This study investigates the interaction of two approved and one newly developed latanoprost formulation with in vitro and in silico models of the tear film and tear film lipid layer (TFLL). Latanoprost, a prostaglandin analogue used for intraocular elevated pressure treatment, is topically delivered by nanocarriers within aqueous solutions or emulsions. The study focuses on the impact of these carriers on drug interactions with the tear film and their effect on the TFLL. Three different types of latanoprost carriers, micellar, nanoemulsion, and polymer-based, were compared, and each revealed distinct interaction patterns with the TFLL. Surface pressure kinetics demonstrated a rapid increase for the benzalkonium chloride formulation and a slow rise for the preservative-free variants. Visualization of the acellular in vitro TFLL model revealed different patterns of incorporation for each formulation, indicating unique interaction mechanisms. Molecular dynamics simulations further revealed different mechanisms of drug release in the TFLL between micellar and nanoemulsion formulations. In-depth examination highlighted the role of triglyceride molecules in replenishing the nonpolar layer of the TFLL, which suggests potential improvements in ocular surface compatibility by adjusting the quality and concentration of the oily phase. These findings suggest the potential for optimizing latanoprost formulations by tuning the oily phase-to-surfactant ratio and selecting suitable surfactants.

• MeSH
• antihypertenziva terapeutické užití   MeSH
• glaukom * farmakoterapie   MeSH
• latanoprost terapeutické užití   MeSH
• lidé MeSH
• nitrooční tlak MeSH
• oči * MeSH
• systémy cílené aplikace léků MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Diabetes mellitus is a chronic disease affecting glucose metabolism. The pathophysiological reactions underpinning the disease can lead to the development of late diabetes complications. The gut microbiota plays important roles in weight regulation and the maintenance of a healthy digestive system. Obesity, diabetes mellitus, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy are all associated with a microbial imbalance in the gut. Modern technical equipment and advanced diagnostic procedures, including xmolecular methods, are commonly used to detect both quantitative and qualitative changes in the gut microbiota. This review summarises collective knowledge on the role of the gut microbiota in both types of diabetes mellitus and their late complications, with a particular focus on diabetic foot syndrome.

• MeSH
• diabetes mellitus * MeSH
• diabetická noha * MeSH
• diabetická retinopatie * MeSH
• diabetické nefropatie * etiologie   MeSH
• lidé MeSH
• obezita MeSH
• střevní mikroflóra * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.

• MeSH
• chirurgové * MeSH
• lidé MeSH
• nádory kůže * chirurgie   MeSH
• nádory očního víčka * chirurgie   MeSH
• oftalmologie * MeSH
• zákroky plastické chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Branchioma is an uncommon benign neoplasm with an adult male predominance, typically occurring in the lower neck region. Different names have been used for this entity in the past (ectopic hamartomatous thymoma, branchial anlage mixed tumor, thymic anlage tumor, biphenotypic branchioma), but currently, the term branchioma has been widely accepted. Branchioma is composed of endodermal and mesodermal lineage derivatives, in particular epithelial islands, spindle cells, and mature adipose tissue without preexistent thymic tissue or evidence of thymic differentiation. Twenty-three branchiomas were evaluated morphologically. Eighteen cases with sufficient tissue were assessed by immunohistochemistry, next-generation sequencing (NGS) using the Illumina Oncology TS500 panel, and fluorescence in situ hybridization (FISH) using an RB1 dual-color probe. All cases showed a biphasic morphology of epithelial and spindle cells with intermingled fatty tissue. Carcinoma arising in branchioma was detected in three cases. The neoplastic cells showed strong AE1/3 immunolabeling (100%), while the spindle cells expressed CD34, p63, and SMA (100%); AR was detected in 40-100% of nuclei (mean, 47%) in 14 cases. Rb1 showed nuclear loss in ≥ 95% of neoplastic cells in 16 cases (89%), while two cases revealed retained expression in 10-20% of tumor cell nuclei. NGS revealed a variable spectrum of likely pathogenic variants (n = 5) or variants of unknown clinical significance (n = 6). Loss of Rb1 was detected by FISH in two cases. Recent developments support branchioma as a true neoplasm, most likely derived from the rudimental embryological structures of endoderm and mesoderm. Frequent Rb1 loss by immunohistochemistry and heterozygous deletion by FISH is a real pitfall and potential confusion with other Rb1-deficient head and neck neoplasms (i.e., spindle cell lipoma), especially in small biopsy specimens.

