels depends on the degree of diabetic retinopathy., Material and Methods: A prospective study comparing values of oxygen saturation in retinal arteries, veins, and arterio - venous (A-V) difference in healthy persons and in patients with diagnosed diabetes. The study included 114 eyes of 76 patients with diagnosed diabetes, and 57 eyes of 57 patients without diabetes as a control group., Results: The average retinal arterial saturation in patients without diabetes was 96.5 ± 2.6 %, and increased in patients with severe non-proliferative or proliferative diabetic retinopathy to 100.5 ± 5.6 %. The average venous saturation in patients without diabetes was 62.3 ± 7.4 % and increased to 74,0 ± 7.2 % in patients with severe non-proliferative diabetic retinopathy., Conclusion: In patients with diabetic retinopathy, we confirmed the increase of hemoglobin oxygen saturation as in the arterial as in the venous blood in retinal vessels; and significant decrease of arterio-venous difference according to the severity of diabetic involvement was confirmed as well.Key words: automatic retinal oxymetry, diabetic retinopathy, oxygen saturation, Oxymap.

Purpose: To determine the effect of pars plana vitrectomy (PPV) on oxygen saturation in retinal vessels in patients with diabetes and non-diabetes after a 1-year follow-up., Methods: This was a prospective consecutive interventional case series in 82 eyes in 82 patients. The sample consisted of 25 patients with non-proliferative diabetic retinopathy with macular oedema based on vitreoretinal traction or epiretinal membrane (ERM) and 57 non-diabetic patients with macular hole and ERM. Automatic retinal oximetry (Oxymap Inc.) was used on all patients 24 hr prior to PPV, and it was also used 7 and 52 weeks after PPV (classic 20G or sutureless 23G). We analysed the data according to subgroup diagnosis and lens status., Results: Arterial saturation increased significantly from 96.4 ± 2.9% at baseline to 96.6 ± 3.4% at week 7 and 97.3 ± 3.4% at week 52 (p < 0.0001; Friedman test). Vein saturation also increased significantly from 63.5 ± 7.9% at baseline to 66.1 ± 7.7% and 67.0 ± 7.2% at weeks 7 and 52 (p < 0.0001; Friedman test). The value of the arteriovenous (A-V) difference decreased significantly after vitrectomy from 32.8 ± 7.5% at baseline to 30.5 ± 7.5% and 30.3 ± 7.0% at weeks 7 and 52 (p < 0.0001; Friedman test). The subgroup analysis revealed that in patients with diabetes, there were no statistically significant changes in oxygen saturation in blood vessels or in the A-V difference after PPV. After vitrectomy, retinal vessel diameter reduced by about 3.5% in both groups of patients. Further, the analysis revealed that opacification of the lens leads to a decrease in oxygen saturation in contrast to a clear lens and pseudophakic IOLs., Conclusion: Oxygen saturation is higher in the retinal veins and arteries after PPV in patients with non-diabetes, and this lasts for at least 52 weeks. In contrast, in patients with diabetes, there is no increase in oxygen saturation in the retinal vessels after vitrectomy. After vitrectomy, retinal vessel diameter reduced in both groups of patients. Further, the nuclear cataract progression has substantial effect on oximetry results. Patients with nuclear cataract exhibited an increase in saturation in both arteries and veins, but the A-V difference remained the same., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Aims: The aim of this communication was to evaluate ranibizumab in the treatment of wet age-related macular degeneration., Methods: Anonymised data on treatment efficacy and safety were consecutively entered into the Czech national database. From 01/09/2008 to 25/10/2011, 671 patients/685 eyes treated with ranibizumab monotherapy were entered in the registry. 454 ranibizumab treated eyes and 444 patients were monitored for 12-months. The dependent variable used to monitor disease progression and treatment results was change in visual acuity in the ETDRS (Early Treatment Diabetic Retinopathy Study) chart over time., Results: After 12 months of treatment, a loss of < 15 letters in the ETDRS chart was found in 81.5% of eyes treated with ranibizumab. A gain of ≥ 15 letters was found in 9.7% of eyes on ranibizumab. The results for our patients treated in clinical practice with ranibizumab were poorer than those in the SUSTAIN (Ranibizumab in Patients With Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration) study. A rationale for this was sought in a sub-analysis., Conclusions: Sub-analysis demonstrated that treatment naive CNV (choroidal neovascularization), occult CNV and lower height of the macular oedema at the outset of the disease may be positive prognostic factors for final visual acuity in anti-VEGF (vascular endothelial growth factor) treated patients.

Aim: The purpose of this study was to evaluate the effect of the systemically administered betablocker metipranolol on the course of central serous chorioretinopathy (CSC)., Methods: A prospective double-blind study involving 48 patients with a first attack of CSC not exceeding two weeks and who agreed to the follow-up ophthalmology examinations every week. The group was divided into a metipranolol group (n=23), receiving 10 mg of drug twice per day and a placebo group (n=25). The outcome measure was time in weeks from drug intervention (metipranolol vs. placebo) to reattachment of macula neuroepithelium., Results: There was no statistically significant difference in duration of CSC in patients who used metipranolol and those who used placebo (P=0.341)., Conclusions: In a prospective double-blind study, we found no effect of the betablocker metipranolol on the duration of central serous chorioretinopathy.

Aim. To assess the significance of age, gender, baseline best corrected visual acuity, baseline macula thickness, and type and size of choroidal neovascularization in early morphological therapeutic response to ranibizumab treatment in patients with the wet form of age-related macular degeneration. Methods. From 09/2008 to 06/2013 we evaluated 1153 newly diagnosed, treatment-naïve patients treated with ranibizumab. Based on the morphological findings in the macula following the initial 3 injections of ranibizumab, the patients were divided into two groups based on active and inactive choroidal neovascularization. Results. After the initial 3 injections of ranibizumab, we examined the sample of 841 eyes with active CNV and 312 eyes with inactive CNV. In the inactive group, we found a statistically higher proportion of occult CNV (P < 0.001) and lower incidence of CNV greater than 5DA (P < 0.001) compared with the active group. We found no statistically significant difference in age, gender, baseline best corrected visual acuity, or baseline macula thickness between the inactive and active groups. Conclusion. Occult CNV and CNV smaller than 5DA are optimistic factors for a better morphological therapeutic response at the beginning of ranibizumab treatment.

Purpose. We investigated two factors linked to diabetic macular edema (DME), vitreous and serum levels of vascular endothelial growth factor (VEGF) and uric acid (UA) in patients with DME, and compared the results with changes in optical coherence tomography (OCT) and visual acuity (VA). Methods. A prospective study of 29 eyes, 16 cystoid DME and nonproliferative diabetic retinopathy (DR) and 13 nondiabetic controls. Biochemical analysis of vitreous and serum samples was performed and OCT scans were graded according to central retinal thickness (CRT), cube volume (CV), cube average thickness (CAT), and serous retinal detachment (SRD). Results. In DME group, intravitreal concentrations of VEGF (p < 0.001), UA (p = 0.038), and total protein (p < 0.001) were significantly higher than in control group. In DME subjects, intravitreal UA correlated significantly with intravitreal VEGF (ƍ = 0.559, p = 0.03) but not with total vitreous protein and serum UA. Increased intravitreal VEGF in DME group correlated with increase in CV (ƍ = 0.515/p = 0.041). None of the OCT parameters correlated with the VA. Conclusions. The results suggest that the CV might be assessor of anti-VEGF therapy efficacy. Second, apart from VEGF, the role of UA in the pathogenesis and progression of DR should be considered.

