The Impact of the COVID-19 Pandemic on the Quality of Examination in Eye Clinics in the Czech Republic - Questionnaire Study.

PURPOSE: The aim of the study was to map the behavior of ophthalmologists regarding protective equipment during the COVID-19 pandemic (coronavirus disease 2019), both during the time of the mandatory restrictive measures and after their relaxation. Another aim was to evaluate the awareness of ophthalmologists in the Czech Republic about the possible impact of nose and mouth protective measures (masks, respirators) on the quality of eye examinations, especially on the results of standard automated perimetry (SAP) and intraocular pressure (IOP) measurement. MATERIALS AND METHODS: As part of two professional ophthalmological events in the Czech Republic, which took place in 2022, we obtained and evaluated data from the ophthalmologists in attendance using a questionnaire. We evaluated demographic parameters, frequency of use and type of nose and mouth protective equipment and their influence on the quality of ophthalmological examination as well as the awareness of ophthalmologists about their possible influence on the outcome of SAP and IOP measurements. RESULTS: We obtained data from a total of 212 respondents (148 women, 44 men, in 20 cases gender was not stated). In 91.5% of cases, ophthalmologists agreed that the use of respirators and masks makes ophthalmological examination more difficult. The most common problems were eyepiece fogging (85.8%), examination lens fogging (85.8%), and lens fogging when spectacles correction was prescribed (79.2%). The respondents most often combated these problems either by completely removing the respirator (24.1%) or at least by pulling it under the nose (39.2%). At the time when the measures were relaxed, significantly more men did not use any nose and mouth protection at all during ophthalmological examinations (15.8% of men vs. 4.2% of women; p = 0.032). An alarming finding was the fact that 35.6% of respondents did not know whatsoever whether the nurse was performing a perimetry examination on a patient with a respirator/mask or without protective equipment, i.e. they were not aware whatsoever of the possible formation of artifacts. Only 21.2% of respondents were aware of the possible difficulties of measuring IOP while wearing a respirator, while 59.9% of respondents were not aware of this risk (39.6% had never considered this problem, 20.3% of respondents were convinced that a respirator could not have an effect on the measurement of IOP). CONCLUSION: The use of nose and mouth protective equipment clearly affects the ophthalmological examination and makes it more difficult. Although ophthalmologists belong to a group at high risk for the possible transmission of infection in the performance of their profession, they often removed nose and mouth protection in an effort to eliminate fogging of eyepieces and examination lenses. The awareness of ophthalmologists regarding the possible influence on the results of SAP and IOP measurement by wearing a respirator was low in our questionnaire survey. It is therefore advisable to discuss this issue more widely and warn doctors about these risks.

Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability.

PURPOSE: The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8 (Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. MATERIAL AND METHODS: 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. RESULTS: mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. CONCLUSION: TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.

Sensitivity of Papilledema as a Sign of Increased Intracranial Pressure.

Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.

Bilateral optic neuropathy as a complication of allogeneic hematopoietic stem cell transplantation.

BACKGROUND: The authors present a case study which describes the development of bilateral optic neuropathy as a complication of allogeneic hematopoietic stem cell transplantation (HSCT) in a patient who underwent a transplant for B-cell acute lymphoblastic leukemia (B-ALL). The patient, who was in remission with regard to the underlying hematological disease, developed edema of both optic discs and maculas three months after transplantation. The morphological finding regressed after treatment with corticoids and comprehensive systemic anti-infective therapy. However, the loss of function was not entirely restored. CASE REPORT: One year after the healing, the atrophy of the optic discs persisted, with corresponding findings in vessel density (VD), retinal nerve fibre layer (RNFL) and visual field changes. Electrophysiological examination by pattern electroretinogram (PERG) showed an alteration in retinal ganglion cells in the left eye, but with significant damage to nerve fibres on both sides. Visual evoked potential (VEP) verified bilateral non-inflammatory neurogenic lesions. This finding was also confirmed by functional magnetic resonance imaging (fMRI). Examination by structural magnetic resonance imaging (MRI) showed inflammatory changes in the optic nerve sheaths over time and a consequent marked narrowing of them. CONCLUSION: The authors believe that edema of the optic discs and maculas was caused by a combination of several factors. Firstly, MRI showed inflammatory changes in the optic nerve sheaths, which led to a blockade of axoplasmic transport. Another factor that may have played a part in the outcome was endothelial damage to blood vessels with impaired microcirculation supplying the optic nerve fibres, which contributed to the occurrence of macular edema.

Floppy iris syndrome associated with specific medication intake: A narrative review.

