Search

Aim To evaluate the incidence of ocular adverse events after loading phase of the brolucizumab therapy in patients with neovascular age-related macular degeneration (nAMD) in real-life clinical practice – in treatment-naive patients and in patients after switching from another anti-VEGF agent. Another aim was to evaluate treatment outcomes in patients with adverse events. Methods This is a multicentre, retrospective, observational study from 16 application centres in the Czech Republic. Patients diagnosed with nAMD were treated with brolucizumab in a fixed regimen of loading phase (3 injections administered at one-month intervals) and the mean follow-up period was 120 ± 10 days after the first injection. The incidence of adverse events and the development of best corrected visual acuity (BCVA) and central retinal thickness (CRT) in patients with complications were evaluated. A total of 1,098 eyes were followed up, of which 783 were treatment-naive and 315 eyes were after switching from another anti-VEGF agent. Results Adverse events were recorded in 42 eyes (3.83%), of which 30 eyes were treatment-naive (2.7%) and 12 eyes were post-switch (1.09%). The mean baseline BCVA ± SD was 56.7 ± 10.7 ETDRS chart letters in the group of patients with adverse events, 58.8 ± 10.1 letters in treatment-naive patients, and 51.4 ± 10.2 letters in patients after switch from another anti-VEGF agent. The mean baseline CRT ± SD was 432.2 ± 154.7 μm, being 435.8 ± 137.3 μm in treatment-naive patients and 424.5 ± 186.6 μm in patients after switch from another anti-VEGF agent. At the end of the follow-up, the mean BCVA ± SD was 53.4 ± 9.5 ETDRS charts letters in patients with adverse events, 55.6 ± 10 letters in treatment-naive patients, and 47.6 ± 10 letters in patients after switching from another anti-VEGF agent. The mean CRT ± SD at the end of the follow-up was 300.7 ± 115.7 μm in the total patient cohort, 285.2 ± 78.8 μm in treatment-naive patients and 334.5 ± 165.4 μm in patients after switching from another anti-VEGF agent. Conclusion We observed the development of adverse events in the form of intraocular inflammation or vasculitis with subsequent decrease in BCVA in 3.83% of cases after loading phase of the brolucizumab therapy. The decrease in BCVA was reversible in most cases after initiation of anti-inflammatory steroid treatment. From a functional and morphological point of view, we did not demonstrate any statistically significant difference between the groups of treatment-naive patients and patients after switching from another anti-VEGF agent.

Purpose To examine vision-related quality of life in patients with diabetic macular edema (DME) treated with intravitreal aflibercept (EYLEA, Regeneron Pharmaceuticals, Inc, Tarrytown, NY). Design AQUA was a multicenter, open-label, single-arm, phase 4 study. Participants Adults 18 years of age or older with type 1 or 2 diabetes mellitus and DME. Methods Patients received intravitreal aflibercept 2 mg every 8 weeks for 52 weeks, after 5 initial doses every 4 weeks. Main Outcome Measures The primary outcome was the change in 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) total score from baseline to week 52. Secondary outcomes included the change in NEI VFQ-25 near and distant activities subscale scores, best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study [ETDRS] letters), and central retinal thickness (CRT) from baseline to week 52. Change in NEI VFQ-25 score at week 52 for better-seeing eyes (BSEs) and worse-seeing eyes (WSEs) also was evaluated. Results A total of 553 patients comprised the full analysis set, and 560 patients comprised the safety analysis set. At baseline, the mean NEI VFQ-25 total score was 70.12, mean BCVA was 61.5 ETDRS letters, and mean CRT was 464.81 μm. A mean of 8.8 injections were administered over 52 weeks. At week 52, the mean improvement from baseline in the NEI VFQ-25 total score was +6.11 (standard deviation [SD], 11.46); the corresponding improvements in near and distant activities were +11.37 (SD, 18.01) and +7.33 (SD, 17.32), respectively. Similarly, improvements in patients whose BSE and WSE were treated were 7.74 (SD, 13.59) and 5.48 (SD, 9.70), respectively. At week 52, mean change in BCVA was +10.0 ETDRS letters (SD, 8.0 ETDRS letters), and mean change in CRT was –175.38 μm (SD, 132.62 μm). Overall, 53.6% of patients reported treatment-emergent adverse events (TEAEs), of whom 26.8% experienced an ocular TEAE in the study eye. The most common serious ocular TEAE was endophthalmitis (0.5% [n = 3]). Five deaths (0.9%) were reported, but were not considered treatment related. Conclusions Intravitreal aflibercept was associated with clinically meaningful improvements in NEI VFQ-25 total score over 52 weeks in patients with DME; these were even more pronounced for near than for distant activities. Adverse events were consistent with the known safety profile of intravitreal aflibercept.

Purpose: To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant) 0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).Design: Two randomized, multicenter, masked, sham-controlled, phase III clinical trials with identical protocols were conducted. Data were pooled for analysis.Participants: Patients (n = 1048) with DME, best-corrected visual acuity (BCVA) of 20/50 to 20/200 Snellen equivalent, and central retinal thickness (CRT) of ≥300 μm by optical coherence tomography.Methods: Patients were randomized in a 1:1:1 ratio to study treatment with DEX implant 0.7 mg, DEX implant 0.35 mg, or sham procedure and followed for 3 years (or 39 months for patients treated at month 36) at ≤40 scheduled visits. Patients who met retreatment eligibility criteria could be retreated no more often than every 6 months.Main Outcome Measures: The predefined primary efficacy endpoint for the United States Food and Drug Administration was achievement of ≥15-letter improvement in BCVA from baseline at study end. Safety measures included adverse events and intraocular pressure (IOP).Results: Mean number of treatments received over 3 years was 4.1, 4.4, and 3.3 with DEX implant 0.7 mg, DEX implant 0.35 mg, and sham, respectively. The percentage of patients with ≥15-letter improvement in BCVA from baseline at study end was greater with DEX implant 0.7 mg (22.2%) and DEX implant 0.35 mg (18.4%) than sham (12.0%; P ≤ 0.018). Mean average reduction in CRT from baseline was greater with DEX implant 0.7 mg (−111.6 μm) and DEX implant 0.35 mg (−107.9 μm) than sham (−41.9 μm; P < 0.001). Rates of cataract-related adverse events in phakic eyes were 67.9%, 64.1%, and 20.4% in the DEX implant 0.7 mg, DEX implant 0.35 mg, and sham groups, respectively. Increases in IOP were usually controlled with medication or no therapy; only 2 patients (0.6%) in the DEX implant 0.7 mg group and 1 (0.3%) in the DEX implant 0.35 mg group required trabeculectomy.Conclusions: The DEX implant 0.7 mg and 0.35 mg met the primary efficacy endpoint for improvement in BCVA. The safety profile was acceptable and consistent with previous reports.

Diabetic retinopathy is together with the diabetic macular edema the most common cause of vision loss in the working population. It is also the most common diabetic microvascular abnormality. Aflibercept is approved for the diabetic macular edema treatment, it is a recombinant fusion protein, binding VEGF A, B, and P1GF. The efficacy and safety of the treatment comparing with the laser treatment were set by VIVID-DME and VISTA-DME studies. The T DRCR.net study protocol confirmed the efficacy of aflibercept, ranibizumab, and bevacizumab in the treatment of diabetic macular edema. The best results in the whole group were obtained if using aflibercept, especially in the group of patients with worse initial visual acuity. In all three studies, the safety of intraviteraly applied aflibercept was proven.

Macular edema due to retinal vein occlusion is the second most common cause of vascular vision impairment. The authors refer two case reports that describe different response to treatment with OZURDEX, biodegradable injectable implant slowly releasing 700 µg dexamethasone. Treatment with corticosteroids is effective also in the case of cystic retinal edema, but its effect can be temporary. The most common adverse events are elevation of intraocular pressure and cataract development.

Arterial hypertension is a serious health problem. Decompensation of blood pressure may cause many ocular complications. We present three case reports of men with decompensated blood pressure and associated ocular complications. Successful compensation of blood pressure leads to objective improvement of fundus changes and vision.

