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Biomedical subjects

Z Dubská

Publications and source records attributed to Z Dubská.

At least 19 recordsLinked to original sources
PubMed2005

[Transpupillary thermotherapy in exsudative age-related macular degeneration. Two-years results and findings on the other eye].

UNLABELLED: The purpose of the prospective randomized study was to analyze long-term results of transpupillary thermotherapy (TTT) in exsudative age-related macular degeneration (ARMD) after 24 months of follow-up and to compare them with findings on the other, not treated eye. MATERIAL AND METHODS: Seventy-two patients aged 50-93 years (average age 70.6 years) with one eye treated by means of TTT and the other considered as control were in the study. Occult choroidal neovascularization (CNV) was treated in 33 eyes (45.8%), serous ablation of the pigment epithelium (SAPE) in 21 eyes (29.2%), and classical CNV in 18 eyes (25.0%). In all patients, the central visual acuity (VA) on EDTRS chart was specified, the macular findings were observed by means of indirect binocular ophthalmoscope and bio-microscopically with the contact lens on the slit lamp, and fluorescence angiography and optical coherence tomography (OCT) examinations were performed before and 3, 6, 12, 18, and 24 months after the TTT treatment. RESULTS: The final VA improved or remained unchanged in 27 eyes (37.5%), and worsened in 45 eyes (62.5%), by 5 or more lines the VA worsened in 19 eyes (26.4%). The average VA decreased from initial 0.24 to final 0.13, but the decrease in different forms of ARMD varied. In SAPE the highest initial as well as final average VA was found, in occult and classical CNV the initial and final average VA was almost identical. Exsudative changes observed by means of biomicroscopical, fluoroangiographical, and OCT examinations totally disappeared in 59.7%, 63.9%, and 59.7% respectively. At the end of the follow-up period we observed chorioretinal atrophy of different stage in the macula in all eyes (100%) and subretinal fibrosis in 44 eyes (61.7%). Both these findings represented final stages of natural course of exsudative ARMD. On the contrary, differently pronounced areas of chorioretinal atrophy corresponding with applied laser burns represented scars after the coagulation. It developed in 31 eyes (43.0 %) and pointed to the possible destructive consequence of the TTT. In 33 patients (45.8%), late stages of exsudative ARMD, mostly disciform scars with chorioretinal atrophy were found on the other not treated eye. In these eyes the final average VA was 0.05, e.g. more than one half worse than final average VA in treated eyes. CONCLUSIONS: Results of TTT treatment after 24 month of follow-up demonstrated full regression of exsudative changes in the macula in 60% of eyes and improved or stable VA in 37.5 % of eyes. Results in SAPE and classical CNV confirmed the efficacy of TTT treatment in those forms of ARMD. The TTT did not prevent the appearance and progress of the chorioretinal atrophy and subretinal fibrosis, causing the main obstacle of better functional results. Extremely unfavorable course of exsudative ARMD in the other (not treated) eye could indirectly confirm the positive influence of the TTT in theARMD treatment. Despite all positives are the possibilities of the TTT limited and determined by the basis and natural course of exsudative ARMD.

Aged↗
PubMed2004

[Transpupillary thermotherapy in age-related serous detachment of retinal pigmented epithelium].

UNLABELLED: The goal of this prospective study was to evaluate results of the transpupillary thermotherapy (TTT) in the age related macular degeneration (ARMD) where the serous detachment of the pigment epithelium (SDPE) was the dominant sign. MATERIAL AND METHODS: Thirty eyes of 29 patients were treated by TTT. All patients were examined before and 3, 6, 9, 12, 18, and 24 months after TTT in terms of visual acuity (VA), indirect binocular ophthalmoscopy, and indirect slitlamp biomicroscopy, fluorescein angiography, and optic coherent tomography (OCT) of the macular region. In 25 eyes (83,3%) signs of choroidal neovascularization (CNV) were present (vascular SDPE). TTT was performed with a standard technique by diode laser (wavelength 810 nm). In 14 eyes (46.7%) the TTT procedure was repeated after 3 to 38 weeks. The follow-up period was 7 to 28 month (mean 15.2 months). RESULTS: After TTT, VA improved in 6 eyes (20.0%), remained stable in 8 eyes (26.7%), and deteriorated in 16 eyes (53.3%). Indirect slitlamp biomicroscopy revealed, that the SDPE re-attached in 13 eyes (43.3%), decreased in size in 12 eyes (40.0%); fluorescein leakage disappeared in 16 eyes (53.3%) and was reduced in 10 eyes (33.3%). By OCT, the re-attachment of SDPE was confirmed in 14 eyes (46.7%) and it's reduction in 13 eyes (43.3%). The leading cause of the same or worse VA after diminishing of SDPE was chorioretinal atrophy, with or without subretinal fibrosis. CONCLUSION: In the long term, the TTT led to the decline of SDPE in the majority of eyes and improved or stabilized VA in nearly on half of eyes. In most cases, signs of neovascularization were present. After the SDPE regression, the chorioretinal atrophy prevented the better functional results. TTT is not economically expensive and widens treatment possibilities in exsudative form of ARMD including SDPE.

Aged↗
PubMed2002

Lipid metabolism and neuropsychological follow-up study of workers exposed to 2,3,7,8- tetrachlordibenzo- p-dioxin.

OBJECTIVE: More than 35 years ago, during 1965-1968, in the former Czechoslovakia, approximately 80 persons became ill due to occupational exposure to 2,3,7,8-tetrachlordibenzo- p-dioxin (2,3,7,8-TCDD). The objective of this study was to investigate the incidence of disorders related to occupational exposure to 2,3,7,8-TCDD. METHODS: Most subjects in the group of 12 former 2,3,7,8-TCDD workers (mean age 56.8 years, exposure 10 days to 23 months) still suffer from disturbances of lipid metabolism, psychic disorders, chloracne, and/or nervous system lesions. All workers were given internal, neuropsychological and ophthalmological examinations. Blood cholesterol and triglycerides were measured, and the common carotid artery was examined by ultrasound (B-mode), with the intima-media thickness (IMT) also being measured. Findings were compared with the 2,3,7,8-TCDD level in 1996. RESULTS: Nine of the 12 previously exposed workers had elevated plasma lipids, and hyperlipidaemia was statistically more frequent in patients with higher 2,3,7,8-TCDD levels ( P=0.03). Subject 1, with the highest 2,3,7,8-TCDD plasma level, had 80% stenosis of the diameter of the carotid artery, which needed acute surgery. Besides him, seven persons had atherosclerotic plaques in the carotid arteries. The mean IMT in the group was 0.85 mm (SD+/-0.19); the normal value is 0.62 mm. Eight subjects had degenerative changes of the ocular fundus. Chloracne was still present in two persons. Neuropsychological findings were assessed as normal only in three persons with lower 2,3,7,8-TCDD plasma levels in 1996. Mean 2,3,7,8-TCDD plasma level in 1996 was 256 pg g(-1) fat (range 14-760). CONCLUSION: Hyperlipidaemia, atherosclerotic plaques, increased IMT, ischaemic heart disease and neuropsychological disturbances were frequent in this group of former 2,3,7,8-TCDD workers. Hyperlipidaemia might have played an important role in most of these disorders. The level of 2,3,7,8-TCDD correlated with the highest level of triglycerides ( P=0.02) and cholesterol ( P=0.01) that was found during the 35-year follow-up. This group belongs to the most heavily 2,3,7,8-TCDD-exposed groups of workers, because the mean estimated concentration at the time of intoxication was approximately 5000 pg g(-1) plasma fat.

Arteriosclerosis↗
PubMed2002

[Optical coherence tomography in age-related macular degeneration].

INTRODUCTION: Optic coherent tomography (OCT) is a new non-contact and non-invasive diagnostic method which visualizes biological tissues in their transverse section, similarly as ultrasound examination. It uses however infrared radiation and during examination of the posterior pole of the eye it has a greater differentiating capacity. THE OBJECTIVE: Of the paper is to compare biomicroscopic OCT and angiographic findings in different forms and developmental stages of age-related macular degeneration (ARMD), to evaluate the asset of OCT for classification and therapy of ARMD. PATIENTS AND METHODS: The authors examined 183 patients (266 eyes) with ARMD in different developmental stages. The clinical diagnosis of ARMD was established by biomicroscopic and/or angiographic examination with fluorescein. RESULTS: In the majority of patients the different manifestations of ARMD were associated, and the OCT findings were polymorphous. OCT defined more accurately the site and character of changes in the retina and adjacent structures, made it possible to assess objectively the thickness of the retina and surrounding structures and to detect the presence of fluid and/or newly formed intra- and subretinal tissue and tissue benewath the RPE. The CNVM classification, introduced by fluorescent angiography differentiating classical and occult forms did not have an accurate correlate in the OCT image in our group of patients. CONCLUSION: OCT is in the diagnosis and follow up of the development of ARMD a suitable supplement of commonly used methods. It provides information on spatial relations of pathologically altered tissues. Visualization of the retina on the section is particularly valuable when evaluating the results of laser or surgical treatment.

Aged↗
PubMed2002

[Transpupillary thermotherapy in age-related macular degeneration. Preliminary results].

OBJECTIVE: To evaluate anatomical and functional results of transpupillary thermotherapy (TTT) in age-related macular degeneration (ARMD) with a chorioid neovascular membrane (CNVM). MATERIAL AND METHODS: TTT was performed by means of a diode laser (Iris Medical Oculight Six) in 38 eyes of 35 patients aged 46-93 years, mean 70.6 years. Ocult CNVM was treated in 34 eyes, classical CNVM in 4 eyes. In TTT we applied 1 to 5 points (on average 1.9 spot) and used a laser beam with a diameter of 0.5-3 mm (mean width 1.61 mm). In 10 eyes with occult CNVM (29%) TTT was repeated after 1-6 months. The patients were followed up after TTT for 6-18 months on average for 9.5 months. RESULTS: The final visual acuity (VA) improved after TTT in two eyes (5.3%), remained unchanged in 22 eyes (57.9%) and deteriorated in 14 eyes (36.8%). The mean VA after TTT declined from 0.23 to 0.17. Biomicroscopic manifestations of exudation disappeared or receded in 29 eyes with occult CNVM (85.3%) and in 3 eyes with classical CNVM (75%). Fluoroangiographic examination revealed a reduced or absent extravasation of the dye in 24 eyes with occult CNVM (70.5%) and in 3 eyes with classical CNVM (75%). Optic coherent tomography confirmed regression of exudative changes and the development of a chorioretinal scar in 23 eyes with occult CNVM (67.6%) and 3 eyes with classical CNVM (75%). CONCLUSION: TTT is a new potential therapy of ACMD with CNVM. It is indicated in particular in occult CNVM. It can be however used also in classical CNVM. TTT is not economically pretentious and can be used also in other than large clinical departments. It is important to test the possibilities and limitations of TTT on a large number of patients and assess its position among other therapeutic procedures.

Aged↗
PubMed2001

[Initial experience with surgical decompression of the vein in branch retinal vein occlusion].

Due to the development of the armamentarium and surgical techniques, the indications of pars plana vitrectomy (PPV) are expanding. It concerns also a relatively new indication, as is the branch retinal vein occlusion (BRVO) of the temporal part of the posterior pole of the retina with the secondary involvement of the macular region. The purpose of this prospective study is to demonstrate anatomical and functional results after the surgical decompression of the occlusion of the branch retinal vein draining the macular region. Since November 1999, 3 patients, one woman and 2 men (age 70, 47 and 76 years) with the quadrant BRVO of the temporal part of the retina involving the macular region were followed. The visual acuity before the surgery in all 3 patients was 6/36 (20/120 or 0.16) and the BRVO lasted for 3-5 months. The patients were examined by slitlamp biomicroscopy, and the course of the disease was documented by means of red-free fundus photographs as well as fluorescein angiograms. In all three patients, PPV and the adventitial sheathotomy of the arteriovenous crossing (AVC) were performed. Surgical decompression of BRVO and reperfusion of the ischemic part of the retina was achieved by separating the overlying arteriole from the venule at AVC. Neither per- nor postoperative complications were noted. In two patients, the visual acuity improved to 6/12 (20/40 or 0.5), and in the last one stabilized at 1/9 (20/180 or 0.11). The minimal follow-up period was 12 months. In conclusion, we recommend to performing this new type of delicate surgery procedure in individual cases on the basis of detailed biomicroscopial examination and fluorecein angiograms by an experienced vitreoretinal surgeon.

Aged↗
PubMed2001

[Tears of the retinal pigment epithelium] ].

The authors describe spontaneous tears of the retinal pigmented epithelium in three eyes of two patients with age-related macular degeneration. In all instances the development of the tear was associated with an occult choroidal neovascular membrane detected by fluoroangiography. The authors describe typical clinical features and contemporary views regarding the pathogenesis of the tear.

Aged↗
PubMed1999

[Vitrectomy and autologous thrombocyte concentrate in the treatment of idiopathic macular holes].

OBJECTIVE: To evaluate the results of surgery of idiopathic macular holes (IMH) using or not using autologous thrombocyte concentrates (ATC). METHOD: Fifty eyes with IMH, stage 2-4, were divided into two groups. Group 1 comprised 27 eyes with an average persistence of complaints of 12 months where pars plana vitrectomy (PPV) and tamponade with 16% C3F8 were combined with the use of ATC. Group 2 comprised 23 eyes with a mean duration of complaints of 14 months which were treated by PPV and 16% C3F8 without ATC. In all IMH stage 2 and 3 the posterior vitreous membrane was detached from the retina. The epimacular membrane was removed, if present. The mean follow-up period in group 1 was 17.2 months and in group 2 12.3 months. RESULTS: In group 1 anatomical success was achieved in 21 eyes (78%), visual acuity improved by two lines and more in 16 eyes (59%). In group 2 anatomical success was recorded in 15 eyes (69%) (p = 0.326) and visual acuity improved in 10 eyes (44%) (p = 0.265). Nine eyes were reoperated with ATC. Reoperations improved the anatomical success in the whole series to 90% and the functional success to 62%. The visual acuity improved in 70% operated eyes within 12 months from the onset of complaints and in 47% eyes with a longer case-history (p = 0.1182). Complications included retinal tears in 5 eyes (10%), detachment of the retina in one eye (2%), minor facete-like defects in the pigmented epithelium in 22 eyes (44%), disciform maculopathy in 5 eyes (10%) and atrophy of the optic disc in 3 eyes (6%). CONCLUSIONS: PPV is beneficial in IMH in the majority of patients. ATC can improve anatomical and functional results. Functional success is more likely after surgery in the early stage of the disease. The results of surgery are jeopardized by various complications. It is important to inform patients on the limitations and risk of surgery.

Adult↗
PubMed1999

[Diffuse retinal pigmented epitheliopathy--a variant of central serous chorioretinopathy of the aged].

The authors describe a group of eight patients (four women and four men) with diffuse retinal pigmented epiteliopathy (four times unilateral and four times bilateral) confirmed by fluoroangiography, in one instance with bullous elevation of the retina. The mean age of the patients was 57.3 years, the investigation period was 4 to 23 years, with a mean of 8.6 years. After laser coagulation which was implemented in four patients vision improved in one instance, in the remaining patients vision was stabilized. In the patient with the bullous elevation of the retina vision improved after spontaneous flattening of the ablation. The authors discuss the pathogenesis and clinical features typical for diffuse retinal pigmented epitheliopathy.

Adult↗
PubMed1990

[Early diagnosis of late complications in juvenile diabetics].

In a group of 69 insulin dependent diabetics aged 19-59 years (mean 25.5 years) with a duration of diabetes of 2 to 34 years (mean 12.5) the authors assessed the incidence of diabetic retinopathy, nephropathy and neuropathy in relation to the duration of diabetes, to its long-term compensation and HLA antigens. In 45 the diabetes was manifested before the age of 15 years. The authors found a rising trend of retinopathy (12-14-25-75-86%) and neuropathy (0-50-60-85-83%) in five groups with a duration of diabetes up to 5, 10, 15, 20 and above 20 years. 15% of the patients with a duration of diabetes of more than 15 years had positive microalbuminuria or permanent proteinuria and hypertension. In diabetic patients with long-term satisfactory compensation there was a lower incidence of these complications than in patients with poorer compensation. The presence of HLA B8 antigen was associated with a prolonged favourable course of diabetes, with a lower incidence and later manifestation of complications.

Adult↗
PubMed1989

[Cardiotocographic examination, pH values in the umbilical artery and the Apgar score in the diagnosis and prognosis in fetal and neonatal hypoxia].

The authors examined 91 neonates with one or several anamnestic signs of intra-partum hypoxia (cardiotocographic record, pH in blood of umbilical artery, Apgar score) and 65 neonates with a normal delivery. When evaluating signs of hypoxia, a very low correlation between the methods used was found. Neurological investigation of all children revealed significant differences in the incidence of neurological abnormalities between groups of hypoxic neonates (whatever method used) and the group of neonates without a history of hypoxia intra partum, but only in the second month. In the other age periods, when the children were subjected to neurological examination (6, 12 months), no differences were found in the frequency of neurological abnormalities between the group of "hypoxic" and normal children.

Apgar Score↗