Simultaneous Penetrating Keratoplasty, Cataract Removal and Intraocular Lens Implantation in Tuzla, Bosnia and Herzegovina.

INTRODUCTION: It is known that simultaneous penetrating keratoplasty, cataract removal and intraocular lens implantation are always a big challenge to a surgeon, especially in developing countries such as Bosnia and Herzegovina. In these cases there is always a higher rate of different kind of intraoperative complications. Phacoemulsification after penetrating keratoplasty especially in older people may cause significant endothelial injury and also could affect long term graft survival. AIM: The aim of this report is to describe one of these challenging cases and the possible ways to manage them in developing countries. CASE REPORT: In this paper we report a case of a 46 year-old female patient, with a cataract on her right eye with a central corneal leukoma. She reported that when she was 6 years old, she had an eye injury with corn leaf. At the age of 10 year she reported that she had another injury of the same eye with a glass. She reported that she wasn't seeing quite good after that. Three years ago she had a transplantation of amniotic membrane due ulcer on the same eye. She reported also that even after this procedure she wasn't seeing quite good. Now she was admitted to hospital for a triple surgical procedure. At that moment patient has been ophthalmological examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found central corneal leukoma, occlusion of pupil and complicated cataract. Before surgery her Uncorrected distance visual acuity (UDVA) on her left eye was light perception. A combined procedure of penetrating keratoplasty (PKP), open-sky cataract extraction, and intraocular lens (IOL) implantation was planned. Thirty days after surgery her visual acuity was 0,5 without correction. It is concluded that cataract surgery in patients after keratoplasty is more complicated. CONCLUSION: Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.

Amblyopia in Children: Analysis Among Preschool and School Children in the City of Tuzla, Bosnia and Herzegovina.

AIM: This study measured the prevalence of amblyopia in preschool and school children between 4 and 15 years of age in Tuzla, Bosnia and Herzegovina and as well and to examine its relations with anisometropia and strabismus. METHODS: Children from eight daycare centers and twenty four elementary schools were screened for amblyopia by volunteer personnel (medical students), any child who failed to pass the screening examination, was referred to the ophthalmologist for complete examination at University Clinic Center Tuzla. The examination included VA, stereopsis, cover testing, refractive retinoscopy, and examination of the red reflex and posterior pole. RESULTS: Total of 7415 children, which included 3790 males and 3625 females, in the age range of 3 to 15 years from 24 schools and 8 preschool were screened. Fifty night children (1.9%) were diagnosed with amblyopia, unilateral in 28 and bilateral in 31. CONCLUSION: Prevalence of significant refractive errors is high enough to justify a school eye screening program solely for this purpose. preschool and school screening program in children in critical period of development of amblyopia must be conducted to find out the ametropias and amblyopia in time; and treat them earlier.

Laryngopharyngeal Reflux Disease - LPRD.

INTRODUCTION: Laryngopharyngeal reflux disease (LPRD) referes to an inflammatory reaction of the mucous membrane of pharynx, larynx and other associated respiratory organs, caused by a reflux of stomach contents into the esophagus. LPRD is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated through different fields of medicine, often without a proper diagnosis. In gastroenterology it is still considered to be a manifestation of GERD, which stands for gastroesophageal reflux disease. Patients suffering from LPRD communicate firstly with their primary physicians, and since further treatment might ask for a multidisciplinary approach, it is important to have a unified approach among experts when treating these patients. GOAL: This paper is written with the intention to assess the frequency of symptoms of LPR in family medicine, possible diagnostics and adequate treatment in primary health care. MATERIALS AND METHODS: This is a prospective, descriptive cohort study. Authors used "The Reflux Symptom Index" (RSI) questionnaire. Examinees were all patients who reported to their family medicine office in Gracanica for the first time with new symptoms during a period of one year. Patients with positive results for LPR (over 13 points) were treated in accordance with the suggested algorithm and were monitored during the next year. RESULTS: Out of 2123 examinees who showed symptoms of LPR, 390 tested positive according to the questionnaire. This group of examinees were treated in accordance with all suggested protocols and algorithms. 82% showed signs of improvement as a response to basic treatment provided by their physicians. CONCLUSION: Almost every fifth patient who reports to their family medicine physician shows symptoms of LPR. On primary health care levels it is possible to establish some form of prevention, diagnostics and therapy for LPR in accordance with suggested algorithms. Only a small number of patients requires procedures which fall under other clinical fields.

