Personality Traits, Stress, and Emotional Intelligence Associated with Central Serous Chorioretinopathy.

BACKGROUND The aim of the present study was to investigate the relationship between personality traits, stress, emotional intelligence, and central serous chorioretinopathy (CSCR). MATERIAL AND METHODS This prospective case-control study included 57 patients with acute CSCR and 57 age- and sex-matched controls with refractive errors. Inclusion criteria for CSCR group were acute unilateral onset of visual disturbances within 2 weeks until the first visit to the ophthalmologist and ophthalmoscopic finding of a round or oval macular detachment confirmed by optical coherence tomography as a dome-shaped serous neuroretinal elevation. RESULTS Using the Sixteen Personality Factor Questionnaire (16 PF), patients with CSCR achieved slightly higher scores on primary characteristics such as warmth (P=0.612) and perfectionism (P=0.137) when compared to the control subjects. Mean scores measured with the Social Readjustment Rating Scale (SRRS) were significantly higher in patients with CSCR (P=0.004), which means that these patients had notably elevated average reactivity to stressful life events. In addition, the number of patients with a high stress level was higher in the CSCR group than in the control group. Considering the level of emotional intelligence measured with the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), patients with CSCR achieved significantly lower scores on well-being (P=0.003) and sociability (P=0.011) factors, as well as on total score (P=0.014). CONCLUSIONS A higher level of perceived stress is the most important psychological risk factor for CSCR. According to our results, a low level of emotional intelligence may be an additional factor that contributes to the occurrence of CSCR.

Assessment of Perfused Peripapillary Capillaries and Peripapillary Capillary Density Maps in Glaucoma Patients.

INTRODUCTION: Monitoring and diagnosing glaucoma until 2017 included funduscopy, IOP measurements, gonioscopy, pachymetry, as well as visual field tests, optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). Radial peripapillary capillaries (RPC) can be observed by fluorescein angiography, as well as histologically - superficial and deep capillary layer. AIM: To correlate density of radial peripapillary capillary network (RPC) and retinal nerve fiber layer (RNFL) thickness in eight peripapillary segments in patients with a primary open angle glaucoma (POAG) which have the disease under 10 years of duration, over 10 years of duration and in a group of healthy patients. METHODS: This is a cross-sectional review which included three groups of patients: POAG patients under 10 years of disease duration, over 10 years of disease duration and control group of patients. The study is performed on the commercial optical coherence tomography angiography system (AngioVue, Avanti RTVue-XR, Optovue, CA). Sectoral RPC density values, RPC maps and RNFL thickness were analyzed in three groups of patients, data was compared and correlation between parameters was examined. RESULTS: Mean RPC Density values in both superior segments (S1, S2) were significantly lower in patients with glaucoma over 10 years of disease duration compared to patients with glaucoma under 10 years of disease duration (p<0.05). Statistically significant positive correlation was established between RNFL thickness and RPC density in all eight peripapillary segments. CONCLUSION: Analysis of radial peripapillary capillary network density on optical coherence tomography angiography may provide an earliest functional sign of progressive optic nerve disease and new insights into the pathophysiology of glaucomatous damage.

Optical Coherence Tomography Angiography Contributions in Classification of Nonproliferative Diabetic Retinopathy.

INTRODUCTION: To show the importance of optical coherence tomography (OCT) angiography imaging of superficial and deep capillary network in patients with non-proliferative diabetic retinopathy (NPDR), and to show the correlation between blood glucose level and changes in the foveal microvasculature. METHODS: A cross-sectional study was performed on eyes with NPDR and healthy subjects using a highspeed 840-nm-wavelength spectral-domain optical coherence tomography instrument (RTVue XR Avanti; Optovue, Inc, Fremont, California, USA). Blood flow was detected using the split-spectrum amplitude-decorrelation angiography algorithm. A fully automated microstructural analysis of the foveal avascular zone (FAZ) and avascular surfaces was performed. Quantitative values from diabetic patients were compared with those of healthy subjects. Data about blood status in diabetic patients and healthy subjects were taken from patients' medical history. RESULTS: Size of both, FAZ and vascular dropout are significantly different between healthy patients and patients with NPDR. OCT angiography detected enlargement and distortion of the foveal avascular zone, retinal capillary dropout, and a higher number of vascular loops and microaneurysms. Sizes of FAZ and vascular dropout increase with the duration of disease. Central macular thickness (CMT) is not significantly different between healthy patients and patients with NPDR. A study has proven a positive correlation between the size of FAZ and the size of vascular dropout in superficial vascular plexus in patients that have DM over 10 years. CONCLUSION: A qualitative and quantitative OCT angiography approach to retinal vascular status can offer objective data on monitoring patients with non-proliferative diabetic retinopathy as well as indicate the progression of the disease.

