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PURPOSE: To report the prevalence of undiagnosed glaucoma, as well as demographic characteristics and risk factors among glaucoma suspects who were detected in a publicly promoted intraocular pressure (IOP) based glaucoma screening event. METHODS: A total of 2468 subjects older than 18 years participated in the glaucoma screening event in Zagreb, in 2014, which included a medical interview and IOP measurement using Icare tonometer. 256 subjects (10.37%) were identified as glaucoma suspects, out of which 125 (5.06%) subjects underwent further detailed ophthalmic examination and were classified into five diagnostic groups. RESULTS: The prevalence of all types of newly diagnosed glaucoma was 1.175%, while the prevalence of ocular hypertension (OH), primary open-angle glaucoma (POAG), primary angle closure (PAC) and secondary glaucoma (SG) was 0.16%, 0.89%, 0.16% and 0.12%, respectively. The prevalence of newly diagnosed glaucoma in glaucoma suspects was 23.2%. 17.60% of glaucoma suspects were diagnosed as POAG. Older age was statistically significantly associated with POAG (p = 0.001) and PAC (p = 0.029). At the univariate level, refractive errors were a statistically significant predictor of POAG, and those with hyperopia had more than three times larger odds for POAG. At the multivariate level, none of the predictors reached statistical significance. CONCLUSION: Successful cooperation between healthcare institutions and media can be a useful way of increasing awareness and detection of individuals at an increased risk for developing glaucoma.

The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate.

The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate., Svrha rada je prikazati sigurnost i učinkovitost implantacije Ahmedove glaukomske valvule (AGV, New World Medical, Inc., Rancho Cucamonga, CA, SAD) kod refraktornog glaukoma dječje dobi tijekom jednogodišnjeg praćenja. Proveden je retrospektivni pregled nalaza 10 očiju u djece mlađe od 11 godina u kojih je ugrađena AGV zbog medikamentima nekontroliranog glaukoma u razdoblju od 2010. do 2014. godine. Pratila se visina intraokularnog tlaka (IOT) i vidna oštrina, a također su bilježene komplikacije. Rezultati su pokazali da su nakon implantacije AGV vrijednosti IOT-a bile od 18 mm Hg do 23 mm Hg (osim kod jednog oka s poslijeoperacijskom hipotonijom zbog suprakoroidnog krvarenja, gdje je poslijeoperacijski IOT bio 4 mm Hg). Broj antiglaukomskih lijekova bio je smanjen: četvoro bolesnika su imali po dva lijeka, jedan je imao jedan lijek, a svi ostali nisu trebali dodatne lijekove na posljednjem pregledu. Kod jednog oka se pojavilo suprakoroidno krvarenje, kod jednog dugotrajna upalna membrana, a kod dva oka kontakt cjevčice s rožnicom. Zaključuje se da implantacija AGV predstavlja izbor u liječenju refraktornog glaukoma dječje dobi i ima uspjeha u kontroli IOT-a. Međutim, relativno velik broj komplikacija ograničava konačan uspjeh.

The aim of this study was to evaluate clinical outcomes after toric intraocular lens implantation for astigmatism correction in patients undergoing cataract surgery. This prospective observational study included eyes undergoing cataract surgery at Sestre milosrdnice University Hospital Center between February and September 2011. The study enrolled eyes that had visually significant cataract and preexisting regular corneal astigmatism of 1.50 D or greater. Phacoemulsification was performed and all eyes received an AT TORBITM 709 M toric foldable intraocular lens. At 3 months, the uncorrected distance visual acuity was 0.8 or better in 9 of 10 eyes. At 3 months postoperatively, the median reduction in refractive cylinder was statistically significant (P, Cilj rada bila je analiza poslijeoperacijskih rezultata nakon operacije katarakte kod bolesnika s prijeoperacijskim astigmatizmom i implantiranom toričnom intraokularnom lećom. Ova studija provedena je u KBC Sestre milosrdnice, a bolesnici su operirani u razdoblju od veljače do studenoga 2011. godine. Svi bolesnici uključeni u studiju imali su vizualno značajnu kataraktu i prijeoperacijski rožnični astigmatizam veći od 1,5 D. Nakon operacije katarakte učinjene metodom fakoemulzifikacije kod svih bolesnika ugrađena je savitljiva intraokularna leća AT TORBI. Tri mjeseca nakon operacijskog zahvata nekorigirana poslijeoperacijska vidna oštrina bila je 0,8 ili bolja kod 9 očiju. Smanjenje cilindrične vrijednosti (medijan) 3 mjeseca nakon operacijskog zahvata bilo je statistički značajno (P

Studying quantitative endophenotypes was advocated to help unravel the genetic architecture of common diseases.1,2 Successes met by this approach include mapping of genes modulating QT elongation measured by ECG and cardiac arrhythmia risk,3 IgE levels and asthma risk,4 serum uric acid level and gout risk,5 and lipid levels and coronary heart disease risk.6 Ocular conditions, in particular the most common one, refractive error, lend themselves very well to this approach. Myopia and hypermetropia can be viewed largely as defects in the eye growth processes that normally adjust AL of the eye to the optical power of the cornea and lens. The values of the separate refractive components (axial length [AL], power of the cornea, and power of the lens), which if uncoordinated lead to refractive errors, have long been recognized as being normally distributed in general population surveys, whereas the distribution of refraction itself has a greater density around emmetropic values.7 Researchers in several large studies of unselected individuals, predominantly twins, have investigated to what extent genetic variation contributes to ocular quantitative components, and results have generally supported a substantial polygenic contribution. These include reports on AL, anterior chamber depth (ACD), corneal curvature (CC), and spherical equivalent refraction (SER) in a Sardinian isolate (n = 741; mean age, 41 years)8; in the Australian GEM twin study (n = 1224; mean age, 52 years)9; and in a Danish twin cohort (n = 114; age range, 20–45 years)10 together with lens thickness (LT), and analysis of refraction alone in a UK female twin cohort (n = 506; mean age, 62.4 years)11 and in the Beaver Dam population study (n = 2138; age range, 43–84 years).12 For corneal thickness (CT) there is, to our knowledge, only one previous report of heritability, 95% in a European sample of UK and Australian twins (n = 256; mean age, 38 years).13 This trait is now a recognized risk factor for progression from ocular hypertension to primary open-angle glaucoma,14 as well as a determinant of corneal refractive power. There has been a call for caution regarding the high heritabilities reported for refraction and AL from twin studies, ranging from 75% to 94%,9,11 in view of the much lower heritabilities, 18%8 to 34%,12 obtained from parent–offspring correlations.15 Heritability estimates, in both twin and family studies depend on different assumptions and are likely to be divergent for traits strongly influenced by environmental cues, such as myopia.15,16 Cross-population studies in isolated populations offer the advantage of accessing large complex pedigrees where heritabilities can be drawn simultaneously from the comparison of multiple pairs of relatives. They also benefit from a more stable and uniform diet, climate, and living conditions. However, oculometric traits were analyzed in only a few of those studies.8 The resemblance between distant relatives is less likely to be biased by nongenetic factors, but their genetic covariance is typically small and not well estimated if based on pedigree knowledge only (due to the stochasticity of segregation and recombination). In the present study, we measured the heritability of six ocular biometric traits in two isolated Croatian populations based on realized co-ancestry coefficients drawn from molecular marker information, allowing better estimates of true sharing and thus of heritability. Because of the ethnic variations in ocular morphology, we compared our results only with data derived from populations of European descent. Although numerous studies have shown that ocular biometry can be affected by the amount of near work,17,18 it has also been hypothesized that a diet rich in processed foods plays a role in the increase in juvenile-onset myopia.19 The extent to which body stature and level of education contribute to the values of the traits analyzed was therefore examined. To a large extent, these covariates, including educational achievement,20 are themselves known to have a strong genetic component. Although heritabilities are population specific in principle, in practice they are very similar across populations for morphometric traits and are usually high.21 Estimates of trait heritability in our study should thus inform on the contribution of genetic variants underlying these traits in the studied populations as well as others and guide the choice of covariates to take into account for follow-up gene-mapping studies.

Central corneal thickness (CCT) is a highly heritable trait, which has been proposed to influence disorders of the anterior segment of the eye. A genome-wide association study (GWAS) of CCT was performed in 2269 individuals from three Croatian and one Scottish population. In the discovery set (1445 individuals), two genome-wide significant associations were identified for single nucleotide polymorphisms rs12447690 (β = 0.23 SD, P = 4.4 × 10(-9)) and rs1536482 (β = 0.22 SD, P = 7.1 × 10(-8)) for which the closest candidate genes (although ≥90 kb away) were zinc finger 469 (ZNF469) on 16q24.2 and collagen 5 alpha 1 (COL5A1) on 9q34.2, respectively. Only the ZNF469 association was confirmed in our replication set (824 individuals, P = 8.0 × 10(-4)) but COL5A1 remained a suggestive association in the combined sample (β = 0.16 SD, P = 1.1 × 10(-6)). Following a larger meta-analysis including recently published CCT GWAS summary data, COL5A1 was genome-wide significant (β = 0.13 SD, P = 5.1 × 10(-8)), together with two additional novel loci. The second new locus (defined by rs1034200) was 5 kb from the AVGR8 gene, encoding a putative transcription factor with typical ZNF and KRAB domains, in chromosomal region 13q12.11 (β = 0.14 SD, P = 3.5 × 10(-9)). The third new locus (rs6496932), on 15q25.3 (β = 0.13, P = 1.4 × 10(-8)), was within a wide linkage disequilibrium block extending into the 5' end of the AKAP13 gene, encoding a scaffold protein concerned with signal transduction from the cell surface. These associations offer mechanistic insights into the regulation of CCT and offer new candidate genes for susceptibility to common disorders in which CCT has been implicated, including primary open-angle glaucoma and keratoconus.

Aim: To study the association between genetic variants in myocilin and collagen type I alpha 1 genes and high myopia in an isolated island population. Methods: A total of 944 examinees from the genetic epidemiology study conducted on the island of Korcula, Croatia, were included in the study. We selected 2 short nucleotide polymorphisms (SNP) available in our genome-wide scan set of SNPs that were previously associated with high myopia and used them to replicate previous claims of possible association. Results: Nineteen cases of high myopia, defined as the refraction of