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.

Juvenile Primary Sjögren Syndrome in a 15-Year-Old Boy with Renal Involvement: A Case Report and Review of the Literature.

Juvenile primary Sjögren syndrome (pSS) with renal involvement is extremely rare, reported approximately in 50 children, predominantly girls. Here, we present the first reported case of a male child with juvenile pSS with ocular surface disease (previously keratoconjunctivitis sicca), submandibular salivary gland involvement, and tubulointerstitial nephritis. First, two symptoms were clinically apparent at presentation. We illustrate here that kidney involvement in pSS should be actively looked for, as juvenile pSS may be associated with asymptomatic renal involvement. Immunophenotyping of peripheral blood cells using multicolor flow cytometry revealed at the time of diagnosis changes in both adaptive (T memory cells and B memory cells), and innate immunity (an increased activation of natural killer cells, as well as monocytes and neutrophils, and an increased representation of intermediate monocytes). Our case report points to the importance of kidney examination, early diagnosis and therapy in juvenile pSS, as well as highlights international collaboration to obtain more data for this rare disease.

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.

Retinal oxygen saturation in monoclonal gammopathies patients: A pilot study.

PURPOSE: The aim of this pilot study was to assess oxygen saturation in retinal blood vessels in patients with monoclonal gammopathies (MGs). METHODS: Thirty-one patients with MGs (11 women and 20 men, mean age 65.9 ± 8.9 years) were enrolled during 2016-2020. The patients were diagnosed at the Haemato-Oncology Department and subsequently examined at the Ophthalmology Department before initiating systemic therapy. All patients were subjected to automatic retinal oximetry (Oxymap ehf.) and had their fundus photographed (Topcon TRC-50DX retinal camera). We assessed the association between retinal oxygen saturation (SatO2 ) - arterial SatO2 , venous SatO2 and arterio-venous (AV) difference-and MGs parameters: serum monoclonal immunoglobulin (M-protein) level and serum immunoglobulin-free light chains (FLC kappa and lambda), total protein, serum viscosity, haemoglobin, albumin, lactate dehydrogenase, C-reactive protein, creatinine and serum calcium level. Hyperviscosity-related retinopathy was also evaluated. RESULTS: Statistical analysis showed a significant positive correlation (r = 0.462; p = 0.009) between the AV difference and the haemoglobin level. A significant, medium strong negative correlation was found between the AV difference and the serum levels of the monoclonal light lambda chains (r = -0.450; p = 0.011). Contrary to expectations, no statistically significant correlation was found between retinal oxygen saturation and the total protein or viscosity. CONCLUSION: This study found correlation between retinal oxygen saturation and certain parameters in the blood of patients with MGs. Increasing levels of monoclonal immunoglobulin seem to reduce oxygen absorption in retinal arterioles, resulting in a lower AV difference, particularly in patients with a high free light chain level.

Ocular hypertension in patients with active thyroid-associated orbitopathy: a predictor of disease severity, particularly of extraocular muscle enlargement.

The purpose was to ascertain if any relation exists between the elevated intraocular pressure (IOP) in patients with thyroid-associated orbitopathy (TAO) in active stage and the severity of extraocular muscle involvement and the extent of exophthalmos. METHODS: A total of 96 eyes and orbits of 48 adult patients with active TAO were investigated. All patients underwent magnetic resonance imaging of the orbit and measurement of all extraocular recti muscles (EOM). The obtained data was divided into two groups according to the IOP value: normal IOP ≤ 21 mmHg; n = 47 and elevated IOP with IOP > 21 mmHg; n = 49, and analyszed. RESULTS: A significant difference was found in the short diameter of medial rectus and inferior rectus muscles and in the sum of short parameters of all EOM. All these parameters were significantly higher in the elevated IOP group. Motility restriction in at least one gaze direction was also significantly more frequent (p < 0.0001) in the elevated IOP group. A positive moderate correlation was found between IOP and the sum of short parameters of EOM (r = 0.496). No correlation was found between the IOP and exophthalmos values (r = 0.267). During the follow-up, the frequency of strabismus surgery and orbital decompression was significantly higher in the elevated IOP group (p = 0.003; p = 0.002). CONCLUSION: Elevated IOP in the active TAO stage particularly correlates with extraocular muscle involvement. These patients are also more likely to require orbital decompression and strabismus surgery.

Retinal oxygen saturation is associated with HbA1c but not with short-term diabetes control, internal environment, smoking and mild retinopathy - ROXINEGLYD study.

PURPOSE: Purpose of this prospective uncontrolled single-centre pilot study was to find an association of retinal oxygen saturation (SatO2 ) with acid-base balance (ABB), carboxyhaemoglobin concentration, current plasma glucose concentration (PG), mean PG and PG variability over the last 72 hr, haemoglobin A1c (HbA1c), and other conditions. METHODS: Forty-one adults (17 men) with type 1 (N = 14) or type 2 (N = 27) diabetes mellitus, age 48.6 ± 13.5 years, diabetes duration 9 (0.1-36) years, BMI 29.4 ± 6.3 kg/m2 , and HbA1c 52 ± 12.7 mmol/mol completed the study. The 4-day study comprised two visits (Day l, Day 4) including 72 hr of continuous glucose monitoring (CGM) by iPro® 2 Professional CGM (Medtronic, MiniMed, Inc., Northridge, CA, USA). Retinal oximeter Oxymap T1 (Oxymap ehf., Reykjavik, Iceland) was used to assess SatO2 . RESULTS: Wilcoxon signed-rank test showed no SatO2 difference between eyes and visits. Spearman's correlation analysis revealed a significant correlation between arterial SatO2 and PG variability in type 2 diabetes mellitus, a positive correlation of venous SatO2 with HbA1c and with finger pulse oximetry. However, no correlation of SatO2 with ABB, carboxyhaemoglobin, current PG, mean PG over the 72 hr, age, diabetes duration, BMI, lipoproteinaemia, body temperature, systolic and diastolic blood pressure, heart rate, central retinal thickness and retinal nerve fibre layer thickness was found. CONCLUSION: This study confirmed the association of venous SatO2 with long-term but not with short-term diabetes control, ABB and other conditions. The increased SatO2 and questionable impact of PG variability on retinal SatO2 is a research challenge.

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.

A Continuous Glucose Monitoring System (CGMS) - a promising approach for improving metabolic control in persons with type 1 Diabetes mellitus treated by insulin pumps.

This pilot study deals with the possibilities of a Continuous Glucose Monitoring System (CGMS, Minimed- Medtronic) to optimize insulin substitution. Ten persons with type 1 diabetes mellitus treated by means of an insulin pump entered the study and eight of them completed the protocol. CGMS was introduced for a period of 5 days. The standard dinner (60 g of carbohydrates) and overnight fasting were designed to ensure standard night conditions in all persons in the study while maintaining their usual daily eating routine, physical exercise and assessment of prandial insulin boluses. The only adaptation of basal rates of insulin pump was performed on day 3. Comparison of the mean plasma glucose concentration (0:00-24:00 hrs) between day 2 (before adaptation) and day 4 (following adaptation) was made. An independent comparison of the mean plasma glucose concentration between the night from day 2 till day 3 (22:00-6:00 hrs) and the night from day 4 till day 5 (22:00-6:00 hrs) was performed. The mean plasma glucose investigated by means of CGMS improved in the 24-hour period in 5 out of 8 persons and in the night fasting period (22:00 to 6 hrs) in 6 out of 8 persons. The CGMS is a useful means for assessment of the effectiveness of basal rate and prandial insulin doses in persons with type 1 diabetes treated by means of an insulin pump. However, further studies are necessary to improve the algorithm for insulin substitution.