A unique case of a recurrent extraosseous ossifying fibroma of the orbit: A diagnostic dilemma.

The aim is to present a unique clinical case of a 62-year-old male with an ossifying fibroma (OF) in the left orbit. He presented with a slow-growing mass with bone consistency which easily shifted with palpation. After removal, it was given the histopathological diagnosis of osteoma. However, the lesion grew back rapidly and it became even larger 4 months later. After a computed tomography scan with a contrast medium, another surgery was performed. The histopathological diagnosis of the recurrent lesion was an epidermal cyst with secondary degenerative changes. As both diagnoses did not fit the clinical picture, we sent the material from both surgeries for a secondary assessment. The final histopathological diagnosis was OF. OF should be included in the differential diagnosis of benign lesions in the orbit with aggressive behavior.

Professional Stress and Burnout Syndrome During the Covid Pandemic in the Medical Field.

Context: The contemporary workplace creates a challenge toward physicians and their teams. They are forced into a situation, in which to be competitive they must have skills outside of their medical specialty, such as health management, pedagogy, and information and communication technologies. Aim: To analyze the level of stress and burnout among the medical employees in the hospital care. Settings and Design: Healthcare professionals from three private, municipal, and regional hospitals filled a questionnaire in the time period January-March 2021. Methods and Material: An adapted Maslach Burnout Inventory 55 question questionnaire was used and analyzed. Statistical Analysis Used: One-way ANOVA, correlation, and multiple regression analysis in SPSS. Results: We identified high levels of emotional exhaustion (>62% report high signs or above), high levels of depersonalization (>70% report signs of depersonalization), and low levels of personal accomplishment (<39% have below average sense of achievements). Conclusions: Despite the physicians and their teams reporting high levels of workload and stress, the satisfaction from work has not diminished and the evaluation for the quality of provided work is still high. Additional research into the topic is required with focus on comparison between hospital physicians and primary care physicians.

Morning Glory Disc Anomaly with Contractile Peripapillary Staphyloma in an 18-Month-Old Girl.

We present an 18-month-old girl with strabismus and a variable esotropia of the left eye. Fixation of the affected eye was intermittent with a relative afferent pupillary defect. A fundus photography of the left eye displayed a combination of features of both morning glory disc anomaly and peripapillary staphyloma. A B-scan ultrasonography examination of the left eye showed a conical excavation of the posterior pole. Cycloplegic refraction measurements showed a large amount of anisometropia. Correction with glasses and part-time occlusion was prescribed and a strict follow-up routine was advised. No other systemic associations with the disease have been discovered so far in our patient. We support the theory that morning glory disc anomaly and peripapillary staphyloma may represent two different morphologies in the spectrum of the same disease.

Refraction in Preschool Children in Kazanlak, Bulgaria.

INTRODUCTION: The refractive state of the eye changes as the eye's axial length increases and the cornea and lens flatten. In general, eyes are hyperopic at birth, become slightly more hyperopic until the age of 7, which at this point we see a myopic shift toward plano until the eyes reach their adult dimensions, usually by about the age 16. AIM: To determine the prevalence of refractive error in preschool children aged 3 - 6 in the city of Kazanlak, Bulgaria. MATERIALS AND METHODS: A cross-sectional study was conducted in a kindergarten based school within the city of Kazanlak, Bul-garia. Out of 15 kindergarten schools, 10 chose to participate in the study. The children underwent non-mydriatic refraction screening using a Plus-Optix S12с mobile camera. Myopia, hyperopia and astigmatism were defined as being a spherical equivalent (SE) ≤ -0.50 D, SE ≥ +2.00 D and cylindrical diopters ≤ -1.00 D. RESULTS: A total of 596 children were screened. Out of these 596 children; 526 were with ametropia (470 hypermetropia, 46 myopia) and 50 had astigmatism. Strabismus was found in 12 children, with a further 8 children suffering from amblyopia and finally 8 children were also found to be diagnosed with anisometropia. In 8 cases there were no results due to opacities or due to the small size of the pupil. CONCLUSION: The prevalence of refractive error in preschool children is similar to that found in other research in the field. While most cases fall into the category of emmetropia or mild hypermetropia, most of the children had never been to an ophthalmologist. A manda-tory checkup should be issued for all children below the age of seven.

Artificial Reproductive Technology - A Risk Factor for Retinopathy of Prematurity.

BACKGROUND: Retinopathy of Prematurity (ROP) is a potentially blinding vasoproliferative disease in premature babies. The presentation and course of ROP are determined by a complex interaction of a series of risk factors, including artificial reproductive technology (ART). AIM: To analyse and combine the information relating ART as an independent risk factor for retinopathy of prematurity. METHODS AND MATERIAL: The article is systematic review and meta-analysis using RevMan 5. Pubmed, Scopus and Medline were searched for articles from 1990 to 2018. RESULTS: Studies suggest that ROP is observed more frequently in ART children. They are more likely to be premature and of low birth weight than those conceived naturally. Results vary from just a tendency to a five-fold increase in risk to develop ROP in ART babies. At the same time, they might develop ROP later, and more mature newborns might be affected. CONCLUSION: The data relating ART as a risk factor for ROP is inconclusive, but most studies show at least a tendency. The ART newborns need to be considered as a risk group for ROP and observed with greater suspicion. Even more mature ART newborns might need to be screened in order not to miss any significant pathology.

Spontaneous Anterior Lens Capsule Rupture Of a Patient with Alport Syndrome - A Case Report.

BACKGROUND: Alport syndrome is a progressive genetic disease which is characterised by glomerulonephritis, sensorineural deafness and ocular abnormalities. We aimed to present a clinical case of a patient with Alport syndrome with spontaneous anterior lens capsule rupture. CASE REPORT: A 16-year-old male with histologically proven Alport syndrome was hospitalised in the Department of Ophthalmology, University Hospital "Prof. Stoyan Kirkovich", Stara Zagora with low vision, pain, redness, high IOP and rupture of the anterior lenticular capsule of the right eye. Phacoaspiration was successfully performed (Millenium, Bausch& Lomb, Rochester, New York, USA) with the bimanual irrigation-aspiration system (Geuder AG, Heidelberg, Germany) with excellent visual results. CONCLUSION: As the syndrome is quite rare and can lead to diagnostic difficulties for the ophthalmologist complications such as spontaneous or traumatic rupture of the capsule are not uncommon. In such cases, phacoaspiration is an efficient method for clear lens extraction after ruptures of the anterior lenticular capsule of young patients with Alport syndrome.