Corneal Fourier and Belin-Ambrósio Enhanced Ectasia Analysis in Healthy 4-Year-Old White Children.

PURPOSE: The aim of this study was to provide normative databases of Fourier analysis (FA) and Belin-Ambrósio enhanced ectasia display (BAD) in healthy White 4-year-old emmetropic children. METHODS: FA parameters analyzed were spherical component (SRmin), spherical eccentricity (SEcc), maximal decentration (MD), regular astigmatism at the center (Astigm. C) and periphery (Astigm. P), and irregularity (I). The parameters obtained by BAD included summary indicator BAD D, anterior corneal curvature (K1 and K2, D), maximal keratometry (Kmax, D), maximal Ambrósio relational thinnest (ART max), and pachymetric and BAD indices. RESULTS: Eighty-nine eyes of eighty-nine 4-year-old children were included. The mean values of FA parameters were the following: SRmin 7.77, SEcc 0.600, MD 0.160, Astigm. C 0.070, Astigm. P 0.050, and I 0.019. The mean K1 and K2 in our study group were 42.92 ± 1.29 D and 43.75 ± 1.41 D, with the mean BAD D value 0.42 ± 0.67. The mean PPI min 0.629 ± 0.117, PPI max 1.059 ± 0.155, PPI avg 0.847 ± 0.103, Kmax 44.10 ± 1.39, and median of ART max 515.0 were recorded. No statistically significant differences between male and female sex in any of FA or BAD parameters were found. CONCLUSIONS: This is the first study providing large normative data on FA and BAD in 4-year-old White emmetropic children. We proposed a cutoff D value for early ectasia and clinical keratoconus in 4-year-old children.

Quality of Life in Road Traffic Accident Survivors.

INTRODUCTION: The loss of quality of life is the major consequence following a non-fatal road traffic accident (RTA). Previous research regarding quality of life did not include uninjured RTA survivors. The research aim was thus to evaluate the quality of life of the RTA survivors regardless of whether or not they sustained injures, and to identify factors associated with decreased quality of life after the RTA. METHODS: A cohort of 200 RTA survivors with and without injuries was followed after experiencing an RTA. The quality of life and mental health outcomes were assessed 1 month following RTA. A vast range of sociodemographic, pre-RTA health-related, RTA related, RTA injury-related, compensation-related factors and mental health outcomes were investigated. RESULTS: Decreased quality of life following an RTA showed an association with the low socioeconomic status of the RTA victims, poor pre-RTA health, injury-related factors, compensation-related factors and psychological disorders after the RTA. CONCLUSIONS: Identifying predictors of decreased quality of life following an RTA will enable planning interventions targeting the most important factors that influence recovery of RTA victims. Assessing and recording of self-reported quality of life should be a part of the routine protocol in RTA survivors' health-care.

THE ROLE OF FREQUENCY DOUBLING TECHNOLOGY PERIMETRY IN EARLY DETECTION OF DIABETIC RETINOPATHY.