Phacoemulsification After Penetrating Keratoplasty Due War Injury at Young Adult.

INTRODUCTION: It is known that phacoemulsification of cataracts after penetrating keratoplasty there are always some difficulties and of course a higher rate of different intraoperative complications. Phacoemulsification after PK may cause significant endothelial injury and affect long term graft survival. AIM: The aim of this report is to describe one of these cases and the possible ways to manage them. CASE REPORT: We report a case o of a 31-year-old female patient, with a cataract on her left eye. She reported that when she was 10 years old, she was admitted to regional hospital in Bosnia and Herzegovina due perforative corneal war injury. At the age of 11 years at Germany on her left eye corneal transplantation was performed. She reported that she wasn't ever seeing quite good, due high myopia. Twenty years after war injury she was admitted to hospital. At that moment patient has been ophthalmologicaly examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found occlusion of pupil and complicated cataract. Her only wish was to get operated due cosmetic reasons. Before surgery her visual acuity on her left eye was light perception. Thirty days after surgery her visual acuity was 0,1 without correction. CONCLUSION: It is concluded that cataract surgery in patients after keratoplasty is more complicated. Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.

Intraocular Pressure Measurements Referring to the Corneal Thickness in Keratoconic Eyes After Corneal Crosslinking with Riboflavin and Ultraviolet A.

AIM: To determine the possible relation between intraocular pressure (IOP), central corneal thickness (CCT) and corneal resistance (CR) in kerotoconic eyes before, 3,6 and 12 months after collagen crosslinking procedure (CXL) with aim to find out does the thicker cornea means already more resistance cornea followed with higher IOP. METHODS: Thirty eyes (30 patients) with central keratoconus (KC)were evaluated in retrospective cross sectional study. The corneal biomechanical parameters were taken with Wave Light Allegro Oculyzer produced by Alcon before the CXL, 3, 6 and 12 months after the procedure. IOP were checked by Goldmann applanation tonometry (GAT) before, 3, 6 and 12 months after CXL. RESULTS: The value of IOP before the CXL was 12,0 mmHg (10,62-15,25 mmHg), 3 months later 13,5 mmHg (11,0-16,0 mmHg), 6 months 14,0 mmHg (11,0-16,0 mmHg) and 12 months later 15,0 mmHg (10,37-17,25 mmHg) and was statistically significant higher (p=0,015) comparing to the value of IOP 3 months after the CXL, IOP 12 months after CXL procedure was statistically significant higher comparing to preoperative values (p=0,010). There were no statistically significant difference between the values 3 and 6 months after CXL. The CCT before the CXL procedure was 449 (433-505,75 microns), 3 months after CXL was 420 (383-473microns, p < 0,005), 6 months later 437 (401,25-480,25, p=0,001), 12 months after CXL 437 (401-503 microns, p=0,001). However there is statistically significant difference in CCT 12 months after CXL 437 (401-503microns p=0,032) and the value of CCT 3 months later the procedure (p=0,004) and the CCT 12 months after CXL and the value of CXL 6 months after CXL (p=0,036). The value of CCT did not show any statistically significant difference 3 and 6 months postoperatively. CONCLUSION: After riboflavin-UVA CXL in eyes with KC there was significant decrease in central corneal thickness 3 and 6 months after the procedure and the thickness is almost the same 12 months later. However IOP is low before CXL, raising up 3 and 6 months after CXL but significant increase is seen 12 months later. It means the regular measurement of IOP could be the serious and confident indicator of increasing of corneal resistance which is the main goal of CXL treatment.

Assessment of the tomographic values in keratoconic eyes after collagen crosslinking procedure.