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

Case report of the different visual functions of the right and left eye of 60-years old man with Stargardt disease is presented. The difference in best corrected visual acuity between both eyes is accompanied with corresponding various alteration of the central retinal activity using multifocal electroretinography (mfERG) and asymmetrical defects of the IS/OS photoreceptor junction using HD-OCT.

The authors present new possibilities in the treatment of the macular edema caused by the retinal venous occlusions; these occlusions are the second most common retinal vessel disease. The earlier possibilities of the treatment were focused on the macular edema laser treatment, laser panretinal photocoagulation in case of retinal or iris neovascularization presence, and the disease's risk factors compensation. In the presence, the intravitreal application of corticosteroids or anti VEGF A preparations are more used for the treatment because of better results, as proved by means of randomized, clinical studies.

Objective: To evaluate the safety and efficacy of 1 or 2 treatments with dexamethasone intravitreal implant (DEX implant) over 12 months in eyes with macular edema owing to branch or central retinal vein occlusion (BRVO or CRVO). Design: Two identical, multicenter, prospective studies included a randomized, 6-month, double-masked, sham-controlled phase followed by a 6-month open-label extension. Participants: We included 1256 patients with vision loss owing to macular edema associated with BRVO or CRVO. Methods: At baseline, patients received DEX implant 0.7 mg (n = 421), DEX implant 0.35 mg (n = 412), or sham (n = 423) in the study eye. At day 180, patients could receive DEX implant 0.7 mg if best-corrected visual acuity (BCVA) was 250 mu m. Main Outcome Measures: The primary outcome for the open-label extension was safety; BCVA was also evaluated. Results: At day 180, 997 patients received open-label DEX implant. Except for cataract, the incidence of ocular adverse events was similar in patients who received their first or second DEX implant. Over 12 months, cataract progression occurred in 90 of 302 phakic eyes (29.8%) that received 2 DEX implant 0.7 mg injections versus 5 of 88 sham-treated phakic eyes (5.7%); cataract surgery was performed in 4 of 302 (1.3%) and 1 of 88 (1.1%) eyes, respectively. In the group receiving two 0.7-mg DEX implants (n = 341), a >= 10-mmHg intraocular pressure (IOP) increase from baseline was observed in (12.6% after the first treatment, and 15.4% after the second). The IOP increases were usually transient and controlled with medication or observation; an additional 10.3% of patients initiated IOP-lowering medications after the second treatment. A >= 15-letter improvement in BCVA from baseline was achieved by 30% and 32% of patients 60 days after the first and second DEX implant, respectively. Conclusions: Among patients with macular edema owing to BRVO or CRVO, single and repeated treatment with DEX implant had a favorable safety profile over 12 months. In patients who qualified for and received 2 DEX implant injections, the efficacy and safety of the 2 implants were similar with the exception of cataract progression. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2011; 118: 2453-2460 (C) 2011 by the American Academy of Ophthalmology.

Objective: To evaluate the safety and efficacy of dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) compared with sham in eyes with vision loss due to macular edema (ME) associated with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Design: Two identical, multicenter, masked, randomized, 6-month, sham-controlled clinical trials (each of which included patients with BRVO and patients with CRVO). Participants: A total of 1267 patients with vision loss due to ME associated with BRVO or CRVO. Intervention: A single treatment with DEX implant 0.7 mg (n = 427), DEX implant 0.35 mg (n = 414), or sham (n = 426). Main Outcome Measures: The primary outcome measure for the pooled data from the 2 studies was time to achieve a >= 15-letter improvement in best-corrected visual acuity (BCVA). Secondary end points included BCVA, central retinal thickness, and safety. Results: After a single administration, the time to achieve a >= 15-letter improvement in BCVA was significantly less in both DEX implant groups compared with sham (P= 15-letter improvement in BCVA was significantly higher in both DEX implant groups compared with sham at days 30 to 90 (P= 15-letter loss in BCVA was significantly lower in the DEX implant 0.7-mg group compared with sham at all follow-up visits (P 25 mmHg peaked at 16% at day 60 (both doses) and was not different from sham by day 180. There was no significant between-group difference in the occurrence of cataract or cataract surgery. Conclusions: Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO and may be a useful therapeutic option for eyes with these conditions.

