Vitreous hyper-reflective dots and the macular thickness after cataract surgery.

PURPOSE: To assess the association between vitreous hyper-reflective dots (VHD) and the macular thickness changes following uneventful phacoemulsification. METHODS: In this prospective cohort study optical coherence tomography (OCT) examinations were performed preoperatively and 1 week, 1 month and 3 months postoperatively in patients undergoing cataract surgery. OCT images were analyzed for retinal central subfield thickness (CST) and preretinal VHDs. Surgeries were recorded for the assessment of lens fragments in the space of Berger. RESULTS: 111 eyes of 97 patient were enrolled of whom 69 (62.2%) were female. VHDs were seen in 25 eyes (22.5%) at week 1; in 21 eyes (18.9%) at month 1 and in 3 eyes (2.7%) at month 3. In all eyes with VHDs retro-capsular lens fragments were visible immediately after phacoemulsification. The number of VHDs significantly decreased over the postoperative period. There was a moderate correlation between the number of VHDs and CST at 1 month (r = 0.426, p<0.001). In eyes with VHD the CST averaged 238.8±17.6 µm (214-266) at 1 week; 276.1±63.5 µm (231-481) at 1 month and 285.1±122.3 µm (227-785) at 3 months. In eyes with no detectable VHDs CST averaged 235.9±23.3 µm (192-311) at 1 week; 240.1±21.6 µm (200-288) at 1 month and 242.2±21.3 µm (205-289) at 3 months. Although the differences among the assessment points were relatively low, there was a significant difference in general (p<0.001, Friedman test). CONCLUSION: In conclusion, VHDs seem to cause macular thickening throughout the postoperative course. The origin of VHDs is still unknown; however, they presumably represent lens fragments that provoke subclinical inflammation.

Modification of the Suprachoroidal Buckling Technique for the Treatment of Rhegmatogenous Retinal Detachment.

PURPOSE: To describe modification of the suprachoroidal buckling technique for the treatment of rhegmatogenous retinal detachment (RRD), which may improve the safety profile. METHODS: A single-surgeon foot-pedal-controlled automated suprachoroidal injection (SCI) of sodium hyaluronate 1%, namely ProVisc (Alcon Laboratories, Fort Worth, TX) was used for the treatment of RRD. MicroDose Injection Kit (MedOne Surgical, Sarasota, FL) including a connector and a 1-mL syringe, designed for subretinal injection, was used to adapt Constellation Vision System (Alcon Laboratories) console for SCI of ProVisc from the 1-mL syringe. RESULTS: This approach enables better surgeon control during SCI. Three highly myopic eyes of three patients with primary macula-on RRD and single superior peripheral retinal break were treated. Complete retinal reattachment was achieved in all eyes without complications. CONCLUSION: Injecting ProVisc under foot-pedal control provides a more precise and potentially safer suprachoroidal buckling technique compared with the manual technique with more variable injection speed and pressure.

Life Quality in Patients with Impaired Visual Acuity Undergoing Intravitreal Medication Applications.

This cross-sectional study aims to examine the quality of life and difficulties in the daily functioning of patients with impaired visual acuity treated with intravitreal drugs. The survey included 180 adult respondents (78 male and 102 female). The standardized, validated questionnaire VFQ 25 version 2000 was used to measure the quality of life. Results show that, in general, regarding visual functioning, men are significantly more satisfied than women, they rate less intensity of pain, and their distance vision is better. Men report fewer restrictions than women, better color, peripheral vision, and overall visual functioning. The best vision results are in individuals under the age of 60 who also report significantly better social functioning, mental health, fewer restrictions, and less dependence on others. The only significant association between the number of drug applications and the scale of visual functioning is driving motor vehicles-the more applications of the drug they received, the less likely they are to drive a car. The quality of life in patients with chronic ophthalmic diseases treated with intravitreal drugs is reduced, particularly in elderly and female patients who have poorer visual acuity, poorer health in general, and limited social roles.

Do Gender, Age, Body Mass and Height Influence Eye Biometrical Properties in Young Adults? A Pilot Study.

BACKGROUND: Do gender, age, body mass and height influence eye biometrical properties in young adults? METHODS: A total of 155 eyes (92 female, 63 male) of healthy subjects between the ages of 18 and 39 years were included in the study. The subjects' gender and age were recorded, and their body mass, height and biometrical properties of the eyes were measured. RESULTS: The male subjects had significantly thicker and flatter corneas and lower minimal rim-to-disk ratios than the female subjects did. In both genders, age showed strong, negative correlations with anterior chamber depth and pupil diameter and a positive correlation with lens thickness. We also found significant, negative correlations between body height and mass with keratometry measurements, negative correlations between body height and optic disk rim area and rim volume, and positive correlations between body mass and axial length in both genders. CONCLUSIONS: Biometric eye parameters differ among people. In addition to age and gender, which are usually taken into consideration when interpreting ocular biometry findings, we strongly suggest that body height and mass should be also routinely considered when interpreting eye biometry data, as these factors have an impact on ocular biometry.

Pentadecapeptide BPC 157 shortens duration of tetracaine- and oxybuprocaine-induced corneal anesthesia in rats.

We focused on the relationship of 0.5% tetracaine- and 0.4% oxybuprocaine-induced corneal anesthesia in rats, and pentadecapeptide BPC 157 (0.4 µg/eye), along with nitric oxide synthase (NOS) inhibitor N(gamma)-nitro-L-arginine methyl ester (L-NAME) (0.1 mg/eye) and/or NOS substrate L-arginine (2 mg/eye), applied in the form of eye drops. We assessed corneal sensitivity recovery (Cochet-Bonnet esthesiometer), corneal lesion elimination (staining with 10% fluorescein) and decrease in tear volume (Schirmer test). BPC 157 administration had a full counteracting effect. Recovery also occurred in the presence of NOS blockade and NOS substrate application. L-arginine eventually shortened duration of corneal insensitivity and exerted corneal lesion counteraction (and counteraction of tetracaine-induced decrease of tear volume) only in earlier but not in later period. L-NAME application led to longer duration of corneal insensitivity, increase in corneal lesions and decrease in tear volume. When L-NAME and L-arginine were applied together, they antagonized each other's effect. These distinctions may indicate particular NOS involvement (corneal insensitivity vs. corneal lesion along with tear production), distinctively affected by the administration of NO agents. However, additional BPC 157 co-administration would re-establish counteraction over topical ophthalmic anesthetic-induced effect, be it in its early or late course. We suggest BPC 157 as an antidote to topical ophthalmic anesthetics.

Zagreb Amblyopia Preschool Screening Study: near and distance visual acuity testing increase the diagnostic accuracy of screening for amblyopia.

AIM: To present and evaluate a new screening protocol for amblyopia in preschool children. METHODS: Zagreb Amblyopia Preschool Screening (ZAPS) study protocol performed screening for amblyopia by near and distance visual acuity (VA) testing of 15 648 children aged 48-54 months attending kindergartens in the City of Zagreb County between September 2011 and June 2014 using Lea Symbols in lines test. If VA in either eye was >0.1 logMAR, the child was re-tested, if failed at re-test, the child was referred to comprehensive eye examination at the Eye Clinic. RESULTS: 78.04% of children passed the screening test. Estimated prevalence of amblyopia was 8.08%. Testability, sensitivity, and specificity of the ZAPS study protocol were 99.19%, 100.00%, and 96.68% respectively. CONCLUSION: The ZAPS study used the most discriminative VA test with optotypes in line as they do not underestimate amblyopia. The estimated prevalence of amblyopia was considerably higher than reported elsewhere. To the best of our knowledge, the ZAPS study protocol reached the highest sensitivity and specificity when evaluating diagnostic accuracy of VA tests for screening. The pass level defined at ≤0.1 logMAR for 4-year-old children, using Lea Symbols in lines missed no amblyopia cases, advocating that both near and distance VA testing should be performed when screening for amblyopia.

Oxidative stress impact on growth hormone secretion in the eye.

AIM: To evaluate the influence of oxidative stress on extrapituitary growth hormone (GH) secretion in the eye and to analyze the interdependence between eye and serum GH levels under normal and hypoxic conditions. METHODS: Pars plana vitrectomy (PPV) was performed in 32 patients with developed proliferative diabetic retinopathy (PDR) and 49 non-diabetic controls, both of whom required this procedure as part of their regular treatment in the period from April 2013 to December 2014. During PPV, vitreous samples were taken and blood was simultaneously collected from the cubital vein. GH levels in serum and vitreous samples were measured by electrochemical luminescence assay. Oxidative stress was measured by enzyme-linked immunosorbent assay of advanced oxidation protein products (AOPP) and lipid hydroperoxide (LPO) in serum and vitreous. RESULTS: Serum AOPP levels were significantly higher than vitreous levels in both groups (P<0.001 for each group) and LPO levels were significantly higher only in PDR group (P<0.001). There was a significant positive correlation between serum and vitreous LPO levels in PDR group (r=0.909; P<0.001). Serum GH levels were significantly higher than vitreous levels in both groups (P<0.001 for each group). Serum GH levels were significantly higher in PDR group than in controls (P=0.012). Vitreous GH values were slightly higher in PDR group, but the difference was not significant. CONCLUSION: Our study confirms that GH production in the eye is autonomous and independent of oxidative stress or pituitary GH influence.

Is the effect of intravitreal triamcinolone acetonide on diabetic macular edema dose-dependent?

PURPOSE: To determine whether the effect of intravitreal triamcinolone acetonide in diffuse diabetic macular edema is dose-dependent regarding the velocity and duration of macular edema reduction, visual acuity improvement, and induction of predictable complications. METHODS: This clinical prospective study included 32 consecutive patients (32 eyes) with diffuse diabetic macular edema. All patients had visual acuity, fluorescein angiogram, and optical coherence tomography performed at the initial visit (baseline). Single triamcinolone acetonide injection was applied intravitreally in different high doses using sterile technique followed by timolol-maleate 0.5%/acetazolamide fixed combination eyedrops twice a day for 6 consecutive months. Macular edema, intraocular pressure, and best-corrected distance visual acuity were reviewed after 5 days and 1, 3, and 6 months. RESULTS: Intraocular pressure did not change significantly during 6 months and was maintained within normal levels in all patients using prescribed antiglaucoma therapy. Best-corrected distance visual acuity and macular edema were better than preoperatively even 6 months after treatment while the highest improvement was recorded 1 month after treatment. There was a slight correlation of macular edema reduction and triamcinolone dose, especially in central 1-mm diameter zone 6 months post triamcinolone acetonide intravitreal injection, but it was not statistically significant. CONCLUSIONS: Triamcinolone intravitreal injection is a relatively safe, inexpensive, and effective method used for diabetic macular edema reduction but its effect is not proven to be dose-dependent, at least in 10-32 mg dose range. Macular edema reduction rate correlated significantly with preoperative edema.

Painless Acanthamoeba keratitis in a soft contact lens wearer--case report.

Aim of our paper is to present a case of painless Acanthamoeba keratitis in a soft contact lens wearer. A 17-year-old male, highly myopic, prolonged soft contact lens wearer, presented to us with painless red watery right eye having remarkably diminished vision. Last six weeks he was treated elsewhere for the microbial keratitis with no improvement. No pain was reported and on the direct questionnaire about it he denied it. There was marked mixed conjunctival and ciliary injection. A central stromal opacity with a pronounced surrounding corneal ring of inflammatory infiltration and epithelial defect was seen on biomicroscopy of the right eye. Circular pannus was already formed reaching epithelial defect overlying corneal ring infiltrate. Acanthamoeba spp in the corneal sample was confirmed. Prolonged therapy with 0.02% chlorhexidine digluconate solution combined with 0.1% hexamidine solution resulted in corneal healing left with a large central dense stromal opacity with circular pannus reaching peripheral third of the cornea but with very thin blood vessels and the best corrected visual acuity of 0.1 tested on Snellen chart. In conclusion, even in a lack of typical symptom for Acanthamoeba keratitis such as pain, this amoeba should be ruled out especially in a soft contact lens wearer.

The expression of human corneal MMP-2, MMP-9, proMMP-13 and TIMP-1 in bullous keratopathy and keratoconus.

We aim to find a link between keratokonus (KC) and bullous keratopathy (BK), and extra cellular matrix re-modellation molecules. The activities of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), pro-matrix metalloproteinase-13 (proMMP-13) and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) were measured using immunoassay in three human corneal tissue layers (epithelium, stroma and endothelium) supernatants of the patients with KC and BK which underwent the perforative keratoplasty. MPP-2, MMP-9, proMMP-13 and TIMP-1 activity was detected in all samples. The epithelial layer showed significantly higher levels of MMP-9 and proMMP-13 in BK than in KC. Increased levels of MMP-2 (p=0.07) levels were found in bullous keratopathy compared to keratoconus patients. Epithelial TIMP-1 showed no significant difference in activity between KC and BK. All these findings suggest an active degradation of the extra-cellular matrix in epithelial corneal layer in Bullous Keratopathy. No difference in the concentration of MMP-2, MMP-9, proMMP-13 and TIMP-1 between KC and BK in corneal stroma and endothelium suggest that neither of these molecules play important role in KC or BK pathogenesis, at least not in stroma and endothelium.

Ultraviolet light and pterygium.

The purpose of this study was to evaluate the contribution of ultraviolet light (UV) as a causal factor of primary and pterygium recurrence. A conjuctival autograft transplantation was a surgical method of pterygium treatment. In the first group (38 eyes) were patients with primary and recurrent pterygium exposed to sun (worked outdoors), evaluating geodemographic status, and in the second group (20 eyes) were patients who were not. During 6-12 months of follow up recurrence rate after surgical removal was 27% in the first group and 10% in the second one. UV light seems to have an important role in cause of primary and recurrent pterygium.

Sunshine on holidays--eye risks.

Ultraviolet (UV) light is the most common cause of radiation injury to the eye which in acute exposure causes photokeratitis and photoconjunctivitis. After a whole day exposure to the sun on the Mediteranian coast patient presented with mixed conjunctival injection, chemosis, edematous corneal epithelium with superficially present fluoresceine positive small pinpoint defects. Epithelial bullous changes, circular stromal infiltration in the middle stromal perifery and reduction of corneal transparency were more pronounced on the left eye. After treatment moderate conjunctival injection remained together with circular stromal infiltration in the middle perifery, corneas were transparent, epithelialised and fluorescein negative. Anterior chambers and lenses were clear. One month after patient regained bilateral visual acuity of 1.0. To our kownledge, this case shows for the first time connection between acute ultraviolet radiation exposure and persistent circular stromal infiltration in the middle corneal perifery in humans.

[Ten years of work of Lions Croatian Eye Bank]. / Deset godina rada Lions Hrvatske ocne banke.

Lions Croatian Eye Bank (LCEB) was founded in December 1995 under the leadership of Professor Nikica Gabric, to grow into the Reference Center for Corneal Transplantation of the Ministry of Health and Social Welfare of Republic of Croatia in 2001. The work of LCEB is coordinated according to the European and International Tissue Bank Association directives and laws (TBI). All donor tissues to be tested in the eye bank to ensure safe clinical usage. During the 1996-2006 period, 796 co have rneas were collected and 592 natio(74.37%) transplanted. Among patients that underwent corneal transplantation, only 26% were from local district, which reflects thenal character of LCEB. Currently there are 235 ients on the waiting list for corneal transplantation, 56 (23.8%) of them from Zagreb County and 179 (76.2%) from other parts of Croatia.

Allergic diseases in relationship with environmental factors in a population of school children in Zagreb, Croatia.

Most scientists believe that increasing number of people with allergic diseases may be connected with some aspects of the "Western lifestyle". This paper discusses data obtained from questionnaires originally designed by the International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee concerning exposure to different environmental factors. The study included 1047 children. Allergic and non-allergic groups showed statistically significant differences in the attendance of kindergarten, vaccination against pertussis, pertussis infection, and parasite infestation. Exposure to tobacco smoke during pregnancy and exposure to dampness and moulds also entailed a risk for allergy. We speculate that changing some conditions, such as use of carpets and use of feather pillows, were connected with the expression of allergic diseases. Some correlations were consistent with earlier observations of other authors, while others differed and need further confirmation on a larger sample.