Updates on Treatment Modalities for Primary Rhegmatogenous Retinal Detachment Repair.

Rhegmatogenous retinal detachment, a severe eye condition, presents anatomic separation of the neurosensory retina from its outermost layer-the retinal pigment epithelium. Early recognition of this relatively common finding and proper referral of patients to the retinal surgery department is essential in order to minimize its consequent possible severe reduction in vision. Several major surgical methods for the repair of primary rhegmatogenous retinal detachment have been in use over the last several decades, and they all aim to find and close the break in the retina that has caused the detachment. Surgery can be performed as pneumatic retinopexy, pars plana vitrectomy, and/or episcleral surgery (buckling). General surgical trends for reattaching the retina include moving from extraocular to intraocular surgery and from bigger gauge to smaller gauge via minimal invasive vitrectomy surgery (MIVS), with implementing shorter-lasting intraocular tamponades. Surgical options for rhegmatogenous retinal detachment treatment nowadays emphasize gaining retinal reattachment, preferably with one surgery and with minimum damage to the eye. The procedure should not bring secondary eye conditions and complications with severe impairment of visual acuity, and it should be performed on as much as a smaller budget, with possibly peribulbar anesthesia, enabling the patient the quickest possible recovery. It should be adjusted to the patient's condition, not to the surgeon's skills or preferences.

Macular Parameters Change during Silicon Oil Tamponade for Retinal Detachment Surgery.

Background and Objectives: To evaluate possible changes in macular thickness parameters during and after silicon oil tamponade and in pars plana rhegmatogenous retinal detachment surgery. Materials and Methods: Our retrospective study included 34 consecutive patients who underwent 23-gauge retinal detachment surgery with silicon oil tamponade. Central macular thickness (CMT), central macular volume cube (CMV) and average macular thickness cube (AVG) were measured by optical coherence tomography (OCT) before rhegmatogenous retinal detachment surgery with silicon oil tamponade during tamponade (seven days, one month and three months after surgery), and one month after silicon oil removal. Results: In our sample, macular parameters CMT, CMV and AVG in patients who underwent retinal detachment surgery were statistically reduced during silicon oil tamponade (p < 0.05). After silicon oil removal, all parameters recovered, reaching numeric values which were not statistically significant compared to preoperative values. The average span of silicon oil tamponade was 162 +/- 23 days. Conclusions: Silicon oil tamponade during 23-gauge rhegmatogenous retinal detachment surgery leads to a transitory reduction of central macular thickness, central macular volume cube and average macular thickness cube in eyes that underwent retinal surgery. After silicon oil removal, macular parameters returned to preoperative values in most of the patients.

Influence of Multiple Anti-VEGF Injections on Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness in Patients with Exudative Age-Related Macular Degeneration.

Backgrounds and Objectives: To analyze the influence of multiple anti-VEGF intravitreal injections for exudative age-related macular degeneration on the thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC + IPL) using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A prospective interventional study of consecutive patients treated with intravitreal bevacizumab (IVB) was performed. Average and sectorial values of RNFL and GC + IPL thickness were recorded using Cirrus SD-OCT at 0, 6, 12, and 24 months. Patients suffering from any ocular disease that could affect RNFL or GC + IPL thickness were excluded. Results: A total of 135 patients (70 women and 65 men, aged 65 ± 15 years) were included. The average number of injections per patient was 12.4 ± 2.4. Average RNFL and GC + IPL thickness prior to the first injection (87.6 ± 12.2 and 47.2 ± 15.5 respectively), and after 24-month follow-up (86.2 ± 12.6 and 46.7 ± 11.9 respectively) did not differ significantly (p > 0.05). There was a significant decrease in GC2, GC5 segments, and minimum GC + IPL thickness. Conclusion: Repeated anti-VEGF treatment did not cause significant changes in the thickness of RNFL and GC + IPL layers over a period of 24 months. The detected decrease in GC2 and GC5 sectors, as well as in minimum GC + IPL thickness, could be a sign of ganglion cell damage induced by the treatment or could occur during the natural course of the disease.

EFFICACY OF CYCLOCRYOTHERAPY AND TRANSSCLERAL DIODE LASER CYCLOPHOTOCOAGULATION IN THE MANAGEMENT OF REFRACTORY GLAUCOMA.

