PURPOSE: Evaluation of the long-term effect of rheopheresis treatment of dry form of age-related macular degeneration (AMD). MATERIALS AND METHODS: The treatment group consisted of 65 patients and 55 patients in the control group, with a minimum follow-up period of 60 months. The basic treatment consisted of 8 rheopheresis procedures, and the additional treatment (booster therapy) of 2 rheopheresis procedures 1.5-2 years after the basic treatment. We evaluated changes in best corrected visual acuity, anatomical effect, electrical activity of the retina, haematological, biochemical and immunological parameters. RESULTS: Rheopheresis treatment contributed significantly: 1) to stabilisation of best corrected visual acuity of the treated patients, which initially showed an insignificant increased during the 2-years follow-up period, and then slightly decreased. By contrast, visual acuity decreased in the control group, to an insignificant degree up to 4 years, then statistically significantly. 2) to an improvement of the morphological findings in 62.4% of treated patients compared to 7.5% in the control group, while disease progression to stage 3 (neovascular form of the disease or geographic atrophy) with a significant decrease of visual acuity occurred in only 7.1% of treated patients, versus 37.0% in the control group. 3) to regression, even to the attachment of drusenoid pigment epithelial detachment (DPED). To a reduction of the area of DPED in 80.4% of treated patients, in contrast with an steaincrease in the area of DPED in 47.1% of patients in the control group, and the development of new DPED in only 2 eyes of treated patients compared with 16 eyes of patients in the control group. 4) to a preservation of the integrity of the ellipsoid layer in the fovea in 68.2% of the treated patients, while by contrast we found a damaged ellipsoid layer in the fovea in 66.6% of the control patients. 5) to a stabilisation of the activity of ganglion cells, the pineal system and the activity of the central area of the retina, with eccentricity between 1.8° and 30° in the treated patients, compared to alteration in the control group manifested mainly after 3.5 years of the follow-up period. 6) to a statistically significant improvement in rheological parameters, thereby increasing flow in microcirculation and positively influencing the metabolism in the retina. Also to a positive effect on the classical, alternative and lectin pathway of complement activation, a reduction in the level of proprotein convertase subtilisin kexin 9 (PCSK9), and thus also the level of LDLcholesterol, and 7) Additional treatment with 2 RHF procedures (so-called "booster therapy") seems to be a safe and suitable method of prolonging the stabilisation phase, or even improving visual acuity, anatomical and functional findings. CONCLUSION: We demonstrated positive changes in anatomical, functional and humoral parameters upon rheopheresis treatment of AMD. Their correlation provides a real possibility to identify patients at risk and to manage an individualised regime of rheopheresis therapy. This method of treatment is effective and safe, with a low percentage of non-serious adverse effects.

• Klíčová slova
• DPED, ERG, dry form of AMD, ellipsoid layer of photoreceptors, rheopheresis,
• MeSH
• lidé MeSH
• makulární degenerace * terapie   MeSH
• plazmaferéza * MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• retina MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• PCSK9 protein, human MeSH Prohlížeč
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH

AIM: The aim of the study was to establish the efficacy of anti VEGF (Vascular Endothelial Growing Factor) drugs in the treatment of wet form ARMD (Age-Related Macular Degeneration) in everyday clinical practice in the Department of Ophthalmology, Faculty Hospital, Hradec Králové, Czech Republic, E.U., in patients registered in the Czech national registry AMADEUS. MATERIAL AND METHODS: Retrospective study with 24 months follow-up period. In the group were evaluated 143 eyes of 140 patients, out of them were 77 women (65.8 %), of average age 73.09 (71.69 - 74.48) years, and 40 men (34.2 %) of average age 74 (58 - 85) years. All of the patients were completely examined before the beginning of the treatment; during the treatment were, except the standardized eye examination, in patients treated with ranibizumab the color fundus photography and Optical Coherence Tomography (OCT) with measuring of the central retinal thickness performed every three months at least. The patients treated by pegaptanib were examined every six weeks before the drug application. The fluorescence angiography (FA) was performed at the beginning of the treatment to establish the type and extension of the choroidal neovascularization and during the treatment in case of necessity to establish the activity of the choroidal neovascular membrane (CNV). The treatment by ranibizumab was in the regimen PRN (pro re nata), and pegaptanib was applied every six months during the first year with the follow-up evaluation of the findings. The treatment evaluations were performed at 12 and 24 months. RESULTS: During the two years follow - up period, the authors noticed in patients treated with ranibizumab loss of 5.12 letters of ETDRS optotypes in case of mostly classical CNV, in occult CNV loss of 5.45 letters, and in minimally classical CNV loss of 2.83 letters. In three evaluated eyes with classical CNV in patients treated with pegaptanib we noticed after 2 years loss of 6.67 letters, in eleven eyes with occult CNV we established loss of 9.91 letters, and in two eyes with minimally classical CNV the average best-corrected visual acuity (BCVA) remained unchanged. The pegaptanib treatment results may be influenced by small number of evaluated patients. The visual acuity changes during the two years treatment were not statistically significant. We noticed the decrease of average CRT (central retinal thickness) in all types of CNV treated both with ranibizumab and pegaptanib after the two years follow up. To reach these results, an average of 5.51 applications of ranibizumab and 9 applications of pegaptanib during the two years were used. CONCLUSION: In the followed-up group we found, comparing to the natural course of neovascular form of ARMD, retarding of the BCVA decrease during the two years treatment with VEGF inhibitors in everyday clinical practice. Better results were achieved with ranibizumab treatment, however the differences were not statistically significant. Key words: age related macular degeneration, AMADEUS Czech national registry, ranibizumab, pegaptanib.

• MeSH
• aptamery nukleotidové aplikace a dávkování   MeSH
• bevacizumab MeSH
• fluoresceinová angiografie MeSH
• fundus oculi MeSH
• humanizované monoklonální protilátky aplikace a dávkování   MeSH
• inhibitory angiogeneze aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• optická koherentní tomografie MeSH
• ranibizumab MeSH
• retrospektivní studie MeSH
• rozvrh dávkování léků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vaskulární endoteliální růstový faktor A antagonisté a inhibitory   MeSH
• vlhká makulární degenerace diagnóza   farmakoterapie   MeSH
• výsledek terapie MeSH
• zraková ostrost účinky léků   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• aptamery nukleotidové MeSH
• bevacizumab MeSH
• humanizované monoklonální protilátky MeSH
• inhibitory angiogeneze MeSH
• pegaptanib MeSH Prohlížeč
• ranibizumab MeSH
• vaskulární endoteliální růstový faktor A MeSH

The conventional polymerase chain reaction (PCR) method to detect the major allergenic protein parvalbumin beta 2 of Atlantic herring (Clupea harengus) and Pacific herring (Clupea pallasii) was developed. The specific set of primers for the amplification of the partial genomic sequence of the pvalb 2 gene encoding the main fish allergen of both herrings was designed and applied to the investigation of 24 commercial fish products. The targeted amplicon size was 189 bp of pvalb 2 gene of Atlantic herring and Pacific herring. As the internal amplification control, the DNA of 18S rRNA gene for eukaryotes (141 bp) was successfully used. The specificity of designed primer pair using 26 various fish species was assessed. The intrinsic detection limit was 10 pg µl(-1) of the present specific DNA. Atlantic herring or Pacific herring allergenic parvalbumins were detected in 22 investigated fish products in conformity with the package declaration. Two fish products were negative in spite of the declaration. The proposed PCR method is specific enough and can be used for the detection of Atlantic and Pacific herrings' major allergen parvalbumin beta 2 in fish food products.

• MeSH
• alergeny analýza   genetika   MeSH
• kontaminace potravin analýza   MeSH
• lidé MeSH
• parvalbuminy analýza   genetika   imunologie   MeSH
• polymerázová řetězová reakce metody   statistika a číselné údaje   MeSH
• potravinová alergie imunologie   MeSH
• rybí proteiny analýza   genetika   imunologie   MeSH
• rybí výrobky škodlivé účinky   analýza   MeSH
• ryby genetika   imunologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Atlantský oceán MeSH
• Tichý oceán MeSH
• Názvy látek
• alergeny MeSH
• parvalbuminy MeSH
• rybí proteiny MeSH