Intraoperative floppy iris syndrome (IFIS) is a cataract surgery complication that remains a challenge for eye surgeons. It is caused by the antagonism of alfa-1-adrenergic receptors within the dilator muscle of the iris, thus preventing the iris from dilation during a cataract surgery. The long-term blocking alfa-1 adrenergic receptors by the chronic use of a number of systemic medications may lead to permanent anatomical atrophy of the dilator muscle of the iris. The most common drugs associated with the development of IFIS are tamsulosin and other alpha-1 adrenergic receptor antagonists prescribed to patients with low urinary tract symptoms (LUTS). There are other systemic medications that have been reported to have increased risk for IFIS. It is crucial for the ophthalmologist to identify the high-risk patients prone to develop IFIS. Its presence may complicate the course of cataract surgery, ultimately negatively affecting visual outcome. Cataract surgery should be performed by an experienced eye surgeon using alternative pharmacological and surgical techniques. Interdisciplinary cooperation is essential to mitigate potential complications. Patients should be informed by their physicians about the need to report a medication history to their eye specialists, especially before cataract surgery.

Hypertension, hyperlipidaemia and thrombophilia as the most common risk factors for retinal vein occlusion in patients under 50 years.

BACKGROUND AND AIMS: Cardiovascular (CV) diseases are the most common risk factors (RFs) for retinal vein occlusion (RVO) development in general. The aim of this study was to identify the most frequent causes of RVO in patients under 50. METHODS: We retrospectively evaluated a group of patients with RVO under 50 years. The parameters of interest included age and sex, RVO type, presence of arterial hypertension (HT), hyperlipidaemia (HLD), diabetes mellitus (DM), congenital thrombophilic disorder (TD), obstructive sleep apnoea syndrome (OSAS), thyroid eye disease (TED), use of hormone contraception (HC) or hormone replacement therapy (HRT), glaucoma and other potential RFs. Patients with central RVO (CRVO), hemi-central RVO (HRVO), branch RVO (BRVO), impending CRVO and combined arterial-venous (AV) occlusion were included. RESULTS: The group consisted of 110 eyes of 103 patients. CV disease was the most common systemic abnormality. 55.3% patients had HT, 17.5% had HLD. TD was the third most frequent RF (12.6%). The cohort also included patients with DM (6.8%), glaucoma (6.8%) and women using HC/HRT (26.2% of female patients). There were isolated cases of RVO due to retinal vasculitis, intense exercise, antiphospholipid syndrome and COVID-19 pneumonia. None of the patients had OSAS, TED or a haemato-oncological disease. The etiology remained unexplained in 20.4% patients. No difference was observed in RF occurrence between patients with CRVO and HRVO and those with BRVO. CONCLUSION: The most common systemic abnormality in our cohort was CV disease, especially HT and HLD. The risk factors for central, hemi-central and branch RVOs were similar.

Changes of intraocular lens position induced by Nd:YAG capsulotomy.

AIMS: The aim of this study was to evaluate the changes in IOL position (axial shift, tilt and decentration) in the capsular bag after Nd:YAG laser capsulotomy and to create a user-friendly software that is optimized for the output of available imaging technology, then verify the relationship between the biometric parameters of the eye and the extent of changes in the IOL position. PATIENTS AND METHODS: The study included 35 artephakic eyes that underwent laser capsulotomy. Before and at least one hour after capsulotomy, all patients underwent the following assessments: optical biometry (Lenstar LS900), OCT with anterior segment module (Optovue Avanti) and IOL photography in infrared mode using reference unit (Verion). The original software solution was designed for the graphical evaluation of the differences between centering, axial displacement and tilt of IOL. Changes in IOL position were evaluated as simple differences before and after the laser procedure and as differences in absolute values (abs). RESULTS: The following results show the average differences in IOL position: ACD=0.02±0.23 mm (abs=0.11±0.20 mm), IOL decentration in x-axis = -0.001±0.091 mm (abs=0.065±0.063 mm), IOL decentration in y-axis =0.012±0.119 mm (abs=0.048±0.53 mm), tilt in horizontal plane TILT-H=0.11±0.83° (abs=0.51±0.66°) and tilt in vertical plane TILT-V = -0.14±0.49° (abs=0.26±0.44°). All changes were insignificant (P>>0.05). In total, 74.29% of IOLs showed a hypermetropic shift. A moderate positive correlation was found between the absolute differences in horizontal tilt and keratometry (r=0.45). Relationship with other changes and parameters were weak. CONCLUSION: In conclusion, the use of the original software solution developed by the authors showed that changes in IOL centering, axial displacement and tilt occur after Nd:YAG capsulotomy, but average differences were insignificant. In almost 3/4 cases, there was a hypermetropic axial displacement of the IOL.

The influence of central corneal thickness on progression of normotensive glaucoma.

OBJECTIVES: To verify whether there is a relation between central corneal thickness (CCT) and progression of normotensive glaucoma (NTG), to assess the impact of early changes in the visual field on their progression in time. METHODS AND PATIENTS: The sample consisted of two groups of patients with NTG. In the first group there were 50 eyes of 25 persons (15 females and 10 males) average age 63 years who had been treated with prostaglandins. The second group consisted of 50 eyes of 25 persons (16 females and 9 males) average age of 62 years who had had no local therapy. All patients were cardiologically compensated and had no other internal or neurological disease. Visual acuity was 1.0 with a possible correction (less than ±3 dioptres) in all patients. The IOP ranged between 10-15 mmHg in all patients. If hypotensive ophthalmological therapy was initiated, it had been stable for the last five years. In all patients, we monitored CCT, excavation in the papilla (c/d), pattern defect (PD) and overall defect (OD) of the visual field. In 2013, changes in the visual fields were approximately the same in all patients. We compared the results of the visual fields after five years, i.e. the results were obtained in 2018. CCT was measured, using the ultrasound pachymeter Tomey SP-100. PD and OD of the visual field using the glaucoma fast threshold program with the MEDMONT M 700 device. For statistical comparison, we used the paired t test and correlation analysis. RESULTS: In both groups, we found progression of PD in time (P=0.0000, P=0.0001, respectively). In the patients treated with prostaglandins, OD had not statistically significantly changed (P=0.49) in contrast to the untreated patients (P=0.001). There was no statistically significant relation between CCT and PD in any of the groups. It was similar between the CCT and OD. In the treated NTG patients, we found a weak correlation between the changes in PD in time (r=0.2846, P=0.0438) and moderately strong relation for OD (r=-0.63). The finding was similar in untreated patients PD (r=-0.2, P=0.162) and OD (r=-0.443, P=0.001). CONCLUSION: We found no relationship between progression of changes in the visual fields in CCT. Progression of changes in the visual fields was higher in patients who had more advanced changes at the beginning of observation. The untreated patients had progression of changes in the visual fields both in PD and OD in contrast to those who were taking prostaglandins and presented changes only in PD.

Effect of prostaglandins and beta blockers on progression of hypertensive and normotensive glaucomas.

AIM: The aim of the study was to evaluate the progression of changes in the visual fields in patients with hypertensive glaucoma (HTG) and normotensive glaucoma (NTG) following administration of prostaglandins and beta blockers, as well as also in NTG without ophthalmological therapy. Methodos. The HTG group included 12 patients (mean age 66 years) with approximately the same changes in the visual field and central corneal thickness (CCT-568um) treated with prostaglandins, and 12 patients (mean age 60 years, CCT=544um) treated with beta-blockers. The IOP ranged from 12 to 18mmHg for the whole follow-up period. The NTG group consisted of three subgroups. The first subgroup consisted of 14 patients (mean age 58 years) who were treated with prostaglandins. The second subgroup consisted of 10 patients (mean age 57 years) who were treated with beta blockers. The third subgroup consisted of 18 patients (mean age 57 years) who underwent no ophthalmological therapy. IOP was within the range of 8-12 mmHg over the whole follow-up period. In all patients, we monitored the pattern defect (PD) and overall defect (OD) within a period of five years. The treatment was not modified during the treatment period. All patients were compensated for cardiovascular status and had no other internal or neurological disease. Visual acuity was 1.0 with a possible correction (less than 3 dioptres) in all patients. RESULTS: There was no statistically significant difference in HTG during the treatment with prostaglandins in PD (P=0.35) and OD (P=0.09) or beta blockers (P=0.37 and 0.23, respectively). In NTG, the greatest changes occurred in PD (P=0.0001) in untreated patients. OD showed no statistically significant changes (P=0.25). Similarly, the patients on prostaglandins had a statistically significant difference in PD (P=0.04), while OD did not show statistically significant changes (P=0.4). We did not find statistically significant differences in progression in patients with NTG treated with beta blockers PD (P=0.7), OD (P=0.4). CONCLUSION: Treatment of glaucoma with prostaglandins and beta blockers has a significant importance in HTG. However, beta blockers have a higher protective effect on the visual field. This is not true in NTG, where we demonstrated this effect only following the administration of beta blockers.

Optical coherence tomography angiography and the visual field in hypertensive and normotensive glaucoma.

BACKGROUND: Hypertensive glaucoma (HTG) causes damage to the retinal ganglion cells and eventually to the entire visual pathway due to high intraocular pressure (IOP). However, increased IOP will also affect the vessel density (VD) of the posterior pole of the eye and the related retinal ganglion nerve fibres (RNFL). In normotensive glaucoma (NTG), the retinal ganglion cells are relatively intact. The pathology is at the level of ganglion fibres. The unanswered question is what has altered ganglion cell fibres at the level of the retina and optic nerve head in NTG? AIM: The aim of this study was to determine whether there is a correlation between the retinal nerve fibre layer (RNFL) and vessel density (VD) at the same altitudinal half of the retina and the sum of sensitivities of the contralateral half of the visual field of the same eye in hypertensive and normotensive glaucoma (NTG). METHODS: Our group included 20 patients with HTG and 20 patients with NTG. The Pearson's correlation coefficient r was used for evaluation of the relationship of the peripapillary RNFL and VD, visual field (using the fast threshold glaucoma program) as the sum of sensitivities in apostilbs (asb) to the extent of 0-22 degrees. The results of sensitivity were compared with the RNFL and VD of the contralateral altitudinal half of the retina in the same eye. RESULTS: In the HTG group there was a moderate relationship between RNFL and VD (both hemifields), but no relationship between RNFL and VF. VD SH and VF IH showed weak correlation and VD IH and VF SH showed no correlation. In patients with NTG, we found a strong correlation between RNFL and VD (both hemifields), between VD SH and VF IH a moderate correlation, between VD IH and VF SH also a moderate correlation and a weak correlation between RNFL and VF. CONCLUSION: By comparing the RNFL and VD at the same altitudinal halves of the retina, we found a moderate correlation in HTG and a strong correlation in NTG. We found no or a weak correlation between VD and VF in HTG. In NTG the relationship between VD and VF showed a strong correlation. These findings reveal the differences in the diagnostic groups.

The importance of angle kappa evaluation for implantation of diffractive multifocal intra-ocular lenses using pseudophakic eye model.

PURPOSE: To determine the critical value of the angle kappa in connection with a higher risk of photic phenomena for the AcrySof ReSTOR and Tecnis multifocal intra-ocular lens (MIOL) on a standardized pseudophakic eye model. To analyse the impact of biometric value changes on the critical angle kappa. METHODS: Geometrical optic rules applied to a suitable optical model of the pseudophakic eye were used to calculate the critical value of the angle kappa for the Tecnis and three types of the AcrySof ReSTOR MIOLs. The angle kappa was defined as critical if the incident ray passed through the first ring's edge area. The influence of different positive optical corneal power (K), effective lens position (ELP) and axial length (AL) on the critical angle kappa (κc) was investigated. The dependence of κc on one of the parameters was studied for standardized values of the remaining parameters. RESULTS: The highest value of the critical angle kappa was evaluated for the Tecnis MIOL. The increase in ELP and K caused an increase in κc under the given conditions. On the contrary, an increase in AL led to lower values of κc. CONCLUSION: We demonstrated the dependence of the critical angle kappa on the central part of the MIOL and on biometric parameters of the eye, especially on the effective lens position. According to these results, we conclude that shallow anterior chamber depth in connection with a higher angle kappa is an important risk factor for pronounced photic phenomena after implantation of a diffractive MIOL.

The in vitro antimicrobial activity of silicone oils used in ophthalmic surgery.

BACKGROUND: The aim of the study was in vitro assessment and comparison of the antimicrobial activity of three types of silicone oils used in ophthalmic surgery. METHODS: The silicone oils (Arciolane 1300 centistokes, Arciolane 5500 centistokes and Oxane Hd, heavy silicone oil) were inoculated with microbes common in endophthalmitis and their growth was observed continuously. Control tests of microbial growth were performed on silicone oil-free media, i.e. saline and standard enrichment media. In both tested oils and control media, the microbes were cultured aerobically for 21 days, bacteria at 37 °C and yeasts and fungi at 30 °C. Prior to and during incubation at given intervals (days 0, 2, 4, 7, 9, 11, 14, 16, 18 and 21), 10 µl samples were taken from all test tubes. These were diluted in saline in a series of test tubes, with the minimum concentration reaching 10(-8). From each dilution, 25 µl were inoculated onto agar media. After 24 h of aerobic incubation at 37 °C (bacteria) and 48 h at 30 °C (yeasts and fungi), the grown colonies were counted and the numbers of colony-forming units in 1 ml (CFU/ml) were determined. RESULTS: In vitro, the highest antimicrobial effect was observed for the Oxane Hd silicone oil. CONCLUSIONS: If endophthalmitis is treated by pars plana vitrectomy, the application of Oxane Hd silicone oil into the vitreous cavity at the end of surgery may contribute to the elimination of microorganisms from the intraocular space but clinical trials are needed to assess its safety.