Cíle: Shrnout historii i současné trendy ve využití sklérálních štěpů v oftalmologii. Materiál a metody: Provedli jsme analýzu literatury prostřednictvím databází MEDLINE a Cochrane Library. Hledaná hesla byla “sclera”, “graft”, “surgery”. Výsledkem vyhledávání bylo 1596 článků, z nichž jsme 192 vyhodnotili jako relevantní. Relevantní články byly seřazeny chronologicky a dle způsobu využití sklerálních štěpu, což umožnilo vypracování přehledového článku. Výsledky: Skléra se v oftalmologii rutinně používá od padesátých let dvacátého století, a to v mnoha různých indikacích. Některé z nich se časem staly prakticky obsoletními (například využití při operačním řešení amoce sítnice), ale velká část nachází uplatnění dodnes (zejména využití v glaukomové či okuloplastické chirurgii, případně jako záplata při defektu skléry nebo rohovky). Závěr: I přesto, že je v současné době alogenní skléra oproti jiným produktům tkáňového bankovnictví v oftalmologii využívána spíše méně často a okruh jejích indikací se částečně zúžil, zůstává vzhledem ke své dostupnosti a vlastnostem užitečným a perspektivním materiálem.

Aim: To summarize the history and current trends in the use of scleral grafts in ophthalmology. Materials and methods: We conducted a review of the literature through the MEDLINE and Cochrane Library databases. The search terms were "sclera", "graft", and "surgery". The search resulted in 1596 articles, of which we evaluated 192 as relevant. The relevant articles were sorted chronologically and according to the method of using scleral grafts, which enabled the development of a review article. Results: The sclera has been routinely used in ophthalmology since the 1950s in many different indications. Some of these indications have become practically obsolete over time (for example, use in the surgical management of retinal detachment), but a large number still find application today (especially use in glaucoma or oculoplastic surgery, or as a patch for a defect in the sclera or cornea). Conclusion: Even though allogeneic sclera is currently used less frequently in ophthalmology compared to other tissue banking products and the range of its indications has partially narrowed, it remains a useful material due to its availability and properties.

• MeSH
• Allografts * classification   MeSH
• History, 20th Century MeSH
• Humans MeSH
• Ophthalmologic Surgical Procedures history   classification   methods   MeSH
• Review Literature as Topic MeSH
• Sclera * surgery   MeSH
• Scleroplasty history   classification   methods   MeSH
• Transplants history   classification   MeSH
• Vitreoretinal Surgery history   classification   methods   MeSH
• Check Tag
• History, 20th Century MeSH
• Humans MeSH
• Publication type
• Review MeSH

PRCIS: Deep sclerectomy (DS) with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing nonallergenic, nontoxic, and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively. OBJECTIVE: To evaluate short and medium-term postoperative results of DS with a fibrin sealant. PATIENTS AND METHODS: This prospective, noncomparative, interventional case series involves 12 eyes of 12 patients with uncontrolled open angle glaucoma who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon fascia, and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure and glaucoma therapy reduction, best-corrected visual acuity changes, and number of complications registered peri and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9, and 12 months after surgery. RESULTS: The mean intraocular pressure decreased from 24.0 ± 9.1 mm Hg to 13.8 ± 6.3 mm Hg at 1 year postoperatively ( P < 0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean glaucoma therapy decreased from 3.2 ± 1.1 to 0.8 ± 1.3 drugs 12 months after surgery ( P < 0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant best-corrected visual acuity changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in 1 eye, transient hypotony in 5 eyes, and mild hyphema in 2 eyes. CONCLUSIONS: Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.

• MeSH
• Sutureless Surgical Procedures * methods   MeSH
• Glaucoma Drainage Implants MeSH
• Fibrin Tissue Adhesive * therapeutic use   MeSH
• Glaucoma, Open-Angle * surgery   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Intraocular Pressure * physiology   MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sclera * surgery   MeSH
• Sclerostomy * methods   MeSH
• Tissue Adhesives * therapeutic use   MeSH
• Tonometry, Ocular MeSH
• Treatment Outcome MeSH
• Visual Acuity * physiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The study aimed to investigate changes in the eye axial length in juvenile guinea pigs and the expression of scleral specificity protein 1 (Sp1) and collagen type I (Col-I) under different light environments with varying spectral composition. The animals were randomly divided into five groups: natural light (N), LED light with a low colour temperature (L), E light (E), Fulia light (F), and Gulia light (G). Axial lengths were measured every two weeks, and the expression of Sp1 and Col-I in the sclera was assessed by immunohistochemistry, Western blot and RT-qPCR. After 4, 6, 8, 10, and 12 weeks of light exposure, the L and G groups showed considerably longer axial lengths than the N group, with the L group exhibiting significantly longer axial lengths compared with the E and F groups. The protein and mRNA expression levels of Sp1 and Col-I, ranked from highest to lowest, were as follows: N, E, F, G, and L. The expression of Sp1 and Col-I was positively correlated, but both were negatively correlated with the length of the eye axis. The E group demonstrated higher Sp1 and Col-I expression than the other artificial light groups. Artificial light with a continuous, full spectrum lacking peaks and valleys can inhibit the elongation of the eye axis in juvenile guinea pigs and has a protective effect against myopia. There may be a certain relationship between Sp1 and Col-I, and the transforming growth factor-β1-Sp1-Col-I signalling pathway may play a crucial role in myopic scleral extracellular matrix remodelling.

• MeSH
• Axial Length, Eye MeSH
• Collagen Type I * metabolism   genetics   MeSH
• RNA, Messenger metabolism   genetics   MeSH
• Guinea Pigs MeSH
• Myopia metabolism   genetics   pathology   MeSH
• Gene Expression Regulation MeSH
• Sclera * metabolism   MeSH
• Light * MeSH
• Sp1 Transcription Factor * metabolism   genetics   MeSH
• Animals MeSH
• Check Tag
• Guinea Pigs MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Cíl: Cílem tohoto sdělení je prezentovat kazuistiku pacienta se syndromem uveální efuze, u kterého byla provedena hluboká zadní sklerotomie. Kazuistika: 73letý pacient s jednostranným poklesem nejlepší korigované zrakové ostrosti, ablací choroidey a sekundárním odchlípením sítnice na pravém oku byl v listopadu 2017 přijat na naši kliniku k vyšetření. Vstupně byla nejlepší korigovaná zraková ostrost na pravém oku 0,3, na levém oku 1,0. Nitrooční tlak byl na pravém oku 16 mmHg a na levém oku 21 mmHg. Po provedení ultrazvukové biomikroskopie předního segmentu (Accutome, Keeler, USA), ultrazvukové sonografie postiženého oka (Accutome, Keeler, USA), magnetické rezonance, počítačové tomografie, ultrazvukové sonografie břicha a krevních náběrů jsme nález uzavřeli jako syndrom uveální efuze. Zahájili jsme konzervativní léčbu spočívající v perorálním podávání inhibitoru karboanhydrázy v kombinaci s lokálním užíváním analogu prostaglandinu. I přes konzervativní léčbu došlo ke zhoršení nálezu i nejlepší korigované zrakové ostrosti na pravém oku až na 0,05, proto jsme přistoupili k operačnímu řešení – hluboké zadní sklerotomii s perioperačním odebráním vzorku skléry k histologickému vyšetření (průkaz glykosaminoglykanů ve stěně skléry barvením alciánovou modří), které bylo negativní. Tento výsledek histologického vyšetření řadí pacienta ke třetímu typu syndromu uveální efuze (tj. non-nanoftalmický s normální sklérou). Po operaci došlo k přiložení ablace choroidey i odchlípené sítnice a zlepšení nejlepší korigované zrakové ostrosti na pravém oku na 0,3. Po následné operaci katarakty došlo opět k ablaci choroidey a odchlípení sítnice, tentokrát se spontánní úpravou. Pooperačně byla nejlepší korigovaná zraková ostrost na pravém oku 0,5, při poslední kontrole na našem pracovišti 0,6. Závěr: Hluboká zadní sklerotomie je možným řešením u pacientů se syndromem uveální efuze, nereagujících na konzervativní léčbu.

Purpose: Purpose of this article is to present a case report of a patient with uveal effusion syndrome who underwent deep posterior sclerotomy. Case report: A 73-year-old patient with unilateral decrease in the best corrected visual acuity, ablation of choroid and secondary retinal detachment in the right eye was admitted to our clinic for examination in November 2017. At the first examination, the best corrected visual acuity in the right eye was 0.3, in the left eye 1.0. Intraocular pressure was 16 mmHg in the right eye and 21 mmHg in the left eye. After performing ultrasound biomicroscopy of the anterior segment (Accutome, Keeler, USA), ultrasound sonography of the affected eye (Accutome, Keeler, USA), magnetic resonance imaging, computed tomography, abdominal ultrasound and blood tests, we concluded the finding as uveal effusion syndrome. We initiated a conservative treatment consisting of oral administration of carbonic anhydrase inhibitor in combination with topical use of prostaglandin analogue. Despite conservative treatment the best corrected visual acuity of the affected eye decreased to 0.05 so we proceeded to a surgical procedure – deep posterior sclerotomy with perioperative scleral sampling for histological examination (detection of glycosaminoglycans in the sclera wall by Alcian blue staining), which was negative. This histological result ranks the patient as the third type of uveal effusion syndrome (ie, non-nanophthalmic with a normal sclera). After the operation both the ablation of choroid and retinal detachment reattached and the best corrected visual acuity in the right eye improved to 0.3. After the subsequent cataract surgery, the ablation of choroid and retinal detachment occurred again, this time with spontaneous recovery. Postoperatively, the best corrected visual acuity in the right eye was 0.5 and at the last check-up at our clinic 0.6. Conclusion: Deep posterior sclerotomy is a method of choice of surgical treatment for uveal effusion syndrome that does not respond to conservative therapy.

• MeSH
• Exudates and Transudates MeSH
• Humans MeSH
• Choroid Diseases diagnosis   therapy   MeSH
• Retinal Detachment * surgery   diagnosis   MeSH
• Aged MeSH
• Sclera MeSH
• Uveal Effusion Syndrome * MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Diagnostic Techniques, Ophthalmological classification   MeSH
• Humans MeSH
• Scleral Diseases * diagnosis   classification   therapy   MeSH
• Ophthalmologic Surgical Procedures methods   MeSH
• Sclera anatomy & histology   enzymology   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Humans MeSH
• Scleral Diseases * diagnosis   etiology   therapy   MeSH
• Sclera anatomy & histology   pathology   MeSH
• Scleritis diagnosis   etiology   drug therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Adult MeSH
• Contact Lenses MeSH
• Humans MeSH
• Young Adult MeSH
• Tomography, Optical Coherence * methods   utilization   MeSH
• Anterior Eye Segment * anatomy & histology   MeSH
• Cornea anatomy & histology   MeSH
• Sclera * anatomy & histology   MeSH
• Statistics as Topic MeSH
• Organ Size MeSH
• Research MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH

Cíl: Zhodnocení dlouhodobé kompenzace a účinnosti u hluboké sklerektomie (HS) s užitím různých typů intrasklerálních implantátů. Metody: Sledovány byly 3 soubory: HS bez implantátu (HS bez): 34 očí, HS se Staar? implantátem (HS+STAAR): 31 očí, HS s T-Flux? implantátem (HS+T): 27 očí. Pooperačně byl hodnocen: NT, terapie a účinnost. Výsledky: Data jsou popsána relativním počtem, spojité parametry jsou popsány mediánem, 5. a 95. percentilem, vždy v pořadí souborů: HS bez; HS+STAAR; HS+T. Věk v době operace: 65,6 (44,9; 77,9); 64,5 (44,8; 85,0); 72,1 (51,8; 77,0) let. Doba sledování: 84 (36; 145); 96 (36; 141); 81 (36; 134) měsíců. NT předoperačně: 26 (20; 32); 26 (20; 34); 26 (21; 34) mmHg. NT 1 měsíc pooperačně: 14 (4; 18); 14 (4; 22); 8 (2; 16) mmHg. NT 96. měsíc pooperačně: 17 (13; 23); 17 (12; 21); 14 (12; 18) mmHg. NT 132. měsíc pooperačně: 18 (13; 20); 18 (10; 22); 15 (13; 16) mmHg. Zcela bez terapie 120 měsíců pooperačně bylo: 0; 7,1; 42,9 % očí. Absolutní úspěch 96. měsíc pooperačně: 0; 7,1; 18,2 %. Relativní úspěch 96. měsíc pooperačně: 87,5; 89,5; 100%. Závěr: HS je vhodnou operační technikou ke snížení NT u pacientů s glaukomem. Užití T-flux implantátu poskytuje nejlepší výsledky v našich souborech.

Objective: To evaluate the long-term compensation and efficacy after non-penetrating deep sclerectomy using different types of implants. Methods: Patients were divided in 3 groups: deep sclerectomy without implant (DS): 34 eyes, deep sclerectomy with Staar implant (DS+STAAR): 31 eyes, deep sclerectomy with T-flux implant (DS+T): 27 eyes. Postoperatively was evaluated: IOP, therapy and efficacy. Results: The data are described by the relative quantity, continuous data by median, 5th and 95th percentile, always in order of groups: DS; DS+STAAR; DS+T, resp. Age at the time of surgery was 65.6 (44.9; 77.9); 64.5 (44.8; 85.0); 72.1 (51.8; 77.0) years. Follow-up period was 84 (36; 145); 96 (36; 141); 81 (36; 134) months. IOP was 26 (20; 32); 26 (20; 34); 26 (21,34) mmHg postoperatively. IOP was 14 (4; 18); 14 (4; 22); 8 (2; 16) mmHg at 1 month postoperatively. IOP was 17 (13; 23); 17 (12; 21); 14 (12; 18) mmHg at 96 months. IOP was 18 (1; 20); 18 (10; 22); 15 (13; 16) mmHg at 132 months. Completely without therapy were 0; 7.1; 42.9 % of eyes at 120 months. Complete success rate was 0; 7.1; 18.2 % at 96 months. Qualified success rate was 87.5; 89.5; 100 % at 96 months. Conclusion: Deep sclerectomy is a good surgical technique to reduce the IOP in patients with glaucoma. Use of T-flux implant provides the best results in our groups. Key words: deep sclerectomy, intrascleral implant, acrylic non-absorbable T-flux implant, absorbable collagen implant Staar, complete success rate, qualified success rate

