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

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

Neurotrofična keratopatija: prikaz slučaja

Neurotrophic keratopathy is a degenerative disease characterized by decreased corneal sensitivity and poor corneal healing. This often results as corneal ulceration with a high risk of corneal perforation. A 36-year-old female presented with perforated neurotrophic corneal ulcer and eyelash in the anterior chamber of the right eye and non-perforated corneal ulcer in the left eye, decreased corneal sensitivity, absent corneal reflex and normal lacrimation. History of previous herpetic keratitis episodes was positive. Medical record review showed heredodegenerative encephalopathy with localized brain atrophy and internal hydrocephalus. The patient has mild mental retardation. Eyelash from the anterior chamber of the right eye was surgically removed through limbal incision using a viscoelastic solution. On the first postoperative day the depth of anterior chamber was normal. Treatment was continued with eye patching and application of antibiotic and vitamin ointments. Perforation and ulcers healed ten days after the surgery and visual acuity improved. After the treatment residual corneal scarring remained on both eyes. The pathophysiology of the neurotrophic ulcer in our patient could be explained by corneal denervation caused by previous herpetic keratitis. Denervation results in decreased cell metabolism, levels of acetylcholine and mitosis. Sensory nerves have a favorable effect on corneal epithelialization via neuromediators such as acetylcholine, substance P, and calcitonin gene-related peptide. This can lead to an epithelial defect even in the absence of direct injury. Early diagnosis and prompt treatment of neurotrophic keratopathy are mandatory to prevent corneal complications such as scarring and perforation.Neurotrofična keratopatija je degenerativna bolest rožnice koju obilježava smanjena osjetljivost rožnice i slabo cijeljenje epitela koje vrlo često rezultira nastankom upale, ulkusa ili perforacije. Prikazan je slučaj žene stare 36 godina s perforiranim neurotrofičkim ulkusom rožnice i trepavicom u prednjoj sobici desnog oka i neperforiranim ulkusom rožnice lijevog oka. Obostrano je bila odsutna osjetljivost rožnica, kornealni refleksi su bili ugašeni, a sekrecija suza normalna. U mladosti je preboljela više epizoda obostranog herpetičnog keratitisa. Od ostalih bolesti u djetinjstvu je bila prisutna heredodegenerativna encefalopatija s manjom atrofijom mozga i internim hidrocefalusom. Bolesnica je blaže mentalno retardirana. Operativnim zahvatom odstranjena je trepavica iz prednje očne sobice uz pomoć viskoelastika, te je liječenje nastavljeno zatvaranjem oka i primjenom antibiotskih i vitaminskih masti. Nakon desetak dana dolazi do zacjeljenja i epiteliziranja ulkusa obostrano, uz uredan izgled prednje očne sobice desno i poboljšanja vidne oštrine. Nakon liječenja ostaju makule na rožnicama oba oka. Patofiziološki mehanizam nastanka neurotrofičkog ulkusa kod naše bolesnice možemo objasniti denervacijom rožnice koja je posljedica herpetičkog keratitisa. Denervacija uzrokuje smanjivanje staničnog metabolizma, razine acetilkolina i mitoze. Osjetni živci imaju povoljan učinak na regeneraciju epitela rožnice putem neuromedijatora kao što su acetilkolin, tvar P i peptid srodan genu kalcitonina. Stoga je oštećenje epitela rožnice moguće i bez izravne ozljede. Rana dijagnoza i pravodobno liječenje neurotrofičke keratopatije ključni su u prevenciji komplikacija kao što su zamućenje ili perforacija rožnice

Penetrating keratoplasty and scleral fixated artifitial iris-IOL implantation following anterior segment trauma

Our patient is a 63-year-old man with an amblyopic left eye, who had a traumatic open-globe injury of the right eye in 2011. Upon ocular examination hyphema, traumatic aniridia, luxated cataract with corneoscleral rupture were found. The eye had been primarily repaired, using 10.0 and 8.0 sutures, intracapsular cataract extraction had been performed, along with and anterior vitrectomy. In 2012., the patient had a corneal ulcus which has been treated with amniotic membrane transplant. A scleral-fixated artifitial iris intraocular lens (Ophtec USA, model 311, +20.00) has been placed and sutured with polypropylene, atraumatic suture 10/0, 16mm needle double armed. Perforative keratoplasty had also been performed, using interrupted and running suture technique. Postoperatively, the artifitial iris-IOL remained well centered. Patients visual acuity improved to best corrected visual acuity of 0.2. Patient also reported a subjective reduction in glare

Ispravljanje hiperopije, hiperopičnog i miješanog astigmatizma excimer laserom: jučer, danas i sutra

The broad acceptance of “spot scanning” or „flying spot“ excimer lasers in the last decade has enabled the domination of corneal ablative laser surgery over other refractive surgical procedures for the correction of hyperopia, hyperopic and mixed astigmatism. This review outlines the most important reasons why the ablative laser correction of hyperopia, hyperopic and mixed astigmatism for many years lagged behind that of myopia. Most of today‘s scanning laser systems, used in the LASI K and PRK procedures, can safely and effectively perform low, moderate and high hyperopic and hyperopic astigmatic corrections. The introduction of these laser platforms has also significantly improved the long term refractive stability of hyperopic treatments. In the future, further improvements in femtosecond and nanosecond technology, eye-tracker systems, and the development of new customized algorithms, such as the ray-tracing method, could additionally increase the upper limit for the safe and predictable corneal ablative laser correction of hyperopia, hyperopic and mixed astigmatism.Široka rasprostranjenost nove generacije „spot scanning“ excimer lasera, odnosno lasera s pomičnom točkastom zrakom, omogućila je u posljednjih deset godina dominaciju laserske ablacijske kirurgije rožnice u korekciji dalekovidnosti, dalekovidnog i miješanog astigmatizma nad drugim refrakcijskim kirurškim postupcima. U članku su navedeni najvažniji razlozi zbog kojih je laserska kirurgija rožnice u ispravljanju dalekovidnosti, dalekovidnog i miješanog astigmatizma niz godina zaostajala za laserskim ispravljanjem kratkovidnosti. Većina današnjih lasera temeljenih na navedenoj tehnologiji omogućuje sigurno i učinkovito ispravljanje niskih, srednjih i visokih dalekovidnosti i astigmatizama uz pomoć postupaka LASI K i PRK. Uvođenje ovih laserskih sustava također je unaprijedilo i dugoročnu stabilnost rezultata nakon tretmana. Može se očekivati da će daljnji napredak u femtosekundnoj i nanosekundnoj tehnologiji, sustavima za praćenje pokreta oka, te razvoj novih individualiziranih algoritama poput metode “ray-tracing” u budućnosti pomaknuti današnje granice sigurne i predvidljive ablacijske laserske korekcije dalekovidnosti, kao i dalekovidnog i miješanog astigmatizma

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