To evaluate the efficacy of the 4 mg triamcinolone acetonide injection into the vitreous in patients with diabetic macular edema not responding to the laser treatment after one-year follow-up.In a prospective study, 20 eyes with diffuse diabetic macular edema, not responding to the previous laser treatment were evaluated. The group consists of 20 patients; the mean age was 61.5 (29-76) years. The mean duration of diabetes was 14.5 (2-28) years. Twelve patients (60%) were treated by means of insulin, and eight patients (40%) by means of oral agents; the blood levels of glucose ranged between 3.2 - 22 mmol/L. In all patients, the treatment by means of intravitreal injection of triamcinolone started at least 3 months after the previous unsuccessful laser therapy of the macular region. Before the application, and at 1, 3, 6, 9 and 12 months after the application the visual acuity at the EDCRS optotypes was examined, the intraocular pressure was measured, the macula was examined by means of biomicroscopy, the photography of the fundus was performed by the funduscamera, and the macular thickness and its volume were measured by means of optic coherence tomography. The intravitreal injection of 4 mg of triamcinolone was performed on the outpatient's basis under aseptic circumstances at the operation theatre.The starting best-corrected visual acuity was 0.17 +/- 0.09 and after 12 months it improved to 0.22 +/- 0.14. During the 12 months follow-up period, the visual acuity improved in 11 eyes (55%), stabilized in 5 eyes (25%) and decreased in 4 eyes (20%). The improvement of the visual acuity was significant in all follow-up controls. In the first month p = 0.001, in the 12th month p = 0.038. The macular thickness decreased from the mean value 506.2 +/- 91.4 microm (range, 389 -719) in the beginning of the study, to the mean 362.4 +/- 92.6 microm (range, 211 - 569) after 12 months. During the follow-up period of twelve months, the macular thickness reduced in 18 eyes (90%), and increased in 2 eyes (10%). The decrease of the macular thickness is significant in all follow-up controls. In the 1st, 3rd, and 6th months, p0.0005, in the 9th and 12th months, p = 0.001. The correlation coefficient between the best-corrected visual acuity and the macular thickness is -0,467, and the probability (p= 0.038) is statistically significant. In 6 patients, the intravitreal injection of triamcinolone was repeated, and in one of them twice.The intravitreal injection of triamcinolone reduces the macular thickness and improves the visual acuity in patients with diabetic macular edema, in whom the laser treatment did not established the improvement. The best effectiveness is observed in the first three months after the application. After 12 months, we observed the reduction of the macular thickness in 90% of patients, and improvement of the visual acuity in 55% of patients. In some cases, it is necessary to repeat the application of triamcinolone to keep its effect.

Macular hole is a disease of the central area of the retina - site of the sharppest vision. Signs of this can be metamorphopsia and different degree of loss of the central vision. More than 100 years didn't exist succesfull treatment but knowledges of that disease have been started since 19 century. The authors evaluate case of macular hole, the differencial diagnosis, up date cognitions and possibilities of the treatment.

We demonstrated the effectiveness of transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularization (CNV) by patients with age- related macular degeneration (ARMD). CNV secondary to ARMD is a leading case of vision loss in patients older than 50 years. TTT is new promising method for the treatment CNV by ARMD. It is able to close CNV while maintaining visual function and in small percentage visual function improving. We have performed TTT by 30 patients (30 eyes) with subfoveolar CNV. We have demonstrated the stabilization or improvement of visual acuity by 16 patients (52%), improvemend two or more lines was documented by 5 patients (17%).

The authors evaluate results of the vitrectomy with the internal limiting membrane (ILM) peeling staining membrane blue by 49 patients. 81% (40) patients had idiopathic macular hole, 13% (6) traumatic case, 6 % (3) epimacular membrane. Anatomic closure of macular hole was achieved in 59% (29) of 49 patients by the operation. Visual acuity improved 2 or more Snellen lines in 28% (14) patients. Vitrectomy with peeling of the limiting membrane staining membrane blue of the better identification MLI is the effective operating technique to treat the macular hole.

The authors evaluate results of the radiotherapy by age- related macular degeneration. 114 patients (123 eyes) were examined. According to the total dose, we have divided the patients in 3 groups. Group A (12 Gy) consisted of 68 patients (74 eyes) and group B consisted of 46 patients (49 eyes), group C was designated as a control group, consisting of 21 patients (22 eyes). They have been performed in Department of Ophthalmology of Teaching Hospital of Charles University in Hradec Králové from February 1999 to April 2003. All examinations were performed before and at 24 months- follow up the radiotherapy. Radiotherapy seems to be a very promising and efficient method for treatment of the wet form of ARMD.

Age-related macular degeneration (AMD) is a complex multifactorial disease, that affects the central region of the retina. AMD is a leading cause of blindness among people over 50 years of age in the industrialized world. Two types of macular degeneration exist, the "dry" form and the "wet-neovascular" form. Neovascular AMD is responsible for 80-90% of cases of severe, irreversible central vision loss in patients over 65 years of age with AMD. The authors present contemporary possibilities of treatment of the patients with this disease.

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

Bevacizumab (Avastin) is a humanized monoclonal antibody to vascular endothelial growth factor A that is approved for the treatment of metastatic colorectal cancer. Although this drug is off-label for intraocular use, it has been widely used as intravitreal therapy for lot of ocular diseases. This paper will describe the efficacy and safety of the intraocular Avastin in the treatment of ocular diseases. The results described in the article warrant further study of bevacizumab in larger, controlled, randomized trials.

To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-related macular degeneration (ARMD) indicated for the intravitreal application of Ranibizumab (Lucentis, Novartis Pharma AG). To evaluate the efficacy of combined local preparation with broad-spectrum antibiotic moxifloxacine 0.5% (Vigamox, Alcon) and povidone iodine solution, 5% (Betadine, Egis Pharmaceuticals, LTD.) and to evaluate subjective toleration of moxifloxacin.In a prospective, non-randomized study were evaluated 20 eyes of 20 patients treated by means of intravitreally-applied ranibizumab. In all patients, the swabs from the conjunctival sac of the treated eye were repeatedly taken in a given time-schedule--before the start of using moxifloxacin, on the day of the intravitreal application of ranibizumab--before the irrigation of the conjunctival sac with povidone iodine solution, 5%, further after the irrigation--immediately before the injection and the control was token three days after the intravitreal injection. At the same time, the moxifloxacine toleration was evaluated by a questionnaire.The samples taken from the conjunctival sac of the treated eye before the application of moxifloxacine had positive bacterial culture in 17 eyes (85%) and negative culture in 3 eyes (15 %). Furthermore, in 2 eyes with positive culture, there was established resistance to moxifloxacine. After 3 days of moxifloxacine application, there was negative culture in 13 eyes (65%), in 7 eyes (35%) was the bacterial cultivation positive. After the irrigation with povidone iodine 5% solution was the cultivation negative in 17 eyes (85%), positive cultivation was in 3 eyes (15%); in all three cases, the cultures were susceptible to moxifloxacine. Three days after the intravitreal injection, the negative cultivation from the conjunctival sac was found in 13 eyes (65%), and in 7 eyes was the cultivation positive; the cultivated bacteria were moxifloxacine susceptible. Subjective symptoms after moxifloxacine application were reported by 10 patients altogether; 5 patients were without symptoms and 5 patients did not return the questionnaire. On average, the symptoms started the second day of moxifloxacine treatment and the average grade of symptoms was 1.6 on the scale from 0 to 5.In our group we found a broad spectrum of microorganisms colonizing the conjunctival sac of patients indicated to the ARMD intravitreal treatment. After the prophylaxis with moxifloxacine, the incidence of positive bacterial cultivation decreased and the povidone iodine 5% solution irrigation this effect increased. The most common pathogen species was Staphylococcus coagulasis negative. Although the resistance to moxifloxacine in two different bacteria in two eyes in the beginning of observation was established, after moxifloxacine treatment, the cultivation of these bacteria in both eyes was negative, and in all other cases the cultivated bacteria were susceptible to moxifloxacine.

