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Cilj istraživanja: Cilj ovog retrospektivnog istraživanje je odrediti učestalost akutnog monosimptomaskog optičkog neuritisa i ispitati povezanost akutne epizode monosimptomaskog optičkog neuritis i razvoja multiple skleroze. Materijali i metode: Podaci za istraživanje su retrogradno prikupljeni iz medicinske dokumentacije ispitanika. Ispitanici sa simptomima akutnog monosimptomatskog optičkog neuritisa i abnormalanostima u oftalmološkom pregledu su bili uključeni u istraživanje, a ispitanici s dijagnozom multiple skleroze, prethodno liječenim optičkim neuritisom i drugim intraokularnim bolestima su bili isključeni iz istraživanja. 87 ispitanika je bilo podvrgnuto pregledu oftalmologa i neurologa i pretrazi VEP-a tijekom hospitalizacije. Zdrastvene promjene u ispitanika kasnije su se pratile oftalmološkim i neurološkim pregledom. Ako bi tijekom razdoblja praćenja ispitanik razvio simptome multiple skleroze i ako bi nalaz MR mozga pokazao nove lezije tada bi smatrali da je došlo do razvoja multiple skleroze. Rezultati: Od 87 ispitanika 59 (67,8 %) ispitanika su bile žene, a 28 (32,2 %) ispitanika su bili muškarci. Prosječna dob pri dijagnosticiranju optičkog neuritisa kod žena je bila 25,9 godina (SD 11,3), a kod muškaraca 29,9 godina (SD 9,2). Godišnja stopa incidencije je bila 1,9 na 100 000 (95 % IP, 0,4 – 3,5) stanovnika. Godišnja stopa incidencije za muškarce je bila 1,2 (95% IP, 0 – 2,9) slučaja na 100 000 stanovnika. Godišnja stopa incidencije za žene je bila 2,5 (95% IP, 0,1 – 4,9) slučaja na 100 000 stanovnika. Izračunati relativni rizik za ženski spol bio je 1,4 (95 % IP, 0,4 - 6,6), što je statistički značajno. Najveća stopa incidencije pojave bolesti u oba spola je u skupini ispitanika čija je životna dob između 20 i 29 godina, a njena vrijednost iznosi 4,9 (95 % IP, 0 - 11,4). Na incidenciju akutnog monosimptomatskog optičkog neuritisa, godišnja doba značajno ne utječu (𝒙 = 6,81, p = 0,080). Od 87 ispitanika, 20 ispitanika (22,9 %) je razvilo multiplu sklerozu. Medijan vremenskog razdoblja do dijagnosticiranja multiple skleroze kod ispitanika je 25 (SE 8) mjeseci, (95 % IP, 9 - 41). Multipla skleroza se razvila kod 12,6 % ispitanika s monosimptomatskim optičkim neuritisom nakon 2 godine, kod 20,6 % ispitanika nakon vremenskog razdoblja od 5 godina i kod 22,9 % ispitanika nakon jednog desetljeća. Optički neuritis neznatno češče progredira u multiplu sklerozu kod ženskog spola (𝒙 2 = 0,72, p = 0,3). 46 Zaključak: Rizik razvoja multiple skleroze poslije epizode akutnog optičkog neuritisa prema istraživanju provedenom u ovom diplomskom radu je umjeren. Optički neurtis je relativno često „uvertira“ multiple skleroze zbog toga je potrebno poboljšati psihološku potporu pacijentima i istraživati nove terapijske metode liječenja., Objectives: The aim of this retrospective study is to determine the incidence of acute monosymptomatic optic neuritis and to examine the association between an acute episode of monosymptomatic optic neuritis and the development of multiple sclerosis. Materials and methods: Data for the research were collected retrogradely from the medical records of the patients. Patients with symptoms of acute monosymptomatic optic neuritis aged between 18 and 46 and abnormalities in the ophthalmological examination were included in the study and patients with a diagnosis of multiple sclerosis, previous optic neuritis treated with corticosteroids and other intraocular diseases were excluded from the study. 87 patients were examined by ophthalmologists and neurologists and examined by VEP during hospitalization. A complete ophthalmological examination included visual acuity examination, color vision examination and visual field examination assessed with the help of Goldmann's perimeter. The patient's health condition was later followed up by an ophthalmological and neurological examination. If the patient developed symptoms of multiple sclerosis during the follow-up period and if the MR examination detected new lesions, then it would be considered that the patient had a diagnosis of multiple sclerosis. Results: Out of 87 patients, 59 (67,8 %) patients were women and 28 (32,2 %) patients were men. The average age at diagnosis of optic neuritis in women was 25,9 years (SD 11,3) and in men 29,9 years (SD 9,2). The annual incidence rate was 1,9 per 100 000 (95 % CI, 0,4 – 3,5) population. The annual incidence rate for men was 1,2 (95 % CI, 0 – 2,9) cases per 100 000 population. The annual incidence rate for women was 2,5 (95 % CI, 0,1 – 4,9) cases per 100 000 population. The calculated relative risk for women was 1,4 (95 % CI, 0,4 – 6,6), which was statistically significant. The highest incidence rate of the occurrence of the disease in both sexes is in the group of patients whose age was between 20 and 29 years and the value was 4,9 (95 % CI, 0 – 11,4). Seasons did not significantly affect the incidence of acute monosymptomatic optic neuritis (𝒙 = 6,81, p = 0,080). Out of 87 patients, 20 patients (22,9 %) developed multiple sclerosis. The median time to diagnosis of multiple sclerosis in patient was 25 (SE 8) months, (95 % CI, 9 - 41). Multiple sclerosis developed in 12,6 % of patients with monosymptomatic optic neuritis after 2 years, in 20,6 % of patients after a time period of 5 years, and in 22,9 % of patients after a decade. Optic neuritis progressed slightly more often to multiple sclerosis in 49 women (𝒙 2 = 0,72, p = 0,3). Conclusion: The risk of developing multiple sclerosis after an episode of acute optic neuritis according to the research conducted in this graduation thesis is moderate. Optic neuritis is relatively often the "overture" of multiple sclerosis which is reason why it is necessary to improve psychological support for patients and research new therapeutic methods of treatment.

Since only few reported studies propose anti-vascular endothelial growth factor (anti-VEGF) delivery through electrospun scaffolds, this study greatly contributes to the potential prevention of patient’s vision loss, as it explores electrospun polycaprolactone (PCL) coated with anti-VEGF for the blockage of abnormal cornea vascularization. In terms of physicochemical properties, the biological component increased the PCL scaffold fiber diameter (by ~24%) and pore area (by ~82%), while ut slightly reduced its total porosity as the anti-VEGF solution filled the voids of the microfibrous structure. The addition of the anti-VEGF increased the scaffold stiffness almost three-fold at both strains of 5 and 10%, as well as its biodegradation rate (~36% after 60 days) with a sustained release profile after Day 4 of phosphate buffered saline incubation. In terms of scaffold application function, the PCL/Anti-VEGF scaffold proved to be more favorable for the adhesion of cultured limbal stem cells (LSCs) ; this was confirmed by the SEM images, where the cells showed flat and elongated conformations. Further support of the LSC growth and proliferation was con-firmed by the identified p63 and CK3 markers after cell staining. These results demonstrate the advantageous effect of the surface-adsorbed anti-VEGF to stop vision loss and help damaged corneal tissue repair.

Senilna makularna degeneracija (SMD) bolest je centralnog dijela mrežnice. Vodeći je uzrok sljepoće u populaciji iznad 55 godina života i treći globalni uzrok sljepoće iza mrene i glaukoma. Brojna su istraživanja usmjerena na razumijevanje etiopatogeneze i pronalazak potencijalnih biomarkera. Glikozilacija je proces posttranslacijske modifikacije proteina. Imunoglobulini G (IgG) najbolje su proučeni N-glikoproteini koji sudjeluju u kontroliranom imunološkom odgovoru, a razlika u glikozilacijskom profilu IgG ovisi o genetičkoj i epigenetičkoj regulaciji, kao i konstitucijskim i okolišnim čimbenicima. Promjene glikozilacije nazočne su u ranoj akutnoj fazi i razvojem kroničnih stadija bolesti, pa bi analiza glikanskog profila proteina i imunoglobulina G u plazmi bila značajna u rasvjetljivanju mehanizama uključenih u patogenezu SMD-a. Cilj ovog istraživanja bio je ispitati promjene obrasca glikozilacije sveukupnih proteina i imunoglobulina G u plazmi, u različitim skupinama ispitanika s degenerativnim promjenama u makuli iz kohorte „10, 001 Dalmatinac” te ih usporediti s relevantnom kontrolnom skupinom. Ispitanici s jednostranim i obostranim znakovima senilne makularne degeneracije bili su starije životne dobi, s poremećenim metabolizmom lipida. Multivarijantnom analizom glikanskih struktura u ispitanika s makularnom degeneracijom mlađih od 55 godina nije dobiven statistički značajan rezultat. U ispitanika starije životne dobi s jednostranom prezentacijom senilne makularne degeneracije najznačajniji rezultat predstavljaju snižene razine digalaktoziliranih biantenarnih glikana sa sržnom fukozom i terminalno vezanom sijalnom kiselinom [IgG_GP18 (P < 0,009)], što upućuje na slom reparativnih mehanizama i poremećaj imunološke regulacije. U ispitanika s obostranim znakovima senilne makularne degeneracije najznačajniji rezultat predstavlja porast tetraantenarnih glikanskih struktura s fukozilacijom vanjske grane [DG13 (P < 0,001)], što odgovara promociji upalnog stanja u organizmu. Sve tri skupine ispitanika u jednoj kategoriji u odnosu na kontrolnu skupinu značajno su se razlikovale samo u porastu tetraantenarnih glikana s fukozilacijom vanjske grane. Takav rezultat otkriva nedostatke provedenog istraživanja u smislu poprečne prirode studije temeljene na jednostrukom mjerenju glikanskih struktura iz jednog dostupnog biološkog uzorka. Ustroj budućih studija trebao bi se temeljiti na preciznijoj procjeni i klasifikaciji ispitanika prema fenotipu bolesti, uz kontinuirano kliničko praćenje i višestruko mjerenje glikana iz različitih bioloških uzoraka., Age-related macular degeneration (AMD) is a disease of the central portion of the retina. It is the leading cause of blindness in over-55 population and the third cause of blindness globally, after cataracts and glaucoma. Numerous research projects are devoted to elucidating the etiopathogenesis and identifying potential biomarkers. Glycosylation is the post-translational modification process for proteins. Immunoglobulin G (IgG) is well-studied N-glycoprotein that participates in the homeostatic control of the immune response. The interindividual variation in the glycosylation profile of IgG is affected by the expression of glycan-related genes, epigenetic regulation, as well as constitutional and environmental factors. Glycosylation changes are present in the early acute phase and the development of chronic stages of the disease; therefore, the analysis of the glycan profile of proteins and immunoglobulin G in plasma would be significant in identifying the processes involved in the pathogenesis of AMD. The objective of this study was to compare the glycosylation patterns of total proteins and immunoglobulin G in plasma from different groups of 10,001 Dalmatian subjects with macula degeneration to a relevant control group. The subjects with unilateral and bilateral signs of AMD were elderly people and had dysfunctional lipid metabolism.The multivariate analysis of glycan structures did not produce a significant result in subjects under 55 years of age with macular degeneration. The most significant result regarded lower odds for di-galactylated bi-antennary glycans with core fucose and terminally attached sialic acid [IgG_GP18 (P < 0,009)] in unilateral cases of AMD. The described alterations in glycan structures may indicate a failure of reparative para-inflammatory mechanisms. The most significant result revealed increased odds for tetra-antennary structures with fucosylation of the outer branch grane [DG13 (P < 0,001)], which is a strong indicator of inflammation, in bilateral cases of AMD. Only the increase in tetra-antennary glycans with fucosylation of the outer branch was significantly different between the three subject groups in one category and the control group. This result reveals the limitations of the conducted research due to the cross-sectional nature of the study based on a single measurement of glycan structures from a single available biological sample. Future studies should aim for a more precise evaluation and classification of subjects according to disease phenotype, with continuous clinical monitoring and multiple measurements of glycans in various biological samples.

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.

Izražaji biljega p19, Ki-67, MSX1, MSX2, PDL1, pRB, CYCLINA2, citokeratina 8 i vimentina kvantitativno su i semikvantitativno analizirani u histološkim presjecima ljudskog oka u razvoju u 8. tjednu i postnatalnom oku te u retinoblastomu i u različitim uvealnim melanomima korištenjem dvostruke imunofluorescencije. Imunoreaktivnost p19 karakterizira mrežnične i/ili žilnične stanice u zdravim i tumorskim tkivima: izražaj je bio niži u postnatalnoj mrežnici nego u mrežnici i retinoblastomu u razvoju, dok je bio visok u epiteloidnim melanomima. Izražaj Ki67 bio je visok u oku u razvoju, retinoblastomu i melanomima žilnice. Izražaj MSX1 i MSX2 bio je sličan u oku u razvoju i retinoblastomu, dok izražaja nije bilo u postnatalnom oku. Njihov različit izražaj bio je očit između epiteloidnog i miksoidnog melanoma. Slično, PDL1 je bio odsutan u epiteloidnim melanomima, dok je bio visoko izražen u tkivima u razvoju i tumorskim tkivima. Izražaj pRB i CYCA2 bio je karakterističan za uzorke oka u razvoju i tumoru, ali ne i u zdravom postnatalnom oku. Izražaj citokeratina 8 i vimentina u korelaciji je s izražajem u epitelu i mezenhimu u razvoju oka i neoplazmi. Uočene razlike u izražaju analiziranih biljega koreliraju s podrijetlom i stupnjem stanične diferencijacije uzoraka tkiva. Fina ravnoteža izražaja mogla bi igrati ulogu u razvoju ljudskog oka i tumorigenezi oka. Stoga bi razumijevanje njihova odnosa i međudjelovanja moglo otvoriti nove puteve za potencijalne terapijske intervencije i bolje razumijevanje mehanizama koji leže u osnovi razvojne plastičnosti oka i nastanka neoplazmi., The expression pattern of the markers p19, Ki-67, MSX1, MSX2, PDL1, pRB, CYCLINA2, citokeratin 8 and vimentin was quantitatively and semiquantitatively analyzed in histologic sections of the developing and postnatal human eye at week 8, in retinoblastoma, and in various uveal melanomas post hoc studies by double immunofluorescence. The p19 immunoreactivity characterized retinal and/or choroidal cells in healthy and tumor tissues: expression was lower in the postnatal retina than in the developing retina and retinoblastoma, whereas it was high in epithelioid melanomas. Ki67 expression was high in the developing eye, retinoblastoma, and choroidal melanomas. MSX1 and MSX2 expression was similar in the developing eye and retinoblastoma, whereas it was absent in the postnatal eye. Their different expression was evident between epithelioid and myxoid melanomas. Similarly, PDL1 was absent in epithelioid melanomas, whereas it was highly expressed in developing and tumor tissues. Expression of pRB and CYCA2 was characteristic of developing and tumorous eye samples but not of the healthy postnatal eye. Cytokeratin 8 and vimentin expression correlated with epithelial and mesenchymal expression in eye development and neoplasm. The observed expression differences of the analyzed markers correlate with the origin and stage of cell differentiation of the tissue samples. The fine balance of expression could play a role in both human eye development and ocular tumorigenesis. Therefore, understanding their relationship and interplay could open new avenues for potential therapeutic interventions and a better understanding of the mechanisms underlying the developmental plasticity of the eye and the development of neoplasms.

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.

Purpose The aim of this study was to analyse the postoperative corneal cross-linking results of corneal parameters and the ABCD grading system, depending on the cone location. Methods Thirty eyes of 25 patients with keratoconus (KC), who received the corneal cross-linking (CXL) treatment, were included in this study. The exclusion criteria were: patients under 18 years of age, corneal pachymetry less than 400 μm, corneal scarring, history of ocular trauma, history of ocular surgery, and corneal pathology other than KC. Patients were examined at the baseline visit, and followed-up at three, six, and twelve months after the CXL. All patients underwent visual acuity and Scheimpflug tomography at all visits. Progression parameters, keratometries, and ABCD grading were compared between the visits. Patients were classified into two groups: central and paracentral cones group (within the central 5 mm corneal zone) and peripheral cones group (outside the central 5 mm corneal zone), based on X-Y coordinates of maximal keratometry (Kmax). Results Parameter A remained relatively stable throughout the follow-up period in both groups. Parameter B and parameter C showed a significant increase in both groups postoperatively. Parameter D showed stability at the 6-month post-CXL visit in the peripheral KC group, while the central and paracentral KC group showed improvement at the 12-month post-CXL visit. Conclusion There was no significant difference in the postoperative response between different cone locations in the ABCD grading system, when classifying according to the Kmax, except an earlier recovery of the parameter D in peripherally located cones.

Objectives: The purpose of this study is to identify similarities in age, sex, eye affected, and visual acuity of rhegmatogenous retinl detachemtn (RRD) and to find a correlation between a patient’s visual acuity and rhegmatogenous RD. In addition, this study aims to determine the seasonal variations of incidences. Methods: This study included 105 patients diagnosed and treated for rhegmatogenous retinal detachment in Split-Dalmatia County. Patients’ ages spanned 20-91 years. All patient data was extracted from the Split Retinal Disorders registry from 2005 to 2022. Results: Out of 105 patients treated with RRD, 64.7% were male; the average age of the patients was 62 years old. In these patients, the left and right eyes were affected the same amount of 49.5%. Regarding visual acuity, myopia prevailed with an average of -2 and -5.3 in the right and left eyes respectively. The majority of cases occurred during winter (42%), with the remaining being summer (25%), spring (19%), and fall (14%). Conclusion: Patients diagnosed with RDD were more likely to be middle-aged, around 60. Males have a slightly higher chance of RRD. While which eye is affected does not bring an indication for occurrence, patients with myopia have a higher risk of RDD than those with hyperopia. Winter is the season with a higher incidence rate., Ciljevi: Svrha ovog rada je utvrditi sličnosti u dobi, spolu, zahvaćenosti oka i oštrini vida kod rematogene RD i pronaći korelaciju između bolesnikove vidne oštrine i regmatogene RD. Osim toga, ova studija ima za cilj utvrditi sezonske varijacije incidencije. Materijali I metode: Ovo istraživanje obuhvatilo je 107 bolesnika s dijagnosticiranom i liječenom regmatogenom ablacijom retine u Splitsko-dalmatinskoj županiji. Dob bolesnika kretala se od 20 do 91 godine. Podaci o svim pacijentima izdvojeni su iz Split Retinal Disorders registra od 2005. do 2022. godine. Rezultati: Od 107 bolesnika liječenih s RRD-om, 64% su bili muškarci; prosječna dob bolesnika bila je 62 godine. U ovih bolesnika lijevo oko bilo nešto više zahvaćeno s 50,5%. Što se tiče vidne oštrine, prevladavala je kratkovidnost s prosjekom -2 i -5,3 na desnom i lijevom oku. Većina slučajeva dogodila se tijekom zime (43%), a ostali su bili ljeto (25%), proljeće (19%), jesen (13%). Zaključci: Bolesnici s dijagnozom regmatogenog odvajanja mrežnice vjerojatnije su bili srednje dobi, oko 60 godina. Muškarci imaju nešto veće šanse za RRD. Dok koje je oko zahvaćeno ne daje indikaciju za pojavu, bolesnici s kratkovidnošću imaju veći rizik od RDD-a od onih s hiperopijom. Zima je godišnje doba s višom stopom incidencije.

Osteo-odonto-keratoproteza vrsta je keratoproteze, tj. nadomjestka koji zamjenjuje rožnicu kada keratoplastika i transplantacija stanica ruba rožnice nisu moguće. Koristi se kod najtežih oblika disfunkcije očne površine , kada su drugi postupci završili neuspjehom ili nisu mogući. Kiruršku tehniku postupkaprvi je izveo i publicirao Strampelli, usavršio Falcinelli, a standardizirana je Rimsko-Bečkim protokolom. Za postupak je potrebna suradnja oftalmološkog i oralnog kirurga, jer se njime sjedinjuju tkiva usne šupljine s tkivima površine oka. Prije operacije vrši se oftalmološka, stomatološka i psihološka provjera i priprema pacijenta. Operacija je složena i sastoji se od više faza. Postupak započinje pripremom površine oka za primanje osteo-dentalne lamine izrađene iz zuba. Tkiva površine oka obrade se i prekriju režnjem sluznice, obično sluznice obraza. Pogodan jednokorjenski zub ekstrahira se zajedno s okolnom kosti i obradi u oblik pločice s otvorom za optički cilindar. Ta osteodentalna lamina implantira se u supkutani džepić gdje se obavija vezivnim tkivom idućih nekoliko mjeseci. U drugoj fazi osteo-dentalna lamina implantira se na prednju površinu bulbusa i pokrije mukoznim režnjem. Za dugotrajnost presatka potrebne su doživotna briga i redovite liječničke kontrole. Pacijent može postići zadovoljavajuću ili odličnu vidnu oštrinu, sa smanjenim vidnim poljem. Najčešće komplikacije su krvarenje, nuspojave sluznice, glaukom, resorpcija osteo-dentalne lamine i odvajanje mrežnice. Osteo-odonto-keratoprosthesis is a type of keratoprosthesis, i.e. prosthesis that replaces the cornea when neither the keratoplasty nor the transplantation of corneal limbus cells are possible. It is used in the most severe forms of ocular surface dysfunction, when other procedures have failed or are impossible. The surgical technique of the procedure had been for the first time performed and published by Strampelli, and afterwards improved by Falcinelli and standardized by the Rome-Vienna Protocol. The procedure requires a cooperation of an ophthalmic and an oral surgeon, as it involves the joining of oral and ocular surface tissues. Prior to the surgery, ophthalmological, dental and psychological assesment and preparation of a patient are done. The operation is complex and consists of several stages. It starts by preparing the ocular surface to receive an osteo-dental lamina made from the tooth. The tissues of the ocular surface are prepared and covered with a mucosal flap, usually the buccal mucosa. A suitable single-rooted tooth is extracted along with the surrounding bone and shaped in the form of a lamina with an opening for the optical cylinder. This osteo-dental lamina is implanted in a subcutaneous pocket where it will be enveloped by connective tissue within a few months. In the second stage, an osteo-dental lamina is implanted on the anterior surface of the bulbus and covered with a mucous flap. Transplant survival requires lifelong care and regular medical check-ups. The patient can achieve a satisfactory or excellent visual acuity, with a reduced visual field. The most common complications are bleeding, mucosal complications, glaucoma, resorption of the osteo-dental lamina and retinal detachment.

Cilj istraživanja: Istražiti ulogu pupilometrije u predviđanju pojave intraoperativnog sindroma mlohave šarenice (IFIS) kao komplikacije operacije mrene, tehnikom fakoemulzifikacija u bolesnika na odjelu za očne bolesti u KBC-u Split od veljače do lipnja 2022.godine. Ispitanici i postupci: Uključena su 72 bolesnika u dobi od 60 do 85 godina kojima je operirana katarakta na odjelu za očne bolesti u KBC-u Split u navedenom petomjesečnom razdoblju. Analizirani su podatci o dob i spol bolesnika, aksijalna duljina oka, broj endotelnih stanica rožnice, dubina prednje sobice (engl. Anterior chamer deapth-ACD), keratometrija, postojanje pseudoeksfolijativnog sindroma (PEX), terapija koju bolesnik uzima te se pratila pojavnost IFIS-a. Rezultati: Uočeno je kako bolesnici s IFIS-om imaju značajno manji promjer zjenice operiranog oka u 5. sekundi u usporedbi s ispitanicima bez IFIS-a (P=0,0411). Također dobivenim rezultatima pokazana je povezanost uzimanja α-adrenergičnog agonista tamsulozina i pojave IFIS-a (P, Objective: The aim of this study was to investigate the role of pupillometry in predicting the occurrence of intraoperative floppy iris syndrome (IFIS) as a complication of cataract surgery, using the phacoemulsification technique in patients at the Department of Eye Diseases in University hospital of Split from February to June 2022. Subjects and methods: 72 patients between the ages of 60 and 85 who underwent cataract surgery at the Department of Ophthalmology at the University Hospital of Split in the specified five-month period were included. Data on the patient's age and sex, axial length of the eye, number of corneal endothelial cells, anterior chamber depth (ACD), keratometry, the existence of pseudoexfoliative syndrome (PEX), the therapy the patient is taking, and the incidence of IFIS were analyzed. Results: It was observed that patients with IFIS have a significantly smaller diameter of the pupil of the operated eye in the 5th second compared to subjects without IFIS (P=0.0411). The results also showed a connection between taking the α-adrenergic agonist tamsulosin and the occurrence of IFIS (P

Sudi Patel,1 Larysa Tutchenko2 1“Svjetlost” Speciality Eye Hospital, School of Medicine, University of Rijeka, Zagreb, Croatia; 2Kyiv City Clinical Ophthalmological Hospital “Eye Microsurgical Center”, Kyiv, UkraineCorrespondence: Sudi Patel Heinzelova 39, Zagreb, 10000, CroatiaEmail drsudipatel1@gmail.comAbstract: Recent evidence indicates that the corneal back surface astigmatism (CBSA) contributes to the refractive state of the eye in cataract surgery, especially with the implantation of toric intraocular lenses. But this has been met with some scepticism. A review of key studies performed over the past three decades shows that the mean CBSA power ranges from 0.18(± 0.16)D to 1.04(± 0.20)D. The clinical assessment of CBSA is problematic. There is poor agreement between the current automated systems for assessment of CBSA and it is assumed that these systems directly measure the CBSA. But CBSA cannot be measured directly in vivo. A historical review of methods used to quantify the curvature of the posterior corneal surface reveals that CBSA estimated by current systems is based on values for corneal front surface astigmatism, corneal refractive index, central corneal thickness, corneal thickness at peripheral locations and the exact distance between the corneal apex and each one of these peripheral locations. Doubts and errors in these values, coupled with the precise details of the algorithm incorporated to estimate CBSA, are the likely sources of the lack of agreement between current systems. These systematic errors cloud the assessment of CBSA. Mean CBSA may be low, but it varies from case to case. There is a clear need for a realistic, practical procedure for clinicians to independently calibrate systems for estimating CBSA. This would help to reduce uncertainty and the discrepancies between instruments designed to measure the same parameter.Keywords: cornea, back surface, astigmatism, radius, thickness, refractive index

Ciljevi: Mjerenje brzine protoka u sistoli (VS), brzine protoka u dijastoli (VD) i indeksa otpora (RI) kroz unutarnju karotidnu arteriju (ACI) kod ispitanika sa pseudoeksfolijativnim glaukomom (PEX) i ispitanika s primarnim glaukomom otvorenog kuta (POAG) kako bi se utvrdila razlika koja bi govorila u korist vaskularnih čimbenika kao rizičnih faktora za nastanak i progresiju pseudoeksfolijativnog glaukoma. Ispitanici i metode: Istraživanje obuhvaća 80 ispitanika podjeljenih u dvije skupine. Skupina POAG sastoji se od 40 ispitanika sa obostranim primarnim glaukomom otvorenog kuta. U skupini PEX je 40 ispitanika sa pseudoeksfolijativnim glaukomom od čega ih 13 ima obostrana oštećenja, 11 unilateralno na desnom oku i 16 ispitanika samo na lijevom oku. Doppler ultrazvukom mjereni su VS ACI, VD ACI, i RI ACI u 4 navrata s razmacima od 6 mjeseci. Rezultati: Indeks otpora pokazao je razlike u vidu viših vrijednosti u PEX skupini (P=0,031) od vrijednosti izmjerenih u skupini POAG. Brzine protoka u sistoli i dijastoli nisu se pokazale statistički značajnima. Unutar skupine PEX pronađene su veće brzine protoka u sistoli i dijastoli na lijevom oku nego na desnom. Zaključci: Povećan indeks otpora u unutarnjoj karotidnoj arteriji upućuje kako vaskularni čimbenici rizika imaju ulogu u razvoju pseudoeksfolijativnog glaukoma. Dobiveni rezultati također sugeriraju postojanje razlike u značaju vaskularnih čimbenika između pseudoeksfolijativnog glaukoma i primarnog glaukoma otvorenog kuta., Objectives: Measurement of systolic flow velocity (VS), diastolic flow velocity (VD), and resistance index (RI) in internal carotid artery (ACI) in subjects with pseudoexfoliative glaucoma (PEX) and subjects with primary open-angle glaucoma (POAG) to determine the difference that would be in favor of vascular factors as risk factors for origin and progression of pseudoexfoliative glaucoma. Subjects and methods: The research includes 80 subjects divided into two groups. The POAG group consists of 40 subjects with bilateral primary open-angle glaucoma. In the PEX group there are 40 subjects with pseudoexfoliative glaucoma, of which 13 have bilateral lesions, 11 unilaterally in the right eye and 16 subjects in the left eye only. Doppler ultrasound measured VS ACI, VD ACI, and RI ACI on 4 occasions at 6-month intervals. Results: The resistance index showed differences in terms of higher values in the PEX group (P=0.031) than the values measured in the POAG group. Flow velocities in systole and diastole were not statistically significant. Within the PEX group, higher flow velocities were found in systole and diastole in the left eye than in the right. Conclusions: The increased resistance index in the internal carotid artery suggests that vascular risk factors have a role in the development of pseudoexfoliative glaucoma. The results obtained also suggest the existence of a difference in the importance of vascular factors between pseudoexfoliative glaucoma and primary open-angle glaucoma.

Kontaktne leće su vrlo lagane i tanke, izrađene od plastike, postavljaju se na rožnicu ili rožnicu i bjeloočnicu. Kontaktnim lećama se postiže bolja vidna oštrina. Nema sferne ili kromatske aberacije kao s naočalama visokih dioptrija. Zbog toga što kontaktne leće prate oko, vid je podjednako oštar u svim smjerovima za razliku od korekcijskih naočala. Od dijagnostike primjenjujemo keratometriju, fitting i fluorescenski test. Tri su vrste kontaktnih leća s obzirom na dio oka koji pokrivaju, tvrde, plino propusne i meke leće. Tvrde kontaktne leće izrađene su od PMMA (polymethymethacrylat), nepropusne su za kisik i hidrofobne su. Primjenjuju se vrlo rijetko, ali apsolutna indikacija im je keratokonus. Krute plin propusne (RGP) leće tolerantnije su i udobnije od PMMA leća. Propusne su za kisik čime su ujedno puno pogodnije za pacijenta. Koriste se kod velikog astigmatizma. Meke leće su napravljene od raznih polimera, najčešće hydroksiethilmethacrylat. Propisuju se bolesnicima koji ne podnose tvrde leće, u nistagmusu, i kod bolesnika gdje je potrebna brza adaptacija. Kontraindikacije za nošenje kontaktnih leća su bakterijama ili virusnima očne infekcije. Glavni klinički oblici infekcija oka konjunktivitis je lokalizacija (66,7% svih bolesnika s upalnim bolestima oka) i blefaritis (23,3%), rijetko viđen keratitis. Komplikacije nošenja kontaktnih leća su blokada dovoda kisika u oči, suhe oči, iritacije, smanjen refleks rožnice, abrazija rožnice, konjuktivitis, ptoza i ulkus rožnice., Contact lenses are very light and thin, made of plastic, placed on the cornea or cornea and sclera. Contact lenses achieve better visual acuity. There is no spherical or chromatic aberration as with high diopter glasses. Because contact lenses follow the eye, vision is equally sharp in all directions as opposed to corrective glasses. From diagnostics we apply keratometry, fitting and fluorescence test. There are three types of contact lenses with respect to the part of the eye that covers, hard, gas permeable and soft lenses. Hard contact lenses are made of PMMA (polymethylmethacrylate), are oxygen impermeable and hydrophobic. They are used very rarely, but their absolute indication is keratoconus. Rigid gas permeable (RGP) lenses are more tolerant and comfortable than PMMA lenses. They are oxygen permeable, making them much more convenient for the patient. They are used for severe astigmatism. Soft lenses are made of various polymers, most commonly hydroxyethyl methacrylate. They are prescribed to patients who do not tolerate hard lenses, in nystagmus, and in patients where rapid adaptation is required. Contraindications to wearing contact lenses are bacteria or viral eye infections. The main clinical forms of eye infections conjunctivitis are localization (66.7% of all patients with inflammatory eye diseases) and blepharitis (23.3%), rarely seen keratitis. Complications of wearing contact lenses are blockage of oxygen supply to the eyes, dry eyes, irritation, decreased corneal reflex, corneal abrasion, conjunctivitis, ptosis, and corneal ulcer.

Telemedicina je relativno nova grana moderne medicine koja predstavlja mogućnost povezivanja najudaljenijih i najugroženijih pacijenata sa vodećim specijalistima u velikim medicinskim centrima. Prednosti telemedicine su doseg, niža cijena i brzina rada. Oftalmologija je posebno pogodna za telemedicinski pristup zbog prirode dijagnosticiranja u ovoj specijalizaciji, koja se većinski zasniva na slikama i vanjskom pregled. COVID-19 pandemija je potaknula ubrzani razvoj i prihvaćanje novih tehnologija i telemedicinskog načina liječenja. Međutim, telemedicina nije u potpunosti prihvaćena, ponajviše među starijim pacijentima. Stoga je idealni pristup liječenja kombinirani pristup gdje se koriste klasični i telemedicinski pregledi, ovisno o željama i mogućnostima pacijenata. Primjena telemedicine u oftalmologiji je već prihvaćena u standardnoj praksi u određenim državama i najčešće se koristi u svrhu probira na dijabetičku retinopatiju, senilnu makularnu degeneraciju, retinopatiju nedonoščadi, katarakte i glaukom. Ovi programi su dokazano jednako učinkoviti kao pregledi uživo i stoga se sve češće primjenjuju. Osim za probir, teleoftalmologija se može koristiti za dijagnostiku, praćenje pacijenta, konzultacije s pacijentom te procjenu progresije bolesti. Primjena umjetne inteligencije je relativno nova pojava unutar teleoftalmologije, ali pokazuje obećavajuće rezultate. Umjetna inteligencija uspješno radi specifične zadatke usporedivo sa specijalistima oftalmologije, ali najuspješniji je hibridni pristup gdje surađuju liječnik i umjetna inteligencija. Nadalje, umjetna inteligencija ima potencijal raditi stvari koje liječnik ne može, primjerice procjenu kardiovaskularnog rizika preko slike fundusa., Telemedicine is a relatively new branch of modern medicine which represents the opportunity to connect the most secluded and high-risk patients with leading specialists in large medical centers. The advantages of telemedicine are reach, low cost and fast workflow. Ophthalmology is especially suited to a telemedical approach because of the nature of diagnostics in this branch of medicine, which mostly relies on images and external observation. The COVID-19 pandemic has kickstarted and accelerated the development and adoption of new technologies relating to telemedicine. However, telemedicine isn't widely accepted, mostly among older patients. Because of this, a combined approach using traditional and telemedical methods is ideal, depending on the wishes and circumstances of the patient. Application of telemedicine in ophthalmology has already been accepted and put into standard practice in select countries, and is most commonly used for screening for diabetic retinopathy, age related macular degeneration, retinopathy of prematurity, cataracts and glaucoma. These programs have been proven to be just as effective as in-person examinations, and as such are used more and more. Apart from screening, teleophthalmology can be used for diagnostics, follow-up exams, consultations, and illness progression assessment. Artificial intelligence application is a relatively new phenomenon within teleophthalmology, but it is showing promising results. Artificial intelligence can successfully perform specific tasks comparatively well to ophthalmology specialists, however, a hybrid approach consisting of a specialist and artificial intelligence cooperating has proven to be the most successful. Furthermore, artificial intelligence has the potential to do things doctors cannot, such as cardiovascular risk assessment using only fundus images.

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.

Cilj istraživanja: Usporediti gustoću i morfologiju endotelnih stanica rožnice te središnju debljinu rožnice između pacijenata sa šećernom bolesti tipa 2 koji puše te nepušača, sa zdravim pojedincima u dobi od 50 do 70 godina, te utvrditi da li pušenje povećava negativan učinak šećerne bolesti tipa 2 na navedene parametre rožnice. Ispitanici i metode: Ova prospektivna i kohortna studija je obuhvatila 200 pacijenata podijeljenih u četiri skupine: pacijenti sa šećernom bolesti tipa 2 koji puše (skupina 1), nepušači sa šećernom bolesti tipa 2 (skupina 2), zdravi pojedinci koji puše (skupina 3) te zdravi ispitanici koji ne puše (kontrolna skupina, skupina 4). Za mjerenje gustoće endotelnih stanica rožnice (eng. endothelial cell density ECD), koeficijenta varijacije stanične površine (eng. coefficient of variation of cell area CV), postotka šesterokutnih stanica (eng. percentage of hexagonal cells HEX) i središnje debljine rožnice (eng. central corneal pachymetry CCT) korišten je bezkontaktni spekularni mikroskop. Rezultati: Prema vrijednostima ECD -a i CCT -a (P

Cilj istraživanja: Cilj ovog istraživanja bio je prikazati epidemiološke podatke ozljeda oka na uzorku pedijatrijske populacije, hospitalizirane i liječene na odjelu Klinike za očne bolesti Kliničkog bolničkog centra Split s područja Splitsko-dalmatinske županije u trogodišnjem intervalu od 2019. do 2021. godine kao i istaknuti važnost prevencije ozljeda oka kod djece. Materijali i metode: U retrospektivnom istraživanju prikupljani su arhivski podaci temeljeni na uzorku pedijatrijske populacije. Ispitanici obuhvaćeni ovim istraživanjem su djeca oba spola mlađa od 18 godina koja su zaprimljena na bolničko liječenje Klinike za očne bolesti Kliničkog bolničkog centra Split zbog mehaničke ozljede oka. Iz studije su isključena djeca s kemijskim ozljedama oka. Svim ispitanicima je učinjen kompletan oftalmološki klinički pregled, nadopunjen alatima slikovne dijagnostike i konzilijarnim pregledima specijalista pedijatrije, otorinolaringologije i neurokirurgije. Dobivene rezultate ispitanika obradili smo s obzirom na dob, spol, težinu, vrstu, vrijeme, uzroke te okolnosti ozljeđivanja uz konačnu vidnu oštrinu. Pri klasifikaciji ozljeda koristili smo se BETT i IOTC ljestvicama. Rezultati: Studijom je obuhvaćen uzorak od 110 ispitanika mlađih od 18 godina. Ukupan broj ozljeda oka bio je 116, što je u postotku iznosilo 25,25% promatrajući cjelokupnu populaciju bolesnika zaprimljenu pod dijagnozom traume oka. Vodeći razlog hospitalizacije bila je zatvorena ozljeda oka kontuzijskog podtipa (86,21%), koja je bila prouzročena pirotehničkim sredstvima (30,54%). Uzimajući u obzir spolne karakteristike, dječaci su kao ispitanici 5 puta češće hospitalizirani zbog mehaničkih ozljeda oka. Glavnina ispitanika činila su muška djeca sa zatvorenim ozljedama (n=44, 88%) , u vremenskom interval od 8-14 godine. Najzastupljeniji udio trauma oka nastupio je kod djece koja nisu bila nadzirana od strane odrasle osobe (30,21%). Najveći broj ozljeda registriran je u tromjesečnom intervalu zimskog razdoblja godine (n=47). Na osnovi kriterija vidne oštrine, zone ozljede na oku i vrste ozljede najveći broj trauma oka kod spadao je u lake ozljede (51,72%). Kao komplikacija, sljepoća je nastala kod 4,3% ispitanika. Zaključci: Analizom podataka utvrđeno je da je broj dječaka s nastalom ozljedom oka znatno veći u odnosu na djevojčice što je u skladu s postavljenom hipotezom. Očekivano, potvrđeno je i da je smanjeni roditeljski nadzor potencirao povećanom broju ozljeda. Broj ozljeda oka dokazao se povećanim u zimskom razdoblju godine. S obzirom da ozljede oka predstavljaju značajni javnozdravstveni problem, a ujedno i izvor trajnog invaliditeta potrebno je uložiti značajne napore u pravodobnu prevenciju, edukaciju i liječenje., Objective: The main aim of this study was to present epidemiological data on eye injuries in a sample of pediatric population from the Split region, hospitalized and treated at the Department of the Eye Disease Clinic of the University Hospital of Split, in a three-year interval from 2019. to 2021., as well as to highlight the importance of preventing eye injuries in children. Subjects and methods: In a retrospective study, archival data were collected based on a sample of pediatric population. The subjects included in this research are children of both sexes under the age of 18, who were admitted to the hospital for a treatment due to a mechanical eye injury. Children with chemical eye injuries were excluded from the study. All subjects underwent a complete ophthalmological clinical examination, complemented by diagnostic imaging tools and consultation examinations done by specialists in pediatrics, otorhinolaryngology, and neurosurgery. We processed the obtained results of the patients regarding the age, sex, type, severity, causes and circumstances of the injury, along with the final visual acuity. When classifying injuries, we used the BETT and IOTC scales. Results: The study included a sample of 110 patients under the age of 18. The total number of eye injuries was 116, which was 25.25% of the entire population of patients admitted. The leading reason for hospitalization was closed globe eye injury, contusion subtype (86.21%), which was caused by pyrotechnics (30.54%). Taking sex characteristics into account, boys were 5 times more likely to be hospitalized due to mechanical eye injuries. The majority of subjects were male children with closed globe injuries (n=44, 88%), in an interval from 8 to 14 years. The highest proportion of eye trauma occurred in children who were not supervised by an adult (30.21%). The largest number of injuries was registered in winter period of the year (n=47). Based on the criteria of visual acuity, zone of injury on the eye and type of injury, the largest number of eye traumas belonged to mild injuries (51.72%). As a complication, blindness occurred in 4.3% of subjects. Conclusion: Data analysis revealed that the number of boys with an eye injury is significantly higher than that of girls, which is in line with the hypothesis. It was also confirmed that reduced parental supervision contributed to an increased number of injuries. The number of eye injuries has proven to increase in the winter. Given that eye injuries represent a significant public health problem, and a source of permanent disability, it is necessary to invest significant efforts in timely prevention, education and treatment.

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi utjecaj dviju različitih vrsta blefarostata na nastanak ptoze. Ispitanici i metode: U prospektivnom kohortnom istraživanju provedenom u Kliničkom bolničkom centru Split, u Klinici za očne bolesti, uključeni su ispitanici predviđeni za operaciju fakoemulzifikacije. Istraživanje se provodilo od veljače do svibnja 2022. godine. U istraživanju je sudjelovalo 27 ispitanika u dobi od 60 do 85 godina. Prvih 20 ispitanika operirano je pomoću punog blefarostata, a zadnjih sedam pomoću žičanog blefarostata. Visina vjeđnog rasporka mjerila se prije operacijskog zahvata te na redovnim kontrolama sedam dana nakon te još tri tjedna poslije pomoću Bulbitech uređaja ili manualno ravnalom. Rezultati: Mjerenjem Bulbitech uređajem na prvoj kontroli prije operacije srednja je vrijednost visine vjeđnog rasporka (VVR) iznosila 10,65 ± 1,69 mm, dok je srednja vrijednost udaljenosti refleksa svjetla u središtu rožnice od ruba gornje vjeđe (engl. MRD 1- Marginal reflex distance) iznosila 5,04 ± 1,22 mm. Na idućoj kontroli, sedam dana nakon operacije, mjerili smo VVR i MRD1 Bulbitech uređajem ili manualno ravnalom. Srednja vrijednost VVR iznosila je 9,94 ± 1,13 mm na Bulbitechu i 9,75 ± 2,63 mm ravnalom, dok je srednja vrijednost MRD1 iznosila 4,40 ± 0,88 mm na Bulbitechu. Na drugoj kontroli, 30 dana nakon operacije, srednja je vrijednost VVR iznosila 9,57 ± 1,57 mm na Bulbitechu i 9,77 ± 1,5 mm ravnalom, dok je srednja vrijednost MRD1 iznosila 3,95 ± 1,10 mm na Bulbitechu. Pri usporedbi vrsta blefarostata, žičanog i punog, dokazano je da su vrijednosti kod punog blefarostata bile niže od onih u žičanog, ali ta razlika nam nije bila statistički značajna (P = 0,398). Analizom pojedinih kontrola utvrđeno je kako su se statistički značajno razlikovali VVR na prvoj kontroli izmjeren na Bulbitechu (P = 0,033) i VVR izmjeren ravnalom nakon 7 dana (P = 0,012). Također postoji i statistički značajna korelacija između VVR i MRD te su te dvije mjere jednako valjane u praćenju poslijeoperacijske ptoze. Čimbenik korelacije r prije operacije iznosio je 0,94, nakon sedam dana 0,87 te nakon 30 dana 0,82. Zaključak: Statistički je utvrđeno značajno smanjenje VVR i MRD1 na kontrolnim pregledima, dok ne postoji statistički značajna razlika između punog i žičanog blefarostata., Objectives: The aim of this study was to determine whether there is a statistically significant difference between the use of two types of eyelid speculum on palpebral fissure height and Margin reflex distance 1 (MRD1) before and after cataract surgery. Subjects and Methods: This prospective cohort study, conducted at the Clinic of Ophthalmology at the University Hospital of Split, included the patients who underwent phacoemulsification cataract surgery. The study was conducted between February and May 2022. The study consisted of 27 patients aged 60 to 85 years. MRD1 and levator muscle function were measured manually or with Bulbitech device before the surgery, 7 days after, as well as 4 weeks after the surgery. With the first 20 patients, we used a solid type of speculum, while for the next 7, a wired speculum was used. Results: Using the Bulbitech device at the first preoperative control, the average value of VVR was 10.65 ± 1.69 mm while the average value of MRD1 was 5.04 ± 1.22 mm. At the next control, 7 days after surgery, we measured VVR and MRD1 either with the Bulbitech device or manually. The average value of VVR was 9.94 ± 1.13 mm on the Bulbitech and 9.75 ± 2,63 mm manually, while the average value of MRD1 was 4.40 ± 0.88 mm on the Bulbitech. At the second control, 4 weeks after surgery, the average value of VVR was 9.57 ± 1.57 mm on the Bulbitech and 9.77 ± 1.5 mm manually, while the average value of MRD1 was 3.95 ± 1.10 mm on the Bulbitech. When comparing the two types of eyelid speculum, wired and solid, it was shown that the values of solid eyelid speculum use were lower than those of the wired (P = 0.398). The analysis of individual controls determined that VVR was statistically significantly different at the first control measured on Bulbitechu (P = 0.033) and VVR measured manually after 7 days (P = 0.012). There is also a statistically significant correlation between VVR and MRD and they are equally valid in tracking postoperative ptosis. Correlation factor r was 0.94 preoperative, 0.87 after 7 days and 0.82 after 30 days. Conclusions: A statistically significant reduction in VVR and MRD1 values was found at control examinations, while there was no statistically significant difference between the use of solid and wired eyelid speculum.

Background: Corneal ectasia is a sight-threatening complication of corneal refractive surgery characterized by progressive steepening and thinning of the cornea and subsequent loss of best-corrected visual acuity. Objective: To report the clinical outcomes following treatment of post-laser in situ keratomileusis (LASIK) induced ectasia. Methods: This is a retrospective case series of 7 patients (10 eyes) which developed post-LASIK ectasia. In these cases of postoperative ectasia, the presented clinical signs were either forme fruste keratoconus, thin cornea, posterior elevation map value > +15.0µm, or residual stromal bed < 300µm. All cases were treated with either collagen crosslinking (CXL) alone or combined with PRK or CXL and phakic intraocular implant using the Dresden protocol and a slight modification thereof. In all cases, the flap was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15±12.88µm), and refractive error was corrected using the Wavelight Allegretto excimer laser. Results: Average preoperative corrected visual acuity (CDVA) was 0.75 (±0.26) Snellen. Postoperative CDVA significantly increased to 0.86 (±0.13) Snellen (p=0.04, paired t-test). One eye lost three lines of its baseline CDVA (before ectasia), while all other eyes regained lines of CDVA. All cases remained stable during the follow-up. Conclusion: Several surgical procedures are used for the management of corneal ectasia. However, the best surgical approach should be determined based on the state of progression of the disease. Although ectasia remains a potentially devastating complication after refractive surgery, most patients can regain functional visual acuity with appropriate management, and corneal transplantation is infrequently indicated.

Purpose: Randomized controlled clinical trials are driven by time-given protocols defined by strict exclusion and inclusion criteria. As a result, clinical trials provide the best possible outcomes regarding the efficacy and safety of investigational medical products. Nonetheless, the implementation of protocols suggested by clinical trials has been shown as non-pragmatic into standard treatment care. Not following the protocols recommended by clinical trials in our standard routine treatment care does not provide the benefits of therapy as clinical trials suggest. Therefore, we wanted to investigate whether our proposed treatment protocols with diabetic macular oedema, designed for standard treatment of care, may achieve non-inferior results compared to clinical trials where the non-inferiority was defined by a difference in the vision of up to 10 ETDRS letters. Methods: Manuscripts amalgamated in this doctoral thesis involved patients with fovea-involving macular oedema who were eligible for treatment with intravitreal anti-VEGF injections. All patients applied met the National Institute of Care and Excellence (NICE) criteria for treatment (center-involving diabetic macular oedema ³ 400 microns) and with baseline visual acuity (VA) equal to or less than 80 ETDRS letters. All patients were treated in Moorfields Eye Hospital NHS Foundation Trust, in London, UK. The primary cohort of interest (treatment-naive cohort) involved 89 patients (99 eyes) who were treatment-naive and funded for intravitreal aflibercept injections. We analyzed primary, secondary and tertiary outcomes in short and long terms. In addition, we wanted to see whether those patients who had started treatment on a different anti-VEGF agent (ranibizumab as another licensed anti-VEGF product in the United Kingdom) and didn't respond well to the initiated treatment may benefit from switching to intravitreal aflibercept injections, which may have more potent effect as per available pharmacokinetic data. Therefore, we formed a second cohort that involved 67 switched patients (90 eyes) who had started treatment with intravitreal ranibizumab and were switched to intravitreal aflibercept. In both cohorts, the primary outcomes were visual acuity (VA), central foveal thickness (CFT), and macular volume (MV) 12 months after treatment was commenced/after switching off a drug. The analysis of the same primary outcomes was performed for the treatment-naive cohort 36 months after initiating treatment. Then, we calculated the percentage of eyes that achieved visual acuity gain of ³ 15 ETDRS letters and the percentage of eyes that achieved improvement in CFT for 100 microns or more at the end of year 1 and year 3. As tertiary outcomes, we made a subgroup analysis according to the baseline VA (< 69 ETDRS letters or ³ 69 ETDRS letters). For switched cohorts, we analysed whether the time of switching plays a role in overall results. Results The mixed ANOVA analysis showed no statistically significant difference in baseline variables and 12-month outcomes between short- and long-term followed treatment naïve patients and switched patients. The mean change in vision after three years of initiation of treatment with intravitreal aflibercept injections was +6.89 EDTRS letters, while improvement in CFT and MV during the same time was -140 microns and – 1.38 mm3, respectively. At the end of follow-up of 36 months, 25% of patients improved vision for three or more ETDRS lines (15 letters or more). Just more than 50% of patients had improvement in central foveal thickness for 100 microns or more. Fifty-eight percent of eyes of the primary cohort had baseline visual acuity less than 69 ETDRS letters. The mean change in visual acuity in the subgroup with baseline VA less than 69 letters was +11.27 ETDRS letters (p < 0.0001). Forty-two percent of eyes from the primary cohort had baseline visual acuity ³ 69 ETDRS letters). The mean change in the visual acuity after 36 months in that subgroup was + 0.88 ETDRS letters (p = 0.6041). We sub-divided the switched eyes into two subgroups according to the duration of time between the ranibizumab being discontinued and the aflibercept commencing; 53 eyes were switched with an interval of fewer than three months after the last injection of ranibizumab, and 37 eyes were switched after three months or more had elapsed. There was no statistically significant difference in outcomes ( p > 0.05) between those subgroups. Conclusion Our short and long-term results of visual acuity and anatomical outcomes in patients with sight-impairing, center-involving diabetic macular oedema treated with intravitreal aflibercept showed a significant improvement in vision, comparable with results suggested by landmark clinical trials. Furthermore, our results were non-inferior when compared to landmark clinical trials related to the safety and efficacy of intravitreal aflibercept in the treatment of DMO (VIVID, VISTA, and Protocol T). Our subgroup analysis based on baseline visual acuity proved the importance of starting treatment when visual acuity is initially better. We achieved stable vision over three years of follow-up in those whose baseline visual acuity was 69 ETRDS letters or better (up to 80 ETDRS letters). Those patients kept their good vision which meets driving criteria. Our results are the first published results from the real world, which show the importance of planning the treatment guided by baseline vision, which was first indicated in the Protocol T study. Regarding the results in our switched cohort, we showed that switching from intravitreal ranibizumab to intravitreal aflibercept has a rationale for speeding up the visual recovery and improving the anatomical outcomes in everyday life offer patients sooner improvement and better functioning by using their vision. We proved that time of switching does not play a role in primary outcomes (VA, CFT, MV), which may indicate that indeed the reason for clinical improvement in our switched cohort relies on the mechanism and pharmacokinetics of the aflibercept molecule., Svrha: Randomizirane kliničke studije su vođene striktno vremenski određenim protokolima koji su definirani isključujućim kriterijima. To rezultira činjenicom da kliničke studije prikazuju najbolje moguće rezultate medicinskih proizvoda, koji su u fazi istraživanja. Ipak, protokoli koje predlažu randomizirane kliničke studije nepragmatičnim u standarnoj kliničkoj praksi. Ukoliko se protokoli koje predlažu randomizirane kliničke dovesti do suboptimalnih rezultata liječenja. Stoga, htjeli smo istražiti može li naš protokol za liječenje dizajniran za potrebe standardne kliničke prakse, postići neinferiorne rezultate u komparaciji sa kliničkim neinferiornost definirana razlikom u vidnoj oštrini do 10 ETDRS slova. Metodologija: Publikacije objedinjene u ovu doktorsku dizertaciju uključuju pacijente sa makularnim edemom koji zahvaća kriterije za liječenje intravitrealnim anti-VEGF injekcijama. Svi pacijenti zadovoljavaju kriterije za liječenje 400 microna) prema uputi National Insititute of Care and Excellence (NICE) i sa bazičnom vidnom oštrinom od 80 ETDRS slova. Svi pacijenti su liječeni u Moorfields Eye Hospital NHS Foundation Trust, u Londonu, Kohorta pacijenata od primarnog interesa (tretman-naivna) uključivala je 89 pacijenata (99 očiju) koji terapiju i kojima je trošak liječenja intravitrealnim injekcijama bio odobren. Analizirali smo kratkoročno sekundarne i tercijarne rezultate. Zatim, željeli smo vidjeti jeli pacijenti koji su započeli liječenje drugim je drugi licencirani anti-VEGF lijek u Ujedinjenoj Kraljevini), a koji nisu odgovorili dobro na inicijalnu terapiju, zamjene na injekcije intravitrealnog aflibercepta. Intravitrealni aflibercept bi trebao imati bolju efikasnost informacija o farmakokinetici. Stoga, formirali smo drugu kohortu pacijenata koja je uključivala 67 pacijenata primarno započeli tretmant intravitrealnim ranibizumabom, a zatim je liječenje zamijenjeno intravitrealnim U obje kohorte, primarni ishod su bili vidna oštrina (VO), centralna fovealna debljina (CFD), te makularni nakon započetog liječenja, odnosno nakon zamjene lijeka. Analiza primarnih rezultata je također napravljena kohortu pacijenata 36 mjeseci nakon započetog liječenja. Zatim, izračunali smo postotak onih očiju koje oštrine za ³ 15 ETDRS slova te poboljšanje CFD za 100 mikrona ili više na kraju prve i treće godine. Kao smo podgrupnu analizu na temelju početne vidne oštrine (< 69 ETDRS slova ili ³ 69 ETDRS slova). Za zamijenili lijek, napravili smo analizu ima li vrijeme promjene lijeka efekt na konačan ishod liječenja. Rezultati Miješana ANOVA analiza pokazala je da nema statistički signifikantne razlike u bazičnim varijablama te između pacijenata koji su analizirani u kratkoročnoj ili dugoročnoj analizi te pacijenata kod kojih je zamijenjena promjena u vidnoj oštrini tri godine nakon početka liječenja sa intravitrealnim aflibercept injekcijama je poboljšanje u CFD i MV tokom istoga razdoblja bila -140 mikrona i -1.38 mm3. Na kraju perioda praćenja od 36 mjeseci, 25% pacijenata je imalo poboljšanje vida za tri ili više ETDRS više od 50% pacijenata je imalo poboljšanje centralne fovealne debljine za 100 mikrona ili više. Pedeset i osam posto očiju u primarnoj kohorti je imalo početnu vidnu oštrinu manju od 69 ETDRS slova. oštrine u podgrupi sa početnom VO manjom od 69 slova je bila +11.27 ETDRS slova (p < 0.0001). Četrdeset kohorte je imalo početnu vidnu oštrinu ³ 69 ETDRS letters. Srednja promjena vidne oštrine nakon 36 mjeseci 0.88 ETDRS slova (p = 0.6041). One oči kod kojih je došlo do zamjene terapije podijelili smo na temelju vremenskog razmaka između zadnje početka liječenja sa intravitrealnim afliberceptom; kod 53 očiju vremenski interval je bio kraći od tri mjeseca ranibizumaba, dok je kod 37 očiju taj vremenski razmak bio tri mjeseca ili dulji. Analiza je pokazala da kod statistički signifikantna razlika u ovim podgrupama ( p > 0.05). Zaključak Naši kratkoročni i dugoročni rezultati vidne oštrine te anatomskih promjena kod pacijenata sa prijetećim dijabetičkim makularnim edemom liječenim intravitrealnim afliberceptom su pokazali signifikatno poboljšanje rezultatima značajnih randomiziranih kliničkih studija. Nadalje, naši rezultati su bili neinferiorni uspoređujući ih sa sigurnošću i efikasnošću intravitrealnog aflibercepta koje indiciraju značajne kliničke studije (VIVID, VISTA, Protokol T). Naša podgrupna analiza bazirana dokazala je značaj početka liječenja kada je vidna oštrina bolja. Postigli smo stabilan vid tokom tri godine je vidna oštrina bila 69 ETDRS slova ili bolja (do 80 ETDRS slova). Ti pacijenti su zadržali vidnu oštrinu koja upravljanje motornim vozilom. Naši rezultati su prvi publicirani rezultati iz realne kliničke prakse, koji pokazuju značaj planiranja liječenja oštrini, što su primarno indicirali rezultati Protokol T studije. Promatrajući naše rezultate kod kohorte pacijenata kod kojih smo zamijenili lijek, pokazali smo da zamjena ranibizumaba sa intravitrealnim afliberceptom ima smisla u ubrzanju oporavka vida i poboljšanja anatomskih svakodnevnoj praksi, dajući pacijentima brži oporavak i generalno bolje funkcioniranje koristeći svoj vid. zamjene lijeka ne igra ulogu u primarnim rezultatima (VO. CFD, MV), što može indicirati da razlog poboljšanja u mehanizmu te farmakokinetskim karakteristikama molekule aflibercepta.

Cilj istraživanja: Cilj istraživanja bio je utvrditi utjecaj glavnog rožničnog reza na postoperativni astigmatizam. Pri izradi rada promatrani su sljedeći parametri: vidna oštrina bez korekcije prije i nakon operativnog zahvata, sferni ekvivalent, kornealna topografija, broj endotelnih stanica rožnice, dodatne dijagnoze pacijenata, subjektivni dojam kvalitete kirurškog noža i resteriliziranost noža. Materijali i metode: Istraživanje se provodilo na Klinici za očne bolesti, Kliničkog bolničkog centra Split. Uključeno je 23 pacijenta. Vrijeme provedeno za prikupljanje podataka iznosilo je 6 mjeseci (siječanj 2021. – srpanj 2021.) Tijekom i nakon istraživanja štite se prava i osobni podaci ispitanika u skladu sa Zakonom o zaštiti prava bolesnika (NN 169/04, 37/08) i Zakonom o zaštiti osobnih podataka (NN 103/03- 106/12), a istraživanje je usklađeno s odredbama Kodeksa liječničke etike i deontologije (NN 55/08, 139/15) te pravilima Helsinške deklaracije (1964. – 2013.). Za provedbu istraživanja, zatraženo je i dobiveno odobrenje Etičkog povjerenstva Kliničkog bolničkog centra u Splitu pod brojem 2181-147/01/06/M.S.-20-02. Pacijenti su pregledani od strane oftalmologa. Bilježila se vidna oštrina (SC,CC, sferni ekvivalent), intraokularni tlak aplanacijskom Goldmannovom tonometrijom, fundus u midrijazi sa superfield beskontaktnom lećom te biomikroskopski pregled prednjeg segmenta oka. Rezultati: Od 23 bolesnika uključenih u ovo istraživanje 10 (43,48%) je muškaraca i 13 (56,52%) žena. Medijan dobi ispitanika iznosi 73 (56-88). Vidna oštrina nakon operacije je značajno bolja. Postoperativni astigmatizam je statistički značajno manji od preoperativnog astigmatizma. Nije pokazana statistički značajna razlika kod korištenja resteriliziranog i novog noža. Dokazana je negativna korelacija predoperativnog astigmatizma u odnosu na postoperativni. Zaključci: Vidna oštrina nakon operacije se poboljšala. Veličina incizije od 2,2 milimetra ima povoljan učinak na postoperativni astigmatizam. Usporedbom osi cilindra na autokeratorefraktometru i Pentacamu nađena je razlika u vrijednostima, ali nije se pokazala statistički značajnom. Postoperativni astigmatizam je statistički značajno manji od preoperativnog astigmatizma. Nismo pronašli statistički značajnu razliku u indukciji postoperativnog astigmatizma u bolesnika operiranih sa resteriliziranim I neresteriliziranim jednokratnim mikrokeratomima. Pokazali smo pozitivnu korelaciju postoperativne promjene astigmatizma, međutim nije statistički značajna. Dokazana je negativna korelacija predoperativnog astigmatizma u odnosu na postoperativni., Objectives: The aim of the study was to determine the influence of the main corneal incision on postoperative astigmatism. The following parameters were observed during the study: visual acuity without correction before and after surgery, spherical equivalent, corneal topography, number of corneal endothelial cells, additional diagnoses of patients, subjective impression of surgical knife quality and knife resterilization. Materials and methods: The research was conducted at the Clinic for Ophthalmology, Clinical Hospital Center Split. 23 patients were included. The time spent collecting data was 6 months (January 2021 - July 2021) During and after the survey, the rights and personal data of respondents are protected in accordance with the Patients' Rights Protection Act (OG 169/04, 37/08) and the protection of personal data (OG 103 / 03-106 / 12), and the research is harmonized with the provisions of the Code of Medical Ethics and Deontology (OG 55/08, 139/15) and the rules of the Declaration of Helsinki (1964-2013). For the implementation of the research, the approval of the Ethics Committee of the Clinical Hospital Center in Split under number 2181-147 / 01/06 / M.S.-20-02 was requested and obtained. Patients were examined by an ophthalmologist. Visual acuity (SC, CC, spherical equivalent), intraocular pressure by applanation Goldmann tonometry, fundus in mydriasis with a superfield non-contact lens and biomicroscopic examination of the anterior segment of the eye were recorded. Results: Of the 23 patients included in this study, 10 (43.48%) were men and 13 (56.52%) were women. The median age of the respondents was 73 (56-88). Visual acuity after surgery is significantly better. Postoperative astigmatism is statistically significantly lower than preoperative astigmatism. No statistically significant difference was shown when using a resterilized and a new knife. There is a negative correlation between preoperative astigmatism and postoperative astigmatism. Conclusions: Visual acuity improved after surgery. An incision size of 2.2 millimeters has a beneficial effect on postoperative astigmatism. A comparison of the cylinder axis on the autokeratorefractometer and the Pentacam found a difference in values, but did not prove statistically significant. Postoperative astigmatism is statistically significantly lower than preoperative astigmatism. We found no statistically significant difference in the induction of postoperative astigmatism in patients operated with resterilized and non-sterilized disposable microkeratomas. We showed a positive correlation of postoperative change in astigmatism, however it is not statistically significant. There is a negative correlation between preoperative astigmatism and postoperative astigmatism.

Ambliopija se definira kao jednostrano, rjeđe obostrano smanjenje vida koje je rezultat neodgovarajućeg vizualnog iskustva tijekom perioda ranog razvoja vidnog sustava. Mozak dojenčadi izuzetno je osjetljiv na promjene, zbog čega se ambliopija i progresivna ireverzibilna oštećenja mogu javiti već u prvim tjednima života. Prevladavajuća teorija nastanka pretpostavlja konkurenciju između neuronskih mreža dva oka za utjecaj na kortikalne neurone, pri čemu se jači impulsi iz dominantnog oka obrađuju u vidnom korteksu, a oni ambliopnog se potiskuju. Kritični period sazrijevanja mozga i razvoja vida uključuje razdoblje do 7 godine djetetova života, tijekom kojeg sposobnost plastičnosti dječijeg mozga može omogućiti restituciju vida narušenog ambliopijom. Stanja koja najčešće dovode do razvoja ambliopije su strabizam, visoke refraktivne greške i anizometropija te neonatalna katarakta. S visokom prevalencijom ambliopije od čak 5% raste i važnost preventivnih programa pomoću kojih se jednostavnim pregledom vidne oštrine mogu otkriti i do 97% svih anomalija oka. Na vrijeme liječena ambliopija spriječava trajno oštećenje i moguć gubitak vida. Ovisno o uzroku, liječenje će uključivati korekcije refraktivnih grešaka, različite tipove okluzija, kirurško liječenje te psihološku pomoć djetetu. Kombinacija svih navedenih metoda liječenja pokazala se najboljim izborom u spriječavanju ponavljajuće ili rezidualne ambliopije te poboljšanju motoričkih i senzornih funkcija oka koje prate ambliopiju., Amblyopia is defined as a unilateral, rarely bilateral, decrease in vision that results from inadequate visual experience during a period of early development of the visual system. The brain of infants is extremely sensitive to change, which is why amblyopia and progressive irreversible damage can occur as early as the first weeks of life. The prevailing theory of origin assumes competition between the neural networks of two eyes to influence cortical neurons, with stronger impulses from the dominant eye being processed in the visual cortex and those of the amblyopic being suppressed. The critical period of brain maturation and vision development includes a period of up to 7 years of the child's life, during which the plasticity ability of the child's brain can allow restitution of vision impaired by amblyopia. The conditions that most often lead to the development of amblyopia are strabismus, high refractive errors and anisometropia, and neonatal cataracts. With a high prevalence of amblyopia of as much as 5%, the importance of preventive programs is growing, with the help of which up to 97% of all eye anomalies can be detected by a simple examination of visual acuity. Timely treatment of amblyopia prevents permanent damage and possible loss of vision. Depending on the cause, treatment will include corrections of refractive errors, different types of occlusions, surgical treatment, and psychological assistance to the child. The combination of all the above treatment methods proved to be the best choice in preventing recurrent or residual amblyopia and improving the motor and sensory functions of the eye that accompany amblyopia.

Katarakta je svako zamućenje inače prozirne leće, a pacijent ju doživljava zamućenjem slike i pojavom monokularne diplopije. ( 3) Glaukom je kronična progresivna optička neuropatija koju karakterizira propadanje ganglijskih stanica unutar mrežnice i gubitak aksonskih vlakana u vidnom živcu. ( 1) Pseudoeksfolijativni sindrom je sistemska bolest karakterizirana taloženjem fibrilarnog materijala u prednjem segmentu oka i drugim organima.( 22) Pseudoeksfolijativni materijal u oku taloži se uz rub zjenice, na prednjoj kapsuli leće, endotelu rožnice, trabekularnoj mreži i u krvim žilama šarenice. Taj materijal ometa otjecanje očne vodice uzrokujući povišenje IOT-a i nastanak pseudoeksfolijativnog glaukoma koji spada u sekundarni glaukom otvorenog kuta. ( 14) Prevalancija PEX glaukoma kod PEX sindroma iznosi oko 50%. ( 23) Operacija katarakte u pacijenata sa PEX glaukomom je komplicirana operacija koja zahtjeva iskusnog kirurga jer postoji veći rizik za intraoperativne i postoperativne komplikacije te se sama operacija izvodi složenije od operacije katarakte bez pridruženih bolesti oka. ( 30) Operacija katarakte sa PEX glaukomom najčešće se izvodi fakoemulzifikacijom. Kod operacije moramo posebno paziti na zonule, endotel rožnice, količinu PEX materijala u odvodnom sustavu i cijeloj prednjoj očnoj sobici i veličinu otvora na prednjoj kapsuli leće. Intraoperativne komplikacije uključuju slabu midrijazu, plitku i duboku prednju komoru, dijalizu zonula i prolaps nukleusa. U rane postoperativne komplikacije ubrajamo keratopatiju, cistoidni makularni edem, naslage na intraokularnoj leći i skokove intraokularnog tlaka. Kasne postoperativne komplikacije uključuju prednju kapsularnu kontrakciju, fibrozu stražnje kapsule i dislokaciju IOL. ( 31) A cataract is any blurring of an otherwise transparent lens, and the patient experiences it with blurred vision and the appearance of monocular diplopia. (3) Glaucoma is a chronic progressive optic neuropathy characterized by the decay of ganglion cells within the retina and the loss of axonal fibers in the optic nerve. (1) Pseudoexfoliative syndrome is a systemic disease characterized by the deposition of fibrillar material in the anterior segment of the eye and other organs. This material interferes with the outflow of aqueous humor causing an increase in IOP and the formation of pseudoexfoliative glaucoma which belongs to secondary open-angle glaucoma. (14) The prevalence of PEX glaucoma in PEX syndrome is about 50%. (23) Cataract surgery in patients with PEX glaucoma is a complicated operation that requires an experienced surgeon because there is a higher risk of intraoperative and postoperative complications; and the operation itself is performed with more complexity than cataract surgeries without associated eye diseases. (30) Cataract surgery with PEX glaucoma is most often performed using the phacoemulsification. During the operation, we must pay special attention to the zonal, corneal endothelium, the amount of PEX material in the drainage system and the entire anterior chamber of the eye, and the size of the opening on the anterior capsule of the lens. Intraoperative complications include weak mydriasis, shallow and deep anterior chamber, zonal dialysis and nucleus prolapse. Early postoperative complications include keratopathy, cystoid macular edema, intraocular lens deposits, and intraocular pressure spikes. Late postoperative complications include anterior capsular contraction, posterior capsule fibrosis, and IOL dislocation. (31)

Incidencija otvorene ozljede oka razlikuje se između različitih krajeva svijeta i uvjeta u kojima ljudi žive. Pojedini poslovi su u jasnoj povezanosti s većim rizikom od otvorene ozljede oka. Perforativna ozljeda oka više se vezuje uz radno okruženje i mlađu životnu dob dok se ruptura očne jabučice više veže uz stariju životnu dob i ozljede u vlastitom domu. Provedena istraživanja pokazala su da se ozljede oka češće događaju muškarcima nego ženama. Ta razlika u raspodijeli među spolovima osobito je izražena kod perforativne ozljede oka, a nešto je manja kod rupture očne jabučice. Uočena je veća učestalost perforativne ozljede oka u ljetnim mjesecima i toplijem dijelu godine kada se odvija više aktivnosti na otvorenom. Otvorena ozljeda oka u velikom broju slučajeva dovodi do trajnog oštećenja vida. Većina pacijenata s otvorenom ozljedom oka imala je konačnu vidnu oštrinu lošiju od 6/60. Po tome možemo vidjeti važnost prevencije perforativne ozljede oka. Kod otvorene ozljede oka naočale je nosilo samo 25% ozlijeđenih. Bolesnici s otvorenom ozljedom oka osim loše prognoze zahtijevaju dugotrajno i skupocjeno liječenje., The incidence of open eye injury varies between different parts of the world and the conditions in which people live. Some jobs are clearly associated with a higher risk of open eye injury. Perforated eye injury is more associated with work environment and younger age while eyeball rupture is more associated with older age and injuries in one’s own home. Research has shown that eye injuries occur more often in men than in women. This difference in distribution between the sexes is particularly pronounced in perforated eye injury, and somewhat smaller in rupture of the eyeball. A higher incidence of perforated eye injury was observed in the summer months and the warmer part of the year when more outdoor activities take place. An open eye injury in many cases leads to permanent damage to vision. Most patients with open eye injury had a final visual acuity worse than 6/60. By this we can see the importance of preventing perforated eye injury. In the case of an open eye injury, only 25% of the injured wore glasses. Patients with an open eye injury in addition to a poor prognosis require long-term and expensive treatment

PURPOSE The purpose of this study was to compare the corneal endothelial morphology and cell density of diabetic smokers and nonsmokers with 50 to 70 age-matched healthy subjects and to determine whether smoking increases the effects of type 2 diabetes mellitus (DM) on these corneal parameters. METHODS This prospective cohort study included 200 patients who were assigned to 4 groups, including smokers with type 2 DM (group 1), nonsmokers with type 2 DM (group 2), healthy smokers (group 3), and healthy nonsmokers (control group, group 4). Noncontact specular microscopy was used to measure central endothelial cell density (ECD), coefficient of variation of cell area, percentage of hexagonal cells, and central corneal pachymetry (CCT). RESULTS According to the ECD and CCT values (P < 0.001 and P = 0.013, respectively), a significant difference was observed between the groups. The mean ECD was lowest in diabetic smokers (1917 ± 399 cells/mm2). Healthy smokers and diabetic smokers had significantly lower ECD compared with the control group (P = 0.03 and P < 0.001, respectively). Healthy smokers and diabetic smokers had significantly lower ECD compared with diabetic nonsmokers (P = 0.012 and P < 0.001, respectively). The cornea was significantly thicker in the diabetic smokers than in the control group (P = 0.013). CONCLUSIONS The coexistence of DM and smoking causes a significant decrease in ECD and an increase in CCT. Cigarette smoking is more harmful to corneal endothelial cells than DM alone.

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.

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi učinak botulinum toksina tipa A i zadovoljstvo kod pacijenata s esencijalnim blefarospazmom. Ispitanici i metode: U ovo prospektivno eksperimentalno istraživanje uključeno je 12 ispitanika koji boluju od esencijalnog blefarospazma te im je primijenjena terapija injekcijama botulinum toksina tipa-A. Istraživanje se provodilo u Klinici za očne bolesti Kliničkog bolničkog centra Split u razdoblju od prosinca 2019. do lipnja 2021. godine. U studiju je uključeno 11 žena i 1 muškarac u dobi od 49 do 86 godina. Ispitanicima je prije te dva do tri tjedna nakon zahvata dana anketa u kojoj se pitanja odnose na kvalitetu života i uključuju poteškoće pri čitanju, vožnji, gledanju televizije, izvođenju svakodnevnih aktivnosti, šetanju i kupovini u dućanu. Također im je dana ljestvica „Jankovic Rating Scale“ u kojoj se pitanja odnose na ozbiljnost i učestalost simptoma. U terapiji se koristio botulinum toksin tipa- A (Botox) koji smo razrijedili s 4 ml fiziološke otopine, tako da je u inzulinskoj brizgalici s integriranom iglom, od jednog mililitra 25 jedinica lijeka. Svi pacijenti su dobili po 25 jedinica po strani, u pet točaka (5 jedinica po točki) subkutano i to na dva mjesta na gornjoj vjeđi, zatim u središnjem području m. orbicularis oculi na donjoj vjeđi te u dvije točke u lateralnom dijelu mišića. Rezultati: Ukupna razina poteškoća snižena je (3,0 (2,2-3,2) vs. 1,6 (0,6-1,8)), odnosno kvaliteta života je narasla nakon primjene botulinum toksina, te je ispitivanjem utvrđeno da je porast statistički značajan (P=0,003). Ozbiljnost simptoma nakon primjene botulinum toksina snižena je (3,5 (3,0-4,0) vs. 2,0(1,0-2,0), što znači da je došlo do smanjenja ozbiljnosti poteškoća, te je ispitivanjem utvrđeno postojanje statistički značajne razlike (P=0,003). Učestalost simptoma je nakon primjene botulinum toksina snižena (3,0 (3,0-3,0) vs. 1,0 (1,0-2,5)), te je ispitivanjem utvrđeno postojanje statistički značajne razlike (P=0,012). Zaključak: Iz rezultata ovog istraživanja možemo utvrditi da primjenom botulinum toksina tipa-A dolazi do povećanja kvalitete života, te da se ozbiljnost i učestalost simptoma statistički značajno smanjuju., Objectives: The aim of this study was to determine the effect of botulinum toxin type A and satisfaction in patients with essential blepharospasm. Subjects and methods: This prospective experimental study included 12 subjects suffering from essential blepharospasm who received therapy with botulinum toxin type-A injections. The research was conducted at the Department of Ophthalmology of University Medical Center Split between December 2019 and June 2021. The study included 11 women and 1 man aged 49 to 86 years. Respondents were given a survey before and two to three weeks after the procedure in which were questions related to quality of life including difficulties in reading, driving, watching television, doing everyday activities, walking and shopping in the store. They were also given a "Jankovic Rating Scale" with questions related to the severity and frequency of symptoms. Botulinum toxin type-A (Botox) was used in the therapy and was diluted with 4 ml of physiological solution, so that in an insulin syringe with an integrated needle, there are 25 units of the drug from one milliliter. All patients received 25 units per side, at five points (5 units per point) subcutaneously in two places on the upper eyelid, then in the central area of the m. orbicularis oculi on the lower eyelid and at two points in the lateral part of the muscle. Results: The overall level of difficulties was reduced (3,0 (2,2-3,2) vs. 1,6 (0,6-1,8)), meaning the quality of life increased after the application of botulinum toxin, and the study found that the increase was statistically significant (P = 0.003). The severity of symptoms after the application of botulinum toxin was reduced (3,5 (3,0-4,0) vs. 2,0(1,0-2,0), which means that there was a decrease in the severity of the difficulties, and the study found a statistically significant difference (P=0,003). The frequency of symptoms was reduced after botulinum toxin administration (3,0 (3,0-3,0) vs. 1,0 (1,0-2,5)), and the study revealed a statistically significant difference (P = 0.012). Conclusions: From the results of this study, we can determine that the use of botulinum toxin type-A increases the quality of life, and that the severity and frequency of symptoms are statistically significantly reduced.

Siva mrena očna je bolest koja može direktno ili posredno dovesti do privremene ili trajne sljepoće. Siva mrena, odnosno katarakta označava svako zamućenje očne leće. Jedno takvo zamućenje, progresivnog je karaktera. Nerijetko dovodi do slijepoće. Međutim, operativnim zahvatom odstranjenja te zamućene leće, pacijentu se ponovno vraća vid, odnosno vrati mu se vidna oštrina kakva je bila prije pojave zamućenja. Ukoliko pacijent primjeti pad vidne oštrine, pojavu sivila, iznenadno otežanu noćnu vožnju, svakako treba posumnjati na prisutnost katarakte, te sukladno tome potraiti pomoć liječnika oftalmologa. Iako su simptomi dosta specifični, i dalje se ne može samo na temelju anamneze odrediti dijagnoza. U oftalmološkoj ambulanti, potrebno je obaviti kompletan oftalmološki pregled kako bi se ustanovilo radi li se doista o sivoj mreni, te postoje li kakve pridružene bolesti oka. Razvoj medicine, utjecao je i na razvoj operativnog zahvata odstranjenja sive mrene. Uloga medicinske sestre/tehničara od iznimne je važnosti na svim razinama zdravstvene zaštite. Medicinska sestra/tehničar pridonose u samoj dijagnostici bolesti i educiraju bolesnika o načinu operacije kao i mogućim komplikacijama. Također, bez njih nije moguće provesti ni sam operativni zahvat. Nakon operativnog zahvata, njihova je pak uloga provesti postoperativnu zdravstvenu njegu te edukaciju pacijenta i obitelji o daljem liječenju ili korištenju pomagala. Cilj rada je tumačenje bolesti oka sive mrene. U radu je prikazan povijesni razvoj saznanja o sivoj mreni, isto kao i povijesni razvoj operativnog zahvata vezanog uz odstranjenje sive mrene. Naglasak je stavljen i na ulogu medicinske sestre/tehničara od same dijagnostike, edukacije, pripreme na operativni zahvat, postupaka na sam operativni dan te poslijeoperacijske zdravstvene njege. Obrađene su i najčešće sestrinske dijagnoze. Cataract disease can led directly or indirectly to temporary or permanent blindness. Cataract denotes any blurring of the eye lens. One such turbulence is of a progressive character. It often leads to blindness. However, by surgical removal of this cloudy lens, the patient is restored to vision, his or her visual acuity, as it was before the appearance of cloudiness, is returned. If a patient notices a decrease in visual acuity, appearance of grey, sudden difficulty in night driving, one should definetly suspect the presence od a cataract, and seek the assistance of an opfthalmogist doctor accordingly. Although the symptoms are very specific, a diagnosis cannot yet be determined based solely on a history. In ophtalmological surgery, it is necessary to perform a complete ophtalmological examination in order to dtermine whether there are any associated eye diseases. The development of medicine also influenced the development of surgery to remove the cataract. The role of nurse/technician is of utmost importance at all levels of health care. The nurse/technician contributes to the disease diagnosis itself and educates the patient about the mode of surgery as well as possible to perform the surgery itself. After surgery, their role is to carry out post-operative health care and educate patients and families about further treatment or use of aids. The aim of this paper is to interpret the sickness of the cataract. The paper presents historical development of information about cataract, as well as the historical development of the operation related to the removal of cataract. The emphasis was also placed on the roe of nurse/technician from the very diagnostics, education, preparation for surgery, procedures on the operational day itself and post-operative health care. Nurse diagnoses were also elaborated.

Objectives: The objective of this study was to evaluate if distraction of patients during cataract surgery in the form of a conversation with the operating surgeon would augment the effect of topical anesthesia in lowering pain. Subjects and methods: This study included 101 eye surgeries in total. 52 of our study participants were female and 49 men. 49 subjects had previous cataract surgery on the other eye. The subjects were randomly divided into interventional and control group. The interventional group included 51 subjects that had a conversation about neutral or pleasant topics with the operating surgeon during the surgical procedure. The control group consisted of 50 patients who were only given minor instructions during the surgery. We used PCS, NRS and STAI to evaluate the pain perception. Results: The data from our questionnaires did not show a statistical significant difference between interventional and control group. A slight correlation was found between NRS results and the duration of surgery. Conclusions: : Our hypothesis that a conversation between the surgeon and patient during cataract surgeries could augment the effect of topical anesthesia and decrease pain was not confirmed., Ciljevi: Cilj ovog istraživanja bio je procijeniti može li distraktiranje pacijenata tijekom operacije katarakta u obliku razgovora s operaterom povećati učinak topikalne anestezije u smanjenju boli. Bolesnici i metode: U istraživanje je uključena 101 operacija oka. Od ispitanika u istraživanju 52 bile su žene, a 49 ispitanika muškaraci. Prethodnu operaciju katarakta na drugom oku imalo je 49 ispitanika. Ispitanici su nasumično podijeljeni u intervencijsku i kontrolnu skupinu. Intervencijsku skupinu činio je 51 ispitanika s kojima je tijekom operativnog zahvata razgovorao operativni kirurg o neutralnim ili ugodnim temama. Kontrolnu skupinu činilo je 50 ispitanika koji su tijekom operacije dobili samo poneke upute. Za procjenu percepcije boli koristili smo Pain Catastrophizing Scale, Numerical Rating Scale i State-Trait Anxiety Inventory. Rezultati: Podaci iz naših upitnika nisu pokazali statistički značajnu razliku između intervencijske i kontrolne skupine. Pronađena je slaba korelacija izmedu rezultata Numerical Rating Scale-a i trajanja operacije. Zaključci: Naša hipoteza da bi razgovor između kirurga i pacjenta tijekom operacije katarakte mogao pojačati učinak topičke anestezije i smanjiti bol nije potvrđena.

Electrospun materials are good candidates for the design of tissue regeneration scaffolds as they can simulate the natural surroundings of tissue cells. The study proposes electrospun polycaprolactone (PCL)/cefuroxime (CFU) scaffolds for human cell culture and investigates the influence of the antibiotic content on scaffold morphology, thermal and mechanical properties. The increase in the CFU concentration resulted in the reduction of fiber diameter and number of deformations. It also influenced the reduction of scaffold thermal enthalpies and improved scaffold break strength. With regard to cell growth, the scaffolds showed precedence in greater colonization of the HeLa cells. Finally, these scaffolds showed compatibility with standard human cell lines, and thus they can be used for the repair of damaged tissues.

Cilj istraživanja: Utvrditi koliko vremenski interval između indikacije i primjene anti-VEGF terapije utječe na ishod liječenja na Klinici za očne bolesti u Kliničkom bolničkom centru Split. Ispitanici i metode: Provedeno je retrospektivno istraživanje koje je uključivalo ukupno 172 bolesnika koji su primili intravitrealno bevacizumab. 116 bolesnika je liječeno zbog AMD te 56 zbog DME. Period obuhvata studije je od ožujka 2016. do studenog 2019. Istraživanje je provedeno na Klinici za očne bolesti KBC-a Split. Bolesnici su bili liječeni s tri doze bevacizumaba svakih mjesec dana uz kontrolu mjesec dana nakon primitka zadnje doze lijeka. OCT nalaz (analizirane vrijednosti: CST, Tmax ,CV i CAT) je napravljen kod postavljanja indikacije i nakon liječenja. Rezultati: Rezultati naše retrospektivne studije pokazuju da je došlo do smanjenja analiziranih vrijednosti (CST, Tmax, CV, CAT) i kod bolesnika s AMD i DME dijagnozom. U prosjeku je smanjenje vrijednosti nakon terapije CST (-34,91 µm), T-max (-81,12 µm), CV (-0,48 µm) i CAT (-13,52 µm) kod bolesnika s AMD , a kod bolesnika s DME u prosjeku je smanjenje vrijednosti CST (-38,18 µm), T-max (-54,71 µm), CV (-0,61 µm) i CAT (-11,07 µm). Utvrđena je povezanost između vremenskog intervala i CST, CV i CAT vrijednosti kod bolesnika s dijagnozom DME, povećanje vremenskog intervala između indikacije i primjene anti-VEGF terapije dovodi do povećanja CST, CV i CAT u bolesnika s DME. Kod bolesnika s AMD vremenski interval nije bio u korelaciji s ishodom liječenja: CST (r=0.02; P=0.397), Tmax (r=0.09; P=0.161), CV (r=0,04; P=0,346), CAT (r=0,05; P=0,289). Kod bolesnika s DME utvrđena je učinkovitost terapije kod primjene unutar 130 dana od indikacije. Zaključci: Tromjesečna intravitrealna injekcija bevacizumaba dovodi do poboljšanja u analiziranim vrijednostima OCT nalaza bolesnika sa dijagnozom senilne makularne degenercije i dijabetičnog makularnog edema. Također, bolesnicima s DME dijagnozom važno je pravovremeno primijeniti anti-VEGF terapiju te je učinkovitost veća ukoliko je terapija primijenjena unutar 130 dana od indikacije. Kod bolesnika s AMD vremenski interval nije bio u korelaciji s ishodom liječenja., Objectives: The aim of this study was to determine the impact of intravitreal injection timing (i.e. the time interval from indication to application of anti-VEGF therapy) on treatment outcome at the Department of Ophthalmology, University Hospital Centre Split. Subjects and Methods: A retrospective study involving 172 patients who received intravitreal bevacizumab was performed. 116 patients were treated for AMD and 56 were treated for DME. Patients were treated between March 2016 and November 2019 at the Department of Ophthalmology, University Hospital Centre Split. Patients were treated with three (3) monthly doses of bevacizumab and follow-up was scheduled a month after receiving the last dose. OCT parameters analysed (CST, Tmax , CV and CAT) before and after therapy. Results: The results of our retrospective study has shown decline in CST, Tmax, CV and CAT values for both, AMD and DME patients. On average, there was a decline in values of CST (-34,91 µm), T-max (-81,12 µm), CV (-0,48 µm) and CAT (-13,52 µm) for AMD patients and for DME patients average decline was for CST (-38.18 µm), T-max (-54.71 µm), CV (-0.61 µm ) and CAT (-11.07 µm). Significant correlation between time interval and CST, CV and CAT values was found in DME patients, increasing the time interval between indication and application of anti-VEGF therapy leads to CST, CV, and CAT increase in patients with DME. The intravitreal injection timing is not in a significant correlation with the treatment outcome for AMD patients: CST (r=0.02; P=0.397), Tmax (r=0.09; P=0.161), CV (r=0,04; P=0,346), CAT (r=0,05; P=0,289). In patients with DME, the efficacy of the therapy is confirmed if applied within 130 days after indication. Conclusions: Three-month intravitreal injection of bevacizumab leads to an improvement of the analyzed OCT values in all patients. Also, for patients with DME diagnosis is important to apply timely anti-VEGF therapy and efficacy is higher if therapy is applied within 130 days after indication. The intravitreal injection timing wasn't in a significant correlation with the treatment outcome for AMD patients.

Cilj istraživanja: Ispitati utjecaj subtenonskog triamcinolona uz intravitrealni bevacizumab na smanjenje makularnog edema. Ispitanici i metode: U istraživanje je uključen 21 bolesnik s edemom makule (CST > 250 μm) kod kojih primjena najmanje 3 intravitrealne injekcije bevacizumaba nije dovela do zadovoljavajućeg poboljšanja makularnog edema. Pet bolesnika je u pozadini imalo dijagnozu senilne makularne degeneracije, tri okluziju centralne retinalne vene, a trinaest dijabetički makularni edem, a svi su liječeni tijekom 2019. godine u Klinici za očne bolesti, KBC Split. Nakon što se ustanovila rezistentnost edema, bolesnici su upućeni na aplikaciju intravitrealne injekcije bevacizumabom uz subtenonsku aplikaciju injekcije triamcinolona. Kontrolni pregled intraokularnog tlaka napravljen je dan nakon zahvata i prilikom svake sljedeće oftalmološke kontrole koja je osim mjerenja intraokularnog tlaka, podrazumijevala i pregled vidne oštrine, OCT makule i pregled očne pozadine, a obavljeni su 1 i 3 mjeseca nakon primjene terapije. Rezultati: Bolesnici su u prosjeku prije gore navedene kombinacijske terapije primili 8,14 injekcija intravitrealnog bevacizumaba ± 3,7. Vidna oštrina nakon jednog mjeseca od injekcije se poboljšala u 12 bolesnika (57%) u odnosu na početnu vidnu oštrinu, dok je nakon 3 mjeseca ostala poboljšana u 10 bolesnika (47%). Nakon jednog mjeseca od injekcije došlo je do statistički značajnog poboljšanja prosječne vidne oštrine (+0,05), a nakon tri mjeseca vrijednost prosječne vidne oštrine nije statistički značajno promijenjena u odnosu na početnu (+0,03). Rezultati su pokazali statistički značajno smanjenje CST-a nakon jednog (-154,96 μm) i nakon 3 mjeseca (-106,57 μm) od injekcije. Nakon jednog mjeseca, u 18 (85%) bolesnika je došlo do smanjenja vrijednosti CST-a, a nakon 3 mjeseca isto se dogodilo u 15 bolesnika (71%). Prosječna vrijednost intraokularnog tlaka povećala se za 1 mmHg. Zaključak: Utvrđeno je statistički značajno smanjenje makularnog edema nakon subtenonske injekcije triamcinolon acetonida u bolesnika koji nisu reagirali na opetovanu monoterapiju intravitrealnim bevacizumabom., Objectives: The aim of this study was to determine the influence of sub-Tenon triamcinolone acetonide added to intravitreal bevacizumab on reduction of macular edema. Materials and methods: The study included 21 patients with macular edema (CST > 250 μm) in whom administration of at least 3 intravitreal injections of bevacizumab did not lead to a satisfactory improvement in macular edema. Five patients were diagnosed with senile macular degeneration, three with central retinal vein occlusion, and thirteen with diabetic macular edema. All of them were treated during 2019 at the Department of Ophthalmology, University Hospital of Split. Once edema resistance was established, patients were referred to intravitreal application of bevacizumab together with sub-Tenon injection of triamcinolone. Intraocular pressure screening was performed one day after the procedure and at each subsequent ophthalmic examination, which, in addition to intraocular pressure measurements, included visual acuity, OCT scan of the macula and fundus examination, and were performed 1 and 3 months after injection. Results: Patients received an average of 8.14 injections of intravitreal bevacizumab ± 3.7 prior to the above combination injection. Visual acuity after one month of injection improved in 12 patients (57%) compared to baseline visual acuity, while after 3 months it remained improved in 10 patients (47%). After one month of injection, there was a statistically significant improvement in average visual acuity (+0.05). After three months, the value of average visual acuity did not change significantly from baseline (+0.03). The results showed a statistically significant decrease in CST after one (-154.96 μm) and after 3 months (-106.57 μm) from injection. After one month, the value of CST decreased in 18 patients (85%), and after 3 months the same occurred in 15 patients (71%). The average intraocular pressure value increased by 1 mmHg after 3 months. Conclusions: A statistically significant decrease in macular edema after sub-Tenon injection of triamcinolone acetonide was found in patients who did not respond to repeated monotherapy with intravitreal bevacizumab.

Cilj istraživanja: Cilj ovog istraživanja je bio utvrditi postoji li značajna razlika u subjektivnom osjetu boli prilikom davanja intravitrealne injekcije ako se pacijentima umjesto postavljanja blefarostata, vjeđe rastvaraju i pridržavaju prstima. Ispitanici i metode: U prospektivnom kohortnom istraživanju provedenom u Kliničkom bolničkom centru Split, na Klinici za očne bolesti, uključeni su bolesnici na redovnom režimu primanja intravitrealne terapije lijeka Avastin. Istraživanje se provodilo od kolovoza 2019. godine do siječnja 2020. godine. U istraživanju je sudjelovalo 90 bolesnika. Prije svakog zahvata, ispitanici su ispunjavali upitnik anksioznosti kao stanja i osobine ličnosti (eng. state-trait anxiety inventory for adults, STAI) i ljestvicu pretjeranog doživljavanja ozbiljnosti boli (eng. pain catastrophizing scale, PCS). Na početku samog zahvata, provedena je dezinfekcija kože oko oka, vjeđa i površine oka 5%-tnim povidon jodidom te lokalna anestezija, pri čemu je korišten topički 0,4% oksibuprokain klorid. Za povlačenje vjeđa kod ispitanika kontrolne skupine primjenjen je sterilni blefarostat, a kod ispitanika eksperimentalne skupine vjeđe za razdvajanje vjeđa koristili su se prsti. Intravitrealno se primijenjivao lijek Avastin u dozi od 1,25mg/0,05ml. U istraživanju je dano sveukupno 174 injekcija u 90 bolesnika. Nakon zahvata ispitanici su kvantificirali jačinu boli na numeričkoj skali (NRS). Rezultati: U istraživanju je dano 174 injekcija u 90 bolesnika, 73 injekcije (41,95%) u žena i 101 (58,05%) u muškaraca. Dvadeset i sedam (15,52%) bolesnika dobili su po jednu injekciju, četrdeset i pet (51,72%) po dvije, petnaest (25,86%) po tri i tri (6,90%) bolesnika po četiri intravitrealne injekcije lijeka Avastin. Nije utvrđena statistički značajna razlika (P=0,996) po spolu između eksperimentalne i kontrolne skupine. Prema dobivenim rezultatima za PCS ukupno i STAI, nije pronađena statistički značajna razlika (P=0,164; P=0,767) između skupina, ali su se statistički značajno razlikovale prema dobivenim rezultatima za NRS (P=0,033). Dobiveni je NRS rezultat za kontrolnu skupinu iznosio 2,86±2,51, a za eksperimentalnu skupinu 2,09±2,18. Pronađena je blaga pozitivna korelacija (r=0,386) između STAI upitnika i PCS ljestvice. Nije pronađena korelacija između STAI upitnika i NRS ljestvice (r=0,156) te između PCS i NRS ljestvice (r=0,141). Zaključci: Iz rezultata ovog istraživanja možemo zaključiti da korištenje prstiju za razdvajanje vjeđa umjesto blefarostata značajno smanjuje osjećaj boli prilikom davanja intravitrealne injekcije. Spol nema utjecaja na doživljaj boli. Postoji blaga pozitivna korelacija između STAI upitnika i PCS ljestvice te ne postoji korelacija između STAI upitnika i NRS te između PCS i NRS ljestvice., Objectives: The aim of this study was to determine whether there is a statistically significant difference in the subjective experience of pain when implementig bimanual lid retraction versus metal speculum eyelid retraction in intravitreal injection Subjects and Methods: This prospective cohort study, conducted at the Clinic for Ophthalmology of University Hospital of Split, included patients treated with intravitreal Avastin. The study was conducted between August 2019 and January 2020. Ninety patients participated in the study. Before each procedure, patients completed a STAI (state-trait anxiety inventory for adults) and PCS (pain catastrophizing scale) questionnaires. At the beginning of the procedure, subjects underwent disinfection using 5% PVI on the skin around eye, eyelids and ocular surface and local anaesthesia with topical 0,4% oxyburocaine hydrochloride. In the control group, the metal speculum lid retraction technique was used, and in experimental group, a bimanual lid retraction technique was. Further, the study applied an intravitreal Avastin in the dose of 1,25mg/0,05ml. 174 injections in 90 patients were given in the study. After the procedure, subjects reported pain intensity using the numerical scale (NRS). Results: 174 injections in 90 patients were given in the study, 73 (41,95%) injections in women and 101 (58,05%) in men. Twenty-seven (15,52%) patients received one injection, forty-five (51,72%) patients received two injections, fifteen (25,86%) patients received three injections and three (6,90%) patients received four intravitreal injection of Avastin. There was no statistically significant difference (P=0,996) based on gender between experimental and control group. According to the obtained results for PCS total score and STAI, there was no statistically significant difference (P=0,164; P=0,767) between group, but there was statistically significant difference (P=0,033) between group according to the obtained results for NRS. The obtained NRS result for the control group was 2.86 ± 2.51, and for the experimental group 2.09 ± 2.18. There was a slight positive correlation (r=0,386) between STAI and PCS. There was no correlation between STAI and NRS (r=0,156) and between PCS and NRS (r=0,141). Conclusion: From the obtained data we can conclude that the use of bimanual lid retraction significantly reduces the feeling of pain during the intravitreal injection procedure. Gender did not affect the experience of pain. There was a slight positive correlation between STAI and PCS. There was no correlation between STAI and NRS and between PCS and NRS.

Cilj istraživanja: Ispitati ulogu hemodinamskih promjena u arteriji oftalmici u oboljelih od vitiliga i njihov prognostički značaj za razvoj primarnog glaukoma otvorenog kuta. Materijali i metode: Tijekom dvogodišnjeg razdoblja od ožujka 2008. godine do ožujka 2010. godine ispitano je 42 pacijenata s vitiligom koji su upućeni od upućeni iz dermatološke ambulante Klinike za kožne i spolne bolesti. Zbog sumnje na razvoj glaukoma upućeni su u ambulantu za glaukom na Klinici za očne bolesti. U svrhu otkrivanja ili kontrole primarnog glaukoma otvorenog kuta svi ispitanici podvrgnuti su kompletnom oftalmološkom pregledu prilikom kojeg se mjerila vidna oštrina i očni tlak, pregledan je fundus oka, napravljena je biomikroskopija prednjeg segmenta oka s gonioskopijom i ispitano je vidno polje. Potom je svim ispitanicima napravljen ultrazvuk arterije oftalmike oba oka na Klinici za unutarnje bolesti KBC-a Split. Rezultati: Od 42 pacijenta s vitiligom koji su zbog sumnje na primarni glaukom otvorenog kuta pregledani na Klinici za očne bolesti KBC-a Split glaukom je dijagnosticiran u 24 (57%) pacijenta. Između skupine pacijenata u kojih je došlo do pojave glaukoma i skupine onih u kojih nije dokazan glaukom nije pronađena statistički značajna razlika ni po spolu (P=0,307) niti prema dobi (P=0,178). U skupini bolesnika s glaukomom medijan trajanja vitiliga duži je 2,83 puta (P=0,001). Podjelom bolesnika prema dužini trajanja vitiliga (12,5 godina) otkriveno je da postoji tri puta više bolesnika s trajanjem vitiliga >12,5 godina u skupini bolesnika s glaukomom nego bez glaukoma (χ2=12,8; P=0,001). Statistički obradom ultrazvučnog nalaza arterije oftalmike oba oka pronađeno je da ne postoji značajna razlika u indeksu otpora, indeksu pulzatilnosti, vršnom protoku u sistoli i protoku krvi na kraju dijastole između skupine pacijenata s vitiligom bez glaukoma i skupine s glaukomom. Zaključci: U oboljelih od vitiliga s duljim trajanjem bolesti raste rizik za razvoj primarnog glaukoma otvorenog kuta. Detaljnim ispitivanjem ultrazvučnih parametara arterije oftalmike oba oka isključena je vaskularna komponenta kao mogući uzrok pojave glaukome u bolesnika s vitiligom., Objectives: To examine the role of hemodynamic changes found in the ophthalmic artery in patients with vitiligo and their prognostic significance for the development of primary open-angle glaucoma. Materials and methods: During the two-year period from March 2008 to March 2010, 42 patients with vitiligo were examined from the dermatology clinic of the Clinic for Skin and Venereal Diseases. Due to the suspicion of the development of glaucoma, they were referred to the glaucoma clinic at the Clinic for Eye Diseases. For the purpose of detection or control of primary open-angle glaucoma, all subjects underwent a complete ophthalmological examination, which measured visual acuity and intraocular pressure, examined the fundus of the eye, performed biomicroscopy of the anterior segment of the eye with gonioscopy and examined the visual field. Then, all subjects underwent ultrasound of the ophthalmic artery of both eyes at the Clinic for Internal Medicine of the University Hospital Center Split. Results: Of the 42 patients with vitiligo who were examined at the Clinic for Ophthalmology of the University Hospital Center Split due to suspicion of primary glaucoma, glaucoma was diagnosed in 24 (57%) patients. No statistically significant difference was found between the group of patients with glaucoma and the group without glaucoma, either by sex (P=0.307) or by age (P=0.178). In the group of patients with glaucoma, the median duration of vitiligo was 2.83 times longer (P=0.001). The division of patients according to the duration of vitiligo ( 12.5 years) revealed that there were three times more patients with a duration of vitiligo> 12.5 years in the group of patients with glaucoma than without glaucoma (χ2 = 12.8; P=0.001). Statistical analysis of the ophthalmic artery ultrasound findings of both eyes found that there was no significant difference in resistance index, pulsatility index, peak systole flow, and end-diastole blood flow between the group of patients with vitiligo who developed glaucoma and the group of patients who didn't develop glaucoma. Conclusions: Patients with vitiligo with a longer duration of the disease have an increased risk of developing primary open-angle glaucoma. A detailed examination of the ultrasound parameters of the ophthalmic artery of both eyes ruled out the vascular component as a possible cause of glaucoma in patients with vitiligo.

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: 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

Prikazati refrakcijski status prijevremeno rođene djece i djece rođene na termin s konvergentnim strabizmom. Utvrditi razlike i specifičnosti u refrakcijskom statusu prijevremeno rođene djece u odnosu na djecu rođenu na termin s konvergentnim strabizmom.MATERIJAL I METODE:Podatci su prikupljeni u registru Klinike za očne bolesti KBC-a Split. Napravljen je kompletan klinički oftalmološki pregled 62 djece sa esotropijom po standardnoj proceduri u cilju isključenja ili dijagnoze refrakcijskih grešaka. U ispitivanje nisu uključena djeca koja su imala obiteljskih refrakcijskih anomalija,ROP ili neki drugi organski poremećaj oka. U skupini prijevremeno rođene djece bez retinopatije kod nedonščadi (ROP – engl. Retinopathy of prematurity) bilo je uključeno 31 dijete sa esotropijom, a u skupini na termin rođne djece također 31 dijete sa esotropijom. Temeljni kriterij određivanja refrakcijskog statusa djece bila je skijaskopija te su podaci dobiveni tom objektivnom metodom uzeti za daljnu statističku obradu podataka. Atropinska sferosferična skijaskopija je objektivna metoda ispitivanja refrakcije. U našem ispitivanju korišten je Atropin sol.0.50% 3x dnevno 3 dana prije pregleda.REZULTATI: Unutar skupine prijevremeno rođene djece metodom skijaskopije određene su vrijednosti: Prema vrsti i veličini sferne dioptrije obzirom na termin poroda u skupini prijevremeno rođene djece određene su vrijednosti: 18 (29%) djece je imalo vrijednosti sferne dioptrije (Dsph) od -1,0 do 0 , 25 (40,3%) od 0 do +1,0 Dsph, 19 (30,6%) od +1,0 do +2,0 Dsph, 0 (0%) od +2,0 do +3,5 Dsph. Unutar skupine djece rođene na termin metodom skijaskopije određene su vrijednosti: 0 (0%) djece je imalo vrijednosti sferne dioptrije (Dsph) od -1,0 do 0, 0 (0%) od 0 do +1,0 Dsph, 36 (58,1%) od +1,0 do +2,0 Dsph, 26 (51,9%) od +2,0 do +3,5 Dsph. ZAKLJUČCI: Postoji statistički značajna razlika u veličini sferne dioptrije petogodišnje djece u odnosu na termin poroda ( Z=8,8;r=0,79; p< 0,001). Medijan sferne dioptrije za 1 je veći kod djece rođene na termin u odnosu na prijevremeno rođenu djecu ( 95% CI: 0,71-1,29 )., The objectives of this research are to demonstrate the refractory status of the children born prematurely compared with the children born at term in preschool age with convergent strabismus, determine the differences and specifics of the refractory status of the children born prematurely compared to the children born at term in preschool age.OBJECTIVES: The objectives of this research are to demonstrate the refractory status of the children born prematurely compared with the children born at term in preschool age with convergent strabismus, determine the differences and specifics of the refractory status of the children born prematurely compared to the children born at term in preschool age. MATERIAL AND METHODS: The data were collected in the register of Department of Ophthalmology, University Hospital of Split. 62 children (124 eyes) were treated at the age of 5 with esotropia. A complete clinical ophthalmic examination was performed according to the standard procedure in order to exclude or diagnose refractive errors. The basic criterion for determining the refractory status of children was retinoscopy, and the data obtained by this objective method were taken for statistical data processing. The study did not include children who had family refractive anomalies, ROP or some other organic eye disorder. Atropine spherospherical retinoscopy is an objective method of examination. RESULTS: Within the group of children born prematurely, the method of retinoscopy was used to determine the following values: 18 (29%) children had values from -1.0 to 0.0 dioptres in the sphere (Dsph), 25 (40.3%) from 0.0 to +1.0 Dsph , 19 (30.6%) from +1.0 to +2.0 Dsph, 0 (0%) from +2.0 to +3.5 Dsph. Within the group of children born at term the method of retinoscopy was used to determine the following values: 0 (0%) children had values from -1.0 to 0.0 Dsph, 0 (0%) from 0.0 to +1.0 Dsph, 36 (58.1%) from +1 , 0 to +2.0 Dsph, 26 (51.9%) from +2.0 to +3.0 Dsph. CONCLUSIONS: The children born prematurely were most commonly diagnosed with myopia in preschool age. There is a statistically significant difference in the refractory status of the children born prematurely and children born at term in preschool age( Z=8,8;r=0,79; p< 0.001).

Kontaktna leća je svaka leća koja se stavlja na površinu oka, prvenstveno rožnice s ciljem korekcije refrakternih anomalija, liječenja očnih oboljenja, otklanjanja kozmetičkih defekata i promjene boje očiju. Ovisno o vrsti materijala, dijelimo ih na dvije velike skupine- meke i tvrde. Ovisno o predviđenom periodu korištenja, razlikujemo dnevne, dvotjedne, mjesečne, tromjesečne i godišnje. Neke od najvažnijih indikacija su: keratokonus anterior, iregularni astigmatizam, anizometropija, afakija i pseudofakija, ametropija kod kojih se naočalama ne postiže zadovoljavajuća vidna oštrina, prezbiopija, albinizam i promjene na šarenici. Odabir vrste kontaktnih leća ponajviše ovisi o indikaciji. Prije svakog propisivanja kontaktnih leća potrebno je provesti detaljan oftalmološki pregled, refraktometriju i keratometriju. Razvojem kontaktnih leća broj komplikacija je smanjen, ali je i dalje prisutan. Danas su najzastupljenije hipoksično- hiperkapnijske i infektivne komplikacije. Terapija je uglavnom simptomatska, osim kod ozbiljnijih infektivnih komplikacija kada se lokalno daje antibiotik. Valja naglasiti važnost pravilnog čišćenja i održavanja leća čime se u stvari prevenira velik broj komplikacija., A contact lens is a thin lens placed directly on the surface of the eye, primarily the cornea with the aim of correcting refractory anomalies, treating eye disorders, removing cosmetic defects, and changing eye color. Depending on the type of material, we divide them into two large groups - soft and hard. Depending on the anticipated period of use, we differentiate daily, two-week, monthly, quarterly, and yearly. Some of the most important indications are: keratoconus anterior, irregular astigmatism, anisometropium, afacita and pseudophysium, amethropia, cases in which glasses do not achieve satisfactory visual acuity, presbyopia, albinism and changes in iris. Choosing the type of contact lens depends mostly on the indication. Prior to any prescribing of contact lenses, a detailed ophthalmic examination, refractometry and keratometry should be performed. By developing contact lenses, the number of complications is reduced but still present. Today, the most common complications are hypoxic-hypercapneal and infectious one. Therapy is mostly symptomatic, except for serious infectious complications when we use antibiotic locally. It is important to emphasize the importance of proper cleaning and maintenance of the lens, which in fact prevents a large number of complications.

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 Kmax changes in the postoperative period of 12 months together with visual acuity changes. Results Visual acuity improved significantly in the first 3 months after the procedure and even more significantly until the end of the first year. Even Kmax is the most relevant and most followed parameter for progression and regression of keratoconus, its lowering was not directly correlated with the visual acuity improvement (both uncorrected and corrected) in the first 6 months after corneal CXL procedure. Kmax was changed significantly in the period of 12 months post cross linking, but not in the first 6 months. Conclusion Corneal CXL should be considered as a procedure not just for corneal stiffening and stabilization, but also for visual acuity improvement in keratoconus patients

Purpose: To determine the significance of changes and and inter-relationships between three markers of binocular function (aniseikonia, distance and near stereoacuity) following unremarkable LASIK at 3 and 6 months postoperatively. Methods: All patients underwent LASIK using the Schwind Amaris 750S and the flaps were created using Intralase 150 kHz. Patients were I, monocular myopes II, binocular myopes III, binocular hyperopes IV, binocular astigmats V, anisometropes and VI, matched age and gender control (n = 20 in each group except III where n = 18). Aniseikonia (Awaya test), distance and near stereoacuity (Randot tests) were measured before surgery, and at 3 and 6 months after surgery. At all times data were collected under constant conditions and analyzed using appropriate non- parametric statistical tests. Results: The following statistically significant changes were found after applying the Bonferroni correction (p ≤ 0.001) ; aniseikonia reduced (groups I, III, IV, V), stereoacuity improved at distance (groups I, III-V) and near (groups I, V). Inter-group differences in aniseikonia distance and near stereoacuity were significant preoperatively, but not postoperatively. In groups I, IV and V, the changes in aniseikonia and stereoacuity (near and distance) were significantly correlated with the preoperative value. Aniseikonia was significantly correlated with distance and near stereoacuity preoperatively but not postoperatively. Conclusion: Binocular function improved in all groups after LASIK except in binocular myopes. In general, binocular function was still low compared with the control group at six months postoperatively. It is unclear why binocular function improved in the binocular astigmats. © 2019 Spanish General Council of Optometry

Cilj: Sloj vlakana vidnog živca (RNFL, engl. retinal nerve fi berlayer) čine aksoni retinskih ganglijskih stanica. Optička koherentna tomografi ja (OCT, engl. optical coherence tomography) važan je alat u dijagnostici optičkih neuropatija. Za procjenu osjetljivosti pretrage izolirano se snimao samo RNFL i posebno se uključila analiza sloja ganglijskih stanica (GCL, engl. ganglion cell layer) u makuli. Metode: Ovo je retrospektivna analiza snimki OCT-a u 348 pacijenata koji su pod sumnjom na optičku neuropatiju upućeni u neurooftalmološki kabinet, u razdoblju od godine dana. OCT snimke dobivene su uređajem SOCT Copernicus REVO (Optopol TechnologySp. z.o.o.; softver verzija 7.0.0). Rezultati: Osjetljivost mjerenja RNFL-a je 37,6 % (62/165) (uz 95 %-tni interval pouzdanosti (CI) 30,2 % - 45,4 %), a dijagnostička točnost testa je 58,6 % (165/292) (CI 95 %: 52,7 % - 64,3 %). Ako se uzme u analizu i GCL čak su 103 pacijenta (35.2 % - 103/292) analizirajući samo RNFL bila lažno negativna, odnosno bez GCL ne bi se otkrila optička neuropatija. Zaključak: OCT je postalo važno pomagalo u neurooftalmološkoj praksi. Omogućava vizualizirati aksonalni/ neuronalni integritet vidnog puta. Upotreba OCT-a makule uz analizu GCL dovela je do dodatnog proširenja primjenljivost OCT-a u neurooftalmologiji., Aim: The retinal nerve fi ber layer (RNFL) is made up of retinal ganglion cell axons. We evaluated sensitivity of optical coherence tomography (OCT) when measuring only RNFL or when a ganglion cell layer (GCL) analysis is added to the evaluation of optic neuropathy. Methods: This was a retrospective analysis of OCT in 348 patients examined at the neuro-ophthalmology department for suspicion of optic neuropathy during one year. OCT scans were taken with SOCT Copernicus REVO (Optopol Technology Sp. z.o.o.; software version 7.0.0). Results: Sensitivity of measuring RNFL alone was 37.6% (62/165) (with 95% confi dence interval (CI) 30.2%-45.5%) with 58.6% accuracy (165/292) (CI 95%: 52.7%-64.3%). When taking GCL in analysis, 103 patients (35.2%; 103/292) would be classifi ed as normal, false-negative if just RNFL measurements would be the only criterion for diagnosing optic neuropathy. Conclusions: OCT has become one of the most important tools in neuroophthalmic practice. It allows us to visualize axonal/neuronal integrity in the afferent visual pathway. Use of macular OCT with GCL analysis has contributed to the extended applicability of OCT in neuro-ophthalmology.

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.

