Background and Objectives: Early diagnosis of the exudative form of age-related macular degeneration (AMD) is very important for a timely first treatment, which is directly related to the ...preservation of functional visual acuity over a long period. The goal of this paper was to examine the correlation between the double-layer sign (DLS) and the presence of non-exudative macular neovascularization (MNV). Materials and Methods: Our research included 60 patients with AMD, exudative in one eye and non-exudative in the other eye. We analyzed only the non-exudative form using optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). The patients were classified into three groups, depending on the duration of the disease (<2 years, 2 to 5 years, >5 years). The onset of the disease was deemed the moment of establishing a diagnosis of exudative AMD in one eye. We defined the presence or absence of a DLS using OCT and the presence of non-exudative MNV using OCT-A, both on 3 × 3 mm and 6 × 6 mm sections. DLS was used as a projection biomarker for non-exudative MNV, with the aim of establishing a rapid diagnosis and achieving early treatment of the disease. Results: We found that there was a statistically significant correlation between the DLS diagnosed using OCT and non-exudative MNV diagnosed by OCT-A for both 3 × 3 mm (p < 0.001) and 6 × 6 mm (p < 0.001) imaging. There was a statistically significant difference between the frequencies of both DLS and MNV in Groups I and III on both 3 × 3 and 6 × 6 mm imaging. A statistically significant difference was also noted in the frequencies of DLS and MNV on 6 × 6 mm imaging, but not on 3 × 3 mm imaging, between Groups I and II. No differences were found between the frequencies of DLS and MNV between Groups II and III. Conclusions: The DLS on OCT can be used as a projection biomarker to assess the presence of a non-exudative MNV.
To test the validity and reliability of the Serbian version of the interviewer-administered format of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25).
The Serbian version of ...NEI VFQ-25 was translated in accordance with standard methods that have been adopted internationally. In order to assess the reliability and validity of the translated NEI VFQ-25, we used a sample of 105 patients with four different chronic ocular diseases. Cronbach's alpha coefficient was used to assess internal consistency for each subscale. To assess test-retest reliability, intraclass correlation coefficients were used. The test-retest data were obtained from clinically stable patients with age-related cataracts, in surveys performed 2 weeks apart. Rasch analysis was also applied as a modern methods of psychometric assessment of the questionnaire.
Four groups of patients were studied and the most prevalent were patients with cataract 40 (38.1%), followed by diabetic retinopathy 31 (29.5%), age related macular degeneration 22 (21.0%) and glaucoma 12 (11.4%). The overall index score on the NEI VFQ-25 ranged from 65.3 to 67.8 with a mean of 67.4 ± 15.0. Cronbach's alpha coefficient (index of internal consistency reliability) ranged from 0.643 to 0.889 for the subscales. Evaluation of the validity of the Serbian version of NEI VFQ-25 is presented in the multi-trait-multi-method matrix and all items passed the convergent and discriminant validity tests. Rasch analysis showed a good measurement precision, but also demonstrated misfitting items and multidimensionality of the questionnaire.
Although traditional validation method indicates that the Serbian version of NEI VFQ-25 is a valid and reliable instrument for the assessment of vision specific QoL in Serbian populations aged 40 years or older, Rasch analysis revealed a substantial weakness of the questionnaire that should be taken into consideration when interpreting the results.
The power density of femtosecond lasers and exposure time to the tissue are crucial for a successful procedure in terms of safety and precision. The reduction of the pulse duration allows reducing ...the quantity of the energy to be delivered to the tissue for disruption with strongly diminished mechanical and thermal collateral damage. The cutting effect of ultra-short pulses is very precise, minimally traumatic, safe, and predictable. Future developments will lead to further energy reductions to achieve optical breakdowns. However, the pulse length cannot be shortened arbitrarily because below 100 fs nonlinear effects can change the process in an unfavorable way. Compared to manual-conventional cataract surgery, femtosecond laser-assisted cataract surgery (FLACS) shows many advantages in clinical application, especially with regard to precision and tissue protection. The femtosecond laser has become particularly important and has made the overall procedure safer when we deal with complex cataract cases such as subluxated lenses. We provide an overview of the evolution of femtosecond laser technology for use in refractive and cataract surgeries. This article describes the advantages of available laser platforms with ultrashort pulses and mainly focuses on the technical and physical backgrounds of ophthalmic surgery technologies.
Background/Aim. Unilateral optic neuritis (ON), and its pathological substrate, retrobulbar neuritis (RBN), is a common presentation of multiple sclerosis (MS). The aim of the study was to determine ...the diagnostic and prognostic value of structural and functional examination using novel ?swept-source? optical coherence tomography (SS-OCT) and OCT angiography (OCTA) techniques in patients with MS who experienced RBN. Methods. For examining retinal structural and functional changes in both the affected and nonaffected eye of patients with MS, novel techniques, OCT and O CTA, w ere u sed. The obtained results w ere compared with the results of the same examination on the left and right eye of the healthy controls. Results. Using OCT, significant differences in the structural integrity and thickness of retinal layers between the eye in which RBN had been detected and the contralateral, nonaffected eye were found (83.73 ? 18.36 vs. 98.67 ? 11.84; p = 0.013). On the other hand, the functional examination of the macular vascular plexus did not show significant differences between the affected and the nonaffected eye in these patients (41.86 ? 1.52 vs. 42.52 ? 1.40; p = 0.228). Interestingly, comparing the nonaffected eye of patients with RBN and healthy controls, a significant difference in the thickness of the retinal layers between the contralateral eye of the patient and both healthy eyes of healthy subjects was found. OCT examination showed particularly significant thinning of the macular ganglion cell-inner plexiform layer (mGCIPL) (61.07 ? 5.04 vs. 67.53 ? 4.57; p < 0.001). Conclusion. Overall, our research showed that OCT and OCTA offer an unprecedented opportunity for a safe, reliable, and repetitive assessment of structural and functional retinal changes as invaluable diagnostic and prognostic tools, paving the way for a better understanding of pathogenic mechanisms underlying inflammatory demyelinating and neurodegenerative diseases. In addition, mGCIPL may be a particularly sensitive and reliable biomarker of pathological changes in MS and perhaps in other neurodegenerative diseases.
The aim of the research was to investigate the differences in the concentrations of IL-12, IL-4, IL-10, and IFN-γ in tears after LASIK and PRK procedures.
The study included 68 myopic eyes up to -3.0 ...D refractive spherical equivalent, divided into two groups: Group 1 LASIK (
= 31) and Group 2 PRK (
= 37). Three tear samples were taken from each eye: immediately before the procedure (t
), 1 h after the procedure (t
), and 24 h after the procedure (t
). The concentrations of IL-12p70, IL-4, IL-10, and IFN-γ in the tear samples were determined by flow cytometry. Participants were not taking anti-inflammatory therapy 24 h after the procedure.
IL-4 levels 1 h after treatment did not differ between LASIK and PRK (
= 0.990), while 24 h after PRK there was a significant decrease in IL-4 levels (
< 0.05), but not after LASIK (
= 0.476). In both the LASIK (
< 0.05) and PRK (
< 0.05) groups, there is an increase in IL-10 concentrations 1 h after treatment, which persists 24 h after LASIK (
< 0.05) but not after PRK (
= 0.081). There is an increase in IL-12p70 concentration 1 h after treatment in both the LASIK (
< 0.001) and PRK groups (
< 0.001). There is also an increase in IL-12p70 concentration 24 h after PRK (
< 0.005), but not after LASIK (
= 0.775).
IL-4 concentration shows a significantly higher value in the LASIK group than in the PRK group after 24 h. IL-10 and IL-12p70 levels increase one hour after surgery in both groups. After 24 h, the IL-10 levels remain elevated in the LASIK group, and the IL-12p70 levels remain elevated in the PRK group. Thus, LASIK and PRK procedures show different inflammatory dynamics.
Background: The efficiency and safety of primary open-angle glaucoma with high-frequency deep sclerotomy (HFDS) combined with cataract surgery has to be investigated. Methods: Right after cataract ...surgery, HFDS was performed ab interno in 205 consecutive patients with open angle glaucoma. HFDS was performed with a custom-made high-frequency disSection 19 G probe (abee tip 0.3 × 1 mm, Oertli Switzerland). The bipolar current with a frequency of 500 kHz is applied. The nasal sclera was penetrated repetitively six times through the trabecular meshwork and consecutively through Schlemm’s canal. Every time, a pocket of 0.3 mm high and 0.6 mm width was created. Results: Mean preoperative intraocular pressure (IOP) was 24.5 ± 2.1 mmHg (range 21 to 48 mmHg). After 48 months, the follow up average IOP was 15.0 ± 1.7 mmHg (range 10 to 20 mmHg). Postoperative IOP has been significantly reduced compared to preoperative IOP for all studied cases (p < 0.001). After 48 months, the target IOP less than 21 mmHg reached in 84.9%. No serious complications were observed during the surgical procedure itself and in the postoperative period. Conclusions: HFDS is a minimally invasive procedure. It is a safe and efficacious surgical technique for lowering IOP combined with cataract surgery.
Background: The aim of the study is to investigate whether the circadian IOP rhythm can be influenced by combined cataract surgery with high frequency deep sclerotomy (HFDS) and whether intraocular ...pressure (IOP) can be significantly reduced by HFDS. Methods: In our study 10 patients were included, in whom 24 h IOP monitoring was installed before and after HFDS/cataract surgery using a Triggerfish. HFDS is a minimally invasive glaucoma surgery (MIGS). Results: After performed HFDS combined with cataract surgery, the IOP was reduced from 27.7 ± 2.11 mmHg to 14.4 ± 2.59 mmHg, which is highly significant (p < 0.001). The contact lens sensor (CLS) cosinor analysis pre- and postoperatively showed that the circadian rhythm is not influenced by the surgery, i.e., the circadian IOP rhythm did not show significant differences before and after surgery. Conclusions: HFDS combined with cataract surgery is a potent surgical method that can significantly reduce the IOP. However, the circadian rhythm cannot be changed by the surgery. The acrophase remained during the night in all patients.
Background/Aim. It is possible that patients with open-angle glaucoma be asymptomatic in the early stage of the disease. The aim of this study was to determine the structural and vascular changes of ...the optic disc (OD) and macula in healthy and primary open-angle glaucoma (POAG) eyes, detected by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) as well as the correlation of the OCT and OCTA measurements and their association with the presence of POAG. Methods. A total of 196 eyes were included and classified into four groups, out of them 48 were healthy eyes, 51 eyes were with mild POAG, 50 eyes with moderate POAG, and 47 eyes with advanced glaucoma. All subjects underwent standard ophthalmic examination. OCT measured the mean, superior and inferior retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (GCC). OCTA evaluated the vessel capillary density (VCD) in OD, foveal avascular zone (FAZ) and macular vessel density (VD) in the superficial (SL) and deep (DL) retinal vascular plexus. Results. Patient characteristics were similar except for decreased visual acuity, thinner corneas, higher intraocular pressure and higher cup/disc ratio in POAG patients. OCT results showed that RNFL and GCC thickness gradually de-creased according to POAG severity. Within the assessment conducted by OCTA, VCD?s value in OD also diminished with the progression of POAG, having the lowest value in patients with advanced glaucoma. The same pattern was observed in vessel density around FAZ and VD values. Comparing the structural and vascular changes, a significant positive correlation was found between RNFL thickness and VCD inside OD, and GCC and VD SL in the macular zone. Conclusion. OCT and OCTA allow of a noninvasive quantification of the structural and vascular changes in OD and the macular zone and accurately distinguish between healthy eyes and eyes with POAG, showing an association with the presence and progression of glaucoma.
Background/Aim. Corneal cross-linking (CXL) treatment shows the best results in stabilizing the cornea and stopping the progress of the ectatic process. The aim of the study was to assess the impact ...of CXL on the keratoconus regarding higher-order aberrations (HOAs) and potential improvement of visual function. Methods. In 19 patients, a standard epithelium-off CXL was performed with an energy density of three mW/cm2 for half an hour. The cornea was examined by Pentacam topography before CXL and one and six months after CXL. Best-corrected visual acuity (BCVA), topographic data, and aberrations were collected. Results. A significant reduction in vertical coma was observed from preoperative -1.03 ? 1.89 to -0.74 ? 1.73 (p = 0.004) six months after CXL, and in spherical aberration from preoperative -0.22 ? 1.05 to -0.08 ? 1.13 (p = 0.002) six months after CXL. Root mean square (RMS) HOAs six months after CXL also significantly reduced from 2.31 ? 1.82 to 2.26 ? 1.84 six months after CXL (p = 0.001). BCVA improved from preoperative 0.43 ? 0.15 to 0.71 ? 0.19 six months after surgery (p < 0.001). Conclusion. CXL is a very potent treatment method for keratoconus, which significantly reduces certain corneal wavefront aberrations, especially vertical coma, spherical aberration, and RMS, and leads to a significant improvement in visual acuity.
Background: Presbyopia treatment in pseudophakic patients with a monofocal IOL is challenging. This study investigates the refractive results of femto-PresbyLASIK and analyzes presbyopia treatment in ...pseudophakic eyes. Methods: 14 patients with 28 pseudophakic eyes were treated with femto-PresbyLASIK. The dominant eye was targeted at a distance and the non-dominant eye at −0.5 D. The presbyopic algorithm creates a steepness in the cornea center by using an excimer laser that leads to corneal multifocality. Results: 6 months after surgery a refraction of −0.11 ± 0.13 D (p = 0.001), an uncorrected distance visual acuity of 0.05 ± 1.0 logMAR (p < 0.001) and an uncorrected near visual acuity of 0.15 ± 0.89 logMAR (p = 0.001) were achieved in the dominant eye. For the non-dominant eye, the refraction was −0.28 ± 0.22 D (p = 0.002), the uncorrected distance of visual acuity was 0.1 ± 1.49 logMAR, and the uncorrected near visual acuity was 0.11 ± 0.80 logMAR (p < 0.001). Spherical aberrations (Z400) were reduced by 0.21–0.3 µm in 32% of eyes, and by 0.31–0.4 µm in 26% of eyes. Conclusion: By steepening the central cornea while maintaining spherical aberrations within acceptable limits, PresbyLASIK created a corneal multifocality that safely improved near vision in both eyes. Thus, femto-PresbyLASIK can be used to treat presbyopia in pseudophakic eyes without performing intraocular surgery.
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