[Evaluation of the quality of life].
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Humans↗
Biomedical subjects
S Pitrová
Publications and source records attributed to S Pitrová.
[Initial clinical experience with deep sclerectomy in ambulatory surgery in glaucoma].
Deep sclerectomy is a non-perforating filtering operation used in surgical treatment of open angle glaucomas. The advantage of the operation is the creation of gradual filtration due to the thin trabecular Descement membrane which reduces markedly the risk of development of postoperative complications typical for perforating antiglaucomatous operations. The authors operated at the out-patient department 10 eyes of 8 patients (age 46-81 years). Indications for deep sclerectomy was seven times primary open angle glaucoma (POAG), once capsular glaucoma and twice normotensive glaucoma (NTG). In all eyes deep sclerectomy was indicated because of decompensation of the intraocular pressure with maximum tolerated therapy before surgery. None of the eyes were operated previously. The mean value of intraocular pressure before surgery was 25.1 +/- 6.5 mm Hg. From the results ensues that in nine operated eyes the intraocular pressure at the end of the 6-month follow-up period was compensated without supplementary therapy, only in one eye beta-blockers were prescribed one month after surgery. The cause of failure of filtration was the development of superficial adherence at the site of microperforatiion of the trabecular Descemet membrane which developed during operation. The mean intraocular pressure values at the end of the investigation period were 14.3 +/- 2.8 mm Hg. In two eyes haemorrhage into the anterior chamber was observed on the first day after surgery, the blood was absorbed within 24 hours. Hypotonia in two eyes was only transient and was not associated with a change in the depth of the anterior chamber or other complications. In none of the patients a decline of visual acuity was observed. In three operated eyes a change of refraction was necessary due to discontinuation of miotics after surgery. Deep sclerectomy is a delicate microsurgical technique which calls for experience and skill of the surgeon. The most complicated task is to prevent perforation of the trabecular Descemet membrane during surgery. Provided the surgical technique is perfect, it burdens the patient less than commonly performed perforating antiglaucomatous operations and it can be implemented in the out-patient department.
Adult↗
[A distance ring for stabilization of the lens capsule (a multicenter clinical study)].
Cataract extraction in eyes with a loose suspension apparatus implies always an unconventional method of surgery. An important contribution towards the stabilization of the capsule during surgery and during the postoperative period is implantation of a polymethyl methacrylate (PMMA) ring into the capsular bag during phacoemulsification and implantation of the lens in patients with dialysis of the zonula. Erilens Co. produced three types of distance rings which were tested in 1997 within the framework of a multicentre clinical trial in seven departments in the Czech Republic: the most frequent indication for implantation of a distance ring was subluxation of the lens in 16 eyes, instability of the capsule in patients with myopia in nine eyes, traumatic cataract after contusion in five eyes and after a perforating injury in five eyes. In two patients the ring was used during normal cataract extraction when during aspiration of the lenticular mass the zonula loosened. From the total number of 47 distance rings it proved possible to implant primarily into the capsule only 42, two further rings were implanted primarily into the sulcus and left there. In patients with ectopia of the lens the ring was fixed into the sulcus ciliaris. In two instances the ring was explanted during the operation on account of instability of its position, in one instance the ring was damaged during implantation. The type and frequency of complications during and after surgery corresponded to the patient's pathology before the operation. More than three quarters of the operated eyes had after operation corrected vision better than 6/18. Poorer vision after surgery in nine patients was due to age-related or post-traumatic changes on the fundus. The results of the multicentre clinical trial evaluating the implantation of the distance ring of Erilens Co. conducted in seven departments of the Czech Republic in 1997 provided evidence that the quality of these rings is comparable with types produced abroad and used in complicated surgery of the anterior segmental of the eye.
Adult↗
[Evaluation of the success of cataract surgery from the viewpoint of the patient].
The relationship between visual acuity assessed by the ophthalmologist and functional visual disorders evaluated by the patient himself by means of special tests is an important indicator of successful cataract operations. At present for this purpose four tests are used: VF 14, CSS, evaluation of problems of vision, evaluation of satisfaction with vision. The use of the above tests under local conditions was tested in a small group of 60 patients, 43 (72%) being women. One third of the patients had cataracts of both eyes operated. 20% of the patients suffered from the dry from of age related macular degeneration of the fundus before operation. These patients suffered after surgery from poorer near vision and a poorer resulting corrected far vision. The results of the trial provided evidence that the patients are indicated for surgery of the second eye when vision is better and the subjective complaints are smaller, in order to restore rapidly binocular vision. This corresponds with higher values of the VF index after surgery of both eyes. In patients with age related macular degeneration there is a markedly reduced value of the VF index after surgery, while the CSS before surgery is the same as in patients with a normal finding. This test cannot be used for accurate evaluation of the part played by age related macular degeneration and cataract in the deterioration of visual functions.
Aged↗
[Naclof in the treatment of chronic non-infectious conjunctivitis].
The group of 60 patients suffering from chronic non-infected reaction of conjunctivits, showing irritation, conjunctival hyperemia, pain and photophobia, have been treated in the open observational clinical trial comparing the efficiency, safety and local tolerance of diclofenac sodium eye drops 0.1% (Naclof) versus dexamethasone eye drops (Dexamethasone oph. 0.1%) during a period of 30 days. Both medications were locally well tolerated. Naclof caused some slight temporary burning slightly more frequently than dexamethasone but the difference was not statistically significant (Naclof 89.7% tolerability and Dexamethasone 89.1% tolerability). The two drugs were equally effective in the treatment of chronic non-infected conjunctivitis. All the patients have shown a gradual improvement of the symptoms as well as of the objective sings. The dexamethasone group showed an increase in intraocular pressure at the third and fourth visit. However, these differences are not statistically significant either.
Aged↗
[Keratomycoses].
Mycotic inflammations of the anterior segment of the eye are relatively rare in our geographical zone. The clinical picture, isolation of the pathogenic organism and possible treatment are discussed with reference to three patients with keratomycosis treated at the First Ophthalmological Clinic of the First Medical Faculty, Charles University Prague. Microscopic examination of the affected tissue revealed Fusarium 1x and Candida alb. also on cultivation. Natamycin 5.0% suspension cured Fusarium keratitis and improved the symptoms of Candida infection. In two patients perforating keratoplasty was necessary in one instance because of imminent perforation of a posterior mycotic corneal abscess and in the second patient because of subsequent bacterial reinfection.
Adult↗
[ProVisc--a new viscoelastic material for surgery of the anterior segment. A multicenter clinical study].
Within the framework of a multicentric clinical study which was implemented at nine selected departments a new viscoelastic material ProVisc of Alcon company was tested during extracapsular extraction of cataract with implantation of posterior chamber intraocular lenses. A total of 100 eyes of 100 patients were operated and all pre- and postoperative data were recorded in uniform protocols. The selection of suitable patients and the type of surgical procedure was within the responsibility of the surgeon. The type and frequency of surgical and postoperative complications was similar as when other viscoelastic material ProVisc can be recommended as safe and effective in modern surgery of cataract.
Anterior Eye Segment↗
[From Beer's knife to the tunnel incision].
The authors present an account on the development of surgical techniques used in operations of cataract. Surgery of cataract was started on April 8, 1745 when the Frenchman Jaques Daviel made the first extraction of an opaque lens by limbal incision. This new method was enforced, however, very slowly and only after 100 years it finally celebrated victory over the hitherto widely used reclination. In the fifties of the present century a great advance in the surgery of cataract was the introduction of cryoextraction; at the First Ophthalmological Clinic a double-jacket instrument was designed which was filled with crushed CO2. The first cryoextraction was made at the authors' department on October 7, 1964, it was the very first operation of this type in Czechoslovakia.
Cataract Extraction↗
[The clinical picture of biocompatibility of intraocular lenses used in cataract surgery].
Implantation of a synthetic prosthesis of a turbid lens is associated with a defined reaction of intraocular tissues. The extent of tissue damage along with a disorder of the haemato-ocular barrier and properties of the implant determine the extent of the inflammatory reaction leading to accumulation of proteins and cells in the anterior chamber of the eye and on the anterior surface of the artificial lens. The intensity of this reaction has an impact also on the final functional effect of the operation.
Biocompatible Materials↗
[The first stage of clinical trials of hydrogel lenses manufactured in Czechoslovakia].
The authors give an account of the results of the first stage of clinical trials of Czechoslovak disc-shaped hydrogel lenses made from the copolymer HEMA and methacrylic acid. Hitherto assembled experience provided evidence that the envelope technique for opening of the anterior capsule does not ensure sufficient stability of these lenses in the later stage and their decentration may cause serious complications. Therefore the optimal solution is to place the implant in the capsule after circular capsulorhexy. Improvement of the geometrical and optic properties of the lenses during the subsequent follow-up and their perfect harmony with the surgical technique will produce even better functional results in operated patients.
Aged↗
[The clinical picture of Fuch's heterochromic cyclitis].
The authors are presenting their experience with the diagnosis and treatment of Fuchs' heterochromic cyclitis. They followed-up 13 patients with this disease for 0.5-3 years. Most often the patients were sent to the clinic with the diagnosis of recurrent anterior uveitis not responding to the treatment with corticosteroids and mydriatics. Patients underwent numerous investigations including neurological, internal and rheumatological examinations. Antibodies against EBV, HSV and CMV were detected. The examination of humoral immunity and HLA was done. The authors describe the ophthalmological findings, the course of the disease and the treatment. They did not find any correlation in the laboratory investigations and the course of the disease, the diagnosis is based on the clinical picture. They point out the advantage of the small incision in the extracapsular extraction of cataract in these patients.
Adult↗
[Significance of immunologic reactions on the surface of intraocular lenses].
The authors summarize their experience assembled during specular examinations of immunological processes on the surface of the intraocular lens. They describe the incidence of significant components of the immunological reaction--of "large cells", "fibroblast-like cells", round elements, fibrous and acellular membranes on the surface of the intraocular lens. The "large cells" are considered the most important components of the reaction from the clinical aspects. Their incidence depends most frequently on a change in the position of the intraocular lens and non-adherence to therapy in the early postoperative stage. The authors present findings assembled in patients with late changes of the position and formation of synechiae and subluxation, most probably traumatic, and occur in patients who did not respect local corticoid treatment in the early postoperative period. A similar character of the specular finding indicates uniformity of the non-specific reaction which is potentiated by interference with the haemotoocular barrier for various reasons.
Female↗
[Treatment of pigmentary glaucoma].
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Adult↗
[Panophthalmitis as a nosocomial infection].
The submitted paper deals with an epidemic of severe postoperative panophthalmitis, its development, course, causes and sequelae incl. epidemiological characteristics. The disease developed in four patients 40 hours after operation of cataract. Despite treatment all four patients developed septicaemia and therefore the affected eyeballs were eviscerated. From smears of the conjunctival sac of the affected patients and from the contents of the eviscerated eyeball Proteus mirabilis and Enterobacter cloaceae were cultivated. The authors draw attention to the epidemiological association with the eye lotion BSS which was used from which Proteus mirabilis and E. coli were cultivated and with the Ringer solution from which Enterobacter cloaceae and Klebsiella pneumoniae were cultivated. An epidemiological analysis of the epidemic was made and provisions were defined to rule out its recurrence.
Cataract Extraction↗
[Biocompatibility of retropupillary intraocular lenses].
The authors give an account on the incidence of two types of reactions in the early postoperative period (within two weeks) after implantation of retropupilar intraocular lenses. In a group of 320 patients they observed them in 51 (16%) incl. 17 diabetics. In the group of diabetic patients the incidence of reactions was twice as frequent. A typical fibrin reaction starting on the third day after operation was recorded in 18 patients (5%), in the remaining 33 patients (11%) there was increased opalescence of the aqueous humour, and exudation of cels and cellular structures to the lens surface was associated with the surgical trauma, in particular in beginner implantologists. The two mentioned types of reactions do not have a substantial influence on the final functional effect.
Biocompatible Materials↗
[Laser microsurgery in glaucoma].
Based on ten years work, the authors summarize their experience with the use of different types of lasers and laser methods in the treatment of glaucomas. They draw attention to the limits of effectiveness of laser microsurgery, to different modifications of hitherto used methods and their combinations. The authors try to define the position of lasers in the therapy of glaucomas.
Glaucoma↗
[A comparative study of various methods of measuring intraocular pressure].
The authors compare measurement of intraocular pressure by aplanation, impression and contact-free tonometry. They draw attention to the advantages of contact-free tonometry in screening of glaucoma which is a reliable, rapid and simple method.
Adolescent↗
[Clinico-pathologic evaluation of one type of intraocular lens].
Four intraocular lenses of Saturn type (extrapupillar iris lens fixated in the posterior chamber) were surgically removed when bullous pseudophakic keratopathy was present, without loss of the eye-bulb, during the period of 2-6.5 years after the performed implantation. Cytologic examination of the surface of the implanted lens displayed the individual tolerance of the implant in various patients. In all cases on the surface of the lenses there was observed a reactive membrane, also in the cases of the low biological tolerance.
Adult↗