Purpose:   To determine the effect of pars plana vitrectomy (PPV) on oxygen saturation in retinal vessels., Methods:   We performed a prospective consecutive interventional case series of 20 eyes of 20 patients with macular hole or epiretinal membrane. We performed automatic retinal oximetry (Oxymap Inc., Reykjavik, Iceland) in each patient 24 hr prior to and 45 days (range 42-49) after PPV (classic 20G or sutureless 23G). We analysed oxygen saturations in retinal arteries and veins. Vessel segments of first or second degree were selected. The same segment was analysed before and after PPV. Oximetry data were compared by paired two-tailed t-test., Results:   Pars plana vitrectomy did not alter arterial haemoglobin saturation with oxygen (98±2% prior to the surgery and 98±3% after the procedure, p=0.549). The mean venous haemoglobin saturation with oxygen increased after vitrectomy from 63±10% to 66±8% (p=0.012)., Conclusions:   Oxygen saturation is higher in retinal veins after pars plana vitrectomy. Further studies are needed to unveil the mechanism of how vitrectomy affects oxygen metabolism in the retina., (© 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Aim: To evaluate photodynamic therapy (PDT) combined with the preferential the cyclooxygenase-2 (COX-2) inhibitor, nabumetone in the treatment of the neovascular age-related macular degeneration (ARMD)., Methods: A prospective, double-blind, randomized study on 60 patients with subfoveal CNV secondary to ARMD without any previous treatment. Patients were divided into a nabumetone or placebo group. The main endpoints were the change of best-corrected visual acuity (BCVA), central macular thickness (CRT) and number of required PDT treatments., Results: In the nabumetone group, 27 patients (90%) and 28 (93%) in the placebo group completed the follow-up of 12 months. In the nabumetone group, the mean CRT decreased from 332 μm (SD 68 μm) to 220 μm (SD 46 μm). In the placebo group, CRT decreased from 331 μm (SD 72 μm) to 254 μm (SD 61 μm). The mean BCVA was 0.68 log MAR (SD 0.22 log MAR) in the nabumetone group and 0.62 log MAR (SD 0.23 log MAR) in the placebo group at baseline. This stabilised in the placebo group to 0.66 log MAR (SD 0.33) but deteriorated in the nabumetone group to 0.86 log MAR (SD 0.41 log MAR). There was a significant reduction in the number of required PDTs in the nabumetone group, but significant progression of the RPE atrophy area., Conclusion: Combined PDT with oral intake of the COX-2 inhibitor, nabumetone reduced the number of required PDT retreatments, but worsening BCVA caused by macular atrophy progression. Therefore the combination of the PDT with the nabumetone is not recommended.

Aim: Aim of this study is to evaluate retrospectively functional results of cryosurgical treatment of uncomplicated, idiopathic rhegmatogenous retinal detachment including macula region in phakic patients operated on at the Department of Ophthalmology, Faculty Hospital, Palacký University, Olomouc, Czech Republic, E.U., during the period 2002 -2013, and to evaluate the significance of the macula detachment duration for the final visual acuity., Methods: In the study group were included 56 eyes of 56 patients operated in the years 2003 - 2012 at the Department of Ophthalmology, Faculty Hospital, Palacký University, Olomouc. All patients were phakic and in all of them, the retinal detachment including the macula region was diagnosed. The mean follow-up period of the patients was 8,75 months. The initial and final visual acuity testing were performed. Comparing the initial and final visual acuity we rated the level of the visual acuity change. The result was stated as improved, if the visual acuity improved by 1 or more lines on the ETDRS chart. The result was rated as stabilized, if the visual acuity remained the same or it changed by 1 line of the ETDRS chart only. The result was evaluated as worsened, if the visual acuity decreased by 1 or more lines of the ETDRS chart. In the followed-up group, the authors compared visual acuity levels in patients with the macula detachment duration 10 days and 11 days. For the statistical evaluation of achieved results, the Mann - Whitney U test was used., Results: The visual acuity improved in 49 (87 %), did not changed in 5 (9 %) and worsened in 2 (4 %) patients. The patients with macula detachment duration 10 days achieved statistically significant better visual acuity than patients with macula detachment duration 11 days., Conclusion: Patients with macula detachment duration 10 days have better prognosis for functional result than patients with macula detachment duration 11 days.

Aim: To evaluate retrospectively anatomical results of cryosurgical treatment of non-complicated idiopathic rhegmatogenous retinal detachment. To assess the successfulness of primary cryosurgical surgeries, permanent retinal re-attachment; to review the efficacy of cryosurgical procedures according to chosen surgical technique and patients age as well., Material and Methods: In the evaluated group were included 120 eyes of 120 patients operated on in the years 2003- 2012 at the Department of Ophthalmology, Faculty Hospital and School of Medicine, Palacký University, Olomouc, Czech Republic, E.U. All of the patients were phakic. The patients were evaluated at one and three months after the surgery. The posterior pole examinations were done by means of biomicroscopic examination and indirect ophthalmoscopy. The retina was evaluated as attached in whole extent in case of re-established contact between the neurosensory retina and the retinal pigment epithelium in the whole periphery., Results: In 106 (88 %) patients, the re-attachment of the retina was achieved by solely cryosurgical procedure; in 117 (97.5 %) patients, the definite re-attachment of the retina was achieved. In three patients (2.5 %), the retina remained detached. Statistically better results were obtained in patients with peroperative exodrainage of the subretinal fluid and in patients younger than 50 years of age., Conclusion: We established the usefulness of cryosurgical operative procedure in treatment of uncomplicated idiopathic rhegmatogenous retinal detachment in phakic patients. Especially in young phakic patients, the cryosurgical procedure may be protective to preserve the clear lens and eye accommodation.

Between 1997 and 2007, we have conducted eye surgery on 72 patients (i.e. 72 eyes) as a consequence of proliferative diabetic retinopathy complications. The patients' average age was 61; the follow-up observations were carried out over a period of one year after the surgery. When we compare the initial vision with the visual acuity measured during the last follow-up examination in the late post-operative period, i.e. one year after the surgery, we can conclude that the vision of46 eyes (63%) had improved, 17 eyes (24%) did not show any change in vision, and the vision of nine eyes (13%) had deteriorated. Visual acuity of 1/60 (metric system) or better was found in 55 eyes (76%) during the late post-operative period; 6/60 vision or better was found in 29 eyes (40%), and four eyes (6%) showed 6/12 vision or better. If we compare the vision in the early post-operative period with the visual acuity during the last follow-up examination in the late post-operative period, we can conclude that in most cases, i.e. in 45 eyes (62.5%), the vision did not change any further during the months after the surgery, and one eye (1.5%) even showed improvement in visual acuity. It was confirmed that a positive result of pars plana vitrectomy observed in the early post-operative period may indeed persist even during the following months and years of the patient's life.

Aims: To determine the effectiveness of second line treatments in patients with neovascular AMD who did not respond adequately to primary treatment., Methods: Retrospective, multicentre assessment. The frequency of primary treatment failure and outcomes of subsequent secondary treatment were assessed according to the type of primary treatment, type of CNV and change in BCVA over a 12 month period., Results: At the time of assessment 750 entries (750 treated eyes, 725 treated patients) had follow-up longer than 12 months. A treatment change required 7.7% subjects treated with ranibizumab, 20.5% with pegaptanib and 22% with PDT and verteporfin. Average BCVA of all patients at the beginning of primary treatment was 50.7 ± 3 letters and 43 ± 3.5 letters in 12(th) month (P<0.001). The mean decrease in BCVA was 7.7 ± 0.6 letters during the first 6 months of observation. During the next 6 months, no significant change occurred. The change of primary therapy was required on average after 6.5 ± 2.1 months., Conclusion: BCVA loss was the most significantly decelerated in patients who received ranibizumab as a secondary therapy following unsuccessful treatment with pegaptanib sodium.

Aim: To evaluate the effect difference of ranibizumab and sodium pegaptanib in the ablation treatment of the retinal pigment epithelium (RPE) in age-related macular degeneration, Material and Methods: Retrospective analysis of data of patients with age-related macular degeneration treated by means of anti-VEGF therapy at the Department of Ophthalmology, School of Medicine, Palacky University, Olomouc, Czech Republic, E.U. during the period May 2009 - October 2010. For the analysis were used data from patients with follow-up period longer than 6 months and present serous RPE ablation caused by occult choroidal neovascularization (CNV), verified by optic coherence tomography (OCT) and fluoresceine angiography (FAG)., Study Group: Ranibizumab was used as treatment during the period in 37 eyes of 37 patients (average age 73.2 years; right eye (RE) in 20 cases, left eye (LE) in 17 cases. Sodium pegaptanib was applied in 17 eyes of 17 patients (average age 72.4 years; RE in 10 cases and LE in 7 cases), The follow-up period in the ranibizumab group was 8.51 (SD 3.32) months, and in the pegaptanib group 9.94 (SD 5.50) months., Results: In the ranibizumab group decreased the average RPE ablation base from 2865 microm (SD 810 microm) to 2270 microm (SD 1265 microm) and the prominence of the ablation from 334 microm (SD 160) to 238 microm (SD 178 microm). In patients treated by pegaptanib, decreased the average basis from 3245 microm (SD 930 microm) to 2159 microm (SD 1185 microm), and the prominence of the ablation from 354 microm (SD 173 microm) to 208 microm (SD 107 microm). The statistical significance test did not prove significant differences (level of significance p = 0.05) in the change either of the base or the prominence of the RPE ablation in any group of patients (prominence p = 0.09, base p = 0.21; Mann-Whitney test). In three patients (8.1%) treated by ranibizumab, the RPE rupture occurred. No RPE rupture was recorded in patients treated by sodium pegaptanib., Conclusion: Although no statistically significant difference in the efficacy of both drugs in the treatment of the RPE ablation was found, in patients treated by sodium pegaptanib, there is evident tendency of higher efficacy in decrease of the RPE ablation prominence, and lower incidence of RPE rupture. The study is limited by small number of patients and short follow-up period.

