PURPOSE: In ophthalmology, data from both eyes of a person are frequently included in the statistical evaluation. This violates the requirement of data independence for classical statistical tests (e.g. t-Test or analysis of variance (ANOVA)) because it is correlated data. Linear mixed models (LMM) were used as a possibility to include the data of both eyes in the statistical evaluation. METHODS: The LMM is available for a variety of statistical software such as SPSS or R. The application was applied to a retrospective longitudinal analysis of an accelerated corneal cross-linking (ACXL (9*10)) treatment in progressive keratoconus (KC) with a follow-up period of 36 months. Forty eyes of 20 patients were included, whereas sequential bilateral CXL treatment was performed within 12 months. LMM and ANOVA for repeated measurements were used for statistical evaluation of topographical and tomographical data measured by Pentacam (Oculus, Wetzlar, Germany). RESULTS: Both eyes were classified into a worse and better eye concerning corneal topography. Visual acuity, keratometric values and minimal corneal thickness were statistically significant between them at baseline (p < 0.05). A significant correlation between worse and better eye was shown (p < 0.05). Therefore, analyzing the data at each follow-up visit using ANOVA partially led to an overestimation of the statistical effect that could be avoided by using LMM. After 36 months, ACXL has significantly improved BCVA and flattened the cornea. CONCLUSION: The evaluation of data of both eyes without considering their correlation using classical statistical tests leads to an overestimation of the statistical effect, which can be avoided by using the LMM.

• MeSH
• Photochemotherapy * MeSH
• Photosensitizing Agents therapeutic use   MeSH
• Keratoconus * diagnosis   drug therapy   MeSH
• Collagen therapeutic use   MeSH
• Humans MeSH
• Cross-Linking Reagents therapeutic use   MeSH
• Retrospective Studies MeSH
• Riboflavin therapeutic use   MeSH
• Cornea MeSH
• Corneal Topography MeSH
• Ultraviolet Rays MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Anisometropia classification   therapy   MeSH
• Astigmatism classification   therapy   MeSH
• Eyeglasses MeSH
• Child MeSH
• Hyperopia classification   therapy   MeSH
• Clinical Decision-Making MeSH
• Contact Lenses classification   adverse effects   MeSH
• Corneal Surgery, Laser methods   MeSH
• Humans MeSH
• Myopia classification   complications   therapy   MeSH
• Refractive Errors * classification   therapy   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

• Keywords
• metoda CXL,
• MeSH
• Child MeSH
• Photochemotherapy methods   MeSH
• Photosensitizing Agents therapeutic use   MeSH
• Keratoconus * diagnosis   complications   therapy   MeSH
• Humans MeSH
• Disease Management MeSH
• Cross-Linking Reagents therapeutic use   MeSH
• Riboflavin therapeutic use   MeSH
• Cornea diagnostic imaging   MeSH
• Corneal Topography methods   instrumentation   MeSH
• Ultraviolet Rays MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

PURPOSE: To evaluate the effect of accelerated corneal crosslinking (CXL) with a "higher peripheral intensity" profile setting compared with a standard "top hat" profile setting performed using different CXL systems. SETTING: Department of Ophthalmology, University Hospital Carl Gustav Carus, Dresden, Germany. DESIGN: Retrospective case series. METHODS: Eyes from patients with progressive keratoconus were included. Group 1 included eyes treated with the higher peripheral intensity profile. Group 2 included eyes treated with the top hat profile. Accelerated CXL was performed based on the modified Dresden protocol (9 mW/cm2, 10 minutes). Corneal-topography and tomography are characterized using the Pentacam Scheimpflug system. RESULTS: The study comprised 45 eyes (25 eyes in Group 1, 20 eyes in Group 2) from 45 patients. The keratometry (K) at the apex (maximum K) decreased significantly from 54.95 diopters (D) ± 6.73 (SD) to 53.21 ± 6.05 D for Group 1 (P < .001) and from 57.29 ± 7.16 D to 56.48 ± 6.88 D for Group 2 (P = .01). In Group 1, flat K (K1) and steep K (K2) decreased significantly after treatment (P < .05). The thinnest corneal thickness decreased significantly by -17.5 ± 21.9 μm (P = .001) in Group 1. In Group 2, no significant flattening was observed in K1 and K2 (P > .05), and the thinnest corneal thickness showed a slight but not significant thinning (P = .097). CONCLUSIONS: In Group 1 (the higher peripheral intensity group), the corneal topographic and tomographic parameters improved significantly after accelerated CXL. The higher peripheral intensity profile effect on keratoconic cornea flattening seemed to be more pronounced compared with the top hat profile.

• MeSH
• Time Factors MeSH
• Adult MeSH
• Photochemotherapy methods   MeSH
• Photosensitizing Agents therapeutic use   MeSH
• Keratoconus diagnosis   drug therapy   MeSH
• Collagen therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Corneal Pachymetry methods   MeSH
• Cross-Linking Reagents therapeutic use   MeSH
• Retrospective Studies MeSH
• Riboflavin therapeutic use   MeSH
• Cornea pathology   MeSH
• Corneal Topography methods   MeSH
• Visual Acuity MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

This study evaluates the efficacy of treatment of progressive keratoconus using Accelerated Corneal Collagen cross-linking (ACXL) method. Patients underwent ACXL at the Dept. of Ophthalmology of University Hospital in Hradec Králové between 2012 - 2013. Uncorrected distance visual acuity, best corrected distance visual acuity, keratometry (K1, K2, Kmax), corneal astigmatism and corneal pachymetry were measured preoperatively and in 6 months, 1year, 2 and 3 years after the surgery. The results were statistically analysed by non-parametric Wilcoxon test. There were found statistically significant changes in K2 values and values of corneal thickness postoperatively.

• Keywords
• akcelerovaný corneal cross-linking, akcelerovaný CXL,
• MeSH
• Dilatation, Pathologic MeSH
• Adult MeSH
• Photochemotherapy * MeSH
• Keratoconus * drug therapy   physiopathology   pathology   MeSH
• Collagen MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Disease Progression MeSH
• Cross-Linking Reagents * therapeutic use   MeSH
• Refraction, Ocular physiology   MeSH
• Ultraviolet Rays MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Evaluation Study MeSH

Cíl: Cílem práce je vyhodnocení a porovnání klinických výsledků implantace dvou typů rotačně asymetrické multifokální nitrooční čočky LENTIS Mplus a LENTIS MplusX. Materiál a metodika: Do studie bylo zařazeno celkem 247 očí 124 pacientů. Průměrný věk pacientů byl 58 let (25–76 let). Po fakoemulzifikaci jsme implantovali multifokální nitrooční čočku LENTIS Mplus (skupina A, n = 141) nebo LENTIS MplusX (skupina B, n = 106). Pacienti byli rozděleni do dvou skupin dle typu implantované nitrooční čočky a vyšetřeni 1 měsíc, 3 měsíce a 6 měsíců po operaci. Cílem studie bylo porovnání výsledků implantace těchto dvou typů nitrooční čočky. Sledovali jsme nekorigovanou zrakovou ostrost do dálky a do blízka (NZO), nejlépe korigovanou zrakovou ostrost do dálky a do blízka (NKZO), subjektivní refrakci, kontrastní citlivost a subjektivní spokojenost. Výsledky: Průměrná hodnota předoperační monokulární NZO na dálku ve skupině A byla 0,40 ? 0,27; ve skupině B 0,34 ? 0,25. Na konci sledovacího období jsme zaznamenali v obou skupinách statisticky významné zlepšení nekorigované zrakové ostrosti do dálky (skupina A: 1,01 ? 0,20; skupina B: 0,90 ? 0,15). Průměrná hodnota předoperační monokulární NZO do blízka ve skupině A byla Jaeger (J.) č. 12,82 ? 4,16; ve skupině B J. č. 12,73 ? 3,99. Na konci sledovacího období jsme zaznamenali v obou skupinách statisticky významné zlepšení NZO do blízka (skupina A: J. č. 1,81 ? 1,42; skupina B: J. č. 1,54 ? 1,72). V porovnání změn hodnot monokulární NZO do blízka, resp. do dálky mezi skupinou A a skupinou B v jednotlivých časech měření nebyl shledán statisticky významný rozdíl. Kontrastní citlivost jsme hodnotili pouze u pacientů, kteří podstoupili oboustrannou výměnu čočky v rámci refrakční lensektomie. Neprokázali jsme statisticky významné snížení kontrastní citlivosti v žádné z obou skupin. Subjektivní spokojenost byla hodnocena ve škále známek 1-5. Průměrná známka hodnocení subjektivní spokojenosti ve skupině A byla 1,37; ve skupině B 1,25. Závěr: multifokální nitrooční čočka LENTIS Mplus a LENTIS MplusX poskytuje kvalitní vidění na dálku i do blízka a poskytuje tak vysokou míru nezávislosti na brýlové korekci. Neprokázali jsme statisticky významný rozdíl v žádném ze sledovaných parametrů mezi skupinou A (implantace LENTIS Mplus) a skupinou B (implantace LENTIS MplusX). V žádné z obou sledovaných skupin jsme neprokázali statisticky významné snížení kontrastní citlivosti. Pozorovali jsme však vyšší subjektivní spokojenost a nižší výskyt rušivých vedlejších optických fenoménů ve skupině pacientů s implantací nitrooční čočky LENTIS MplusX.