PURPOSE: To evaluate the experience with rheohaemapheresis (RH) in the treatment of age-related macular degeneration (AMD). METHODS: Thirty-eight patients were each treated with 8 procedures of RH (14 males, 24 females). The control group consisted of 34 random patients (30 females, 4 males) with the dry form of AMD but not treated by RH. Our modification of the cascade method (named rheohaemapheresis) was used for plasma separation. After plasma separation (blood cell separator, Cobe Spectra, Denver, CO, USA), the separated plasma was pumped through a rheofilter (Evaflux 4A, Kuraray, Osaka, Japan) to remove lipoproteins and other high-molecular-weight rheologic factors. RESULTS: In treated patients, best-corrected visual acuity (BCVA) increased significantly from 0.61 (0.06-1.00) to 0.68 (0.35-1.00) after 2.5 years (p = 0.035). We found no significant changes or differences in scotopic activity, whereas cone response and paramacular activity in the more peripheral region between 14° and 22° of eccentricity were significantly higher in treated patients after 2.5 years. CONCLUSION: RH therapy favourably influenced BCVA. During 2.5 years after the therapy, no progression of dry to wet AMD was observed in our patients. RH reduced the area of drusenoid retinal pigment epithelium detachment (which increased during the natural course of dry form AMD). RH influenced rheological markers and probably improved metabolism in the affected retinal areas which lead to the aforementioned positive results.

• MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• elektroretinografie MeSH
• lidé MeSH
• lipoproteiny krev   MeSH
• makulární degenerace krev   diagnóza   patofyziologie   terapie   MeSH
• noční vidění MeSH
• obnova funkce MeSH
• optická koherentní tomografie MeSH
• prediktivní hodnota testů MeSH
• progrese nemoci MeSH
• reologie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• separace krevních složek metody   MeSH
• viskozita krve MeSH
• výsledek terapie MeSH
• zraková ostrost MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• biologické markery MeSH
• lipoproteiny MeSH

AIM: To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-related macular degeneration (ARMD) indicated for the intravitreal application of Ranibizumab (Lucentis, Novartis Pharma AG). To evaluate the efficacy of combined local preparation with broad-spectrum antibiotic moxifloxacine 0.5% (Vigamox, Alcon) and povidone iodine solution, 5% (Betadine, Egis Pharmaceuticals, LTD.) and to evaluate subjective toleration of moxifloxacin. MATERIALS AND METHODS: In a prospective, non-randomized study were evaluated 20 eyes of 20 patients treated by means of intravitreally-applied ranibizumab. In all patients, the swabs from the conjunctival sac of the treated eye were repeatedly taken in a given time-schedule--before the start of using moxifloxacin, on the day of the intravitreal application of ranibizumab--before the irrigation of the conjunctival sac with povidone iodine solution, 5%, further after the irrigation--immediately before the injection and the control was token three days after the intravitreal injection. At the same time, the moxifloxacine toleration was evaluated by a questionnaire. RESULTS: The samples taken from the conjunctival sac of the treated eye before the application of moxifloxacine had positive bacterial culture in 17 eyes (85%) and negative culture in 3 eyes (15 %). Furthermore, in 2 eyes with positive culture, there was established resistance to moxifloxacine. After 3 days of moxifloxacine application, there was negative culture in 13 eyes (65%), in 7 eyes (35%) was the bacterial cultivation positive. After the irrigation with povidone iodine 5% solution was the cultivation negative in 17 eyes (85%), positive cultivation was in 3 eyes (15%); in all three cases, the cultures were susceptible to moxifloxacine. Three days after the intravitreal injection, the negative cultivation from the conjunctival sac was found in 13 eyes (65%), and in 7 eyes was the cultivation positive; the cultivated bacteria were moxifloxacine susceptible. Subjective symptoms after moxifloxacine application were reported by 10 patients altogether; 5 patients were without symptoms and 5 patients did not return the questionnaire. On average, the symptoms started the second day of moxifloxacine treatment and the average grade of symptoms was 1.6 on the scale from 0 to 5. CONCLUSION: In our group we found a broad spectrum of microorganisms colonizing the conjunctival sac of patients indicated to the ARMD intravitreal treatment. After the prophylaxis with moxifloxacine, the incidence of positive bacterial cultivation decreased and the povidone iodine 5% solution irrigation this effect increased. The most common pathogen species was Staphylococcus coagulasis negative. Although the resistance to moxifloxacine in two different bacteria in two eyes in the beginning of observation was established, after moxifloxacine treatment, the cultivation of these bacteria in both eyes was negative, and in all other cases the cultivated bacteria were susceptible to moxifloxacine.