Uvod: Panretinalna fotokoagulacija (PRP) učinkovita je i rasprostranjena metoda terapije u pacijenata s proliferativnom dijabetičkom retinopatiom (PDR). Međutim, ova terapija se pokazala bolnom u prethodnim istraživanjima. Dokumentirane su različite strategije kojima se pokušava povećati udobnost pacijenata laserskom fotokoagulacijom, ali većina ih ima potencijalne nedostatke. Retrobulbarna injekcija anestetika jednostavna je metoda kojim bi se mogla smanjiti bolnost PRP-a. Cilj istraživanja: Cilj ovog istraživanja bio je ispitati postoji li razlika u percepciji boli oka tretiranog retrbulbarnom injekcijom anestetika u odnosu na drugo oko koje je tretirano topičkim anestetikom u pacijenata s dijabetičkom retinopatijom koji su podvrgnuti panretinalnoj fotokoagulaciji. Ispitanici i metode: Ovo prospektivno eksperimentalno istraživanje uključivalo je 13 ispitanika (26 očiju) koji boluju od proliferativne dijabetičke retinopatije te su podvrgnuti panretinalnoj fotokoagulaciji u Klinici za očne bolesti KBC-a Split između kolovoza 2019. i siječnja 2020. godine. U studiju je uključeno 11 muškaraca i 2 žene. Medijan dobi ispitanika iznosi 63 (48 - 74). Rezultati: Razlika u percepciji boli, koja je bila zabilježena NRS (Numerical Rating Scale) ljestvicom, između ispitivane eksperimentalne skupine (RBB) i kontrolne skupine (topička anestezija) se pokazala statistički značajnom (P < 0,05). Eksperimentalna skupina kojoj je prije panretinalne fotokoagulacije (PRP) apliciran anestetik putem retrobulbarne injekcije je imala manju percepciju boli u odnosu na kontrolnu skupinu kojoj je apliciran topički anestetik prije PRP. Zaključak: Iz rezultata ovog istraživanja možemo zaključiti da apliciranje anestetika (lidokain 2 mg) retrobulbarnom injekcijom prije samog izvođenja panretinalne fotokoagulacije statistički značajno smanjuje bolnost ove procedure u usporedbi s apliciranjem topičkog anestetika (Benoxi kapi za oči)., Introduction: Panretinal photocoagulation (PRP) is an effective and widespread method of therapy in patients with proliferative diabetic retinopathy (PDR). However, this therapy has been shown to be painful in previous studies. Various strategies have been documented to attempt to increase patient comfort during laser photocoagulation, but most have potential drawbacks. Retrobulbar injection of anesthetics is a simple method that could reduce the pain of PRP. Objectives: The aim of this study was to examine whether there is a difference in the pain perception in an eye treated with retrobulbar application of anesthetic compared to the other eye treated with a topical anesthetic in patients with diabetic retinopathy who underwent panretinal photocoagulation. Subjects and methods: This prospective experimental study included 13 subjects (26 eyes) suffering from proliferative diabetic retinopathy and underwent panretinal photocoagulation at the Department of Ophthalmology of University Medical Center Split between August 2019 and January 2020. The study included 11 men and 2 women. The median age of the subjects was 63 (48 - 74). Results: The difference in pain perception, which was recorded by NRS (Numerical Rating Scale), between the examined experimental group (RBB) and control group (topical anesthesia) was statistically significant (P

Leishmania donovani is a human blood parasite that belongs to the genus Leishmania. We would like to present a case of late Leishmania donovani endophthalmitis in one eye of a patient that underwent simultaneous bilateral grade 3 cataract surgery.

Glaucoma is a chronic, progressive eye disorder that can lead to visual impairment and blindness. The projection of glaucoma prevalence in the world suggests that in 2020, 79,6 million of people will have glaucoma, 11,2 million of them will be bilaterally blind. The chronic disease, such as glaucoma, affects the different roles of a patient in everyday life and his/her well-being. Quality of Life (QoL) helps to define the inability of performing specific task that is most important to patient. Patients’ perspective on their visual impairment and well-being are essential in the planning of management of glaucoma. The assessment of QoL should be standard procedure in the management of glaucoma patients. In clinical practice it should represent a gold standard in the care of chronic patients and a proof of fulfilling the patients’ rights. The assessments of QoL should serve as a tool for good clinical practice, for respecting the patients’ rights, and respect for the value of human life in general.

Objectives: The objective of this study was to analyze the tissue characteristics in retinal surface disorders in four groups of patients including iERM, macular rupture, retinal detachment and diabetic retinopathy. It was hypothesised that VEGF is more expressed in less differentiated cells which should also show an overexpression of NESTIN. Materials and methods: ERM samples were collected over 4 years from 157 patients whose age group ranged between 12 and 82 years. The median age was 71 years. 85 out of the 157 patients were male and 72 were female. The inclusion criteria for the study was the diagnosis of ERM that were confirmed with optical coherence tomography (OCT) and visual acuity of 0.5 or less. The ERM tissues were collected during the Pars Plana Vitrectomy (PPV) surgery. The samples were embedded in paraffin blocks before they were cut and stained using immunohistochemistry. NESTIN was the primary antibody used and VEGF was the secondary antibody. Sections were observed and images were captured using a BX51 microscope (Olympus, Tokyo, Japan) equipped with a DP71digital camera (Olympus, Tokyo, Japan). Images were then processed with CellA Imaging Software for Life Sciences Microscopy (Olympus Tokyo, Japan). Microscopic imaging with Hematoxylin and eosin stain were also performed. Tsanou et al. scoring system was used to evaluate the expression of VEGF and NESTIN. The intensity of staining was scored 0 to 3 (0 = negative, 1 = weak, 2 = intermediate and 3 = strong staining) and was semiquantitatively scored as +, ++ and +++ corresponding to small, moderate and high number of positive cells, respectively. Results: We found that the expression of NESTIN was mostly seen in ERMs of retinal detachments and VEGF was equally expressed in Groups 1, 3 and 4. Neither of the proteins were expressed in Group 2 samples which represented iERMs. It was also discussed that during future studies, it would be ideal to use a confocal microscope which will allow better tissue preservation and the expression of Ki67 and GFAP would also be analyzed. Conclusions: It was concluded that the exact mechanism in the development and pathogenesis of some retinal surface disorders such as iERM formation is still unclear. We found NESTIN positive tissue in our samples which suggests their proliferation capacity and their immaturity. Positive VEGF expression in these tissues shows their potential for angiogenesis especially in patients with retinal detachments and diabetic retinopathy. The results from this study confirmed the hypothesis that VEGF is more expressed in less differentiated cells which also show an overexpression of NESTIN., Ciljevi: Cilj ovog istraživanja je analiza karakteristika tkiva u poremećajima površine mrežnice u četiri skupine bolesnika, uključujući iERM, rupturu makule, odvajanje mrežnice i dijabetičku retinopatiju. Pretpostavljeno je da je VEGF izraženiji u manje diferenciranim stanicama, što bi također trebalo pokazati prekomjernu ekspresiju NESTIN-a. Materijali i metode: Uzorci ERM-a prikupljeni su tijekom 4 godine od 157 pacijenata bolesnika čija se dobna skupina kretala između 12 i 82 godina. Srednja dob bila je 71 godina. Od ukupnog broja bolesnika 85 ih je bilo muškog spola, a 72 ženskog. Kriteriji za uključivanje u studiju bili su dijagnoza ERM-a koja je potvrđena optičkom koherentnom tomografijom (OCT) i oštrinom vida od 0,5 ili manje. ERM tkiva prikupljena su tijekom operacije Pars Plana Vitrektomije (PPV). Uzorci su ugrađeni u parafinske blokove prije nego što su izrezani i imunohistokemijski obojeni. NESTIN je primarno korišteno protutijelo, a VEGF je sekundarno antitijelo. Promatrane su sekcije i snimljene su slike pomoću mikroskopa BX51 (Olympus, Tokyo, Japan) opremljenog digitalnim fotoaparatom DP71 (Olympus, Tokyo, Japan). Slike su zatim obrađene pomoću CellA Imaging Software-a za mikroskopiju Life Sciences (Olympus Tokyo, Japan). Također su provedena mikroskopska snimanja s Hematoxylin i eosin bojama. Tsanou i sur. Sustav bodovanja korišten je za procjenu ekspresije VEGF-a i NESTIN-a. Intenzitet bojenja je bodovan 0-3 (0 = negativno, 1 = slabo, 2 = srednje i 3 = jako) i bio je polu-kvantitativno ocjenjen kao +, ++ i +++ što odgovara malom, umjerenom i velikom broju pozitivnih stanica. Rezultati: Otkrili smo da se ekspresija NESTIN-a uglavnom vidi u ERM-u retinalnih izdvajanja, a VEGF je jednako izražen u skupinama 1, 3 i 4. Nijedan od proteina nije eksprimiran u uzorcima skupine 2 koji su predstavljali iERM. Također je raspravljano da bi tijekom budućih studija bilo idealno koristiti konfokalni mikroskop koji će omogućiti bolje očuvanje tkiva i analizirati ekspresiju Ki67-a i GFAP-a. Zaključci: Zaključeno je da je točan mehanizam u razvoju i patogenezi nekih poremećaja površine mrežnice kao što je iERM formacija još uvijek nejasan. Našli smo NESTIN pozitivno tkivo u našim uzorcima što sugerira njihovu sposobnost proliferacije i njihovu nezrelost. Pozitivna ekspresija VEGF-a u tim tkivima pokazuje njihov potencijal za angiogenezu, posebno u bolesnika s retinalnim odvajanjima i dijabetičkom retinopatijom. Rezultati ove studije potvrdili su hipotezu da je VEGF izraženiji u manje diferenciranim stanicama koje također pokazuju prekomjernu ekspresiju NESTIN-a.

Objectives: The aim of this study was to analyze how patients experience pain during cataract surgery and the possible impact of speaking to the patients during the procedure. Materials and methods: Fifty-seven patients that were to undergo cataract surgery were enrolled in the study and randomly assigned to an experimental or a control group after they filled out the STAI and PCS. The experimental group was distracted during the procedure by the surgeon speaking to them. NRS and STAI once again were used after the procedure to evaluate how pain was perceived. Results: No significant difference in pain perception could be shown between the experimental and the control group. But there were significant differences between men and women in their pain perception shown by the results of the PCS helplessness section as well as the post interventional STAI results. Also, some positive correlation was found between duration od surgery and NRS results. Conclusions: As of now distracting patients by speaking to them could not be proven to aid in decrease pain perceived during cataract surgery., Ciljevi: Cilj ovog rada je utvrditi kako bolesnici percepiraju bol za vrijeme operacije mrene i kako utječe na to razgovor s bolesnikom za vrijeme operativnog zahvata. Materijali i metode: U studiju je bilo uključeno 57 bolesnika s mrenom. Nasumično su bili podijeljeni u ispitaničku i kontrolnu skupinu nakon što su ispunili SRAI i PCS upitnike. Za vrijeme zahvata je operater pričao s bolesnicima u ispitaničkoj skupini. Svi bolesnici su ponovno nakon operacije popunjavali NRS i STAI upitnik kako bi se ispitala njihova percepcija boli. Rezultati: Nije nađena značajna razlika u percepciji boli između dviju skupina, no nađena je značajna razlika u percepciji boli između muškaraca i žena što se očitovalo u rezltatima PCS skale i to u dijelu koji definira pespomoćnosti i u postoperativnom STAI upitniku. Također je nađena određena razina pozitivne korelacije između trajanja operacije i NRSa. Zaključak: Za sada nema dokaza da distrakcija u obliku govora s pacijentom za vrijeme operacije može smanjiti percepciju boli koja se javlja za vrijeme operacije mrene.

Cilj istraživanja: Pokazati razliku u vrijednostima parametara vidnih evociranih potencijala kod ponovljenog optičkog neuritisa u demijelinizirajućim bolestima, u mlađoj populaciji. Ispitanici i metode: 18 ispitanika u dobi od 14 do 36 godina u kojih je dijagnosticiran optički neuritis. Svi ispitanici su podvrgnuti oftalmološkom pregledu, urađeno im je testiranje vidnih evociranih potencijala, neurološki pregled te je provedena adekvatna kortikosteroidna terapija, kod akutnog i ponovljenog optičkog neuritisa. Rezultati: U svih ispitanika je uočena statistički značajna razlika u vrijednostima amplitude, latencije i vidne oštrine u akutnom i ponovljenom optičkom neuritisu (p, Aim: To show difference in parameter values of visual evoked potentials in repeated optic neuritis in demyelinating diseases in younger population. Patients and methods: 18 patients aged 14-36 years with diagnosed optic neuritis. Each patient underwent ophtalmologic examination, visual evoked potentials testing, neurologic examination and adequate corticosteroid therapy, in acute and repeated optic neuritis. Results: In all subjects a statistically significant difference was observed in values of visual acuity, amplitude and latency of P100 wave in acute and repeated ophthalmic neuritis (p

Cilj istraživanja: Cilj ovog znanstvenog rada bio je istražiti karakteristike i metode kirurškog liječenja regmatogenog odignuća mrežnice u bolesnika liječenih u Klinici za očne bolesti KBC-a Split tijekom trogodišnjeg vremenskog razdoblju (od 1. siječnja 2016. do 1. siječnja 2019. god.) te procijeniti njihov utjecaj na anatomski i funkcionalni uspjeh liječenja. Materijali i metode: Ovom retrospektivnom studijom obuhvaćeni su svi bolesnici, njih 151, koji su u navedenom vremenskom razdoblju bili podvrgnuti jednom od tri vrste operativnog načina liječenja (pneumoretinopeksija, konvencionalna metoda i pars plana vitrektomija). Uvidom u medicinsku dokumentaciju dobiveni su podatci o životnoj dobi i spolu bolesnika, karakteristikama regmatogenog odignuća mrežnice (dolazna vidna oštrina, lokalizacija i proširenost odignuća, lokalizacija, veličina i broj retinalnih ruptura, stanje staklastog tijela, prisutnost perifernih degeneracija, stanje makule i leće), vremenu trajanja odignuća i vrsti operacijskog zahvata te je procjenjivan njihov utjecaj na anatomski i funkcionalni ishod liječenja. Rezultati: Medijan životne dobi bolesnika bio je 63 godine (Q1-Q3: 54-70; min-maks: 18-88 godina). Ukupno je bilo 90 (60%) muškaraca i 61 (40%) žena. Muškarci i žene nisu se statistički značajno razlikovali prema životnoj dobi (Z=0,410; P=0,682). Od 151 operiranog bolesnika 130 (86%) je bilo uspješno operirano, a u 21 (14%) bila je potrebna ponovna operacija. Ukupna kumulativna incidencija regmatogenog odignuća mrežnice za navedeno trogodišnje razdoblje u Splitsko-dalmatinskoj županiji bila je 43 (95%CI: 36-50) na 100 000 stanovnika za životnu dob od 18 do 88 godina. Izgled neuspješnih u odnosu na uspješne operacije za 3,4 puta je veći u skupini bolesnika u kojih su tegobe trajale jednako i više od 15 dana u odnosu na ispitanika čije su tegobe trajale manje od 15 dana (OR=3,4; 95%CI: 1,3-9,3). Izgled za uspjeh operacije, u odnosu na neuspjeh, za 3,5 puta je veći u skupini bolesnika u kojih je ruptura prijeoperacijski pronađena nego u skupini bolesnika u kojih ruptura nije nađena (OR=3,5; 95CI: 1,2-10). Analizom vidne oštrine prije i nakon operacije (Wilcoxon Signed Ranks test) dobili smo statistički značajno poboljšanje poslijeoperacijske konačne vidne oštrine u odnosu na prijeoperacijsku (Z=6,1; P, Objectives: The aim of this study was to investigate characteristics and surgical techniques for the repair of rhegmatogenous retinal detachment in patients treated in Department of Ophthalmology, University Hospital of Split during the 3 year period (from the 1st of January 2019 until the 1st January 2019) and to assess their influence on anatomical and functional success of the treatment. Materials and methods: All 151 patients, who were treated by one of three surgical techniques (pneumoretinopexy, scleral buckling and pars plana vitrectomy) for the repair of rhegmatogenous retinal detachment during the observed period are included in this retrospective study. Medical records of all patients were reviewed for age and sex of patients, the characteristics of rhegmatogenous retinal detachment (visual acuity at presentation, localization and size of the lesion, localization, size and number of retinal tears, vitreous status, presence of peripheral degeneration, macula and lens status) and the duration of the detachment and types of surgical techniques. All the collected data were analyzed and their influence on anatomical and functional outcome of the treatment has been evaluated. Results: The median age of the patients was 63 years (range, 18-88 years). There were 90 (60%) males and 61 (40%) females. There was not statistically significant difference between males and females according to their age. (Z=0.410, P=0.682). Of all 151 operated patients, 130 (86%) were successfully operated, and in 21 patients (14%), another surgical procedure was required. The total cumulative incidence of rhegmatogenous retinal detachment for the three-year period in the Split-Dalmatia County was 43 (95%CI: 36-50) per 100,000 of population aged 18 to 88 years. The outcome of unsuccessful in relation to the successful operation was 3.4 times higher in the group of patients with the duration of symptoms equal or more than 15 days, compared to subjects whose symptoms lasted less than 15 days (OR=3.4; 95%CI: 1.3-9.3). The success rate of the operation compared to the failure, was 3.5 times higher in the group of patients in whom the retinal tears were preoperatively found than in the group in which the tears were not found (OR=3.5; 95%C1: 1.2-10). A statistically significant improvement was achieved in final visual acuity compared to visual acuity on presentation (analyzed by Wilcoxon Signed Ranks test), although good visual acuity (equal to higher than 0.5) was achieved in only 52 (34.4%) patients. The final visual acuity was statistically significantly associated with the duration of the symptoms before the surgical procedure, the macula status, the type of surgery, the preoperative lens status and the preoperative visual acuity. Conclusions: The results showed that good anatomical success was not followed by equally good functional success. It can be concluded that the success rate of treating rhegmatogenous retinal detachment mostly depends on early surgical procedure (especially in the case when the macula has not been detached yet), as well as localization of all retina breaks because these are the only factors (beside the choice of surgical techniques) that can be modified in order to improve the outcomes of the treatment.