Concentrations of Selected Cytokines and Vascular Endothelial Growth Factor in Aqueous Humor and Serum of Diabetic Patients.

Purpose: To investigate the aqueous humor and serum levels of selected cytokines and vascular endothelial growth factor (VEGF) in diabetic patients, implicating their role in the pathogenesis of diabetic eye complications.Materials and methods:   Atotal of 65 patients (27 males and 38 females) who underwent cataract surgery were recruited into the study. The study group consisted of 30 cataract patients with type 2 diabetes mellitus, and this group was divided into two subgroups: 14 patients with diabetic retinopathy (DR group) and 16 patients without DR (NDR group). The control group consisted of 35 non-diabetic cataract subjects.Results: Patients in the DR group had significantly higher aqueous humor concentrations of interleukin (IL)-1ß, IL-6, IL-8, IL-10, monocyte chemotactic protein (MCP-1) and VEGF. Likewise, serum concentrations of IL-1ß, IL-6, IL-8, IL-12, TNF-α and IFN-γ were significantly higher in the DR group as compared to the controls. Aqueous humor concentrations of IL-1ß, IL-8, MCP-1 and VEGF were significantly higher in the DR group as compared with the NDR group.Conclusion: Our findings support the hypothesis that chronic inflammation and a disturbance of the immune system play important roles in the pathogenesis of diabetic cataract and DR.

New Insights into Schizophrenia: a Look at the Eye and Related Structures.

BACKGROUND: Schizophrenia is a multifactorial neurodevelopmental disorder associated with cognitive dysfunction and changes in primary sensory processing. This article aims to explore the current insights into the relationship between schizophrenia and different visual disturbances. METHODS: To provide a literature review of visual impairments in schizophrenia, we performed a PubMed/MEDLINE and Scopus search to identify all articles in English on the topic up to the end of 2018. RESULTS: Multiple retinal functional and structural abnormalities are found in patients with schizophrenia. Wider retinal venules suggest chronically insufficient brain supply of oxygen and this could contribute to the occurrence of psychotic symptoms. Optical coherence tomography studies showed that retinal nerve fiber layer, macular thickness, and macular volume were significantly lowered in the chronic phase of schizophrenia. Results from electroretinogram recordings have demonstrated different declinations such as abnormalities of a - wave activity in the photoreceptors or b - wave activity in the bipolar and Muller cells. Abnormalities in eye movements, such as a notable decrease in saccades and smooth pursuit eye movements, are one of the most reliable and reproducible impairments associated with schizophrenia. Disrupted visual processing of the magnocellular pathway may result in a decrease of contrast sensitivity, sensory processing, orientation discrimination, visual integration, trajectory and spatial localization, backward masking and motion tracking. Visual perceptual abnormalities occur in more than 60% of schizophrenic patients and these are visual hallucinations, perceptual distortion of colors, shapes and light intensity, decrease in contour integration and surround suppression. Other, frequently present eye disorders include impaired visual acuity, strabismus and nystagmus. CONCLUSION: Visual impairments are one of the most important features of schizophrenia, which could help in defining the disease state and assigning appropriate treatment.

HEALTH-RELATED QUALITY OF LIFE IN PRIMARY OPEN-ANGLE GLAUCOMA PATIENTS.

The purpose of this research was to evaluate the relationship between general health-related quality of life (GHRQL) and sociodemographic factors in primary open-angle glaucoma (POAG) patients. A prospective cross-sectional study included 207 glaucoma patients. GHRQL was determined via two self-administered questionnaires: the 36-Item Short Form Survey (SF-36) and the EuroQol-5D (EQ-5D) questionnaire. Male and 50- to 69-year-old glaucoma patients, followed by patients who regularly used antiglaucoma therapy and those without progression of glaucoma reported a significantly higher quality of life as measured by the EQ-5D index and the EQ-5D visual analog scale (VAS) (p<0.05 all). Similarly, the Physical Component Summary (PCS) and Mental Component Summary (MCS) of SF-36 had significantly higher values for these patients (p<0.05 all). Furthermore, glaucoma patients with higher education and economic status, glaucoma patients who lived in rural areas, and those who were married achieved higher scores on EQ-5D and SF-36. In conclusion, progression of the disease, female sex, older age, lower education and economic status, urban area and unmarried status negatively affect quality of life in glaucoma patients.

Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia.

Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that can cause different ophthalmological and neurological symptoms. Preeclampsia toxemia or eclampsia is one of the leading causes of PRES. Herein, we present a study of a 35-year old woman who gave birth to healthy twins at 35 weeks of gestation by cesarean section because of threatened preterm delivery. On the 1st postoperative day, the woman developed a severe headache, arterial hypertension, tachycardia, generalized tonic-clonic seizures, and loss of consciousness that persisted for about 2 min. A provisional diagnosis of eclampsia was made, and the woman was then quickly transferred to the intensive care unit where she was treated with antihypertensive therapy, magnesium sulphate, and diazepam. Following stabilization of the general condition, the patient noticed sudden bilateral blindness. An ophthalmological examination revealed significant bilateral loss of vision at the level of insecured light perception, normal pupillary responses to a light stimulus, and normal fundus findings. On this basis, an ophthalmologist made the diagnosis to cortical blindness. Radiographic analysis showed an edematous change in the occipital and parietal brain regions, thus suggesting a diagnosis of PRES. In conclusion, cortical blindness is a clinically striking ophthalmic disorder that may occur in PRES associated with postpartum eclampsia.

Hallucinatory experiences in visually impaired individuals: Charles Bonnet syndrome - implications for research and clinical practice.

BACKGROUND: Charles Bonnet syndrome (CBS) refers to visual hallucinations that occur in individuals with preserved cognitive functions associated with visual impairment. METHODS: This article reviews occurence of visual hallucinations in subjects with CBS by journals published in English in the Pubmed database in the period 1992-2018. Criteria for selection of appropriate papers were sufficient information and perspicuous view on pathogenesis, epidemiology, clinical presentation and treatment possibilities of CBS. RESULTS: Most commonly, visual hallucinations in patients with CBS are complex, repetitive and stereotyped. Such individuals have preserved insight that those percepts are not real, and there is an absence of secondary explanatory delusions and hallucinations within other modalities. Seeing as the aforementioned percepts do not share all the characteristics of hallucinations, it remains unresolved how they should be referred to. Terms as release hallucinations, one that is reflecting its underlying pathogenesis, or confabulatory hallucinatory experiences have been proposed. Moreover, CBS has also been referred to as phantom vision syndrome and may occur in any ophthalmological disease. It is not particularly connected with loss of function along any level of the visual pathway. Although this syndrome is mostly associated with age-related macular degeneration, glaucoma and cataract, it could be related to almost any other ophthalmological conditions. The incidence of CBS alongside with mostly other ocular pathology is rising as population is ageing. CONCLUSIONS: Nonetheless, CBS remains commonly underreported, under recognized and/or misrecognized. Albeit the treatment recommendations and guidelines are not yet fully established, it is important to raise awareness of this specific and distinct condition, which inevitably implicates many differential diagnostic deliberations.

Comparison of Optic Nerve Head Morphology in Patients with Primary Open Angle Glaucoma and Non-Arteritic Anterior Ischemic Optic Neuropathy.

The aim of this study was to assess damage to retinal ganglion cells (RGC) and morphology of the optic nerve head (ONH) in patients with primary open angle glaucoma (POAG) and non-arteritic anterior ischemic optic neuropathy (NAION). The study included three groups of patients, as follows: 40 eyes with POAG, 40 eyes with NAION and 40 eyes with refraction anomaly. All patients underwent standard automated perimetry and analysis of ONH topography by using confocal scanning laser ophthalmoscopy (CSLO)-HRT II. Visual field defects such as decreased retinal sensitivity prevailed in the eyes with POAG, whereas in the eyes with NAION they were mostly manifested as concentrically narrowed visual field and quadrant excesses. Topographic ONH alterations, examined by HRT II, showed the same number of sectors to be affected in the eyes with POAG and NAION. A larger number of sectors in the upper part of ONH were affected in the eyes with NAION. Optic disc morphology differed significantly between the eyes with POAG and NAION by a higher rate of neuroretinal rim thinning and higher mean cup depth in the POAG group.

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%.

Metabolic risk factors, coping with stress, and psychological well-being in patients with age-related macular degeneration.

The aim of this study was to determine the relationship between the risk factors (age, obesity, hypertension, hyperlipidemia, smoking, consumption of alchohol and drugs, positive family history, and exposure to sunlight), coping with stress, psychological well-being and age-related macular degeneration (ARMD). Forty patients with ARMD (case group) and 63 presbyopes (control group) participated in the study. Patient data were collected through general information questionnaire including patient habits, the COPE questionnaire that showed the way the patients handling stress, and the GHQ that analyzed the psychological aspects of their quality of life. These questionnaires were administered to the patients during ophthalmologic examination. The study involved 46 (44.66%) men and 57 (55.33%) women. Statistical analysis showed that the major risks for the development of ARMD were elevated cholesterol, triglycerides and LDL cholesterol in plasma. A significantly higher number ofARMD patients had a positive family history when compared with presbyopes. This study showed presbyopes to cope with emotional problems significantly better and to have a lower level of social dysfunction when compared with ARMD patients. However, it is necessary to conduct further studies in a large number of patients to determine more accurately the pathophysiological mechanisms of metabolic factors as well as the impact of the disease on the quality of life in patients with ARMD.

Macular thickness after glaucoma filtration surgery.

The aim of present study was to analyze early postoperative changes in the macular area using optical coherence tomography (OCT) after uncomplicated glaucoma filtration surgery. This prospective study included 32 patients (34 eyes) with open-angle glaucoma, which underwent trabeculectomy with or without use of mitomycin C. Exclusion criteria were macular edema, uveitis, age-related macular degeneration, blurred optical media, secondary glaucoma and angle-closure glaucoma. All standard clinical examinations were made before surgery, at the 2nd day, 1 week and 1 month after surgery. Tomography of the macula was performed during every examination using Cirrus HD OCT for the analysis of central subfield thickness. Results show that thickening of the macula was slightly higher 1 week and 1 month after operation in comparison with baseline end 2nd day postoperativelly. There was no significant difference in the change of macular thickness in patients who have used topical prostaglandins compared with those who have used other topical medications. Also, there was no difference in macular changes between patients treated with or without mitomycin C. In conclusion, we found a slight subclinical increase in macular thickness after uncomplicated trabeculectomy, for which we considered that was the result in reduction of intraocular pressure after glaucoma surgery. Macular thickening after glaucoma filtering surgery could be a physiological reaction to the stress of the retina caused by a sudden reduction of intraocular pressure and it is the consequence of altered relationship between capillary pressure and interstitial fluid pressure.

Child- and family-centered care in the treatment of children - knowledge, attitudes, practice.

Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child's well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children's institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine.

Trauma symptoms in pupils involved in school bullying--a cross sectional study conducted in Mostar, Bosnia and Herzegovina.

To determine the association between involvement in school bullying and trauma symptoms and to find whether children with presence of trauma symptoms participate in school bullying more as victims, as bullies or as bully/victims. The study included 1055, 6th to 8th grade (12-14 years of age) elementary school pupils from the western part of Mostar, The pupils were self-interviewed using a Questionnaire on School Violence developed in 2003 and validated in Croatia, and Trauma Symptoms Check List for Children (TSCC). The pupils involved in the school violence, either as victims, bullies, bully/victims had significantly more trauma symptoms than the not involved. Involvement in school bullying as a bully/ victim was a strong indicator of trauma symptoms, particularly anxiety, anger, posttraumatic stress, dissociation, obvious dissociation, and dissociation fantasy symptoms, while the victims of school violence had the highest odds ratio for the development of depressive symptoms. There is strong association between bullying and trauma symptoms in young adolescents. From our results, emphasis should be placed at the regularly screening on bullying in praxis of family physicians and regularly conduction of preventive measures and early intervention in every primary school.

Cataract surgery and intraocular lens implantation in children with juvenile rheumatoid arthritis associated uveitis.

Clinical records of 6 children (7 eyes) with juvenile rheumatoid arthritis (JRA) who underwent cataract surgery with IOL implantation between January 1998 and December 2002 were reviewed. The median age at the time of cataract surgery was 8 years (range 5-14 years). The median follow up was 48 months (range 26 to 60 months). Five of six children (6 eyes) were on systemic immunosuppressive or anti-inflammatory therapy. Glaucoma was present in three eyes before surgery, and all three eyes underwent combined cataract surgery and trabeculectomy with mitomycin C. A final best corrected visual acuity of 0.5 or better was achieved in all eyes Postoperative complications included posterior capsule opacification (n = 5), glaucoma (n = 1), and cystoid macular edema (n = 1). Intraocular lens implantation in children with control of preoperative and postoperative ocular inflammation could lead to favorable visual results.