Dear Colleagues

Държите специалния брой на списание „Български офталмологичен преглед`, в който сме отпечатали пълнотекстовите публикации на нашите млади колеги, участващи в конкурса за наградата за млад изследовател „Проф. Дъбов`.You are holding in your hands the special issue of the Bulgarian Review of Ophthalmology journal in which we have published the full-text articles of our young colleagues participating in the contest for the Prof. Dabov Young Researcher Award

Skills and habits of young ophthalmologists in the diagnostics of glaucoma

Introduction:Globally, glaucoma is the second leading cause of blindness. The diagnosis of the disease, especially at an early stage, is often an occupational challenge for young ophthalmologists. Adequate diagnostics requires a comprehensive ophthalmologic examination that is related to a broad range of knowledge, skills and various high-tech devices. Bulgarian scientific literature does not offer information about the currently used methods for treatment and diagnosis by residents and young ophthalmologists; there is also no detailed information about the difficulties that ophthalmologists experience in the management of the disease.Aim:The main goal of this study is to provide information about the methods used for the management of glaucoma by residents and young ophthalmologists in Bulgaria, as well as data on the potential difficulties and problems that may reduce the quality of health care.Methods:Detailed anonymous questionnaires about workplace, used equipment, methods of investigation, potential weaknesses in the diagnosis and management of the disease, as well as personal attitude towards the problems in the field, were sent to residents and young ophthalmologists with experience of up to 5 years by e-mail and with the help of social networks.Results:One hundred and twenty questionnaires were sent but only 45 individuals responded to the survey. Of these, 30 were classified as residents (66.7%) and 15 as specialists with up to 5 years of experience (33.3%). Regarding the number of glaucoma patients examined, 27 of the participants (60.0%) indicated that they have examined under 5 patients who suffer from glaucoma or are suspected of glaucoma, 14 (31.1%) under 10 and only four (8.9%) managed less than 20 glaucoma patients per day. Thirty-four of the participants (75.6%) mentioned air tonometry as the main method in their practice. Eleven percent of the participants never performed gonioscopy, and 4.4% had tried but failed. Only 11 (24.4%) of the participants said they had no difficulty performing gonioscopy. A preferred method of determining the depth of the anterior chamber was Van Herick's method (51.1%). Regarding perimetry, 43 (95.6%) of the participants always required the presence of a glaucoma diagnosis, and 39 (86.7%) reported that they always performed a visual examination to evaluate the optic nerve and the neurofibrillary layer. Fifteen respondents (33.3%) (of them 12 residents) never assisted in an anti-glaucoma operation. Thirty-eight (84.4%) of the participants found a need for more trainings and seminars on glaucoma.Conclusion:Diagnosis of glaucoma is a challenge for doctors as well as for patients. Identifying potential weak spots among ophthalmology residents and young professionals and obtaining sufficient feedback is essential to improve the proper management of the disease nationwide

CLINICAL EXAMINATION OF TROPICAMID OPHTHALMIC DROPS-POLAND

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Sjogren`s syndrome and ocular surface changes by laser-scanning in vivo confocal microscopy

Introduction: Dry eye disease (DED) and ocular allergy are common conditions in the eye practice. They have more than 20% of prevalence and that fact increases healthcare problems and affects life quality. Rheumatologic diseases such as Sjogren`s syndrome (SS) are often associated with ophthalmic findings, and belong to the dry eye but with decreased tear film production.Material and Methods: The laser-scanning confocal microscopy (LSCM) was performed to 16 eyes of 8 patients with subjective complains and objective clinical signs of DED and SS. The results of examinations were compared with control group of 28 eyes of 14 healthy patients. The qualitative analysis was performed to calculate the cell density in all cornea layers. The presence and distribution of Langerhans cells (LCs) in cornea was estimated. The quantitative survey understood monitoring of inflammation signs and corneal changes such as a presence of leukocytes. Changes in subbasal nerve plexus (SNP) and Meibomian glands (MGs) were evaluated over time.Results: The quantitative analysis presented calculations of cell density of all cornea layers. The most important finding was the reduction of epithelium cell density. In healthy patients it was 5048.6±56 cells/mm2 compared to 4603±70 cells/mm2 in DED-SS patients, but also the keratocyte number was significantly lower. The density of corneal LCs was compared to the healthy patients: 71±8 cells/mm2 and 19±3cells/mm2 respectively. The quantitative observation showed visible changes in SNP especially in tortuosity and destiny of sub-basal nerves.Conclusion: The ability of LSCM technology to examine different components of the ocular surface has opened new doors for studying the physiology and pathology. LSCM allows understanding the pathological changes of DED and SS. Our study proved that these diseases affect all structures of the anterior ocular surface