• MeSH
• branchiom * patologie   MeSH
• dospělí MeSH
• hybridizace in situ fluorescenční MeSH
• lidé MeSH
• molekulární biologie MeSH
• nádory brzlíku * MeSH
• nádory glandulární a epitelové * MeSH
• nádory měkkých tkání * patologie   MeSH
• nádory sítnice * MeSH
• retinoblastom * genetika   patologie   MeSH
• thymom * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

UNLABELLED: PURPOSE : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS: MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS: Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS: Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.

• MeSH
• antihypertenziva škodlivé účinky   MeSH
• benzoáty * MeSH
• beta-alanin analogy a deriváty   MeSH
• bimatoprost terapeutické užití   MeSH
• dvojitá slepá metoda MeSH
• glaukom s otevřeným úhlem * diagnóza   farmakoterapie   MeSH
• latanoprost škodlivé účinky   MeSH
• lidé MeSH
• nitrooční tlak MeSH
• oční hypertenze * diagnóza   farmakoterapie   MeSH
• oční roztoky MeSH
• prospektivní studie MeSH
• timolol škodlivé účinky   MeSH
• tonometrie oční MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

INTRODUCTION: The SALL4 gene encodes a transcription factor that is essential for early embryonic cellular differentiation of the epiblast and primitive endoderm. It is required for the development of neural tissue, kidney, heart, and limbs. Pathogenic SALL4 variants cause Duane-radial ray syndrome (Okihiro syndrome), acro-renal-ocular syndrome, and Holt-Oram syndrome. We report a family with vertical transmission of a SALL4 pathogenic variant leading to radial hypoplasia and kidney dystopia in several generations with additional growth hormone deficiency (GHD) in the proband. CASE PRESENTATION: Our male proband was born at the 39th week of gestation. He was born small for gestational age (SGA; birth weight 2,550 g, -2.2 SDS; length 47 cm, -2.0 SDS). He had bilateral asymmetrical radial ray malformation (consisting of radial hypoplasia, ulnar flexure, and bilateral aplasia of the thumb) and pelvic kidney dystopia, but no cardiac malformations, clubfoot, ocular coloboma, or Duane anomaly. He was examined for progressive short stature at the age of 3.9 years, where his IGF-1 was 68 μg/L (-1.0 SD), and growth hormone (GH) after stimulation 6.2 μg/L. Other pituitary hormones were normal. A brain CT revealed normal morphology of the cerebral midline and the pituitary. He had a dental anomaly - a central mandibular ectopic canine. MRI could not be done due to the presence of metal after multiple corrective plastic surgeries of his hands. His mother's and father's heights are 152.3 cm (-2.4 SD) and 177.8 cm (-0.4 SD), respectively. His father has a milder malformation of the forearm. The affected paternal grandfather (height 164 cm; -2.3 SD) has a radial ray defect with missing opposition of the thumb. The family reports a similar phenotype of radial dysplasia in the paternal grandfather's mother. The proband started GH therapy at age 6.5 years when his height was 109 cm (-2.8 SDS) and he experienced catch-up growth as expected in GHD. Puberty started spontaneously at the age of 12.5 years. At age 13, his height was 158.7 cm (-0.2 SDS). Whole-exome sequencing revealed a nonsense variant in the SALL4 gene c.1717C>T (p.Arg573Ter) in the proband, his father, and paternal grandfather. CONCLUSION: This is the first observation of a patient with a congenital upper limb defect due to a pathogenic SALL4 variant who has isolated GHD with no apparent cerebral or facial midline anomaly and has been successfully treated with growth hormone.

