Corticosteroid therapy in patients with non-arteritic anterior ischemic optic neuropathy [Kortikosteroidi u liječenju bolesnika s nearteritičkom prednjom ishemičkom optičkom neuropatijom]

Non-arteritic anterior ischemic optic neuropathy is one of the most common conditions affecting the optic nerve in the elderly. It may lead to severe visual loss. Typical symptoms are painless impairment of visual function accompanied by relative afferent pupillary defect, edema of the optic disc and visual field defects. Aim is to present 38 patients with nonarteritic anterior ischemic optic neuropathy who were treated with corticosteroid therapy. This prospective study involved 38 patients, 20 men and 18 women aged 60-75 years who were treated with corticosteroid therapy. The study included patients with visual acuity in the affected eye from 0.1 to 0.8 according to Snellen. Every patient underwent clinical examination, the Octopus 900 perimetry in G program, laboratory testing, while the compressive optic neuropathy was rule out with MSCT of the brain and orbits. The most common forms of visual field defect are altitudinal defect and diffuse depression. Corticosteroid therapy led to recovery in 65% of patient, in 30% of patients did not change, while the deterioration occurred in 5% of patients

Corticosteroid Therapy in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy

Non-arteritic anterior ischemic optic neuropathy is one of the most common conditions affecting the optic nerve in the elderly. It may lead to severe visual loss. Typical symptoms are painless impairment of visual function accompanied by relative afferent pupillary defect, edema of the optic disc and visual fi eld defects. Aim is to present 38 patients with nonarteritic anterior ischemic optic neuropathy who were treated with corticosteroid therapy. This prospective study involved 38 patients, 20 men and 18 women aged 60–75 years who were treated with corticosteroid therapy. The study included patients with visual acuity in the affected eye from 0.1 to 0.8 according to Snellen. Every patient underwent clinical examination, the Octopus 900 perimetry in G program, laboratory testing, while the compressive optic neuropathy was rule out with MSCT of the brain and orbits. The most common forms of visual fi eld defect are altitudinal defect and diffuse depression. Corticosteroid therapy led to recovery in 65% of patient , in 30% of patients did not change, while the deterioration occurred in 5% of patients

Comparison Between Refractometer and Retinoscopy in Determining Refractive Errors in Children – False Doubt

Early detection of a refractive error and its correction are extremely important for the prevention of amblyopia (poor vision). The golden standard in the detection of refractive errors is retinoscopy – a method where the pupils are dilated in order to exclude accomodation. This results in a more accurate measurement of a refractive error. Automatic computer refractometer is also in use. The study included 30 patients, 15 boys, 15 girls aged 4–16. The first examination was conducted with refractometer on narrow pupils. Retinoscopy, followed by another examination with refractometer was performed on pupils dilated with mydriatic drops administered 3 times. The results obtained with three methods were compared. They indicate that in narrow pupils the autorefractometer revealed an increased diopter value in nearsightedness (myopia), the »minus overcorrection«, whereas findings obtained with retinoscopy and autorefractometer in mydriasis – cycloplegia, were much more accurate. The results were statistically processed, which confirmed the differences between obtained measurements. These findings are consistent with the results of studies conducted by other authors. Automatic refractometry on narrow pupils has proven to be a method for detection of refractive errors in children. However, the exact value of the refractive error is obtained only in mydriasis – with retinoscopy or an automatic refractometer on dilated pupils

Contact Lenses as the best Conservative Treatment of Newly Diagnosed Keratoconus – Epidemiological Retrospective Study

