Pavel Kuchynka

Malignant Epithelioma of the Ciliary Body

A rare case of malignant epithelioma of the ciliary body (verified histologically) is described. Some difficulties of clinical diagnosis are mentioned as well as the general properties of this kind of tumor, which mostly requires an anatomical investigation for recognition. As a special feature of this kind of tumor the precocious consecutive cataract is mentioned; this arises in cases of melanomas of the ciliary body considerably later in the course of malignant growth.

Hybrid Technique of Lamellar Keratoplasty (DMEK-S)

Purpose: To evaluate the outcomes of the hybrid technique of posterior lamellar keratoplasty (DMEK-S). Materials and Methods: 71 eyes of 55 patients enrolled in a single-center study underwent posterior lamellar keratoplasty with a hybrid lamella DMEK-S implanted using a solution implantation technique, owing to endothelial dysfunction. The outcome measures studied were visual acuity and endothelial cell density. Results: The rate of endothelial cell loss caused by surgery was 43.8%. During followups, we observed the stabilization of postoperative findings, or at minimum a very low rate of corneal endothelial cell loss. The UCDVA and BCDVA dramatically improved postoperatively. The rebubbling rate in our group of patients was 61.9%. We replaced the lamella due to its failure or malfunction in 17 patients (23.9%). Conclusion: In summary, DMEK-S combines the advantages of DSEK/DSAEK and DMEK. The central zone of bare Descemets membrane and endothelium allows for very good visual outcomes, and the peripheral rim allows for better manipulation of the lamella during implantation. It is an effective method of treating the endothelial dysfunction of various etiologies, but the high complication rate needs to be addressed before widespread implementation of the technique in the future.

Descemet membrane endothelial keratoplasty with a stromal rim in the treatment of posterior polymorphous corneal dystrophy

A 20-year-old patient, diagnosed with posterior polymorphous corneal dystrophy, developed corneal edema for which he underwent Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) in the right eye. No intra- or postoperative complications were noted. At the last follow-up 2 years and 9 months after the procedure, the best corrected visual acuity was 1.0 and endothelial cell density declined from 3533 cells/mm2 to 1012 cells/mm2. Despite the endothelial cell loss, DMEK-S appears to be a good alternative to other surgical techniques for the treatment of corneal endotheliopathies, and it may be of benefit to young patients.

Intraocular astrocytoma without phacomatosis.

PURPOSE Astrocytic tumors occur in the retina or in the optic disc usually as a part of tuberous sclerosis complex or other phacomatosis and their isolated occurrence is rare. The authors present two adult patients in whom the diagnosis of intraocular astrocytoma was established but no signs of phacomatosis were revealed.(Eur J Ophthalmol 2004; 14: 350-4).

Safety of hydroimplantation: a foldable intraocular lens implantation without the use of an ophthalmic viscosurgical device.

Purpose To compare the safety of a single-piece, foldable intraocular lens (IOL) hydroimplantation with that of a standard implantation using an ophthalmic viscosurgical device (OVD). Methods One hundred consecutive patients with bilateral age-related cataract surgery were enrolled into a prospective double-blind study. Each patients first eye was randomly assigned to a standard implantation technique with an OVD or the hydroimplantation technique, while the fellow eye received the opposite technique. The main outcomes measured were endothelial cell loss, postoperative changes of intraocular pressure (IOP), and the frequency of complications. Results The reduction of endothelial cell density 1 month and 6 months after the surgery was 9.76% ± 13.5%, 10.7% ± 12.6%, respectively, in group A (OVD) and 9.07% ± 12.7%, 9.13% ± 13.7%, respectively, in group B (hydroimplantation). The differences were not statistically significant. The mean IOP 2 hours after surgery was 10.19 ± 6.78 mm Hg in group A and 9.92 ± 7.01 mm Hg in group B. Twenty-four hours and 1 month after surgery, the mean IOP was 14.52 ± 5.59 mm Hg and 13.21 ± 3.5 mm Hg, respectively, in group A, and 15.45 ± 5.77 mm Hg and 13.1 ± 3.44 mm Hg, respectively, in group B. The differences between groups A and B were not statistically significant. Conclusions The hydroimplantation technique is a safe technique for single-piece foldable IOL implantation. There was no increase in intraoperative and postoperative complications compared with the standard implantation technique using an OVD.

Eye Health Care in the Czech Republic

Objective: An analysis of eye health care in the Czech Republic as of 1998 was performed. Methods: A questionnaire was used to obtain information from all 59 in-patient eye departments. Results: The number of ophthalmologists per 1 million inhabitants was 95. The number of cataract operations per 1 million inhabitants was 4,209: phaco-emulsification (36,926 surgeries, 85.2%), extracapsular extraction (6,094 surgeries, 14.1%) and intracapsular extraction (90 surgeries, 0.2%). Intra-ocular lenses were implanted in 99% of cases; 404 corneal transplantations and 1,220 operations for retinal detachment were performed. The number of pars plana vitrectomies for diabetic eye complications was 661. Conclusion: Selected regional clinical centres should be equipped and preferred by health insurance companies to provide comprehensive eye health care services and training.

Use of PocketMaker Microkeratome for Creation of Corneal Pocket for Foldable Keratoprosthesis KeraKlear Implantation – Case Series

Purpose : To describe a surgical method for corneal pocket creation for KeraKlear keratoprosthesis implantation by PocketMaker microkeratome. Methods : We implanted keratoprosthesis KeraKlear in 3 patients. In all cases, we used a microkeratome PocketMaker to create a corneal pocket, where the incision was made at a depth of 300 µm with a vibrating diamond blade. Results : Although corneas have been extensively opaque and vascularized, in all three cases we successfully performed suction of the microkeratome system and created a corneal pocket without any difficulties. Subsequent keratoprosthesis implantations were performed without any problems. Conclusion : The technique is simple, relatively cheap, and the creation of the corneal pocket is possible even in patients with vascularized and opaque cornea.

Deep Sclerectomy with Nonabsorbable Implant (T-Flux) in Patients with Pseudoexfoliation Glaucoma

Purpose. To evaluate the effectiveness of deep sclerectomy with T-flux implant (DS T-flux) in patients with pseudoexfoliation glaucoma (PExG). Methods. 20 eyes of 18 patients with medically uncontrolled PExG have undergone DS T-flux implantation. Postoperatively we evaluated the IOP values and the frequency of complications. The minimum follow-up time was 12 months (20 eyes) and the maximum 24 months (10 eyes). Results. The mean preoperative IOP was 36.8 ± 8.7 mmHg. The IOP significantly decreased throughout all postoperative periods (P < 0.05) and reached 1 day after surgery 11.45 ± 6.6 mmHg; 3 months 13.45 ± 3.6 mmHg; 12 months 14 ± 2.8 mmHg; and 24 months 14.80 ± 2.4 mmHg. Complete success rate, defined as IOP ≤ 18 mmHg without medication, was 85% (17/20 eyes) at 12 months. Qualified success rate, defined as IOP ≤ 18 mmHg with or without medication, was 100% (20/20 eyes). The most frequent postoperative complications were mild hyphaema (9 patients, 45%), choroidal detachment (3 patients, 15%), and hypotony—IOP < 5 mmHg (2 patients, 10%). Conclusions. DS with T-flux implant is a safe and effective surgical treatment method for medically uncontrolled PExG. The number of complications is low.

Book Reviews · Livres nouveaux · Buchbesprechungen

Conjunctival inflammation is one of the most frequent conditions presenting to the ophthalmologist. While in the past decades, bacterial infections of the conjunctiva have become much easier to diagnose and treat, the non-infectious disorders still pose confounding problems. Inflammatory Diseases of the Conjunctiva provides an in-depth review of the pathological mechanisms causing these diseases. The strength of this book lies in its presentation of immunological knowledge which is indispensable for the understanding of conjunctival inflammation. As immunology is a very dynamic field of research, the authors put great emphasis on giving up-to-date information on basic research findings and putting them in perspective regarding their clinical relevance. In this the book is of great value for the clinician. It is also very well structured, dealing with individual disease entities in separate chapters and providing sections on laboratory investigations, differential diagnosis and treatment options in each of them. Some topics are given special consideration in ‘focus’ sections, among them dry eye syndrome, laboratory investigations of conjunctival inflammation and apoptosis in the conjunctiva. Dr. Holger Baatz, Frankfurt G.A. Fishman, D.G. Birch, G.H. Holder, et al.

Augenmanifestationen der Wegenerschen Granulomatose

A series of 3 patients with Wegener’s granulomatosis is described. Diagnosis, therapy and the relation of the eye involvement to the general condition are discussed.A series of 3 patients with Wegener’s granulomatosis is described. Diagnosis, therapy and the relation of the eye involvement to the general condition are discussed.