• MeSH
• dospělí MeSH
• Duaneův retrakční syndrom * genetika   patologie   MeSH
• fenotyp MeSH
• horní končetina patologie   MeSH
• hypopituitarismus * genetika   MeSH
• ledviny patologie   MeSH
• lidé MeSH
• lidský růstový hormon * MeSH
• předškolní dítě MeSH
• transkripční faktory genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Inebilizumab, an anti-CD19 B-cell-depleting antibody, demonstrated safety and efficacy in neuromyelitis optica spectrum disorder in the randomised controlled period of the N-MOmentum trial. Here, end-of-study data, including the randomised controlled period and open-label extension period, are reported. METHODS: In the double-blind, randomised, placebo-controlled, phase 2/3 N-MOmentum trial, adults aged 18 years and older with an neuromyelitis optica spectrum disorder diagnosis, Expanded Disability Status Scale score of 8·0 or less, and history of either at least one acute inflammatory attack requiring rescue therapy in the past year or two attacks requiring rescue therapy in the past 2 years, were recruited from 81 outpatient specialty clinics or hospitals in 24 countries. Eligible participants were randomly assigned (3:1), using a central interactive voice system or interactive web response system, and a permuted block randomisation scheme (block size of 4), to receive intravenous inebilizumab (300 mg) or identical placebo on days 1 and 15 of the randomised period, which lasted up to 197 days. Participants and all study staff were masked to treatment assignment. The primary endpoint of the randomised period of the trial was time to onset of adjudicated neuromyelitis optica spectrum disorder attack on or before day 197. Participants in the randomised controlled period who had an adjudicated attack, completed 197 days in the study, or were in the randomised controlled period when enrolment stopped, could voluntarily enter the open-label period. In the open-label period, participants either initiated inebilizumab if assigned placebo (receiving 300 mg on days 1 and 15 of the open-label period) or continued treatment if assigned inebilizumab (receiving 300 mg on day 1 and placebo on day 15, to maintain B-cell depletion and masking of the randomised controlled period). All participants subsequently received inebilizumab 300 mg every 6 months for a minimum of 2 years. The end-of-study analysis endpoints were time to adjudicated attack and annualised attack rate (assessed in all participants who received inebilizumab at any point during the randomised controlled period or open-label period [any inebilizumab population] and the aquaporin-4 [AQP4]-IgG seropositive subgroup [any inebilizumab-AQP4-IgG seropositive population]) and safety outcomes (in all participants who were exposed to inebilizumab, analysed as-treated). This study is registered with ClinicalTrials.gov, NCT02200770, and is now complete. FINDINGS: Between Jan 6, 2015, and Sept 24, 2018, 467 individuals were screened, 231 were randomly assigned, and 230 received at least one dose of inebilizumab (n=174) or placebo (n=56). Between May 19, 2015, and Nov 8, 2018, 165 (95%) of 174 participants in the inebilizumab group and 51 (91%) of 56 in the placebo group entered the open-label period (mean age 42·9 years [SD 12·4], 197 [91%] of 216 were female, 19 [9%] were male, 115 [53%] were White, 45 [21%] were Asian, 19 [9%] were American Indian or Alaskan Native, and 19 [9%] were Black or African American). As of data cutoff for this end of study analysis (Dec 18, 2020; median exposure 1178 days [IQR 856-1538], total exposure of 730 person-years) 225 participants formed the any inebilizumab population, and 208 (92%) participants were AQP4-IgG seropositive. Overall, 63 adjudicated neuromyelitis optica spectrum disorder attacks occurred in 47 (21%) of 225 treated participants (60 attacks occurred in 44 [21%] of 208 in the AQP4-IgG seropositive subgroup); 40 (63%) of 63 attacks occurred in 34 (15%) of 225 treated participants during the first year of treatment. Of individuals who had an adjudicated attack while receiving inebilizumab, 36 (77%) of 47 were subsequently attack-free at the end of 4 years. Annualised attack rates decreased year-on-year, with end-of-study adjusted annualised attack rates being similar in the any inebilizumab-AQP4-IgG seropositive subgroup (0·097 [95% CI 0·070-0·14]) and any inebilizumab populations (0·092 [0·067-0·13]). Overall, 208 (92%) of 225 participants who received any inebilizumab had at least one treatment-emergent adverse event, the most frequent of which were urinary tract infection (59 [26%]), nasopharyngitis (47 [21%]), and arthralgia (39 [17%]). Infection rates did not increase over 4 years. Three (1%) of 225 participants in the any inebilizumab population died during the open-label period (one each due to a CNS event of unknown cause and pneumonia, respiratory insufficiency resulting from an neuromyelitis optica spectrum disorder attack and viral pneumonia related to COVID-19), all of which were deemed to be unrelated to treatment. INTERPRETATION: Data from the end-of-study analysis of the N-MOmentum trial showed continued and sustained clinical benefits of long-term inebilizumab treatment in individuals with neuromyelitis optica spectrum disorder, which supports the role of inebilizumab as a CD19+ B-cell-depleting therapy in neuromyelitis optica spectrum disorder. FUNDING: MedImmune and Viela Bio/Horizon Therapeutics, now part of Amgen.

• MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• humanizované monoklonální protilátky * terapeutické užití   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• neuromyelitis optica * farmakoterapie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Cíle: Autoři představují spektrum klinických forem, počáteční klinický obraz a trendy v léčbě 14 případů syndromu Vogt-Koyanagi-Harada (VKH) v terciálním očním centru v severní Malajsii. Série případů: 14 případů Vogt-Koyanagi-Harada syndromu (VKH) bylo v průběhu pěti let (2015–2020) retrospektivně zhodnoceno. Průměrný věk byl 37,7 roku (rozmezí 21–64 let), s převahou žen (85,7 %). U všech případů bylo postižení obou očí akutní uveitidou. 11 z nich (78,6 %) mělo pravděpodobně syndrom VKH a tři (21,4 %) jeho neúplnou formu. Všichni pacienti se k prvnímu vyšetření dostavili s akutní panuveitidou. V oblasti zadního segmentu byl nejčastějším postižením edém terče u 57,1 % (16 z 28 očí) a exsudativní odchlípení sítnice (ERD) u 35,7 % (10 z 28 očí). U 35,1 % případů byla zjištěna slepota (slabozrakost 3/60 a horší) a u stejně velké skupiny (35,1 %) středně těžké zrakové postižení (6/18–6/60). Mírné zrakové postižení (6/12–6/18) a těžké zrakové postižení (6/60–3/60) mělo v obou skupinách 7,1 % případů. Léčba deseti pacientů (71,4 %) vyžadovala při následných návštěvách kombinovanou imunomodulační léčbu druhé linie. Pouze čtyři pacienti (28,6 %) dobře reagovali na léčbu kortikosteroidy. Na konci sledovaného období většina pacientů nevykazovala žádné poškození zraku (64,3 %), následovala skupina pacientů s lehkým zrakovým postižením (21,4 %) a středně těžkým poškozením zraku (14,3 %). Žádný z pacientů nevykazoval těžké zrakové postižení nebo slepotu. Závěr: VKH je potenciálně oslepující onemocnění v případě, že je v akutním stadiu nedostatečně léčeno. Většina našich pacientů dosáhla dobrých výsledků vidění díky včasnému zavedení imunomodulační léčby a systémových kortikosteroidů.

Aims: We present the clinical spectrum, the initial clinical presentation with management trends in treating 14 Vogt-Koyanagi-Harada (VKH) disease cases in a tertiary center in the Northern part of Malaysia. Case series: There were 14 cases of Vogt-Koyanagi-Harada (VKH) disease retrospectively reviewed over five years (from 2015 to 2020). The mean age at presentation was 37.7 years (range 21–64 years), with female predominance (85.7%). All cases presented with acute uveitic stage and bilateral eye involvement. Of them, 11 (78.6%) were probable VKH, and three (21.4%) were incomplete VKH. All patients attended with acute panuveitis at first presentation. The main posterior segment involvement was disc edema in 57.1% (16 out of 28 eyes) and exudative retinal detachment (ERD) in 35.7% (10 out of 28 eyes). Most of them presented with blindness (3/60 and worse) and moderate visual impairment (6/18–6/60); 35.71% each, followed by mild visual impairment (6/12–6/18), and severe visual impairment (6/60–3/60); 7.1% each. Ten patients (71.4%) required combination second-line immunomodulatory treatment during subsequent visits, and only four patients (28.6%) responded well to corticosteroid therapy. Most of the cases achieved no visual impairment (64.3%), followed by mild visual impairment (21.4%) and moderate visual impairment (14.3%), and none were severe or blind at the end of follow-up. Conclusion: VKH is a potentially blinding illness if there is inadequate control of the disease in the acute stage. Most of our patients achieved good visual outcomes with early immunomodulatory treatment and systemic corticosteroids.

