Correlation between clinical outcomes and patients' satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects.

Aim To examine and quantify patients' satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique. Methods A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17 patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients' satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed. Results Pearson correlation coefficient between patients' satisfaction and clinical presentation was 0.534. Out of 510 (the highest summed score for patients' satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones. Conclusion Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.

The Risk and Protective Factors for Pediatric Eye Injuries: A Case-Crossover Study.

Purpose: To investigate state- and trait-like risk factors leading to childhood eye injuries controlling for the between-subject difference. This study measured socioeconomic, environmental, behavioral, and injury event characteristics to identify eye injury protective and risk factors.Methods: A retrospective case-crossover study including patients aged 0-18 years old (y.o.) with severe eye trauma treated at the Canton Hospital Zenica between 2011 and 2017 was conducted. One case time point was at the time of injury, and two control time points 1 month before the injury and a month before the survey.Results: Of 36 patients meeting the criteria, four were excluded, resulting in 32 cases and 64 controls. The mean age was 10.79 in males (77.8%) and 11 y.o. in females (22.2%). In univariate GEE logistic regression unusual activity had odds of 17.25 (95%CI = 6.97, 42.70), working/chores vs.running activity odds of 6.60 (95%CI = 1.71, 25.46), very active level vs.an intermediate child activity level odds of 5.26 (1/0.19, 95%CI = 1.75, 16.67) no supervision odds of 2.63 (1/0.38, 95%CI = 1.45, 4.76) and less than 7 hours of sleep odds of 4.69 (95%CI = 1.06, 20.77) of sustaining an eye injury. Using the quasi-likelihood approach and QICu as an indicator, the best model yielded odds of getting eye injured = 0.59 + 19.35*engaging in unusual activity+0.21*supervised by an adult person+0.84*playing+3.04*working within the households+0.22*other activity.Conclusions: Giving the best model to predict injuries, the combined strategies of teaching, modifying the environment, and the watchful supervision present a preventive triad that needs to be further explored and encouraged in practice.

Evaluation of refractive errors in retinopathy of prematurity screening.

Aim To evaluate the frequency of refractive errors in premature children in retinopathy of prematurity (ROP) screening to find mutual connection of the prematurity level, disease activity and refractive errors. Methods A retrospective study was conducted in the Eye Clinic of the University Clinical Centre Sarajevo, between December 2013 and January 2017. A total of 126 patients of gestational age ≤ 34 weeks and birth weight ≤ 2000 g underwent ROP screening program. The patients were divided into three groups: patients without ROP (n=15), patients with spontaneous regression (n=106) and those with active form of ROP (n=5). Results There were 68 (54.0%) patients with refractive errors: 45 (35.7%) had hyperopia, 17 (13.5%) myopia and six (4.8%) astigmatism. There were three (60.0%) patients with an active form of ROP who had refractive errors: two (40.0%) had myopia and one (20.0%) hyperopia. The group without active ROP had hyperopia as most frequent refractive error, with 10 (66.7%) patients. The average birth weight of the patients without refractive errors was 1403.9±43.4 g compared to 1390.3±104.2 g of the patients with refractive errors (p=0.498). The average gestational age was 29.7±0.3 weeks in patients without and 29.0 ± 0.3 weeks in patients with refractive errors (p=0.126). Conclusion The birth weight and the gestational age were significantly lower in patients with the active form of ROP. Lower gestational age and birth weight of premature children increase the chance for the development of refractive errors such as hyperopia in all premature children and myopia in patients with active form of ROP.

Prevalence and risk factors associated with work-related eye injuries in Bosnia and Herzegovina.

BACKGROUND: Eye injuries are a prevalent workplace injury and cause substantial disability when vision is impaired. OBJECTIVE: To examine work-relatedness of demographic, injury, and clinical characteristics of eye injuries in a large clinic in Bosnia and Herzegovina. METHODS: We performed a nine-year retrospective study of patients admitted with an eye injury to the Canton Hospital in Zenica, Bosnia and Herzeogvina. Controlling for age and sex, we used logistic regression to examine the influence of work-relatedness on patient and injury characteristics and clinical outcomes. RESULTS: Of 258 patients, 71 (27.5%) had work-related and 180 (69.8%) had non-work-related eye injuries. Work-related eye injury was associated with age, education, occupation, and injury type. Agricultural workers were eight times more likely to experience work-related eye injury (95%CI = 1.21-152.0) compared to manual workers. Work-relatedness of injury did not predict final visual acuity or length of hospital stay. CONCLUSION: Promotion of eye safety is needed countrywide. Occupational eye protection is a priority due to the relatively proportion of eye injuries and the workplace being a relatively controlled environment.

CONTRIBUTING FACTORS FOR DEVELOPMENT OF NECROTIZING ENTEROCOLITIS IN PRETERM INFANTS IN THE NEONATAL INTENSIVE CARE UNIT.

BACKGROUND: necrotizing enterocolitis is a serious condition that affects mostly preterm infants, with high mortality rate. AIM: to estimate the influence of potentially contributing factors of this multifactorial disease. METHODS: the study group included 51 necrotizing enterocolitis infants who were less than 37 week gestation who were hospitalized in NICU during a five year period. The control group consisted of 71 patients with approximately the same gestational age and birth weight. Average gestational age in the study group was 30.2 weeks (SD 3.7), average birth weight 1502g (SD 781.5). Average postnatal age in the time of the presenting NEC was 18.2 days (SD 12.8). RESULTS: Logistic regression estimates the influence of risk factors, which in our study related to the treatment of preterm infants on the likelihood of NEC development. Our regression model consisted of seven independent variables (nosocomial infections, mechanical ventilation, nasal continuous positive pressure, morphine, inotropes, blood transfusions, and H2 blockers), which were shown to have a statistically significant impact, X2 (7, n=1222) = 49.522, p<0.0001; two independent variables (nosocomial infection and H2 blockers use) were statistically significant. Preterm infants with nosocomial infection had a three times greater chance of developing NEC, and infants who received H2 blockers had a 1.5 higher risk. CONCLUSIONS: Underlying pathology of very low birth weight infants and their treatment in NICU contribute to NEC development. Identifying risk factors can be crucial for the early diagnosis and outcome of disease. Awareness of risk factors should influence changes in practice to reduce the risk of NEC.

Recession Vs Myotomy-Comparative Analysis of Two Surgical Procedures of Weakening Inferior Oblique Muscle Overaction.

INTRODUCTION: Inferior oblique overaction (IOOA) can be primary or secondary, isolated or combined to other types of horizontal deviation, mostly with esotropias. Surgical weakening of IOOA means several techniques like; recession, myotomy, myectomy, anteroposition etc. GOALS: we analyzed the effect of inferior oblique muscle surgical weakening comparing two groups of patients with primary hypertropia. MATERIAL AND METHODS: In 5-years retrospective study, we observed 33 patients on which we did the surgical procedure of weakening inferior muscle overaction by two methods; recession and myotomy. RESULTS: In total number of 33 patients, there were 57,6% male and 42,4% female patients with average age of 10,6±7,5 (in range of 4-36). There was 33,3% of isolated primary hypertropias, and 66,7% combined with esotropias. At 23 (69,9%) patients the recession surgical procedure was done, and with 10 (30,1%) myotomy. Better effect and binocularity was in 65,2% of patients in recession group which was statistically significant with significance level of p<0,0, χ2=5,705; p=0,021. CONCLUSION: Comparing of two surgical procedures of weakening inferior oblique muscles overaction, recession is better procedure than myotomy.

Risk Factors for Retinopathy of Prematurity in Premature Born Children.

INTRODUCTION: Retinopathy of Prematurity (ROP) represent disease of the eye in premature born children which affects immature blood vessels of the retina during their development. The emergence of retinopathy of prematurity depends on the interaction of multiple factors, such as: gestational age, low birth weight, hypoxia, duration of oxygen supplementation, respiratory distress syndrome, twin pregnancy, anemia, blood transfusions, sepsis, intraventricular hemorrhage, hypotension, hypothermia, etc. If remain unrecognized and untreated it can cause severe visual impairment and blindness in children, but can also be prevented with timely screening. GOALS: To establish the number of patients with development of retinopathy of prematurity active forms in the observed time period and examine which risk factors have most significant impact on its origin. MATERIAL AND METHODS: In a clinical, retrospective study we observed a total of 80 premature born children in the period from January to May 2015 with regard to listed risk factors identified for eye examination. RESULTS: From a total of 80 premature newborns sample included 48.8% male and 51.2% female children. The active form of ROP developed in 6.2% of cases, while in 93.8% of cases there was a spontaneous resolution. Patients who developed active form of ROP have significantly younger gestational age (26.4±1.5 weeks) and lower birth weight (874±181 grams), lower Apgar score in the first and fifth minute and were longer on oxygen therapy (20±3.4 days). CONCLUSION: Of the potential risk factors that could affect the development of ROP active form following factors have a statistically significant influence: early gestational age, low birth weight, lower Apgar score and prolonged oxygen therapy (p <0.05).

Relation between physical activity and myopia progression in student population.

AIM: To determine the relation between physical activity and myopia progression in student population. Causes of myopia occurrence are not sufficiently explained. METHODS: This retrospective-prospective, descriptive research included 100 students with verified myopia up to -3 Dsph. The research was conducted in the Institute for Occupational and Sports Medicine of Zenica-Doboj Canton and at the University of Zenica in the period from January 2011 until January 2012. Ophthalmological examination and Multistage Fitness Test were done twice. RESULTS: A significant correlation was recorded only according to assessment of physical competence during the second measurement with a negative sign, indicating that an increase of physical activity had an impact on the decrease of differences in values of automatic computer refractometry in cycloplegia of measurements (right eye Rho: -0.260, p less than 0.01; left eye Rho: - 0.255, p less than 0.05). Multivariate regression analysis of impact on the difference of distance visual acuity without correction as well as the impact on difference of automatic computer refractometry in cycloplegia indicated that assessment of physical competence during the measurements had statistically significant impact on the decrease of distance visual acuity between measurements (right eye OR: I measurement -0.748, II measurement -0.660, p less than 0.05; left eye OR: I measurement -0.613, II measurement -0.515, p less than 0.05) and on decreased difference of automatic computer refractometry in cycloplegia (right eye OR: I measurement -0.822, II measurement -0.831, p less than 0.05; left eye OR: I measurement -0.641, II measurement -0.706, p less than 0.05). CONCLUSION: Physical activity did not cause the increase of myopia. This research opened a perspective for other researches on the impact of physical activity on myopia.

[Surgical overcorrection squint angle in extropia related to retinal correspondence relationship]. / Hirurska hiperkorekcija ugla devijacije kod divergentnih strabizama s aspekta retinalnih odnosa.

PURPOSE: Exotropia is the type of concomitant strabismus with wide clinic symptoms, and sensorial relationships. We have analyzed the patients with different types of divergent strabismus, the condition of sensors before and after operation, and influence of retinal relationships to post-operative result, with regards to long-time stablization of the angle of anomaly and stereo acuity. WORK METHOD: there were 30 patients examined and surgically treated in the Orthpleotics Department of the Eye Clinic of Clinical Center of Sarajevo University. WORK RESULTS: Average age of the patients is 8 years, 13 male (43.34%) and 17 female (56.66%). Deviation angle was, at 11 (36.66%) cases less than -10 degrees, and in 19 cases (63.34 %) over -1 degrees. Stereo acuity before the surgery was found at 9 (30%) patients, 21 (70%) without stereo acquity. RKK at 9 (30%) cases was normal, at 19 (63.34%) was ARK, and at 2 (6.6%) there was double correspondence. With patients with surgical overcorrection of the anomaly angle from +1 degrees to +5 degrees, we had a good result with 13 (43.34%) cases, as well as good stereo acuity on all tests, ortophoria with 7 (23.34%) patients, with variable stereo acuity and variable correspondence, and 10 (33.32%) undercorrected with ARKK, low stereo cooperation and bad estetic result. DISCUSSION: In cases where the surgical overcorrection was done, we get the best functional and esthetic results. Binocular cooperation was stabile, the deviation angle was low esophoria, with good fusion. The experiences of other authors also learn us about positive effect of surgical overcorrection of at least +4 degrees to +5 degrees. CONCLUSION: Author concludes that, in a case of surgical treatment of exotropia, it is enough to do overcorrection of angle because of getting more stabile postoperative results.

[Pathologic ophthalmologic changes in prematurity]. / Zastupljenost patoloskih oftalmoloskih promjena kod prematurusa.

The personal author's experiences has been presented, with regards to the early discovering and adequate preventing of ophthalmology diseases at prematurely born children. Thanks to the development of perinatology, almost every organ can be monitored and functionally examined even before the child is born. Despite all problems, the work of ophthalmo-paediatritians is extremely challenging, because that is the only situation in which embryology of the eye can be seen "In Vitro" and in which the physiological development of the eye's function can been monitored. During the period from 1999 to 2002, it was examined 66 children in total, who had an anamnestical data about prematurity, as well as the data about delivery-weight. Out of these 66 children, there were 40 (60.6%) boys and 26 (39.4%) girls, with 1-4 of age. All children were examined by usual, in daily work available, examination methods. The biggest percentage of children (80%) were sent to us by the paediatritian-neonathologist, and 20% war sent from the Primary Health Care centers, or they were sent from other centers. At 52 (78.7%) of children, the certain changes on the eyes were found, while at 10 (15.1%) children no changes at all were found. At 4 (6.2%) cases, we found minor changes, but we monitored those children as well. Ophthalmology changes were found in almost all forms, from the most complicated (ROP, coloboma horioretinae, congenital glaucoma, congenital cataract), to the simpler ones on which are less difficult to treat (refraction changes, amblyopia, strabismus, ptosis etc). Since these changes are still present with prematuruses, it is necessary to intensively monitor this population, as a part of the multidisciplinary team, made of the experts of the different profiles (paediatritian-neonatologist, otologist, logopedist, ophthalmologist, etc), and which would be possible through the Register of Prematurity. Author introduces her own experience of ophthalmologic diseases in children who are categorized as "risky". A team of different specialists does treatment.