Background: The aim of the study was in vitro assessment and comparison of the antimicrobial activity of three types of silicone oils used in ophthalmic surgery., Methods: The silicone oils (Arciolane 1300 centistokes, Arciolane 5500 centistokes and Oxane Hd, heavy silicone oil) were inoculated with microbes common in endophthalmitis and their growth was observed continuously. Control tests of microbial growth were performed on silicone oil-free media, i.e. saline and standard enrichment media. In both tested oils and control media, the microbes were cultured aerobically for 21 days, bacteria at 37 °C and yeasts and fungi at 30 °C. Prior to and during incubation at given intervals (days 0, 2, 4, 7, 9, 11, 14, 16, 18 and 21), 10 μl samples were taken from all test tubes. These were diluted in saline in a series of test tubes, with the minimum concentration reaching 10(-8). From each dilution, 25 μl were inoculated onto agar media. After 24 h of aerobic incubation at 37 °C (bacteria) and 48 h at 30 °C (yeasts and fungi), the grown colonies were counted and the numbers of colony-forming units in 1 ml (CFU/ml) were determined., Results: In vitro, the highest antimicrobial effect was observed for the Oxane Hd silicone oil., Conclusions: If endophthalmitis is treated by pars plana vitrectomy, the application of Oxane Hd silicone oil into the vitreous cavity at the end of surgery may contribute to the elimination of microorganisms from the intraocular space but clinical trials are needed to assess its safety.

The authors present the knowledge summarization of vision substitute using artificial retinal neuroprostheses. The overview was compiled from available literature found in the Medline and Embase databases. The text focuses on global summarizing of the whole issue since the beginning of the development to the state up to date. In individual types of neuroprostheses, the advantages, disadvantages, and possible obstacles to their use in clinical practice are discussed. Furthermore, the brain plasticity and functional changes of the brain in blinds are considered. The aim of the review is not to present all information in detail, but complex overview with relevant literature sources.

Purpose: To evaluate the role of initial visual acuity (VA) as a potential prognostic factor for final VA in patients with branch retinal vein occlusion (BRVO)., Methods: A retrospective data analysis involving 163 patients with macular edema secondary to BRVO treated according to the recommendations of the Branch Vein Occlusion Study Group was performed using univariate and multivariate logistic regression models, and receiver-operating characteristics analysis. The analyses take factors into account that can potentially influence final visual result: sex, age, type of occlusion (major temporal or macular), grid photocoagulation and ischemia., Results: The final VA ≤ 0.1 was statistically significantly related to initial VA ≤ 0.16 and age > 70 years. Sex, type of occlusion, grid photocoagulation and ischemia did not significantly influence the prediction of final VA based on age and initial VA., Conclusions: The analysis shows that initial VA and age > 70 years significantly influence the prognosis for final visual results in patients with BRVO., (Copyright © 2010 S. Karger AG, Basel.)

The nation-wide register of patients with the exsudative age-related macular degeneration surveys the appearance and the success rate of the treatment of this disease in the Czech Republic. During the 12 months follow-up period of 38 patients treated with Macugen in monotherapy, receiving at least 7 injections of Macugen during one year period, we found the loss of less than 15 letters of the ETDRS chart in 62.2 % of treated eyes. During the 12 months follow-up period of 205 patients treated with Lucentis in monotherapy, receiving at least 3 injections of Lucentis, we found the loss of less than 15 letters of the EDTRS chart in 82.0 % of treated eyes. During the 12 months follow-up period of patients treated with Visudyne in monotherapy we found the loss of 15 letters of the EDRTS chart in 77.1% of treated eyes.

