Ophthalmologic Examination of the Child

The ophthalmologic examination of the child consists of an assessment of the physiological function, anatomic eye, and visual system status. A comprehensive eye examination of the child should include history of presenting problem, patient’s and family’s medical histories, estimation of fixation and measurement of visual acuity, assessment of binocular vision, Bruckner test, assessment of ocular motility, Hirschberg’s test, cover/uncover test, and assessment of anterior and posterior segments. The order of examination may vary depending on the child’s cooperation. The record of the child’s level of cooperation during the examination is of great benefit in the interpretation of the results

Intraocular Lens (IOL) Materials

In 1949, first intraocular lens (IOL) insertion after cataract surgery was performed by Sir Harold Ridley, in London. Only in the 1970s, the IOL insertion after cataract surgery began to be a standard procedure. The material the first IOL-s were composed of was polymethyl methacrylate (PMMA). The PMMA is a rigid material and the corneal incision had to be at least as big as the IOLs optic and it became its biggest disadvantage in the cataract surgery. The main goal of modern cataract surgery is as smallest incision possible, so the IOL-s had to be flexible and therefore foldable. This goal was achieved by improvements in the IOL design and materials that made them foldable. First foldable IOL-s were made of hydrogel but they were unstable and the development of the first silicone IOL-s overcame that problem. Foldable silicone IOL-s were first implanted in 1978 by Kai-yi Zhou. Foldable IOL’s benefits are its compatibility with a small incision surgery that is self-sealing procedure and the possibility of insertion by a single-use applicators that made the surgery safer. In the future, we can expect some new, different and innovative approaches in the IOL design and materials

COVID-19 Conjunctivitis

The outbreak of new Cov-2 epidemic was detected in December 2019 in the city of Wuhan, China, caused by Severe Acute Respiratory Syndrome Coronavirus −2 and started its rapid spread througth the world. The World Health Organisation (WHO) declared a public health emergency of international concern (PHEIC) on the 30th of January 2020. -2 infection can present with spectrum of clinical manifestations, primary of upper respiratory tract and in some cases, especially in immunocompromised patients can cause changes in lower respiratory tract such as pneumonia and bronchitis. Conjunctivitis is not a common manifestation of SARS-Cov-2 infection. It should however be kept in mind that patients with ocular manifestations and symptoms can represent the COVID-19 cases. CoVs can produce several ocular manifestations from conjunctivitis, uveitis – anterior and posterior, retinitis and optic neuritis

Aktivna okularna toksoplazmoza pacijenata dijagnosticiranih i liječenih u Općoj bolnici Zadar

Toxoplasma gondii is responsible for the 20-60% of all the cases of chorioretinitis. Causes of permanently reduced vision (found in about 25% of the patients) include macular active lesions and macular oedema, optic nerve involvement, vascular occlusion, retinal detachment, and late secondary choroidal neovascularization. A retrospective, non-consecutive chart review was performed on 11 patients with active ocular toxoplasmosis. At examination, all patients had central active lesions on retina. Preexisting chorioretinal scars were found in seven patients (63.6%). Eight patients (72.7%) had vitritis, while three patients (27,3%) had iridocyclitis. Six patients (54.6 %) had macular inflammatory lesions, four (36,37%) of them had active lesions out of vascular arcades, and one (9.1%) had active lesions inside vascular arcades, while macula was not affected. The mean value of visual acuity at first visit of the patients was 0,5. The mean value of visual acuity was 0.9 after the healing process. All the patients were treated with oral antibiotics. Seven patients also received oral corticosteriods, and seven of them were also treated with pyrimethamine. All patients with signs of iridocyclitis were also treated with topical corticosteroids. Although toxoplasmosis chorioretinitis is usually a self-limited infection and generally resolves spontaneously, unrecognised cases can result in severe visual impairments.Toxoplasma gondii je uzročnik 20-60 % svih slučajeva korioretinitisa. Uzroci trajno smanjenog vida (slučaj kod otprilike 25% pacijenata) uključuju aktivne lezije u makuli, makularni edem, lezije optičkog živca, vaskularne okluzije, ablacije mrežnice i kasne koroidalne neovaskularizacije. Prilikom pregleda, svi su pacijenti imali aktivne lezije na mrežnici. Raniji korioretinalni ožiljci pronađeni su u sedam pacijenata (63,6%). Osam pacijenata je imalo vitritis (72,7%), dok su tri pacijenta imala iridociklitis (27,3%). Šest pacijenata (54,6 %) imalo je upalne lezije u makuli, četvero (36,37%) je imalo aktivne lezije izvan krvožilnih arkada, a jedan (9,1%) je imao aktivne lezije unutar krvožilnih arkada, dok makula nije bila zahvaćena. Srednja vrijednost vidne oštrine prilikom prvog pregleda bila je 0,5. Poslije izlječenja srednja vrijednost vidne oštrine bila je 0,9. Svi pacijenti liječeni su peroralnim antibioticima. Sedam pacijenata je, također, primilo peroralne kortikosteroide, a sedam pirimetamin. Svi pacijenti s iridociklitisom su, također, primili topičke kortikosteroide. Iako je korioretinitis uzrokovan toksoplazmom uobičajeno samolimitirajuća bolest koja se može spontano izliječiti, nedijagnosticirani slučajevi mogu rezultirati ozbiljnim oštećenjima vida