Keratoconus is a progressive, non-infl ammatory corneal ectasia characterized by thinning and weakening of the corneal stroma which results in its’ protrusion. The onset is during puberty and progresses until the fourth decade of life. In earlier stages, good visual acuity can be provided with spectacles. With progression, contact lenses are considered to be a better therapy. Aim of this study was to determine if there is statistically signifi cant difference between best corrected visual acuity (BCVA) obtained by spectacles and contact lenses in newly diagnosed keratoconus patients, as well as to determine which type of contact lenses provide better BCVA in keratoconus patients. We conducted a 5-year retrospective study of all 2891 patients attending our Contact Lens Department for the fi rst time, searching for patients newly diagnosed with keratoconus. Data were obtained on gender, age, education level, treated eyes, corneal changes, keratoconus severity, BCVA with spectacles, contact lenses and best fi tted contact lens type. All patients underwent standard ophthalmic exam, refractometry and keratometry have been done, followed by a spectacles correction and lens fi tting. Wilcoxon signed rank test was used for statistical analysis. Results showed that of all 2891 patients examined for the fi rst time, 137 patients (4.74%) have been newly diagnosed with keratoconus, there was male bias (72.26%), mean age 27.7±9.9 years. Most patients had high school education (51.11%), 3.70% had present corneal changes, 50.37% had mild keratoconus. Majority had keratoconus on both eyes (36.3%) or keratoconus of right eye (26.67%). There was a statistically signifi cant difference (p<0.001) between the BCVA obtained with contact lenses (0.82±0.21 Snellen chart) rather than spectacles (0.37±0.27 Snellen chart). The best corrected visual acuity was achieved with rigid gas permeable (RGP) lenses in majority of keratoconus eyes (51.85%), with semi-gas permeable (SGP) lenses in 43.39%, in 4.23% with polymethyl methacrylate (PMMA) lenses and with hard-soft gas permeable (GP) contact lenses in 0.53% of keratoconus eyes. We have showed that there is a statistically signifi cant difference in BCVA achieved better with contact lenses than with spectacles. RGP lenses are most frequently used in conservative treatment of keratoconus, but SGP lenses were also shown to be a good option that gives equally satisfying fi nal visual acuity with subjective comfortable feeling of contact lens wear

Razina i percepcija suradljivosti u održavanju higijene leća među nosiocima tvrdih plinopropusnih leća - pilot studija

The aim was to estimate compliance rate among rigid gas permeable lens wearers (RGPLW) in lens system care, identify procedures in lens care process with poorest compliance levels, and assess concordance between participant reported practices and their subjectively perceived compliance. The study included outpatient RGPLW managed at Zagreb University Hospital Center in Zagreb, Croatia. They filled out a questionnaire that included demographic data, duration of lens wear, self-evaluation compliance grade, and 14 lens care procedures and wearing habits indicative of compliance. There were 50 patients (mean age 34.6 years, 68% female). Full compliance was found in a single patient. The mean number of non-compliant procedures was 5.48, with 32% of participants non-compliant in more than 50% of the compliance criteria. Critical procedures of the lens care process were infrequent lens case exchange (74%), using tap water for lens (70%), and improper case cleaning (68%). The mean lens case replacement time was 9.8 months (SD 6.76), with only 26% of patients replacing lens case at least once in 3 months. Excessive daily lens wear was associated with greater total number of non-compliant procedures (p<0.0008). RGPLW were aware of their inappropriate lens care only when achieved non-compliance in almost 50% of the procedures. In conclusion, lens wearers were not aware of their extremely low compliance rate in several aspects of lens and lens case maintenance. Study results indicated the key procedures the practitioners should focus on when evaluating subjective and objective compliance and reinforcing care and hygiene education of RGPLW.Cilj je bio ispitati razinu suradljivosti nosilaca tvrdih plinopropusnih leća (NTPL) u održavanju higijene leća, utvrditi koji su koraci u postupku higijene leća kojih se najmanje pridržavaju i procijeniti povezanost između objektivne i vlastite subjektivne procjene o suradljivosti NTPL u održavanju higijene leća i kutijica za leće. Uključeni su ambulantno kontrolirani NTPL u Kliničkom bolničkom centru Zagreb, Zagreb, Hrvatska. Ispitanici su ispunili upitnik koji je sadržavao demografske podatke, dužinu nošenja leća, ocjenu za samoprocjenu suradljivosti u održavanju leća i 14 koraka i navika nošenja leća koji su važni za procjenu suradljivosti. Uključili smo 50 bolesnika (srednja dob 34,6 godina, 68% bolesnika ženskog spola). Potpuna suradljivost utvrđena je u samo jednog bolesnika. Srednji broj nesuradljivih koraka je bio 5,48, a 32% ispitanika je bilo nesuradljivo u više od 50% kriterija suradljivosti. Najkritičniji koraci nepridržavanja odgovarajuće higijene leća bili su neredovita zamjena kutijica za leće (74%), uporaba tekuće vode za ispiranje leća (70%) i nepravilno čišćenje posudica za leće (68%). Srednje vrijeme zamjene kutijica za leće bilo je 9,8 mjeseci (SD 6,76), a samo 26% bolesnika mijenjalo je kutijice u preporučenom roku od 3 mjeseca. Prekomjerno nošenje leća u danu povezano je s većim ukupnim brojem koraka nesuradljivosti (p<0,0008). NTPL postali su svjesni svoje neprimjerene higijene leća tek kada bi postali nesuradljivi u gotovo 50% koraka za procjenu održavanja higijene leća. U zaključku, NTPL nisu bili svjesni svoje iznimno niske razine suradljivosti u nekoliko aspekata održavanja leća i kutijica za leće. Rezultati ove studije pokazali su ključne korake na koje bi se liječnici trebali usredotočiti kada procjenjuju subjektivnu i objektivnu razinu suradljivosti bolesnika i potiču na izobrazbu NTPL o pravilnoj brizi za leće

Compliance among Soft Contact Lens Wearers

Contact lens compliance is proven to be crucial for preventing lens wear- related complications because of the interdependence of the steps in lens care regime and their infl uence on lens system microbial contamination. Awareness of the patients’ lens handling compliance as well as correct recognition of non-compliant behaviours is the basis for creating more targeted strategies for patient education. The aim of this study was to investigate compliance among soft contact lens (SCL) wearers in different aspects of lens care handling and wearing habits. In our research 50 asymptomatic lens wearers fi lled out a questionnaire containing demographic data, lens type, hygiene and wearing habits, lenses and lens care system replacement schedule and self-evaluation of contact lens handling hygiene. We established criteria of compliance according to available manufacturer’s recommendations, prior literature and our clinical experience. Only 2 (4%) of patients were fully compliant SCL wearers. The most common non-compliant behaviours were insuffi cient lens solution soaking time (62%), followed by failure to daily exchange lens case solution and showering while wearing lenses. 44% of patients reported storing lenses in saline solution. Mean lens storage case replacement was 3.6 months, with up to 78% patients replacing lens case at least once in 3 months. Average grade in self evaluating level of compliance was very good (4±0.78) (from 1-poor level of hygiene to 5-great level of hygiene). Lens wearers who reported excessive daily lens wear and more than 10 years of lens wearing experience were also found to be less compliant with other lens system care procedures. (t= –2.99, df=47, p<0.0045 and t= –2.33, df= 48, p<0.024, respectively). Our study indicates that almost all patients had some degree of non-compliance in lens system maintenance steps. Most common non-compliant behaviours were the ones that are crucial for maintaining lens sterility and preventing infection. Despite the low objective compliance rate, self grading was relatively high. Therefore, these results indicate the need for patient education and encouragement of better lens wearing habits and all of the lens maintenance steps at each patient visit

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparison between refractometer and retinoscopy in determining refractive errors in children - false doubt [Usporedba refraktometra i skijaskopije u određivanju refrakcijskih grešaka - lažna sumnja]

Early detection of a refractive error and its correction are extremely important for the prevention of amblyopia (poor vision). The golden standard in the detection of refractive errors is retinoscopy--a method where the pupils are dilated in order to exclude accomodation. This results in a more accurate measurement of a refractive error. Automatic computer refractometer is also in use. The study included 30 patients, 15 boys, 15 girls aged 4-16. The first examination was conducted with refractometer on narrow pupils. Retinoscopy, followed by another examination with refractometer was performed on pupils dilated with mydriatic drops administered 3 times. The results obtained with three methods were compared. They indicate that in narrow pupils the autorefractometer revealed an increased diopter value in nearsightedness (myopia), the minus overcorrection, whereas findings obtained with retinoscopy and autorefractometer in mydriasis cycloplegia, were much more accurate. The results were statistically processed, which confirmed the differences between obtained measurements. These findings are consistent with the results of studies conducted by other authors. Automatic refractometry on narrow pupils has proven to be a method for detection of refractive errors in children. However, the exact value of the refractive error is obtained only in mydriasis--with retinoscopy or an automatic refractometer on dilated pupils

Usporedba refraktometra i skijaskopije u određivanju refrakcijskih grešaka - lažna sumnja

Early detection of a refractive error and its correction are extremely important for the prevention of amblyopia (poor vision). The golden standard in the detection of refractive errors is retinoscopy--a method where the pupils are dilated in order to exclude accomodation. This results in a more accurate measurement of a refractive error. Automatic computer refractometer is also in use. The study included 30 patients, 15 boys, 15 girls aged 4-16. The first examination was conducted with refractometer on narrow pupils. Retinoscopy, followed by another examination with refractometer was performed on pupils dilated with mydriatic drops administered 3 times. The results obtained with three methods were compared. They indicate that in narrow pupils the autorefractometer revealed an increased diopter value in nearsightedness (myopia), the minus overcorrection, whereas findings obtained with retinoscopy and autorefractometer in mydriasis cycloplegia, were much more accurate. The results were statistically processed, which confirmed the differences between obtained measurements. These findings are consistent with the results of studies conducted by other authors. Automatic refractometry on narrow pupils has proven to be a method for detection of refractive errors in children. However, the exact value of the refractive error is obtained only in mydriasis--with retinoscopy or an automatic refractometer on dilated pupils.Rano otkrivanje refrakcijske greške te njena pravodobna korekcija iznimno su bitni kako bi se prevenirao nastanak slabovidnosti – ambliopije. Zlatni standard u dijagnostici refrakcijske greške je skijaskopija – metoda širenja zjenica midrijaticima kako bi se isključila akomodacija, čime se dobiva točniji nalaz refrakcijske greške. Za postizanje midrijaze koristimo atropin i homatropin kapi. Pregled se radi u tamnoj sobi, na udaljenosti od jednog metra, kada ispitivač usmjerava svjetlo direktno u oko, te promatra refleksiju svjetla u zjenici oka pacijenta. Refraktometrija, s druge strane, metoda je gdje se koristimo kompjuteriziranim uređajem koji sadrži infracrveno svjetlo valne duljine 800–900 nm, točku fiksacije i Badelov optometar. Cilj našeg rada je dokazati postoji li statistički značajna razlika u vrijednostima refrakcijske greške dobivenima homatropin skijaskopijom i automatskim refraktometrom

Contact lenses as the best conservative treatment of newly diagnosed keratoconus - epidemiological retrospective study [Kontaktne leće kao najbolji izbor u konzervativnom liječenju keratokonusa - epidemiološka retrospektivna studija]

Keratoconus is a progressive, non-inflammatory corneal ectasia characterized by thinning and weakening of the corneal stroma which results in its' protrusion. The onset is during puberty and progresses until the fourth decade of life. In earlier stages, good visual acuity can be provided with spectacles. With progression, contact lenses are considered to be a better therapy. Aim of this study was to determine if there is statistically significant difference between best corrected visual acuity (BCVA) obtained by spectacles and contact lenses in newly diagnosed keratoconus patients, as well as to determine which type of contact lenses provide better BCVA in keratoconus patients. We conducted a 5-year retrospective study of all 2891 patients attending our Contact Lens Department for the first time, searching for patients newly diagnosed with keratoconus. Data were obtained on gender, age, education level, treated eyes, corneal changes, keratoconus severity, BCVA with spectacles, contact lenses and best fitted contact lens type. All patients underwent standard ophthalmic exam, refractometry and keratometry have been done, followed by a spectacles correction and lens fitting. Wilcoxon signed rank test was used for statistical analysis. Results showed that of all 2891 patients examined for the first time, 137 patients (4.74%) have been newly diagnosed with heratoconus, there was male bias (72.26%), mean age 27.7 +/- 9.9 years. Most patients had high school education (51.11%), 3.70% had present corneal changes, 50.37% had mild heratoconus. Majority had keratoconus on both eyes (36.3%) or keratoconus of right eye (26.67%). There was a statistically significant difference (p<0.001) between the BCVA obtained with contact lenses (0.82 +/- 0.21 Snellen chart) rather than spectacles (0.37 +/- 0.27 Snellen chart). The best corrected visual acuity was achieved with rigid gas permeable (RGP) lenses in majority of kera- toconus eyes (51.85%), with semi-gas permeable (SGP) lenses in 43.39%, in 4.23% with polymethyl methacrylate (PMMA) lenses and with hard-soft gas permeable (GP) contact lenses in 0.53% of keratoconus eyes. We have showed that there is a statistically significant difference in BCVA achieved better with contact lenses than with spectacles. RGP lenses are most frequently used in conservative treatment of heratoconus, but SGP lenses were also shown to be a good option that gives equally satisfying final visual acuity with subjective comfortable feeling of contact lens wear