Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in detection of complete posterior vitreous detachment.

BACKGROUND: To evaluate the accuracy of preoperative biomicroscopy (BM), ultrasonography (US), and spectral domain optical coherence tomography (SD-OCT) to determine complete posterior vitreous detachment (PVD) confirmed by intraoperative findings of triamcinolone acetonide-assisted pars plana vitrectomy (PPV). METHODS: This prospective study included all consecutive patients admitted for surgical treatment of the epiretinal membrane (ERM) and macular hole (MH). The presence of complete PVD was determined one day before PPV using BM, US, SD-OCT. The preoperative findings were compared to the PVD status determined during PPV. RESULTS: A total of 123 eyes from 123 patients were included in the study. Indications for PPV included ERM in 57 (46.3%), full thickness macular hole in 57 (46.3%) and lamellar macular hole in 9 (7.3%) patients. Complete PVD during PPV was observed in 18 (31.6%; 95%CI:18.7-49.9) patients with ERM and 13 (19.7%; 95%CI:10.4-33.7) patients with MH. The sensitivity of preoperative BM, US, SD-OCT was 48.4% (95%CI:30.2-66.9), 61.3% (95%CI:42.2-78.2) and 54.8% (95%CI:36.0-72.7) respectively. The specificity of preoperative BM, US, SD-OCT was 81.5% (95%CI:72.1-88.9), 90.2% (95%CI:82.2-95.4) and 85.9% (95%CI:77.0-92.3) respectively. With a prevalence of 25.2% of PVD in our sample the positive predictive value of preoperative BM, US, SD-OCT was 46.9% (95%CI:29.1-65.3), 67.9% (95%CI:47.6-84.1) and 56.7% (95%CI:37.4-74.5) respectively. CONCLUSION: Preoperative BM, US, and SD-OCT showed relatively low sensitivity but also good specificity in assessing complete PVD. A combination of all three diagnostic methods can provide a good assessment of the vitreoretinal interface state.

Corneal astigmatism in cataract surgery patients from Bosnia and Herzegovina.

PURPOSE: To determine corneal astigmatism prevalence, its correlations with age and symmetry pattern in fellow eyes of patients undergoing cataract surgery. METHODS: This is a clinical-based retrospective cross-sectional study. Keratometry measurements of patients undergoing cataract surgery assigned to University Clinical Center Tuzla, Bosnia and Herzegovina, between January 2011 and June 2012 were recorded and analyzed retrospectively. RESULTS: The study consisted of 4080 eyes of 2205 consecutive cataract surgery patients with a mean age of 68.24 years ± 9.25 (SD) (range 32-84 years), and 54.0% of the patients were women. Mean corneal astigmatism was 0.72 ± 0.61 D (range 0-6.5 D). The prevalence of corneal astigmatism 1.0 D or more was in 1291 eyes (31.64%), 1.5 D or more in 736 eyes (18.03%), 2.0 D or more in 396 eyes (9.71%) and 3.0 D or more in 108 eyes (2.65%). There was no significant difference in the magnitude of astigmatism between age groups (p = 0.10), male and female (p = 0.29) or right and left (p = 0.75) eyes. The prevalence and amount of astigmatism increased with age (p < 0.05). Gradual shift from with-the-rule astigmatism toward against-the-rule astigmatism was observed (p = 0.03). Patients with higher amount of astigmatism in one eye are more likely to have significant astigmatism in fellow eye (p < 0.01). Symmetry in pairs of eyes is present in eyes with astigmatism greater than 2.5 D (p < 0.01). CONCLUSION: This study provides useful reference data for cataract surgeons and patients from Bosnia and Herzegovina.

The safety and efficacy of day care cataract surgery.

PURPOSE: To evaluate safety and efficacy of day care cataract surgery in developing country. PATIENTS AND METHODS: This prospective study included 200 patients planned for cataract surgery during October and November 2012 divided in to two groups, day care cataract surgery (DCCS) and inpatient cataract surgery (ICS), with same number of male and female patients right and left eyes. All patients had same operative conditions and postoperative follow up. RESULTS: The average age of patients in this study was 68.4 +/- 7.47 years. Visual acuity before cataract extraction was 0.1754 where 44.5% of patients had severe visual impairment and another 23% had complicated cataract. Posterior capsule rupture was noted in 4.5% of cases. The main risk factors in both groups were: higher age, female gender, left side, complicated cataract, higher dioptric power of IOL and ECCE. Regular control opthalmologic examinations 30, 90 and 180 days after the cataract extraction did not reveal signs bullous keratopathy, wound dehiscence, cystoid macular edema and endophtalmitis in any of patients. Postoperative visual acuity 180 days after the operation in DCCS was 0.920 +/- 0.154 and 0.928 +/- 0.144 in ICS. Visual acuity less than 0.5 was noted in 4.5% due to posterior eye segment changes. Patients in DCCS group had 30 control examinations more and 95 days of hospitalization less than ICS with 16.5% cost reduction. CONCLUSION: The concept of day care cataract surgery is equally safe and more cost effective than inpatient cataract surgery.

Treatment of congenital aniridia associated with subluxated infantile cataract.

A 5 year old boy was presented at Eye clinic University clinical center Tuzla with congenital aniridia in both eyes. Clinical examination revealed visual acuity of 0,08 without correction in right and 0.7 with -5.0 Dsph and -1.0 Dcyl Axx 109° in left eye. Opthalmologic examination showed bilateral aniridia associated with moderate cataract in the right and incipient cataract in the left eye. In the right eye, zonular weakness with incipient capsular displacement and esotropia of Δ6º, were noted. The patient underwent phacoemulsification, implantation of capsular tension ring and Artificial Iris implant in the capsular bag. Phacoemulsification went uneventful and early postoperative recovery was successful with no signs of aniridia-associated keratopathy development and normal values of intra ocular pressure. Patient was not motivated for operation of the left eye and it was corrected with soft contact lens. Six month after the operation visual acuity in the right eye improved to 0.9 with +1.25Dsph and maintained stable in left eye, with complete elimination of esotropia and signs of binocular vision restoration. Small incision cataract extraction with IOL and Artificial Iris implantation in one procedure can be used to correct congenital aniridia and cataract with significant visual function improvement.

Gender- and Age-Related Differences of Ocular Biometric Parameters in Patients Undergoing Cataract Surgery in Bosnia and Herzegovina.

Purpose: The aim of the study is to determine the distribution and mutual relationship of ocular biometric parameters, as well as to evaluate gender- and age-related differences in patients undergoing cataract surgery in Bosnia and Herzegovina. Materials and Methods: It was a retrospective cross-sectional study of consecutive patients who underwent cataract surgery between January 2017 and December 2021 in a tertiary care clinic. All biometric measurements were performed using the optical biometer OA-2000 (Tomey, Nagoya, Japan). Results: The study evaluated 1278 eyes from 1278 consecutive cataract patients. The average age of all included patients was 69.4 ± 9.98 (range 40-96). A total of 672 eyes (52.58%) were from females. The mean axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and mean keratometry were 23.46 ± 1.18 mm, 3.17 ± 0.40 mm, 4.54 ± 0.48 mm, and 43.42 ± 1.55D, respectively. Corneal astigmatism of ≥1D, >2D and >3D was found in 33.4%, 7.8% and 2.5% patients, respectively. Females were found to have shorter AL (p < 0.0001), shallower ACD (p < 0.0001) and steeper corneas (p < 0.0001). In both genders, AL, ACD and with the rule astigmatism showed a decreasing trend (p = 0.0001), while keratometry, the average cylinder, and against the rule astigmatism showed an increasing trend (p = 0.0001) with increasing age. Furthermore, in both genders, there was an increasing trend in ACD (p = 0.0001), and a decreasing trend in keratometry (p = 0.0001) and LT (p = 0.0001) with increasing AL. Conclusions: This study provides useful reference data on ocular biometry for cataract surgeons in Bosnia and Herzegovina. Female patients tend to have steeper corneas, shorter AL and shallower AC than males, and these differences are independent of age or AL.

Significance of ultrasonography in evaluation of vitreo-retinal pathologies.

PURPOSE: To assess the diagnostic value of ultrasonography in the detection of vitreo-retinal pathologies. MATERIAL AND METHODS: This prospective study included all patients from retina department in Eye Clinic University Clinical Center Tuzla first time referred and examined by a single experienced vitreo-retinal surgeon in period from January 2011 to January 2012. Complete ophthalmic examination and ultrasonography-standardized echography were performed to all patients for detection and confirmation of vitreo-retinal pathology. RESULTS: Study included 146 eyes from 122 patients. 58 (39.7%) eyes had poor posterior segment visualization, 21 (14.4%) eyes due to dense cataracts and 37 (25.3%) eyes due to different vitreous opacities. 88 (60.3%) eyes had good or partial posterior eye segment visualization, where 67 (45.9%) eyes had proliferative vitreo-retinopathy and 55 (37.7%) eyes had tractional retinal detachment. Most common causes for referral to vitreo-retinal surgeon were ocular complications of diabetes mellitus 94 (64.4%), ocular trauma 18 (12.3%), rhegmatogenous retinal detachment 16 (10.9%) and intraocular inflammation 9 (6.2%). Ultrasonography confirmed suspected diagnosis and operative management plan in 120 (82.2%) eyes, sublassified previously established diagnosis in 19 (13%) eyes and helped further operative planning and established completely new diagnosis and changed initial management plan in 7 (4.8%) eyes. The final clinical diagnosis confirmed the ultrasonography findings in 142 from 146 (97.3%) eyes. CONCLUSION: Ultrasonography is useful part of ophthalmic examination for detection, evaluation and follow up of different vitreo-retinal pathologies.

Socioeconomic Status and Decreasing Incidence of Ocular Injuries in Bosnia and Herzegovina.

Purpose: To examine the epidemiologic and clinical characteristics of ocular injuries and their association with socioeconomic status (SES).Material and Methods: All cases of ocular injuries hospitalized in Department of Ophthalmology of University Clinical Center Tuzla, Bosnia and Herzegovina, from January 2009 to December 2012 and January 2017 and December 2019 were prospectively followed. The injuries were classified according to Ocular Trauma Classification System (OTCS) and Birmingham Eye Trauma Terminology (BETT).Results: This study included a total of 420 eyes from 396 patients. There were 162 (38.57%; 95%CI: 32.86-44.99) open globe injuries (OGI) and 258 (61.43%; 95%CI: 54.16-69.4) closed globe injuries (CGI). The decrease in incidence of ocular trauma requiring hospitalization was noted from 16.7 per 100 000 (95%CI: 13.11-20.97) in 2009 to 9.25 per 100 000 (95%CI: 6.64-12.55) in 2019 (p=0.006). Most injuries occurred in males 341 (81.19%; 95%CI: 72.8-90.28), active working patients 258 (61.43%, 95%CI:54.16-69.4), and patients with rural residence 285 (67.86%; 95%CI: 60.21-76.21). Almost all ocular injuries 418 (99.52%; 95%CI: 90.21-109.54) occurred in patients with middle and lower SES categories, and home was the most prevalent place of injury in 258 (61.43%, 95%CI: 54.16-69.4) patients. The total of 289 (70.49%; 95%CI: 62.59-79.1) patients had good final best corrected visual acuity (BCVA). Poor final BCVA was associated with lower ocular trauma score (OTS) (p=0.000), poor initial BCVA (p=0.000), penetrating injuries of cornea (p=0.004) and sclera (p=0.001), Zone III injuries (p=0.000), intraocular foreign body presence (p=0.000), cataract (p=0.002), retinal detachment (p=0.001), endophthalmitis (p=0.000) and vitreous hemorrhage (p=0.010).Conclusion: This study provides a detailed insight into epidemiology and socio-economic characteristics of patients hospitalized for ocular injuries.

Ocular Dirofilariasis in Bosnia and Herzegovina: A Case Report and Review of the Literature.

PURPOSE: To report a rare occurrence of ocular dirofilariasis in Bosnia and Herzegovina and provide a short overview on clinical characteristics and treatment options for ocular dirofilariasis. METHODS: A 75-year-old woman was admitted to the University Clinical Centre Tuzla with pain and redness in her left eye. A live, white, coiled, and active worm was noticed in subconjunctival space of bulbar conjunctiva. RESULTS: After successful surgical extraction, the parasite was identified as the adult form of Dirofilaria repens. There were no signs of intraocular or systemic inflammation. CONCLUSION: Ophthalmologists should have in mind a possible infestation, especially in cases with repeated inflammatory reactions and swelling of the ocular region, which does not respond to conventional therapy.

Eccentric Macular Hole Formation Following Successful Macular Hole Surgery.

OBJECTIVE: Postoperative eccentric macular hole formation is a rare complication after vitrectomy with internal limiting membrane peeling for a macular hole. We report a rare case of late eccentric macular hole formation following successful macular hole surgery. CASE REPORT: A 73-year old woman was referred with a long standing full thickness macular hole in both eyes. The patient underwent sequential cataract surgery, 23 gauge sutureless pars plana vitrectomy with internal limiting membrane peeling and inverted flap in both eyes. Control examination six months after the surgery revealed best corrected visual acuity of 20/40 in both eyes, complete closure of the macular hole, with retinal atrophy in both eyes. Control examination eighteen months after the surgery revealed a stable finding in the right eye and an eccentric temporal macular hole in the left eye. The patient was closely observed for one year with no signs of visual acuity reduction or macular hole changes. CONCLUSION: Postoperative eccentric macular holes may occur after a long follow up period. Most cases remain stable for a long period of time and do not require further surgical intervention. This case highlights the need for close monitoring of patients after macular hole surgery with internal limiting membrane peeling.

Premium intraocular lenses: The past, present and future.

PURPOSE: To present potential benefits as well as limitations of premium intraocular lens (IOL) use, and provide insight in future of premium cataract surgery. METHODS: Bibliographic research was performed in PubMed/Medline database, and the most recently updated papers were evaluated. Keywords used were: premium intraocular lens, multifocal intraocular lens, toric intraocular lens, toric multifocal intraocular lens, accommodative intraocular lens, and the respective brand names. RESULTS: Multifocal IOLs provide uncorrected distance visual acuity (UDVA) of 0.03 logMAR in 82.3%-95.7% of patients and overall spectacle independence in 81%-85% of patients. Toric IOLs provide UDVA of 0.3 logMAR in 70%-95% of patients, residual astigmatism of 1 D or less is noted in 67%-88% of patients, and spectacle independence is reported in 60%-85% of patients. Toric multifocal IOLs provide UDVA of 0.3 logMAR in 92%-97% of patients, and spectacle independence is reported in 79%-90% of patients. Accommodative IOLs represent intensively developing field in ophthalmology, and the results are still variable depending on the IOL model. CONCLUSIONS: Premium IOL technology and advanced surgical techniques have significantly improved postoperative visual outcomes. Future developments will potentiate development of new premium IOL designs that will provide spectacle independence and excellent visual outcomes after cataract surgery.

The Prevalence of Refractive Errors and Visual Impairment among School Children in Brcko District, Bosnia and Herzegovina.

In this study we investigate the prevalence of refractive errors and visual impairment among primary school children in the urban population of Brcko District, Bosnia and Herzegovina. A cross-sectional study included 40 randomly selected classes of children aged 7-16 years attending five different primary schools in Brcko District. The examination included visual acuity testing, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, examination of the external eye, anterior segment, media and fundus. A total of 1,005 children were enumerated, and 997 (99.2%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 9.9%, 5.9% and 0.5%, respectively. The prevalence of myopia and hyperopia measured with retinoscopy was 17.3% and 3.0% eyes, and measured with autorefraction 20.4% and 3.3% eyes, respectively. Astigmatism was found in 12.9% eyes with retinoscopy and in 18.1% with autorefraction.

Spontaneous closure of a full thickness macular hole.

No abstract available.

The Use of Smart phones in Ophthalmology.

Smart phones are being increasingly used among health professionals. Ophthalmological applications are widely available and can turn smart phones into sophisticated medical devices. Smart phones can be useful instruments for the practice of evidence-based medicine, professional education, mobile clinical communication, patient education, disease self-management, remote patient monitoring or as powerful administrative tools. Several applications are available for different ophthalmological examinations that can assess visual acuity, color vision, astigmatism, pupil size, Amsler grid test and more. Smart phones can be useful ophthalmic devices for taking images of anterior and posterior eye segment. Professional literature and educational material for patients are easily available with use of smart phones. Smart phones can store great amount of informations and are useful for long term monitoring with caution for patient confidentiality. The use of smart phones especially as diagnostic tools is not standardized and results should be carefully considered. Innovative role of smartphone technology and its use in research, education and information sharing makes smart phones a future of ophthalmology and medicine.