The Resident Surgeon Phacoemulsification Learning Curve at Clinical Department of Ophthalmology, Sestre Milosrdnice University Hospital Center

The aim of the study was to analyze the resident learning process of phacoemulsification cataract surgery and to assess the resident phacoemulsification learning curve. This prospective study comprised 86 consecutive cases of phacoemulsification performed using standard technique by eight residents over a one-year period at Clinical Department of Ophthalmology, Sestre milosrdnice University Hospital Center in Zagreb. Operative data on each case included resident and attending surgeon, date of operation, step-by-step success questionnaire, and intraoperative complications. Postoperative data included visual acuity at one-month postoperative visit and postoperative complications. Eighty-six operations were performed under the supervision of attending surgeon. The mean best-corrected visual acuity improved from 0.47±0.25 to 0.8±0.25 postoperatively. Intraoperative complications occurred in 13 (15.12%) cases and continued to decrease throughout residency training. The mean number of individually performed steps per operation increased throughout residency (from 7.6 to 9.0). There was one early postoperative complication, endophthalmitis, which was successfully treated, and no other postoperative complications occurred. Resident surgical competency can be improved by maximizing the number of cataract procedures since the complication rates and the number of individually performed steps improved continuously with increasing surgical experience.

Masqueraded sebaceous gland carcinoma of the lower eyelid in a young pregnant patient.

The purpose of this case report is to present misdiagnosed sebaceous gland carcinoma of the lower eyelid with rapid growth in a young woman during pregnancy. Eyelid sebaceous gland carcinoma is a relatively rare tumor and a disease primarily of older patients. It occurs more commonly in oriental populations and with a predilection for the upper eyelid. Early diagnosis and appropriate treatment may help improve disease control and patient survival.

Common variant in myocilin gene is associated with high myopia in isolated population of Korcula Island, Croatia.

AIM: To study the association between genetic variants in myocilin and collagen type I alpha 1 genes and high myopia in an isolated island population. METHODS: A total of 944 examinees from the genetic epidemiology study conducted on the island of Korcula, Croatia, were included in the study. We selected 2 short nucleotide polymorphisms (SNP) available in our genome-wide scan set of SNPs that were previously associated with high myopia and used them to replicate previous claims of possible association. RESULTS: Nineteen cases of high myopia, defined as the refraction of

[Ophthalmological causes of headache]. / Okularni uzroci glavobolje.

Ophthalmologic causes of headache represent a very complex and extensive problem, and very often differential diagnostic problem too. Many various reasons of headache can be caused by ophthalmologic diseases like those of anterior and posterior eye segments, acute and subacute angle closed glaucoma and orbital diseases. Headache can be caused by no or poor correction of the refraction anomalies. Ophthalmologic causes of headache are quite frequently connected with conditions that affect other body systems apart from the eyes, nervous and/or vascular system in particular. Although ophthalmologic examination very provides the clue in patients with headache, the diagnostic and therapeutic approach to the problem has to be interdisciplinary.

Structure-Function Relationship of Changes in Visual Field Indices with Quadrant and Average Retinal Nerve Fiber Layer Thickness in the Eyes with Exfoliation.

The progressive nature of glaucoma suggests it should be possible to detect structural changes such as retinal nerve fiber layer (RNFL) thickness loss before the condition becomes clinically apparent with visual field (VF) impairment. Therefore, the aim was to analyze RNFL thickness and VF changes in study groups with unilateral exfoliation syndrome (XFS), bilateral XFS and bilateral exfoliative glaucoma (XFG), and compare it with controls. The study included 114 subjects (228 eyes) divided into 4 groups according to the presence of exfoliation: 30 subjects with unilateral XFS (30 with clinically visible XFS and 30 fellow eyes), 24 subjects (48 eyes) with bilateral XFS, 28 (56 eyes) subjects with bilateral XFG, and control group (32 subjects). All subjects underwent VF and RNFL measurements after ophthalmologic examination. Both eyes of unilateral XFS (clinically -visible and fellow eye) showed positive correlation between Mean Defect (MD) and square root of Loss of Variance (sLV) and between MD and inferior quadrant RNFL thickness. In bilateral XFS and XFG, there was negative correlation between MD and inferior quadrant RNFL thickness. Inferior, superior and nasal quadrant RNFL thickness was lower in XFG group than in other groups. In bilateral XFS group, the inferior quadrant RNFL thickness was lower as compared with unilateral XFS group (in both eyes). The mean RNFL thickness negatively correlated with MD in bilateral XFS and XFG groups. In conclusion, structural changes before VF impairment have an important role in early detection of glaucoma in subjects at risk.

[Triamcinolone acetonide in the treatment of inflammation after cataract surgery]. / Triamcinolon acetonid u lijecenju upale nakon operacije katarakte.

AIM: To compare the use of single injection of triamcinolone acetonide and steroid drops in the treatment of inflammation after cataract surgery. PATIENTS AND METHODS: This retrospective study included 80 patients operated on by phacoemulsification with intraocular lens implantation. After the operation, patients were divided into two groups. Group A received dexamethasone-neomycin drops for four weeks, whereas group B received single application of triamcinolone acetonide into the subtenon space. Postoperative evaluation included the degree of inflammation, intraocular pressure and therapeutic response. RESULTS: Triamcinolone acetonide appeared to be an as valuable therapy in minimizing inflammation after cataract surgery as steroid drops on days 7, 14 and 21 postoperatively, a significantly lower intraocular pressure was recorded in the group of patients administered a single injection of triamcinolone acetonide. CONCLUSION: Single application of triamcinolone acetonide appeared to be as efficient as steroid drops in controlling postoperative inflammation after uncomplicated cataract surgery.

[Distichiasis]. / Distihijaza.

Distichiasis is a rare congenital or acquired eyelid anomaly in which an accessory row of eyelashes arises from the openings of meibomian glands or near them. The abnormal cilia are posterior to the normal row of cilia and may abrade the eye causing ocular irritation and corneal damage. We describe a 9-year-old Caucasian girl with bilateral and symmetric distichiasis. This condition was treated with lid splitting followed by cryotherapy to the posterior lid lamella. The technique has been used in four eyelids with congenital distichiasis, with very good results.

Eye drops preservative as the cause of corneal band keratopathy in long-term pilocarpine hydrochloride treatment.

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.

Multifocal intraocular "mix and match" lenses.

The new generation multifocal lenses provide the surgeon with several options to meet the specific visual needs and desires of patients. A revolution in presbyopia surgery is being driven by two multifocal intraocular lenses, ReStor and ReZoom. Combined implantation of the ReZoom multifocal lens in nondominant eye and ReStor multifocal lens in dominant eye has been demonstrated to produce statistically and clinically superior results in bilateral uncorrected intermediate vision improving vision effectiveness in presbyopia patients after cataract surgery. Also, the mix and match approach can maximize patient vision at both near and far distance, thus improving the patient quality of life.

Surgical technique and postoperative complications in pediatric cataract surgery: retrospective analysis of 21 cases.

AIM: To evaluate postoperative complications of different surgical techniques for cataract treatment in children. METHODS: We reviewed clinical records of 21 children (33 eyes) who underwent cataract surgery between January 1998 and December 2002. The median age of children at the time of cataract surgery was 39 months (range, 4-115 months). The median follow up was 26 months (range, 6-58 months). A posterior continuous curvilinear capsulorhexis with anterior vitrectomy was performed in 24 eyes, and posterior continuous curvilinear capsulorhexis without anterior vitrectomy in 9 eyes (children older than 7 years). Nine eyes were left aphakic and intraocular lens was implanted in 24 eyes. RESULTS: Opacification of the visual axis was the most frequent complication. One of nine eyes in the group of children undergoing posterior continuous curvilinear capsulorhexis developed posterior capsule opacification. This also occurred in 6 out of 24 eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy. In 5 eyes with secondary opacification Nd:YAG laser capsulotomy was performed as a secondary procedure. In uncooperative children (2 eyes) more extensive anterior vitrectomy was repeated. Other postoperative complications included aphakic glaucoma (n=1), synechia formation (n=4), intraocular lens deposits (n=2), and pupil capture (n=1). CONCLUSIONS: The main complication in the pediatric cataract surgery was posterior capsule opacification, and the management of posterior capsule seems to be a very important factor. In younger children, cataract surgery with posterior capsulorhexis and anterior vitrectomy was advantageous, whereas in older children a clear visual axis was achieved without vitrectomy.

Surgical treatment, clinical outcomes, and complications of traumatic cataract: retrospective study.

AIM: To analyze clinical outcomes and complications after traumatic cataract extractions because of post-traumatic lens opacification. METHODS: We performed a retrospective analysis of 24 eyes with traumatic cataract surgically treated between May 2000 and June 2003. Preoperative visual acuity, postoperative best corrected visual acuity, and preoperative, intraoperative, and postoperative complications were analyzed for all eyes. RESULTS: Most patients were young men, with preoperative visual acuity of 0.05-0.1, who underwent surgery between one and six months after the trauma. We found corneal scar in 5 eyes, rupture of the anterior capsule in 4 eyes, sphincter damage in 2 eyes, anterior synechiae in 3 eyes, iridodialysis in one eye, zonullar loss in one eye, and macular scar in one eye. Mild or moderate postoperative complications occurred in 9 out of 24 cases. Visual acuity improved in 17 eyes. Seven out of 24 patients did not benefit from cataract surgery because of traumatic involvement of the retina and opacification of posterior capsule. CONCLUSION: The majority of the eyes with traumatic cataract were safely rehabilitated with intraocular lens implantation.