• MeSH
• autoimunitní nemoci diagnóza   farmakoterapie   klasifikace   MeSH
• dospělí MeSH
• hormony kůry nadledvin farmakologie   terapeutické užití   MeSH
• imunomodulace účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• oční nemoci diagnóza   farmakoterapie   imunologie   klasifikace   MeSH
• panuveitida diagnóza   etiologie   MeSH
• retrospektivní studie MeSH
• Vogtův-Koyanagiho-Haradův syndrom * diagnóza   farmakoterapie   komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Malajsie MeSH

Cílem práce je prezentovat případ pacienta, u kterého se rozvinula oboustranná kalcifikace hydrofilní nitrooční čočky (NOČ) Lentis M+ LS-313 MF30 (Oculentis). Vzhledem k negativnímu vlivu na zrakové funkce byla nutná explantace a výměna umělé čočky na obou očích. Kazuistika: Přehledem dostupné literatury byla shrnuta diagnostika, aktuální vyšetřovací metody a možnosti chirurgického řešení kalcifikace hydrofilní čočky Lentis M+ LS-313 MF30 (Oculentis). Konkrétní řešení je popsáno v kazuistice pacienta, u něhož se kalcifikace obou čoček rozvíjela 6 let po implantaci NOČ. V roce 2015 76letý muž podstoupil na našem pracovišti nekomplikovanou operaci šedého zákalu obou očí s implantací umělé nitrooční čočky do pouzdra. V září 2021 byl na doporučení spádového očního lékaře na naší ambulanci vyšetřen pro snížení zrakové ostrosti a změny materiálu umělé NOČ patrné při klinickém vyšetření. Dominantní bylo rozmazané vidění. Diagnóza opacifikace nitrooční čočky byla potvrzena a dokumentována pomocí Scheimpflugovy kamery (OCULUS Pentacam HR) a předněsegmentového OCT (Optovue, Avanti RTVue XR). Pacient byl indikován k explantaci a výměně zkalené nitrooční čočky na levém a následně i na pravém oku. K reimplantaci byl použitý konstrukčně stejný typ NOČ s dobrým funkčním výsledkem. Závěr: Od roku 2010 mají implantace multifokálních čoček celosvětově vzestupný trend. Také zmíněný typ NOČ byl použit v tisících implantací. Lze tak v dalších letech očekávat řadu dalších explantací. Optimálním řešením je korektní výměna kalcifikované NOČ za stejnou konstrukci z bezpečnějšího hydrofobního materiálu.

The aim of the thesis is to present the case of a patient in whom bilateral calcification of the hydrophilic intraocular lens (IOL) Lentis M+ LS-313 MF30 (Oculentis) has developed. Due to the negative effect on visual functions, explantation and replacement of the artificial lens was necessary in both eyes. Case Report: An overview of the available literature summarized the diagnostics, current examination methods and possibilities of the surgical solution of calcification of the bifocal hydrophilic lens Lentis M+ LS-313 MF30 (Oculentis). The specific solution is described in a case report of a patient in whom calcification of both lenses developed 6 years after implantation of the IOL. In 2015, the patient underwent uncomplicated cataract surgery of both eyes with the implantation of an artificial intraocular lens into the capsule. In September 2021, an 82-year-old man was examined at our outpatient clinic for deterioration of visual acuity and changes in the material of the artificial IOL which were perceptible during a clinical examination, on the recommendation of a local ophthalmologist. Blurred vision predominated. A diagnosis of intraocular lens opacification was confirmed and documented using a Scheimpflug camera (OCULUS Pentacam HR) and anterior OCT (Avanti RTVue XR Optovue,). The patient was indicated for explantation and replacement of the opacified intraocular lens in the left and subsequently in the right eye- The same type of IOL was used for reimplantation with good functional results. Conclusion: Since 2010, multifocal lens implantation has been on an upward trend worldwide. This type of MF IOL has also been used in thousands of implantations. A number of other explantations can be expected in the coming years. The optimal solution is the correct replacement of the calcified IOL with the same construction made of safer hydrophobic material.

• Klíčová slova
• hydrofilní nitrooční čočky,
• MeSH
• implantace nitrooční čočky klasifikace   metody   ošetřování   MeSH
• kalcinóza * komplikace   patologie   MeSH
• katarakta komplikace   terapie   MeSH
• lidé MeSH
• nitrooční čočky * klasifikace   MeSH
• senioři nad 80 let MeSH
• zkalení zadního pouzdra čočky diagnóza   patologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• kazuistiky MeSH

Retinoblastom je nejčastějším nitroočním maligním nádorem v dětském věku. Zásadní parametr určující stupeň retinoblastomu dle mezinárodní klasifikace retinoblastomu představuje seeding, neboli disperze nádorových partikulí do přilehlých kompartmentů. V článku jsme se zaměřili na vitreální seeding, jeden z hlavních limitujících faktorů úspěšné léčby retinoblastomu, při níž je zachován bulbus tzv. „eye-preservation treatment“. Článek shrnuje přehled vývoje léčby vitreálního seedingu retinoblastomu, zavedených postupů a zároveň seznamuje s novinkami na úrovni výzkumu. Zavedení systémové chemoterapie v léčbě retinoblastomu koncem 90. let znamenalo významný přelom, který umožnil postupné opuštění externí radioterapie s jejími vedlejšími účinky. Docílené koncentrace chemoterapeutik ve sklivcovém prostoru při systémové chemoterapii však nejsou pro léčbu vitreálního seedingu dostatečné a toxické účinky systémově podávaných chemoterapeutik nejsou zanedbatelné. Významnou změnou byl nástup chemoterapie in situ s cíleným podáváním chemoterapeutik, a to intraarteriálně a intravitreálně, což přispělo k definitivní eradikaci externí radioterapie a omezení systémové chemoterapie. Ačkoliv vitreální seeding zůstává nejčastějším důvodem selhání intraarteriální chemoterapie, tato technika výrazně ovlivnila původní léčebné schéma retinoblastomových dětí. Nejvíce se však zasloužila o zvýšení pravděpodobnosti zachování oka i zrakových funkcí u pacientů s pokročilým nálezem intravitreální chemoterapie. Nadále probíhá mnoho prací na vývoji nových terapeutických technik, a to s použitím periokulární aplikace chemoterapeutika, imunoterapie, genové terapie či onkolytických virů, z nichž se některé jeví jako slibné, ale k rutinnímu využití nejsou zatím dokončeny klinické studie.

Retinoblastoma is the most common primary malignant intraocular tumor in children. Seeding, specifically the dispersion of the tumor into the adjacent compartments, represents a major parameter determining the degree of retinoblastoma according to the International Classification of Retinoblastoma. In this article we focused on vitreous seeding, one of the main limiting factors in the successful “eye preservation treatment” of retinoblastoma. This article presents an overview of the history of vitreous seeding of retinoblastoma, established treatment procedures and new-research modalities. The introduction of systemic chemotherapy in the treatment of retinoblastoma at the end of the 1990s represented a significant breakthrough, which enabled the progressive abandonment of radiotherapy with its attendant side effects. However, the attained concentrations of chemotherapeutics in the vitreous space during systemic chemotherapy are not sufficient for the treatment of vitreous seeding, and the toxic effects of systemic chemotherapy are not negligible. A significant change came with the advent of chemotherapy in situ, with the targeted administration of chemotherapeutic drugs, namely intra-arterial and intravitreal injections, contributing to the definitive eradication of external radiotherapy and a reduction of systemic chemotherapy. Although vitreous seeding remains the most common reason for the failure of intra-arterial chemotherapy, this technique has significantly influenced the original treatment regimen of children with retinoblastoma. However, intravitreal chemotherapy has made the greatest contribution to increasing the probability of preservation of the eyeball and visual functions in patients with advanced findings. Novel local drug delivery modalities, gene therapy, oncolytic viruses and immunotherapy from several ongoing preclinical and clinical trials may represent promising approaches in the treatment of vitreous retinoblastoma seeding, though no clinical trials have yet been completed for routine use.

• Klíčová slova
• intravitreální chemoterapie,
• MeSH
• farmakoterapie klasifikace   metody   MeSH
• injekce intravitreální klasifikace   metody   MeSH
• léčba šetřící orgány klasifikace   metody   MeSH
• lidé MeSH
• retinoblastom * diagnóza   farmakoterapie   komplikace   MeSH
• rozsev nádorových buněk * MeSH
• sklivec patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH