Refractive surgery with excimer laser has been a very common surgical procedure worldwide during the last decades. Currently, patients who underwent refractive surgery years ago are older, with a growing number of them now needing cataract surgery. To establish the power of the intraocular lens to be implanted in these patients, it is essential to define the true corneal power. However, since the refractive surgery modified the anterior, but not the posterior surface of the cornea, the determination of the corneal power in this group of patients is challenging. This article reviews the different sources of error in finding the true corneal power in these cases, and comments on several approaches, including the clinical history method as described originally by Holladay, and a modified version of it, as well as new alternatives based on corneal tomography, using devices that are able to measure the actual anterior and posterior corneal curvatures, which have emerged in recent years to address this issue.

• MeSH
• laserová modelace rohovky pod rohovkovou lamelou * MeSH
• lasery excimerové MeSH
• lidé MeSH
• refrakce oka * MeSH
• rohovka chirurgie   MeSH
• rohovková topografie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Chemické poleptania sú zrak ohrozujúce poranenia, vyžadujúce okamžitú liečbu. Hlavným cieľom počiatočnej terapie je intenzívny a výdatný výplach spojovkového vaku, za účelom neutralizácie a eliminácie pôsobiacej chemikálie. Ďalšie terapeutické postupy, či už konzervatívne, alebo chirurgické, závisia od klinického nálezu. Cieľ: V kazuistike popisujeme priebeh a liečbu pacientky s poleptaním oboch očí zásaditou látkou. Kazuistika: V práci uvádzame kazuistiku 35-ročnej ženy, s chemickým poleptaním oboch očí alkalickým činidlom. Do troch týždňov nastala úplná reepitelizácia oboch rohoviek. Vzhľadom k tomu sme predpokladali uspokojivú prognózu hojenia, avšak na ľavom oku došlo s odstupom času k lýze rohovky. Stav sa podarilo zvládnuť, ale následne došlo na ľavom oku zrejme v súvislosti s infekciou COVID-19 k závažnej keratouveitíde s hypopyonom a lýzou rohovky, čo v konečnom dôsledku viedlo k eviscerácii postihnutého oka. Výsledky a záver: V kazuistike popisujeme management ľahkého poleptania na pravom oku a komplikovaného stredne ťažkého poleptania ľavého oka zásaditou chemikáliou. Obe oči boli do troch týždňov kompletne prehojené, no nález na ľavom oku sa skomplikoval, čo dospelo v konečnom dôsledku až k eviscerácii postihnutého oka. Ochorenie COVID-19 mohlo prispieť k zhoršeniu nálezu na rohovke alebo mohlo ísť iba o koincidenciu dvoch ochorení a keratouveitída mala závažný priebeh z dôvodu predchádzajúceho ťažkého priebehu hojenia a mnohých komplikácií po chemickom poleptaní oka.

Chemical burns are sight-threatening injuries that require immediate management. The main goal of the initial treatment is prompt and copious irrigation to neutralize and eliminate the chemical, followed by various therapeutic options (conservative and surgical) according to the individual patient’s postinjury findings. Purpose: In this case report, we describe the course and treatment of a patient with chemical alkali burns of both eyes. This study reports the outcomes of an ocular alkali burn patient who became infected with COVID-19 and where severe keratouveitis with corneal graft melting and hypopyon occurred, ultimately resulting in evisceration of the eye. Observations: We report the case of a 35-year-old woman, after an alkali burn of both eyes. Complete re-epithelialization of both corneas occurred within three weeks. Due to this observation, we assumed a satisfactory healing prognosis. However, corneal lysis occurred in the left eye over time. The condition was managed, but subsequently severe keratouveitis with hypopyon and corneal lysis occurred in the left eye, apparently in connection with the COVID-19 infection, which ultimately led to the evisceration of the affected eye. Conclusions and Importance: In the case report, we describe the management of a mild chemical alkali burn of the right eye and a complicated moderate burn of the left eye with an alkaline chemical. Both eyes were completely healed within three weeks. However, the findings on the left eye became complicated, which ultimately led to the evisceration of the affected eye. The disease of COVID-19 could have contributed to the deterioration of the findings on the cornea, or it could have just been a coincidence of two diseases, with the keratouveitis having a serious course due to the previous difficult course of healing and many complications after the chemical burn.

• Klíčová slova
• lýza rohovky,
• MeSH
• amnion transplantace   MeSH
• chemické popálení * diagnóza   etiologie   komplikace   terapie   MeSH
• COVID-19 komplikace   virologie   MeSH
• dospělí MeSH
• eviscerace oka MeSH
• hydroxid sodný škodlivé účinky   MeSH
• keratokonjunktivitida etiologie   MeSH
• keratoplastika perforující MeSH
• lidé MeSH
• poranění oka * diagnóza   etiologie   komplikace   terapie   MeSH
• rohovka chirurgie   patofyziologie   patologie   MeSH
• transplantace rohovky MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: The goal of our study is to find an optimal approach to the preparation and preservation of corneal stromal tissue. We want to compare different methods of corneal stromal tissue creation and storage to optimize the efficacy of this process under the conditions of an eye bank. After we find the most suitable method to create a safe high quality product, we want to prove the possibility of using a single donor cornea for more than one patient. We would also like to verify the feasibility of making more corneal lenticules after the removal of a corneal endothelium for DMEK transplantation. METHODS: We provided morphological (histology, scanning electron microscope) and microbiological analysis in order to compare different methods of corneal lenticule and corneal stromal lamellae preparation and preservation. We also tested the surgical handling of the tissue to secure a safe manipulation of the tissue for clinical use. We compared two methods of corneal lenticule preparation: microkeratome dissection and femtosecond laser. As methods of preservation, we tested hypothermia, cryopreservation at -80 degrees Celsius in DMSO (dimethyl sulfoxide) and storage at room temperature with glycerol. Some intrastromal lenticules and lamellae in each group were previously irradiated with gamma radiation of 25 kGy (KiloGray). RESULTS: Corneal stromal lamellae prepared with a microkeratome have a smoother cut - side surface compared to lamellae prepared with a femtosecond laser. Femtosecond laser preparation caused more irregularities on the surface and we detected more conglomerates of the fibrils, while lamellae made with microkeratome had more sparse network. Using femtosecond laser, we were able to make more than five lenticules from a single donor cornea. Gamma irradiation led to damage of collagen fibrils in corneal stroma and a loss of their regular arrangement. Corneal tissue stored in glycerol showed collagen fibril aggregates and empty spaces between fibrils caused by dehydration. Cryopreserved tissue without previous gamma irradiation showed the most regular structure of the fibrils comparable to storage in hypothermia. CONCLUSION: Our results suggest that formation of a corneal lenticule lamellae by microkeratome results in smoother corneal lenticules, while being much cheaper than formation by femtosecond laser. Gamma irradiation of 25 kGy caused damage of the collagen fibres as well as their network arrangement, which correlated with loss of transparency and stiffer structure. These changes impair possible surgical utilisation of gamma irradiated corneas. Storage in glycerol at room temperature and cryopreservation had similar outcomes and we believe that both methods are appropriate and safe for further clinical use .

• MeSH
• dimethylsulfoxid MeSH
• glycerol * MeSH
• hypotermie * MeSH
• kolagen MeSH
• lidé MeSH
• rohovka chirurgie   MeSH
• stroma rohovky chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Cíl: Referovat klinické výsledky terapie zonulární keratopatie chelací v dlouhodobém sledování. Materiál a metody: Retrospektivně byla zhodnoceny dlouhodobé výsledky 5 pacientů (5 očí) se symptomatickou zonulární keratopatií se sledovací dobou minimálně 6 měsíců, u kterých byla provedena chelace 2% EDTA na postiženém oku ve studovaném období od 4/2018 do 3/2021. Sledovací doba byla 9–37 měsíců. Výsledky: U všech pacientů došlo k výraznému zlepšení lokálního nálezu a zvýšení transparence rohovky. Efekt terapie byl verifikován na barevné fotografii předního segmentu i na AS-OCT vymizením hyperreflektivních ložisek subepiteliálně a doprovodných optických stínů. Pooperačně tím bylo umožněno detailnější zobrazení hlubších vrstev rohovky a dalších struktur předního segmentu. U nemocného s potenciálem zlepšení vidění se rovněž podařilo významně zlepšit zrakové funkce. U dalších tří pacientek s bolestmi postiženého oka došlo k ústupu bolesti a profitovaly z operace i kosmeticky. Závěr: Na základě našich zkušeností i dříve publikovaných sdělení je chelace rohovky pomocí EDTA schopna kauzálně řešit patologii a zlepšit vidění u očí s potenciálem zrakových funkcí. Současně u dlouhodobě drážděných očí tlumí diskomfort a působí analgeticky. Operace je vhodná i pro amaurotické kosmeticky nevzhledné bulby, neboť úspěšná intervence zachovávající bulbus a zlepšující vzhled takovýchto očí vede ke spokojenosti a subjektivnímu zvýšení kvality života pacientů.

Aim: To report the clinical results of chelation of band keratopathy in long-term follow-up. Material and methods: The long-term results of 5 patients (5 eyes) with symptomatic band keratopathy with a follow-up period of at least 6 months, in whom 2% EDTA was chelated on the affected eye in the study period from April 2018 to March 2021, were retrospectively evaluated. The follow-up period was 9-37 months. Results: In all patients, there was a significant improvement in the local findings and an increase in the transparency of the cornea. The effect of therapy was verified on a color photograph of the anterior segment and on AS-OCT by the disappearance of subepithelial hyperreflective foci and accompanying optical shadows. Postoperatively, this enabled a more detailed visualization of the deeper layers of the cornea and other structures of the anterior segment. In a patient with the potential to improve vision, it was also possible to significantly improve visual functions. In the other three patients with pain in the affected eye, the pain subsided, and they also benefited cosmetically from the operation. Conclusion: Based on our experience and previously published reports, EDTA corneal chelation is able to causally resolve the pathology and improve vision in eyes with visual potential. At the same time, it reduces discomfort and has an analgesic effect in long-term irritated eyes. The operation is also suitable for amaurotic, cosmetically unsightly bulbs, as a successful intervention preserving the eye and improving the appearance of such eyes leads to satisfaction and a subjective increase in the quality of life of the patients.

• Klíčová slova
• zonulární keratopatie, chelatace,
• MeSH
• bolest MeSH
• EDTA terapeutické užití   MeSH
• kvalita života MeSH
• lidé MeSH
• následné studie MeSH
• nemoci rohovky * chirurgie   farmakoterapie   MeSH
• optická koherentní tomografie MeSH
• rohovka chirurgie   patologie   MeSH
• zraková ostrost MeSH
• Check Tag
• lidé MeSH

Corneal stromal lenticule is a part of corneal stroma, which can be created by manual dissection, by femtosecond laser from the donor cornea, but chiefly it is a waste product of a refractive procedure ReLex SMILE (Small Incision Lenticule Extraction). Corneal lenticule has a huge potential in corneal surgery. In recent years, many studies have been published to show the possibility to use this tissue to treat corneal defects, as well as in refractive surgery. Thanks to the quantity of lenticules which arise every day during SMILE operations, this tissue is much more accessible than any other kind of corneal tissue. According to the experience with lenticule implantation in animal models, or even human patients, lenticule implantation is considered safe, reversible method, which is not associated with immune rejection or other severe complications. However, the crucial step before the process of lenticule implantation, is proper preservation of this tissue. Donor corneal tissue containing endothelium is usually preserved in hypothermia and then usable maximally for two weeks. Newer methods such as organ culture storage and use of a sterile cornea prolong the time of usability of the tissue. The possibilities for corneal lenticule storage are theoretically wider thanks to the fact, that we do not need to preserve fragile cellular structures. Besides the storage in hypothermia, other preserving methods such as cryopreservation and storage after decellularization have been tested. This review aimed to examine the current literature that describes possible methods of corneal lenticule preservation. A comprehensive search was created based on articles published in English on PubMed.gov, Cochranelibrary.com and Scopus.com using following keywords: corneal lenticule preservation, corneal lenticule storage, cold storage corneal lenticule, corneal lenticule cryopreservation till 2020.

• MeSH
• hypotermie * MeSH
• kryoprezervace MeSH
• lidé MeSH
• rohovka chirurgie   MeSH
• rohovkový endotel MeSH
• stroma rohovky * chirurgie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• keratokonus * diagnóza   chirurgie   terapie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• oftalmologické chirurgické výkony metody   MeSH
• optometrie metody   MeSH
• reagencia zkříženě vázaná farmakologie   terapeutické užití   MeSH
• rohovka chirurgie   účinky léků   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Úvod: Implantácia intrastromálnych segmentov s použitím femtosekundového lasera predstavuje bezpečný a efektívny chirurgický prístup v korekcii keratokónusu, resp. aj sekundárnych rohovkových ektázií. Napriek tomu sa zriedka stretávame s komplikáciou v podobe pooperačnej extrúzie segmentu. Na trhu je v súčasnosti dostupných niekoľko typov intrastromálnych segmentov. Keraring od Mediphacos Ltd. je navrhnutý primárne pre korekciu keratokónusu.Materiál a metodika: V našej práci sme hodnotili výsledky implantácie segmentov Keraring u 32 pacientov (48 očí) s keratokónusom, alebo s pelucidnou marginálnou degeneráciou. Za obdobie január 2015 až február 2017 sme zaimplantovali celkovo 78 segmentov s použitím femtosekundového lasera. Sledovali sme nekorigovanú a najlepšiu korigovanú centrálnu ostrosť zraku (COZ a NKCOZ), zmeny subjektívnej a objektívnej refrakcie. Taktiež sme hodnotili výskyt komplikácií.Výsledky: U 44 očí (91,6%) bola predoperačne COZ nižšia alebo rovná 0,3, zatiaľ čo pooperačná COZ po 6 mesiacoch bola u 29 očí (60,41%) vyššia alebo rovná 0,3. Priemerná NKCOZ sa z predoperačných 0,5 v celom súbore zlepšila na 0,6 na konci 6 mesačného sledovacieho obdobia. Celkovo sa COZ zlepšila u 38 očí (79,16%) a u 27 očí (56,25%) došlo k zlepšeniu v NKCOZ. V subjektívnej a objektívnej refrakcii sa priemerné hodnoty sférického ekvivalentu pooperačne znížili. U 9 očí (18,75%) došlo pooperačne k definitívnej extrúzii s nutnosťou explantácie prstenca, a to priemerne po 7,3 mesiacoch (od 2 do 16 mesiacov) od vlastnej primárnej implantácie.Záver: Implantácia intrastromálnych rohovkových prstencov Keraring predstavuje efektívnu chirurgickú liečbu u správne indikovaných pacientov s ektatickým ochorením rohovky.

Introduction: The intrastromal corneal ring segments implantation is widely used as an effective method for keratoconus correction. Femtosecond laser technology represents very precise and modern approach in corneal tunnel creation. Nevertheless complication like an extrusion of the implanted ring segment rarely appears. There are few different types of intrastromal corneal segments available. Keraring (Mediphacos Ltd.) is primary designed for keratoconus treatment.Materials and methods: We evaluated results of the Keraring implantations in 32 patients (48 eyes) with keratoconus or with marginal pellucid degeneration. We implanted 78 segments totally in the period from January 2015 to February 2017, with the assistance of femtosecond laser. We present our data collected after the 6 months follow up. Uncorrected visual acuity – UCVA and best corrected visual acuity – BCVA were evaluated. We scored the changes in the subjective and objective refraction. The complications were observed.Results: Preoperative UCVA was in 44 (91,60%) eyes under or equal 0,3. Postoperative UCVA after 6 months was in 29 (60,41%) eyes over or equal 0,3. Visual acuity improved in 38 (79,16%) eyes totally with the gain of 1 to 9 lines, BCVA improved in 27 (56,25%) eyes and in 15 (31,25%) eyes stayed postoperatively unchanged. There was reduction of the spherical equivalent (SE), in the subjective and objective refraction. In our group there we detected 9 (18,75%) extrusions of the implanted ring segment, which occurred on average 7,3 months (range 2/ 16 months) after the surgery.Conclusion: Intrastromal corneal ring segments implantation with the femtosecond laser assistance is an effective approach in the keratoconus treatment. Complications are not often observed. With careful selection of the suitable patient it is possible to avoid them.

• Klíčová slova
• femtosekundový laser, instrastromální prstence,
• MeSH
• keratokonus * chirurgie   MeSH
• lasery MeSH
• lidé MeSH
• oftalmologické chirurgické výkony metody   MeSH
• protézy a implantáty * MeSH
• retrospektivní studie MeSH
• rohovka * chirurgie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

BACKGROUND AND AIMS: Refractive eye surgery is a rapidly expanding field of ophthalmology and corneal surgery is undergoing constant development leading to less invasive technologies. The goal of this study was to compare the most common femtoLASIK surgery with the newer ReLEx SMILE surgery which is gentler to the cornea. The comparison was made in terms of dioptric error reduction. METHODS: The studied cohort of patients consisted of two major groups: 30 patients who underwent femtoLASIK surgery and 30 who underwent ReLEx SMILE surgery. -30 patients, 60 eyes. All patients were aged 18-45 years with moderate myopia or astigmatism ranging from -3.25 to -6.0 spherical diopters and from 0 to -1.0 cylindrical diopters. In all, the best corrected visual acuity measured prior to surgery was 1.0. Pachymetry was not comparable because each surgical method was performed at a different time point and the introduction of an innovative method into practice led to a change in selection criteria. RESULTS: During postsurgical check-ups, the ReLEx SMILE method (0.74) led to lower values of non-corrected visual acuity compared to the femtoLASIK method (0.88), (P<0.001). However, the results changed at the one-year post-surgery check-up, when ReLEX SMILE patients achieved non-corrected visual acuity of 0.97 compared to femtoLASIK patients, who scored 0.83, (P=0.007). Based on data analysis from the automatic refractometer, the average spherical diopters of the femtoLASIK (-0.32 D) were higher than those of the ReLEx SMILE (-0.07 D), (P<0.001). The results for the cylindrical diopters were also significant, (P=0.021). When we compared the spherical equivalent one year after surgery, the difference between methods was significant. The FemtoLASIK method resulted in an average SE -0.55 D compared to -0.09 D for the ReLEx SMILE method, (P<0.001). CONCLUSION: This study showed that there was a significant difference in results between the two surgical methods of treatment of moderate myopia and astigmatism, in terms of regression of dioptric error, as well as in achievement and maintenance of visual acuity during the observed period. The ReLEx SMILE had better results.

• Klíčová slova
• FemtoLASIK, ReLEx SMILE,
• MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• pooperační komplikace MeSH
• refrakční chirurgické výkony * metody   MeSH
• refrakční vady terapie   MeSH
• rohovka * chirurgie   patologie   MeSH
• zraková ostrost MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• femtosekundový laser, instrastromální rohovkový prstenec, extruze prstence, explantace,
• MeSH
• keratokonus * chirurgie   MeSH
• laserová chirurgie rohovky metody   škodlivé účinky   MeSH
• lasery MeSH
• lidé MeSH
• oftalmologické chirurgické výkony metody   MeSH
• optická koherentní tomografie MeSH
• pooperační období MeSH
• refrakce oka MeSH
• retrospektivní studie MeSH
• rohovka * chirurgie   patofyziologie   MeSH
• rohovkové aberace chirurgie   diagnostické zobrazování   klasifikace   MeSH
• statistika jako téma MeSH
• výsledek terapie MeSH
• zraková ostrost MeSH
• zrakové protézy škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

PURPOSE: To assess the impact of Acanthamoeba keratitis (AK) and amniotic membrane transplantation (AMT) in corneal explants on presence of two multifunctional endogenous lectins, i.e. galectins-1 and -7. METHODS: Ten corneal explants from AK patients (five with previous AMT and five controls without this treatment) and seven specimens of disease-free control cornea were processed by indirect fluorescent immunohistochemistry. RESULTS: Immunostaining for both galectins was obtained in the epithelium, stroma and the endothelial layer of all controls, with the strongest positivity in the epithelium. Significantly decreased intensity for galectin-1 was recorded in the epithelium of corneal explants from patients with AK and AMT. The signal for galectin-7 was significantly decreased in the epithelium of AK patients and normalized after AMT. CONCLUSIONS: AMT has a marked impact on presence of the two galectins in opposite directions, encouraging complete profiling for this family of endogenous effectors.

• MeSH
• akantamébová keratitida metabolismus   chirurgie   MeSH
• amnion transplantace   MeSH
• biologické krytí * MeSH
• biologické markery metabolismus   MeSH
• dospělí MeSH
• galektin 1 MeSH
• galektiny metabolismus   MeSH
• imunohistochemie MeSH
• keratoplastika perforující metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• oční infekce parazitární diagnóza   metabolismus   chirurgie   MeSH
• rohovka metabolismus   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH