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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.

Background: 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. Objective: This article is designed to review the results of testing binocular vision in patients with multifocal intraocular lenses implanted in cataract surgery. Methods: 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. Results: 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. Conclusion: 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.

Introduction: Refractive surgery procedures, transepithelial photorefractive keratectomy (T- PRK) and femtosecond laser in situ keratomileusis (Fs-LASIK) are regarded as safe and efficacious methods for correcting myopia and myopic astigmatism. These two methods do not have much differences in results when treating spherical myopia, while some differences does exist in treatment of myopic astigmatism. Vector analysis presents powerful tool to show the real differences between these two methods regarding higher order ocular aberrations and central corneal thickness of treated eyes. Aim: The aim of the study is to investigate changes in higher order ocular aberrations (HOAs) and central corneal thickness (CCT) following treatment of myopia and myopic astigmatism above -5.00DS and up to -2.00DC after either T-PRK or Fs-LASIK. Methods: Patients (30 eyes per group) underwent T- PRK (group I) or Fs-LASIK (group II) procedure using Schwind Amaris 750S laser. HOAs (3mm&5mm pupil) and CCT were measured objectively at pre-, 1, 3 & 6 months postop in each case. Results: Key results at 6 months were: i) mean values of trefoil (5mm pupil) were 0.092μm (sd, 0.055, 95% CI 0.072 to 0.112) & 0.126μm (sd, 0.078, 95% CI 0.098 to 0.154) in group I, and 0.088μm (sd, 0.058, 95% CI 0.067 to 0.109) & 0.064μm (sd, 0.034, 95% CI 0.052 to 0.076) in group II (P=0.001 at 6 months) ; ii) Changes in CCT (ΔCCT) and best spherical equivalent correction (ΔBSE) was significant in group II (ΔCCT=-26.55[ΔBSE]-14.06, R=0.486, P=0.006) but not in group I (p=0.034). Conclusions: After T-PRK trefoil is worse than Fs- LASIK. The predictability of corneal changes is better following Fs-LASIK.

Background: Congenital fibrosis of extraocular muscles ( CFEOM) is a group of genetically defined eye-moving disorders. The syndrome is clinically characterized by congenital non-progressive ophthalmoplegia caused by dysinervation of the cranial nerves with or without ptosis. As a main sign of a CFEOM, extraocular muscles get shrunken and fibrotic, which makes surgery more technically demanding and the result more unpredictable, which makes the treatment challenging and highly customized. Our paper presents variations of the clinical picture and treatment cases of CFEOM1. Objective: To outline the importance of the clinical examination with the exact measurement of deviations for the patients with ocular fibrosis and passive duction test under general anesthesia, establishing them as the main criteria for treatment. Methods: We treated seven patients (14 eyes) with CFEOM1. The decision of the treatment was based on the measurement of the eye position in the primary position (PP), the severity of compensatory head position (CHP), restriction of motility, and passive motility test performed before surgery in general anesthesia. In 3 cases, patients were treated conservatively with the treatment of refractive error and amblyopia. However, in 4 patients, CHP and position of the eyes in PP were not acceptable, motility was severely impaired, and patients underwent surgery. The first surgery was performed on eye muscles: recession of inferior rectus muscle (IRM), anteposition, and resection of superior rectus muscle (SRM). As a second step procedure, ptosis surgery was performed. When the muscle was too tight, and it wasn’t possible to have a satisfying result with conventional surgery, we used a tissue expander to improve the position and motility of the affected eyes. Results: In all operated cases, CHP has significantly improved and the position of the eyes in PP. Conclusion: Exact eye and head position measurements and a passive motility test during general anesthesia should guide the surgery. In the case when conventional surgery is not possible, implantation of a bovine pericard is a safe and effective method.

Background: The main causes of severe vision loss and blindness in Europe are age-related retinal diseases, particularly age-related macular degeneration (AMD), diabetic eye disease (DED), and a host of vascular conditions. Both the prevalence and incidence of severe vision loss are expected to increase in territories where life expectancy is increasing. Objective: The aim of this study is to estimate the current prevalence of diabetic retinopathy and the most common risks for its development in the city of Sarajevo, a Capital of Bosnia and Herzegovina. Methods: This retrospective single center study included 205 diabetic patients from the city of Sarajevo who attended the regular ophthalmological examination at the Specialty Eye Hospital Svjetlost, in a branch located in the city center, from August 2021 to August 2022. Patients underwent a complete medical assessment by ophthalmology specialists. The retinal examination included an evaluation of the presence of diabetic retinopathy. Any retinopathy present was graded as mild non-proliferative retinopathy, moderate-severe non-proliferative retinopathy, or proliferative retinopathy (PDR). Results: Retinopathy was present in 40.49 % of patients included in this study; 13.17 % had the mild form of diabetic retinopathy, 7.80 % had the moderate-severe form, and 19.51 % had a proliferative form of diabetic retinopathy. The mean duration of diabetes diagnosis was 11.12 years overall, 11.74 years in men, and 10.22 in women. Macular edema was present in 38.55% of patients with retinopathy, 6.02 % in patients with mild form, 8.43 % in patients with moderate-severe form, and 24.09 % in patients with PDR. Conclusion: The prevalence of diabetic retinopathy in Sarajevo is relatively high, and the most common is a severe form of the disease. Regular diabetic retinopathy screening in primary healthcare services and hospital eye services is highly recommended for the timely prevention of visual impairment and blindness.

Purpose To compare changes in astigmatism by refraction and total corneal astigmatism after tPRK, LASIK and FsLASIK. Setting Specialty Eye Hospital Svjetlost, Zagreb, Croatia. Design Partially masked, semi-randomized, prospective, case-by-case, interventional, clinical study. Methods Patients with a stable refraction (-0.75DS to −8.00DS, astigmatism ≤1.00DC) underwent tPRK, LASIK or FsLASIK without complication. Astigmatism was measured at both corneal surfaces over the central 3.2 mm zone (approximately using Pentacam HRTM) preoperatively and 3 months postoperatively. Pentacam and refraction data were subjected to vector analysis to calculate the surgically induced changes in i) total corneal astigmatism (SIATCA) ii) any astigmatism by refraction (SIAR) and the vectorial difference (DV) between SIATCA and SIAR. Results Reporting key findings (p TCA and SIAR powers after tPRK (75eyes) but not after LASIK (100eyes) or FsLASIK (100eyes). Mean (±sd,95% CIs) values for DV powers were, tPRK −1.13DC(±0.71, −1.29 to −0.97), LASIK −0.39DC(±0.23,-0.44 to −0.34), FsLASIK −0.55DC(±0.38,-0.62 to −0.47). The differences were significant. For the tPRK and FsLASIK cases, linear regression revealed significant associations between I) SIATCA (x) &DV (z) powers (tPRK z = 1.586x-0.179, r = 0.767, p TCA (x1) &DV (z1) axes (tPRK, z1 = 0.523 × 1 + 0.394, r = .650,p 1 = 0.460 × 1-0.308, r = .465,p Conclusions tPRK is more prone to unintended changes in astigmatism. The difference between SIATCA & SIAR after tPRK or FsLASIK is mediated by SIATCA. Photoablating deeper regions of the cornea reduces the gap between SIATCA & SIAR.

Purpose: To compare predicted and measured changes in astigmatism at the posterior corneal surface (PCS) after FsLASIK or LASIK. Methods: Astigmatism was measured at both corneal surfaces (PentacamTM) before and 3 months after unremarkable FFsLASIK (roup 1, n = 100) or LLASIK (roup 2, n = 100) for myopia (−7.25DS to −0.75DS) and low astigmatism (≤1.00DC). Photoablation was achieved using Schwind Amaris750STM laser (Aberration Free profile, centered on corneal vertex). Pre-and postop astigmatic data, according to subjective refraction and estimates for the corneal surfaces (over the central 3.2 mm zone), were subjected to vector analysis to calculate surgically induced astigmatism (SIA) by refraction (SIAR), at the anterior (SIAFact) and posterior corneal surfaces (SIABact). The difference vector between SIAR and SIAFact was regarded as the predicted SIA at the PCS (SIABest). Results: Reporting key findings. Mean(±sd, 95%CI) SIABest and SIABact powers in group 1 were −0.52DC(±0.35, -0.56 to −0.45) and −0.11DC(±0.08, -0.13 to −0.10) in group 1, −0.35DC(0.20, -0.39 to −0.32) and −0.08DC(0.07, -0.09 to −0.06) in group 2. Differences between SIABest and SIABact were significant for powers but not axes. Significant correlations(p < .01) were revealed between (I) SIAR and SIAFact powers [Group 1, SIAR = 0.370.SIAFact-0.292, r = 0.299. Group 2, SIAR = 0.484.SIAFact-0.394, r = 0.519] but not the axes and (II) ΔC (difference between pre-[x1] and postop measured PCS astigmatic powers) and x1 [Group 1, ΔC = 0.384x1 + 0.119, r = 0.423. Group 2, ΔC = 0.135x1 + 0.047, r = 0.229, p = .022]. There was no correlation between SIABest and SIABact powers or axes. Conclusion: The changes in posterior corneal astigmatic powers according to Pentacam measurements are small and do not account for the deficit between SIAR and SIAFact after FsLASIK or LASIK.

To evaluate residual astigmatism following correction with toric implantable collamer lens (TICL) (group I) over a period of 4 years and compare with the change of astigmatism in spectacle wearers (group II).Groups I (86 cases implanted with TICL [EVO + Visian ICL, Staar Surgical, Nidau, Switzeland], preop refractive error [sphere and cylinder] - 22.25 DS to - 1.00 DS and - 5.50 DC to - 1.00 DC) and II (80 cases initial refractive error [sphere and cylinder] - 18.00 DS to 0.00 DS and - 7.00 DC to - 1.00 DC) were reviewed annually. Refractive and tomography data were subjected to vector analysis to determine surgically induced astigmatism (SIA), angle of error [Δθ° = angle of target-induced astigmatism (TIA) - angle of SIA], and ΔC [TIA-SIA powers] and total corneal astigmatism (TCA) in group I and induced change in astigmatism (ICA) in group II.In group I, on all occasions, SIA correlated with TIA (p 0.05); differences between SIA and TIA means were insignificant and changes in TCA were not correlated with ΔC. Mean (± sd, 95% CI) residual astigmatic powers (RA) in attending group I cases (1-4 years) were - 0.40 DC (0.58, - 0.52 to - 0.28), - 0.40 DC (0.59, - 0.52 to - 0.27), - 0.41 DC (0.58, - 0.54 to - 0.28), and - 0.61 DC (0.74, - 0.82 to - 0.40). In group II, the corresponding ICA powers were - 0.47 DC (0.53, - 0.61 to - 0.32), - 0.49 DC (0.48, - 0.69 to - 0.29), - 0.60 DC (0.40, - 0.76 to - 0.44), and - 0.86 DC (0.71, - 1.19 to - 0.52). Differences between RA and ICA were not significant. Of the group I cases presenting at 1-4 years postop, 23, 18, 16, and 28 had RA powers ≤ - 0.75 DC. Of these 12, 10, 6, and 16 were associated with Δθ° 5° (ΔC - 0.50 to 0 DC) and 5, 1, 4, and 4 were related to ΔC (Δθ° 5°).The development of astigmatism after TICL implantation is on par with the natural change in astigmatism in untreated cases. In about 50% of TICL cases presenting with astigmatism ≤ - 0.75 DC, the residual astigmatism could be neutralized by realigning the TICL.

PURPOSE: To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL). METHODS: This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up. RESULTS: A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes ( P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery ( P < .001). CONCLUSIONS: This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [ J Refract Surg . 2021;37(4):256–262.]

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.

Purpose: To determine if the manifest sphero-cylindrical residual refractive error, at various time points over a 12-month postop period after laser in situ keratomileusis (LASIK) was associated with patient age at time of surgery. Methods: Patients with moderate to high hyperopia (3.00–7.00 DS) and astigmatism ⩽2 DC underwent LASIK using Wavelight Allegretto Eye Q (400 Hz). Treatments were centered on corneal vertex, flaps were made with Moria M2 mechanical microkeratome. Pre-and postoperative uncorrected and corrected distant visual acuity, best corrected spherical equivalent (SEQ) were measured. Measurements were taken at 1 week, 1, 3, 6, and 12 months after the surgery. Target refraction was emmetropia. Total of 161 patients were treated. In binocular cases, data from the right eyes were included for analysis. In this article, we report on refraction data only. Raw data were subjected to several permutations to elicit any links between refractive outcomes and patient age. Results: The key findings were as follows y = postop SEQ (diopters), x = patient age (years), ln( x) = natural logarithm of patient age: At 1 month, y = x[0.049 −0.011.ln( x)] ( R = −0.205, p = 0.001, n = 161). At 3 months, y = x[0.077 −0.017.ln( x)] ( R = −0.355, p 0.05). Conclusion: Residual postop refractive error after LASIK for hyperopia has a logarithmic association with patient age at time of surgery. In younger patients there is tendency toward undercorrection, the opposite occurs in older patients and this persists 1 year after treatment.

Introduction: Keratoconus (KCN) is known to affect all ethnicities but its incidence exhibits geographical variability plausibly due to subclinical forms of the disease, differences in diagnostic methods and criteria, or differences in genetic variations in populations. Aim: To examine the prevalence of keratoconus among the refractive surgery population of Vojvodina, who underwent refractive surgery screening at Eye Clinic Svjetlost Novi Sad, Serbia from September 2018 to September 2019. This is a single-center study. Methods: Retrospective analysis of 876 patients who presented for refractive surgery evaluation. Corneal tomographers represent the gold standard in the detection and classification of corneal ectatic diseases and screening is an essential part of the preoperative diagnostics before any refractive surgery. The corneal tomographer used in this study was a Scheimpflug imaging device (Pentacam AXL, Oculus Optikgeräte GmbH, Wetzlar, Germany). The device was realigned before each measurement. Results: Out of a total number of patients, 619 (70,7%) were candidates for corneal refractive surgery procedure, and 257 patients (29.3%) were not. Out of 257 patients that were not candidates for the procedure 157 (61,0%) patients had thin corneas, high myopia/hypermetropia or had some retinal disease; 75 patients (29,1) were keratoconus suspect and 25 patients (9,7%) had keratoconus. KCN patients had a mean age of 29.5 ± 7.7 years, 18 patients (72.0%) were male and 7 patients were female (28%). Conclusion: The most cited annual incidence of KCN is 2 approximately 1 per 2,000. Recent data from the biggest Netherland study revealed many different epidemiological results which deprive keratoconus of the community of rare diseases. The incidence of keratoconus in Vojvodina refractive surgery population presented in our Clinic was 2.9%.

Introduction: In the field of ophthalmology, laser technology is used in many basic and clinical disciplines and specialities. It has played an important role in promoting the development of ophthalmology. Aim: This article is designed to review the evolution of laser technology in refractive surgeries in ophthalmology, mainly focusing on the characteristics of the excimer laser applied in corneal refractive surgery. Methods: 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. Result: The literature on excimer laser technology addresses the technical and physical aspects of excimer lasers including types, characteristics and commercially available lasers on the market. Conclusion: The conclusion on this forum aims to help understand the benefits of excimer laser use in ophthalmology, with focus on correction of refractive errors

Myopia is the most prevalent refractive error in the world and its incidence is increasing. Together with conservative methods of treatment, various surgical methods have been proposed. Corneal refractive surgery is probably the most accepted one. Laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE) are suitable for treatment of myopia up to −8.00 D in the younger age group. For patients not suitable for corneal refractive surgery, lens-based procedures are available. Phakic intraocular lenses are suitable for patients younger than 45 years of age with high myopia or some other contraindications for corneal refractive surgery. For older patients, refractive lens exchange (RLE) with implantation of multifocal or monofocal intraocular lenses is gaining popularity.Myopia

Introduction T Transepithelial photorefractive keratectomy (T-PRK) and femtosecond laser in situ keratomileusis (Fs-LASIK) are reftactive surgery methods for treating myopia and myopic astigmatism. Although T-PRK obtains similar results to Fs-LASIK with spherical myopia, it has differences in astigmatism correction. Vector analysis is a perfect tool to see the real difference between these two methods regarding astigmatic refraction and visual acuity. Aim The aim of the study is to investigate changes in astigmatism and visual acuity following treatment of myopia and myopic astigmatism above -5.00DS and up to -2.00DC after either T-PRK or Fs-LASIK. Methods Patients (30 eyes per group) underwent unremarkable T-PRK (group I) or Fs-LASIK (group II) using Schwind Amaris 750S laser. Astigmatic data acquired by subjective refraction were subjected to vector analysis to determine the association between surgically (SIA) and target induced (TIA) astigmatic powers and differences in axes(θ). Results Key results at 6 months were: i) Mean astigmatism changed from -0.92 DC (sd ±0.49,95%CI-1.10to-0.75) to -0.38 DC (sd ±0.40,95% CI-0.52 to -0.24) in group I and -0.93DC (sd±0.55,95%CI -1.07 to -0.67) to -0.14DC (sd±0.31,95% CI-0.25 to -0.03) in group II (P=0.005 at 6 months). ii) Mean (±sd) θ was +9.7° (±19.0°) in group I and -2.2° (±15.5°) in group II (P=0.005). Conclusion There was a greater mismatch between SIA and TIA powers and axes after T-PRK. T-PRK tends to induce more unwanted astigmatism. The predictability of the refractive and optical changes is better following Fs-LASIK.

Background: A cataract is a type of degenerative change of the lens, which is characterized by the clouding of the lens followed by symptoms of optical deterioration. Over 70 years ago, Sir Harold Ridley implanted the first useable modern-day intraocular lens (IOL) implant. A lot has happened since then. The IOL is arguably the most life-changing and innovative implant in the history of medicine. Currently, there are several types of intraocular lenses on the market. The main classification could be monofocal lenses, multifocal, trifocal, extended depth of focus (EDOF) lenses, and toric lenses. Objective: The aim of this case report is to report the importance of IOL selection in patients with young-age cataracts. Case report: A 35-year-old patient presented first time at our Clinic. In the last six months, he noticed poor vision in his left eye, even with spectacles. The right eye was operated on in another institution in 2020, due to the presence of a young-age cataract. After a complete preoperative ophthalmological examination, we discovered the presence of a cataract in the left eye. UDVA of the left eye was 0.4, and CDVA was +0.50/+0.50/30°=0.5. UNVA and DCNVA was J2. We decided to implant TECNIS Synergy™ IOL (Johnson & Johnson Vision, Santa Ana, CA, USA) during the cataract surgery. That EDOF IOL bridges the gap between the performance of monofocal and multifocal IOLs and delivers continuous high-contrast vision for patients with cataracts from far through near, even in low-light conditions. There were no intraoperative or postoperative complications. On a 7-day, check-up UDVA of the left eye was 1.0, and UNVA was J1. The patient was satisfied with the vision in the left eye, so he wanted to correct the vision of the right eye which was implanted with SENSAR® IOL (Johnson & Johnson Vision, Santa Ana, CA, USA), with a residual diopter of +2.00/+1.00/120 for distance, and +4.50/+1.00/120 for near vision. This choice of IOL in the other institution was not an ideal solution for this patient due to his young age and occupation. The capsular bag was already in slight fibrosis, so the explantation of the existing IOL and implantation of the new one was not a reasonable option. We decided to go with the multifocal AddOn® toric lens (1stQ GmbH, Mannheim, Germany), the refractive-surgery platform for vision enhancement of pseudophakic eyes, that also correct residual astigmatism. On a 7-day check-up, this patient’s UDVA was 1.0 and UNVA was J1. The result was a happy patient, who could go back to his everyday life without spectacle independence. Conclusion: Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. We should be aware of patient expectations and demands, especially when having a patient with young-age cataracts. Often more time should be spent on preoperative IOL planning than cataract surgery itself.

Introduction Marcus Gunn syndrome is a rare phenomenon with very less number of cases reported in literature. It may be congenital or acquired. Aim The aim of this case report was to report the clinical characteristics of Marcus Gunn patient from our Clinic. Case report A comprehensive opthalmologic examination, CDVA (corrected distance visual acuity), fundus examination and photography, was conducted in Marcus Gunn patient. Clinical findings of patient presented as - chin positioned slightly upwards, extraocular motility normal on both eyes, cover test with normal findings, pupillary examination normal on both eyes. Left upper eyelid was in a lower position than the right one. On right eye, rima interpalpebrarum was 9 mm with upgaze of 13mm. On the left eye, rima interpalpebrarum was 5 mm with upgaze of 6 mm, and with open mouth, left rima interpalpebrarum was 10 mm. Visual acuity on both eyes was 1.0. Cycloplegic refraction on both eyes was +0,75 diopters (D), and Lang test was normal. In the differential diagnosis of patients with ptosis, Marcus Gunn jaw winking syndrome should be considered especially if it improves during feeding, sucking, chewing, smiling or any kind of mouth movement. In case of ptosis always do the jaw test. Have the infant bottle-feed. An older child can chew gum. Have the patient open the mouth, move the jaw from side to side, or protrude the jaw forward. Conclusion Address first to treatment of any amblyopia if present - eyeglasses, patching etc., or strabismus. Think twice before deciding to operate.

Introduction: The WaveLight Allegretto Eye-Q is a flying-spot excimer laser, with a pulse repetition rate of 400Hz, with two galvanometric scanners for positioning laser pulses. The system has an infrared high speed camera operating at 400Hz to track the patient’s eye movements that either compensates for changes in eye position or interrupts the treatment if the eye moves outside a preset predetermined range. Aim: The purpose of this study was to investigate WaveLight Allegretto Eye-Q 400Hz laser delivery platform aimed to correct astigmatism by subjecting the pre and postoperative astigmatic values to vector analysis. Methods: Patients were divided into two groups, depending on the type of astigmatism. Astigmatism was between 2 and 7 diopters (D). A total of 188 eyes (110 patients), 127 eyes (71 patients) with myopic astigmatism and 61 eyes (39 patients) with mixed astigmatism underwent unremarkable LASIK correction on WaveLight Allegretto Eye-Q 400Hz. The preoperative and postoperative sphere, negative cylinder [C] and axis (ø) of manifest refractions were subjected to vector analysis by calculations of the standard J0 (cos [4π(ø-90)/360]xC/2) and J45 (sin[4π(ø-90)/ 360]xC/2). Results: Reporting the key results, we found that J0 significantly reduced after LASIK (p

Purpose: To determine the temporal effect of toric implantable collamer lens (TICL) implantation and location on corneal endothelial cell density (ECD) over a period of 36 months after surgery. Methods: ECD [number of cells per square millimeter estimated using the Specular Microscope SP-1P (Topcon Europe Medical B. V., Netherlands)] data were collected from cases deemed suitable for the TICL (VTICMO, VTICM5 ; STAAR Surgical, Nidau, Switzerland). The preoperative refractive error (sphere and cylinder) ranged from -1.00 to -22.25 diopter sphere and from 20.50 to -5.50 diopter cylinder. ECD was evaluated at preoperative and all postoperative sessions. Results: Key findings were as follows: the mean ECD (6SD, 95% confidence interval) was 2720 cells/mm(2) (6272, 2620-2820 cells/mm(2)) preoperatively, which was reduced to 2372 cells/mm(2) (+/-325, 2250-2490 cells/mm(2)) at 36 months postoperatively (P, 0.001). Linear regression revealed the following significant correlations between the (1) log of the change in ECD (y(1)) and log of preoperative ECD (x(1)) at 2 years postoperatively, y(1) =2.513x(1)-6.2816 (n=62, r=0.3503, P =0.005) ; (2) mean ECD (y(2)) and log time (in months, x(2)), y(2)=2543.7- 36.997x(2)-38.99x(2) 2 (r=20.9654, n =7, P = 0.0004) ; and (3) mean axial distance between the front surface of the crystalline lens and the TICL back surface (y3) and time postoperatively (in months, x(3)), y(3) =0.1035x3 225.2808x(3) + 473.18 (r =0.8512, n =7, P =0.015). Conclusions: Expected ECD loss after TICL implantation by 2 years postoperatively is predictable. On average, over 3 years after implantation, there is (1) an initial rapid decline in ECD, followed by a gradual fall in the rate of cell loss, and (2) a gradual fall in the distance between the TICL and the crystalline lens by 2 years postoperatively, followed by a reversal by the third year.

Aim: To evaluate safety and efficacy of Laser in situ Keratomileusis (LASIK) procedure for the correction of high hypermetropia. Methods: Retrospective study of 160 patients (266 eyes) who underwent LASIK procedure for the correction of hypermetropia between +3.00 and +7.00 diopters(D) and cylinder up to 2.00D from January 2013 and August 2015. All ablations were performed with Wavelight Allegretto Eye-Q400Hzexcimer laser (Alcon, Forth Worth, TX, USA) with aberration free module and were centered on a corneal vertex. All flaps were made with Moria M2 (Moria, Antony, France) mechanical microkeratome (90μm head). Preoperative and postoperative uncorrected and corrected distant visual acuity (UDVA, CDVA), spherical equivalent (SE) and a berrometry for 5mm pupil were measured. Measurements were taken at 1 week, 1, 3, 6 and 12 months after the surgery. Wilcoxon Signed Ranks Test was used for statistical analysis. Results: Postoperative UDVA was lower than preoperative CDVA at 1 week(p=0.001), at 1 month there was no difference (p=0.099), and at 3, 6 and 12 months UDVA was better (p

Background The creation of corneal flap is considered to be the most critical part of laser in situ keratomileusis (LASIK) surgery. Currently, flaps can be created with mechanical micorkeratomes or femtosecond lasers. Objective To analyze and compare flap characteristics created with two different methods for flap creation in Laser in situ keratomileusis (LASIK). Methods This was a retrospective study. The thickness and morphology of the flap were compared between the two mechanical microkeratomes (group I - Moria M2, group II - Moria SBK One Use Plus) and femtosecond laser (group III - Ziemer Femto LDV). Central flap thickness was measured intraoperatively, while the flap profile was measured with anterior optical coherence tomography at two axes (90° and 180°) and 5 measuring points on the first day, the first week, and one month after the surgery. Results Central flap thickness was 110.91±15.79 micrometers (µm) (80-164 µm) in group I, 98.08±13.33 µm (65-136 µm) in group II and 103.52±13.89 µm (66-138 µm) in group III. Anterior optical coherence tomography revealed a meniscus-shaped flap in all three groups at both axes (90° and 180°). The least variability in flap thickness was observed in group III (±6 µm). Conclusion All three methods of flap creation provide good shape and thickness reproducibility. Ziemer Femto LDV femtosecond laser had the least variable flap thickness in a single flap. Mechanical microkeratomes had slightly lower performance.

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.

Purpose: To report the incidence of postoperative ectasia after laser in situ keratomileusis (LASIK). Methods: A retrospective case review of 30, 167 eyes (16, 732 patients) was conducted following LASIK between August 2007 and August 2015. The follow-up was between 2 and 8 years. Tomography was performed after 2 years postop. After identifying cases of ectasia, the charts of these patients were examined to identify any common factors that may have predisposed them to develop ectasia. Results: Ten eyes of seven patients developed post-LASIK ectasia. Eight eyes had been treated for myopia and myopic astigmatism, two eyes for mixed astigmatism. There were no cases of ectasia after LASIK for hyperopia. All 10 cases of ectasia had a flap that was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15 ± 12.88 µm) and refractive error corrected using the Wavelight Allegretto excimer laser. Retrospectively, most prevalent risk factors were thin cornea (≤ 500 µm, 50% of cases), anterior topographic map irregularities (e.g., asymmetric bow tie, 40% of cases), Ectasia Risk Score > 3 (40% of cases), percent tissue thickness alteration ≥ 40% (20% of cases) and low residual stromal bed (≤ 300 µm, 30% of cases). One eye had no identifiable risk factors. In the retrospective chart review 14.97% (4, 506) of all the eyes had similar risk factors to the cases that went on to develop ectasia. Conclusion: The incidence of ectasia was 0.033% over 8 years. The incidence could be higher as some cases may destabilize beyond this period and some patients were lost to follow-up asymptomatic of any clinical signs. Other intrinsic factors may trigger the development of post LASIK ectasia. The current widely accepted risk factors are not sufficiently rigorous for screening out potential ectasia from developing after LASIK. There is a need to augment accuracy with higher sensitivity and specificity.

Significance Small incision lenticule extraction (SMILE) is advanced as the most minimally invasive and least traumatic corneal procedure for correcting refractive errors using a single laser. Although SMILE obtains similar results to femtosecond laser in situ keratomileusis (LASIK) with spherical myopia, it has deficiencies in astigmatism correction. Purpose The purpose of this study was to compare refractive outcomes and high-order aberrations (HOAs) between SMILE and femtosecond LASIK corneal procedures at 1 year post-operative. Methods Ninety-two patients (181 eyes) with myopia/myopic astigmatism underwent either SMILE (group 1) or femtosecond LASIK (group 2). The refractive target was to achieve emmetropia in all cases. Data were analyzed to determine significance of change in refraction and HOAs. Furthermore, astigmatism was subjected to vector analysis using the Thibos (calculation of change, Δ, in J0 and J45 values) and Alpins (calculation of difference, ΔC, between target-induced astigmatism [TIA] and surgically induced astigmatism) methods. Results Forty-five patients (89 eyes) from group 1 and 47 patients (92 eyes) from group 2 completed the study. The main significant (P ≤ .001) findings were as follows: (a) residual astigmatism was greater in group 1; (b) group 1, ΔJ0 = 1.015J0 + 0.040 (R = 0.861), ΔJ45 = 1.082J45 + 0.019 (R = 0.792), ΔC = 0.401TIA + 0.323 (R = 0.489), and mean spherical aberration increased from -0.003 (SD, ±0.059; 95% confidence interval [CI], -0.015 to 0.009) to 0.028 μm (SD, ±0.041; 95% CI, -0.037 to -0.020); and (c) group 2, ΔJ0 = 0.952J0 - 0.005 (R = 0.921), ΔJ45 = 0.962J45 - 0.002 (R = 0.923), ΔC = 0.187TIA + 0.101 (R = 0.272), mean coma reduced from 0.114 (SD, ±0.087; 95% CI, 0.096 to 0.132) to 0.077 μm (SD, ±0.059; 95% CI, 0.065 to 0.089), and trefoil from 0.089 (SD, ±0.049; 95% CI, 0.079 to 0.0990) to 0.056 μm (SD, ±0.047; 95% CI, 0.046 to 0.066). Conclusions In comparison with SMILE, femtosecond LASIK offered better precision in the overall control of astigmatism and HOAs.

Objectives: The aim was to examine efficacy and safety after Implantable Collamer Lens (ICL) implantation for correction of myopia et myopic astigmatism. Methods: This prospective clinical study included 28 eyes of 16 patients which underwent implantation of ICL for correction of myopia up to -18,00 diopters (D) and myopic astigmatism up to -6,00 D in the Eye Clinic Svjetlost Sarajevo, from January 2013 to January 2016. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell (EC) density were evaluated at one, six and twelve months. For statistical analysis SPSS for Windows and Microsoft Excel were used. Results: Out of 16 patients, with mean age of 28,21 ± 4,06 years, 12 of them had binocular and 4 of them had monocular procedure. After 12 months mean UDVA was 0,76 ± 0,16 compared to UDVA 0,04 ± 0,03 preoperatively. Mean SE preoperatively was -0,21 ± 0,27 D compared to -9,52 ± 3,69 D preoperatively. At 12 months one eye (3,57%) lost 2 Snellen lines. In this study 8 eyes (28,57%) gained 1 line, 5 eyes gained (17,56%) 2 lines, and 3 eyes (10,72%) gained 3 lines. EC loss was 5,50±4.71% after 12 months. There was no significant change of IOP by the end of 12 months follow up period. One haptic crack was reported as the only intraoperative complication. Three postoperative complications were: two lens rotations and one retinal detachment. Conclusion: Implantation of ICL is an effective and safe method for reducing or correcting myopia and myopic astigmatism.

PURPOSE: To calculate the surgically induced astigmatism (SIA) following LASIK and identify any association between SIA and the target induced astigmatism (TIA) at 1 year postoperatively. METHODS: The SIA was calculated using the TIA and residual astigmatism values for [A] myopic astigmatism and [B] mixed astigmatism treated with either the [I] WaveLight Allegretto EyeQ 400-Hz (Alcon Laboratories, Inc. Fort Worth, TX) or [II] Schwind Amaris 750S (Schwind eye-tech-solutions, Kleinostheim, Germany) platforms. The TIA and corresponding SIA results were analyzed using various techniques. RESULTS: Key findings were the negative SIA power (y 1 ) was significantly correlated with negative TIA power (x 1 ) and sine of the TIA axis (x 2 ) as follows: [A] I, y 1 = 0.829x 1 –0.403x 2 –0.325 ( F = 87.76, r = 0.804, P < .001, n = 127); II, y 1 = 0.891x 1 –0.037x 2 –0.192 ( F = 240.06, r = 0.901, P < .001, n = 119) and [B] I, y 1 = 1.063x 1 +0.233x 2 +0.411 ( F = 990.99, r = 0.881, P < .001, n = 61); II, y 1 = 1.029x 1 –0.115x 2 +0.322 ( F = 270.12, r = 0.908, P < 0.001, n = 111). The sine of negative SIA axis (y 2 ) was significantly correlated with negative TIA power (x 1 ) and TIA axis (x 2 ) as follows: [A] I, y 2 = 0.951x 2 –0.007x 1 +0.008 ( F = 446.58, r = 0.950, P < .001, n = 127); II, y 2 = 0.856x 2 +0.007x 1 +0.105 ( F = 277.18, r = 0.912, P < .001, n = 119) and [B] I, y 2 = 0.953x 2 +0.009x 1 +0.075 ( F = 362.6, r = 0.963, P < .001, n = 61); II, y 2 = 0.977x 2 –0.004x 1 +0.002 ( F = 2910.9, r = 0.990, P < .001, n = 111). CONCLUSIONS: The predicted SIA power was up to 12% less than expected in cases of −6.00 diopters cylinder treated for myopic astigmatism using the Allegretto platform. The mean predicted angle of error (the angle between the SIA and TIA axes) was less than 4°, increasing to 12° for against-the-rule astigmatism. The Allegretto platform tended toward a clockwise axis rotational error, whereas the Amaris platform tended toward the opposite. [ J Refract Surg. 2017;33(2):104–109.]

Aim: The aim of this case report was to report the clinical and genetic characteristics of choroideremia patient and a family member carrier. Case report: A comprehensive ophthalmologic examination, BCVA (best corrected visual acuity), fundus examination and photography, optical coherence tomography (OCT), OCT–angiography (OCTA), perimetry was conducted in choroideremia patient and a family member carrier. Clinical findings of choroidermia patient presented as significant atrophy of the choroid and retinal pigment epithelium (RPE) with the exception of a portion of preserved tissue in the macula. OCT showed foveal thickening with parafovoal RPE and fotoreceptor (FR) atrophy. OCTA revealed loss of choriocapillaris vasculature. Clinical diagnosis of CHM mutation was confirmed by multiplex ligation-dependent probe amplification assay (MLPA), followed by sequencing which revealed pathogen variance (c.1584_1587delTGTT). Clinical findings of carrier: small peripheral zones of atrophy and hyper pigmentation, without any symptoms or major visible changes on OCT or OCTA. Conclusion: Following new frontiers in gene therapy it is of curtail importance to diagnose patients correctly as well as confirm clinical diagnosis by genetic testing.

Introduction: Diabetic retinopathy (DR) is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes. Disease severity was most often classified by the Early Treatment Diabetic Retinopathy Study (ETDRS) classification for DR severity. Patients are usually categorized based on the severity of DR as having mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative diabetic retinopathy (PDR). Aim: To evaluate DR status among patients at Eye Clinic Svjetlost Sarajevo , both, type 1 and type 2 DM patients who presented in our clinic at 2 years period – from June 2016 to June 2018. This is single center study. Methods: Retrospective analysis of 753 diabetic patients that came for the first check up in our institution during those two years, 363 patients were male and 390 were female. Patients were divided in 3 groups (based on DR changes): a) No changes, b) Nonproliferative DR (with and without Diabetic macular edema–DME), c) Prolipherative DR (with and without DME + Advanced PDR). Results: There were 35% of patients with no ocular changes, 41.2% had NPDR and 24% had PDR. Prevalence of DR in our study was 65.32%. Distribution of NPDR was 66.27%, and PDR was 33.73%. DME was present in 33.70% cases. In NPDR, DME was presented in 51% of the cases, while in PDR was presented in 49% of the cases. In state of advanced PDR, PDR was presented in 30.52% cases, tractional detachment and haemophtalmus in 50.20% of cases and neovascular glaucoma in 19.28%. Sixty-three patients ended up with vitroretinal surgery (8.4%) while in other studies that number is up to 3%. Out of that number 9 patients were patient with virgin eyes (14.28%). Neovascular glaucoma occurred in 19.28% of diabetics with proliferative retinopathy and 4.60% in all of diabetics. Conclusion: Diabetic retinopathy status of patients presenting at Eye clinic Svjetlost Sarajevo, Bosnia and Herzegovina is quite poor. There is a big need for early DR screening measures, good prevention and management of DR risk factors. Adequate and ON TIME management of DM and its vision threatening complications is of major importance.

Introduction DVD is a rare, poorly understood eye motility disorder of unknown etiology. In socially unacceptable deviation, surgical treatment is an option. We present patients operated with three different surgical methods. Aim To evaluate and compare different surgical approaches for treatment of dissociated vertical deviation (DVD). Methods Total amount of 20 patients with DVD of ≥ 20 PD are operated with three different techniques on superior rectus (SR) muscle: Group I with preoperative angle of 20-30 PD was operated with 8 mm recession of SR, Group II with preoperative angle of ≥ 30 PD undergo 3 mm recession with posterior fixation on SR and Group III with preoperative angle of ≥ 30 PD undergo-splitting of SR muscle. Surgeries for associated horizontal deviations were performed before surgery for DVD. Follow up was three years. Results In all cases amount of DVD deviation was significantly reduced. No binocularity was gained. Although hyperdeviation of affected eye was reduced in all patients, we didn't eliminate deviation completely. Despite smaller preoperative angle, residual angle was bigger (6-12 PD) in the patients in group I where only recession of SR was performed, compared to Group II and III where postoperative angle was 4-8 PD in both groups. Conclusion There are no recommended guidelines for the surgical treatment of DVD and treatment is based more on the surgeon's experience than evidence based data. In our experience recession of the SR should be method of choice in the cases of smaller deviation. SR recession combined with posterior fixation suture and Y-splitting seems to be a safe and effective method for surgical treatment of unilateral DVD with bigger deviation angles. Y splitting with less surgical complications and increasing effect with time can be a good alternative to posterior fixation surgery.

One of the most widely performed surgical procedures nowadays is cataract surgery combined with monofocal intraocular lens implantation (IOL). Monofocal IOLs are able to compensate for the spherical refractive error but not astigmatism. Thus, patients with astigmatism are unable to see well after surgery without spectacles. New generation of IOLs, called toric IOLs, improve uncorrected visual acuity in eyes with high astigmatism due to a specific lens design. The amount and the axis of astigmatism in each particular eye is specific; thus, toric IOL has to be produced individually, making cataract surgery in patients with astigmatism a personalized one. Additional problem with monofocal IOLs in all cataract cases (including those with astigmatism) is presbyopia. With monofocal lenses, only the distance vision is fully corrected and every patient has to wear spectacles for near vision. Optical design of IOLs with more foci, so-called multifocal IOLs, enables patients to see well both at a distance and near. When first models of toric bifocal and trifocal IOLs were invented, combined refractive errors (myopia, hyperopia, or presbyopia with astigmatism) could also be successfully corrected. Toric multifocal IOLs are again produced as personalized lens since the amount and angle of astigmatism is different in each eye. A truly exciting new era has started in the field of ophthalmology, enabling the surgeon to provide patients with specific needs with an intraocular lens produced specifically for them and thus to fully correct patient vision at all distances.

Objectives: The aim of this study was to evaluate visual and refractive outcomes after Veriflex phakic intraocular lenses (pIOL) implantation in moderately myopic eyes as well as postoperative complications. Methods: This prospective clinical study included 40 eyes of 26 patients which underwent implantation of Veriflex for correction of myopia from -6.00 to -14.50 diopters (D) in the Eye Clinic Svjetlost Sarajevo, from January 2011 to January 2014. Uncorrected distance visual acuity (UDVA), manifest residual spherical equivalent (MRSE), intraocular pressure (IOP), endothelial cell (EC) density were evaluated at one, three, six and 12 months. Other complications in postoperative period were evaluated. For statistical analysis SPSS for Windows and Microsoft Excel were used. Results: Out of 26 patients 14 had binocular and 12 monocular procedure, with mean age of 29.8±6.5 years. After 12 months mean UDVA was 0.73±0.20. Mean MRSE was -0.39±0.31D and 90% of eyes had MRSE within ±1D. EC loss was 7.18±4.33%. There was no significant change of IOP by the end of 12 months follow up period. The only intraoperative complication was hyphema and occurred in one eye. Few postoperative complications were: subclinical inflammation in three eyes (7, 5%), pigment dispersion in four eyes (10%), ovalisation of papilla in 2 eyes (5%) and decentration of pIOL in 2 eyes (5%). Conclusion: Implantation of iris-claw phakic lenses Veriflex for treating moderately high myopia is a procedure with good visual and refractive results and few postoperative complications.

PURPOSE: To compare the outcomes of astigmatic laser in- situ keratomileusis (LASIK) procedures between two different platforms using J0 and J45 vector analysis. METHODS: Patients were divided into four groups, depending on the type of astigmatism and laser platform on which they were treated. Astigmatism was between 2 and 7 diopters (D). One hundred and thirty-five patients with myopic astigmatism (246 eyes) and 102 patients with mixed astigmatism (172 eyes) underwent unremarkable LASIK correction on Wavelight Allegretto Eye-Q 400Hz and Schwind Amaris 750S laser platform. The preoperative and postoperative sphere, negative cylinder [C] and axis (ø) of manifest refractions were subjected to vector analysis by calculations of the standard J0 (cos [4π(ø-90)/360]xC/2) and J45 (sin[4π(ø-90)/360]xC/2). RESULTS: Reporting the key results, we found J0 significantly reduced after LASIK in both groups (p

Objective: To evaluate the effect of an aspheric LASIK refractive enhancement performed by relifting the original flap on the higher order aberrations (HOA) of the eye and the relationship between central corneal thickness (CCT) and intra-ocular pressure (IOP). Methods: Consecutive case series of 30 eyes requiring refractive enhancement from 1804 uncomplicated primary LASIK procedures performed in 2012. Flap relift and wavefront optimized ablation (Wavelight Allegretto Eye Q 400 Hz excimer laser) were performed in all cases. Pre-and post-operative examination included Shack-Hartmann aberrometry for 3 mm and 5 mm pupil sizes, CCT and IOP. Postoperative results at 1 year were compared to baseline values. Results: Changes in average values of coma, spherical aberration (SA), trefoil, CCT and IOP were not significant. Linear regression revealed significant associations between change (y) in trefoil and pre-enhancement value of trefoil for 3 mm pupil (0.828x-0.045, r=0.722, p

Objective: Corneal grafts have a major risk of fungal keratitis due to long-term local and sometimes systemic steroid/antibiotic use. The aim of this study was to evaluate the efficacy of intrastromal voriconazole as a therapeutic adjunctive for the management of fungal keratitis in corneal graft. Design: Presentation of two cases of fungal keratitis occurring after corneal transplantation and treated at the University Eye Hospital “Svjetlost”. Participants and Methods: Two cases of postkeratoplasty fungal keratitis are presented in the study. Both patients had decreased visual acuity, eye redness and severe pain occurring at 10 and 12 months after uneventful corneal transplantation. They were still receiving steroid/antibiotic topical treatment to protect their corneal graft. Patients presented with a stromal infiltrate in a donor tissue, accompanied with corneal ulcer at recipient/donor junction. Candida infection was proven by corneal scraping. Topical and systemic antimycotic treatment was started, fortified by intrastromal injection of voriconazole (50 μg/0.1 ml) given all around the junction of clear cornea and infiltrate (or ulcer). Results: One week after injection, corneal ulcers had healed and corneal infiltrates decreased; resulting in visual acuity improvement from 20/100 to 20/20 in first, and from 20/80 to 20/40 in a second case. One year after infection visual acuity in the first case remained 20/20, and improved to 20/20 in a second case. Conclusion: Intrastromal voriconazole seems to be a safe method for providing a higher concentration of the drug in the cornea affected by fungal keratitis; it can serve as an adjunctive treatment to topical and systemic antifungal therapy.

Purpose To compare functional outcomes of Wavelight Allegretto Eye-Q 400Hz and Schwind Amaris 750S excimer laser for astigmatism between 2 and 7 diopters(D). Methods Prospective comparative non-randomized case series of 480 eyes assigned in two laser groups and further divided into myopic and mixed astigmatism subgroups. All treatments were centered on corneal vertex. One-year results were compared between the groups. Statistical analysis was performed using z-test. Results Both Allegretto and Amaris postoperative uncorrected distance visual acuity (UDVA) improved in comparison to preoperative corrected distance visual acuity (CDVA). The difference was significant in the Allegretto group for myopic astigmatism (p = 0.017). There was no difference in postoperative UDVA between lasers. Average sphere decreased in all groups for both lasers (p