Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that can lead to irreversible loss of vision. Intravenous thrombolysis (IVT) has been used experimentally for its treatment. Our study aimed to evaluate the effect of emergency IVT on CRAO and its impact on visual acuity outcomes. We conducted a retrospective observational study of patients with CRAO. A total of 46 patients with CRAO were analysed; 16 patients received IVT treatment (IVT group) while 30 did not (no-IVT group). Seven patients from the IVT group received IVT early, within 4.5 hours (h) after the onset of symptoms (early-IVT), and 9 patients received it beyond this timeframe (late-IVT). The median time-to-hospital was 8.5 h: 3 h for the IVT group and 24 h for the no-IVT group. The median time-to-treatment was 5 h. The median outcome of visual acuity was 0.05 in the early-IVT, 0.025 in the late-IVT, and 0.01 in the no-IVT group. Among patients who received IVT early, 86% exhibited significant visual improvement. This improvement was four-fold greater compared to all other groups (p = 0.040), including the late-IVT (p = 0.011) and no-IVT groups (p = 0.023). No complications of the treatment were reported. Our study confirms that the administration of IVT treatment for CRAO within the 4.5-h time window is both safe and effective.
BACKGROUND: Stickler syndrome (STL) is an inherited progressive connective tissue collagen disorder. STL is the most common hereditary cause of retinal complications, retinal tears, and the development of retinal detachment (RD) in childhood. The aim of the study was to evaluate the long-term anatomical and functional results of surgical treatment of retinal complications in children and adolescents affected by STL. METHODS: A retrospective, single-center study was performed a cohort of children with STL who underwent retinal surgery between 2004 and 2021. RESULTS: The study group consisted of nine children; the mean age at the time of the retinal tear with/without retinal detachment was 7.2 (2-10) years, and the mean follow-up period was 9.6 (5-16) years. Pathogenic variants COL2A1 (5 children) and COL11A1 (3 children) were confirmed in our cohort. In total, we operated on 13 eyes, 11 eyes with complicated RD and two eyes with multiple retinal defects, but without RD. At the end of the follow-up period, an attached retina was achieved 77% (10 eyes) with or without silicone oil tamponade: cryopexy alone was successful in one eye (10%), scleral buckling (EB) in five eyes (50%), and vitrectomy with silicone oil tamponade combined with EB in four eyes (40%). The mean number of surgeries was 2.3 per eye. The resulting best corrected visual acuity ranged from 0.03 to 0.1 in one eye, from 0.16 to 0.4 in two eyes, and from 0.5 to 1.0 in 7 eyes. CONCLUSION: Repair of retinal tears with/without retinal detachment in patients with Stickler syndrome often requires multiple surgeries with combinations of cryopexy, scleral buckling, and/or vitrectomy with silicone oil tamponade. Treatment of the ocular complications arising from STL requires long-term comprehensive care.
- MeSH
- bukláž skléry MeSH
- dědičné nemoci očí * chirurgie MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- odchlípení sítnice * diagnóza etiologie chirurgie MeSH
- perforace sítnice * chirurgie MeSH
- retina patologie MeSH
- retrospektivní studie MeSH
- silikonové oleje MeSH
- vitrektomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: To determine the efficacy of pars plana vitrectomy (PPV) in children with intraocular hemorrhage (IOH) secondary to Abusive head trauma (AHT). METHODS: A long-term retrospective analysis evaluating epidemiology, management, safety, anatomical and functional results of PPV for IOH in children with AHT at tertiary referral center for children in the Czech Republic from 2004 to 2017. RESULTS: 18 children were identified with IOH due to AHT during observation period of 14 years. Overall incidence of IOH related to AHT was 29.6/100 000, in children under 1 year 22.2/100 000, in children 1 to 5 years 7.4/100 000. Mean age at the time of diagnosis was 13.7 (SD±20.53) months, median 5 months. IOH resolved in 56% of children, 64% eyes, spontaneously. 44% children, 36% eyes, underwent PPV. PPV was performed 30.5 (SD±16.98) days after established diagnosis on average. Postoperatively, 80% of eyes had anatomical improvement, 20% eyes had preexisting irreversible changes in the posterior pole. Vision of 50% eyes improved after surgery, vision of 20% eyes remained poor, 30% of eyes was not possible to test due to severe neurological impairment. Mean observational period was 33.4 (SD±38.21) months. Mortality rate of AHT in our group was 17%, all victims were younger 4 months. CONCLUSIONS: PPV is a safe and effective procedure to clear IOH in children with AHT. Ophthalmology outcomes are strongly associated with degree of neurological impairment. Best outcomes were achieved with PPV performed between 2 and 5 weeks after trauma. Opportunity to plan surgery within this time frame indicates a good neurological prospect and prevents deprivation amblyopia.
- MeSH
- dítě MeSH
- kraniocerebrální traumata * chirurgie MeSH
- lidé MeSH
- odchlípení sítnice * chirurgie MeSH
- retrospektivní studie MeSH
- vitrektomie MeSH
- zraková ostrost MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
A case report of post-traumatic exogenous endophthalmitis caused by Nocardia farcinica, including treatment procedures, microbiology examination, and systemic medications. A 23-year-old male suffered a penetrating corneal injury that was treated with sutures. On the thirteenth day after the final suture was removed, an anterior uveitis developed and progressed to whitish, plump, nodular, and tufted exudates within the anterior chamber over the next 10 days; this led to an indication for intraocular surgery. Anterior chamber lavage and resection of solid fibrinous exudates (using a vitrectomy knife) for a complete microbiological examination were performed. Nocardia farcinica was identified. Systemic medications were chosen according to sensitivity, and a fixed combination of sulfamethoxazole 400 mg/trimethoprim 80 mg was administered long-term (months). In this case, accurate, early detection of an atypical infectious agent and determination of its sensitivity to antibiotic treatment enabled effective treatment that achieved the best functional and anatomical results under the circumstances.
- Publikační typ
- časopisecké články MeSH
Cíl: Cílem práce je referovat o případu oboustranného poranění očí a oboustranné fraktuře spodiny očnice způsobené vysokotlakým proudem vody z hasičské hadice u šestnáctileté dívky v průběhu soutěže mladých hasičů. Metody: Uvádíme kazuistiku 16leté pacientky, která utrpěla oboustranné zhmoždění, edém a laceraci horních očních víček, laceraci obou bulbárních spojivek, kontuzi obou očních bulbů, levého optického nervu a oboustrannou frakturu spodiny očnice. Výsledky: Vstupní oční vyšetření odhalilo zrakovou ostrost pohyb na pravém a žádné vnímání světla na levém oku. Nitrooční tlak byl velmi nízký na obou očích. Oční pohyblivost byla redukována, zejména na levém oku. Lacerace horních víček a spojivky vyžadovaly chirurgické řešení. Reparace lacerace horního slzného kanálku levého oka nebyla provedena. Paralytická mydriáza a ztráta akomodace obou očí trvá po celou dobu sledování. Chirurgicky byla řešena levostranná zlomenina spodiny očnice, pohyblivost pravého oka se upravila spontánně. Traumatická katarakta se na levém oku vytvořila rok po vlastním úrazu a vyžadovala chirurgické řešení zahrnující implantaci zadněkomorové nitrooční čočky a iridoplastiku. Pravá čočka zůstala čirá. Masivní zjizvení sítnice a cévnatky v dolních partiích obou sítnic spolu s makulou snížilo nejlepší korigovanou zrakovou ostrost pravého oka na 0,15 a levého oka na 0,08. Nitrooční tlak je ve fysiologických mezích bez nutnosti terapie. Sledovací doba je tři roky. Závěr: Tato kazuistika je prvním popsaným případem pacienta s hydraulickým poškozením očí v dětském věku a při sportu.
Purpose: The aim is to present a report of a case of bilateral eye injury with bilateral blowout fracture caused by a high-pressure water jet from a fire hose in a 16-year-old girl during a competition for young firefighters. Methods: We present a case report of a 16-year-old female patient with bilateral extensive eyelid contusion, oedema and lacerations of upper eyelids, lacerations of bulbar conjunctiva, contusion of both eyes, left optic nerve and bilateral blowout fractures of orbits. Results: The initial ocular examination revealed "hand motion" in the right eye and no light perception in the left eye. Intraocular pressure was low in both eyes. Motility of both eyes was reduced, especially in the left eye. Lacerations of the eyelids and conjunctiva required a surgical procedure. No repair of the upper canaliculus of the left eye was attempted. Paralytic mydriasis and loss of lens accommodation in both eyes did not change throughout the follow-up period. A surgical procedure was applied to resolve the left blowout fracture, ocular motility of the right eye improved spontaneously. Traumatic cataract developed in the left eye within 1 year after injury, requiring cataract surgery and posterior capsule lens implantation, the right lens remained clear. Massive scarring of the retina and choroid in the lower parts of the eyes and in the macula reduced best corrected visual acuity in the right eye to 0.15 and in the left eye to 0.08. Intraocular pressure is within normal limits without any glaucoma therapy. The follow up period is three years. Conclusion: This is the first reported case of child with an eye injury caused by a high-pressure water jet during a sports activity.
- Klíčová slova
- traumatická katarakta,
- MeSH
- extrakce katarakty MeSH
- fraktury očnice etiologie terapie MeSH
- hasicí systémy MeSH
- hydrostatický tlak škodlivé účinky MeSH
- katarakta etiologie MeSH
- lidé MeSH
- mladiství MeSH
- poranění oka * etiologie terapie MeSH
- sportovní úrazy MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíl: Cílem práce bylo zhodnotit změny povrchu oka a slzného filmu u pacientů s dětským (primárním nebo sekundárním) jednostranným glaukomem a porovnat nálezy na oku léčeném a na zdravém oku bez léčby. Metodika: Do studie byli zařazeni pacienti s jednostranným glaukomem sledovaní v dětské ambulanci Oční kliniky dětí a dospělých 2. LF UK a FN v Motole. Bylo provedeno vyšetření osmolarity slz, tloušťky epitelu rohovky, slzného menisku, Schirmerova testu, barvení povrchu oka pomocí fluoresceinu a hodnocení stability slzného filmu (TBUT). Ke zjištění subjektivních potíží byl použit standardizovaný dotazník (Ocular Surface Disease Index, OSDI). Byly porovnávány hodnoty na oku léčeném a na oku zdravém bez léčby. Výsledky byly uváděny jako průměrné hodnoty ± SD a byly statisticky analyzovány. Výsledky: Celkem bylo vyšetřeno 13 pacientů. Průměrný věk pacientů byl 17,2 ± 8,1 let. Na léčeném oku jsme prokázali statisticky významně nižší tloušťku epitelu rohovky (45,9 ± 5,3 µm) a kratší TBUT (6,0 ± 1,7 s) oproti hodnotám na zdravém oku (50,2 ± 2,6, resp. 8,8 ± 3,2 s; p = 0,0106, resp. p = 0,0015). Povrch léčeného oka se statisticky významně více barvil fluoresceinem (1,7 ± 2,1) než povrch zdravého oka (0,5 ± 0,8; p = 0,0243). V ostatních sledovaných parametrech jsme neprokázali rozdíl mezi léčeným okem a okem bez léčby. Závěr: Výsledky potvrzují změny povrchu oka a slzného filmu na léčeném oku, které mohou být vyvolané nežádoucími účinky chronicky podávané antiglaukomové terapie nebo i jako následek prodělaného chirurgického zákroku. Z hlediska minimalizace těchto nežádoucích účinků je vhodné věnovat v klinické praxi zvýšenou pozornost výběru léčivého přípravku, zejména s ohledem na obsah konzervačních látek.
Purpose: The aim of the study was to evaluate ocular surface and tear film in patients with pediatric (primary or secondary) unilateral glaucoma and compare results obtained from the treated eye and untreated healthy eye. Methods: Patients with unilateral pediatric glaucoma, followed in the outpatient department of the Department of Ophthalmology, Motol University Hospital, were included in this study. Tear osmolarity, corneal epithelial thickness, lower tear meniscus area, Schirmer test, corneal fluorescein staining and tear break-up time test (TBUT) were evaluated in both healthy and treated eye. The Ocular Surface Disease Index (OSDI) was used to establish subjective impairment. The values obtained through testing the healthy and treated eye were compared. Results: Thirteen patients met the inclusion criteria of the study. The mean age of the patients was 17.2 ± 8.1 years. There was statistically significant decrease in corneal epithelial thickness and TBUT in the treated eye (45.9 ± 5.3 µm, 6.0 ± 1.7 second resp.) compared to the healthy eye (50.2 ± 2.6 µm, 8.8 ± 3.2 second resp.; p = 0.0106, p = 0.0015 resp.). Fluorescein staining score of the ocular surface was higher in the treated eye (1.7 ± 2.1) than in the healthy eye (0.5 ± 0.8; p = 0.0243). We found no statistically significant difference in the other evaluated parameters between the treated and the healthy eyes. Conclusion: The results confirmed signs of ocular surface damage in treated eyes. The damage may be induced by chronic topical antiglaucoma therapy, but that could be a consequence of the previous ocular surgery as well. The possible damage of the ocular surface should be taken into account when selecting appropriate treatment in these patients.
- MeSH
- dítě MeSH
- dospělí MeSH
- glaukom * MeSH
- lidé MeSH
- mladiství MeSH
- osmolární koncentrace MeSH
- průřezové studie MeSH
- slzy MeSH
- syndromy suchého oka diagnóza farmakoterapie MeSH
- zvlhčující oční kapky MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
Cíl: Cílem práce je referovat o pacientce postižené Miller Fisherovým syndromem, komplikovaným současně probíhajícím, oboustranným akutním glaukomem uzavřeného úhlu na lehce (+1,5) hypermetropických očích. Metody: Uvádíme kasuistiku 71leté pacientky, která měla při úvodním vyšetření oftalmoplegii, areflexii a ataxii, společně s oboustranným akutním glaukomem uzavřeného úhlu. Výsledky: V klinickém obraze na obou očích dominoval oboustranný pokles vidění na prsty před okem, certa, s edémem obou rohovek. Úvodní nitrooční tlak byl neměřitelně vysoký (měření Tonopenem Avia). Po intravenózním podání 20 % Mannitolu byl na pravém oku nitrooční tlak 54 mm Hg a na levém 56 mm Hg. Lokální léčba pilocarpinem, timololem, dorsolamidem a dexamethasonem zlepšila nitrooční tlak na úroveň fysiologických hodnot v průběhu několika hodin. Profylaktická Nd-YAG laserová periferní iridotomie byla provedena na obou očích za dva dny. Systémová léčba zahrnovala plazmaferézu a rehabilitační program. Následná operace katarakty s implantací zadněkomorové nitrooční čočky zlepšila nejlepší korigovanou zrakovou ostrost pravého oka z 0,5 na 1,0 a levého oka z 0,5 na 0,8. Nitrooční tlak je fysiologický bez nutnosti léčby. Sledovací doba jsou tři roky. Závěr: Tato kasuistika je druhým dosud popsaným případem pacienta s oboustranným současně probíhajícím akutním glaukomem uzavřeného úhlu u Miller Fisherova syndromu a pátým dosud popsaným případem s akutním glaukomem uzavřeného úhlu u tohoto syndromu vůbec. Celková i lokání léčba vedla k normalizaci neurologického a úpravě očního nálezu.
Purpose: To report a case of patient with Miller Fisher syndrome, complicated by simultaneous bilateral acute angle-closure glaucoma in her slightly (+1.5) hyperopic eyes. Methods: We present a case report of a 71-year-old female patient presenting with total ophthalmoplegia, areflexia, ataxia and bilateral acute angle-closure glaucoma. Results: The initial ocular examination revealed hand motion in the both eyes and oedematic corneas. Initial intraocular pressure was immeasurable high (measurment by Tonopen Avia). Measurement was possible after intravenous Mannitol 20 % infusion on both eyes as 54 and 56 mm Hg, respectively. Local medical therapy of pilocarpine, timolol, dorsolamide and dexamethasone improve intraocular pressure into normal limits within several hours. Prophylactic peripheral Nd-YAG laser iridotomy was performed on a both eyes two days later. Systemic treatment involved plasma exchange and rehabilitation program. Subsequent cataract surgery on both eyes with posterior capsule lens implantation improve the best corrected visual acuity on right eye from 0.5 to 1.0 and the left eye from 0.5 to 0.8, respectively. Intraocular pressure is within normal limits without any glaucoma therapy. Follow up period is three years. Conclusions: This is the second reported case of patient with Miller Fisher syndrome and simultaneous bilateral acute angleclosure glaucoma and the fifth reported case of Miller Fisher syndrome and acute angle-closure glaucoma. Treatment for both conditions made a very good recovery.
- Klíčová slova
- akutní glaukom uzavřeného úhlu, oboustranný akutní glaukom uzavřeného úhlu,
- MeSH
- glaukom s uzavřeným úhlem * diagnóza patologie terapie MeSH
- lidé MeSH
- Miller Fisherův syndrom * diagnóza patologie terapie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Relation of diabetes mellitus (DM) to the various stages of corneal nerve fiber damage is well accepted. A possible association between changes in the cornea of diabetic patients and diabetic retinopathy (DR), DM duration, and age at the time of DM diagnosis were evaluated. The study included 60 patients with DM type 1 (DM1) and 20 healthy control subjects. The density of basal epithelial cells, keratocytes and endothelial cells, and the status of the subbasal nerve fibers were evaluated using in vivo corneal confocal microscopy. Basal epithelial cell density increased with age (p=0.026), while stromal and endothelial cell density decreased with age (p=0.003, p=0.0005, p<0.0001). After the DM1 diagnosis was established, this association with age weaken. We showed nerve fiber damage in DM1 patients (p<0.0001). The damage correlated with the degree of DR. DM1 patients with higher age at DM1 diagnosis had a higher nerve fiber density (p=0.0021). These results indicated that age at DM1 diagnosis potentially has an important effect on final nerve fiber and corneal cell density.
- MeSH
- diabetes mellitus 1. typu epidemiologie patologie MeSH
- diabetická retinopatie epidemiologie patologie MeSH
- dospělí MeSH
- epitelové buňky patologie MeSH
- konfokální mikroskopie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervová vlákna patologie MeSH
- počet buněk metody MeSH
- prospektivní studie MeSH
- rohovka patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Purpose: Neuropathies are among the most common long-term complications of diabetes mellitus (DM) and good glycemic control is essential in prevention of this complication. DM patients with similar mean glucose levels or HbA1c levels often exhibit differences in glucose variability. We tested for possible associations between parameters of glycemia compensation and corneal sub-basal nerve fiber status. Methods: The study included 20 patients with DM type 1 treated using an intensified insulin regimen. The corneas of both eyes were examined using in vivo corneal confocal microscopy. Corneal nerve fiber density (NFD), nerve fiber length (NFL), and nerve branch density (NBD) were evaluated. Possible associations between parameters of glycemia compensation (HbA1c, glycemia SD, and insulin dose), and other clinical factors were analyzed. Results: NBD was the highest in those with higher glycemic variability (P = 0.023). HbA1c had a negligible effect on corneal nerve parameters. NFD, NFL, and NBD were statistically significantly higher in those with higher total insulin per kilogram (P = 0.02, P = 0.01, and P = 0.012, respectively). Among other factors, a positive correlation between free thyroxine (fT4) levels and NFD and NBD was also found (P = 0.041 and P = 0.015, respectively). Conclusions: Total insulin dose per kilogram may be an important factor influencing nerve fiber status and needs to be considered in future studies of diabetic neuropathy pathophysiology and its progression. Also, more attention must be paid to other possible factors when elucidating the development of diabetic complications.
- MeSH
- diabetes mellitus 1. typu farmakoterapie MeSH
- diabetická retinopatie patologie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza MeSH
- hypoglykemika aplikace a dávkování terapeutické užití MeSH
- inzulin aplikace a dávkování terapeutické užití MeSH
- konfokální mikroskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervová vlákna patologie MeSH
- rohovka inervace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH