PURPOSE: To report a case of patient with Miller Fisher syndrome, complicated by simultaneous bilateral acute angle-closure glaucoma in her slightly (+1.5) hyperopic eyes. METHODS: We present a case report of a 71-year-old female patient presenting with total ophthalmoplegia, areflexia, ataxia and bilateral acute angle-closure glaucoma. RESULTS: The initial ocular examination revealed hand motion in the both eyes and oedematic corneas. Initial intraocular pressure was immeasurable high (measurment by Tonopen Avia). Measurement was possible after intravenous Mannitol 20 % infusion on both eyes as 54 and 56 mm Hg, respectively. Local medical therapy of pilocarpine, timolol, dorsolamide and dexamethasone improve intraocular pressure into normal limits within several hours. Prophylactic peripheral Nd-YAG laser iridotomy was performed on a both eyes two days later. Systemic treatment involved plasma exchange and rehabilitation program. Subsequent cataract surgery on both eyes with posterior capsule lens implantation improve the best corrected visual acuity on right eye from 0.5 to 1.0 and the left eye from 0.5 to 0.8, respectively. Intraocular pressure is within normal limits without any glaucoma therapy. Follow up period is three years. CONCLUSIONS: This is the second reported case of patient with Miller Fisher syndrome and simultaneous bilateral acute angle-closure glaucoma and the fifth reported case of Miller Fisher syndrome and acute angle-closure glaucoma. Treatment for both conditions made a very good recovery.

• Klíčová slova
• Miller Fisher syndrome, acute angle-closure glaucoma, bilateral acute angle-closure glaucoma,
• MeSH
• glaukom s uzavřeným úhlem komplikace   terapie   MeSH
• laserová terapie * MeSH
• lidé MeSH
• Miller Fisherův syndrom komplikace   MeSH
• nitrooční tlak MeSH
• senioři MeSH
• tonometrie oční MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Secondary uveitic glaucoma is a serious sight-threatening complication of intraocular inflammation (uveitis). It develops in approximately 10-20% of patients with uveitis (although this figure may be higher depending on the type of inflammation). It is more commonly associated with chronic forms of uveitis, especially anterior uveitis. Elevation of intraocular pressure (IOP) and the development of secondary glaucoma arise as a direct or indirect consequence of uveitis, and may develop further in association with therapy for intraocular inflammation. Several types of uveitic glaucoma are distinguished according to the mechanism of development: open-angle secondary glaucoma (including steroid-induced secondary glaucoma), angle-closure secondary glaucoma, and a combination of both. It is necessary to determine the pathogenesis of uveitis and target the treatment of the inflammatory process according to it. Subsequently, it is necessary to determine the type of secondary glaucoma, which influences the choice of therapy. Compensation for IOP should be achieved as quickly as possible, before irreversible damage to the optic nerve and visual field occurs. In the first instance, we choose conservative pharmacological therapy. However, this therapy fails more often in secondary uveitic glaucoma than in primary open-angle glaucoma. For this reason, surgical or laser therapy is necessary for refractory glaucoma. Trabeculectomy remains the gold standard in surgical therapy for secondary uveitic glaucoma, but other surgical techniques can also be used (Ahmed drainage implants, goniotomy in the paediatric population, surgical iridectomy, and synechiae for angle closure etc.). The choice of method is individualised according to the clinical findings of the patient and previous ocular procedures. However, the main factor influencing the success and efficacy of filtration surgery is adequate therapy and control of the intraocular inflammatory process.

• Klíčová slova
• Uveitis, secondary uveitic glaucoma, therapy of secondary uveitic glaucoma, uveitis,
• MeSH
• dítě MeSH
• glaukom s otevřeným úhlem * MeSH
• glaukom s uzavřeným úhlem * MeSH
• glaukom * MeSH
• lidé MeSH
• nitrooční tlak MeSH
• trabekulektomie * MeSH
• zánět MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma. CASE REPORT: The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure. CONCLUSION: The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.

• Klíčová slova
• Epilepsy, Migraine, acute myopia, angle-closure glaucoma, epilepsy, migraine, topamax, topiramate,
• MeSH
• fruktosa škodlivé účinky   MeSH
• glaukom s uzavřeným úhlem * chemicky indukované   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nitrooční tlak MeSH
• tonometrie oční MeSH
• topiramat škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• fruktosa MeSH
• topiramat MeSH

PURPOSE: The objective of the study is to evaluate of primary open-angle glaucoma (POAG) with the use of EX-PRESS drainage implant. Evaluated was the decrease of intraocular pressure (IOP), visus stabilization, perimeter Humphrey - related finding (T 30-2), Heidelberg Retina Tomograph (HRT) and possibility of reducing the local drug therapy. PATIENTS AND METHODS: Retrospective data analysis was performed in 40 eyes with POAG in 28 subjects (14 female- and 14 male patients) average-aged 69.5 years. In all 40 eyes, surgery was performed by one surgeon within the years 2011-2017. Indications for EX-PRESS implantation in our study were the POAG with decompensated IOP, decompensated chronic secondary glaucoma or failure previously anti-glaucoma surgical operations. Within the preoperative period, in all cases the progression was observed on the perimeter T 30-2 or on the HRT. Before and after surgery, all 40 eyes were evaluated for the following factors: the IOP, visus, pachymetry, therapy by anti-glaucomatic drugs and regular inspections of the perimeter and HRT. The average post-surgery following-up time in our total of patients was 3 years and 8 months. The identified data of our total of patients were statistically processed using the Wilcoxon Signed-Rank Test. RESULTS: The average pre-surgery IOP was 21.4 mm Hg, 6 months post-surgery 11.2 mm Hg, and 13.2 mm Hg at the last inspection. Pre-surgery anti-glaucoma therapy: monotherapy in 2 eyes, dual therapy in 25 eyes, triple therapy in 13 eyes. Post-operatively without the need of therapy were 19 eyes, the need for monotherapy in 7 eyes, dual therapy in 13-eyes and triple therapy in 1 eye. During the last inspection of the perimeter or HRT within the postoperative period, we identified stationary finding in 39 eyes and only a mild progression in 1 eye. Peroperatively, we have not identified any serious complications. Within the postoperative period, we observed choroid ablation in 10 eyes as recovered within 6-7 days. As a more serious complication, we noted endophthalmitis in 1 eye on the background of generalized lichen planus complicating skin disease. In 5 eyes within the late postoperative period we found occlusion of lateral orifices in the EX-PRESS implant by the fibrotic tissue, the 4 eyes developed cataracts, and the eyeball hypotonia persists in 1 eye at the level of 5 torr without affecting the visus of the operated eye. CONCLUSION: It outflows from the above results that the use of EX-PRESS implant in the surgery of glaucoma is an effective and safe method with a minimal number of complications.

• Klíčová slova
• EX-PRESS implant, filtering surgery, filtering surgery EX-PRESS implant., primary open-angle glaucoma,
• MeSH
• drenážní implantáty glaukomové * MeSH
• glaukom s otevřeným úhlem * chirurgie   MeSH
• lidé MeSH
• následné studie MeSH
• nitrooční tlak MeSH
• retrospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The study provides an up-to-date overview of pathogenesis, functional and structural changes in normal tension glaucoma (NTG) and its differences from high tension glaucomas (HTG). The authors point to less known facts which make both diagnostic groups different. First of all, there are electrophysiological findings that verify pathology in the complete visual pathway in HTG in contrast to NTG where the retinal ganglion cell response is relatively normal but the abnormalities are in the visual pathway. This corresponds to the findings of functional magnetic resonance imaging of the brain with a significant decrease in activity in HTG compared to NTG. We found a higher decrease in activity in HTG following application of the colour paradigm compared to NTG where we did not see a similar difference. We also investigated the central corneal thickness (CCT) in both diagnostic groups. We did not find a statistically significant difference. However, we found the effect of CCT on progression of the changes in visual fields in HTG. In relation to suspicion of abnormally low cerebrospinal pressure and a possible cerebrovascular fluid flow disturbance in NTG, we examined the optic nerve thickness (OND) and optic nerve sheath diameter (OSD) at a distance of 4, 8, 16 and 20mm from the posterior pole of the eye. In the comparison with the healthy population, we did not find any abnormalities except for the width of the optic chiasma that was markedly lower in NTG. In relation to a possible impairment of cerebral perfusion we determined the degrees of cerebral atrophy using magnetic resonance imaging by measuring the bicaudate ratio (BCR) and white matter lesions using the Fazekas scale. We did not find a difference between HTG and NTG in BCR. We found statistically significant changes in BCR which correlated with the changes in visual fields. The higher values of the pattern defect were associated with increased brain atrophy (BCR). We did not detect similar relations in the Fazekas scale. We found a significant difference in this parameter among NTG, HTG and a control group. We found the most advanced changes in the patients with HTG. Conclusion: In HTG, impairment of retinal ganglion cells and subsequently also their axons, including visual cortex occurs because of a high intraocular pressure. In NTG, the retinal ganglion cells are relatively normal like the visual cortex, but alteration occurs in their axons. The cause is not a high intraocular pressure but most probably ischemia.

• Klíčová slova
• differences from high tension glaucomas, normal tension glaucoma, structural and functional changes,
• MeSH
• discus nervi optici * MeSH
• glaukom s otevřeným úhlem * diagnóza   terapie   MeSH
• glaukom * MeSH
• lidé MeSH
• nitrooční tlak MeSH
• optická koherentní tomografie MeSH
• testy zrakového pole MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The purpose of the study was to evaluate influence of betaxolol, brimonidine and carteolol in the progression of the visual field defects during time at patients with normotensive glaucoma (NTG). MATERIALS AND METHODS: This study included (60 eyes of) 30 patients with NTG. First group consisted of 20 eyes of 10 patients of the average age of 58.5 years, who were treated by betaxolol. Second group also consisted of 20 eyes of 10 patients of the average age of 62.6 years and they were treated by brimonidine. Third group had the same count of the eyes and patients, the average age was 61.1 years and these patients were treated by carteolol. Diagnose of NTG was based on the comprehensive ophthalmological examination including electroretinography and visual evoked potentials. Visual fields were examined by fast threshold glaucoma test using Medmont M700 device. We compared pattern defect (PD) in the visual field for 3 years. The including criteria were: similar visual field findings at the beginning of the study, stable eye therapy (treatment was not changed during the study), uncorrected or best corrected (up to +-3 D) visual acuity of 1,0 of ETDRS, intraocular pressure between 10-15 mm Hg, if present, then compensated cardiovascular disease, no other internal or neurological disorders. RESULTS: We didnt notice any statistically important difference of PD. The study revealed that brimonidin (p=0,99) and betaxolol (p = 0,81) had the best effect. CONCLUSION: Local therapy of betaxolol, brimonidine and carteolol has an essential clinical value in normotensive glaucoma. All the mentioned treatments had a protective effect on the visual field. However, local side-effects of brimonidinu are a question.

• Klíčová slova
• betaxolol, brimonidin, brimonidin and carteol treatment, normotensive glaucoma, pattern defect,
• MeSH
• betaxolol MeSH
• glaukom s otevřeným úhlem * MeSH
• glaukom * MeSH
• karteolol * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nitrooční tlak MeSH
• zrakové evokované potenciály MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• betaxolol MeSH
• karteolol * MeSH

AIMS: The aim of the work is to verify the necessity of full-field perimetry test in incipient glaucoma. MATERIAL AND METHODS: The study included group of 16 incipient hypertension glaucoma (HTG group) patients without obvious changes in visual field and control group of 10 patients with normal ocular findings and value 1.0 of visual acuity. In both groups, full-field perimetry test was performed followed by a glaucoma perimetry test (rapid threshold strategy in both cases). Evaluated parameters were pattern defect (PD) and overall defect (OD) using Pearsons correlation coefficient. RESULTS: Strong correlation coefficient between PD (r = 0.74) and OD (r = 0.63) of both perimetry test were found in HTG group. Moderate correlation of PD (r = 0.54) and strong correlation of OD (r = 0.64) in control group. CONCLUSION: Results of the study shows, that expected changes of peripheral visual field will be recorded first in HTG group, but opposite is true. Perimetry glaucoma test is for incipient glaucoma sufficient to document the course and the examination of glaucoma disease.

• Klíčová slova
• brimonidin, hypertension glaucoma, overall defekt, pattern defect, perimetry test,
• MeSH
• glaukom * komplikace   diagnóza   MeSH
• hypertenze * MeSH
• lidé MeSH
• nitrooční tlak MeSH
• oční hypertenze * MeSH
• testy zrakového pole MeSH
• zraková pole MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIM: Mutations in the myocilin gene (MYOC) cause trabecular dysfunction and thus are involved in the pathogenesis of primary open-angle glaucoma (POAG). The aim of this study was to characterize and describe the clinical findings in two Czech families with POAG due to pathogenic variants in the MYOC gene. MATERIAL AND METHODS: Members of the two families affected by POAG underwent complete ophthalmological examination. In the proband from the first family, a direct sequencing of the three most frequent mutations in the MYOC gene was performed, and in the proband from the second family, an exome sequencing was performed. Other family members underwent targeted tests using direct sequencing. RESULTS: In total, 10 individuals diagnosed with POAG aged 20-70 years (mean 32.2 years, SD ±10,9 years) were examined. Eight of them showed advanced glaucomatous neuropathy with severe changes in the retinal nerve fiber layer. Clinical signs of POAG were present in six individuals in the third decade of life already; another four developed POAG during the fourth decade of life. Eight out of 10 patients had to undergo filtration surgery. Surgery was performed within 1 to 7 years of diagnosis, but mostly was performed within 2 years of glaucoma diagnosis. In the first family, MYOC variant c.1099G>A p.(Gly367Arg) was shown in the affected family members; in the second family MYOC variant c.1440C>A p.(Asn480Lys), both in heterozygous state. The changes were assessed as pathogenic. CONCLUSION: Our study is the first to describe mutations in the MYOC gene causing POAG in Czech patients. Genetic testing may be recommended for this diagnosis, especially in individuals with early presentation and a positive family history. Carriers of pathogenic variants of the MYOC gene have a lifetime risk of developing POAG of more than 50% and the course of their disease is often more aggressive, requiring surgical intervention to permanently control the intraocular pressure.

• Klíčová slova
• Mutation, Myocilin, juvenile glaucoma, mutation, primary open angle glaucoma,
• MeSH
• glaukom s otevřeným úhlem * diagnóza   genetika   MeSH
• lidé MeSH
• mutace MeSH
• nitrooční tlak MeSH
• oční proteiny genetika   MeSH
• rodokmen MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• oční proteiny MeSH

PURPOSE: The aim of our study was to find out whether in patients with hypertensive glaucoma (HTG) and normotensive glaucoma (NTG), there is a change in the size of the chiasm depending on the changes in the visual field. Therefore, we retrospectively measured the width of the chiasm in the patients to whom we measured the size of the corpus geniculatum laterale in 2013. MATERIALS AND METHODS: The group consisted of two groups of patients. Nine with hypertensive glaucoma (HTG) and nine with normotensive glaucoma (NTG). The diagnosis was based on a complex ophthalmological examination and in NTG and electrophysiological examination. The visual field was examined by a rapid threshold program on the Medmont M700. The sum of the sensitivity from both visual fields in the range of 0-22 degrees was compared with the width of the chiasm obtained by the magnetic resonance imaging using the eight channel head coil. The measured values of all subjects were analyzed using a paired t-test and a correlation coefficient. RESULTS: We found a reduction in the chiasma width in both glaucoma groups. We found a statistically significant difference in the size of the chiasm (p = 0.0003) between the control group and the HTG group (p = 0.001). The narrowing of the chiasm showed a slight correlation in HTG with changes in the field of vision (r = 0.139) and in NTG a moderate correlation (r = 0.375). CONCLUSION: We found a reduction in the size of the chiasm in both HTG and NTG. The sum of sensitivities in the central parts of the visual field, however, more correlated with the reduction in the size of the chiasm in NTG. This finding shows that there are two different diagnostic groups.

• Klíčová slova
• Hypertensive glaucoma, MRI, changes in visual field, normotensive glaucoma, optic chiasm width,
• MeSH
• chiasma opticum diagnostické zobrazování   MeSH
• discus nervi optici * MeSH
• glaukom s otevřeným úhlem * MeSH
• glaukom * MeSH
• lidé MeSH
• nitrooční tlak MeSH
• optická koherentní tomografie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Hypertensive glaucoma (HTG) causes damage to the retinal ganglion cells and eventually to the entire visual pathway due to high intraocular pressure (IOP). However, increased IOP will also affect the vessel density (VD) of the posterior pole of the eye and the related retinal ganglion nerve fibres (RNFL). In normotensive glaucoma (NTG), the retinal ganglion cells are relatively intact. The pathology is at the level of ganglion fibres. The unanswered question is what has altered ganglion cell fibres at the level of the retina and optic nerve head in NTG? AIM: The aim of this study was to determine whether there is a correlation between the retinal nerve fibre layer (RNFL) and vessel density (VD) at the same altitudinal half of the retina and the sum of sensitivities of the contralateral half of the visual field of the same eye in hypertensive and normotensive glaucoma (NTG). METHODS: Our group included 20 patients with HTG and 20 patients with NTG. The Pearson's correlation coefficient r was used for evaluation of the relationship of the peripapillary RNFL and VD, visual field (using the fast threshold glaucoma program) as the sum of sensitivities in apostilbs (asb) to the extent of 0-22 degrees. The results of sensitivity were compared with the RNFL and VD of the contralateral altitudinal half of the retina in the same eye. RESULTS: In the HTG group there was a moderate relationship between RNFL and VD (both hemifields), but no relationship between RNFL and VF. VD SH and VF IH showed weak correlation and VD IH and VF SH showed no correlation. In patients with NTG, we found a strong correlation between RNFL and VD (both hemifields), between VD SH and VF IH a moderate correlation, between VD IH and VF SH also a moderate correlation and a weak correlation between RNFL and VF. CONCLUSION: By comparing the RNFL and VD at the same altitudinal halves of the retina, we found a moderate correlation in HTG and a strong correlation in NTG. We found no or a weak correlation between VD and VF in HTG. In NTG the relationship between VD and VF showed a strong correlation. These findings reveal the differences in the diagnostic groups.

• Klíčová slova
• hypertensive glaucoma, normotensive glaucoma, optical coherence tomography angiography, retinal nerve fibre layer, vessel density, visual field,
• MeSH
• angiografie MeSH
• glaukom s otevřeným úhlem * MeSH
• glaukom * MeSH
• lidé MeSH
• nitrooční tlak MeSH
• optická koherentní tomografie MeSH
• zraková pole MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH