Rudolf Autrata

Laser-assisted subepithelial keratectomy for myopia: Two-year follow-up

Purpose: To assess and compare the clinical results (efficacy, safety, stability, and postoperative pain or discomfort) of laser‐assisted subepithelial keratectomy (LASEK) and conventional photorefractive keratectomy (PRK) for the correction of low to moderate myopia. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. Methods: A prospective comparative study was performed in 184 eyes of 92 patients who had surface excimer ablation for the correction of myopia. The preoperative mean spherical equivalent (MSE) was −4.65 diopters (D) ± 3.14 (SD) (range −1.75 to −7.50 D). In each patient, LASEK was performed in 1 eye and PRK in the fellow eye by the same surgeon. The first eye treated and the surgical method used in the first eye were randomized. Both procedures were performed with the Nidek EC‐5000 excimer laser using the same parameters and nomogram. The postoperative pain level, visual recovery, complications (haze), uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA), and refractive outcome were evaluated and compared. All eyes completed a 24‐month follow‐up. Results: The postoperative MSE was −0.18 ± 0.53 D in the PRK eyes and −0.33 ± 0.46 D in the LASEK eyes. At 1 week, the mean UCVA was 0.64 ± 0.21 and 0.87 ± 0.23, respectively. No LASEK eye lost a line of BSCVA. There were no statistically significant differences between PRK and LASEK eyes in the safety and efficacy indices at 2 years. The mean pain level was significantly lower on days 1 to 3 in the LASEK eyes (P < .05). The mean corneal haze level was lower in the LASEK eyes (0.21) than in the PRK eyes (0.43) (P < .05). Seventy‐nine patients preferred LASEK to PRK. Conclusions: Laser‐assisted subepithelial keratectomy provided significantly quicker visual recovery, eliminated post‐PRK pain, and reduced the haze level in eyes with low to moderate myopia compared with conventional PRK. It provided good visual and refractive outcomes. There were no serious complications.

Visual results after primary intraocular lens implantation or contact lens correction for aphakia in the first year of age.

Purpose: The optimal role of intraocular lenses (IOLs) in infants remains a controversial topic. Some ophthalmologists advocate correction with a contact lens (CL), whereas others recommend an IOL correction. Our study compared visual acuity, ocular alignment, retreatment rate and binocular vision outcomes in children treated with these two methods at our clinic. Methods: This study included 41 children with unilateral congenital cataract who underwent cataract surgery with posterior capsulorhexis and anterior vitrectomy, coupled with (IOL group, n = 18) or without (CL group, n = 23) primary IOL implantation. All infants underwent the first surgery during the first 12 months of their life and they were operated on in the period from 1994 to 1999. The mean age at surgery was 3.11 ± 2.65 months (range: 28 days to 11 months). All patients were prescribed the same half-time reduced occlusion therapy. Good cooperation of the parents and good compliance with patching were the necessary conditions to include a patient in the study. Between January and February 2003, the final visual acuity and binocular vision outcomes were examined. Results: The mean final visual acuity (logarithm of the minimum angle of resolution) of the operated eye was 0.43 ± 0.33 for the IOL group and 0.58 ± 0.39 for the CL group (p = 0.14). The mean interocular difference in visual acuity was 0.22 ± 0.29 for the IOL group and 0.56 ± 0.31 for the CL group (p = 0.042). The reoperation rate was 78% in the IOL group compared with 35% in the CL group (p = 0.017). Esotropia or exotropia of more than 8 prism diopters were present in 55% of children (10/18) in the IOL group compared with 83% of children (19/23) in the CL group (p = 0.039). Conclusions: We suggest that correction of aphakia after unilateral congenital cataract surgery with primary IOL implantation results in improved visual acuity, improved binocular vision outcome and less occurrence of strabismus, but a higher rate of complications requiring reoperation. Further studies with a larger pediatric patient group are necessary to confirm the optimal treatment of aphakia after unilateral congenital cataract extraction.

Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children☆☆☆★

Purpose: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) and laser‐assisted subepithelial keratectomy (LASEK) for high myopic anisometropia with amblyopia and contact lens (CL) intolerance in children. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. Methods: This prospective comparative study comprised 27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years (range 4 to 7 years). Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC‐5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2‐year follow‐up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The visual acuity and binocular vision outcomes in both groups were analyzed and compared. Results: In Group A, the mean spherical equivalent refraction was −8.25 diopters (D) ± 2.37 (SD) (range −6.00 to −11.25 D) preoperatively and −1.61 ± 0.73 D (range +0.50 to −2.25 D) postoperatively. The mean best corrected visual acuity (BCVA) was 0.23 ± 0.21 preoperatively and 0.78 ± 0.19 at 2 years. In Group B, the mean BCVA was 0.16 ± 0.19 at the start of CL correction and amblyopia therapy and improved to 0.42 ± 0.15 after 2 years. The mean BCVA at the final examination was significantly better in Group A (P<.05). Binocular vision improvement expressed by the proportion of patients who gained fusion and stereopsis was better overall in Group A (78%) than in Group B (33%) (P<.05). There were no complications postoperatively. Conclusions: Photorefractive keratectomy and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.

Laser-assisted subepithelial keratectomy and photorefractive keratectomy for the correction of hyperopia. Results of a 2-year follow-up.

Purpose: To evaluate and compare the efficacy, safety, predictability, and stability of laser‐assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for low to moderate hyperopia with a 2‐year follow‐up. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. Methods: This prospective comparative single‐surgeon study included 216 eyes of 108 patients with hyperopia who received PRK in 1 eye and LASEK in the contralateral eye. The mean patient age was 38.3 years (range 25 to 58 years). The mean preoperative spherical equivalent (SE) cycloplegic refraction was +3.67 diopters (D) ± 1.15 (SD) (range +2.00 to +5.00 D), and astigmatism was less than 1.00 D. In each patient, PRK was performed in 1 eye (Group A) and LASEK was performed in the other eye (Group B) using the Nidek EC‐5000 excimer laser. Postoperative uncorrected visual acuity (UCVA), best corrected visual acuity, contrast sensitivity, manifest and cycloplegic refractions, refractive stability and predictability, postoperative pain, and corneal haze were examined and statistically analyzed. A P value less than 0.05 was considered significant. Results: At 1 week, the UCVA was 20/40 or better in 58% of PRK eyes and 85% of LASEK eyes (P = .037); at 2 years, it was 20/40 or better in 81% and 91%, respectively (P = .076). At 2 years, the UCVA for near was N8 or better in 73% of PRK eyes and 89% of LASEK eyes (P = .064). No patient lost 2 or more lines of Snellen visual acuity. The safety index was 1.03 in PRK eyes and 1.08 in LASEK eyes. Refractive stability was achieved at 6 months in LASEK eyes and at 12 months in PRK eyes. The mean SE cycloplegic refraction decreased from +3.58 D (PRK eyes) and +3.76 D (LASEK eyes) at baseline to +0.74 D and +0.32 D, respectively, at 2 years; in 57% and 78% of eyes, respectively, the refraction was within ±0.50 D of the targeted refraction. Peripheral corneal haze scores at 3 to 9 months and pain scores at 1 to 3 days were significantly lower in the LASEK group than in the PRK group. Conclusions: Laser‐assisted subepithelial keratectomy for hyperopia up to +5.00 D provided good visual and refractive results. It significantly reduced postoperative pain, grade of peripheral ring‐shaped corneal haze, and regression of hyperopia. Hyperopic LASEK provided quicker visual recovery and achieved better efficacy, predictability, and refractive stability than hyperopic PRK.

Long-Term Results of Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma Patients

We evaluated efficacy and complications of diode laser cyclophotocoagulation in pediatric patients with refractory glaucomas. The retrospective study comprised 69 eyes of 53 pediatric patients with uncontrolled refractory glaucoma treated by transscleral diode laser cyclophotocoagulation. The mean age was 6.1 ± 4.29 (range 0.9–15) years. The main parameters evaluated were: intraocular pressure (IOP), visual acuity, and complications. The mean follow-up period was 5.6 ± 2.8 (range 2.2–9.5) years. Treatment success was defined as a postoperative IOP of ≤21 mm Hg, with or without adjunctive glaucoma medications. The baseline mean pretreatment IOP was 34.08 ± 7.13 (range 24–47) mm Hg. The final mean postoperative IOP was 20.81 ± 6.38 (range12–33) mm Hg after a mean of 2.13 ± 1.47 (range 1–6) laser procedures. After one treatment session, 66% of the eyes had a successful reduction in IOP (≤21 mm Hg), but this had fallen to 41% by 1 year. With repeat cyclophotocoagulation, 79% of the eyes had a clinically effective reduction in IOP(≤21 mm Hg) for 1 year (mean 7.1-month interval between treatments). Postoperative complications included choroidal detachment in 4 eyes and retinal detachment in 2 eyes with progression of vision loss. All these complications occurred in aphakic patients. Cyclophotocoagulation by diode laser is a useful therapy for the treatment of refractory pediatric glaucomas with uncontrolled IOP. Cyclodiode repeated treatment can provide effective control of IOP with a low risk of severe complications. Aphakic patients may have an increased risk of postoperative complications.

Clinical results of excimer laser photorefractive keratectomy for high myopic anisometropia in children: Four-year follow-up

Purpose: To evaluate the visual and refractive results of multizonal photorefractive keratectomy (PRK) for high myopic anisometropia and contact‐lens intolerance in children. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. Methods: Twenty‐one patients aged 7 to 15 years with high myopic anisometropia had multizonal PRK in the more myopic eye and were retrospectively analyzed. The scanning‐slit Nidek EC‐5000 excimer laser was used. Postoperatively, patients were reviewed at 1 and 3 days, 1 week, and 1, 3, 6, 12, 18, 24, 36, and 48 months. The examination included cycloplegic refraction, uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA), biomicroscopy, grading of postoperative haze, corneal topography, pachymetry, intraocular pressure, biometry, orthoptic status, binocular vision (BV), and fundus evaluation. The safety, efficacy, predictability, and stability of the procedure were evaluated. Long‐term binocular vision outcome was analyzed. All patients completed a 4‐year follow‐up. Results: The mean preoperative spherical equivalent (SE) refraction was 8.93 diopters (D) ± 1.39 (SD) (range −6.75 to −11.75 D) and the mean postoperative SE, −1.66 ± 0.68 D (range −0.50 to −2.75 D) (P < .05). The mean preoperative UCVA of 0.034 ± 0.016 increased to 0.35 ± 0.15 (P < .05) postoperatively. The mean preoperative BSCVA was 0.53 ± 0.19 and changed to 0.64 ± 0.16 postoperatively. The safety index was 1.21. No eye lost a line of BSCVA; 9 eyes gained 1 line, and 5 eyes gained 2 lines. The efficacy index was 0.66. The postoperative uncorrected and best spectacle‐corrected BV were the same or improved. No eye had +3 haze. There were no significant complications. Conclusions: Photorefractive keratectomy was safe and effective in correcting high myopic anisometropia in children who were contact‐lens intolerant. It provided good visual results and preserved or improved BV over the 4‐year follow‐up.

Intravitreal pegaptanib combined with diode laser therapy for stage 3+ retinopathy of prematurity in zone I and posterior zone II.

Purpose To investigate efficacy of intravitreal injection of pegaptanib and laser photocoagulation for treatment of stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels, and final structural outcome with conventional laser photocoagulation or combined with cryotherapy. Methods In a prospective comparative study, 152 eyes with zone I, II posterior ROP 3+ (76 premature rabies), from 2009 to 2011, were included. Patients were randomly assigned to receive intravitreal pegaptanib (Macugen® 0.3 mg = 0.02 mL, Pfizer) with conventional diode laser photocoagulation in group 1 (68 eyes of 34 infants) or only laser therapy combined with cryotherapy in group 2 (84 eyes of 42 infants), bilaterally. The primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP. The mean follow-up after treatment was 19.3 months in group 1 and 21.5 months in group 2. Results Final favorable anatomic outcome and stable regression of ROP at last control examination was noted in 89.7% of eyes in group 1 and 60.8 % of eyes in group 2. Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in group 1. No recurrence of neovascularization (stage 3+ ROP) was identified in 85.4% of patients in group 1 and 50% of patients in group 2. Conclusions Results of this study support the administration of intravitreal pegaptanib as useful therapy in the management of stage 3+ ROP.

Glaucoma drainage implants in the treatment of refractory glaucoma in pediatric patients.

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

Phototherapeutic keratectomy in children: 5-year results.

Purpose: To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK) for the treatment of superficial corneal opacities, surface irregularities, epithelial instability, and reepithelialization failure in pediatric patients and study the visual and refractive changes after combined PTK and photorefractive keratectomy (PRK). Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. Methods: This retrospective clinical study comprised children who had PTK or PTK combined witih PRK from September 1996 to January 2000. The goals of treatment were to improve visual acuity and reduce or eliminate subjective ocular discomfort (eg, pain, lacrimation, and photophobia). A Nidek EC‐5000 excimer laser was used in PTK mode with a 3.0 to 6.0 mm optical zone and a 4.0 to 7.5 mm transition zone. Results: Forty‐one pediatric patients (41 eyes) were included. Twenty‐three eyes had PTK only, and 18 eyes had PTK combined with PRK to reduce preoperative myopia (11 eyes) or hyperopia (7 eyes). The mean patient age was 11.4 years (range 8 to 18 years) and the mean follow‐up, 4.8 years (range 3 to 6 years). The best spectacle‐corrected visual acuity (BSCVA) improved in all patients, and episodes of ocular pain or discomfort, lacrimation, and photophobia diminished. The mean preoperative BSCVA of 6/38 (range 6/10 to 1/60) improved to 6/12 (range 6/6 to 6/38) at the last postoperative examination. Eight eyes gained 5 or more Snellen lines of BSCVA; 11 gained 4 lines, 9 gained 3 lines, 7 gained 2 lines, 5 gained 1 line, and 1 eye was unchanged. No eye lost a line of BSCVA. The mean preoperative spherical equivalent (SE) decreased from −5.32 to −1.16 diopters (D) in the 11 myopic eyes and from +4.72 to +1.51 D in the 7 hyperopic eyes within 3 years of the combined procedure. Conclusions: Phototerapeutic keratectomy is an effective and safe procedure for the treatment of various surface corneal disorders in children. It can improve best corrected visual acuity and eliminate ocular pain and irritation. Preoperative myopia and hyperopia were effectively reduced by a combination of PTK and PRK.

Combined treatment with laser photocoagulation and cryotherapy for threshold retinopathy of prematurity.

Purpose To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP). Methods Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Results A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over −6 diopters. Conclusions Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.