The Influence of Tear Film Quality on Visual Function.

BACKGROUND: The prevalence of dry eye disease (DED) is increasing globally, resulting in a variety of eye symptoms characterized by discomfort and visual disturbances. The accurate diagnosis of the disease is often challenging and complex, requiring specialized diagnostic tools. This study aimed to investigate the impact of tear film instability on visual function and to evaluate the value of post-blink blur time (PBBT) as an alternative method for assessing tear film stability. METHODS: The study included 62 subjects: 31 with subjective symptoms of DED (Group A) and a control group consisting of 31 healthy participants (Group B). Symptoms were assessed using the standard Schein questionnaire, supplemented with additional questions. PBBT was measured using standard Snellen charts to investigate a potential association between PBBT and tear film dysfunction. Additional clinical assessments included tear film break-up time (TBUT). RESULTS: Statistically significant differences were observed in the average values of PBBT and TBUT between the examined groups. The average PBBT was 8.95 ± 5.38 s in the group with DED and 14.66 ± 10.50 s in the control group, p < 0.001. Group A exhibited an average TBUT of 4.77 ± 2.37 s, while Group B had a TBUT of 7.63 ± 3.25 s, p < 0.001. Additionally, a strong positive correlation was identified between PBBT and TBUT values (r = 0.455; p < 0.001). CONCLUSIONS: The research confirms that tear film stability has an important role in the refraction of light and the maintenance of optical quality of vision. PBBT could potentially function as an objective and clinically significant screening test for DED.

Intravitreal bevacizumab for the management of age-related macular degeneration.

The aim of this study is to report short-term effect of the treatment of "wet" ARMD (age-related macular degeneration) with intravitreal bevacizumab (Avastin). Prospective study included 36 patients (36 eyes) with "wet' form of ARMD. All patients were over 60 year old (22 female, 14 male). Changes of macula included minimally classic CNV (choroidal neovascularisation) (24), occult subfoveal CNV (10) and first stage of cicatrial CNV (2). Bevacizumab 1.25 mg was administered intravitreally through pars plana using a 27-gauge needle. Patients had no previous eye treatment. Ophthalmic exam before and after the treatment included: Snellen VA (visual acuity) and examination including measurement of IOP (intraocular pressure), FA (fluorescein angiography) and interview with patients. After 4-6 weeks 28 (78%) patients had significant improvement of VA. Median VA improved from 0.083 to 0.200 (p<0.01). Eight patients (22%) had no significant improvement in VA but three of them reported to see more light. FA showed complete resolution of macular edema in 6 patients (17%), partially resolved in 23 patients (64%) and no change in 7 patients (19%). No systemic side-effect was found. Short-term results suggest that intravitreally administered bevacizumab is well tolerated treatment for ARMD with very high number of patients showing improvement in VA.

Acanthamoeba keratitis--importance of the early diagnosis.

This is a case report of Acanthamoeba as a causative agent of keratitis at the Department of Ophthalmology, University Hospital Rijeka. Delay in treatment led to an advanced stage of the disease with multiple complications. Initially, presented symptoms were similar to those of herpetic keratitis. In the mean time progression of the disease led to a cloudy cornea with a stromal ring infiltrate, poor vision, elevated intraocular pressure, a mature cataract and finally corneal melt. Corneal scrapings were obtained from a 28 years old female patient, wearing soft contact lenses and with poor lens hygiene. Acanthamoeba cysts were identified by the cytological examination. Culture of the corneal scraping had confirmed Acanthamoeba as the etiological agent. Making the diagnosis of Acanthamoeba is difficult. We presented this case of delayed diagnosis and unfavorable outcome as a reminder that clinical suspicion remains the most important diagnostic tool. Contact lens wears with a new diagnosis of herpes simplex keratitis are in high risk group, especially those with significant pain or poor response to conventional therapy. We also wanted to point out the possibility of an early, prompt and inexpensive diagnosis with the cytological examination.

Appearance of age related maculopathy after cataract surgery.

The pathogenesis of age-related maculopathy (ARM), the most common cause of visual loss after the age of 60 years, involves a variety of hereditary and environmental factors. When the cataractous lens is removed and replaced by clear intraocular lens, a significant increase in ocular transmittance of optical radiation occurs. The aim of this study was to assess whether cataract surgery in older persons may increase the risk for development of ARM. This is a retrospective study. Medical records of 307 patients, aged 43 to 96 years, (163 male and 144 female) were randomly evaluated. They had undergone cataract extraction (phacoemulsification or extracapsular lens extraction) with clear intraocular lens implantation from January 2001 to December 2005 at the Department of Ophthalmology, University Hospital Rijeka. Patients were examined two weeks after surgery and followed up for at least two years. Based on the exclusion criteria, only patients without any sign of AMD at the first postoperative check up were included. A total of 80 patients (26%) showed development of ARM at the last check up, which was at least 2 years after surgery. Our results indicate that pseudophakia is a risk factor for development of ARM.

Expression of vascular endothelial growth factor in proliferative diabetic retinopathy.

The study included 20 patients with diabetes mellitus type I (DM I) and 16 with type II (DM II) suffering from prolipherative diabetic retinopathy (PDR) for which they underwent vitrectomy. The quantity of VEGF and its receptors in the vitreous of investigated patients were measured by immunoassay and results compared between patients with DM I and II. The mean levels in the vitreous were significantly higher in diabetics with PDR and diabetes mellitus I (432.2 pg/mL, 1460.4 pg/mL and 1054.6 pg/mL) than in diabetics with PDR and diabetes mellitus II (147.5 pg/mL, 641.4 pg/mL and 448.5 pg/mL) and in control group (63.26 pg/mL). Considering that VEGF VEGFR1 and VEGFR2 levels were significantly higher in diabetics with PDR than in controls and that the patients with DM I had higher levels than with DM II, anti-VEGF therapy might be beneficial for diabetics with PDR, especially those with DM I.

Incidence of age related macular degeneration in correlation with age, sex and occupation.

This study assesses the relation between age related macular degeneration (ARMD) and age, sex and occupation. It is designed as a retrospective study conducted on patients presenting to the Eye Polyclinic "Dr. L. Pavicevic", Rijeka, Croatia, during the years 1995, 2000 and 2005, and included total of 6617 patients. The number of patients diagnosed with ARMD, their age and sex distribution, as well as the correlation between occupation type (indoor/outdoor) and the incidence of ARMD were analyzed. The results of our study show that the incidence of ARMD is slightly increased in female vs. male, strongly age related, as expected, and significantly increased in patients with outdoor type of occupation. Besides, an increasing trend of incidence is noted.