• MeSH
• antibakteriální látky aplikace a dávkování   MeSH
• aza sloučeniny aplikace a dávkování   MeSH
• Bacteria izolace a purifikace   MeSH
• bakteriální léková rezistence MeSH
• chinoliny aplikace a dávkování   MeSH
• fixní kombinace léků MeSH
• fluorochinolony MeSH
• humanizované monoklonální protilátky aplikace a dávkování   MeSH
• injekce intravitreální * MeSH
• jodovaný povidon aplikace a dávkování   MeSH
• konjunktiva mikrobiologie   MeSH
• lidé MeSH
• moxifloxacin MeSH
• ranibizumab MeSH
• senioři MeSH
• vlhká makulární degenerace farmakoterapie   mikrobiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky MeSH
• aza sloučeniny MeSH
• chinoliny MeSH
• fixní kombinace léků MeSH
• fluorochinolony MeSH
• humanizované monoklonální protilátky MeSH
• jodovaný povidon MeSH
• moxifloxacin MeSH
• ranibizumab MeSH

Case report of the different visual functions of the right and left eye of 60-years old man with Stargardt disease is presented. The difference in best corrected visual acuity between both eyes is accompanied with corresponding various alteration of the central retinal activity using multifocal electroretinography (mfERG) and asymmetrical defects of the IS/OS photoreceptor junction using HD-OCT.

• MeSH
• elektroretinografie MeSH
• fotoreceptory obratlovců patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• optická koherentní tomografie MeSH
• retinální dystrofie patologie   patofyziologie   MeSH
• zraková ostrost MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The authors present new possibilities in the treatment of the macular edema caused by the retinal venous occlusions; these occlusions are the second most common retinal vessel disease. The earlier possibilities of the treatment were focused on the macular edema laser treatment, laser panretinal photocoagulation in case of retinal or iris neovascularization presence, and the disease's risk factors compensation. In the presence, the intravitreal application of corticosteroids or anti VEGF A preparations are more used for the treatment because of better results, as proved by means of randomized, clinical studies.

• MeSH
• lidé MeSH
• makulární edém farmakoterapie   etiologie   MeSH
• okluze retinální žíly komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Diabetic retinopathy is an important microvascular complication of diabetes as it threatens the vision. Diabetic maculopathy is the main cause of legal blindness in the adult population in western countries. The examination method involves digital fundus photography that enables comparison of the incidence, number as well as the size and the shape of pathological foci on the retina during patient visits. It, however, does not depict one important change--chronic retinal ischemia. This is identified using contrast imaging--fluorescein angiography (FAG). Administration of a contrast medium--fluorescein--into cubital vein enables depiction of non-perfused regions of the retina that form the basis for laser therapy indication as part of the prevention of proliferative diabetic retinopathy. Optical coherence tomography (OCT), during which an optical beam makes a cross-section through all 10 layers of the retina, is an important advance in the diagnostics of diabetic macular oedema. The spectral OCT (S-OCT) in particular is an analogy of a histological examination of retina but on a living tissue. RESULTS: Owing to the advances in examination techniques and treatment methods, diabetic neuropathy can now be diagnosed and treated. Early diagnosis of vascular and, consequently, tissue changes in the retina, and in its midsection in particular, is a prerequisite. Tight control of diabetes and the risk factors is sufficient to maintain good visual acuity in patients with intact inner blood-retinal barrier. In collaboration with a diabetologist, fenofibrates are used as the first line treatment when the inner blood-retinal barrier is disturbed (damaged tight junctions between endothelial cells of retinal vessels). To reduce focal macular oedema, the sources of fluid leakage into central retina are occluded using laser interventions on microaneurysms. In diffuse macular oedema, a more intensive laser technique using grid laser coagulation is applied to the central region as well as the surrounding areas of non-perfused retina. It is our view that major macular oedemas often result from an occlusion of a branch of retinal or macular venule. This is why we recommend complementing, in collaboration with a diabetologist, laser treatment of macular oedema with trombolytics. The aim of diabetic macular oedema treatment is its early elimination to avoid irreversible damage to the outer segments and later to photoreceptor cells. These changes are the main cause of the previously mentioned legal blindness in diabetic patients and are well identifiable on S-OCT. DISCUSSION: Laser therapy is the gold standard in the treatment of diabetic macular oedema as well as diabetic retinopathy. However, efficacy is lacking if diabetes and the risk factors are not tightly controlled. Instead of laser therapy to treat diabetic macular oedema with or without macular traction, some authors use a more expensive and more complicated surgery technique (pars plana vitrectomy with internal limiting membrane peeling) performed at early stages of the disease. CONCLUSION: Prevention of microangiopathy of retinal vessels through tight compensation of diabetes and the risk factors form the basis of successful treatment of diabetic retinopathy and maculopathy. At present, we are able to successfully treat developed diabetic retinopathy as well as maculaopathy, including stabilisation of visual function, subject to early diagnosis of retinal changes.

• MeSH
• diabetická retinopatie diagnóza   prevence a kontrola   chirurgie   MeSH
• fluoresceinová angiografie MeSH
• laserová koagulace MeSH
• lidé MeSH
• makulární edém diagnóza   chirurgie   MeSH
• optická koherentní tomografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: The age related macular degeneration (ARMD) is the most common cause of practical blindness in the population older than 60 years of age. Usually it starts as a dry form with soft drusen.The progression of the dry form is difficult to control-promising seems to be the influence of rheologic factors in the choroid and the retina and thus improvement of their blood flow. AIM: By means of haemorheopheresis to improve blood rheology and thus micocirculation in the choroid and retina. The authors describe the development of the dry form of the ARMD in the sensitive stage with soft drusen and the eventual presence of retinal pigment epithelium detachment (RPED) after haemorheopheresis. The treated patients were compared with a control group (natural course of the ARMD) with the same number of patients. METHODS: In a prospective, randomized study, comprising of 16 patients with the dry form of ARMD were treated with haemorheopheresis (cascade filtration) and 16 patients in the control group. Haemorheopheresis treatment comprised of 8 cycles in 10 weeks. Plasma obtained by separator was filtered by the Evaflux 4A (Japan) separator, where, the defined spectrum of high molecular proteins was captured. This lead to a decrease in blood and plasma viscosity and thus to improvement of rheologic conditions of the retina. RESULTS: Results show a positive influence on the absorption of soft drusen, reduction of the retinal pigment epithelium detachment, and the possibility to improve the visual acuity of the treated patients. CONCLUSION: Comparing to the worsening of clinical signs and visual functions in natural course of the ARMD development, the rheopheresis as well tolerated method may cause the retardation or stop of the unfavorable course of the disease.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• makulární degenerace patologie   patofyziologie   terapie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• separace krevních složek * MeSH
• zraková ostrost MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Rheological conditions basically influence tissue perfusion, oxygen and nutrient supply, tissue regeneration and in its consequence the course of pathological processes, especially in microcirculation and partially even in macrocirculation. Haemorheotherapy has shown to be successful in several indications (critical disorders in microcirculation) when other methods of therapy have failed. In this study we describe the changes of effectivity indicators in haemorheopheresis treatment and their clinical importance in cases of eye microcirculation, statoacoustic apparatus and disorders of the lower extremities. We treated with haemorheopheresis (separator Cobe.Spetra + Evaflux filter) 24 patients (16 patients with age related macular degeneration, 5 with critical peripheral arterial foot disease, and 3 with acute hearing loss). After the procedures alpha2-macroglobulin decreases by about 58%, fibrinogen by about 69%, IgM by about 61%, LDL-cholesterol by about 77%, apolipoprotein B by about 76% and lipoprotein(a) by about 63%. It corresponds with a decrease in blood and plasma viscosity and clinical improvement in the observed patients, i.e. visual improvement, acceleration of tissue defect healing and improvement in hearing. We noticed 7.1% clinically insignificant side-effects. The method of haemorheopheresis was safe. It led to improvement in patients' clinical condition in the above mentioned indications when other methods of treatment failed.

• MeSH
• hyperlipidemie terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• makulární degenerace krev   terapie   MeSH
• mikrocirkulace fyziologie   MeSH
• náhlá nedoslýchavost krev   terapie   MeSH
• noha (od hlezna dolů) krevní zásobení   patofyziologie   MeSH
• obnova funkce MeSH
• onemocnění periferních cév krev   terapie   MeSH
• plazmaferéza * MeSH
• senioři MeSH
• vředy na noze (od hlezna dolů) terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH