Publications by authors named "Rudolf Autrata"

11 Publications

  • Page 1 of 1

Emergency management in epidermolysis bullosa: consensus clinical recommendations from the European reference network for rare skin diseases.

Orphanet J Rare Dis 2020 06 6;15(1):142. Epub 2020 Jun 6.

Dermatology Department, reference Centre MAGEC, Necker- Enfants Malades Hospital, Paris-Centre University, Paris, France.

Epidermolysis bullosa (EB) comprises a group of genetic disorders with the hallmark of fragility of the skin and mucosal surfaces. The severity of different types of EB varies markedly as does the occurrence of extra-cutaneous involvement and complications. A number of emergency situations may occur in the context of EB including obstruction to oral intake from oral or esophageal blisters or scarring, acute airway obstruction, acute urinary retention, sepsis and corneal erosions. Whilst general management principles apply in each of these settings, specific considerations are essential in managing EB to avoid undue trauma or damage to delicate tissues. These recommendations have been developed from a literature review and consensus from experts of the European Network for Rare Skin Disorders (ERN-Skin) to aid decision-making and optimize clinical care by non-EB expert health professionals encountering emergency situations in babies, children and adults with EB.
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http://dx.doi.org/10.1186/s13023-020-01403-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276067PMC
June 2020

Influence of Artificially Generated Interocular Blur Difference on Fusion Stability Under Vergence Stress.

J Eye Mov Res 2019 Sep 11;12(4). Epub 2019 Sep 11.

Masaryk University, Faculty of Medicine, Dept. Pediatric Ophthalmology, Brno, Czech Republic.

The stability of fusion was evaluated by its breakage when interocular blur differences were presented under vergence demand to healthy subjects. We presumed that these blur differences cause suppression of the more blurred image (interocular blur suppression, IOBS), disrupt binocular fusion and suppressed eye leaves its forced vergent position. During dichoptic presentation of static grayscale images of natural scenes, the luminance contrast (mode B) or higher-spatial frequency content (mode C) or luminance contrast plus higher-spatial frequency content (mode A) were stepwise reduced in the image presented to the non-dominant eye. We studied the effect of these types of blur on fusion stability at various levels of the vergence demand. During the divergence demand, the fusion was disrupted with approximately half blur than during convergence. Various modes of blur influenced fusion differently. The mode C (isolated reduction of higher-spatial frequency content) violated fusion under the lowest vergence demand significantly more than either isolated or combined reduction of luminance contrast (mode B and A). According to our results, the image´s details (i.e. higher-spatial frequency content) protects binocular fusion from disruption by the lowest vergence demand.
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http://dx.doi.org/10.16910/jemr.12.4.4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880136PMC
September 2019

A new modified technique for the treatment of high-risk prethreshold ROP under the direct visual control of RetCam 3.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015 Sep 3;159(3):413-6. Epub 2015 Jul 3.

Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University, Brno and Faculty Hospital Brno.

Purpose: To describe a new modified technique in the treatment of ROP (retinopathy of prematurity) using the RetCam 3 digital imaging system - Camera-Assisted Laser photocoagulation and Cryotherapy of the Retina (CALCR).

Methods: From Nov 2011 to Oct 2013, 113 infants were diagnosed with ROP. The average post-conceptual age (PCA) at the time of diagnosis was the 35(th) week of PCA; the average birth weight was 1,041 g. According to the ETROP study, the avascular part of the retina of infants with high-risk prethreshold ROP was treated with a trans-scleral diode laser or with cryotherapy within 48-72 h after the diagnosis. The intervention was performed under general anaesthesia under the direct visual control of the RetCam 3.

Results: The CALCR technique was used in all 23 infants (46 eyes) diagnosed with high-risk prethreshold ROP. The average age of these infants at the time of the intervention was the 38(th) week of PCA. None of the infants had any serious complications during the CALCR procedure. In contrast to the traditional technique, CALCR offers many benefits: the image of the retina is real, magnified and not inverted, it shows details of the retina in a high resolution, photo and video documentation is available. Therefore the preoperative, intraoperative and postoperative condition of the retina can be precisely evaluated and compared on a fully standardized basis.

Conclusions: The CALCR procedure represents a new technique providing greater accuracy when targeting the avascular part of the retina, enables better visualisation and more precise treatment, and reduces the risk of unintended damage to healthy retinal tissue.
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http://dx.doi.org/10.5507/bp.2015.027DOI Listing
September 2015

Intravitreal pegaptanib combined with diode laser therapy for stage 3+ retinopathy of prematurity in zone I and posterior zone II.

Eur J Ophthalmol 2012 Sep-Oct;22(5):687-94

Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University and Faculty Hospital Brno, Brno, Czech Republic.

Purpose: To investigate efficacy of intravitreal injection of pegaptanib and laser photocoagulation for treatment of stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels, and final structural outcome with conventional laser photocoagulation or combined with cryotherapy.

Methods: In a prospective comparative study, 152 eyes with zone I, II posterior ROP 3+ (76 premature rabies), from 2009 to 2011, were included. Patients were randomly assigned to receive intravitreal pegaptanib (Macugen® 0.3 mg = 0.02 mL, Pfizer) with conventional diode laser photocoagulation in group 1 (68 eyes of 34 infants) or only laser therapy combined with cryotherapy in group 2 (84 eyes of 42 infants), bilaterally. The primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP. The mean follow-up after treatment was 19.3 months in group 1 and 21.5 months in group 2.

Results: Final favorable anatomic outcome and stable regression of ROP at last control examination was noted in 89.7% of eyes in group 1 and 60.8 % of eyes in group 2. Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in group 1. No recurrence of neovascularization (stage 3+ ROP) was identified in 85.4% of patients in group 1 and 50% of patients in group 2.

Conclusions: Results of this study support the administration of intravitreal pegaptanib as useful therapy in the management of stage 3+ ROP.
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http://dx.doi.org/10.5301/ejo.5000166DOI Listing
December 2012

Complicated relationship between autism with regression and epilepsy.

Neuro Endocrinol Lett 2008 Aug;29(4):558-70

Department of Paediatric Neurology, Children's Medical Centre, University Hospital Brno, Czech Republic.

We retrospectively evaluated a set of 205 children with autism and compared it to the partial sub-set of 71 (34.6%) children with a history of regression. From 71 children with regression, signs of epileptic processes were present in 43 (60.6%), 28 (65.12%) suffered clinical epileptic seizures, and 15 (34.9%) just had an epileptiform abnormality on the EEG. In our analysis, autistic regression is substantially more associated with epileptic process symptoms than in children with autism and no history of regression. More than 90% of children with a history of regression also show IQ < 70 and reduced functionality. Functionality and IQ further worsens with the occurrence of epileptic seizures (98% of children with regression and epilepsy have IQ < 70). We proved that low IQ and reduced functionality significantly correlate rather with epileptic seizures than just sub-clinical epileptiform abnormality on EEG. Clinical epileptic seizures associated with regression significantly influence the age of regression and its clinical type. The age of regression is higher compared to children with regression without epileptic seizures (in median: 35 months of age in patients with seizures while only 24 months in other patients). Patients with seizures revealed regression after 24th months of age in 68% of cases, while patients without seizures only in 27%. However, coincidence with epilepsy also increased the occurrence of regression before the 18th month of age (23% of patients), while only 4% of patients without epilepsy revealed regression before the 18th month. Epileptic seizures are significantly associated especially with behaviour regression rather than speech regression or regression in both behaviour and speech. Also epileptic seizures diagnosed before correct diagnosis of autism were significantly associated with delayed regression (both behavioural and speech regression).
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August 2008

Visual results after primary intraocular lens implantation or contact lens correction for aphakia in the first year of age.

Ophthalmologica 2005 Mar-Apr;219(2):72-9

Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University Hospital, Brno, Czech Republic.

Purpose: The optimal role of intraocular lenses (IOLs) in infants remains a controversial topic. Some ophthalmologists advocate correction with a contact lens (CL), whereas others recommend an IOL correction. Our study compared visual acuity, ocular alignment, retreatment rate and binocular vision outcomes in children treated with these two methods at our clinic.

Methods: This study included 41 children with unilateral congenital cataract who underwent cataract surgery with posterior capsulorhexis and anterior vitrectomy, coupled with (IOL group, n=18) or without (CL group, n=23) primary IOL implantation. All infants underwent the first surgery during the first 12 months of their life and they were operated on in the period from 1994 to 1999. The mean age at surgery was 3.11+/-2.65 months (range: 28 days to 11 months). All patients were prescribed the same half-time reduced occlusion therapy. Good cooperation of the parents and good compliance with patching were the necessary conditions to include a patient in the study. Between January and February 2003, the final visual acuity and binocular vision outcomes were examined.

Results: The mean final visual acuity (logarithm of the minimum angle of resolution) of the operated eye was 0.43+/-0.33 for the IOL group and 0.58+/-0.39 for the CL group (p=0.14). The mean interocular difference in visual acuity was 0.22+/-0.29 for the IOL group and 0.56+/-0.31 for the CL group (p=0.042). The reoperation rate was 78% in the IOL group compared with 35% in the CL group (p=0.017). Esotropia or exotropia of more than 8 prism diopters were present in 55% of children (10/18) in the IOL group compared with 83% of children (19/23) in the CL group (p=0.039).

Conclusions: We suggest that correction of aphakia after unilateral congenital cataract surgery with primary IOL implantation results in improved visual acuity, improved binocular vision outcome and less occurrence of strabismus, but a higher rate of complications requiring reoperation. Further studies with a larger pediatric patient group are necessary to confirm the optimal treatment of aphakia after unilateral congenital cataract extraction.
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http://dx.doi.org/10.1159/000083264DOI Listing
April 2005

Phototherapeutic keratectomy in children: 5-year results.

J Cataract Refract Surg 2004 Sep;30(9):1909-16

Department of Ophthalmology, Masaryk University Hospital, Brno 61300, Czech Republic.

Purpose: To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK) for the treatment of superficial corneal opacities, surface irregularities, epithelial instability, and reepithelialization failure in pediatric patients and study the visual and refractive changes after combined PTK and photorefractive keratectomy (PRK).

Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Methods: This retrospective clinical study comprised children who had PTK or PTK combined with PRK from September 1996 to January 2000. The goals of treatment were to improve visual acuity and reduce or eliminate subjective ocular discomfort (eg, pain, lacrimation, and photophobia). A Nidek EC-5000 excimer laser was used in PTK mode with a 3.0 to 6.0 mm optical zone and a 4.0 to 7.5 mm transition zone.

Results: Forty-one pediatric patients (41 eyes) were included. Twenty-three eyes had PTK only, and 18 eyes had PTK combined with PRK to reduce preoperative myopia (11 eyes) or hyperopia (7 eyes). The mean patient age was 11.4 years (range 8 to 18 years) and the mean follow-up, 4.8 years (range 3 to 6 years). The best spectacle-corrected visual acuity (BSCVA) improved in all patients, and episodes of ocular pain or discomfort, lacrimation, and photophobia diminished. The mean preoperative BSCVA of 6/38 (range 6/10 to 1/60) improved to 6/12 (range 6/6 to 6/38) at the last postoperative examination. Eight eyes gained 5 or more Snellen lines of BSCVA; 11 gained 4 lines, 9 gained 3 lines, 7 gained 2 lines, 5 gained 1 line, and 1 eye was unchanged. No eye lost a line of BSCVA. The mean preoperative spherical equivalent (SE) decreased from -5.32 to -1.16 diopters (D) in the 11 myopic eyes and from +4.72 to +1.51 D in the 7 hyperopic eyes within 3 years of the combined procedure.

Conclusions: Phototerapeutic keratectomy is an effective and safe procedure for the treatment of various surface corneal disorders in children. It can improve best corrected visual acuity and eliminate ocular pain and irritation. Preoperative myopia and hyperopia were effectively reduced by a combination of PTK and PRK.
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http://dx.doi.org/10.1016/j.jcrs.2004.02.047DOI Listing
September 2004

Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children.

J Cataract Refract Surg 2004 Jan;30(1):74-84

Department of Ophthalmology, University Hospital, Brno, Czech Republic.

Purpose: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) for high myopic anisometropia with amblyopia and contact lens (CL) intolerance in children.

Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Methods: This prospective comparative study comprised 27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years (range 4 to 7 years). Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC-5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2-year follow-up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The visual acuity and binocular vision outcomes in both groups were analyzed and compared.

Results: In Group A, the mean spherical equivalent refraction was -8.25 diopters (D) +/- 2.37 (SD) (range -6.00 to -11.25 D) preoperatively and -1.61 +/- 0.73 D (range +0.50 to -2.25 D) postoperatively. The mean best corrected visual acuity (BCVA) was 0.23 +/- 0.21 preoperatively and 0.78 +/- 0.19 at 2 years. In Group B, the mean BCVA was 0.16 +/- 0.19 at the start of CL correction and amblyopia therapy and improved to 0.42 +/- 0.15 after 2 years. The mean BCVA at the final examination was significantly better in Group A (P<.05). Binocular vision improvement expressed by the proportion of patients who gained fusion and stereopsis was better overall in Group A (78%) than in Group B (33%) (P<.05). There were no complications postoperatively.

Conclusions: Photorefractive keratectomy and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.
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http://dx.doi.org/10.1016/S0886-3350(03)00417-6DOI Listing
January 2004

Laser-assisted subepithelial keratectomy and photorefractive keratectomy for the correction of hyperopia. Results of a 2-year follow-up.

J Cataract Refract Surg 2003 Nov;29(11):2105-14

Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Purpose: To evaluate and compare the efficacy, safety, predictability, and stability of laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for low to moderate hyperopia with a 2-year follow-up.

Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Methods: This prospective comparative single-surgeon study included 216 eyes of 108 patients with hyperopia who received PRK in 1 eye and LASEK in the contralateral eye. The mean patient age was 38.3 years (range 25 to 58 years). The mean preoperative spherical equivalent (SE) cycloplegic refraction was +3.67 diopters (D) +/- 1.15 (SD) (range +2.00 to +5.00 D), and astigmatism was less than 1.00 D. In each patient, PRK was performed in 1 eye (Group A) and LASEK was performed in the other eye (Group B) using the Nidek EC-5000 excimer laser. Postoperative uncorrected visual acuity (UCVA), best corrected visual acuity, contrast sensitivity, manifest and cycloplegic refractions, refractive stability and predictability, postoperative pain, and corneal haze were examined and statistically analyzed. A P value less than 0.05 was considered significant.

Results: At 1 week, the UCVA was 20/40 or better in 58% of PRK eyes and 85% of LASEK eyes (P =.037); at 2 years, it was 20/40 or better in 81% and 91%, respectively (P =.076). At 2 years, the UCVA for near was N8 or better in 73% of PRK eyes and 89% of LASEK eyes (P =.064). No patient lost 2 or more lines of Snellen visual acuity. The safety index was 1.03 in PRK eyes and 1.08 in LASEK eyes. Refractive stability was achieved at 6 months in LASEK eyes and at 12 months in PRK eyes. The mean SE cycloplegic refraction decreased from +3.58 D (PRK eyes) and +3.76 D (LASEK eyes) at baseline to +0.74 D and +0.32 D, respectively, at 2 years; in 57% and 78% of eyes, respectively, the refraction was within +/-0.50 D of the targeted refraction. Peripheral corneal haze scores at 3 to 9 months and pain scores at 1 to 3 days were significantly lower in the LASEK group than in the PRK group.

Conclusions: Laser-assisted subepithelial keratectomy for hyperopia up to +5.00 D provided good visual and refractive results. It significantly reduced postoperative pain, grade of peripheral ring-shaped corneal haze, and regression of hyperopia. Hyperopic LASEK provided quicker visual recovery and achieved better efficacy, predictability, and refractive stability than hyperopic PRK.
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http://dx.doi.org/10.1016/s0886-3350(03)00415-2DOI Listing
November 2003

Clinical results of excimer laser photorefractive keratectomy for high myopic anisometropia in children: four-year follow-up.

J Cataract Refract Surg 2003 Apr;29(4):694-702

Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Purpose: To evaluate the visual and refractive results of multizonal photorefractive keratectomy (PRK) for high myopic anisometropia and contact-lens intolerance in children.

Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Methods: Twenty-one patients aged 7 to 15 years with high myopic anisometropia had multizonal PRK in the more myopic eye and were retrospectively analyzed. The scanning-slit Nidek EC-5000 excimer laser was used. Postoperatively, patients were reviewed at 1 and 3 days, 1 week, and 1, 3, 6, 12, 18, 24, 36, and 48 months. The examination included cycloplegic refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), biomicroscopy, grading of postoperative haze, corneal topography, pachymetry, intraocular pressure, biometry, orthoptic status, binocular vision (BV), and fundus evaluation. The safety, efficacy, predictability, and stability of the procedure were evaluated. Long-term binocular vision outcome was analyzed. All patients completed a 4-year follow-up.

Results: The mean preoperative spherical equivalent (SE) refraction was 8.93 diopters (D) +/- 1.39 (SD) (range -6.75 to -11.75 D) and the mean postoperative SE, -1.66 +/- 0.68 D (range -0.50 to -2.75 D) (P <.05). The mean preoperative UCVA of 0.034 +/- 0.016 increased to 0.35 +/- 0.15 (P <.05) postoperatively. The mean preoperative BSCVA was 0.53 +/- 0.19 and changed to 0.64 +/- 0.16 postoperatively. The safety index was 1.21. No eye lost a line of BSCVA; 9 eyes gained 1 line, and 5 eyes gained 2 lines. The efficacy index was 0.66. The postoperative uncorrected and best spectacle-corrected BV were the same or improved. No eye had +3 haze. There were no significant complications.

Conclusions: Photorefractive keratectomy was safe and effective in correcting high myopic anisometropia in children who were contact-lens intolerant. It provided good visual results and preserved or improved BV over the 4-year follow-up.
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http://dx.doi.org/10.1016/s0886-3350(02)01896-5DOI Listing
April 2003

Laser-assisted subepithelial keratectomy for myopia: two-year follow-up.

J Cataract Refract Surg 2003 Apr;29(4):661-8

Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Purpose: To assess and compare the clinical results (efficacy, safety, stability, and postoperative pain or discomfort) of laser-assisted subepithelial keratectomy (LASEK) and conventional photorefractive keratectomy (PRK) for the correction of low to moderate myopia.

Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.

Methods: A prospective comparative study was performed in 184 eyes of 92 patients who had surface excimer ablation for the correction of myopia. The preoperative mean spherical equivalent (MSE) was -4.65 diopters (D) +/- 3.14 (SD) (range -1.75 to -7.50 D). In each patient, LASEK was performed in 1 eye and PRK in the fellow eye by the same surgeon. The first eye treated and the surgical method used in the first eye were randomized. Both procedures were performed with the Nidek EC-5000 excimer laser using the same parameters and nomogram. The postoperative pain level, visual recovery, complications (haze), uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and refractive outcome were evaluated and compared. All eyes completed a 24-month follow-up.

Results: The postoperative MSE was -0.18 +/- 0.53 D in the PRK eyes and -0.33 +/- 0.46 D in the LASEK eyes. At 1 week, the mean UCVA was 0.64 +/- 0.21 and 0.87 +/- 0.23, respectively. No LASEK eye lost a line of BSCVA. There were no statistically significant differences between PRK and LASEK eyes in the safety and efficacy indices at 2 years. The mean pain level was significantly lower on days 1 to 3 in the LASEK eyes (P <.05). The mean corneal haze level was lower in the LASEK eyes (0.21) than in the PRK eyes (0.43) (P <.05). Seventy-nine patients preferred LASEK to PRK.

Conclusions: Laser-assisted subepithelial keratectomy provided significantly quicker visual recovery, eliminated post-PRK pain, and reduced the haze level in eyes with low to moderate myopia compared with conventional PRK. It provided good visual and refractive outcomes. There were no serious complications.
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http://dx.doi.org/10.1016/s0886-3350(02)01897-7DOI Listing
April 2003
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