The aim was to assess whether standard automated perimetry (SAP) and frequency doubling technology (FDT) perimetry are able to detect the effect of diabetes mellitus (DM) on retinal function in DM patients in the early stage of disease and to analyze which method is more specific and sensitive. A randomized cross-sectional study was conducted in three different groups of patients to compare the capability of these two methods to examine visual field and to detect the change in light sensitivity. Visual function was assessed in 60 adults with normal retinal finding, 60 adults with DM without clinically detectable retinopathy and 60 adults with DM and non-proliferative diabetic retinopathy but normal visual acuity. FDT perimetry and SAP were performed in all study patients. The presence and severity of diabetic retinopathy was determined by taking and evaluating two 50° field color photographs per eye, macula-centered and disc-centered. The following results were obtained by analyzing parameters in the groups of diabetic patients: sensitivity and specificity of SAP and FDT for medium sensitivity 86.7/33.3 (p<0.061) and 71.7/41.7 (p<0.228), respectively; for medium deficit 41.7/76.7 (p<0.063) and 65/50 (p<0.362), respectively; for loss of variance/pattern standard deviation (LV/PSD) 51.7/61.7 (p<0.536) and 61.7/51.7 (p<0.666), respectively; and for foveal sensitivity 81.7/36.7 (p<0.096) and 23.3/86.7 (p<0.839), respectively. Analysis of parameters between diabetics and control group yielded sensitivity and specificity for medium sensitivity 71.7/61.7 (p<0.001) and 70.8/55 (p<0.002), respectively; for medium deficit 56.7/60 (p<0.058) and 77.5/43.3 (p<0.037), respectively; for LV/PSD 58.3/58.3 (p<0.042) and 33.3/83.3 (p<0.437), respectively; and for foveal sensitivity 82.5/53.3 (p<0.001) and 28.3/85 (p<0.195), respectively. We concluded that neither of these methods was sensitive and specific enough to distinguish diabetics without retinopathy from diabetics with retinopathy. Both of these methods were highly specific and sensitive to distinguish diabetics from healthy subjects, but neither of these methods proved superior.

Protective Effect of Blepharospasm on the Anterior Segment of the Eye.

The aim of the study was to determine the role of blepharospasm as a protective factor for the anterior segment of the eye by comparing the degree of blepharospasm and changes of the anterior segment structures. The study included sixty female patients older than forty years with the clinical diagnosis of blepharospasm. They were divided into two groups; the first group consisted of patients with stage I and II of blepharospasm with dominant dry eye symptoms, and the second group consisted of patients with stage III and IV of blepharospasm who required interventional therapy (all patients in this study were treated with botulinum toxin type A). Staining of ocular surface with vital dyes such as fluorescein was used to determine ocular surface defects. Fluorescein stains the corneal epithelial defects, which were statistically less pronounced in the interventional group. In conclusion, comparison of the results between the two groups of patients may implicate that advanced blepharospasm has a protective effect on ocular surface.

Glaucoma, depression and quality of life: multiple comorbidities, multiple assessments and multidisciplinary plan treatment.

BACKGROUND: The present mini review evaluates assessment and comorbidity of glaucoma and depression with the possibilities of treatment options. SUBJECTS AND METHODS: Web of science was searched for relevant articles using search terms "glaucoma", "depression", "glaucoma and depression", "quality of life and glaucoma". The additional relevant papers were added from the bibliography of selected papers. All types of articles were included, no time period was defined. RESULTS: We have reviewed 11 studies regarding the comorbidities of glaucoma and depression. The number of participants in all studies ranged from 86 to 6760. Formats of scale in one study was clinician rated, others were self-reported scales. Two studies of the above mentioned studies explored specific types of glaucoma. In the three studies out of 11 there was no significant evidence of elevated depressive symptoms associated with glaucoma. In the six studies the prevalence of depression was significant among glaucoma patients. One study provided suboptimal assessments of depression in glaucoma patients. The other one showed the presence of glaucoma significantly associated with depression after adjustment for the demographic factor. Most of the studies used one scale, while two of them used two scales. The reviewed studies did not analyze the therapy options of included patients. CONCLUSION: The results presented in this review indicate that glaucoma is accompanied by depression in the majority of analyzed studies. The comorbidity of glaucoma and depression should be the subject of further research on both, self-reflecting and clinician-rated scales, taking into account subjective experience of patients and physicians. The therapy options should be taken into account in future researches focusing on the multidisciplinary approach including novel possibilities of treating both diseases respectively.

Prevalence of Open Angle Glaucoma in Risk Groups in Slavonia and Baranya Region.

The aim of this prospective study was to detect primary open angle glaucoma (POAG) in its early stage in patients at a higher risk of its development, and to identify the risk group with the highest prevalence of POAG. The study was conducted at Department of Ophthalmology, Osijek University Hospital Centre, and included 250 patients divided into five groups, as follows: group 1, patients with diabetes type 1 and type 2; group 2, patients with arterial hypertension (blood pressure >140/90 mm Hg); group 3, patients with positive family history of POAG; group 4, patients with myopia between -3.0 and -8.0 diopters; and group 5, control group including patients aged 40 with no risk factors for POAG development. Study results showed that distribution of glaucoma patients was not equal across the groups. The prevalence of POAG in all patients was 5.6%, whereas in patients with positive family history of POAG it was 14%, which was statistically significantly higher than in patients with diabetes and myopia (4% both), as well as in control group. The difference was greatest in comparison to control group. There was no statistically significant difference in glaucoma incidence between the group of patients with positive family history (14%) and patients with systemic hypertension (6%). The results obtained suggest that of all risk factors analyzed, positive family history of POAG is the most important risk factor for glaucoma development in all risk groups.

Sensitivity of Diagnostic Tests for Dry Eye in Patients with Blepharospasm.

The aim of the study was to evaluate diagnostic tests for keratoconjunctivitis sicca (Schirmer test, tear break-up time (TBUT) test, and corneal staining with fluorescein and lissamine green dye) in patients with blepharospasm. This prospective study included 60 female patients older than 40 with blepharospasm, divided into two groups according to clinical symptoms. For fluorescein test, the surface under the ROC curve was 1.0 with standard error (SE) 0 and 95% confidence interval (95% CI) 0.940-1.0; for Schirmer test, the surface under the ROC curve was 0.817 with SE 0.0555 and 95% CI 0.696-0.905; for lissamine green test, the surface under the ROC curve was 0.813 with SE 0.056 and 95% CI 0.691-0.902; and for TBUT test, the surface under the ROC curve was 0.772 with SE 0.061 and 95% CI 0.645-0.870. According to the results of ROC curve, which determines the sensitivity and specificity of normal values, comparison of diagnostic tests for keratoconjunctivitis sicca used in this study showed that fluorescein test had the best sensitivity and specificity. Schirmer test should be avoided in patients with blepharospasm because its results are influenced by frequent blinking and are not appropriate for study interpretation. Despite the pathologic values of TBUT test (numerically), this test is still acceptable for patients with blepharospasm because its interval takes more time than the interval between two blinks.

Retinal Nerve Fiber Layer Thickness in Glaucoma Patients Treated with Multiple Intravitreal Anti-Vegf (Bevacizumab) Injections.

Over the past decade, intravitreal injections of anti-VEGF agents have been widely used and intensively developed as a treatment option for many ophthalmological indications. Due to its availability and low cost, the most frequently used anti-VEGF agent is bevacizumab. This type of therapy is often indicated in patients with exudative age-related macular degeneration (ARMD) and diabetic macular edema (DME). If, in addition to these two conditions, patients have a diagnosis of primary open angle glaucoma (POAG), they also present with optic nerve head (ONH) retinal nerve fiber layer (RNFL) thinning. The aim of this prospective study was to establish whether administering bevacizumab to patients with POAG leads to additional reduction of RNFL thickness. The study included 60 patients divided into two groups. First group comprised the eyes of patients with exudative ARMD and POAG, whereas second group comprised the eyes of patients with DME and POAG, all treated with bevacizumab. Control group comprised the fellow eye of each involved patient, which was not treated with bevacizumab. In a period of one year, all patients underwent optical coherence tomography (OCT) measurements of ONH RNFL thickness. The results of all patients were compared between the two study groups and then with control group results. Study results showed a decrease of RNFL in both groups of patients. Comparison of these two groups of patients after one year revealed a statistically more significant decrease in RNFL thickness in the second group (DME + POAG).

Analysis of biomechanical properties of patellar ligament graft and quadruple hamstring tendon graft.

INTRODUCTION: Two types of transplant are commonly used in the surgical management of anterior cruciate ligament lesions: the central part of the patellar ligament and quadruple tendons of the gracilis muscle and semitendinosus muscle. AIMS: The aim of this study was to determine the biomechanical characteristics of patellar ligament transplants and transplants of the quadruple tendons of the hamstring muscles under tensile force in the laboratory, and to compare the results in each group of samples. MATERIALS AND METHODS: The study comprised 160 specimens: 40 specimens of gracilis muscle tendons, 40 of semitendinosus muscle tendons, 40 of quadruple tendons and 40 of the patellar ligament, approximately equally distributed according to sex, age (50-70 years) and the side of the body from which the specimen had been taken. RESULTS: The working curve analysis of the specimens under tensile load of a maximum force of 30N showed the least elongation (0.31%) in the quadruple tendon, followed by the gracilis muscle tendon (1.48%) and patellar ligament tendon (3.91%). CONCLUSIONS: The quadruple tendon specimen showed greater strength and higher elasticity compared with the patellar ligament specimen, which proved the starting hypothesis.

Histological analysis of cross-sectional area of quadruple hamstring tendons and patellar ligament samples in relation to age and gender.

AIMS: The middle of the patellar ligament and the quadruple hamstring tendons (gracilis and semitendinosus) are two types of graft predominantly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to determine the morphometric characteristics of patellar ligament grafts and hamstring tendon grafts and to compare the results according to subject age and gender. MATERIALS AND METHODS: The study was conducted on a total of 120 samples: 40 of gracilis tendon, 40 of semitendinosus tendon and 40 of patellar ligament, distributed equally according to gender, age (50-75 years) and the side of the body from which the sample was harvested. RESULTS: Morphometric and histological analyses showed that patellar ligament samples had less cross-sectional area than quadruple tendon samples (49.29 mm(2) compared with 51.46 mm(2), respectively). Sexual dimorphism was noticed in distal cross-sections of gracilis tendons (p=0.09), cross-sections of quadruple tendons (p=0.07) and patellar ligament samples (p=0.01) because of different muscular build. CONCLUSIONS: All samples obtained from male subjects had larger cross-sectional areas compared with the samples taken from females. Furthermore, samples obtained from subjects aged 60 years or under had larger cross-sectional areas than samples obtained from subjects aged at least 61 years for all types of graft.

Influence of silicone oil tamponade after vitrectomy on intraocular pressure.

The aim of this prospective study was to determine the possible influence of the silicone oil tamponade after vitrectomy on the early intraocular pressure (IOP) elevation, which is a major risk factor for developing secondary glaucoma in patients with vitreal and retinal proliferative changes. The research included 110 patients which were allocated in three groups according to the medical history data. The surgical procedures were performed at the Eye Clinic, University of Zagreb School of Medicine. The control group comprised 40 patients who underwent vitrectomy with air or saline solution tamponade. The second group consisted of 40 patients with retinal detachment and proliferative retinopathy who had vitrectomy with silicone oil tamponade and the third group were 30 patients with diabetic retinopathy who underwent vitrectomy and tamponade with silicone oil. The intraocular pressure was measured and gonioscopy was performed in all patients one month before and after vitrectomy. The results showed that there is no statistically significant difference among IOP values before and after vitrectomy in the control group (p = 0.104) as well as in the preoperative IOP values among all three groups of patients. The data analysis determined that in both groups of patients with silicone oil tamponade after vitrectomy, there is a statistically significant difference in IOP values one month after the surgical procedure (p = 0.000). The mean IOP values in those patients a month after vitrectomy were significantly higher compared to the control group (p < 0.05). Comparison of the IOP one month after vitrectomy between the patients with retinal detachment and those with diabetic retinopathy showed no statistically significant difference (p = 0.331) but the qualitative analysis showed that the IOP one month after vitrectomy was 2 mmHg higher in the diabetic retinopathy group. The results suggest that there is no difference in angle width before and after vitrectomy among different groups of patients. Emulsified silicone oil was confirmed in 18% of patients in the retinal detachment group. In 17% of patients in the diabetic retinopathy group the emulsified oil was found in the angle, whereas a 10% of patients had neovascularization of the angle one month after vitrectomy. The IOP elevation in the early postoperative course may be caused by intravitreal instillation of the silicone oil after vitrectomy. Emulsification of the silicone oil may lead to the early IOP rise; especially in the diabetic patients with angle neovascularization which itself can additionally accelerate the development of the secondary glaucoma.

Chalazion management--surgical treatment versus triamcinolon application.

The aim of the study was to compare the length of treatment and efficiency of applied therapy in two groups of patients with chalazion who underwent surgical procedure or got triamcinolone application in chalazion. Our study included 30 patients with chalazions that persisted for about one month. All of them were resistant to applied topical antimicrobial therapy. These patients were devided in two groups. 15 patients underwent surgical procedure that included incision, excochleation and excision of the capsule of chalazion, while other 15 patients underwent triamcinolone aplication directly in chalazion (dosage of 2-4 mg). Patients were followed up a day after therapy, two weeks after therapy and one month after applied therapy. We found that chalazion treatment with triamcinolone application directly in the lesion was to be more comfortable for patients, took less time to treat and needed no additional topical antimicrobial therapy.

Quality of life in patients with blepharospasm.

The aim of this prospective study was to analyse the quality of life in patients with blepharospasm grade III and IV and to explore whether Botulinum neurotoxin type A treatment improves their quality of life. We used a WHOQOL-BREF questionnaire, based on the existing WHO recommendation and its meaningful metric characteristics. The study included 37 patients with either grade/type III or IV blepharospasm who were treated with Botulinum neurotoxin Type A. Each patient completed the WHOQOL-BREF questionnaire by themselves just before the Botulinum Neurotoxin Type A (BT-A) therapy application, when the clinical symptoms of blepharospasm were most manifest and a month and a half after, when the regression of symptoms appeared. Consequently, the application of BT-A resulted in improved changes in terms of quality of life in 3 of the 4 measured fields (psychical and physical health as well as the environmental living conditions).

Safety and efficacy of monotherapy change to fixed combination (travoprost 0.004%/timolol 0.5%) in 6 months follow up period.

PURPOSE: To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0.004%/timolol 0.5% (TTFC) fixed combination from previous monotherapies. METHODS: Prospective, open-label, observational, multicenter cohort. A change was done from prior monotherapy at day 0 to TTFC dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy. i.e., intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120). RESULTS: 40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15.92 +/- 1.85 mm Hg (21.66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15.67 +/- 2.17 mm Hg (21.14% reduction), and at control 3 for 40 patients 16.28 +/- 1.59 mm Hg (19.86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0,5% (N = 33/66), latanoprost 0.005% (N = 49/98), betaxolol 0.5% (N = 30/60), and travoprost 0.004% (N = 43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0.5% (N = 7/14), latanoprost 0.005% (N = 14/28), betaxolol 0.5% (N = 7/14), travoprost 0.004% (N = 12/23)). CONCLUSIONS: Changing patients from prior monotherapy to TTFC can provide on average a further reduction in IOP, while demonstrating a favorable safety profile.

Serum sickness and uveitis.

Serum sickness is immune response to a foreign antigen, usually a heterologous protein. Incidence rate is less than 0.5%. Antigens and responding antibodies form circulating immunocomplex that is characteristic for serum sickness. The condition occurs 7-15 days after exposure to the antigen, usually with clinical picture of glomerulonephritis. The immunocomplex circulates to other tissues where it sediments and causes inflammation, such as arteritis, neuritis, synovitis. The aim of this research is to present the break out of serum sickness in form of anterior uveitis due to azithromycin therapy administered by mouth. Identifying of anterior uveitis may help in early diagnostics and treatment of serum sickness.