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Purpose: To determine the prevalence of keratoconus (KC) in relation to ethnicity 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 was 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), 1209 (43%) were male. 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 was statistically significant (𝑥2=90.225, pConclusion: The prevalence of KC at a refractive surgery practice in N.Macedonia is much higher compared with general population and similar to the prevalence in Middle East Asia. Nationwide screening programs are needed to diagnose the disease earlier.

Laser in situ keratomileusis (LASIK) is one of the most commonly performed refractive surgical procedures. During the last two decades, surgical procedure has evolved, but still, there are several intraoperative and postoperative complications possible. Every young LASIK surgeon spends most of the reading time on LASIK complications. They are not frequent, but you have to know precisely what to do when they happen. This chapter should be a guide, based on literature and experience, on how to deal with intraoperative, early postoperative, and late postoperative complications. This chapter will include managing irregular flaps, buttonholes, and free flaps. The treatment scheme for DLK, epithelial ingrowth, and PISK, and when is the time for flap re-lifting. How frequent should be patients’ visits not to miss the complication on time? When is the right time for LASIK reoperation? Post LASIK corneal ectasia and how to perform cross-linking over LASIK. Young surgeons need precise guidelines, not just theoretical treatment options to achieve optimal visual outcomes after LASIK procedure.

Objective: Analysis of visual acuity parameters in patients with moderate to high myopia and myopic astigmatism 1 year after treatment with phakic intraocular lenses. Material and methods: This was a retrospective study on 35 patients (52 eyes) with moderate to high myopia who were implanted with the Visian V4c phakic implantable Collamer lens (Staar Surgical, Nidau, Switzerland). Examined parameters were: uncorrected distance visual acuity (UDVA) and best corrected visual acuity (CDVA), manifest and cycloplegic refraction, intraocular pressure, and endothelial cell count. The investigated parameters were measured preoperatively, 1, 3, 6 and 12 months postoperatively. Results: In 17 patients, phakic lenses were implanted binocularly and in 18 patients monocularly. Preoperatively 34.62% of patients had CDVA from 0.9 to 1.0. One year after the surgery 48.08% of patients had UDVA from 0.9 to 1.0. Preoperatively 80.77% of patients had diopter range from -6.00 Dsph to -10.00 Dsph. At 1 year postoperatively 78.85% of patients were within 0.00 Dsph to -1.00 Dsph. Preoperatively, in patients with astigmatism -4 Dcyl to -2 Dcyl dominated, as opposed to significant improvement postoperatively when 94.23% had astigmatism ranging from -1.0 Dcyl to 0 Dcyl. Conclusion: The implantation of phakic lenses demonstrated a successful postoperative outcome in the treatment of myopia and myopic astigmatism. Visual acuity and refraction show a gradual and significant improvement in visual function parameters within 1 year of lens implantation.

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 rs = − 0.464, II rs − 0.449) and logCDVA at postop(y), log CDVA at preop(x1), and ARC/PRC at preop(x2) in I (at 12 months, y = 0.356x1 − 1.312x2 + 1.806, r21 = 0.494, r22 = 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.

Aim To correlate the maximum anterior sagittal curvature (Kmax) changes and uncorrected (UDVA) and corrected distance visual acuity (CDVA) in keratoconus patients after the cross-linking (CXL) procedure. Methods Forty-four eyes of 34 patients with keratoconus were analysed after the standard Dresden protocol CXL procedure had been performed. All patients underwent complete preoperative examination with a follow-up of 12 months with focus on UDVA, CDVA and Oculus Pentacam (Scheimpflug technology) analysis. We analysed and correlated K

Introduction Keratoconus is described as a degenerative bilateral, progressive, noninflammatory corneal disorder characterized by ectasia, thinning, and increased curvature. Keratoconus progression classification 1 year after performed crosslinking method in this study is based on the ABCD keratoconus grading system. Aim To evaluate the possible keratoconus progression one year after performed a crosslinking (CXL) method based on the ABCD keratoconus grading system. Methods: Seventeen keratoconus patients (22 eyes) were included in this prospective study. CXL procedure was performed using the standard Dresden protocol at Eye Clinic Svjetlost Sarajevo with the inclusion period from January 2017 to January 2018. Twelve patients had monocular, and 5 patients had binocular treatments with follow up of 12 months. Preoperative and postoperative stages were compared using the ABCD keratoconus grading system measured on rotating Scheimpflug corneal tomography-based machine - Pentacam (Pentacam HR, Oculus Optikgerate GmbH, Wetzlar, Germany). Results Out of 22 eyes, one eye had keratoconus stage I-II, 6 eyes had stage II, 4 eyes had stage III, and 9 eyes had stage III-IV. There was no statistically significant gradient change of keratoconus in comparison to one month after the surgery, p>0.05. There was no progression of the gradient when comparing to the preoperative stage. Conclusions Corneal cross-linking could effectively stabilize the progression of keratoconus, as assessed by key corneal topographic parameters. Analyzing the trend of stage change in 12 months follow up after the crosslinking procedure of keratoconus patients there was no progression of a gradient in comparison to the preoperative stage. According to our results, we can conclude that CXL is a safe and effective procedure in treating keratoconus.