Patient-reported outcomes - an approach and application in amniotic membrane transplantation

Patient-reported outcomes (PROs) are a comparatively novel concept in medicine and in public health ser­vices evaluation. It relies on the fact that medical technologies are not able to give all the information about the treatment or a medical condition. Some essential data can be obtained only from the patient.Herewith, the PROs approach is presented in relation to amniotic membrane transplantation (AMT) which is applied to patients who have been treated at Varna Specialized Eye Hospital for different severe anterior ocular surface diseases (AOSDs).The aim of the study is to present the PROs approach and the created especially for the study Patient-Re­ported Outcome Measures (PROMs) tool. Further on, we aim to summarize, analyze and discuss the PROs-data of the study.MATERIALS AND METHODS: The presented PROs study enrolls 306 hospitalized patients diagnosed in seven cohorts and suitable for AMT for a period of seven years (2010-2016). It is a part of a wider research project. Demographic data and disease-related characteristics were collected in addition to the PROMs ques­tionnaire. The PROMs instrument consists of 4 domains/questions, and the possible answers are arranged in ordinal scales. The first domain is Pain, and the possible answers are 5 (0 - none; 1 - sometimes low; 2 - always low; 3 - moderate to severe; 4 - always severe). The second domain is Photophobia, and the possible answers are 4 (0 - none; 1 - only at strong light; 2 - at daylight; 3 - at moderate light). The third domain is Se­cretion and the possible answers are 4 (0 - none; 1 - watery; 2 - mucous secretion; 3 - purulent discharge). The fourth domain is Hyperemia and the possible answers following the Efron grading scale are 5 (grade 0 - normal; grade 1 - trace; grade 2 - mild; grade 3 - moderate; grade 4 - severe).RESULTS AND DISCUSSION: The AM treatment resulted in a significant reduction of the symptoms in all domains (p< 0.001). Regarding the Pain domain, in all the groups, over 60% of the patients report­ed improvement. More than 90% of the patients with the most severe conditions like keratitis reported im­provement. The reported and analyzed results indicate that AMT has a positive impact on all the PROs do­mains - Pain, Photophobia, Secretion and Hyper­emia, for every patient (p<0.001). This is a novel study for Bulgaria, which aims to measure the im­pact of AMT on PROs among a large number of pa­tients with severe AOSDs divided into seven cohorts for seven years. AMT proved to be a surgical method for treatment of chronic, recurrent AOSDs that im­prove patients` subjective well-being

Surgical treatment of periocular basal cell carcinomas - 15 years of experience

PURPOSE: To analyze the outcome of periocular basal cell carcinoma (BCC) treated by surgical excision and evaluated using formalin fixed, paraffin-embedded sections.METHODS: One hundred-ninety-three patients with periocular BCC, were operated in Department of ophthalmology and Specialized Eye Hospital, Varna, Bulgaria since 1999 to 2013. Data were analyzed considering demographics, tumor localization, histological results, type of eyelid reconstruction, recurrence rate and aesthetic outcome.RESULTS: Of the total 193 patients with BCC, 136 (70.5%) had lower eyelid involvement. The most common histologic subtype was solid 126 (65.3%). One hundred seventy-six patients (91.2%) were with primary and 17 (8.8%) with recurrent tumors. Fifty-nine percent of lid defects were treated by direct closure. The mean follow-up period was 50 months. There were 15 (7.8%) recurrences. Excellent aesthetic outcome was achieved in 45%.CONCLUSIONS: Basal cell carcinoma is the most common malignant tumor of the eyelid engaging mainly the lower eyelid. Surgical excision with paraffin sections is a viable technique for managing periocular BCCs. Delayed repair is advisable in cases of poorly demarcated tumors. Significantly higher risk of recurrence exists in a more aggressive form of BCC. Using different techniques of reconstruction provides very good functional and aesthetic results