Cataract Surgery

Phacoemulsification is the most common ophthalmic surgery and it revolutionized cataract surgery. With the introduction of sutureless clear corneal incisions surgical time has been reduced, faster postoperative recovery enabled, and induced astigmatism lowered. Various premium intraocular lenses (IOLs) such as multifocal, accommodative and toric IOLs are designed to enable the best refractive outcomes. In order to further increase accuracy and precision femtosecond laser assisted cataract surgery (FLACS) has been introduced with ability to perform incisions, capsulorhexis and disassembly of the lens

Photoaging

Among harmful environmental factors that contribute to extrinsic aging, long-term effects of repeated exposure to ultraviolet light are the most significant and are referred to as photoaging. Photoaging is a multisystem degenerative process that involves the skin and skin support system. It is a cumulative process and depends primarily on the degree of sun exposure and skin pigment. The epidermis and dermis are both affected by UVB, but the dermis is also affected to a significant extent by UVA. It has long been thought that the majority of human photo-lesions due to UVB rays, now it is believed that UVA play a substantial role in photoaging. Photoaging affects the sun-exposed areas and is characterized clinically by fine and coarse wrinkling, roughness, dryness, laxity, teleangiectasia, loss of tensile strength and pigmentary changes. There is also an increase in development of benign and malignant neoplasms on photoaged skin. During the years the progress has been made in understanding the photoaging in human skin. UV irradiation invokes a complex sequence of specific molecular responses that damage skin connective tissue. Restriction of UV irradiation and the use of high-protection, broad-spectrum sunscreens may slow progression of photoaging

Botulin toxin A in lower lid entropium correction

To evaluate the clinical results and report the results of 12 cases of senile involutional entropion of the lower lid treated with botulinum toxi

Vitamin D – The True and the False about Vitamin D

Vitamin D has a positive impact on our overall health. Also there are a few conditions with strong evidence for a protective effect of vitamin D, such as bone diseases, internal cancers, multiple sclerosis, hypertension and DM type 1. Skin is the major source of vitamin D through the action of UVB light on keratinocytes, although the biologically active form of vitamin D is not exclusively produced in the kidney, but also in prostate, colon, skin and osteoblast where it acts as an autocrine or paracrine hormone. In the past decade raising incidence of skin cancers, especially melanoma and its connection with sun exposure lead to a sun protection policies and practices as part of the public health campaigns. The question is how much solar UV exposure is adequate to maintain the balance between the risk and the benefit. We as dermatologists have to raise public awareness of the potential health effects from excessive exposure to UV radiation but also we have to be aware that adequate blood level of vitamin D is necessary for optimal health. So future recommendation on sun protection have to balance between the risk and benefits of sun exposure, as well as to promote vitamin D supplementation as a safe alternatives in high risk population

New Option in Photoprotection

All the people are exposed to solar ultraviolet radiation. Exposure to sun with living in an oxygen-rich atmosphere causes unwanted photodemage. Sunburned skin is a leading risk factor for melanoma and non-melanoma cancers. UV exposure causes immunosuppression via multiple mechanisms in the skin. In this review the main topic is to mention new or alternative ways of photoprotection. Sunscreens are commonly used as protection against sun damage. They reduce the penetration of damaging solar UV wavelengths in skin by reflecting or absorbing them. Sunscreens are very valuable, but they have limitations. They have to be used properly to gain the full effect (application a little while before UV exposure, at frequent time points and in adequate amounts). Also, they have the problem of photoinactivation, which is the degeneration of the UV-filter due to exposure to UV rays resulting in the loss of absorbing capacity. Products with immune protection factor contain DNA-repair enzymes and antioxidants that may reduce mutations and enable the immune system to combat photodamage. The use of antioxidants and polyphenols may exert an anti-aging effect by preventing and even reversing sun damage. Adequate photprotection is essential to control photocarcinogenesis and photoaging

Photosensitivity Skin Disorders in Childhood

Photosensitivity in childhood is caused by a diverse group of diseases. A specific sensitivity of a child’s skin to ultraviolet light is often the first manifestation or a clinical symptom of photodermatosis. It might indicate a serious underlying systemic disease such as lupus erythematosus or dermatomyositis, or a rare group of genetic skin disorders like Xeroderma pigmentosum, Cockayne syndrome, Trichothyodystrophy, Bloom syndrome, Rothmund-Thomson and Kindler syndrome as well as metabolic disorders and cutaneous porphyria. Photosensitivity secondary to topical or systemic agents may also cause photosensitivity in children. Early recognition and prompt diagnosis may prevent complications associated with unprotected exposure to sunlight and avoid actinic injuries that can leed to malignant skin changes

Poslijeoperacijsko smanjivanje debljine donorske rožnične lamele nakon konvencionalne stražnje slojevite transplantacijske rožnice

The purpose of this study was to evaluate postoperative deturgescence of lamellar donor graft after conventional Descemet’s stripping automated endothelial keratoplasty (DSAEK). It was a prospective study that included 55 eyes of patients (mean age 70.9±9.4 years; female 61.8%, male 38.2%). Preoperative thickness of lamella was compared with postoperative thickness six months after surgery. Central lamellar graft thickness decreased from 142±27 µm preoperatively to 124±20 µm 6 months postoperatively (p<0.01). After performing conventional DSAEK corneal transplantation, surgeons should expect deturgescence of corneal graft and reduction in thickness of lamellae by about 12% of initial thickness according to our results. We found this information important for better planning of surgical procedures and knowing what to expect after surgery, as well as for better cooperation with eye banks when ordering pre-cut corneal tissue.Svrha ovoga istraživanja bila je procjena poslijeoperacijske deturgescencije donorske rožnične lamele nakon konvencionalne stražnje slojevite transplantacije rožnice (engl. Descemet’s stripping automated endothelial keratoplasty). U ovu prospektivnu studiju bilo je uključeno 55 očiju bolesnika (srednja dob 70,9±9,4 godina; žene 61,8%; muškarci 38,2%). Prijeoperacijska debljina lamele uspoređena je s poslijeoperacijskom debljinom šest mjeseci nakon transplantacije. Centralna debljina donorske lamele smanjila se s prijeoperacijskih 142±27 µm na 124±20 µm šest mjeseci nakon operacije (p<0,01). Prema rezultatima očekivano stanjivanje donorske rožnične lamele nakon konvencionalne stražnje slojevite transplantacije iznosilo je u prosjeku 12% od početne debljine. Smatramo da je taj podatak važan zbog boljeg planiranja operacijskog zahvata stražnje slojevite transplantacije rožnice i preciznijeg naručivanja rožničnog tkiva iz očne banke

Influence of Donor Thickness on Visual Acuity in Descemet’s Stripping Automated Endothelial Keratoplasty

Purpose: Conventional Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is a corneal transplantation procedure where the patient’s inner dysfunctional layer is replaced with donor lamella. The data currently present in the literature about the correlation between lamellar thickness and visual acuity is sometimes contradictory and lacks clarity. Methods: Study included 55 eyes that underwent the conventional DSAEK procedure. Patients had no other comorbidities that could affect visual acuity. Data about lamellar thickness and visual acuity were measured six months after surgery with anterior segment optical coherent tomography (A5-OCT). Results: The results show that visual acuity before surgery improved from 0.82 to 0.25 logMAR after surgery. Better visual acuity of 0.20 logMAR was achieved with postoperative lamellas thinner than 124 μm, while statistically significantly lower visual acuity of 0.29 logMAR was gained with postoperative lamellas thicker than 124 μm. Conclusion: Our results suggest that the goal after conventional DSAEK is to have postoperative lamellas thinner than 124 μm in the eye, as this will result in better postoperative visual acuity. This value represents the optimal thickness for conventional DSAEK surgery that could minimize tissue loss for eye banks and surgeons may experience fewer problems during surgery, while obtaining good final visual acuity