Combined Procedure of Phacoemulsififi cation and Implantation of Ex-PRESS Miniature Glaucoma Shunt

Glaucoma patients not responding to maximum medical therapy with coexistent cataract are candidates for combined cataract and glaucoma therapy. There are different therapy models. The choice of therapy depends on numerous patient and surgeon related factors. Ex-PRESS mini glaucoma shunt is a modifi ed trabeculectomy and can be combined with cataract surgery when indicated. In this paper we presented our experience with this combined procedure. Our results showed good intraocular pressure control and visual acuity improvement, comparable to other therapy choices

Ex-PRESS Miniature Glaucoma Shunt in Treatment of Refractory Glaucoma

Refractory glaucoma in a complicated type of glaucoma of different ethyologies with one same characteristic – intraocular pressure of great resistance to therapy. There are different methods of treatment in such glaucomas, primary surgical options. Ex-PRESS miniature glaucoma shunt implantation was our treatment of choice. In our group of patients we achieved stabile intraocular pressure values in 4 month period of time with no serious or unexpected complications

Capsular Tension Ring in Damaged Zonules

Capsular tension ring (CTR) is endocapsular support device important during cataract surgery in eyes with weak zonular apparatus. It was presented our experience, advantages and limitations of CTR in phacoemulsifi cation cataract surgery with damaged zonules. Phacoemulsifi cation surgery was performed by clear corneal technique using topical anesthesia. Capsular ring was implanted to stabilize the capsular bag before implantation of intraocular lens. CTR has become increasingly important in the management of zonular weakness during cataract extraction. It lowers the incidence of capsule contraction, stabilizes the capsular bag and enhances IOL centration

Ocular Surface Changes in Glaucoma Patients Related to Topical Medications

Topical glaucoma therapy is a long termed, usually lifelong. Antiglaucomatous drugs have toxic effects on ocular surface, due to preservative toxicitiy or the drug itself. Adding a lubricant eyedrops to antiglaucomatous therapy, especially if considering the preservative used, can have protective effect. The purpose of this study was to evaluate the stability of precorneal tear fi lm in glaucoma patient prior and after administration of lubricant eye drops with different tipe of preservatives. The study showed the protective role of ocular surface lubrication especially when using drugs with less harmful preservatives

Assessing literature of Vitamin D and diabetic retinopathy

Background: Vitamin D plays an important role in a variety of biological functions.1 Numerous studies demonstrating that adequate vitamin D levels are important in eye homeostasis.2 There is increasing evidence of the association between eye diseases and vitamin D in literature. Aim: To evaluate scientometric data of Vitamin D and diabetic retinopathy. Methods: We analyzed the number of publications of Vitamin D and diabetic retinopathy as key words at Web of Sciences with advanced search using TS=(Vitamin D and diabetic retinopathy) from 1955 to 2019. Hypotheses: There is still a lack of important clinical studies on the role of vitamin D in diabetic retinopathy. Results: We retrieved a total of 114 articles published in the Clinical Medicine and Life Sciences section. The h-index of these publications was 25, an average citation per item was 20.46, the sum of times cited was 2.332. There were 1.864 citing articles. The number of citations significantly increased from 2002 to 2018, with the highest rate in 2017 (308 articles). The article with the highest number of citations had a total of 296 citations. The highest number of articles 48 (42.105%) was published in the field of endocrinology metabolism. Out of 114 articles, 91 were original scientific articles (79.825%), there were 13 reviews (11.404%), 10 meeting abstract (8.772%) and one book chapter (0.877%). Conclusions: Although the number of articles on Vitamin D and diabetic retinopathy is increasing every year, it is still insufficient to establish the role of vitamin D in diabetic retinopathy