• Keywords
• hluboká sklerektomie, intrasklerální implantát, akrylátový neresorbovatelný T-flux implantát, kolagenový resorbovatelný implantát Staar, absolutní úspěch, relativní úspěch,
• MeSH
• Glaucoma * surgery   MeSH
• Kaplan-Meier Estimate MeSH
• Clinical Trials as Topic standards   MeSH
• Humans MeSH
• Intraocular Pressure MeSH
• Ophthalmologic Surgical Procedures methods   standards   statistics & numerical data   MeSH
• Postoperative Period MeSH
• Preoperative Period MeSH
• Prostheses and Implants MeSH
• Aged MeSH
• Sclera * surgery   MeSH
• Statistics as Topic MeSH
• Wounds, Nonpenetrating * MeSH
• Treatment Outcome * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Comparative Study MeSH

The aim of this study was to detect a spectrum of cytokeratins (CK) present in the adult human cornea, limbus and perilimbal conjunctiva. Cryosections from seven corneo-scleral discs were fixed, and indirect immunofluorescent staining was performed using antibodies directed against CK1-CK10 and CK13-CK20. The percentage of positive cells was calculated in the epithelium of the cornea, limbus and perilimbal conjunctiva. Quantitative real time RT-PCR (qRT-PCR) was used to detect CK6 and CK18 expression in the corneal and conjunctival epithelium. The most intense staining present throughout the cornea was observed for CK3, CK5 and CK14; CK19 was found at the corneal periphery only. CK4 and CK10/13 revealed mild to moderate positivity mostly in the superficial layers of the cornea. The suprabasal cell layers of all examined areas showed a strong positivity for CK16. A heterogeneous staining pattern with a centrifugal decrease in the signal was observed for CK8 and CK18. CK5/6, CK14 and CK19 were present in the limbus, where a positive signal for CK3 was observed in the suprabasal and superficial cells only. In contrast to the cornea, CK15 appeared in the basal and suprabasal layers of the limbus. The perilimbal conjunctiva showed strong immunostaining for CK10/13, CK14 and CK19. A moderate signal for CK7 was detected in the superficial layers of the conjunctiva. qRT-PCR confirmed CK6 and CK18 expression in the corneal and conjunctival epithelium. The detailed characterization of the corneal, limbal and perilimbal conjunctival epithelium under normal circumstances may be useful for characterizing the changes occurring under pathological conditions.

• MeSH
• Adult MeSH
• Microscopy, Fluorescence MeSH
• Fluorescent Antibody Technique, Indirect MeSH
• Glyceraldehyde-3-Phosphate Dehydrogenases metabolism   MeSH
• Immunohistochemistry MeSH
• Keratins biosynthesis   genetics   metabolism   MeSH
• Conjunctiva metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Limbus Corneae metabolism   MeSH
• Reverse Transcriptase Polymerase Chain Reaction MeSH
• RNA biosynthesis   genetics   MeSH
• Cornea metabolism   MeSH
• Epithelium, Corneal metabolism   MeSH
• Aged MeSH
• Sclera metabolism   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Idiopatická sklerochoroidálna kalcifikácia je zriedkavé benígne ochorenie ukladania kalciových solí do periférnych oblastí zadného úseku cievovky a skléry. Vyskytuje sa u pacientov staršieho veku bez ohrozenia zrakových funkcií s nízkou progresiou a skoro žiadnymi komplikáciami. V práci sa diskutujú diagnostické kritériá klinických prejavov, zobrazovacích techník, laboratórnych testov a spojenie s niektorými celkovými chorobami.

Idiopathic sclerochoroidal calcification is an uncommon ocular entity that manifests as calcium deposits in the mid-peripheral choroid and sclera. It is typical for older patients, without disturbances of visual functions, with low progression and almost no complications. Clinical characteristics, diagnostic laboratory tests, ancillary imaging techniques and systemic associations are discussed in this paper.

• MeSH
• Chorioretinitis diagnosis   MeSH
• Diagnosis, Differential MeSH
• Calcinosis diagnosis   classification   MeSH
• Humans MeSH
• Choroid Diseases diagnosis   classification   MeSH
• Sclera physiopathology   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Case Reports MeSH