Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period.

BACKGROUND: To assess the safety and effectiveness of the exclusive use of 27-gauge instruments for all vitreoretinal diseases requiring vitrectomy. METHODS: In this retrospective study, 1020 consecutive surgeries were performed on 958 eyes of 848 patients using 27-gauge instruments from March 2017 to June 2021. Patients with a minimum follow-up of 3 months were included. Surgical case-mix, best-corrected visual acuity (BCVA), intraocular pressure (IOP), intra- and post-operative complications, and surgery times were recorded. RESULTS: The study patients were followed up for averagely 11 months. Of the 1020 vitrectomies, 958 were primary procedures. Of the 148 retinal detachment (RD) cases, 138 (93%) required a single vitrectomy. Primary macular hole closure was achieved in 143 of 145 (99%) cases. The average surgical times were 55 and 38 min for RD surgeries and for all other indications, respectively. BCVA improved significantly at the final visit (20/49) compared with the pre-operative visit (20/78) (p < 0.01). IOP was similar at the pre-operative (14.8mmHg) and final (14.3mmHg) visits. Complications recorded include transient hypotony in 39 eyes, iatrogenic retinal breaks in 2 eyes, and a vitreous bleed in 1 other eye. CONCLUSION: This study revealed that 27-gauge vitrectomy instruments can be used for a wide range of indications, with exclusive use in certain settings. The outcomes were similar to other gauges, including for rhegmatogenous retinal detachment, with minimal complications.

Prevalence of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma in Population of North-West Croatia Aged 40 and Over

The purpose of this study was to assess the prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma and to evaluate its association with open-angle glaucoma in patients attending the Department of Ophthalmology, Dr Tomislav Bardek General Hospital in Koprivnica, northwestern Croatia. This prospective study was conducted at Dr Tomislav Bardek General Hospital between December 2012 and October 2013. A total of 5349 subjects aged 40 or above presenting for general ophthalmic examination were screened for pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Each patient underwent complete ophthalmologic examination including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, optic disc evaluation, visual field analysis, and gonioscopy if glaucoma was suspected. Exclusion criteria were pseudophakic and/or aphakic patients of any age, patients with concomitant congenital eye disease, and patients with very dense ocular media opacities. Out of 5349 patients examined, there were 1994 (38.38%) males and 3201 (61.61%) females. The prevalence of pseudoexfoliation syndrome was 3.6% and primary open angle glaucoma 9.4%, out of which 23.6% with pseudoexfoliation glaucoma. The findings of this study improve our knowledge of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Croatia, particularly in the northwest region.

The Use of Fixation Suture to Treat Inferonasal Hypertrophic Bleb after Xen Gel Stent Implant: A Case Report.

We report a case of an inferonasal hypertrophic bleb complication which formed 5 months after Xen Gel Stent implantation for intraocular pressure (IOP) control in a primary open-angle glaucoma patient and its management using a fixation suture. The patient underwent an uneventful right-eye phacoemulsification and intraocular lens implantation combined with Xen Gel Stent ab interno implantation surgery. A month after the surgery, a second needling was performed due to a flat bleb and increased IOP. Post-needling slit-lamp examination showed a well-formed diffuse bleb in the superonasal quadrant. Two months after the needling, the patient presented with redness and irritation medially. Upon examination, a large inferonasal bleb was observed together with scarring of a previously formed superior bleb above the Xen Gel Stent implant. Fornix-based conjunctival incision technique was used to release the conjunctival scarring, and a fixation suture was used for the Xen implant in order to change the filtration direction. A Palmberg compression mattress suture was used to stop the inferior filtration. Despite an open conjunctiva surgical revision in the superior quadrant, no additional scaring was formed in the follow-up period of 20 months. There was good post-operative IOP control and formation of superiorly positioned bleb. To our knowledge, this is the first report to describe the use of a fixation suture for treating inferonasal hypertrophic bleb as a late complication of Xen Gel Stent implantation surgery.

Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: UK and Ireland Results from the VISIONARY Study.

INTRODUCTION: Reducing intraocular pressure (IOP), the only modifiable risk factor for open-angle glaucoma (OAG), is important for the preservation of vision and slowing of disease progression. Preservative-free tafluprost (0.0015%)/timolol (0.5%) fixed combination (PF Taf-T FC) is an approved combination therapy for OAG treatment. The VISIONARY study aimed to evaluate the effectiveness and tolerability of PF Taf-T FC in real-world clinical settings. Here, we present the results from the United Kingdom (UK) and Ireland. METHODS: This observational, multicentre, European, prospective study recorded data during routine clinic appointments on the use of PF Taf-T FC for the treatment of OAG and ocular hypertension (OHT) in patients whose disease was insufficiently controlled on a prostaglandin analogue (PGA) or beta blocker monotherapy or who did not tolerate these medications. Mean change in IOP, symptom severity, changes in clinical signs, and tolerability were investigated over 6 months. RESULTS: Eighty-two patients were recruited in the UK and Ireland. After 6 months of PF Taf-T FC treatment, mean IOP was significantly reduced from 22.0 to 16.2 mmHg in the UK group and from 18.6 to 14.1 mmHg in the Ireland group. In the UK (65 patients), 49 adverse events (AEs) were reported, of which 3 were serious. No AEs were reported in the Ireland group (17 patients). Overall, 91.9% of UK physicians reported PF Taf-T FC treatment to be the same or better than prior medication for improving clinical signs; 90.0% of UK patients reported PF Taf-T FC treatment to have good or very good tolerability. CONCLUSIONS: Treatment with PF Taf-T FC resulted in significant reductions in mean IOP over 6 months. Patients and physicians reported that treatment was well tolerated. These data demonstrate real-world efficacy of PF Taf-T FC for the treatment of OAG and OHT in routine clinical practice in the UK and Ireland. TRIAL REGISTRATION: European Union electronic Register of Post-Authorisation Studies (EU PAS) register number, EUPAS22204.

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

[Causes of blindness in 25% of the blind population in Croatia and the possibilities of prevention]. / Uzroci sljepoce 25% populacije slijepih Hrvatske i moguca prevencija.

AIM: To identify the causes of blindness and to launch preventive actions to reduce the prevalence of blindness in Croatia. METHODS: In February 2005, data on 25% of the blind population in Croatia including associations of the blind in the City of Zagreb, Koprivnica-Krizevci County and Medimurje County were analyzed. RESULTS: The analysis showed the blind to account for 0.13% of the 4.5 million population of Croatia. The leading causes of blindness were myopia, diabetic retinopathy and glaucoma. In 212 individuals, blindness developed before age 16, in 84 of these due to retinopathy of prematurity. CONCLUSION: Many ophthalmologic diseases are preventable or curable if early detected and timely treated. The prevention of blindness is of paramount social importance and definitely among most cost-effective interventions in health care.

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.

Intralesional triamcinolone acetonide injection for chalazion.

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of 15.27 +/- 6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.

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.