Purpose
To determine the prevalence of keratoconus (KC) in relation to ethnicity in a group of people who consulted an ophthalmological care institution seeking for refractive surgery in N. ...Macedonia.
Methods
This was a cross-sectional, interventional retrospective study. Chart reviews were performed for all new patients attending between January 2016 and January 2020 at the Sistina Ophthalmology Hospital in Skopje. All patients were screened; KC diagnosis and classification were based on the corneal topography. Ethnicity and gender classifications were according to patients’ self-opinions.
Results
A total of 2812 patients charts reviewed. The mean age was 31.71 years (SD ± 9.73), and 1209 (43%) were male. A total of 2050 (72.9%) declared themselves as Macedonians, 649 (23.1%) Albanians, 76 (2.7%) Turks and 37 (1.3%) in other ethnicities. Differences in age between the ethnic groups were statistically significant (
x
2
= 90.225,
p
< 0.001). KC was diagnosed in 343 patients (12.2%), while 9 (0.7%) were KC suspects and 6(0.21%) presented pellucid marginal degeneration. KC was more frequent in males (
n
= 246, 71.7% of total) and skewed toward younger patients. Increasing patients’ age decreased the odds of KC diagnosis by 3.7% (95% CI 1.8%-4.4%) per annum. Males were four times more likely to be diagnosed with KC (AOR = 4.01; 95% CI 3.12–5.16). In comparison with Macedonian patients, Turks were more likely to be diagnosed with KC (AOR = 4.09; 95% CI 2.47–6.78). There was no difference between Macedonians and Albanians (
p
= 0.08).
Conclusion
The prevalence of KC at a refractive surgery practice in N. Macedonia is much higher compared with general population (6.8/100,000) and similar to the prevalence in Middle East Asia. Nationwide screening programs are needed to diagnose the disease earlier.
Purpose
To evaluate changes in corrected distance visual acuity (CDVA), ratio of anterior and posterior corneal radii over the thinnest region of the cornea (ARC/PRC), and astigmatism after ...cross-linking (CXL) in keratoconus.
Methods
Subjective refraction and ARC/PRC (using Pentacam™) were monitored over 1 year in (I) keratoconus treated with routine CXL (
n
= 53), (II) relatively stable keratoconus (
n
= 23), and (III) age/gender matched controls (
n
= 24).
Results
CDVA (median, mode, interquartile range) improved significantly in group I, compared with groups II and III (
p
< 0.05), from 0.45 (0.60, 0.20–0.63) to 0.80 (0.95, 0.60–0.95); change in CDVA was associated with preop CDVA (
p
< 0.01 at all times postop). ARC/PRC (mean ± sd, 95% CI) changed from 1.362 (± 0.048, 1.347–1.377) to 1.425 (± 0.073, 1.401–1.449). CDVA and ARC/PRC remained stable in II and III. Significant relationships were revealed between logCDVA and ARC/PRC in I and II (at 12 months, I
r
s
= − 0.464, II
r
s
− 0.449) and logCDVA at postop(y), log CDVA at preop(x
1
), and ARC/PRC at preop(x
2
) in I (at 12 months,
y
= 0.356
x
1
− 1.312
x
2
+ 1.806,
r
2
1
= 0.494,
r
2
2
= 0.203). Astigmatic power (mean ± sd, 95% CI) improved from − 3.10DC (± 1.52, − 3.55 to − 2.66) to − 2.53DC (± 1.24, − 2.90 to − 2.17) in I, and worsened from − 1.27DC (± 1.32, − 1.81 to − 0.73) to − 1.61DC (± 1.28, − 2.13 to − 1.09) in II. Vector analysis revealed in group I (a) the power of the surgically induced astigmatism (SIA) was linked to astigmatic power at preop and (b) the difference between the axis of astigmatism at preop(ø) and the axis of the SIA was linked to ø.
Conclusion
CXL improved CDVA, increased the ARC/PRC ratio, and modified the association between CDVA and ARC/PRC. The change in CDVA was linked to preop CDVA and ARC/PRC values. The association between SIA and preop astigmatism implies there is not a simple cause and effect relationship with CXL.
Among various visual functions, stereoacuity, or the ability to perceive depth, is the most sophisticated binocular function. Many publications discuss the influence of retinal image formation by ...multifocal intraocular lenses on glare and contrast sensitivity, but only a few present results of testing binocular vision in patients with multifocal intraocular lenses.
This article is designed to review the results of testing binocular vision in patients with multifocal intraocular lenses implanted in cataract surgery.
This article was performed based on a literature review and Internet search through scientific databases such as PubMed, Scopus, Web of Science, and Google Scholar.