GOAL: This study aimed to investigate the differences in values of K1 and K2 readings, the central corneal thickness (PAH) before the collagen crosslinking procedure (CXL) and 3, 6, 12 months later. METHODS: 64 eyes were evaluated in retrospective cross sectional study. The corneal biomechanical parameters were taken with WaveLight Allegro Oculyzer produced by Alcon before the CXL, 3,6, 12 months after the procedure. The curvature of K1 reading and K2 reading were taken and the central corneal thickness were considered due to the time after CXL. RESULTS: The value of K1 reading before the treatment was 48.8 diopters (D) (46.65-50.50) and was statistically significant lower comparing to the value of K1 3 months after the collagen CXL procedure 46.30 D (43.57-49.45) (p=0.0006), K1 reading one year post collagen CXL procedure was 47.20 D (44.35-50.07) (p=0.002). The value of K2 reading before the collagen CXL procedure was 52.65 D (47.55-54.72), 3 months after the procedure was 51.4 (45.05-54.0), 6 months later 48.55 D (47.20-50.62), 12 months later 51.30 D (47.22-54.77). There is statistically significant lower value of K2 reading 6 months after the treatment comparing to the values 3 months postoperatively (p=0.014). However there is significantly lower values of K2 reading 12 months postoperatively comparing to preoperative period (p=0.006). The value of central corneal thickness preoperative was 431.0 microns (398.0-446.25), 3 months after collagen CXL procedure was 373.50 microns (363.25-430.75), 6 months later 435.0 microns (360.0-464.75), 12 months after the CXL procedure was 429.50 microns (357.75-496.25). There is statistically significant lower values of central corneal thickness 3 months after collagen CXL treatment comparing to the central corneal thickness preoperative (p<0.005). There is statistically significant lower values of pachymetry 12 months after the CXL procedure comparing to the values 6 months later (p=0.036) and those preoperativelly (p=0.032). There is no statistically significant difference in the values of central corneal thickness in the period from 3 and 6 months postoperatively. CONCLUSION: After riboflavin-UVA CXL in eyes with keratokonus there was significant decrease in central corneal thickness 3 and 6 months after the procedure and the thickness is almost the same 12 months. However, K2 (Kmax) reading is significantly changed 3 and 6 months later and is followed by changing of K1 reading.

A new approach to the management of uninvestigated dyspepsia in primary care.

INTRODUCTION: The prevalence of dyspepsia in the general population worldwide is very high (20-40%). Upper abdominal complaints are one of the most common cause of patients' visits to primary care settings. Making an accurate etiological diagnosis of dyspepsia is difficult, but is an important challenge and goal for every doctor in primary care practice. Clinical guidelines have standards for gastroesophageal reflux disease, management of Helicobacter infection and indications for the use of endoscopy (empiric treatment, prompt endoscopy, "test and treat"). In spite of the application of those standards, many patients experience no improvement in their symptoms or often the recurrence of disease. AIM: This study presents a new approach to the diagnostic and therapeutic management of uninvestigated dyspepsia in primary care settings to provide long-term effective control of symptoms for family doctors. MATERIAL AND METHODS: 3000 unselected consecutive dyspeptic patients underwent abdominal ultrasound, and 1000 dyspeptic patients from the same group upper endoscopy.. In this approach diagnostic evaluation of dyspepsia includes: abdominal ultrasonography as a first line obligatory routine method and the exact estimation of nutritional condition. RESULTS: Abdominal ultrasound, physical examination and BMI control have significant value in the diagnostic evaluation of dyspepsia. The therapeutic approach includes, besides general standards (acid suppressive drugs, eradication of H. pylori, prokinetic and antidepressant agents), life style modification and nutritional interventions as first-line treatments. In this approach the use of new drugs such as ursodeoxycholic acid (UDCA), pre and probiotics, and digestive enzymes supplements is recommended. CONCLUSION: Throug the combination of different diagnostic procedures as first line methods, including abdominal ultrasound and nutritional condition (BMI), a family doctor can manage successfully uninvestigated dyspepsia at the primary care level.

Predictive Values of Optical Coherence Tomography (OCT) Parameters in Assessment of Glaucoma progression.

GOAL: the purpose of the current study was to estimate the predictive values of optical coherence tomography parameters in early, developed perimetric and terminal glaucoma. METHODS: 180 eyes of 120 consecutive patients were evaluated in this retrospective cross sectional pilot study. Copernicus Spectral -domain optical coherence tomography with resolution of 3 mm obtained throught the optic nerve head were included. All examined eyes were divided to four groups (healthy,early, developed perimetric glaucoma and terminal glaucoma). The values of the thicknes of the retinal nerve fibre layer, the size of the disk, the volume of the cup, the E/D parameter and the size of the RIM were compared in four study groups. RESULTS: The sensitivity of RNFL was 90,0%, specificity 82,0 %, positive predictability 83,3 % and negative predictability was 89,1 %. The total accuracy was 86,0 % and area under curve (AUC) was 0,878 for RNFL indeks compering early to developed glaucoma. The sensitivity for CUP was 78%, the specificity was 80,8 %, the positive predictability 81,2% and the negative predictability was 77,5 %. The total accuracy was 79,3 % and area under curve (AUC) was 0,86 compering early to developed glaucoma. The sensitivity for E/D was 82,0%, the specificity was 82,9 % the positive predictability 83,7 % and the negative predictability was 81,3 %. The total accuracy was 82,5 % and area under curve (AUC) for E/D was 0,89 compering eearly to developed glaucoma. The sensitivity for RIM was 78,0%, the specificity was 76,6 %, the positive predictability was 84,7 and the negative predictability was 67,7 %. The total accuracy was 77,5 % and area under curve (AUC) for the RIM compering the developed to terminal glaucoma was 0,792. The sensitivity of RNFL was 88,0 %, the specificity was 66,7 %, the positive predictability was 81,5% and the negative predictability was 76,9%. The total accuracy was 80,0% and the area under curve (AUC) for RNFL compering developed to terminal glaucoma was 0,815. The incrreasing 0,1 unit RNFL decreases the risk of developing glaucoma from early to another developed stage of glaucoma for 6,95%. The increasing of E/D for only one unit increases the risk to develop another stage of glaucoma for 18,75 times. The increasing of RNFL for only one unit decreases the risk of performing developed glaucoma from initial stage for 7,8%. The increasing for only one unit of CUP increases the risk to develop terminal glaucoma for 8,47 times and increasing for 0,1 unit of the value of RIM decreases the risk developing terminal glaucoma for 9,27%. The increasing for 0,01 unit of the E/D index increases the risk for terminal glaucoma for 23,23 times. The increasing for one unit of RNFL decreasing the risk developing terminal glaucoma for 5,7%.

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 degrees 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 delta6 degrees, 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 +1.25 Dsph 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.

Correlation between retinal nerve fiber layer and disc parameters in glaucoma suspected eyes.

GOAL: The aim of the study was to estimate the diagnostic accuracy of optical coherence tomography parameters in normal, preperimetric, developed perimetric and terminal glaucoma. METHODS: 180 eyes of 140 consecutive patients were evaluated in this retrospective cross sectional pilot study. Copernicus Spectra--domain optical coherence tomography with resolution of 3 mm obtained through the optic nerve head were included. All examined eyes were divided into four groups (healthy eyes, initial, preperimetric glaucoma, developed perimetric glaucoma and terminal glaucoma). RESULTS: The highest value of the RIM is noticed in control group 1.44 (1.21-1.70). There is no significant difference in the size of the disc in the eyes with developed open angle glaucoma (1.80 +/- 0.66) compared to normal eyes (p = 0.663), to the eyes with initial glaucoma (p = 0.120), and terminal glaucomatous atrophy (p = 0.068). There is statistically importance of E/D parameter in healthy group 0.17 (0.04-0.27), early glaucomatous group 0.44 (0.35-0.51), developed glaucoma 0.47 (0.39-0.61) respectively p < 0.005. The volume of cup was significantly greater in the eyes with terminal glaucomatous atrophy 1.05 (0.85-1.4) compared to the healthy eyes 0.31 (0.06-0.51) (p < 0.005), significantly greater to initial glaucoma 0.84 (0.58-1.12) (p = 0.007) and significantly higher compared to developed glaucoma 0.82 (0.62-1.07) (p = 0.003). There is no significant difference in the cup between the eyes with early and developed glaucoma (p = 0.912). The eyes with terminal glaucoma had significant lower value of the thickness of retinal nerve fiber layer 56.50 (45.50-71.25) compared to developed glaucoma group 82.5 (72-95.75), initial glaucoma 110.50 (102-123) and healthy eyes 132 (119-150) (p < 0.005). CONCLUSION: The SD-OCT scanning should be used to quantify optic nerve head anatomy in human eyes. The changes can be recognized and can indicate as important risk factor in considering glaucoma changes. It also should be considered as an exact model of glaucoma pathology.

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.

Use of the toric intraocular lens for keratoconus treatment.

A 50 year old man presented to Eye clinic University clinical centre Tuzla with bilateral visual impairment. Clinical examination revealed low visual acuity and keratoconus in both eyes, white cataract in right eye and diabetic retinopathy in left eye. Ultrasonography examination was normal. The patient underwent Trypan blue capsule staining, phacoemulsification and implantation of intraocular lens Alcon AcrySof SN60T9 16 D spherical and 6.0 D cylinder power. Phacoemulsification went uneventful and early postoperative recovery was successful. Visual acuity improved to 0,8 and fundus examination revealed background diabetic retinopathy. Postoperative follow up two years after surgery showed no signs of keratoconus progression and visual acuity maintained the same.

Pediatric cataract in Tuzla Canton, Bosnia and Herzegovina.

AIM: To estimate incidence and to present descriptive epidemiological data on pediatric cataract in Tuzla Canton, Bosnia and Herzegovina. METHODS: Medical records of all patients hospitalized at the Eye Clinic of the University Clinical Center Tuzla over the 8-year period were retrospectively examined. Prevalence, morphology and type of cataract, its possible etiology and existence of other associated ocular and systemic diseases were analyzed. RESULTS: The study included 87 eyes of 58 children. Average age at presentation was 11.12 (SD ± 9.03) years. A total of 34 (58.62%) patients were males and twenty-four (41.38%) females. Twentynine (50%) cataracts were unilateral. Thirty-seven (63.79%) patients had isolated cataracts and 24 (29.31%) patients had other ocular anomalies associated with pediatric cataract. High refractive anomalies, nystagmus and microphthalmus were most commonly associated ocular findings. Strabismus was present in 14 (24.13%) cases. Posterior cortical cataract was present in 29 (32.58%) and nuclear cataract in 28 (31.46%) cases. Estimated incidence of congenital cataract was 2.62 per 10.000 births and incidence of pediatric cataract was 8.6 per 10.000 births. CONCLUSION: Prevalence of pediatric cataract in Tuzla Canton is within the worldwide range. Late presentation of children with cataract remains the problem that needs to be addressed. Improved patient education and public awareness are needed in order to change the course of avoidable childhood visual impairment.

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.

Phacoemulsification of irradiation cataract after brachytherapy.

A 24-year old man presented to the Policlinic with severe visual impairment in his left eye. The patient had been treated earlier with Iodine-125 brachytherapy due to iris melanoma. Clinical examination revealed low visual acuity, filtration device, iris atrophy, posterior synachiae and completely white cataract. Ultrasonography revealed scleral thinning with no signs of retinal detachment. The patient underwent synechiolysis, trypan blue capsule staining, phacoemulsification and implantation of 23D intraocular lens Alcon AcrySof (MA60BM). Phacoemulsification went uneventful and early postoperative recovery was successful. Visual acuity improved to 0,2 and fundus examination revealed radiation retinopathy with diffuse retinal scaring.

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.

Early ultrasonographic diagnosis of retinal detachment: multidisciplinary approach and benefit.

Patients with eye problems are often present in family medicine and emergency wards, whether it is isolated disturbances of vision, or as part of other diseases. A large number of pathological entities of the eye require prompt and accurate diagnosis and appropriate therapy before they get to specialized ophthalmological institutions. Ultrasonography of the eye is a simple, non-invasive, painless method that can be done at the first contact with patients and can provide very important information for accurate diagnosis of pathological changes. Early detection of retinal ablation, intra ocular bleeding and tumors by this method can save sight and lives of patients. Sonography of the eye in 667 patients over two years revealed 27 retinal ablation and hemophthalmos in 36 patients. Every fifth patient with retinal ablation was referred by a doctor of family medicine. Knowing the possibilities of ultrasonography in ophthalmology, teamwork at the level of primary health care can open access to ultrasonography of the eye for other specialty physicians which can improve population health and provide a new quality in the prevention of vision loss.