Treating advanced glaucoma often requires numerous therapeutic modalities in order to achieve the desired intraocular pressure (IOP) reduction. The purpose of this study was to evaluate the IOP lowering efficacy of both cyclocryotherapy (CCT) and transscleral diode laser cyclophotocoagulation (TS-DCPC) in the management of refractory primary open-angle glaucoma. This prospective, randomized, controlled clinical trial included 40 patients (40 eyes) with refractory glaucoma treated at the Eye Department, Clinical Center of Vojvodina, Novi Sad, Serbia, between January 2016 and June 2019. Twenty patients underwent CCT (group 1), while another twenty patients were treated with TS-DCPC (group 2). Each patient underwent complete eye examination on the treatment day, as well as follow-up eye examinations 7 days and 1, 6 and 12 months after the intervention, when IOP and number of anti-glaucoma drugs used were recorded. The median baseline IOP was 36.50 mm Hg (IQR, 28.75-42.00) in group 1 and 27.00 mm Hg (IQR, 22.00-35.00) in group 2. Follow-up measurements of IOP in group 1 showed the following results: 16.50 mm Hg (IQR, 7.75-20.00) (60% decrease from the baseline value), 12.00 mm Hg (IQR, 9.25-18.00) (67% decrease from the baseline value), 9.00 mm Hg (IQR, 2.00-13.75) (73% decrease from the baseline value), and 9.50 (IQR, 2.50-12.00) (75% decrease from the baseline value) after 7 days, 1, 6 and 12 months, respectively. Follow-up measurements of IOP in group 2 showed the following results: 16.00 mm Hg (IQR, 10.00-17.00) (48% decrease from the baseline value), 14.00 mm Hg (IQR, 10.00-16.00) (56% decrease from the baseline value), 14.00 mm Hg (IQR, 12.25-16.50) (43% decrease from the baseline value) and 14.00 mm Hg (IQR, 11.25-15.75) (53% decrease from the baseline value) after 7 days, 1, 6 and 12 months, respectively. The mean number of antiglaucoma drugs used decreased from 4 to 0.65±0.81 and 2.25±1.07 in groups 1 and 2, respectively. In conclusion, study results confirmed the CCT and TS-DCPC to have a rapid and statistically significant ocular hypotensive effect in eyes with refractory glaucoma at one-year follow-up.

Serum erythropoietin concentration and its correlation with stage of diabetic retinopathy.

BACKGROUND: Erythropoietin (EPO) is one of the systemic angiogenic factors, and its role in ocular angiogenesis and in diabetic retinopathy (DR) is not yet fully understood. The latest research data reveal a possible correlation of higher erythropoietin concentrations in the blood and in the eye with the development of more advanced stages of DR. The main aim of this work was to examine the possible influence of serum concentrations of erythropoietin on the development of diabetic retinopathy in patients with diabetes mellitus type 2. METHODS: The research involved 90 patients examined at the University Eye Clinic of the Clinical Center of Vojvodina, Novi Sad, Serbia. The first group comprised 60 patients with diabetes mellitus lasting for 10 years or more, with diabetic retinopathy. The second, control group consisted of 30 healthy individuals. In the first group of 60 patients with diabetes, 30 of them had non-proliferative diabetic retinopathy (NPDR), and 30 had proliferative diabetic retinopathy (PDR). Laboratory EPO serum levels were determined, and they were correlated to the stage of DR. Concentration of EPO was assessed by ELISA method. RESULTS: The highest average concentration of EPO in serum (9.95 mIU/ml) was determined in the group of people with diabetes with PDR. The lowest average concentration of EPO in the serum (6.90 mIU/ml) was found in the control group. The average concentration of EPO in serum in the group of patients with diabetes with NPDR was 7.00 mIU/ml. The EPO concentration in serum was elevated in the group of PDR, and it was directly proportional to the level of the clinical stadium of PDR, being significantly higher in the moderate and severe subgroup of PDR comparing to the control healthy subjects, NPDR and mild PDR (p = 0.007). CONCLUSIONS: Significantly elevated serum concentration of EPO in the advanced stages of DR, and positive correlation between EPO serum concentration and clinical stages of PDR, suggest that erythropoietin represents an important growth factor from blood, which plays a significant role in retinal ischemia and angiogenesis in diabetic retinopathy, especially in the proliferative stage of this disease.

Hypomagnesemia in adults of northern Serbia: prevalence, nutritional risk factors, and associated comorbidities.

INTRODUCTION: Magnesium (Mg) deficiency is associated with numerous non-communicable diseases. The aim of the study was to estimate the prevalence of hypomagnesemia in the general adult population of Northern Serbia (NS), and to determine the level of Mg in drinking water. METHODS: This is a cross-sectional study with 5,122 adults from the general population. Serum level of Mg was determined by spectrophotometry, while the level of Mg in the drinking water was done by atomic absorption spectrophotometry. Standard laboratory methods were used to determine individual's blood lipid status and complete blood count. RESULTS: The prevalence of hypomagnesemia (Mg < 0.75 mmol/L) in the general population was 2.7%, while the prevalence of the subjects with high risk for the Mg deficiency (Mg 0.75-0.85 mmol/L) was 20.1%. The public water supply showed variable values between 17.3-35.3 mg/L. Age, systolic blood pressure, duration of diabetes mellitus, and glycemia increase with the decrease of Mg level. In addition, increased level of Mg was associated with higher red blood cell count and hemoglobin levels. CONCLUSIONS: The prevalence of hypomagnesemia in Northern Serbia is low (2.7%) and level of Mg in drinking water is not satisfactory. Serum level of Mg in the range 0.75-0.85 mmol/L is present in about 1/5 of the population. Glycemia, advanced age, gender, and smoking have a predictive role in hypomagnesemia occurrence. There is a significant correlation between serum level of Mg and lifestyle and dietary habits.

PROGNOSTIC FACTORS FOR POSTOPERATIVE VISUAL OUTCOME IN SURGICALLY TREATED SUPRASELLAR MENINGIOMAS.

INTRODUCTION: The prognosis of postoperative visual acuity in patients with surgically treated suprasellar meningiomas is influenced not only by the size and precise localization of meningiomas in the optochiasmatic region and their compressive effect, but also by certain parameters, such as the age of patient, duration of symptoms, and preoperative visual acuity. The purpose of this study was to analyze the influence of these factors on postoperative visual acuity in the patients with surgically treated optochiasmatic meningioma as well as to determine their prognostic value in the recovery of visual function after surgery. MATERIAL AND METHODS: The study sample consisted of 43 pati- ents operated for suprasellar meningioma. All tumors were dia- gnosed by computed tomography or nuclear magnetic resonance scans. Visual acuity was analyzed both before surgery and six months after surgery. The effects of age, preoperative Visual loss, duration of visual symptoms and tumor size on visual outcome were analyzed. RESULTS: Postoperative improvement of visual acuity was observed in 50% of eyes (68.4% of patients). Visual outcome was better in the younger patients. The patients with better preoperative visual acuity had better postoperative visual acuity outcome. Chances of achieving better postoperative visual function and favorable tumor resection outcome were inversely proportional to the increased length of history of disease and tumor size. CONCLUSION: Postoperative visual acuity prognosis in suprasellar meningioma surgery was favorably affected by the mean duration of symptoms of less than 24 months, tumor size less than 30 mm. and preoperative visual acuity loss below 0.1.

[Intraocular foreign body removal: case report].

INTRODUCTION: An intraocular foreign body may traumatize the eye mechanically, introduce infection or exert other toxic effects on the intraocular structures. Removal of a metallic intraocular foreign bodies (IOFB) use an internal (vitrectomy followed by forceps or internal magnet use) or external approach (large electromagnet). OUTLINE OF CASES: A 51-year-old man sustained injury of the left eye by a metal foreign body. On admission visual acuity was normal (VOS = 1.0) and intraocular tension was within normal limits (TOS = 10 mmHg). Nasal scleral entry wound was noticed. Ultrasound of the left eye was done, which confirmed existence of IOFB laying nasally, next to the ciliary body. Extraction of IOFB with a big electric magnet was done. Visual acuity on discharge was the same (VOS = 1.0). Another man, aged 30 years, came to the clinic after injury of the left eye by a foreign body. On admission visual acuity was VOS = L + P+ (light and projection), TOS = 44 mmHg (higher), traumatic cataract, scleral entry wound, corneal edema, existence of IOFB and initial endophtalmitis. Lensectomia and vitrectomia via pars plana with IOFB extraction were done.Visual acuity on discharge was VOS = 5/60 with +6.50 Dsph = 0.3-0.4; TOS= 7 mmHg. CONCLUSION: Magnet removal is indicated in patients when IOFB is laying free in the vitreous body or stopped near the entry wound during injury without other complications. Internal approach--pars plana vitrectomy with forceps removal is used when IOFB is stuck either on the peripheral or posterior part of the retina or if there are some of aforementioned complications.

Changes of serum VEGF concentration after intravitreal injection of Avastin in treatment of diabetic retinopathy.

PURPOSE: Avastin (bevacizumab) intravitreal injections are widely used for treatment of diabetic retinopathy. The aim of our study was to analyze effect of 1.25 mg of intravitreal Avastin on serum concentration of vascular endothelial growth factor (VEGF) in diabetic patients. METHODS: Participants were 10 diabetic patients on insulin therapy, without any other eye or systemic disease, and no kidney disfunction. Both eyes of diabetic patients were injected simultaneously with 1.25 mg of intravitreal Avastin, as a first step in treatment of nonproliferative diabetic retinopathy with clinically significant macular edema (4 patients), and of proliferative diabetic retinopathy (6 patients). Fluorescein angiography was performed prior to and laser therapy followed 1 month after Avastin treatment. VEGF concentration in patients serum was measured by ELISA technique: on the day of the Avastin administration, and 1, 7, and 28 days after intravitreal injection. RESULTS: In all analyzed participants, 24 hours after Avastin treatment, serum levels of VEGF were lower then basal (preinjection value). Maximal reduction of serum VEGF was noted on the 7th postoperative day. Twenty-eight days after, VEGF level in serum was raised, without completely reaching basal preoperative concentrations in most patients. CONCLUSIONS: Intravitreal injections of anti-VEGF drugs have an effect on decreasing systemic VEGF values. Rhythm of changes in serum VEGF concentrations and lowest detected concentration on the seventh postinjection day are according to pharmacokinetics of Avastin in serum and vitreous, reported by similar studies. The small number of patients involved in this pilot study implicates the need for further studies.

Long-term effect of 1-piece and 3-piece hydrophobic acrylic intraocular lens on posterior capsule opacification: a randomized trial.

PURPOSE: To compare the intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of the foldable hydrophobic acrylic AcrySof intraocular lens (IOL) over a 5-year period. DESIGN: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. PARTICIPANTS: Fifty-two patients with bilateral age-related cataract (104 eyes). METHODS: Each study patient had cataract surgery in both eyes and received a 1-piece AcrySof IOL in 1 eye and a 3-piece AcrySof IOL in the other eye. Follow-up examinations were performed at 1 week, 1 month, 6 months, and 1, 2, and 5 years. Digital retroillumination images were obtained of each eye. The amount of posterior capsule opacification (score range, 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software 1, 2, and 5 years after surgery. MAIN OUTCOME MEASURE: Posterior capsule opacification score (scale, 0-10). RESULTS: There was no significant difference between the 1-piece and 3-piece AcrySof IOL in best-corrected visual acuity, overlap of rhexis and IOL, capsular folds, anterior capsule opacification, and posterior capsule opacification (1-piece AcrySof PCO score, 1.7+/-1.7; 3-piece AcrySof PCO score, 1.3+/-1.4; P = 0.30). CONCLUSIONS: Modification of the IOL haptic design of the sharp optic edged AcrySof IOL from a 3-piece to a 1-piece haptic design caused no significant change in PCO intensity and neodymium:yttrium-aluminium-garnet laser treatment rate 5 years after surgery.

[Vision related quality of life--a cataract study].

INTRODUCTION: Since 1996, advanced methods and new instruments for the assessment of vision quality of life (VisQoL) index (37 and 15) have been developed and applied at the University Eye Clinic in Novi Sad. Many researches assume that postoperative results should not be evaluated only by postoperative visual acuity, but also by subjective perception of visual function and the patients ability to perform everyday activities, i.e. by quality of life. Therefore, our clinical results were based on both parameters of visual function, as the most objective attributes for assessing outcomes of certain types of cataract surgery. MATERIAL AND METHODS: Based on the results of the Cataract Study in Vojvodina in 2004, 5.7% of patients waiting for cataract surgery were already blind, 16.5% had low vision with cataract on both eyes, and 57% of patients had monocular blindness. RESULTS AND DISCUSSION: With improvement of visual acuity to 0.5 or higher, after cataract surgery in 96.5% of patients, the cumulative VisQoL 15-index changed from 59.3 to 95.5. Intraocular lens implantation contributed most to the significant improvement in the vision related quality of life. Our study showed that pseudophakic patients had better qualitiy of life than aphakic patients, who had the same visual acuity and refractive correction. Difficulties in performing everyday activities, such as shopping, using the telephone and reading, were found in 12.7% of aphakic, but only in 3% of pseudophakic patients. CONCLUSION: Advanced phacoemulsification techniques enable operated cataract patients immediate vision recovery, better quality of life, and personal satisfaction with visual function in everyday activities.