Some reports found that patients implanted with the monofocal lens, when measured with a near addition, presented statistically significant better stereoacuity scores than those implanted with any of the multifocal intraocular lens types. When the TNO test was used for measurement, statistically significant better stereoacuity was disclosed with the refractive multifocal intraocular lens than with the diffractive-based multifocal intraocular lens design. Stereoacuity scores, even within the same types of lenses, were significantly better with the Titmus test than with the TNO test.
Stereoacuity is not affected by multifocality-induced retinal blur as it is by other causes of image degradation such as small residual refractive error very early opacification of ocular media or dry eye. Multifocal intraocular lenses do not cause more functional aniseikonia than would be expected with a monofocal intraocular lens. Since stereoacuity is compromised with unilateral multifocal intraocular lens implantation bilateral implantation should be attempted.
Acute optic neuritis is often associated with multiple sclerosis. It is considered to be the most common ocular symptom of multiple sclerosis. In addition to acute optic neuritis, in patients with ...multiple sclerosis, subclinical optic neuritis is also described. It is characterized by slow progression and bilateral involvement, thus being unnoticed by the patient. The purpose of the present study was to assess vision impairment in multiple sclerosis patients without a history of acute optic neuritis, using a number of functional tests including visual field testing by Octopus 101 perimetry N1 program, contrast sensitivity testing by Pelli Robson chart, and color vision by Ishihara pseudoisochromatic plates. The study included 35 multiple sclerosis patients aged 18-50 years, without subjective signs of vision impairment and visual acuity 1.0 according to Snellen. Visual field defects were found in 28 patients. The most common defects of visual fields were retinal sensitivity depression in peripheral zone and nerve fiber bundle defect. Reduced contrast sensitivity was found in 30 (86%) patients. Study results indicated multiple sclerosis patients free from signs of optic neuritis to suffer vision function impairment, as demonstrated by Octopus perimetry and contrast sensitivity testing with Pelli Robson charts.
The aim was to determine feasibility and reliability of noninvasive tear break-up time (NIBUT) assessment using handheld lipid layer examination instrument, and to compare it with standard tear ...break-up time (TBUT) test. Fifty patients were enrolled, 31 with and 19 without dry eye symptoms. Schein questionnaire was used to assess dry eye symptoms. During examination, three NIBUT measurements were performed on each eye using handheld instrument, followed by three TBUT measurements. Receiver operating characteristic curves, sensitivity, specificity and logistic regression analysis were generated. Median NIBUT values were significantly shorter in dry eye symptom group than in control group in all three measurements (9, 8 and 8 s
. 21, 22 and 21 s; p<0.001). TBUT values showed no significant difference between the groups in the first measurement (p=0.053), but the values were significantly shorter in dry eye symptom group in second and third measurements (p=0.020). The cutoff value to distinguish patients with symptoms of dry eye from control group was 12 seconds for NIBUT and 8 seconds for TBUT, with NIBUT having significantly higher sensitivity, specificity, area under the receiver operating characteristic curve and positive predictive value. NIBUT, measured by handheld lipid layer examination instrument, was superior to TBUT in detecting dry eye.
Optic nerve can be infiltrated with various tumors and inflammatory processes, with a considerable prevalence of primary over secondary tumors. Metastases of gastric carcinoma to the optic nerve are ...less frequently, and those of prostatic carcinoma very infrequently observed. A 66-year-old man presented with metastasis to the optic nerve with consequential vision loss to the level of light perception developed two years after prostatic surgery. Systemic therapy with methylprednisolone resulted in a satisfactory vision function recovery. According to literature data, prostatic carcinoma metastases to the optic nerve occur very rarely. In our patient with the optic nerve infiltration found on the first clinical examination, papillary edema was associated with the signs of optic nerve functional impairment (visual acuity, visual field, unilateral RAPD). An infiltrative process involving a distal portion of the optic nerve usually does not cause papillary alterations, and produces a clinical picture of retrobulbar optic neuropathy, such as that observed in our patient on the second clinical examination, showing the signs of optic nerve damage.
The aim was to compare retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses in patients with primary open angle glaucoma (POAG), ocular hypertension (OH) and healthy subjects, ...and to investigate the role of GCC parameters in glaucoma diagnosis. Eighty-one patients were divided into four groups according to Hodapp-Parrish-Anderson classification: 26 OH, 22 early POAG, 10 moderate to advanced POAG, and 23 healthy subjects. All patients underwent RNFL and GCC thickness measurement using SOCT Copernicus HR. All RNFL and GCC parameters were significantly lower in POAG than in OH and healthy subjects, especially Average RNFL, RNFL Superior and Inferior, GCC Average, and GGC Inferior. Of all RNFL parameters, the highest area under the receiver operating characteristic curve (AUC) was recorded for Average RNFL, 0.906. GCC Average, and GCC Superior and Inferior had the overall highest AUCs (0.957, 0.955 and 0.946, respectively) with 100% specificity. The RNFL Average and Inferior and GCC Average, Superior and Inferior were identified as the main predictors for development of glaucoma (p=0.015 and p=0.014 vs. p=0.002, p=0.002 and p=0.003, respectively). In conclusion, GCC parameters showed a slightly better glaucoma discriminating ability and were found to be better predictors for development of glaucoma as compared with RNFL.
A lot of pathological conditions could provoke damaging of the innervations of the cornea and lead to persistent epithelial defect (PED). AMX is lyophilized preparation of amniotic membrane (AM), ...which contains biological components and efficacy of AM for treatment of the corneal surface defects. In processing all the substances essential for biological effects of AM are preserved (growth factors, neutrophins, interleukins, receptors, fibronectins and different types of collagen). A patient can apply AMX as eye drops by himself in his home, thus avoiding surgical procedure. We presented two patients with PED; we treated them with eye drops of AMX, 2 drops every hour during day time. There was observed healing effect by reducing epithelial defect. Almost after a second day of application, and after 1-2 week period PED that persisted for weeks healed completely.
The aim of this prospective study was to determine the possible influence of the silicone oil tamponade after vitrectomy on the early intraocular pressure (IOP) elevation, which is a major risk ...factor for developing secondary glaucoma in patients with vitreal and retinal proliferative changes. The research included 110 patients which were allocated in three groups according to the medical history data. The surgical procedures were performed at the Eye Clinic, University of Zagreb School of Medicine. The control group comprised 40 patients who underwent vitrectomy with air or saline solution tamponade. The second group consisted of 40 patients with retinal detachment and proliferative retinopathy who had vitrectomy with silicone oil tamponade and the third group were 30 patients with diabetic retinopathy who underwent vitrectomy and tamponade with silicone oil. The intraocular pressure was measured and gonioscopy was performed in all patients one month before and after vitrectomy. The results showed that there is no statistically significant difference among IOP values before and after vitrectomy in the control group (p = 0.104) as well as in the preoperative IOP values among all three groups of patients. The data analysis determined that in both groups of patients with silicone oil tamponade after vitrectomy, there is a statistically significant difference in IOP values one month after the surgical procedure (p = 0.000). The mean IOP values in those patients a month after vitrectomy were significantly higher compared to the control group (p < 0.05). Comparison of the IOP one month after vitrectomy between the patients with retinal detachment and those with diabetic retinopathy showed no statistically significant difference (p = 0.331) but the qualitative analysis showed that the IOP one month after vitrectomy was 2 mmHg higher in the diabetic retinopathy group. The results suggest that there is no difference in angle width before and after vitrectomy among different groups of patients. Emulsified silicone oil was confirmed in 18% of patients in the retinal detachment group. In 17% of patients in the diabetic retinopathy group the emulsified oil was found in the angle, whereas a 10% of patients had neovascularization of the angle one month after vitrectomy. The IOP elevation in the early postoperative course may be caused by intravitreal instillation of the silicone oil after vitrectomy. Emulsification of the silicone oil may lead to the early IOP rise; especially in the diabetic patients with angle neovascularization which itself can additionally accelerate the development of the secondary glaucoma.
Tear film status in glaucoma patients Jandroković, Sonja; Suić, Smiljka Popović; Kordić, Rajko ...
Collegium antropologicum
37 Suppl 1
Journal Article
Recenzirano
The purpose of this study was to determine the prevalence of ocular surface disease symptoms and the state of the tear film among patients with glaucoma who are receiving topical intraocular pressure ...lowering monotherapy. 62 responders were divided in 2 groups: 32 glaucoma patients and 30 healthy individuals. Tear film break-up time (TBUT), Schirmer 1 testing and ocular surface disease questionnaire were performed in both groups. 50% glaucoma patients and 25% control group participants had dry eye symptoms. Advanced disorder in TBUT was found in seven 21.9% glaucoma patients and was not found in the control group. Basal tear secretion measured by Schirmer 1 testing was found reduced in 87% of glaucoma patients and in 16.7% control group patients. Glaucoma patients on topical intraocular pressure lowering monotherapy showed a significantly higher prevalence of ocular surface disease symptoms, significantly reduced basal tear secretion and destabilisation of tear film in comparison with healthy volunteers.
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