Access To Visual Rehabilitation And Difficulties In Implementation

Subject of visual rehabilitation with optical aids are patients with definitely reduced visual acuity, not corrected with glasses or usual lenses, hindering their daily activity. It is not about restoring the reduced vision, but about its maximum use. The purpose of this study is to analyze the possibilities of access to visual rehabilitation and the difficulties in implementing it. Materials and methods: The study was conducted at the Eye Clinic “Sv. Nikolay” – Varna, for the period from 1 January 2019 to 29 February 2020. Patients diagnosed with H54 blindness according to ICD-10 were monitored and an algorithm for work has been developed. Visual rehabilitation with optical aids of patients with visual acuity ≤ 0.3 with correction of better eye or both eyes is prescribed. The results were statistically processed with Microsoft Excel 2013. Results: For the period from 1 January 2019 to 29 February 2020, 123 patients were diagnosed with blindness H54.0 – H54.7. The average age of patients with offeredvisual rehabilitation was 68.1 years and the women were 65%. Only 40 patients visited specialized consultation for visual rehabilitation. Of these patients, 14 were men and 26 were women, and the predominant diagnosis was AMD. The distribution according to the vision shows that the eyes with vision ≤ 0.1 are 86.25%. Only 19 of the rehabilitated patients – 38%, purchased the recommended magnifier. Of these, 13 patients or 68.4% of the cases required detailed training by the optician who consulted them. Only 36.8% is satisfied with their vision rehabilitation and uses the optical device daily. Conclusion: With the help of special reading techniques and training, magnifying devices and other advances in technology, the visually impaired can use the most of their residual vision. The most preferred optical device for them is the magnifying glass. The necessity of introducing an algorithm for low vision specialist ophthalmologists is justified. All this would expand the possibilities for visual rehabilitation and social integration of the visually impaired

Lateral Tarsal Strip Procedure for Correction of Involutional Ectropion

Инволутивният е най-често срещания ектропион в клиничната практика. За развитието му значение имат хоризонталното отпускане на клепача, лошия тонус на арбикуларния мускул и действието на гравитацията. Известни са различни хирургични техники за корекцията му.Цел: Да представим опита си в хирургичната лечение на инволутивен ектропион с оформяне на латерална тарзална лента.Материал и методи: Оперирани са 15 болни с инволутивен ектропион, всички представители на мъжкия пол, на средна възраст 78,3 години. За по прецизна оценка на степента на ектрапиона е използвана скала за стадирането му. Използвана е хирургична техника с оформяне на латерална тарзална лента и пришиването й към периоста от вътрешната страна на латералния орбитен ръб. Постоперативното проследяване е от 3 до 10 месеца, средно 6 месеца.Резултати: От оперираните 15 болни четирима бяха с ектропион II стадий, шестима- III стадий и петима - IV стадий. На първия, седмия и тридесетия ден след операцията при всички болни мигленият ръб на долния клепач беше в нормална позиция, не се установи видима ивица еклера между лимба и мигления ръб, слъзната точка беше с нормално положение в слъзното езерце. Постоперативния период премина без съществени оплаквания. Полученият естетичен резултат удовлетворяваше оперираните болни.Заключение: Хирургичната лечение на инволутивен ектропион с оформяне на латерална тарзална лента е достъпен метод, осигуряващ минимален постоперативен дискомфорт за пациента и много добър анатомичен и естетичен резултат.Involutional ectropion is often observed in clinical practice. Horizontal lid laxity, poor orbicularis muscle tone, succumbing to the effect of gravity are part of reasons for this type of ectropion. There are different surgical procedures for treatment of it.Aim: To present our experience in surgical treatment of involutional ectropion with lateral tarsal strip procedure.Materials and methods: Fifteen male patients on mean age 78,3 years were operated by one surgeon using lateral tarsal strip procedure. For assessment of ectropion stage was used Ectropion Grading Scale. Follow up period was from 3 to 10 months, mean 6 months.Results: With stage II ectropion were 4 patients, with stage III - 6 patients and with stage IV - five patients. On days 1, 7 and 30 after surgery in all patients lid margin was in normal position, there were not scleral show and tear punctum was in tear lake. There were not postoperative complications and all of the patients were satisfied of the final esthetic result.Conclusion: Lateral tarsal strip procedure restored normal lid function and give a rapid rehabilitation with few complications and excellent cosmetic outcome

Macular structural changes in diabetic patients

Purpose: To determine whether diabetes causes changes of central macular thickness (CMT), nerve fiber layer (NFL) and ganglion cell-inner plexiform layer (GCIPL) thickness, and to investigate the possible relationship between this changes and duration of diabetes mellitus and glycemic control (HbA1c). Materials and Methods: Mean CMT, NFL and GCIPL thickness of 60 eyes without DR and 60 eyes with minimal DR was calculated following automated segmentation of 3D-Topcon 2000 OCT images of 85 diabetic patients. A control group of 60 eyes of 60 age-matched healthy volunteers was included for comparison. To determine the correlation between CMT, inner retinal layers thickness and diabetes duration, and HbA1c levels, a Pearson correlation analysis was used. Results: The mean CMT, NFL and GCIPL thickness in eyes without DR was 210,08μm, 34,75μm and 68,55μm, respectively; in eyes with minimal DR was 214,2μm, 35,63μm and 70,83μm, respectively and in healthy eyes was 214,73μm, 35,53μm and 69,35μm, respectively. There was no significant difference in CMT, NFL and GCIPL thickness between studied groups. There was positive significant correlation between CMT and diabetes duration (p=0.005) and negative significant correlation between GCIPL thickness and diabetes duration (p=0.013), and between NFL+GCIPL and diabetes duration (p=0.04). No relationship between CMT, NFL and GCIPL thicknesses and HbA1c was present. Conclusions: Our study demonstrated absence of difference between CMT, NFL, GCIPL thickness of diabetic patients without or with minimal diabetic retinopathy, compared with normal eyes. Despite this, we found relationship between CMT and inner retinal layers thickness, and diabetes duration