The Czech Ophthalmologic Society (member of the Czech Medical Society of Jan Evangelista Purkyne) in collaboration with the Institute of Biostatistics and Analysis of the Masaryk University in Brno established a nation-wide information system for the follow-up of the epidemiology and treatment of the exsudative age-related macular degeneration (ARMD). The project named AMADEUS is a multi-centric, non-invasive, observation prospective study with the aim to improve the patients' treatment and to unify the criteria for the follow-up of the ARMD in the real clinical practice in the Czech Republic. The basic instrument of the whole project is a clinical register collecting parametric data from 9 specialized centers. Especially the project monitors the photodynamic therapy with Verteporfyrine (Visudyne) and treatment by anti-VEGF agents, or Pegaptanib (Macugen) and Ranibizumab (Lucentis). The project's protocol is trying to collect representative data about ARMD diagnosis and treatment; during regularly controls, the efficacy and safety of the treatment are followed-up.The data collecting does not influence the treatment strategy or the availability of chosen treatment for the patient. Since October 2008 until the end of the year 2009, the registry collected complex information about more than 1402 newly treated ARMD patients; out of them, in 582 cases the one-year follow-up period was regularly terminated. The available data shows well-considered indication of drugs indications by the doctors; the treated patients fulfill the indications criteria set by the scientific society. According to the data from the registry, in some treating centers the application schedule is not followed-up in some drugs (especially Pegaptanib); there is the possibility to improve the treatment. All the clinical centers participating in the AMADEUS registry will continue in the data collecting, which after a longer period of time will facilitate further treatment optimization and eliminating of the established imperfections. Further information about the project may be found at the web site: www.amadeus.registry.cz.

The authors present the possibility to influence therapeutically the submacular hemorrhage caused by age-related macular degeneration in the presence of choroidal neovascular membrane by means of recombinant plasminogen tissue activator (rt-PA) and expansive gas intravitreal injection followed by pneumatic relocation of the hemorrhage out of the foveolar region. The therapy is presented in a case report. The submacular hemorrhage without treatment causes serious decrease of visual functions. The human recombinant plasminogen tissue activator that is a glycoprotein, activating the transformation of plasminogen directly to plasmin has a trombolytic effect. Rt-PA is activated by binding to fibrin with high affinity. This minimally invasive procedure gives the possibility to treat this prognostic unfavorable finding, so after the lysis and pneumorelocation of the hemorrhage from the macular region we can treat the choroidal neovascular membrane.

The authors present a case report of a patient, in whom after a head injury the monolateral blindness occurred. Because of autoimmune thrombocytopeny the patient was treated with long-term corticosteroids. The clinical findings corresponded with the orbital apex syndrome. According to the results of the CT and MRI examinations, the sphenoidotomy was indicated, and the histological findings verified fragments of paranasal sinuses' aspergiloma. During the next course of the disease, despite antimycotic therapy, the progression of the aspergiloma in to the anterior cranial fossa occurred. Invasive sino-orbital aspergilosis, after the penetration of the infectious agent across the wall of the sinus, may cause the orbital apex syndrome with paralysis of all three cranial nerves innervating the extraocular muscles, sensoric defect in the area of the ophthalmic nerve and the involvement of the optic nerve.

In the years 1997-2004, we operated on and at least one year followed-up due to complication of prolipherative diabetic retinopathy 47 eyes (40 patients), of the mean age 61 years. If we compare the initial visual acuity (VA) to the vision at the last examination in the late postoperative period, or at least one year after the surgery, we may state, that in 28 eyes (60%) the vision improved, in 11 eyes (23%) VA remained stable and in 8 eyes (17%) the vision decreased. In the late postoperative period, the visual acuity 1/60 (3/200 or 0.17) and better had 33 eyes (70%), VA 6/60 (20/200 or 0.1) and better 17 eyes (36%) and VA 6/12 (20/40 or 0.5) and better 2 eyes (4%). Comparing the VA at the time of the early postoperative period and the VA at the last examination in the late postoperative period, we observed, that mostly, in 34 eyes (72%) the VA did not changed during the months after the surgery, and, in one eye (2%), the VA even improved. It was confirmed to be realistic the favorite result of pars plana vitrectomy found in the early postoperative period may be preserved for the next month and years of patient's life.

The authors report a case of 14-year-old boy presented to the Ophthalmologic Department of University Hospital in Olomouc with the diagnosis af acute anterior uveitis. A living parasite has been detected in the anterior chamber in a slit lamp examination. The vitreous and retina remained uninvolved. The acute iridocyclitis associated with parasitic infection is a very rare cause of anterior uveitis in Central Europe. The patient underwent surgical removal of the parasite via paracentesis. The inflammation resolved under the treatment with atropine and dexamethasone drops within a few days. Histopathological examination revealed the parasite as a young larval stage of tapeworm from family Pseudophyllidea (sparganum). Based on the analysis of development cycles of different types of tapeworms and according the literature data on tapeworms found in the Czech Republic genus Spirometra seemed to be the most plausible cause of the patient's disease. As the most probable source of viable parasites authors suspect swallowed water containing tiny infected crustaceans in the dam near the town Olomouc in Moravia.