Alexandr Stepanov

Anterior chamber migration of dexamethasone intravitreal implant (Ozurdex®) through basal iridectomy (Ando) in a pseudophakic patient.

Purpose Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure. Methods This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens. Conclusions Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.

Re-operation of idiopathic macular hole after failed initial surgery.

BACKGROUND Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) appears in approx. 12% of cases. It is, therefore, one of the most common complications. IMH re-operation results tend to be better in eyes where IMH had been closed, while IMH re-operations in cases when the initial surgery had failed tend to be less successful: IMH often becomes even larger and visual acuity decreases, anatomical success rate of closure is about 60% and the resulting postoperative visual acuity is about 20/100. AIMS To establish anatomical and functional success rate of repeated operations of recurrent idiopathic macular hole. MATERIALS AND METHODS We evaluated the retrospective results of re-operations of persisting IMH that is cases in which the initial surgery did not result in closure: 6 eyes in 6 patients out of the overall 55 operated on IMH (primary PPV failed in almost 11% of cases). The follow-up period was 18 months (since the first surgery). RESULTS AND CONCLUSION After the second PPV, the IMH was closed in 100% of operated eyes. It was not necessary to perform a third PPV during the follow-up period. In all cases the visual acuity improved. Anatomical and functional results of IMH treatment can be considered satisfactory. We consider the following combination of factors significant for the anatomical success rate of PPV: IMH size and stage, technical precision of the ILM peeling and the suction of the IMH contents, strict adherence to the recommended head positioning in early postoperative period, and IMH duration.

Microincision 25G pars plana vitrectomy with peeling of the inner limiting membrane and air tamponade in idiopathic macular hole.

Purpose To evaluate the success of a mini-invasive technique for operation of idiopathic macular hole (IMH). Methods We retrospectively examined 29 patients (30 eyes) in whom 25-G pars plana vitrectomy (PPV), peeling of the inner limiting membrane (ILM), and application of air tamponade were performed. The group of the patients included 7 males and 22 females (76%), age range 57-79 years (median 70). The follow-up period was 3-47 months (median 17). Results Pars plana vitrectomy was indicated only in the stages of full-thickness macular hole. Prior to operation, 13 eyes (43%) were in stage 2, 15 eyes (50%) in stage 3, and 2 eyes (7%) in stage 4. The IMH healed in 28 eyes after operation. Persistence of IMH occurred in 2 eyes (7%). After subsequent reoperation with extension of the peeling zone of the ILM and gas tamponade (with 10% C3F8), these macular holes also healed (100%). Prior to carrying out PPV, best-corrected visual acuity (BCVA) ranged between 20/40 and 20/500 (median 20/125). At the end of the follow-up period, BCVA was improved to 20/40 (median). The change in the final BCVA compared to the initial visual acuity was statistically significant (p = 0.008; Wilcoxon). Conclusions The 25-G PPV with peeling of the ILM and air tamponade is an effective technique and presents no increased risks in comparison with routine procedures. The main benefit of the intervention is its good tolerance by the patient, particularly with respect to painfulness and postoperative irritation.

The natural evolution of idiophatic epimacular membrane

BACKGROUND AND AIMS Epiretinal membrane (ERM) refers to a semi-translucent tissue layer found on the inner surface of the retina especially in older people. Surgical treatment remains controversial, optimal timing for such treatment is difficult to determine and data on the natural evolution of this disorder are limited. In this study we evaluated the natural course of idiopathic epimacular membrane in 49 patients (53 eyes). MATERIALS AND METHODS Retrospective evaluation of a group of 49 patients (53 eyes) with idiopathic epimacular membrane confirmed by biomicroscopy, photography and optical coherence tomography (OCT). RESULTS Patient age ranged from 51-85 years (median 72). The average follow-up was 21.3 months (± 14). Between the initial and final best corrected visual acuity (BCVA) there was no statistically significant difference although there was a significant tendency to decrease in BCVA (Spearman P=0.05) during the follow-up. Initial BCVA correlated with initial central retinal thickness (CRT), final CRT, final volume, and age. The final BCVA significantly correlated with all parameters measured. CONCLUSION BCVA during follow-up tended to decrease: difference of starting BCVA and final BCVA values depending on the time of monitoring is significant. This we attribute to a slow gradual progression of macular changes. But, initial and final BCVA measurements were not substantially different at the end. Thus, in the absence of any clear signs of ERM progression, we can safely postpone the decision whether to perform PPV.

Navigated Laser Photocoagulation of Chronic Diabetic Macular Edema

Objective: This paper deals with a retrospective evaluation of the effect of navigated photocoagulation of chronic DME with the NAVILAS device. Methods: The cohort comprised 18 eyes with clinically significant DME. The age range was 41-82 years (median 68) and the monitoring time in all eyes lasted for 12 months. The following examination techniques were employed: best corrected visual acuity (BCVA) tested on ETDRS charts, biomicroscopic examination of the fundus in artificial mydriasis, colour photography, fluorescent angiography (FAG), and optical coherence tomography (OCT, spectral domain Cirrus, C. Zeiss). The values of BCVA and OCT were statistically tested by means of a non-parametric pair test (Wilcoxon). The performed therapy included 1 focal laser treatment of the macula, 9 grid photocoagulations of the macula, and 8 direct photocoagulations of leaking microaneurysms. Laser treatment was done using navigated photocoagulation by NAVILAS device. Results: The initial BCVA ranged between 0.1 and 0.8 (average 0.5); at the end of the monitoring period the range of BCVA was 0.1 to 1.0 (average 0.5). No statistically significant difference was found between the pre- operative and post-operative values of BCVA. The average value of the thickness of the macula in the central field on OCT was 360 µm prior to the intervention and 322 µm at the end of the monitoring time. This difference was statistically significant (p=0.015 Wilcoxon). After laser treatment with a NAVILAS device there was an anatomical improvement in DME. The sight functions (BCVA) remained stabilized. Conclusion: Navigated photocoagulation of the macula for DME showed in the present cohort of patients a favourable and functional benefit of the used method.

Transient branch retinal artery occlusion in a 15-year-old girl and review of the literature.

BACKGROUND Retinal artery occlusion is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals. METHODS AND RESULTS This case report a rare case of transient branch retinal artery occlusion (BRAO) in a healthy young girl. A fifteen-year-old girl presented with painless decreased vision in her right eye. Fundus examination revealed in the right eye intensive edema of the part of superior half of the retina, but the vessels were absolutely normal. She was hospitalized for diagnosis and treatment. A thorough workup was performed to determine any etiologic factor. Her physical examination was normal, but from anamnesis has been found that patient began use oral contraception at the time of occurrence eye problems. The condition is evaluated as transient branch retinal artery occlusion by the course of the disease. The paper includes the review of the literature also. CONCLUSION Though retinal arterial obstruction is rare in the pediatric population, this case highlights the importance of including this in the differential diagnosis of acute vision loss.

Ophthalmic Manifestations of Acute Leukaemias

BACKGROUND AND AIMS To determine the incidence of ocular pathological findings in a group of patients with acute leukemia. To define the predictive value of the presence of the ocular pathological findings. MATERIALS AND METHODS Retrospective evaluation of a group of 67 patients with acute leukemia (age 1-75 years) examined at the Ophthalmology Clinic, Faculty Hospital Ostrava, from 2005 to 2014. RESULTS Ocular pathological findings were found in 13 patients of the group (19.4 %) - 7 patients with acute myeloid leukemia (10.9 %) and 6 patients with acute lymphoblastic leukemia (8.5 %). 10 patients died due to of the underlying disease. Ocular pathological findings were found in 6 of them (60 %). A higher prognostic value was found in a group of patients with AML. CONCLUSION Ophthalmology examination is a necessary part of the examination of patients with acute leukemia. This prognostic benefit is particularly significant in patients with AML. Key words: acute myeloid leukemia, fundus leucaemicus, Roths spot, ophthalmology examination.

Migration of emboli in the retinal artery: case report

Branch retinal artery occlusion (BRAO) is a prevalent vascular occlusive disorder of the eye. In transient BRAO, an embolus temporarily blocks the vessel and then moves on resulting in recovery of blood circulation. In this case, we have documented migration of the embolus with recovery of perfusion of the retina and improvement of visual acuity in a patient with transient BRAO. Early diagnosis and fast action are important in the case of patients with retinal artery occlusion.

Long-term follow-up of posterior capsule opacification after AquaLase and NeoSoniX phacoemulsification.

AIM To compare the degree of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods during an 8-year follow-up period using two types of software. DESIGN Prospective, randomized clinical trial. METHODS AquaLase was used in the right eye and NeoSoniX in the left eye of each patient with bilateral cataract. RESULTS Fifty patients were analyzed 1 year, 46 patients 3 years, and 37 patients 8 years after cataract surgery. Mean EPCO 2000 values were for the AquaLase group 0.324 ± 0.305 and for the NeoSoniX group 0.298 ± 0.341 (P = 0.53) 1 year after surgery, for the AquaLase group 0.582 ± 0.506 and for the NeoSoniX group 0.594 ± 0.515 (P = 0.87) 3 years after surgery, and for the AquaLase group 0.648 ± 0.567 and for the NeoSoniX group 0.673 ± 0.542 (P = 0.30) 8 years after surgery. The OSCA results were for the AquaLase group 0.7097 ± 0.3778 and for the NeoSoniX group 0.8584 ± 0.4323 (P = 0.046) 1 year after surgery, for the AquaLase group 0.9667 ± 0.736 and for the NeoSoniX group 0.9540 ± 0.5250 (P = 0.91) 3 years after surgery, and for the AquaLase group 1,035 ± 0,952 and for the NeoSoniX group 1,103 ± 0,741 (P = 0.44) 8 years after surgery. CONCLUSION There was minimal PCO difference between these 2 approaches, AquaLase and NeoSoniX. Neither AquaLase nor NeoSoniX technique was able to prevent a natural progression of PCO.

Femtosecond Laser-assisted Cataract Surgery in Marfan Syndrome

This case report a rare case of 67-year-old man, presented with Marfan’s syndrome, cataract and crystalline lens dislocation of the left eye. The best corrected visual acuity (BCVA) of the left eye was 0.2. Cataract surgery was asissted by femtosecond laser LenSx. One month after surgery uncorrected visual acuity (UCVA) of the left eye was 0.9, BCVA with sph. +1.5 was 1.0. Intraocular lens have perfectly centered in the eye. Femtosecond laser is a significant improvement in surgery of patients with Marfan syndrome. Femtosecond laser is a significant improvement in surgery of patients with Marfan syndrome.