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.
AIM: The aim of the study is to retrospectively evaluate the anatomical success rate and functional results of 25G+ PPV in the treatment of newly diagnosed rhegmatogenous retinal detachment (RRD). MATERIAL AND METHODS: The set consists of 152 eyes of 152 patients, of which 71 (47%) were men, average age 54 years, operated on by one surgeon for RRD at the Eye Clinic of the University Hospital and Medical Faculty of Masaryk University Brno from 1.7.2019 to 4.5.2021 using the 25G+ PPV technique. 25G+ PPV with pre-equatorial cerclage was performed on 7 patients. The patients' anamnesis included blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens. The cause of RRD was retinal tear/s, regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grade A-D2 was admissible. Patients with a history of penetrating ocular trauma were excluded. The postoperative findings and functional outcomes of the patients were evaluated 1-3 months after PPV. The operation was anatomically successful if the retina was fully attached. Final visual acuity (VA) was evaluated for each patient. The final visual acuity examination was carried out typically on a Snellen optotype, either without correction, with the patient's own spectacle correction or with correction according to the current values on the autorefractometer. The arithmetic average was used for the numerical expression of the attained results, and the numerical values were also expressed in percentages. Since the different groups were not compared with each other, no statistical test was necessary to analyze the results. RESULTS: In 150 (98.7%) of the 152 patients in the group, we achieved complete retinal reattachment, in 2 (1.3%) patients the retina remained detached, and we recorded anatomical failure of the treatment. Fifty (33%) patients achieved VA ≥ 4/8. CONCLUSION: In 133 (87.5%) patients, we are able to state anatomical success even without the presence of intraocular tamponade in the operated eye. These patients can be considered completely cured. 25G+ PPV has demonstrated its contribution to resolving RRD.
- MeSH
- bukláž skléry škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- odchlípení sítnice * etiologie MeSH
- poranění oka * komplikace MeSH
- retina chirurgie MeSH
- retrospektivní studie MeSH
- vitrektomie škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM: To report the clinical results of treatment of patients with retinal tears or holes, including rhegmatogenous retinal detachment, who were treated primarily with laser retinopexy. MATERIAL AND METHODS: The effect and results of the therapy of patients with one or more retinal tears who underwent therapy with the green laser IQ 532 IRIDEX between December 2019 and August 2022 at our center with a follow-up observation period of at least 3 months were retrospectively evaluated. RESULTS: A total of 14 eyes of 14 patients were treated by this method during the monitored period. All the tears found were primarily successfully repaired. The overall success rate of prophylaxis of rhegmatogenous retinal detachment was 93% in our cohort. In one patient, subsequent pars plana vitrectomy was required due to the progression of retinal detachment from another biomicroscopically inaccessible hole, which was part of lattice degeneration in the peripheral part of the retina. This pathology was only verified during intraocular surgery. Postoperatively, the retina was attached with a very good anatomical and functional effect. The other patients did not require any adjuvant therapy. Visual functions improved or remained stable in all patients in the cohort. The follow-up observation period ranged from 3 to 36 months. CONCLUSION: Laser retinopexy is a sparing, safe and effective method of retinal tear therapy. From our clinical experience, the technique is also applicable in the case of partial vitreous hemorrhage or incipient rhegmatogenous detachment. We did not record any complications of perioperative or postoperative treatment among our patients.
- Klíčová slova
- IRIDEX, Retinal detachment, hemovitreus, laser, photocoagulation, retinal tear,
- MeSH
- laserová terapie * škodlivé účinky MeSH
- lidé MeSH
- odchlípení sítnice * chirurgie etiologie MeSH
- perforace sítnice * chirurgie MeSH
- retina chirurgie MeSH
- retrospektivní studie MeSH
- vitrektomie škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Stickler syndrome (STL) is an inherited progressive connective tissue collagen disorder. STL is the most common hereditary cause of retinal complications, retinal tears, and the development of retinal detachment (RD) in childhood. The aim of the study was to evaluate the long-term anatomical and functional results of surgical treatment of retinal complications in children and adolescents affected by STL. METHODS: A retrospective, single-center study was performed a cohort of children with STL who underwent retinal surgery between 2004 and 2021. RESULTS: The study group consisted of nine children; the mean age at the time of the retinal tear with/without retinal detachment was 7.2 (2-10) years, and the mean follow-up period was 9.6 (5-16) years. Pathogenic variants COL2A1 (5 children) and COL11A1 (3 children) were confirmed in our cohort. In total, we operated on 13 eyes, 11 eyes with complicated RD and two eyes with multiple retinal defects, but without RD. At the end of the follow-up period, an attached retina was achieved 77% (10 eyes) with or without silicone oil tamponade: cryopexy alone was successful in one eye (10%), scleral buckling (EB) in five eyes (50%), and vitrectomy with silicone oil tamponade combined with EB in four eyes (40%). The mean number of surgeries was 2.3 per eye. The resulting best corrected visual acuity ranged from 0.03 to 0.1 in one eye, from 0.16 to 0.4 in two eyes, and from 0.5 to 1.0 in 7 eyes. CONCLUSION: Repair of retinal tears with/without retinal detachment in patients with Stickler syndrome often requires multiple surgeries with combinations of cryopexy, scleral buckling, and/or vitrectomy with silicone oil tamponade. Treatment of the ocular complications arising from STL requires long-term comprehensive care.
- Klíčová slova
- COL11A1, COL2A1, Child, Retinal complication, Retinal detachment, Retinal surgery, Stickler syndrome,
- MeSH
- bukláž skléry MeSH
- dědičné nemoci očí * chirurgie MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- odchlípení sítnice * diagnóza etiologie chirurgie MeSH
- perforace sítnice * chirurgie MeSH
- retina patologie MeSH
- retrospektivní studie MeSH
- silikonové oleje MeSH
- vitrektomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- silikonové oleje MeSH
PURPOSE: Retinal vasoproliferative tumor is one of the benign vascular tumors which in advanced stages leads to exudative retinal detachment with the formation of epiretinal and subretinal membranes. In such advanced stages, one of the therapeutic options is pars plana vitrectomy. This article presents the case of a patient on whom was performed 23-gauge pars plana phacovitrectomy with en bloc resection of the tumor followed by histological confirmation. CASE REPORT: A 70-year-old patient with a one-year history of unilateral loss of vision in his left eye was admitted to our clinic for examination in February 2018. At admission, the best corrected visual acuity in the right eye was 1.0, and in the left eye was light perception. Based on the clinical picture, sonographic examination of the eye, and fluorescein angiography, the patient was diagnosed with a retinal vasoproliferative tumor. Due to the advanced stage of disease, we proceeded with surgical intervention. We performed 23-gauge phacovitrectomy with a bloc resection of the tumor. Subsequent histological examination confirmed the presence of the presumed tumor. The follow-up exam a few months later showed a completely attached retina with silicone oil tamponade, without exudative retinopathy. However, the best corrected visual acuity improved only slightly to the ability to count fingers at one meter. CONCLUSION: Pars plana vitrectomy with en bloc resection of retinal vasoproliferative tumor is one of the therapeutic modalities in advanced stages.
- Klíčová slova
- en bloc resection, exudative retinal detachment, pars plana vitrektomy, retinal vasoproliferative tumor,
- MeSH
- fluoresceinová angiografie škodlivé účinky MeSH
- lidé MeSH
- odchlípení sítnice * etiologie MeSH
- retina patologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- vitrektomie * škodlivé účinky MeSH
- zraková ostrost MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients. MATERIAL AND METHODS: The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test. RESULTS: Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 μm (median -37.5 μm), -84.3 μm (median -85 μm) and -109.3 μm (median -81 μm) in patients treated with ranibizumab, and -46.3 μm (median -30 μm, p = 0.389), -127.7 μm (median -104 μm, p = 0.096) and -204.4 μm (median -163 μm, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891). CONCLUSION: We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.
- Klíčová slova
- aflibercept, age related macular degeneration, age-related macular degeneration, intraretinal fluid, pigment epithelium detachment, ranibizumab, subretinal fluid,
- MeSH
- inhibitory angiogeneze farmakologie terapeutické užití MeSH
- injekce intravitreální MeSH
- lidé MeSH
- odchlípení sítnice * diagnóza MeSH
- optická koherentní tomografie MeSH
- ranibizumab terapeutické užití MeSH
- receptory vaskulárního endoteliálního růstového faktoru MeSH
- rekombinantní fúzní proteiny terapeutické užití MeSH
- retinální pigmenty terapeutické užití MeSH
- retrospektivní studie MeSH
- vaskulární endoteliální růstový faktor A MeSH
- vlhká makulární degenerace * diagnóza farmakoterapie MeSH
- zraková ostrost MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- aflibercept MeSH Prohlížeč
- inhibitory angiogeneze MeSH
- ranibizumab MeSH
- receptory vaskulárního endoteliálního růstového faktoru MeSH
- rekombinantní fúzní proteiny MeSH
- retinální pigmenty MeSH
- vaskulární endoteliální růstový faktor A MeSH
PURPOSE: To determine the efficacy of pars plana vitrectomy (PPV) in children with intraocular hemorrhage (IOH) secondary to Abusive head trauma (AHT). METHODS: A long-term retrospective analysis evaluating epidemiology, management, safety, anatomical and functional results of PPV for IOH in children with AHT at tertiary referral center for children in the Czech Republic from 2004 to 2017. RESULTS: 18 children were identified with IOH due to AHT during observation period of 14 years. Overall incidence of IOH related to AHT was 29.6/100 000, in children under 1 year 22.2/100 000, in children 1 to 5 years 7.4/100 000. Mean age at the time of diagnosis was 13.7 (SD±20.53) months, median 5 months. IOH resolved in 56% of children, 64% eyes, spontaneously. 44% children, 36% eyes, underwent PPV. PPV was performed 30.5 (SD±16.98) days after established diagnosis on average. Postoperatively, 80% of eyes had anatomical improvement, 20% eyes had preexisting irreversible changes in the posterior pole. Vision of 50% eyes improved after surgery, vision of 20% eyes remained poor, 30% of eyes was not possible to test due to severe neurological impairment. Mean observational period was 33.4 (SD±38.21) months. Mortality rate of AHT in our group was 17%, all victims were younger 4 months. CONCLUSIONS: PPV is a safe and effective procedure to clear IOH in children with AHT. Ophthalmology outcomes are strongly associated with degree of neurological impairment. Best outcomes were achieved with PPV performed between 2 and 5 weeks after trauma. Opportunity to plan surgery within this time frame indicates a good neurological prospect and prevents deprivation amblyopia.
- Klíčová slova
- Abusive head trauma, intraocular hemorrhage, pars plana vitrectomy, retinal hemorrhage, shaken baby syndrome, vitreous hemorrhage,
- MeSH
- dítě MeSH
- kraniocerebrální traumata * chirurgie MeSH
- lidé MeSH
- odchlípení sítnice * chirurgie MeSH
- retrospektivní studie MeSH
- vitrektomie MeSH
- zraková ostrost MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Knobloch syndrome is an autosomal recessive phenotype mainly characterized by retinal detachment and encephalocele caused by biallelic pathogenic variants in the COL18A1 gene. However, there are patients clinically diagnosed as Knobloch syndrome with unknown molecular etiology not linked to COL18A1. We studied an historical pedigree (published in 1998) designated as KNO2 (Knobloch type 2 syndrome with intellectual disability, autistic behavior, retinal degeneration, encephalocele). Whole exome sequencing of the two affected siblings and the normal parents resulted in the identification of a PAK2 non-synonymous substitution p.(Glu435Lys) as a causative variant. The variant was monoallelic and apparently de novo in both siblings indicating a likely germ-line mosaicism in one of the parents; the mosaicism, however, could not be observed after deep sequencing of blood parental DNA. PAK2 encodes a member of a small group of serine/threonine kinases; these P21-activating kinases (PAKs) are essential in signal transduction and cellular regulation (cytoskeletal dynamics, cell motility, death and survival signaling and cell cycle progression). Structural analysis of the PAK2 p.(Glu435Lys) variant that is located in the kinase domain of the protein predicts a possible compromise in the kinase activity. Functional analysis of the p.(Glu435Lys) PAK2 variant in transfected HEK293T cells results in a partial loss of the kinase activity. PAK2 has been previously suggested as an autism-related gene. Our results show that PAK2-induced phenotypic spectrum is broad and not fully understood. We conclude that the KNO2 syndrome in the studied family is dominant and caused by a deleterious variant in the PAK2 gene.
- MeSH
- degenerace retiny * genetika patologie MeSH
- encefalokéla diagnóza genetika patologie MeSH
- HEK293 buňky MeSH
- lidé MeSH
- mutace MeSH
- odchlípení sítnice * vrozené genetika MeSH
- p21 aktivované kinasy genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- p21 aktivované kinasy MeSH
- PAK2 protein, human MeSH Prohlížeč
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.
- Klíčová slova
- deep posterior sclerotomy, secondary retinal detachment, uvea, uveal effusion syndrome,
- MeSH
- exsudáty a transsudáty MeSH
- lidé MeSH
- nemoci choroidey * diagnóza terapie MeSH
- odchlípení sítnice * diagnóza chirurgie MeSH
- senioři MeSH
- skléra MeSH
- syndrom uveální efuze * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: To assess the effect of intravitreal aflibercept on pigment epithelial detachment (PED) secondary to occult choroidal neovascularization (CNV) in treatment-naive patients. PATIENTS AND METHODS: Retrospective analysis of thirty-six patients (thirty-eight eyes) with mean age 77 (SD ± 7), who were treated with aflibercept 2.0 mg (Eylea, Bayer) at the Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague. All patients were treated in fixed regimen, which means 3 loading doases 1 month apart, followed by further 2-monthly doses over total 12-month period. Best corrected visual acuity (BCVA) was evaluated on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Diameters as PED height, width and central retinal thickness (CRT) were assesed using spectral-domain optical coherence tomography. All previously mentioned were analyzed et the baseline and than at every visit. Therapy complications were also evaluated. RESULTS: Borderline significant improvement in the mean of BCVA score of 3.2 letters (SD ± 11.6, p = 0.05) at the end of follow-up period was observed. Mean PED height at 12 months significantly decreased by 140 µm (SD ± 238, p < 0.01). Reductions in PED height were correlated with reductions in central macular thickness (R = 0.94, p < 0.001) simultaneously with PED width (R = 0.45, p < 0.01). There was no significant correlation between PED height decrease and visual acuity. PED rupture was observed in 3 eyes (8 %). CONCLUSION: Aflibercept intravitreal therapy in fixed regimen in patients with PED secondary to occult CNV shows great anatomical effect. However, correlation between PED diameters and visual acuity was not observed.
- Klíčová slova
- aflibercept, anti-VEGF, occult CNV, pigment epithelial detachment,
- MeSH
- inhibitory angiogeneze terapeutické užití MeSH
- injekce intravitreální MeSH
- lidé MeSH
- odchlípení sítnice * komplikace farmakoterapie MeSH
- optická koherentní tomografie MeSH
- receptory vaskulárního endoteliálního růstového faktoru terapeutické užití MeSH
- rekombinantní fúzní proteiny terapeutické užití MeSH
- retinální pigmentový epitel * MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- aflibercept MeSH Prohlížeč
- inhibitory angiogeneze MeSH
- receptory vaskulárního endoteliálního růstového faktoru MeSH
- rekombinantní fúzní proteiny MeSH