The age related macular degeneration (ARMD) is the most common cause of practical blindness in the population older than 60 years of age. Usually it starts as a dry form with soft drusen.The progression of the dry form is difficult to control-promising seems to be the influence of rheologic factors in the choroid and the retina and thus improvement of their blood flow.By means of haemorheopheresis to improve blood rheology and thus micocirculation in the choroid and retina. The authors describe the development of the dry form of the ARMD in the sensitive stage with soft drusen and the eventual presence of retinal pigment epithelium detachment (RPED) after haemorheopheresis. The treated patients were compared with a control group (natural course of the ARMD) with the same number of patients.In a prospective, randomized study, comprising of 16 patients with the dry form of ARMD were treated with haemorheopheresis (cascade filtration) and 16 patients in the control group. Haemorheopheresis treatment comprised of 8 cycles in 10 weeks. Plasma obtained by separator was filtered by the Evaflux 4A (Japan) separator, where, the defined spectrum of high molecular proteins was captured. This lead to a decrease in blood and plasma viscosity and thus to improvement of rheologic conditions of the retina.Results show a positive influence on the absorption of soft drusen, reduction of the retinal pigment epithelium detachment, and the possibility to improve the visual acuity of the treated patients.Comparing to the worsening of clinical signs and visual functions in natural course of the ARMD development, the rheopheresis as well tolerated method may cause the retardation or stop of the unfavorable course of the disease.

The aim of the study was to establish the efficacy of anti VEGF (Vascular Endothelial Growing Factor) drugs in the treatment of wet form ARMD (Age-Related Macular Degeneration) in everyday clinical practice in the Department of Ophthalmology, Faculty Hospital, Hradec Králové, Czech Republic, E.U., in patients registered in the Czech national registry AMADEUS.Retrospective study with 24 months follow-up period. In the group were evaluated 143 eyes of 140 patients, out of them were 77 women (65.8 %), of average age 73.09 (71.69 - 74.48) years, and 40 men (34.2 %) of average age 74 (58 - 85) years. All of the patients were completely examined before the beginning of the treatment; during the treatment were, except the standardized eye examination, in patients treated with ranibizumab the color fundus photography and Optical Coherence Tomography (OCT) with measuring of the central retinal thickness performed every three months at least. The patients treated by pegaptanib were examined every six weeks before the drug application. The fluorescence angiography (FA) was performed at the beginning of the treatment to establish the type and extension of the choroidal neovascularization and during the treatment in case of necessity to establish the activity of the choroidal neovascular membrane (CNV). The treatment by ranibizumab was in the regimen PRN (pro re nata), and pegaptanib was applied every six months during the first year with the follow-up evaluation of the findings. The treatment evaluations were performed at 12 and 24 months.During the two years follow - up period, the authors noticed in patients treated with ranibizumab loss of 5.12 letters of ETDRS optotypes in case of mostly classical CNV, in occult CNV loss of 5.45 letters, and in minimally classical CNV loss of 2.83 letters. In three evaluated eyes with classical CNV in patients treated with pegaptanib we noticed after 2 years loss of 6.67 letters, in eleven eyes with occult CNV we established loss of 9.91 letters, and in two eyes with minimally classical CNV the average best-corrected visual acuity (BCVA) remained unchanged. The pegaptanib treatment results may be influenced by small number of evaluated patients. The visual acuity changes during the two years treatment were not statistically significant. We noticed the decrease of average CRT (central retinal thickness) in all types of CNV treated both with ranibizumab and pegaptanib after the two years follow up. To reach these results, an average of 5.51 applications of ranibizumab and 9 applications of pegaptanib during the two years were used.In the followed-up group we found, comparing to the natural course of neovascular form of ARMD, retarding of the BCVA decrease during the two years treatment with VEGF inhibitors in everyday clinical practice. Better results were achieved with ranibizumab treatment, however the differences were not statistically significant. Key words: age related macular degeneration, AMADEUS Czech national registry, ranibizumab, pegaptanib.

The aim of this study was to evaluate the efficacy of intravitreal application of triamcinolone in macular edema of different etiology. In this prospective study, 20 eyes were evaluated: 12 with diabetic macular edema, 6 with macular edema due to venous occlusion, 1 with pseudophakic cystoid macular edema, and 1 with cystoid macular edema in case of uveitis. Four milligrams of tramcinolon acetonide were injected in to the vitreous cavity. Before and in one month intervals after the application, the intraocular pressure was measured, visual acuity on the ETDRS optotypes was established, the macula was examined biomicroscopically, examination of the photography of the fundus was performed, and macular thickness was measured by means of optical coherence tomography. The follow-up period was 3 months. The mean visual acuity was 0.16 at the beginning of the study, 1 month after the application 0.32, and after 3 months 0.31. The mean thickness of the macula decreased from the initial value 537 microm by 249 microm after one month (improvement by 46.6%) and by 203 miceom after three month (improvement by 39.7%). As a complication, the elevation of the intraocular pressure was noticed in 20% of eyes, and this was compensated in all cases by means of local therapy. The intravitreal injection of triamcinolon seems to be a promising part of treatment of the macular edema of different origin.

To explain the mechanism of the origin of unilateral retrohyaloid and vitreous hemorrhage in case of subdural haematom after a severe brain injury.A detail examination by help of fluorescein angiography and funduscopy revealed a fluorescein leakage site in lamina limitans interna into the vitreous.Fluorescein angiography revealed a fluorescein leakage site at the margin of the optic disc. It was possible to find the source of hyperfluorescence that increased its intensity over a time after vitreous hemorrhage had been removed.The diagnosis of Terson syndrome was started on the base of eye examination. The damage to peripapillary tissues demonstrated by fluorescein leakage suggests that intracranial hypertension affects peripapillary structures through the intervaginal space of the optic nerve sheath.

Punctate Inner Choroidopathy (PIC) is a rare idiopathic ocular inflammatory disease. It occurs mostly in young, myopic, otherwise healthy women. Symptoms of the disease include acute vision decrease associated with central and paracentral scotoma. In 80% of cases PIC occur bilaterally. We report the case of a woman at the age of twenty-five, who was treated for PIC. Due to the finding of active inflammatory deposit in the retina of the left eye and low visual acuity was recommended corticosteroid therapy with a good therapeutic effect.Punctate Inner Choroidopathy (PIC), white dot syndromes.

Authors refer to one year's results of the study of 56 eyes of 50 patients with the exsudative form of the age-related macular degeneration treated by means of transpupillary thermotherapy at the Department of Ophthalmology, School of Medicine, Charles University, Hradec Králové (Königgrätz), Czech Republic, EU.In all patients, the best-corrected visual acuity (BCVA) before treatment was established. Beside the ordinary examination methods, the digital color photography of the fundus with topography of the lesion, fluoresceine angiography (FAG), or possibly indocyanine green angiography and optical coherence tomography (OCT) were performed. After the treatment, in given intervals, the BCVA was established, and retinal findings were evaluated by means of biomicroscopic examination, comparative color photography of the fundus, optical coherence tomography, fluoresceine angiography, or possibly indocyanine green angiography.During one year after the treatment, the visual acuity decreased by 2 or more lines on Snellen optotypes in 38.2% of patients, remained stable in 52.9%, and improved in 8.8% of patients. The FAG findings improved in 83.9% and the OCT findings in 84.8% of patients. This improvement was statistically significant. In patients with classical choroidal membrane, the BCVA decreased in 35.8%, remained stable in 57.1% and improved in 7.1% of patients. The FAG finding improved in 78.7%, and the OCT finding improved in 90.8% of patients. The improvement of the OCT findings was statistically significant. In patients with occult choroidal membrane, the visual acuity decreased in 45 %, remained stable in 45%, and improved in 10% of patients. The FAG findings improved in 88.9%, and the OCT findings in 78.9% of patients. The improvement was statistically significant.Our results show that transpupillary themotherapy belongs to important methods of treatment of the classical and occult membranes of the choroid in exsudative forms of the ARMD.