Aesthetic and Functional Outcomes of Upper Blepharoplasty Combined with Dacryoadenopexy in Lacrimal Gland Prolapse.

INTRODUCTION: Lacrimal gland prolapse (LGP) is a term used to describe a benign, anterior displacement of the lacrimal gland. If this condition is not properly addressed during upper blepharoplasty, the aesthetic and functional results are less than optimal. This study aimed to report the surgical outcomes of upper blepharoplasty combined with dacryoadenopexy in patients with LGP. METHODS: We reported an unusual case of severe LGP in a young patient. In addition, we performed a systematic review of the English literature on surgical cases of LGP published between 1973 and 2023. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical technique used for lacrimal gland repositioning/suspension. The primary outcome variable was relapse rate. RESULTS: The bibliographic search retrieved 488 surgical cases of LGP: 12 in IPD, and 476 in APD datasets. The relapse rates in the IPD and APD cohorts were 8.3% (1/12) and 1.2% (6/476), respectively. Within the APD dataset, no significant difference in the relapse rates between dacryoadenopexy via suture suspension and Whitnall's ligament suspension (5/409 and 1/20, respectively; P > 0.05) was observed. Light cauterization of the lacrimal gland capsule and surrounding soft tissues was performed in mild LGP cases (< 4 mm prolapse), with a relapse rate of 0% (0/47). CONCLUSION: Upper blepharoplasty combined with dacryoadenopexy proved to be a safe surgical procedure with very satisfactory aesthetic outcome and minimal relapse rate. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The short form endometriosis health profile questionnaire (EHP-5): psychometric validity assessment of a Croatian version.

PURPOSE: To translate, adapt and validate the Endometriosis Health Profile-5 (EHP-5) in Croatian population. METHODS: This validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. A 150 consecutive patients with surgically proven endometriosis were enrolled. The translation to Croatian followed standardized procedure. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test-retest reliability was calculated using intraclass correlation coefficient (ICC). The t test for independent samples was used to assess known-groups validity. RESULTS: Both EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach's Alpha coefficient (α = 0.793 and α = 0.842, respectively). Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (ICC = 0.896 and 0.936, respectively). The independent t test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p < 0.001) on EHP-5 (M = 50.63) compared with women who reported their pain 6 or less (M = 26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p < 0.001), whereby infertile women had higher average result on EHP-5 (M = 49.55) compared with fertile women (M = 34.36). CONCLUSIONS: The Croatian version of the EHP-5 have very good psychometric characteristics and can be used as a reliable tool for assessing patients with endometriosis in everyday clinical practice.

Anxiety and Treatment Adherence among Glaucoma Patients during COVID-19 Pandemic and Earthquakes in Croatia.

BACKGROUND: The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort. SUBJECTS AND METHODS: This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant. RESULTS: This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p<0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228). CONCLUSION: Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies.

LENS CARE COMPLIANCE RATES AND PERCEPTIONS AMONG RIGID GAS PERMEABLE CONTACT LENS WEARERS - A PILOT STUDY.

The aim was to estimate compliance rate among rigid gas permeable lens wearers (RGPLW) in lens system care, identify procedures in lens care process with poorest compliance levels, and assess concordance between participant reported practices and their subjectively perceived compliance. The study included outpatient RGPLW managed at Zagreb University Hospital Center in Zagreb, Croatia. They filled out a questionnaire that included demographic data, duration of lens wear, self-evaluation compliance grade, and 14 lens care procedures and wearing habits indicative of compliance. There were 50 patients (mean age 34.6 years, 68% female). Full compliance was found in a single patient. The mean number of non-compliant procedures was 5.48, with 32% of participants non-compliant in more than 50% of the compliance criteria. Critical procedures of the lens care process were infrequent lens case exchange (74%), using tap water for lens (70%), and improper case cleaning (68%). The mean lens case replacement time was 9.8 months (SD 6.76), with only 26% of patients replacing lens case at least once in 3 months. Excessive daily lens wear was associated with greater total number of non-compliant procedures (p<0.0008). RGPLW were aware of their inappropriate lens care only when achieved non-compliance in almost 50% of the procedures. In conclusion, lens wearers were not aware of their extremely low compliance rate in several aspects of lens and lens case maintenance. Study results indicated the key procedures the practitioners should focus on when evaluating subjective and objective compliance and reinforcing care and hygiene education of RGPLW.

BILATERAL SEROUS CHORIORETINOPATHY AND PIGMENTARY GLAUCOMA - WHAT IS THE ASSOCIATION?

We present a patient with concurrent pigmentary glaucoma, bilateral central serous chorioretinopathy and unilateral optic disc pit, and propose a possible association of these conditions. Comprehensive ophthalmic examination of a 36-year-old man who was complaining of blurry vision and pain in the eyes showed reduced visual acuity on the left eye, elevated intraocular pressure in the right eye, bilateral signs of pigment dispersion syndrome, and bilateral central serous chorioretinopathy, combined with optic disc pit in the left eye. Visual field and optical coherence tomography findings demonstrated functional and structural glaucoma changes. Choroidal circulation abnormalities were observed by angiographic methods. Genetic and developmental anomalies of the external layer of the optic disc cup that gives rise to many anterior and posterior eye segment structures suggest a possible association of a clinical condition characterized by the combination of pigmentary glaucoma, central serous chorioretinopathy and optic disc pit. Future research would enable to determine proper diagnostic protocols, treatment and follow-up procedures for this chronic-progressive disorder.

Psychometric properties of the Croatian version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).

PURPOSE: The purpose of the study was to translate, adapt and validate the Croatian version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in participants with visual impairment. This study also aims at evaluating the relationship between visual impairment and health-related quality of life (HRQoL). METHODS: The prospective observational study was conducted at the University Hospital Centre Zagreb, Department of Ophthalmology. The sample consisted of 175 patients with four chronic ocular diseases: cataract, glaucoma, diabetic retinopathy and age-related macular degeneration. The translation of the NEI VFQ-25 to Croatian was conducted following the standardised procedure. All participants underwent an ophthalmological examination and completed the NEI VFQ-25 and the Medical Outcomes Study Short Form-36 Questionnaire (SF-36). In order to assess the psychometric properties of the NEI VFQ-25, we calculated Cronbach's α coefficient, intraclass correlation coefficient (ICC), convergent and discriminant validity, as well as criterion and concurrent validity. RESULTS: Results show high internal consistency (Cronbach α range 0.739-0.932) and high test-retest reliability (ICC 0.876-0.975) for all subscales. None of the items had failed either convergent or discriminant validity. Moderate to high Spearman's rho coefficients of correlations were found between best corrected visual acuity and eight subscales in the NEI VFQ-25 (0.430 < ρ < 0.631). Moderate correlations were found between comparable domains in the NEI VFQ-25 and in the SF-36 questionnaire (p < 0.01). CONCLUSION: The Croatian version of the NEI VFQ-25 has very good psychometric properties and can be a useful instrument for assessing vision-related quality of life in Croatian population with chronic ophthalmic diseases.

POSTOPERATIVE THINNING OF LAMELLAR DONOR GRAFT AFTER CONVENTIONAL DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY.

- The purpose of this study was to evaluate postoperative deturgescence of lamellar donor graft after conventional Descemet's stripping automated endothelial keratoplasty (DSAEK). It was a prospective study that included 55 eyes of patients (mean age 70.9±9.4 years; female 61.8%, male 38.2%). Preoperative thickness of lamella was compared with postoperative thickness six months after surgery. Central lamellar graft thickness decreased from 142±27 µm preoperatively to 124±20 µm 6 months postoperatively (p<0.01). After performing conventional DSAEK corneal transplantation, surgeons should expect deturgescence of corneal graft and reduction in thickness of lamellae by about 12% of initial thickness according to our results. We found this information important for better planning of surgical procedures and knowing what to expect after surgery, as well as for better cooperation with eye banks when ordering pre-cut corneal tissue.

Influence of Diastolic Blood Pressure on Glaucoma Progression in Glaucoma Patients with Systemic Hypertension.

The aim of this study is to determine relationship between glaucoma progression and diastolic blood pressure. It was conducted on 64 glaucoma patients at the Department of Ophthalmology of Clinical Hospital Centre Zagreb in three years period. The patients were on anti glaucoma therapy and had mean intraocular pressure values under 20 mmHg. At the same time they were on antihypertensive drug therapy. Patients were classified according Glaucoma Staging System based on the perimetric indices mean deviation (MD) and Pattern Standard Deviation into stage 2-4 (moderate glaucoma) at baseline. Rate of visual field progression was calculated in db/year for MD in the last three visits. Patients were divided in 3 groups according to progression--stabile, moderate and progressive. There was no statistically significant difference between 3 groups in terms of intraocular pressure values at baseline and in follow up period. After reviewing their blood pressure, the progressive group showed a significantly lower diastolic blood pressure compared to both stable group and the group with moderate progression. There was no statistical difference between the group with moderate progression and the stable group in terms of diastolic blood pressure. Results suggest that greater risk of glaucoma progression is connected with lower diastolic blood pressure. Diastolic pressure values could be important as one of the risk factors for progression in glaucoma patients with controlled intraocular pressure values.

Ocular surface disease in pseudoexfoliation syndrome.

Aim of the study is to determine connection between pseudoexfoliation (PEX) syndrome and symptoms and signs of ocular surface disease. Tear film break-up time test, Schirmer II test and assessment of lid parallel conjunctival folds were performed in 40 PEX syndrome patients and 40 controls. All data was statistically analyzed. Results show statistically significant difference in every component between groups, most prominent in tear film break up time test. We have concluded that patients with PEX syndrome have higher predisposition of tear function disorders and that both components of dry eye syndrome are present in PEX syndrome.

Progression of conjunctival primary acquired melanosis (PAM) to widely spreaded malignant melanoma.

Primary acquired melanosis (PAM) is an acquired pigmentation of the conjunctival epithelium, a preinvasive pigmented lesion. When it is associated with cellular atypia it can lead to the developement of melanoma. We report a case report of malignant melanoma of the conjuntiva, which arrised from the conjuntival PAM. The disease was too extensive for ocular conservation, therefore exenteration was performed. This case highlights the need for regular follow-up of patients with melanocytic lesions of the ocular adnexa, and particular attention to the surgical technique, and careful follow-up to detect further disease activity.

Compliance among soft contact lens wearers.

Contact lens compliance is proven to be crucial for preventing lens wear-related complications because of the interdependence of the steps in lens care regime and their influence on lens system microbial contamination. Awareness of the patients' lens handling compliance as well as correct recognition of non-compliant behaviours is the basis for creating more targeted strategies for patient education. The aim of this study was to investigate compliance among soft contact lens (SCL) wearers in different aspects of lens care handling and wearing habits. In our research 50 asymptomatic lens wearers filled out a questionnaire containing demographic data, lens type, hygiene and wearing habits, lenses and lens care system replacement schedule and self-evaluation of contact lens handling hygiene. We established criteria of compliance according to available manufacturer's recommendations, prior literature and our clinical experience. Only 2 (4%) of patients were fully compliant SCL wearers. The most common non-compliant behaviours were insufficient lens solution soaking time (62%), followed by failure to daily exchange lens case solution and showering while wearing lenses. 44% of patients reported storing lenses in saline solution. Mean lens storage case replacement was 3.6 months, with up to 78% patients replacing lens case at least once in 3 months. Average grade in self evaluating level of compliance was very good (4 +/- 0.78) (from 1-poor level of hygiene to 5-great level of hygiene). Lens wearers who reported excessive daily lens wear and more than 10 years of lens wearing experience were also found to be less compliant with other lens system care procedures. (t = -2.99, df=47, p < 0.0045 and t = -2.33, df= 48, p < 0.024, respectively). Our study indicates that almost all patients had some degree of non-compliance in lens system maintenance steps. Most common non-compliant behaviours were the ones that are crucial for maintaining lens sterility and preventing infection. Despite the low objective compliance rate, self grading was relatively high. Therefore, these results indicate the need for patient education and encouragement of better lens wearing habits and all of the lens maintenance steps at each patient visit.

Effect of the against the rule myopic astigmatism on the near vision of the elderly.

In the two groups of patients with myopic astigmatism the uncorrected near vision was tested after catatract surgery. Each group with 20 patients ages 60-80. All patients enrolled in study have uncorrected far vision 0.5 or better on Snellen tables. In the first group patients were with the rule after surgery myopic astigmatism (1-1.50 Diopter), and in the second group were patients with against the rule after surgery myopic astigmatism (1-1.50 Diopter). Patients in the second group with against the rule astigmatism achieved significantly (p<0.01) better uncorrected near vision.

Clinical Experience of Using a Combination of Dexamethasone and Levofloxacin After Cataract Surgery.

Background: Where routine prophylactic antibiotics have been adopted following cataract surgery, rates of endophthalmitis have been decreasing. Intracameral and topical antibiotics are currently used to prevent endophthalmitis after cataract surgery. When applying topical antibiotics, there are different recommendations on the frequency and duration of therapy. The development of bacterial resistance to the excessive and long-term use of antibiotics is a growing problem worldwide. The goal is to achieve a good antibiotic effect with the shortest possible use of antibiotics. Objective: The aim of this study was to compare the effectiveness of a new combination therapy of dexamethasone and levofloxacin for seven days after cataract surgery with the previous regimen of dexamethasone, neomycin sulfate, and polymyxin B, which was given for 21 days. Methods: A retrospective analysis of medical records and administered a questionnaire was conducted to assess the effectiveness of postoperative therapy in our cataract surgery patients. The study involved 52 patients who underwent surgery within the last year, performed by a single surgeon at our institution. The findings can help us improve the quality of care we provide and optimize our patients' overall quality of life. Results: We conducted an in-depth study on 52 individuals who underwent cataract surgery at our institution. The prescribed therapeutic regimen for the participants included administering Ducressa solution four times daily for the first seven days and Maxidex solution three times daily for the subsequent 14 days. The study found that none of the participants experienced complications after surgery, and all found it easy to instill the medication. The prescribed regimen effectively managed the postoperative recovery of the participants, and the medication was well-tolerated. Conclusion: Our research found that a new combination of levofloxacin and dexamethasone, when used topically, may require a shorter treatment period, reducing the risk of antibiotic resistance and providing a safe alternative for endophthalmitis prevention.

Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence.

BACKGROUND: Cloninger's psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient's temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger's personality dimensions and medication adherence among glaucoma patients. METHODS: The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS - German Clinical Trials Register; (DRKS-ID: DRKS00022081). RESULTS: According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). CONCLUSIONS: The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients' personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.

Automated static perimetry: the influence of myopic anisometropia on evaluation of visual field.

The aim of study was to establish which level of myopic refractive error influences visual field defects in automated static perimetry, if these defects are typical, and if optimal correction normalized the visual field. The study included 100 patients (200 eyes) divided into three groups according to the severity of the myopic refractive error: group A (till -3.25 Dsph), group B (-3.50 Dsph to -5.25 Dsph) and group C (-5.50 Dsph to -8.00 Dsph). The control group included 20 emmetropes (40 eyes). This study confirms that optimal corrected and uncorrected myopia up to -3.25 Dsph does not produce quantitative visual field defects, when tested by static automated perimetry. Even in optimally corrected myopics, with myopia higher than -5.50 Dsph, visual field defects on gray scale can be found. Defects are in the intermediary zone with more prominent defects in the upper quadrants. Visual field indices (MD, MS, LV RF) were completely normalized.

Testing of the retinal visual acuity in high myopia with cataracts.

In the presence of the media opacities and extreme ametropia, especially in high myopia, often arises a question of expected visual acuity, e.g. after cataract extraction because of the possible degenerative changes of the choroid and retina. In the measurements were enrolled 15 patients between 45 and 60 years of age, 9 female and 6 male. We have tested preoperative retinal visual acuity by the interferometer. One month postoperatively visual acuity was measured by Snellen international charts at a distance of 6 m. Both measurements are calculated using log MAR scale. Measurements were paired and the differences are calculated and analyzed for the significance. No significance was found (p > 0.05). It was concluded that measured differences were incidental and interferometer measurements are reliable in predicting post cataract visual acuity in high myopia

Comparative study of antibacterial and antifungal effects of rigid gas permeable contact lens disinfecting solutions.

The aim of this study was to compare antimicrobial efficacy of rigid contact lens disinfecting solutions. We tested five commercially available solutions: Unique pH (Alcon Laboratories), Boston Advance (Polymer Technology Corp.), Nitilens Conditioner GP (Avizor), Total Care (AMO), Boston Simplus (Bausch&Lomb). Their efficacy to disinfect saline solution experimentally contaminated with American Type Culture Collection (ATCC): Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Candida albicans (ATCC 90028) and Staphylococcus epidermidis (isolated from our laboratory) was tested. All tested solutions reduced concentrations of bacteria and fungi below 1000 CFU/mL (Colony forming unit; reduction by 3 log and 1 log, respectively) after the 8 hours period. Overall, all contact lens care solutions showed good disinfecting activity against tested bacteria and fungi, with more variation in their antifungal than in antibacterial efficacy. Results of our study might be valuable when selecting appropriate solutions for non-compliant contact lens wearers.

Ocular related emergencies in Zagreb University Hospital Centre--ten month analysis.

To determine number, demographic characteristics and presenting symptoms of patients admitted to Emergency ophthalmologic department of Zagreb University hospital centre. Prospective analysis of data of 743 patients admitted to Emergency ophthalmologic department of University hospital centre Zagreb during period of 10 month. Main presenting symptoms at admission were red eye, pain and foreign body sensation. 64% of all patients admitted to emergency unit were male. Almost 40% of them were between 20 and 40 years of age. In female population majority is between 50 and 60 years old (19.33%). The study shows that the most frequent reason for admission in emergency ophthalmic unit is red eye, pain and foreign body sensation. These symptoms were present most frequently in young male patients. Considering fact of their working ability, data can suggest that they don't comply with occupational safety measures. Further research in this direction is needed.

Application of the amniotic membrane extract (AMX) for the persistent epithelial defect (PED) of the cornea.

A lot of pathological conditions could provoke damaging of the innervations of the cornea and lead to persistent epithelial defect (PED). AMX is lyophilized preparation of amniotic membrane (AM), which contains biological components and efficacy of AM for treatment of the corneal surface defects. In processing all the substances essential for biological effects of AM are preserved (growth factors, neutrophins, interleukins, receptors, fibronectins and different types of collagen). A patient can apply AMX as eye drops by himself in his home, thus avoiding surgical procedure. We presented two patients with PED; we treated them with eye drops of AMX, 2 drops every hour during day time. There was observed healing effect by reducing epithelial defect. Almost after a second day of application, and after 1-2 week period PED that persisted for weeks healed completely.