Purpose: The aim of the study was evaluation and comparison of clinical results of two types of rotationally asymmetric multifocal intraocular lens (LENTIS Mplus and LENTIS MplusX). Material and methods: The study included 247 eyes of 124 patients aged 25 - 76 years (mean, 58 years). After phacoemulsification multifocal intraocular lens LENTIS Mplus (group A, n = 141) or LENTIS MplusX (group B, n = 106) was implanted. Patients were divided into two groups according to the type of intraocular lens. Patients were evaluated at 1 month, 3 months and 6 months after surgery. We assessed the uncorrected visual acuity, best corrected visual acuity, subjective refraction, contrast sensitivity and subjective satisfaction. Results: Mean preoperative monocular uncorrected distance visual acuity (UCDVA) in the group A was 0,40 ? 0,27; in the group B 0,34 ? 0,25. Postoperatively UCDVA was statistically significant improved in both groups (group A: 1,01 ? 0,20; group B: 0,90 ? 0,15). Mean preoperative monocular uncorrected near visual acuity (UCNVA) was Jaeger (J) 12,82 ? 4,16 (group A), resp. J 12,73 ? 3,99 (group B). Postoperatively UCNVA was statistically significant improved in both groups (group A: J 1,81 ? 1,42; group B: J 1,54 ? 1,72). There was not found statistically significant difference between both groups in these parameters. Contrast sensitivity was evaluated in patients who have undergone clear lens extraction in both eyes. There was not found the statistically significant reduction of contrast sensitivity in both groups. Subjective satisfaction was assessed in the range of marks 1-5. The average mark of the subjective satisfaction ratings in the group A was 1,37; in the group B 1,25. Conclusion: Our study found the multifocal intraocular lens LENTIS Mplus and LENTIS MplusX give high-quality distance and near vision and provide high degree of spectacle independence. There was not found statistically significant difference in all parameters between the Group A (implantation Mplus LENTIS) and the Group B (implantation LENTIS MplusX) in our study. However, in our study we have observed higher subjective satisfaction and lower incidence of optical phenomena in the Group of patients with the implantation of intraocular lens LENTIS MplusX.

• Keywords
• LENTIS Mplus, LENTIS MplusX, multifokální nitrooční čočka,
• MeSH
• Contrast Sensitivity MeSH
• Adult MeSH
• Lens Implantation, Intraocular * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lenses, Intraocular MeSH
• Prostheses and Implants MeSH
• Refractive Surgical Procedures MeSH
• Aged MeSH
• Patient Satisfaction MeSH
• Treatment Outcome MeSH
• Visual Acuity MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Comparative Study MeSH

Práce se zabývá léčbou progredujícího keratokonu metodou akcelerovaného corneal cross-linkingu (ACXL). Obsahuje vyhodnocení souboru pacientů, kteří podstoupili tuto terapii na Oční klinice Fakultní nemocnice Hradec Králové v letech 2012–2013. Byly sledovány tyto parametry: nekorigovaná zraková ostrost (NZO), nejlépe korigovaná zraková ostrost (NKZO), hodnota keratometrie rohovky v nejplošším (K1) a nejstrmějším (K2) meridiánu, hodnota zakřivení rohovky na apexu keratokonu (Kmax), hodnota rohovkového astigmatismu a pachymetrie rohovky. Předoperační data byla porovnána s výsledky získanými za 6 měsíců, 1, 2 a 3 roky po operačním zákroku. Výsledky byly statisticky zpracovány neparametrickým Wilcoxonovým testem. Ve sledovaném souboru pacientů jsme zaznamenali statisticky významné snížení keratometrických hodnot (K2) a současně statisticky významné snížení hodnot tloušťky rohovky. Ostatní sledované parametry zůstaly nezměněny.

This study evaluates the efficacy of treatment of progressive keratoconus using Accelerated Corneal Collagen cross-linking (ACXL) method. Patients underwent ACXL at the Dept. of Ophthalmology of University Hospital in Hradec Králové between 2012 - 2013. Uncorrected distance visual acuity, best corrected distance visual acuity, keratometry (K1, K2, Kmax), corneal astigmatism and corneal pachymetry were measured preoperatively and in 6 months, 1year, 2 and 3 years after the surgery. The results were statistically analysed by non-parametric Wilcoxon test. There were found statistically significant changes in K2 values and values of corneal thickness postoperatively.

• Keywords
• akcelerovaný corneal cross-linking, akcelerovaný CXL,
• MeSH
• Dilatation, Pathologic MeSH
• Adult MeSH
• Photochemotherapy * MeSH
• Keratoconus * drug therapy   physiopathology   pathology   MeSH
• Collagen MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Disease Progression MeSH
• Cross-Linking Reagents * therapeutic use   MeSH
• Refraction, Ocular physiology   MeSH
• Ultraviolet Rays MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Evaluation Study MeSH

Changes in the biomechanical properties of the human cornea play an important role in the pathogenesis of corneal ectatic diseases. Many different pathological conditions in the cornea may reduce its biomechanical resistance. Corneal collagen cross-linking (CXL) has emerged as a promising technique to slow or even to stop the progression of ectasia. In this procedure, riboflavin (vitamin B2) is administered in conjunction with ultraviolet A light (UVA, 365 nm). This interaction causes the formation of reactive oxygen species, leading to additional covalent bonds between collagen molecules, with consequent biomechanical stiffening of the cornea. Although this method is not yet accepted as an evidence-based treatment of corneal ectasia, the results of prospective, randomised studies of CXL used in the treatment of this pathological entity show significant changes in the properties of corneal tissue. This procedure is currently the only aetiopathogenetic treatment of ectatic eyes that can delay or stop the process of cornea destabilisation, reducing the necessity for keratoplasty. Despite promising results, CXL is associated with issues that include long-term safety and duration of the stabilising effect.

• MeSH
• Photochemotherapy methods   MeSH
• Photosensitizing Agents administration & dosage   MeSH
• Keratoconus drug therapy   MeSH
• Humans MeSH
• Evidence-Based Medicine MeSH
• Cross-Linking Reagents radiation effects   MeSH
• Riboflavin administration & dosage   MeSH
• Cornea drug effects   radiation effects   MeSH
• Ultraviolet Therapy methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Corneal cross-linking can halt the progression of keratoconus, but what is the best approach for treatment? There are a number of treatment options for keratoconus, but only corneal cross-linking (CXL) appears to halt the progression of the disease. To guarantee effective cross-linking, CXL treatment involves removal of the corneal epithelium prior to riboflavin application and ultraviolet light illumination - "epi-off" CXL. Several methods of "epi-on" (transepithelial) CXL have been proposed, such as keeping the corneal epithelium intact which should be less painful and help avoid other CXL-associated adverse events. The evidence so far is that epi-off CXL remains the most effective method of strengthening the cornea and slowing keratoconus progression - but transepithelial methods are gaining ground.

• MeSH
• Photochemotherapy methods   MeSH
• Photosensitizing Agents administration & dosage   MeSH
• Keratoconus pathology   therapy   MeSH
• Combined Modality Therapy methods   MeSH
• Humans MeSH
• Evidence-Based Medicine MeSH
• Cross-Linking Reagents administration & dosage   MeSH
• Riboflavin administration & dosage   MeSH
• Epithelium, Corneal surgery   MeSH
• Ultraviolet Therapy methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Review MeSH

PURPOSE: To analyze the 10-year results of corneal collagen crosslinking (CXL) for keratoconus. SETTING: Department of Ophthalmology, University Hospital, Dresden, Germany. DESIGN: Retrospective interventional case series. METHODS: The study included eyes treated for progressive keratoconus from 2000 to 2004. Corneal collagen crosslinking was performed by applying riboflavin and ultraviolet-A. The corrected distance visual acuity (CDVA), corneal topography, and endothelial cell count (ECC) were recorded preoperatively and 10 years postoperatively. RESULTS: The study enrolled 24 patients (34 eyes). The mean age of the 18 men and 6 women was 28.4 years ± 7.3 (SD) and the mean follow-up, 131.9 ± 20.1 months. The mean apical keratometry (K) value was 61.5 diopters (D) preoperatively and 55.3 D 10 years postoperatively; the decrease was statistically significant (P<.001). The mean values for maximum K (53.2 D and 49.56 D, respectively) and minimum K (47.5 D and 45.5 D, respectively) were also significantly lower (P<.001). The preoperative and postoperative CDVA were statistically significantly different (P=.002). The mean CDVA improved by 0.14 logMAR over preoperatively; the change was statistically significant (P=.002). The ECC was unchanged. CONCLUSIONS: Corneal CXL was effective in treating progressive keratoconus, achieving long-term stabilization of the condition. It was easy to perform, had a good safety profile, and reduced the need for corneal transplantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

• MeSH
• Adult MeSH
• Photochemotherapy * MeSH
• Photosensitizing Agents adverse effects   therapeutic use   MeSH
• Keratoconus drug therapy   metabolism   physiopathology   MeSH
• Collagen metabolism   MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Disease Progression MeSH
• Cross-Linking Reagents * MeSH
• Retrospective Studies MeSH
• Riboflavin adverse effects   therapeutic use   MeSH
• Corneal Stroma metabolism   MeSH
• Ultraviolet Rays MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH