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Micropulse Laser Therapy of Cystoid Macular Edema
Závorková, Martina ; Jirásková, Naďa (advisor) ; Chrapek, Oldřich (referee) ; Šín, Martin (referee)
Micropulse laser therapy of cystoid macular edema Introduction: Diabetic retinopathy (DR) is a typical microvascular complication of diabetes mellitus (DM). The most common manifestation of DR that reduces vision is diabetic macular edema (DME). The objective of this study was to evaluate the efficacy of DME therapy using subthreshold micropulse laser (SMPL) with a wavelength of 577 nm. Cohort and methods: The cohort with a monitoring period of 1 year included the total number of 167 eyes of 111 patients with DME. The cohort with a monitoring period of 3 years included the total number of 70 eyes of 47 patients. The cohort with a monitoring period of 5 years included the total number of 52 eyes of 34 patients. None of the patients met the reimbursement criteria for DME treatment with intravitreal administration of anti-VEGF or did not wish to undergo that treatment. All the eyes underwent treatment of the retina outside the macula with a standard laser pulse therapy. The treatment depended on the type of DR. On the day of being included in the study, DME therapy using SMPL. Subsequent check-ups were followed every 3 months in the first year of the treatment, and every 4 to 6 months in the following years. The laser treatment of the retina was repeated during the check-ups as needed. The treatment...
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Issues in local and systemic side effects of chemotherapeutics after their experimental intraocular and periocular delivery
Petrušková, Denisa ; Dotřelová, Dagmar (advisor) ; Baráková, Drahomíra (referee) ; Jirásková, Naďa (referee)
achieving control over retinoblastoma cells floating within the vitreous cavity in advanced retinoblastoma of grade C, D and E. Periocular and intravitreal drug injection is a promissing route for maximum bioavailability to the vitreous but it requires a well defined dose for achieving tumor control while limited toxicity to the ocular structures. Objective: 1. Experimentally evaluate local ocular toxicity of carboplatin and topotecan on the model of rabbit eye after periocular and intravitreal administration. 2. To evaluate the clinival applicability of the new method of intravitreal application of chemotherapeutics using transcorneal approach. Material and methods: In vivo experiment was conducted on the model of 54 New Zealand White rabbits, which were dividend into groups of six rabbits according to protocol. Only right eyes were applicated and received: 1. periocular carboplatin at a dose of 15 mg and 30 mg and periocular topotecan at a dose of 2 mg, 2. intravitreal carboplatin at a dose od 0,05 mg a 0,008 mg and intravitreal topotecan at a dose of 1 μg a 2 μg. Left eyes received the same amount of saline. Concentrations of carboplatin in the vitreous humor and plasma were determined by atomic absorption analysis, topotecan concentrations by high performance liquid chromatography and concentrations of...
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Retinal nerve fiber layer measurement in patients with Alzheimer's disease
Kasl, Zdeněk ; Jirásková, Naďa (advisor) ; Pašta, Jiří (referee) ; Skorkovská, Šárka (referee)
Retinal nerve fiber layer measurement in patients with Alzheimer's disease The current ophthalmologist's possibilities in diagnostics of Alzheimer's disease Alzheimer disease (AD) is the most common cause of dementia syndrome and mild cognitive impairment. To enroll the disease most securely there are used so called biomarkers using evidence of changed brain metabolism by pozitron emission tomography (PET) and in cerebrospinal fluid or the brain's structure magnetic resonance imaging (MRI). These methods are expensive, organisationally and temporally challenging and burdening for the patients. According to that reasons we are still seeking for alternative attitudes suitable for early diagnosis. The evaluation of thickness of retinal nerve fiber layer (RNFL) which is well accessible to examination through optical aparatus of the eye could be one of the options. The aim of our work was to present current knowledges about Alzheimer's disease targeting relations of Alzheimer's disease and an ophthalmological finding. In the next part of this paper we introduce the retinal nerve fiber layer measurement by optical coherence tomography (OCT) as a potential diagnostics method by screening of patients with Alzheimer's disease and to present our results measured in our cohort of patients. The studied cohort...
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The evaluation of the effect in supression of the inflammatory reaction by oral intake Relifex (nabumeton) after photodynamic therapy in the treatment of exsudative age-related macular degeneration
Šín, Martin ; Jirásková, Naďa (advisor) ; Sosna, Tomáš (referee) ; Dotřelová, Dagmar (referee)
Purpose: To evaluate photodynamic therapy (PDT) combined with the preferential the cyclooxygenase-2 (COX-2) inhibitor, nabumetone in the treatment of the neovascular age-related macular degeneration (ARMD). Methods: A prospective, double-blind, randomized study on 60 patients with subfoveal CNV secondary to ARMD without any previous treatment. Patients were divided into a nabumetone or placebo group. The main endpoints were the change of best-corrected visual acuity (BCVA), central macular thickness (CRT) and number of required PDT treatments Results: In the nabumetone group, 27 patients (90%) and 28 (93%) in the placebo group completed the follow-up of 12 months. In the nabumetone group, the mean CRT decreased from 332 μm (SD 68 μm) to 220 μm (SD 46 μm). In the placebo group, CRT decreased from 331 μm (SD 72 μm) to 254 μm (SD 61 μm). The mean BCVA was 0.68 log MAR (SD 0.22 log MAR) in the nabumetone group and 0.62 log MAR (SD 0.23 log MAR) in the placebo group at baseline. This stabilised in the placebo group to 0.66 log MAR (SD 0.33) but deteriorated in the nabumetone group to 0.86 logMAR (SD 0.41 logMAR). There was a significant reduction in the number of required PDTs in the nabumetone group, but significant progression of the RPE atrophy area. Conclusion: Combined PDT with oral intake of the COX-2...
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Implantation of artificial corneas AlphaCor and KeraKlear in patients with severe corneal disorder: long-term outcomes
Burova, Mariya ; Jirásková, Naďa (advisor) ; Těšínský, Pavel (referee) ; Baráková, Drahomíra (referee)
Implantation of artificial corneas AlphaCor and KeraKlear in patients with severe corneal disorder: long-term outcomes. Purpose: To assess the long-term results of AlphaCor and KeraKlear implantation, to evaluate the main complications and risk factors. Methods: An artificial cornea AlphaCor was implanted in 15 eyes of 15 patients. KeraKlear has been used in 4 eyes of 4 patients. All patients before the surgery were examined in detail. The evaluation of best corrected visual acuity (BCVA) and slit-lamp examination of anterior segment of the eye were performed. The status of posterior segment of the eye was assessed with B-scan ocular ultrasaund examination. Corneal pachymetry was performed in patients before the KeraKlear implantation. Digital photographs of anterior segment of the eye in all cases were obtained. Intraocular pressure (IOP) was satisfactory controlled before AlphaCor and KeraKlear surgery in all eyes. Postoperatively evaluation of BCVA and IOP, slit-lamp examination with digital photography of anterior segment of the eye and B-scan ocular ultrasaund examination were regularly performed. Results: Best corrected visual acuity after AlphaCor surgery ranged from hand movement to 0.8. The survival rate of the AlphaCor at 1, 2, 3 and 4 years was 80%, 53%, 40% and 27%, respectively. The...
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Evaluation of posterior capsule opacification after cataract surgery
Kalfeřtová, Marie ; Jirásková, Naďa (advisor) ; Baráková, Drahomíra (referee) ; Těšínský, Pavel (referee)
Purpose: To study effect of AquaLase method used for final management of posterior capsule during cataract surgery on the posterior capsule opacification (PCO) creation and to verify safety of this method for the corneal endothelium. Methods: The prospective clinical study involving 56 patients with bilateral cataract having lens removal at the Department of Ophthalmology, University Hospital Hradec Králové in the period from September 2007 to March 2009. During the surgery lens was removed using torsional phacoemulsification and bimanual irigation/aspiration. Cleaning of the posterior capsule of the right eye was performed using AquaLase method (Alcon Laboratories, Forth Worth, Texas, USA) based on pulsed warm, naturally balanced surgical solution. Intraocular lens AcrySof SA60AT was implanted bilaterally to all patients. All patients were examined preoperatively and 3, 6, 12 and 24 months after surgery. Each examination covered best corrected visual acuity (BCVA), endothelial cell count (ECC) and corneal pachymetry. Moreover postoperatively digital retroillumination photographs of the anterior segment focused on the posterior capsule were always obtained. The Evaluation of Posterior Capsule Opacification (EPCO 2000) software and the Open-Access Systematic Capsule Assessment (OSCA) system were used...
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Assessment of the Efficacy of Photodynamic Therapy in Patients with Chronic Central Serous Chorioretinopathy
Myslík Manethová, Kateřina ; Jirásková, Naďa (advisor) ; Hejsek, Libor (referee) ; Chrapek, Oldřich (referee)
Assessment of the efficacy of photodynamic therapy in patients with chronic central serous chorioretinopathy The presented postgraduate thesis deals with the issue of macular edema based on central serous chorioretinopathy (CSC) and the current possibilities of therapeutic solution of this disease. Although in most cases central serous chorioretinopathy does not belong to frequent and vision-threatening diseases, it can, especially its chronic form, lead to impaired vision. The aim of the theoretical part of this work is to characterize this chorioretinal disease and describe the basic principles of treatment. The work also describes the pathogenesis of CSC, the examination methods, the up-to-date accepted CSC classification and the therapeutic modalities of the treatment of the disease. The clinical part of this work is a prospective study of 52 patients (54 eyes), aged 30- 75, with chronic form of central serous chorioretinopathy treated at the Eye Clinic of the 1st Faculty of Medicine of Charles University and Military University Hospital Prague in the years 2012 to 2018. The aim of this prospective study is to evaluate the anatomical and functional results of the treatment of 54 eyes with chronic form of central serous chorioretinopathy using photodynamic therapy in a reduced (half) dosing...
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Improvement in the Quality of Life in Patients with Stable Maculopathy by Scharioth Macula Lens Implantation and Visual Plasticity Modulation by Transcranial Electrical Stimulation
Středová, Markéta ; Jirásková, Naďa (advisor) ; Pašta, Jiří (referee) ; Skorkovská, Šárka (referee)
Improvement in the quality of life in patients with stable maculopathy by Scharioth macula lens implantation and visual plasticity modulation by transcranial electrical stimulation Aim: To evaluate the change in the quality of life in patients with stable maculopathy after Scharioth macula lens (SML) implantation followed by transcranial electrical stimulation (tES) and visual rehabilitation. Methods: Our prospective study included 14 patients with dry age-related macular degeneration (AMD) who underwent SML implantation from May 2018 to September 2019 at the Ophthalmology Clinic of the University Hospital in Hradec Kralove. The follow-up period was 6 months. The evaluated parameters were distant best corrected visual acuity (BCVA), near uncorrected visual acuity (UNCVA), intraocular pressure (IOP), central retinal thickness (CRT) and visual plasticity in the form of visual evoked potentials (VEP). The occurence of any complications and subjective satisfaction were also assessed. Results: The mean preoperative distant BCVA was 0.23 ± 0.09 and 0.17 ± 0.06 at 6 months. The mean preoperative near UNCVA was Jäger (J) 14.9 ± 2.1 and J 4.2 ± 3.1 at 6 months. Preoperative mean near visual acuity (VA) with addition of +6 diopters was J 5.0 ± 2.3. There was no statistically significant difference in the near...
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Use of Optical Coherence Tomography and Visual Evoked Potentials Recording in Preoperative and Postoperative Monitoring of Patients with Optic Chiasm Compression
Póczoš, Pavel ; Jirásková, Naďa (advisor) ; Lešták, Ján (referee) ; Skorkovská, Karolína (referee)
Use of optical coherence tomography and visual evoked potentials recording in preoperative and postoperative monitoring of patients with optic chiasm compression The objective of this prospective study is to explore the benefits of optical coherence tomography (OCT), resp. visual evoked potentials (VEP), in cases of optic chiasm (OC) compression by measuring the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL), resp. the implicit time and the amplitude resulting from pattern- reversal VEP (R-VEP) and motion-onset VEP (M-VEP). Material and methods: 16 patients (32 eyes) with chiasmal compression were included in the study. They presented no other pathology of the visual pathway or of the eye globe. The second inclusion criterion was a subsequent indication of decompressive surgery. Measurements of visual acuity, visual field, RNFL, GCL, R-VEP and M-VEP were performed once preoperatively and three times postoperatively (one week, 3 and 6 months postoperatively). The degree (grade 0-5) of chiasmal compression was determined on preoperative brain magnetic resonance imaging (MR). In need of some data analysis, participants were split into a group with no or minimal (grade 0-1) and with substantial pressure (grade 2-4) on OC. Results: The median global peripapillary RNFL...
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Correction of Myopia and Myopic Astigmatism by Implantation of Phakic Posterior Chamber Implantable Collamer Lens
Řeháková, Tereza ; Jirásková, Naďa (advisor) ; Pašta, Jiří (referee) ; Skorkovská, Šárka (referee)
Aim: We analysed two years results in patients with correction of moderate-to-high myopia or myopic astigmatism by implantation of posterior chamber phakic intraocular Impantable Collamer Lens (ICL). Methods: To the retrospective study were included 63 eyes of 32 patients (3 men, 29 women), who underwent implantation of ICL between 2007 - 2016 in the outpatient Department of Ophthalmology clinic, University Hospital in Hradec Králové, to correction moderate-to-high myopia or myopic astigmatism. We assess uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), subjective refraction, intraocular pressure (IOP), endothelial cell density (ECD) and the incidence of complications in the two years follow-up period. Results: At the time of implantation the mean patient's age was 28,14 ± 5,35 years (range 21 to 36 years). The mean preoperative subjective refraction improved from -7,8 ± 2,7 D sf (range - 14 to -3,25 D sf) and -0,65 ± 0,8 D cyl (range -3,25 to 0 D cyl) to -0,01 ± 0,1 D sf (range -0,75 to 0 D sf) and -0,05 ± 0,16 D cyl (range -0,55 až 0 D cyl). The mean ECD value was 3270,5 ± 454,7 cells/mm2 (range 2155 to 4201 cells/mm2 ) compared to 2803,4 ± 441,8 cells/mm2 (range 2079 to 4184 cells/mm2 ) at the end of our follow-up period. The percentage loss of ECD two years...
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